BUTEYKO BREATHING

COURSE MANUAL
A DVA N C E D B U T E Y KO I N S T I T U T E

by Drs. Eduard Reuvers

 CHAPTER 1

Course Guidelines

Follow these guidelines to get the most benefit from your Buteyko
Breathing course. It's important to also understand the reasons for these
guidelines, so if something in’t clear to you please ask your instructor. Ex-
ceptions to the guidelines can be made after consulting with your instruc-
tor.

1) During the course you'll attend regular teaching sessions with

your instructor to review and improve your practice of the Buteyko Breath-
ing exercises.

2) Do the exercises following the instructions and inquire with your

Buteyko Instructor for further clarification if needed. Do 3 to 5 Buteyko
Breathing sessions per day during the coming month for best results. 4 or
5 sessions per day is best and 3 is still all right. But doing just 1 or 2 ses-
sions per day is not enough. Also keep at least 2 hours between your ses-
sions and avoid doing sessions on a full stomach (directly after a meal).
There are 39 Buteyko exercise levels and in general we recommend to
raise your level once a day, doing each level at least 3 times before going
up to the next level.

3) Breathe through the nose during all your activities (not through
the mouth). Exceptions can be made after consulting with your instructor.
The nose is very good in breathing while the mouth is very good for speak-
ing and eating. Breathing through the nose is better is no many ways: it

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helps retain water from the air you exhale, helps cool the brain like air-
conditioning and improves NO (nitric oxide) and CO2 (carbon dioxide) lev-
els. Nasal breathing also makes you look more intelligent - you can test this
by opening your mouth while looking in the mirror. In short, the mouth is
great for speaking and eating but it’s not a healthy alternative to nasal
breathing.

4) Keep your mouth closed during physical exercise: This improves

endurance and recovery. If you can’t manage doing your activity with
mouth closed, it means your fitness level isn’t good enough for that activ-
ity. Take a break or continue your activity at an easier level. Do keep an
open mind because there are activities where mouth breathing is recom-
mended during certain stages.

5) Don’t sleep with your mouth open. If you find that your mouth is
always dry when you wake up in the morning, you probably sleep with
your mouth open. In that case we recommend to try to use a small piece
of "3M Micropore" tape to help keep the mouth closed during sleep. When
you first try using the tape, just use a very small piece of tape to keep your
upper lip connected to the bottom lip. After you get used to it, you can try
out a larger piece of tape horizontally covering the whole mouth. Take it
slowly and play with it, do it step by step.

6) Avoid eating foods containing a lot of complex proteins, especially

when combined with other foods. Foods such as chicken, duck, all sea-
foods, unboiled milk and young or unripened cheeses are quite difficult for
the stomach to break down and they a longer time to process. Your breath-
ing will most likely be worse than usual after eating foods rich in complex
proteins - and it will take a few hours for your breathing to recover to it’s
usual values. These foods take a lot of energy to process and temporarily
drain your energy.

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 7) Avoid overeating & keep your stomach feeling light. When eating,
just stop eating if you're not really hungry any more. This will help improve
your energy levels and enhance your progress made with Buteyko Breath-
ing.

8) Vegetables and fruits are foods that complement your Buteyko

Breathing practice very well. They are light and easy to break down and
contain many healthy vitamins, enzymes and amino-acids your body needs
to function well. They are an excellent replacement for food rich in com-
plex proteins.

9) Avoid sleeping on your back. Intend to sleep on your stomach or

the left or right side. Why? When you sleep on your back, your lungs experi-
ence very little resistance and will expand more, leading to the tendency to
over-breathe during sleep. With Buteyko, we’d rather see you avoid over-
breathing and sleeping on your side will help.

10) Make sure to have some natural sea salt at home. Sea salt helps
your body improve its electrolyte levels while your breathing is getting bet-
ter. Specifically, sea salt prevent the occurrence of minor headaches, dizzi-
ness and/or exhaustion due to a low level of electrolytes during or directly
after a Buteyko session. If you experience these symptoms during or after
a Buteyko breathing session, take some sea salt and be sure to let your in-
structor know.

Of all these guidelines, the most important ones are number 1 and 2:
Be consistent and diligent in doing your daily Buteyko breathing exercises
and attend the teaching sessions with your instructor.

