Breath & Blood Flow Play Class Notes

I very much enjoy many forms of breath play and for several years I taught a class on the topic for the kink community.  I have since retired from teaching but would like to continue sharing the class info for anyone interested. 


Breath & blood flow play are among the most dangerous forms of play practiced with in the kink community. Anyone that chooses to engage in this activity must be aware that there is no absolute SAFE way to play with breath and that some forms of it are far riskier than others. In order to make an informed decision as to whether to engage in this activity or not, all parties must fully understand what the risks are, and that legally you are criminally and civilly liable for your actions.  Also, any party giver who allows permits these practices at their parties is looking at being held co-liable, both civilly and criminally, for any deaths or injuries that result, either from their giving such permission or from their “looking the other way” while such practices occur.

 What is Breath & Blood Flow Play?

I feel that “Breath Play” takes no single identifiable format but rather includes a wide array of activities. These activities can be grouped into quite a few categories and each different style not only can create a different “feel” or affect to the recipient, but also can carry it’s own risks.  I feel the one thing they do have in common is that all of the forms change the amount of oxygen the body & brain receives, either by restricting, increasing or altering the flow of breath, which then changes the chemical content of the blood. These factors can cause very real dangers to the body which I will get to shortly. 

 Most severe medical dangers:
  • Cardiac Dangers – Depending on what style of play you are doing one of two main things can go wrong in the heart.
  • PVCs – When the blood is low on oxygen, for any reason, it can cause the heart to start firing off faster and more erratically leading to what are knows as premature ventricular contractions or PVCs. If a PVC happens to fire off during a particular phase of cardiac contraction, especially if the heart muscle is low on oxygen, it can kick the heart over into ventricular fibrillation, a kind of cardiac arrest. The lower the heart gets on oxygen, the more PVC’s it creates and the more dangerous this becomes. You need to be aware that each and every PVC is potentially lethal and that there is no way to tell it is happening without a heart monitor (I know very few folks that have one of THOSE in their toy bag!). Even if you stop the activity immediately, there’s no telling when the PVC’s will end. They could stop almost at once, or they could continue for as long as 36 hours, and send the person into cardiac arrest at any time, even long after the play has ended.
  • Carotid Pressure – Pressing on the carotid arteries, causes a reaction in the body that basically tells your brain your blood pressure is too high which causes vasodilation in the brain (to allow the blood to flood with less pressure), but since blood flow is restricted by the pressure on the carotids there is not enough blood to feed the brain and the bottom can lose consciousness quite quickly and suddenly. In the same instant, a message is also sent to the main pacemaker of the heart, via the vagus nerve, to decrease the rate and force of the heartbeat (to lessen the pressure on the receptors in the neck except that it wasn’t the cause of the pressure in the first place). There is no sure way to predict if the heart will slow to a level that can still sustain life or if it will stop entirely and send them into cardiac arrest.
    There is some evidence that shows that the fatalities from this happen more often in persons who are in a strong state of emotional or physical distress at the time that a choke hold is applied which causes the heart to go from a rapid rate and force of contraction to a sudden drop that it cannot recover from, but only doing this on someone in a relaxed state cannot be counted on as safe. How this applies to someone who is in a strong state of emotional and physical “distress” because they are sexually aroused is not yet clear, but it seems logical to conclude that they would face at least somewhat of an elevated risk.
    There is no way to tell whether or not either of these will happen in any particular instance, or how quickly.  BDSM author and attorney Jay Wiseman (a noted and respected authority and expert witness on this subject, whom I consulted with in preparing this material) says there are many documented cases of as little as five seconds of choking or suffocation causing cardiac arrest.  He further says that there are no reliable warning signs that signal when things are about to go too far and that if a cardiac arrest does occur; the chances of a successful resuscitation are very low.
  • Stroke – is a very serious danger of strangulation or carotid pressure play. A stroke can be caused by dislodging fatty plague build ups in the arteries of the neck which can travel to the brain and cause injury or clog the artery and deprive portions of the brain of oxygen. Some of the symptoms of a stroke are loss of consciousness, paralysis, unequal pupils size, paralysis usually on one side, sweating, slightly lowered temperature, and speech disturbances.
    Some risk factors for stroke cannot be helped. Men are far more likely to have one than women.  After age 55 the risk factor increases each year.  If you have a history of stroke in your family or have had one before, you are at risk.  Other factors that increase chances of stroke are being over weight, lack of exercise, poor diet, smoking, as well as conditions such as heart or artery disease, diabetes mellitus, sickle cell disease, high blood pressure and especially high cholesterol. You should definitely NOT engage in breath play if you are at high risk of a stroke or heart attack. If you feel you or someone you are with may be having a stroke or a heart attach: Get Medical Help Immediately!
  • Respiratory & Metabolic Acidosis
    If breathing is restricted, CO2 builds up in the blood stream and which decreases the pH and makes the blood more acidic. At the same time, blood oxygen levels also drop.  Medically, this drop in blood oxygen level is known as hypoxia. Oxygen is needed in the body as part of the metabolic process that breaks down glucose in the body to create fuel. If there is an insufficient amount of O2 to power this operation properly there is a chemical reaction that creates a build up of lactic acid in the cells and can lead to yet another drop in the blood’s ph, a condition called metabolic acidosis. An acidosis caused by both an increase in blood levels of carbon dioxide and a decrease in blood levels of oxygen, such as occurs in suffocation where breath has difficulty both in getting in and getting out, is sometimes called a “mixed acidosis.”
  • Respiratory Alkalosis
    If the person hyperventilates, CO2 is blown off and it raises the pH making the blood more alkaline. This can cause confusion and stupor, vomiting, hyperactive reflexes, seizure, rapid respiration, numbness, and coma. The best way to treat it is by having them do some form of rebreathing until they calm down and then have them breath normally. Hyperventilation is something that we run into when doing breath control play because the body tries to compensate for the lack of oxygen and may go a bit overboard in doing so. It also is common that at times of fear a person will hyperventilate. An acidosis caused by both an increase in blood levels of carbon dioxide and a decrease in blood levels of oxygen, such as occurs in suffocation where breath has difficulty both in getting in and getting out, is sometimes called a “mixed acidosis.” All three of these conditions can cause headache, drowsiness, hyperventilation (as a way to compensate), cardiac dysrhythmias, gastrointestinal distress, abdominal pain, nausea, vomiting, diarrhea and blurred vision. The best way to treat it is to restore normal breathing as soon as possible. Most of these symptoms should clear up with in a few moments once normal breathing is restored if but any persist please seek immediate medical attention.

