August 06, 2014


Sooner or later, whether from panic or in our final hour, each of us will find ourselves breathless. A former neuropsychologist offers three tips for when awareness of breath becomes difficult or even impossible.Meikyo Robert Rosenbaum

Many meditators learn first to focus on the breath, following it mindfully in the manner described in the Satipatthana Sutta; counting breaths in a way frequently taught at Zen centers; or using one of the many methods of pranayama from yoga. None of these work very well when breathing is compromised.

I recently recovered from a bout of pertussis (“whooping cough”)—what the Chinese call the hundred-day cough. For three months my meditation was marked by a heavy chest and constricted bronchioles, and deep breaths would bring on paroxysms of coughing.

Recalling this and other occasions when I have had respiratory troubles, I think ahead to how, at the end of my life, I might be stricken with the pneumonia that is so often the cause of death in the elderly, what doctors sometimes call “the old person’s friend.” Pneumonia or not, many face death literally gasping for breath, and these last moments of our lives are important: you don’t have to be a believer in bardo or reincarnation to know that the way you face your death will be meaningful for you and the people around you. The point is, eventually, even if it is only in our final hour, each of us will find ourselves breathless. It would be awful if, having relied on the mercies of your breath as the basis for meditation, you felt abandoned by your practice in your last moments, the ultimate encounter with the Great Matter.

Breathlessness can interfere with any kind of meditation, including those involving mental imagery, mind-awareness techniques, or koans. Even a small decrease in oxygen to the brain can cause attention and concentration to become fuzzy. For this reason, it’s important to have a sense of how to practice when the breath brings feelings of suffocation and strain instead of openness and calm.

So here are a few suggestions for when you find yourself breathless. These might also be valuable to beginning meditators who feel discouraged because they find awareness of breathing difficult, or to anyone who has experienced a nagging sense of worry, doubt, or self-conscious anxiety about breathing “correctly” in meditation.

Catch catastrophizing. When we have trouble breathing, it’s easy to panic. Physiologically, the more we panic, the more our airways constrict, leading to a vicious cycle. Because breathing is so intimately connected to both the involuntary and voluntary nervous system, our conscious efforts to breathe can interfere with its natural autonomic function. (Incidentally, because of this, I’ve found that people with breathing difficulties often do better with forms of qigong or other movement practices that do not involve conscious manipulation of the breath).

Patients who suffer from panic attacks usually complain of shortness of breath accompanied by thoughts that they are going to die from a heart attack or pass out. It helps to be mindful that these thoughts are just thoughts. The reality is that if your heart functions are healthy, shortness of breath is not a harbinger of cardiac arrest, and even if you pass out, your breath will continue.

Expand the field of awareness. When I worked with patients who came into the emergency room with panic attacks, often fearing they would die, I found that the single most useful intervention was to direct them to be aware of the feeling of their feet on the floor. This not only moves attention away from the areas of distress to other physical sensations, but also has the literal effect of “grounding.” Being aware of the sole of the foot is especially helpful, opening it up to receive the compassion of the earth, which supports everyone and everything without discrimination.

If you are seriously ill, you are unlikely to be standing up, so this focus on the feet might not be possible. In such a case, turn your attention to any part of the body that is healthy. When sitting up, bring awareness to the support of the sitting bones of the pelvis. Touching whatever is beneath you can bring a feeling of solidity.

Use the suffering for insight into impermanence and life and death. This, of course, is a basic principle of Buddhist meditation. It can be particularly helpful when difficulty in breathing acts as a reminder of our mortality. All of us know we will die, but this knowledge exists mostly as an abstract idea.

Difficulty breathing can brush us against death and cut through our denial. Frightened, we instinctively clutch to our so-precious life. Yet Buddhism (along with many other religions) insists we must confront this Great Matter. A deep spiritual awakening is thus sometimes called “dying the Great Death."

Bringing up the thought “Someday, my breath will cease” can help us confront the inevitability of our death. One traditional way of doing this was to practice meditation on charnel grounds, but these are a little difficult to find in modern societies. When we have difficulties breathing, it brings the charnel ground to the body. This can be an excellent practice, but if death is still a frightening stranger to you, the resulting anxiety can temporarily make your breathing problems worse.