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 CHAPTER 2

Measuring the Breath

In Buteyko Breathing, we measure the breath using the Easy Breath-

hold (EBH, also called the Control Pause or CP). The Easy Breath-hold is ex-
plained in the level 1 exercise of our Advanced Buteyko app. You will also
do the Easy Breath-hold together with your instructor during the first class
of the Buteyko group course.

How to Measure
The Easy Breath-hold measures how many seconds it takes before you
experience the feeling of lack of air (very minor air-hunger) after starting a
breath-hold after a normal exhalation.

For consistent and accurate measurement, the Easy Breath-hold should

be measured when sitting and at rest. It is extremely important not to
push your measurement: It should always feel easy and without difficulty.
If you notice the start of any difficulty, stop the Easy Breath-hold immedi-
ately.

The most common error in Easy Breath-hold measurement is due to

pushing the score beyond the first feeling of air-hunger. Remember the
Control Pause is not a competition but a scientific measurement very
much like measuring your pulse.

Meaning of the Easy Breath-hold Score

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 The average modern person has an EBH of about 15 to 20 seconds.
With a EBH of 20 seconds or lower, people are at high risk of developing se-
rious chronic disease. With an EBH of less than 10 seconds, chronic dis-
eases may become acutely life-threatening, requiring emergency care at
the hospital. The ideal EBH is 60 seconds which indicates optimal breath-
ing and very strong health. An EBH of 80 to 180 seconds indicates the
breathing is extremely very well suited for high performance by athletes.

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 CHAPTER 3

Breathing Health
Zones
In Buteyko Breathing, the Easy Breath-hold is the main indicator of your
breathing and general health. If your EBH is lower than 60, your state
health can be described as chronic disease. However, the extend to which
chronic disease manifests is dependent on the height of your EBH. With a
EBH of about 40 or 50, you likely won’t really notice any chronic diseases
yet, but as the EBH goes down to 10 you will surely notice various chronic

Type of 
 Minute Volume Easy Breath-hold Breaths
 Alveolar

State of Health
breathing (air per minute) (Control Pause) per min CO2 %

1.2 180 3 7.5

Hypo 1.4 150 4 7.4
Super ventilation
1.7 120 5 7.3
Performance (breathing
very little) 2.1 100 6 7.1
2.6 80 7 6.8

Optimal
Health 3.5 60 8 6.5
Breathing

4.2 50 10 6.0
5.3 40 12 5.5
Hyper
Chronic ventilation 7 30 15 5.0
Disease (breathing too 10.5 20 20 4.5
much)
21 10 26 4.0
42 5 30 3.5
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disease symptoms arising, simply due to having a low EBH which implies
worsening oxygen distribution and CO2 values.

The table above describes how specific EBH values relate to breathing
pattern, CO2 values and health status. For example: Breathing of a person
with an Easy Breath-hold of 20 can be described as hyperventilation. He
breathes 10.5 liters air per minute while the optimal breathing (with a EBH
of 60) is 3.5 liters per minute. With a EBH of 20 you really are breathing an
amount of air which ideally would be used by 3 people: It’s simply way too
much.

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 CHAPTER 4

Getting More Oxygen

The strongest benefit of better breathing is simply getting more oxygen.

But most people misunderstand the theory of how we can increase the oxy-
gen supply. In a way, that’s because the theory is a bit counter-intuitive.

Most people think that if you breathe more, you’ll get more oxygen. But
actually in modern times most people breathe so much that the opposite
is true for them.... If they want more oxygen, they need to learn how to
breathe less.

Oxygen supply is not just dependent on how much oxygen we breathe

in, but also on how much CO2 we breathe out. If we breathe out too much
CO2, the CO2 content of our blood becomes dangerously low, inhibiting ef-
ficient oxygen distribution.

Most people have the perception that oxygen is good (like a god) while
CO2 is evil (like the devil). But when we look at how our blood distributes
oxygen, it becomes clear that oxygen needs CO2, they are actually team
players who work best in each others presence.

The key point to understand is that CO2 makes it easier for oxygen to
be released from the blood. Haemoglobin has a chemical bond with oxy-
gen and the strength of this bond is determined by the CO2 content of the
blood. More CO2 in the blood lowers the strength of the bond between

8
oxygen and haemoglobin. So our haemoglobin will simply release more
oxygen to be used by cells.