Important Note – Our bloods chemical consistency must be maintained within a fairly narrow range for life and health to exist. A blood pH that is either too low or too high is “incompatible with life” and the extremes of any of these conditions can be deadly.
It is also VERY important to note that vomiting could occur as a result of any of these conditions, and that can be deadly if the airway is restricted or obstructed or if they are tied on their back and lead to asphyxiation. Be sure that whatever you are doing or using can be stopped or removed within seconds, and that if they were to vomit that they will not choke on it.

  • Brain Damage- Obviously these games also cause shifts in the amount of oxygen getting to brain which lead to either vasodilation (when deprived) or constriction (as in hyperventilation). Depriving the brain of oxygen can definitely lead to cell death and there is good evidence to show that if this practice is repeated often enough, it can lead to cumulative and permanent brain damage.
  • Additional Dangers- There are many additional dangers associated with Breath play. These include, but are not limited to: seizures which can lead to airway obstruction by the tongue, damage to the windpipe, larynx, cervical spine and blood vessels in the neck / throat from too much pressure, twisting or constriction. Also, injuries could occur if someone falls or passes out suddenly.
 Before you try any of this at home:

Persons at highest risk: Both parties need to be fully aware that conditions such as asthma, smoking & other respiratory disorders or breathing difficulties, low / high blood pressure & circulatory issues, heart conditions, and hardening or obstructions in the arteries will dramatically increase the risks of serious injury or death. At highest risk are men over 40, persons with a history of a seizure disorder, using street drugs, alcohol or on prescription drugs, particularly digitalis preparations and tricyclic antidepressant or people with manic-depressive disorders while in the manic phase. I personally also avoid doing this activity on people who are obese in otherwise questionable health or are using drugs like Viagra or Cialis because those drugs mess with the blood pressure.