Find the fundamental. When we can’t breathe, we feel ill in a fundamental way that is difficult to tolerate. But Buddhist practice involves finding release precisely by confronting illness and suffering. There is a Zen koan:

Health and sickness subsume each other.
The whole world is medicine.
What is your original self?

In Zen, we sometimes ask people to show us their original face before they were born, their true face throughout life and after death. Unconditioned, it neither comes nor goes. The Heart Sutra reminds us: in emptiness there is no birth, no death, no suffering, no origination, no path. But how does this help us when we feel we can’t breathe, when the pain is so bad that tears are running down our face, when we are vomiting with food poisoning so severe we feel we’d be better off dead than continuing to suffer?

When we meditate, we take care of the Original Self. It’s easy to make the mistake, though, of thinking that this self is healthy, and expecting it to take care of us. To see Original Self as separate from the self who is suffocating and dying is the source of all suffering. It is separation that strangles us, not illness—not even death.

When you can’t breathe, a strong sense of “me” arises, and with it, a sense that something is different than it “should” be. Frequently, this gives rise to the feeling that this Original Self should make “me” feel well.

Sometimes, though, there’s nothing that can be done. More often than we might think, there is nothing we can do beyond coming to terms with our experience not as we want it to be, but with as it is. As Dogen teaches in the Genjokoan, if we try to grasp at something—even the breath—flowers fall, and we choke on our efforts; if we are averse to something—even difficulties breathing—weeds spring up, and the lungs of our mind constrict.

We can find inspiration in the midst of breathlessness if we don’t grasp at the oxygen. When we are not averse to losing our breath, we can find release as we exhale and let go. We can breathe easy even when we can’t catch our breath, because stillness is ungraspable, always flowing without beginning or end.

While we live, we are able to live. When it’s time to die, we are able to die. This is the natural order of things, and to the extent that we align ourselves with this, we experience peace even in the midst of distress.

Here’s a true story. A few years ago, a man told me of how my teacher, Sojun Mel Weitsman, had saved his life. He’d met Sojun only once, in a single session of meditation instruction taught as part of a college course. Five years later, he was surfing in a bay when a strong undertow pulled him and all the other swimmers and boats out toward sea. He looked behind him and saw a tidal wave. It crashed over him and pushed him down toward the sea floor, tumbling him over and over until he didn’t know which way was up.

After a while, he felt he had to take a breath, but he knew that if he did, he’d breathe in water and drown. At that moment, he remembered Sojun’s words: Open up and let go. Accepting whether he lived or died would be determined over the next few moments, and that it simply wasn’t up to him, he relaxed a bit, and the feeling of needing to breathe receded as he felt the currents of the water. As he eased up, his natural buoyancy brought him to the surface. He drew a breath, and saw the wave had brought him near enough to shore so that he could swim in.

He looked around. Everyone else had drowned.

Meikyo Robert Rosenbaum is resident teacher at the Meadowmont Zen Community in the foothills of the Sierras. Formerly a neuropsychologist and psychotherapist, he now devotes full time to Zen and Dayan Qigong.

Image: Flickr/daltraparte

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bill.cook68's picture

Thank you all very much I have found this discussion both very moving and inspiring.
With love and deep gratitude. Bill.Cook

jackelope65's picture

I am an asthmatic and here is what I do: first, always use inhalers ( Bronchodilators first, eg. Albuterol, wait 5 minutes then steroid, Cromolyn, or other always using an aerochamber or similar device.) 10 minutes prior to meditation; secondly one cup of coffee or tea with the inhalers will dilate bronchioles and stimulate to avoid all types of hypoxic hypoventilation( not good for anxiety/panic. ); thirdly, after prayers and intentions, take 5-10 deep breaths, slowly filling the lungs and following the breath as usual imagining the universe coming through the top of my head( At the original fontanel. ) and the earth pushing hard into my seated contacts, and as I breathe out slowly the breath goes out to the universe again through my head and into the earth below, at the end clenching my perineal( Peri-anal, or bum and peri- urethral or pee ) muscles for a brief moment.( This type of breathing is complex, grounding, distracting and takes practice ); fourthly, I do Guru Yoga. As an MD the first instructions are medical and the remaining practices are described in Buddhist literature, not mine.

meikyo bob's picture

A deep gassho to all of you who have responded to this - I've found your contributions very moving.