The scientific formula that describes this effect is called the ‘Borh Effect’.
The expanded version of this is called the ‘Buteyko Effect’ and is as follows:

In this formula, MVr is our Minute Breathing Volume at rest (how many
liters of air we breathe per minute). When MVr goes down, the CO2 con-
tent in our blood goes up (PaCO2). That leads to a weaker chemical bond
between haemoglobin (Hb) and oxygen (O2) which is called Hb-O2 affinity.
When Hb-O2 affinity goes down, we release more oxygen from the blood
so the oxygen content of our venous blood goes down (SvO2) which
causes the oxygen difference between arterial and venous blood (a-vO2
diff) to rise. This means the oxygen supply and consumption have gone up
(VO2) which leads to better health and fitness and improvements in
chronic disease symptoms.

To learn more about the Buteyko Effect, read the article available at
http://www.buteykoeffect.com/buteykoeffect.php

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 CHAPTER 5

Better CO2 Levels

Carbon dioxide is the chief hormone of the entire body; it is the only one that is
produced by every tissue and that probably acts on every organ.

Yandell Henderson, Ph.D. - Cyclopedia of Medicine (1940)

When we breathe too much, we exhale too much CO2 and so the CO2
content in our lungs and blood goes down. Most people are not aware that
CO2 has many important functions in the body - the most important being
that CO2 is essential in maintaining blood pH and delivering oxygen to
body cells.

To illustrate the importance of healthy CO2 values of the blood, here’s a

list of the health problems that will occur when CO2 levels are too low:

1. Low CO2 content makes the bond between haemoglobin and oxy-
gen too strong so that it is difficult for oxygen to leave the blood and body
cells experience a lack of oxygen. The reason for this is that CO2 deter-
mines the strength of the bond between oxygen and haemoglobin (Hb-O2
Affinity). This effect is known as the Bohr effect or perhaps more accu-
rately, the Verigo-Bohr Effect. It was first discovered in 1892 by the Russian
scientist Bronislav Verigo, and later in 1904 again by the Danish scientist
Christian Bohr (the father of Niels Bohr).

2. The organism may compensate for the lack of oxygen supply

caused by low CO2 by raising blood pressure and raising the heart beat.

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Higher blood pressure helps oxygen leave the blood more easily, while a
higher heart beat pumps the blood around more quickly so more oxygen
can be distributed. But these 2 compensation mechanisms create other
problems on the long term...

3. A drop in CO2 content of the blood immediately causes a change

of blood pH into the alkaline direction. This change in blood pH negatively
influences the activities of all 1000+ enzymes and vitamins. When the
blood pH reaches 8 or higher, the organism dies. We need CO2 to maintain
a balanced blood pH, which works by using the bicarbonate buffering sys-
tem of the blood.

4. With low CO2 content, the airway passages and blood vessels con-
strict and become narrow. With higher CO2 content, these passages relax
and increase in diameter, allowing for the improved flow of air and blood.
CO2 acts as a relaxant for the smooth muscles of airway passages (bron-
chi) and blood vessels.

5. A lack of CO2 negatively influences important metabolic processes

that rely on CO2. For example, CO2 is required for the carboxylation of py-
ruvate and acetyl in the metabolic pathways of gluconeogenesis and lipo-
genesis. Also the synthesis of the essential aminoacid glucamine (and the
non-essential asparagine) requires CO2 molecules. Many other biosyn-
thetic reactions require the involvement of CO2 molecules and low CO2 lev-
els makes it more difficult for them to take place. This will affect your
energy-levels.

6. Low CO2 levels increase the excitability of the nervous system.

Smaller and subtle stimuli can then easily cause a big reaction by the nerv-
ous system, causing the nervous system to enter a state of permanent ex-
citement characterized by high stress, low relaxation and low ability to fo-
cus (ADHD).

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 7. Low CO2 content worsens brain function and intellect. For neu-
rons to synapse with brain cells in an orderly and efficient manner, an
ideal level of CO2 is needed. A lack of CO2 makes communication between
brain cells more erratic and thus lowers your IQ and EQ.

8. Low CO2 levels cause an increase in respiratory center excitability.

This means that your breathing will respond very quickly and strongly to
an increase in physical activity, making you quickly feel exhausted and out
of breath. With high CO2 levels, your respiratory center will allow the
breathing to stay more normal during exercise, so you can do more exer-
cise without feeling out of breath.

