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 it 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.

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