Breath Hold

The Breath-Hold Test: Simpler Than It Sounds

The breath-hold test is exactly what it sounds like—you hold your breath and time how long you can last. It might seem too simple to be useful, but it actually tells you a lot about how your cardiovascular, respiratory, and nervous systems are working together.

Here’s how to do it:

1.Sit comfortably and rest for about 5 minutes. Just breathe normally and relax.

2.Take a normal breath in, then breathe in a bit more until your lungs feel comfortably full—not bursting, just full.

3.Hold your breath and pinch your nose (no cheating!). Start your timer.

4.Hold until you absolutely have to breathe. Don’t try to be a hero—stop when your body is screaming at you that it needs air.

5.Record your time and note how you felt. Was it just uncomfortable, or did you feel panicky? Did your heart pound?

6.Wait 3-5 minutes and try it two more times. You’ll get slightly different numbers each time—that’s normal.

What This Test Actually Shows

When you hold your breath, carbon dioxide builds up in your blood. Your body has sensors (chemoreceptors) that detect this and tell your brain “Hey, we need to breathe NOW.” In people with Long COVID, these sensors often become oversensitive. It’s like they’re set on a hair trigger.

You might also notice:

   Your heart racing during the breath-hold 

   Feeling panicky or anxious 

   An overwhelming sensation of needing air way sooner than you expected 

   Feeling shaky or weird afterward

These reactions suggest your autonomic nervous system is in overdrive—specifically, your sympathetic nervous system (the “fight or flight” mode) is too active, while your parasympathetic system (the “rest and digest” mode) isn’t doing its job to calm things down.

Adding the Pulse Oximeter: More Information

Now let’s make this test even more useful by adding a pulse oximeter. These little devices cost $20-40 and clip onto your finger. They show two numbers: your oxygen saturation (SpO2) and your heart rate.

Enhanced breath-hold test with pulse oximeter:

1.Clip the pulse oximeter on your finger before you start.

2.Note your resting heart rate and oxygen level (should be 95-100% for oxygen, and heart rate varies but maybe 60-90 beats per minute at rest).

3.Do the breath-hold test while watching the numbers.

4.Keep the oximeter on for 2-3 minutes after you start breathing again to see how things recover.

What to watch for:

Your oxygen saturation will usually stay pretty stable during a breath-hold (maybe dropping to 92-95% at most). If it drops lower, that could suggest lung issues. But the really interesting number is your heart rate.

In people with autonomic dysfunction, you’ll often see:

 Heart rate jumping up 20-30 beats or more during the breath-hold 

    Heart rate staying elevated for a while after you start breathing 

    Feeling your heart pounding even though you’re sitting still 

    A disconnect between how you feel and what the numbers show 

The Standing Test: Catching POTS

While we’re at it, let’s do one more simple test that can spot POTS (Postural Orthostatic Tachycardia Syndrome), one of the most common forms of autonomic dysfunction in Long COVID.

How to do it:

 1.Lie down for 5 minutes. Relax completely. 

   2.With your pulse oximeter on, note your heart rate while lying down. 

   3.Stand up and immediately check your heart rate. Keep standing and check it again at 2, 5, and 10 minutes. 

   4.Write down all these numbers. 

What it means:

If your heart rate increases by 30 beats per minute or more within 10 minutes of standing (or 40+ if you’re a teenager), that meets the criteria for POTS. For example, if you’re at 70 lying down and hit 100+ when standing, that’s significant.

You might also notice:

   Feeling dizzy or lightheaded 

   Vision getting blurry or spotty 

   Heart pounding in your chest 

   Feeling like you might faint 

   Brain fog getting worse when upright 

Okay, so you’ve done these tests and things don’t look great. Your breath-hold time is short, your heart is racing, and standing up makes you feel terrible. Now what?

First, don’t panic. Autonomic dysfunction is real and it’s miserable, but there are things you can do at home that really help. Here are the most effective strategies:

1. Salt and Water (Seriously, This Helps)

This sounds too simple to work, but for many people, it’s life-changing.

Increase your salt intake to 6-10 grams per day. That’s about 2-3 teaspoons. You can use salt tablets (easier to track), add salt to everything you eat, drink pickle juice, eat salty snacks, or have bouillon cubes in hot water. When increasing salt intake, it is also important to increase your potassium intake just as much. My Balanced Salt has this correct ratio.

Drink 2-3 liters of water daily. Not all at once—spread it throughout the day.

Why does this work? Salt and water increase your blood volume, which helps prevent blood from pooling in your legs when you stand up. More blood volume means better blood flow to your brain and less compensatory racing of your heart.

Important: Check with your doctor first if you have high blood pressure, heart failure, or kidney problems.