9. Low CO2 content causes decreased uptake of glucose from the

blood and raises your blood sugar levels. The rate and efficiency in which
sugar is delivered to cells is regulated by the level of carbon dioxide. If CO2
levels are optimal, sugar can be burned more quickly and blood sugar lev-
els are more stable.

10. A low CO2 level also weakens your immune system by lowering
the antibody-antigen affinity. This means that it becomes more difficult for
your antibodies to attach to and disable viruses and bacteria.



To learn more about CO2, we recommend you to read Yandell Henderson’s full
article available at www.buteykoeffect.com/CO2

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 CHAPTER 6

More Nitric Oxide

Nitric oxide (NO) is a gas which promotes fitness and health which is pro-
duced by our own bodies in the lining of our arteries and in the nasal pas-
sages. Nitric oxide (NO) is not to be confused with nitrous oxide (N2O)
which is better known as ‘laughing gas’.

Nitric oxide has several very important functions in our body:

1. Nitric oxide is a powerful vasodilator: It relaxes blood vessels, lower-

ing blood-pressure and the heart rate and thus protect organs such as
the liver from damage due to a restricted blood supply.

2. Nitric oxide helps improve communication between nerve cells in the

brain.

3. Nitric oxide assists the immune system at fighting off bacteria and vi-
ruses.

4. Nitric oxide reduces inflammation.

5. Nitric oxide improves sleep quality.

6. Nitric oxide increases strength and endurance.

The 1998 Nobel Prize was awarded for the discovery of the role of nitric
oxide as an important cardiovascular signaling molecule.

When we breathe through the mouth, we won’t benefit from the nitrous
oxide produced and present in our nasal passages. By breathing through

13
the nose, we enrich the inhaled air with nitrous oxide in our nasal pas-
sages which will then enter the blood so we’ll receive the many health
benefits. So make sure to always keep breathing through the nose unless
you have a very good reason not to!

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 CHAPTER 7

The Buteyko
Exercise Levels
During the course, course participants use the Advanced Buteyko app
to do and learn the Buteyko exercises. The Advanced Buteyko app contains
61 Buteyko Breathing exercises, arranged by level. You’ll start at level 1 and
as you gain experience and learn valuable skills, your instructor will give
you access to the higher levels to make your Buteyko practice more power-
ful and advanced and get better results.

In general, we recommend course participants to raise their level once a

day. So if you start at level 1 on day 1, you’d raise your level to level 2 on
day 2, after doing level 1 three or four times on day 1. This way, you’ll
slowly raise your level day by day. If your progress is smooth, you’ll be do-
ing advanced Buteyko Breathing exercises (at level 10 and higher) after
about 10 days.

You’ll also have regular coaching sessions with your personal Buteyko in-
structor so you can be confident to have a good foundation in the practice
and apply Buteyko techniques which are suitable for you and work well for
you.

You won’t need to learn all levels. Your instructor will pick the ones most
suitable for you. The first 13 levels are the learning levels, where raising
your level means your practice is becoming more advanced and powerful.

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 After level 13 you’ll gain access to the many advanced levels that pro-
vide alternative ways to practice. There are a number of specialized levels
such as meditation, walking, recovery, nose clearing, etc. Some of the lev-
els are quite long and take up to an hour while others are very short and
take just 5 minutes. We encourage our students to try out various levels
and do the ones they like most and give best results. Not all levels are suit-
able for everybody and your instructor will provide you with guidance on
the best levels for you to use.

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 CHAPTER 8

Cleansing & Detox

As your breathing becomes better and your Buteyko Breathing scores

improve, all body systems become stronger: respiratory system, metabolic
system, immune system, nervous system, digestive system, cardiovascular
system, endocrine system, muscular system, etc.

As the body gains in strength and health, three cleansing and detox
processes often occur:

1. Autophagy is where individual cells start recycling broken mole-

cules (proteins, amino-acids, etc) that are stored in the garbage-collectors
in each individual cell. This is a very good sign of increasing health: the
body really starts a deep clean.

2. The body will also start removing toxic substances that were origi-
nally stored in fat cells to get the out of the way and keep them out of the
bloodstream where they can do a lot of damage. When the toxins are
again removed from the fat cells, they will need to really be processed, bro-
ken down and disposed through urine, feces, sweat, breath etc.

