Most breathwork is safe for most people, but certain health conditions and environments make specific breathing techniques genuinely dangerous. The biggest risks come from rapid, forceful breathing patterns (like holotropic breathwork or Wim Hof-style techniques) and prolonged breath-holding, which alter blood chemistry in ways that can trigger seizures, loss of consciousness, or spikes in pressure inside the eyes. Gentle, slow breathing exercises carry far fewer risks, so the type of breathwork matters as much as the person doing it.
Epilepsy and Seizure Disorders
This is one of the clearest and most serious contraindications. Rapid breathing, sometimes called hyperventilation-style breathwork, triggers seizures in over 90% of people with absence epilepsy. The mechanism is straightforward: when you breathe fast, you blow off carbon dioxide faster than your body produces it. This makes your blood more alkaline, and that shift in blood pH is what provokes seizure activity. Neurologists actually use voluntary hyperventilation as a diagnostic tool during EEG testing precisely because it’s so reliable at triggering absence seizures.
What’s notable is that heavy breathing during exercise doesn’t carry the same risk. When you’re physically active, your body produces enough carbon dioxide to offset the faster breathing, so blood pH stays stable. It’s specifically the combination of rapid breathing without physical exertion that creates the dangerous pH shift. If you have any seizure disorder, vigorous breathwork techniques like holotropic breathing, breath of fire, or Wim Hof-style hyperventilation rounds should be off the table entirely.
In or Near Water
Practicing breathwork before swimming or diving is one of the most dangerous combinations on this list, and it kills people every year. The condition is called shallow water blackout: you hyperventilate before going underwater, which drops your carbon dioxide levels. Carbon dioxide is your body’s primary signal to breathe. With that signal suppressed, you can lose consciousness from oxygen depletion before you ever feel the urge to surface.
The physiology is deceptive. Oxygen levels in your blood drop sharply at the tail end of a breath-hold, plunging from adequate to blackout-level in seconds rather than gradually. Normally, rising carbon dioxide would force you to the surface well before that point. But if you’ve hyperventilated beforehand, the carbon dioxide warning system is delayed just long enough for oxygen to bottom out first. This typically happens in water less than 15 feet deep, often in pools.
A related phenomenon called ascent blackout affects deeper dives. As a diver rises, decreasing water pressure causes blood to redistribute away from the lungs, and the already-depleted oxygen supply drops further. Consciousness can be lost just meters below the surface. The rule is simple: never practice breath-holding exercises or hyperventilation before, during, or around water.
Glaucoma and Eye Conditions
Breath-holding techniques and any breathwork done in head-down positions can spike intraocular pressure, the fluid pressure inside your eyes. For people with glaucoma, this can worsen visual field damage. In a study of 76 yoga practitioners, roughly 12% experienced ocular complications including acute glaucoma, worsening of chronic glaucoma, and retinal vein occlusion. While that study focused on yoga inversions specifically, the same concern applies to any breathwork that involves straining, bearing down, or holding the breath forcefully.
If you have glaucoma, high myopia (severe nearsightedness), or risk factors for retinal vein occlusion like high blood pressure, avoid breath-holding techniques and any practice that creates significant pressure in the chest and head. Gentle slow breathing done upright or lying flat is a different story and generally poses no eye-related risk.
During Pregnancy and Labor
Gentle breathing exercises are widely used and beneficial during pregnancy and labor. The concern is specifically with the Valsalva maneuver, which involves holding your breath and bearing down hard. During labor, a prolonged Valsalva maneuver has been associated with reduced blood pH in the newborn’s umbilical vein and increased fetal distress, because the sustained pressure disrupts normal blood flow to the placenta. It also increases the risk of perineal trauma compared to breathing out while pushing.
Outside of labor, the same caution applies to any breathwork involving forceful breath retention or intense abdominal engagement. Deep, slow breathing consistently produces the best outcomes for both mother and baby. Aggressive hyperventilation-style practices carry the additional risk of dizziness and fainting, which is more dangerous during pregnancy for obvious reasons.
Panic Disorder and Trauma History
Intense breathwork deliberately activates the body’s stress response. For most people, this creates a manageable wave of sensation that passes. For someone with panic disorder, it can trigger a full panic attack. The physical sensations of hyperventilation, including tingling, lightheadedness, chest tightness, and a racing heart, closely mimic panic symptoms, and for people whose nervous systems are already primed to interpret those sensations as danger, the experience can spiral rather than release.
People with a history of significant trauma, particularly complex PTSD, face a similar concern. Practices like holotropic breathwork are specifically designed to bring up intense emotional and physical experiences. Without proper support or readiness, this can be retraumatizing rather than therapeutic. This doesn’t mean all breathwork is off limits. Slow, controlled techniques like extending your exhale or paced breathing at around six breaths per minute tend to calm the nervous system rather than activate it.
Cardiovascular Conditions
Forceful breathing techniques create large swings in pressure inside the chest, which directly affects blood pressure and heart rhythm. The Valsalva maneuver temporarily raises blood pressure, then causes it to drop sharply when the breath is released. For someone with uncontrolled high blood pressure, a history of stroke, an aortic aneurysm, or certain heart rhythm disorders, these pressure swings can be dangerous. Breath-holding also stimulates the vagus nerve in ways that can slow heart rate dramatically in susceptible individuals.
Hyperventilation-style breathwork causes blood vessels to constrict as carbon dioxide drops, temporarily reducing blood flow to the brain and heart. This is why people feel dizzy or see stars during rapid breathing exercises. For a healthy person, this is transient and harmless. For someone with compromised circulation, it introduces real risk.
While Driving or Operating Machinery
This seems obvious but comes up frequently. Any breathwork intense enough to cause lightheadedness, tingling, altered consciousness, or visual changes should never be done while driving, operating heavy equipment, or in any situation where losing focus or fainting could cause injury. Hyperventilation can cause transient loss of consciousness even in healthy people, and breath-holding can trigger vasovagal responses that cause fainting. Save intense practices for a safe, comfortable, seated, or lying-down position in a place where you won’t be interrupted.
What Stays Safe
Most of the risks above involve aggressive techniques: rapid hyperventilation, prolonged breath-holding, forceful straining. Slow, gentle breathing exercises are a different category of practice entirely. Breathing at a pace of about five to six breaths per minute, extending your exhale longer than your inhale, or simply practicing diaphragmatic breathing carry minimal risk for nearly everyone. Research consistently links these slower practices to reduced stress, and a systematic review of breathing techniques in people with serious respiratory illness, including asthma and COPD, found no adverse events.
The key distinction is intensity. If a breathwork practice makes you feel dizzy, tingly, or lightheaded, it’s significantly altering your blood chemistry. That’s the threshold where the conditions above become relevant. If you’re breathing slowly and comfortably, you’re almost certainly fine. For more technical practices like alternate nostril breathing, getting proper instruction for your first session makes a measurable difference in both safety and effectiveness.