Kesho's picture

Powerful, for me for several reason. First, the idea that one day, I will cease to breathe. Yes. Face it. Say it out loud. WOW. Next, the idea that I could surrender to the discomfort of breathlessness even if it comes with water, anger, hunger or addictions. WOW again. Face it. Finally, that death is moving to the next stage of being....I rejoin the Great Matter which I am now....but meditation is remembering that I AM CONNECTED to this MATTER right now. WOW WOW WOW. I love Tricycle readings. Thanks.

wsking's picture

In between breaths there is vast space. You can enter there, rest, and develop Samadhi. When you are dying you can go there to let go. It will be familiar and supportive and not scary. There is a sound there like a deep hum that arises after awhile, you can go into that too and just rest. There may be other doorways too, farther in. The banner of the wind.

roboutwest's picture

It's inspiring and humbling to hear others experience and challenges in this basic life function that I often take for granted.

I'm sure that many years ago when I was whitewater kayaking and occasionally couldn't roll my boat upright and had to get out as oxygen dwindled that I was propelled solely by fear and the desire to live. I hope down the road, when resolution to some situation such as breathlessness is not as simple as "getting out of the boat", that my practice will be in the game.

janetmartha's picture

I had a very similar near-drowning experience to what the author's friend describes. Tumbling underwater in a huge wave 'til I was close to the end of being able to not breath, not knowing which way was up, it was clear effort was futile and I just let go of fighting, without giving up. A very brief moment later I was on top of the water. Surrendering to the wave is what brought me up.

Thank you both so much for the realization, Meiyko and kay.fine, that there can be peace in distress. It's amazing that even tho I've lived that in the flesh I still forget it so easily. Like every little incident of anger or fear seems initially so overwhelming that I totally forget there's this stillness all through it and everything, at the very bottom, is always all right. Getting to the very bottom is scary but once you're there you see you haven't got anything to lose.

I'm so grateful to have this community to share things like this. I live in a an isolated island, literally, and these daily doses of dharma keep me going. _/\_ to this sangha!

kay.fine's picture

As someone who has been ventilator-dependent for about nine years now, this articulation of how breathing and the focus on it can complicate meditation practice is so very gratifying to me. I'm a true beginner and have found most traditional meditation instruction inaccessible to living in a body with severe impairments. (Sit upright, feet grounded, focus on the breath.)

Sometimes just abandoning all attention to breath is useful to me. Focus on sound, for example, can free me from too much attention to grounded physical sensation and create a more ethereal-but-steady connection for me. And then, sometimes attention to pain can seem almost like bodily music - a symphony of physical suffering that fills me and then enlarges beyond my body.

The experience of having no breath, or the imminent threat of no breath, is quite common with my trach and ventilator. As Rosenbaum suggests, surrendering to that in the moment can be liberating and even transcendent. Not having breath is such an elemental way to live in the moment. It's taken me these years of practice in breathlessness to find my way back around to a meditation practice that works for me.

Thank you, Meikyo Robert Rosenbaum, for this speaking to my experience.

wsking's picture

Our love to you, Kay. May you be filled with courage. May you be happy and well. We will all keep you in our prayers.

myers_lloyd's picture

Thank you, kay.fine, for your clear and sane talk about your life with the common threat of the breath ending. How valuable your insight has been for me. In a Zen chant by Hakuin, we describe ourselves as "like one in water crying I thirst". Here you are literally in a vast field of air, sometimes crying "No breath".
If there is a Buddhist miracle, I think it is your years of breathlessness in practice. And your great generosity in sharing that practice with us readers.
Deep gassho, Marie