3. As the immune system becomes stronger, it starts to seek for hid-

den viruses more actively and intensively. When it encounters a virus in for
example the throat, urinary tract or somewhere else, the traditional symp-
toms of flu, fever, pain or infection may arise while the immune system is
eradicating the virus. This usually happens after a solid improvement in

17
your breathing scores (breaking your personal record). Often big improve-
ment in scores will be followed by temporary symptoms of fever or cold
and the corresponding reduction in wellness and breathing scores.

These processes are how the body gains health through cleaning up on
the cellular level and by removing toxins, viruses and infections from the
system. Symptoms can become acute before they disappear. Detox and
cleansing are often a positive sign as your health will be stronger after-
wards. It's very important to keep us informed so we can help solve compli-
cations.

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 CHAPTER 9

Medication

If you take any medications to treat chronic disease symptoms, we of-

ten see that as the breathing improves, your chronic disease symptoms
will lessen which will eventually warrant a reduction in medication.

So when after a few days, weeks or months of Buteyko Breathing your

health and symptoms have improved significantly, you may find your usual
dosage of medication is too strong. When this happens, please visit your
doctor and tell him about the symptomatic improvements you’ve been ex-
periencing and ask your doctor if it may be suitable to adjust your medica-
tion?

Also do keep us informed of any big changes in medication taken during

the course, as this may affect your Buteyko Breathing practice and scores.

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 C H A P T E R 10

Making Progress

with Buteyko
When doing the Buteyko Breathing course, progress can show in differ-
ent ways:

1. Buteyko breathing scores are going up.

2. Chronic disease symptoms are improving.

3. Feeling more energetic, healthy, balanced & stronger in general.

4. Experiencing the typical detox and cleansing symptoms.

5. Experiencing a reduced need for medications.

Some course participants are able to smoothly improve their breathing

in less than 2 months from a CP of 12 to more than 40 (view chart on the
next page) and experience strong health benefits and strong improve-
ments in chronic disease symptoms. For other course participants how-
ever the path may be different, with obvious improvements in some areas
while in other areas progress may - for the time being - seem elusive.

The point here is that we cannot choose which kind of progress we will
experience in what time period. All we can do is keep doing the daily
breathing exercises. Sometimes we just need to be patient and steady and
give our body some time to adjust so our scores can go up further.

At other times however we may benefit a lot from changing the ap-
proach or choosing another Buteyko level to continue our practice with. It’s

20
your instructor’s job to recognize what’s happening and select a suitable re-
sponse.

The chart above is an example chart from one of our course participants, showing excel-
lent progress: the Easy Breath-hold time (Control Pause) went up from about 12 to over
40 seconds in less than 2 months. This increase in breathing scores was accompanied by
a complete 100% reversal of all asthma symptoms.

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 C H A P T E R 11

Stay in Touch

When you experience any issues or sudden changes in breathing or

health during or after the course, please get in touch with us immediately.

Sudden Changes in Breathing

If you experience a sudden rise or drop in breathing scores, do inform
your Buteyko Breathing instructor of your current situation. Sudden
changes in your breathing scores can indicate that your Buteyko Breathing
practice needs to be adjusted to ensure smooth progress. The sooner the
adjustment is made, the better.

Lack of Progress
If you don't observe satisfactory growth in scores nor an improvement
in chronic disease symptoms or general wellness and energy level, do in-
form your instructor so they can have a more detailed look at what exactly
is going on.

Changes in Disease Symptoms

If you experience a sudden worsening or improvement of your chronic
disease symptoms, do inform your Buteyko Breathing instructor. Sudden
changes in symptoms can be related to your Buteyko Breathing practice.

Changes in Medication
If your doctor prescribes new medications or changes your medication

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 C H A P T E R 12

Recommended
Videos
There’s a very interesting BBC documentary on Buteyko Breathing (from
1998). It’s about 3 patients with very serious breathing problems, trying out
Buteyko Breathing and seeing how it goes. It gives a quick overview on But-
eyko Breathing theory and history and shows how effective Buteyko can
be. The documentary is a great introduction to Buteyko Breathing to share
with family and friends.

You can view the BBC documentary video now by clicking this link:
www.advancedbuteyko.com/bbc.

We also have a few Buteyko instruction videos (on Youtube).

We also recommend to watch the Australian TV broadcast on Buteyko

Breathing (from 1993).

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 C H A P T E R 13

Advanced Buteyko
App
Visit www.advancedbuteyko.com/app to download our Advanced But-
eyko app for iOS and Android.

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