Nadi Shodhana Goes Wrong in Session Five
It is the fifth session of a beginner course, and you introduce Nadi Shodhana seated on chairs. You have been taught the classical ratio as 1:4:2 and decide to scale it to a 4-second inhale, 16-second hold and 8-second exhale, for six rounds. On round four, Anil, 29, a call-centre worker, stops, says he feels dizzy and "floaty", and shows you tingling in his fingertips and around the mouth. He looks pale and is breathing fast and shallow. A second student, Sunita, 55, mentions afterwards that she has glaucoma and asks whether she should be holding her breath too. The room is warm, the session is nearly over, and there are 14 other students watching.
1. What is happening to Anil, what do you do in the next two minutes, and what in your instruction caused it?
Read the worked answer
The picture - dizziness, perioral and fingertip paraesthesia, pallor, fast shallow breathing - is the classic hyperventilation / respiratory-alkalosis response: over-breathing blows off CO2, plasma pH rises, and free ionised calcium falls, producing tingling and, in more severe cases, carpopedal spasm. A 16-second hold in a beginner, with an uncomfortable urge to breathe, also drives a compensatory over-breath after each round, and anxiety amplifies the whole loop.
Do now:
- Stop the practice for him and say calmly, "this is common and it settles - just breathe normally through your nose."
- Have him sit back, loosen the shoulders, drop the chin slightly; do not have him breathe into a paper bag or hold his breath - let the breath normalise spontaneously.
- Give him a simple grounding task: feel the feet on the floor, let the exhale be quiet and unforced for 10-15 breaths.
- Check he is not known to have a seizure disorder, cardiac condition or panic disorder, and do not let him drive if he still feels unwell; offer water and a seat.
- Do not restart the practice with the group - close the session with natural breathing and savasana.
What caused it: a 1:4:2 ratio with a 16-second hold is far beyond a beginner's tolerance. Classical ratios exist, but they are goals reached over months under supervision, not a starting point in session five, and I never verified that he could breathe comfortably without retention first.
2. Redesign your pranayama progression for the remaining four sessions, including how and whether to introduce retention.
Read the worked answer
Rebuild from breath awareness upward.
- Sessions 6-7: establish the mechanics with no retention. Nadi Shodhana with 4 in / 6 out, no hold, 5 rounds; sitting upright, spine supported, nostrils only, no sound. The longer exhale is the whole point at this stage; it is calming and gives him a skill he can use.
- Session 8: 4 in / 6 out for 6-8 rounds, then introduce a 2-second pause after the exhale only if the breath is smooth and unforced. The pause should be a rest, not a strain; if the breath snatches afterwards, the pause is too long.
- Session 9: 4 in / 2 hold / 6 out, briefly, with a clear exit rule: stop the retention the moment there is any urge to gulp, dizziness or tingling.
Principles to state to the class:
- Retention is optional and always the first thing dropped. No kumbhaka for anyone who is unwell, pregnant, or new; no retention in a class setting without individual screening.
- The ratio is scaled to the student's comfortable count, and the exhale is always longer than the inhale; the breath is never forced or audible.
- Any symptom - dizziness, tingling, chest tightness, panic - means return to natural breath, end the practice, and sit quietly.
- Anil should stay on the no-retention version indefinitely and should be told to mention the episode to his doctor if it recurs outside class.
3. Sunita has glaucoma. How do you answer her question about breath holding, and who else in a general class needs a caution - and why?
Read the worked answer
Sunita: thank her for raising it, and say clearly that she should not hold her breath or do forceful breathing in class. Kumbhaka, particularly with a full-chest hold and any straining, raises intraocular pressure; raised intraocular pressure is a documented concern in glaucoma, so the risk is not worth the benefit. Offer her the no-retention version (4 in / 6 out) and make clear that she should confirm with her ophthalmologist, especially if her pressure is not well controlled or she has had recent surgery.
Others to caution, with the mechanism:
- Hypertension / cardiac disease - retention and forceful breathing cause sharp blood-pressure swings; no kumbhaka, no bhastrika, no kapalabhati.
- Pregnancy - no retention, no forceful abdominal breathing; keep breathing natural and quiet.
- Epilepsy / seizure history - hyperventilation-type practices can lower the seizure threshold; avoid bhastrika and kapalabhati.
- Hernia, recent abdominal or eye surgery, detached-retina risk - avoid abdominal pumping and any straining; pressure is transmitted to the surgical site.
- Panic or anxiety disorder, or a previous bad reaction - skip retention and forceful breathing altogether; slow exhale and grounding only.
How to manage it in class: ask about these conditions on the enrolment form, state the cautions publicly at the start of the pranayama section in general terms ("if you have glaucoma, high blood pressure, are pregnant or have a heart condition, stay with the simple version and do not hold the breath"), and always demonstrate the no-retention option alongside the fuller one so nobody has to declare anything out loud.