The question: Why do I feel like I can't get enough air when my lungs and oxygen levels are normal?
The short answer: Often the problem is not a lack of oxygen but the signal your body is responding to. Stress and anxiety change your breathing pattern, your brain reads the resulting sensations as a threat, and that keeps the loop going. James Stewart teaches a slow 4-6 nasal breath to send your body a calmer signal.
What James explains
James regularly works with clients who feel short of breath or can never get a satisfying breath, even though their lung tests are normal and their oxygen levels are in the normal range. This is common in people living with stress, anxiety or a high-performance, always-on lifestyle. The feeling is real, but the reason behind it is often misunderstood. As James puts it, breathlessness is a sensation, not a shortage.
When stress changes your breathing, through mouth breathing, over-breathing, or short, fast, irregular breaths, you can blow off more carbon dioxide than normal. CO2 is not just a waste gas: it is part of the blood chemistry that helps deliver oxygen to your muscles and organs. When it drops, your nervous system shifts into an activated state. Your brain then interprets that pattern and those sensations as a threat or danger.
That creates a loop. The sensation reinforces the breathing behavior, and the behavior reinforces the sensation. Trying to fix it with deeper or faster breaths usually keeps the loop running. Changing the pattern on purpose, with slow, quiet breathing, gives your brain a different message to interpret, which is how James describes the loop being broken.
Try it: a slow 4-6 nasal breath
- Pause and notice what your breathing is doing right now.
- Close your mouth and breathe in low and slow through your nose for a count of four.
- Breathe out gently through your nose for a count of six.
- Keep the breath comfortable and quiet: you are not trying to fill your lungs or force a big breath.
- Repeat for several rounds, letting the exhale stay slow and unforced.
What to watch for
The most common mistake is chasing the feeling with deeper, faster breaths, which James says feeds the loop rather than ending it. Remember, you are not trying to get more oxygen; you are trying to steady the message your body receives. James also notes that some breathlessness has a physical cause: new, severe, persistent or unexplained shortness of breath should get a medical evaluation.
Key points
- Feeling breathless with normal lungs is often a response to a signal, not a shortage of oxygen.
- Stress changes your breathing, your brain reads the resulting sensations as a threat, and the loop feeds itself.
- Slow, quiet nasal breathing with a gentle exhale gives your body a new signal and helps interrupt the loop.
Common questions
Should I take deep breaths when I feel short of breath?
James says that taking deeper or faster breaths often continues the loop and makes the problem worse. Instead, pause, breathe low and slow through your nose, and let the exhale be longer and gentle.
Is the feeling of breathlessness just in my head?
No. James stresses that the feeling is very real. It comes from how your body and brain respond to changes in your breathing pattern and blood chemistry, which your brain can interpret as a threat.
Does a longer exhale matter, or is slow breathing enough?
James uses a longer exhale as a calming cue. In a 12-week trial, regular slow breathing reduced psychological stress, but a longer exhale did not add a significant extra effect over equal breaths. Slow, controlled breathing is the part with the strongest support.
When should breathlessness be checked by a doctor?
James notes that there are cases where breathlessness has a physical cause and needs a medical evaluation. New, severe, persistent or unexplained shortness of breath should be assessed by a healthcare professional.
Research mentioned
Leyro TM, Versella MV, Yang MJ, Brinkman HR, Hoyt DL, Lehrer P. Respiratory therapy for the treatment of anxiety: Meta-analytic review and regression. Clinical Psychology Review, 2021;84:101980. A meta-analysis of 40 randomized controlled trials found respiratory-focused interventions improved anxiety symptoms more than control conditions, with considerable variation between studies. https://doi.org/10.1016/j.cpr.2021.101980
Boulding R, Stacey R, Niven R, Fowler SJ. Dysfunctional breathing: a review of the literature and proposal for classification. European Respiratory Review, 2016;25(141):287-294. Describes how altered breathing patterns can cause breathlessness and other symptoms. https://doi.org/10.1183/16000617.0088-2015
Birdee G, et al. Slow breathing for reducing stress: The effect of extending exhale. Complementary Therapies in Medicine, 2023;73:102937. A 12-week randomized trial in 100 healthy adults found regular slow breathing reduced psychological stress, with no significant difference between a longer exhale and equal inhale and exhale. https://doi.org/10.1016/j.ctim.2023.102937
Read the full transcript
Auto-generated from the video captions, so expect small errors.
Have you ever felt like you just can't get enough air? You can't catch your breath. You take a deep breath and then you take another, but that feeling is just not satisfied. That can be uncomfortable, frightening even. Often the problem isn't you don't have enough oxygen, it's the signal that your body is responding to. I see this regularly. Clients will present with shortness of breath or just simply that inability to feel like they are getting enough air. They've often had lung tests and their lung function feels normal. Their oxygen levels fall within the normal ranges and yet they still have labored breathing and are unable
to feel satisfied with their normal breathing pattern. This is also very common with people who deal with elevated levels of stress, anxiety, people who live a high-performance lifestyle who are simply in go mode a lot of the time. The feeling is very real, but the reason that you have it is often very misunderstood. Often, even when your oxygen levels are normal, but your breathing patterns changed, your level of CO2 shifts, and your body interprets that message very differently. Those of you who are familiar with hyperventilation or have seen someone who hyperventilates where they [panting and sighs] in that panic state where they are breathing heavily.
What's happening there is often we are blowing off a lot more CO2 than normal. When our CO2 level drops, it changes our blood chemistry and our body responds. That puts us into an activated state. So, our autonomic nervous system shifts into that sympathetic dominance and we are activated. Remember, CO2 isn't just a waste gas. It is a very important part of your blood chemistry in order to deliver oxygen and make it available to muscles and organs that desperately need it. Breathlessness is a sensation. It is not a shortage. So often we get stuck in loops that we are totally unaware of as our body responds
to stimulus both from the external world but also our internal state. So whether it is stress, speed of our breath. So it can be mouth breathing, it can be over breathing, it can be short breaths. It can be fast, uncontrolled, irregular patterns. A lot of this is synonymous with anxiety and what happens is our brain interprets that pattern. It sees it as a threat or danger. So this sensation then reinforces the behavior and then the behavior reinforces the sensation and we get stuck in these loops. So often what happens is we're trying to solve this problem. We're taking deeper breaths, faster breaths. We're actually continuing
that loop and exacerbating the problem. So here is a breathing pattern that I will show you that can reset and recalibrate your body by the message that it is able to send to relax and calm the body both your internal and external state. And it is a 4-6 breath and what we are going to do is we're going to breathe in low slow through our nose for a count of four and then we're going to breathe out for a count of six. The longer our exhale, the more parasympathetic dominant or relaxed we're going to be. So that breathing pattern looks a little something like this.
We're going to go in two three four through the nose and then we're going to go shh. So in and out through our nose breathing in breathing out. In two three four out two three four five six in two 3 4 out 2 3 4 5 6. This breath work pattern will help you break the loop that you may be aware or unaware that you are in and allow you to reset and recalibrate your internal state. Remember, you're not trying to get more oxygen. You are trying to stabilize the message that your body is receiving. So, that feeling of breathlessness or or being out of
breath is very real and often it is your body responding to the signal that it is receiving. Certainly, there are cases where it is physiologically based and you should receive medical evaluation. But, quite often as I've explained it is not the level of oxygen in our body. It is the way our body responds, if you want to call it to the threat assessment that it is receiving. So, the next time you feel out of breath, pause, focus on your breathing, breathing low, slow through your nose, extend your exhale, and send your body a new signal.