2. Compression Garments

Get yourself some waist-high compression stockings (20-30 mmHg) or an abdominal binder. Yes, they’re uncomfortable and annoying to put on, but they work.

Put them on before you get out of bed in the morning (while you’re still lying down). They prevent blood from pooling in your legs and abdomen, which reduces that awful feeling when you stand up.

3. Change How You Move

Never jump straight out of bed. Instead:

   Roll to your side 

   Sit up slowly and dangle your legs 

   Pump your ankles up and down 10-20 times 

   Wait a minute or two 

   Stand slowly 

   Wait another 30 seconds before walking

When standing, don’t stand still (that’s actually the worst position). Instead:

   Rock back and forth 

   Shift your weight from foot to foot 

   Do calf raises 

   Cross your legs and squeeze your thighs 

   Lean against something 

   Better yet, sit on a tall stool instead

4. Exercise Lying Down

This sounds weird, but it’s crucial. When you have autonomic dysfunction, upright exercise makes things worse. Start with exercise that keeps you horizontal:

   Recumbent bike 

   Rowing machine (if you can recline) 

   Swimming (floating horizontally) 

   Floor exercises (leg lifts, bridges, arm movements) 

Start with just 5-10 minutes and slowly build up. Keep your heart rate low—you’re not trying to train for a marathon, you’re retraining your nervous system.

If you currently crash with any activity then be sure you can do 30-45 minutes of horizontal exercise without crashing before you even think about upright activities like walking or regular biking.

5. Breathing Exercises

Remember how your nervous system is stuck in “fight or flight” mode? Breathing exercises can help flip it back to “rest and digest.”

Simple diaphragmatic breathing:

   Lie down or sit comfortably 

   Put one hand on your chest and one on your belly 

   Breathe in through your nose, making your belly rise      (chest shouldn’t move much) 

   Breathe out slowly through your mouth 

   Make your exhale twice as long as your inhale 

   Do this for 5-10 minutes, 3-4 times a day

This activates your vagus nerve, which is like the master switch for calming your nervous system down.

6. Keep Your Cool

Many people with autonomic dysfunction can’t handle heat well. Hot showers, hot weather, and hot rooms all make symptoms worse.

   Take lukewarm showers (use a shower chair) 

   Keep your house cool 

   Use fans liberally 

   Wear light, breathable clothing 

   Exercise in the coolest part of the day

7. Eat Small, Frequent Meals

Big meals divert blood to your digestive system, which can make you feel dizzy and exhausted (postprandial hypotension). Instead, eat 5-6 small meals throughout the day. Avoid high-sugar foods that cause blood sugar swings—those make autonomic symptoms worse.

Tracking Your Progress

Do these tests weekly and write down your results. You’re looking for trends:

Is your breath-hold time increasing? 

   Is your heart rate less reactive? 

   Can you stand longer without symptoms? 

   Are you tolerating more activity?

Progress is usually slow—think months, not weeks. You’ll have good days and bad days. That’s normal. The key is the overall trend over time.

When to See a Doctor

These home tests and strategies can help a lot, but they’re not a substitute for medical care. See a doctor if:

You’re fainting or nearly fainting regularly 

You have chest pain or concerning palpitations 

Your symptoms are getting worse despite trying these strategies 

You can’t maintain basic self-care 

Your breath-hold time is under 10 seconds 

Ask about seeing a cardiologist or an autonomic specialist. There are medications that can help (like beta-blockers, ivabradine, or midodrine), but lifestyle modifications should be tried first.

The Bottom Line

Long COVID autonomic dysfunction is real, measurable, and manageable. You’re not imagining it, you’re not crazy, and you’re not alone. These simple tests—breath-holding with a pulse oximeter and the standing test—can give you objective data about what’s happening in your body.

More importantly, the basic strategies of salt, water, compression, horizontal exercise, breathing exercises, and smart pacing can make a huge difference. Most people see meaningful improvement within 3-6 months of consistently doing these things.

Your nervous system got knocked out of whack by COVID, but it can recover. It just needs time, support, and the right approach. Start with these simple tests to understand what’s going on, then give your body what it needs to heal. You’ve got this.

Take care,

David

Ellen

Ellen has had a wide variety of life experiences. Back about 40 years ago, between husbands 4 and 5, she had a career as an esthetician. That experience has stuck with her and to this day she is always experimenting with different facial care products. Recently someone told her that my Fungi Stop product would take away brown spots on the skin. Naturally she wanted to experiment with it to see if it actually works. Here she is putting some on a small spot on her left cheek. We shall see if it takes the spot away. So far the last couple of days it seems to be acting like a dermal peeling agent. The area gets dry and a layer of skin peels off.