 Learn and practice CPR but you need to know that if a problem does occur, while CPR should be done, it is not a guarantee and will do little to help with a heart problem or a stroke. Jays says the likely hood of saving their life with CPR is only about 10%

 Past experience, either with others or with the same person, does not make this safe.  You need to understand that no matter how many times you do this, or how much you think you have mastered it… shit happens. You could do the exact same thing with the same person a 100 times with no visible adverse results, and then the 101st time something can go terribly wrong with no apparent rhyme or reason.  That is just the way it is

As a precaution, if possible, play in public or have a spotter. If you do run into trouble it can be very helpful to have someone nearby to call for help or to help continue CPR

Other Things to Consider –

Tops – Are you sure you want to be fully responsible for someone else’s life and physical well being? And no matter how careful you think you are, you need to think about whether or not you could accept & live with the possible consequences.

If you do decide to try this.. You should also be aware if the bottom has had any previous trauma, (near drowning, house fire, attacks, etc) phobias or negative psychological experiences that may be triggered in a bad way by this. A little freak out can be fun..  serious panic type freak outs get people hurt.

Please also carefully consider the position the bottom is in .. what will happen if they do suddenly pass out? Are you strong enough to catch them or hold them up? Will they sustain secondary injuries? If they got nauseous would they be able to throw up without injury?

 Bottoms – Ask yourself if you are really sure you want to literally put your life in this person’s hands. Are you willing to take a chance on dying and letting them hang for your death, for the experience?

If you do decide to try it you need to carefully consider the top’s health status, mental state & sobriety. If the top has a medical emergency, or if s/he is not fully present and able to respond with a clear head in an emergency the risks skyrocket.

Set up a safe call or other message – If you are crazy enough to do this with someone you don’t know really well or feel you can trust to “do the right thing” in case of an emergency, at least try to leave behind enough info so that your family can hopefully get the body back and or prosecute.

 The American Psychiatric Association estimates a death rate of one person per year per million of population — thus about 250 deaths last year in the U.S. alone. Law enforcement estimates go as much as four times higher. Most such deaths occur during solo play, however there are many documented cases of deaths that occurred during play with a partner. It should be noted that the presence of a partner does nothing to limit the primary danger, and does little or nothing to limit most of the secondary dangers.

Types of Breath Play

There are dozens of ways to do “breath play” but some of the most popular modalities are:

  • Auto Erotic Asphyxiation (Engaging in any activity that restricts breathing or blood flow to the brain while alone and is the cause of the majority of breath play related deaths.) I personally find this to be an unacceptable risk and just plain stupid. Please do not try this stuff at home alone. If anything at all goes wrong, you are dead, no question.
  • Conscious breathing (voluntarily altering normal breathing rhythm)
    Examples – The dominant can tell the submissive / bottom how & when to breathe or even order them to hold their own breath. He / she can have the submissive follow his or her own breathing pattern or use patterns for desired results such as: relaxing breath, charging breath, “Big Draw” breath.
    Principal Dangers – I feel this is relatively the safest form of breath play but it can cause hypoxia, hyperventilation, dizziness, spasm in the muscles of the hands or feet, and loss of consciousness. If any these occur, simply returning to normal breathing usually fixes it pretty quickly.
    [Jay says that, the main danger of having the submissive hold their own breath is that when they do so they are probably also performing what’s called a Valsalva maneuver, (something identical happens during straining during a bowel movement) and this can also stop the heart via vagal stimulation.  The risk of this is higher in “older” people, but there is no bright line between “older” and “younger” people.]
  • Extreme Exertion (vigorous activity that initiates a need for more air)
    Examples – Tickle torture, physical exercise, wild sex, heavy “play” or extreme pain.
    Principal Dangers – cardiac arrest due to exertion-induced PVCs.
  • Chest Compression or Positional Asphyxia (chest or body pressure or position that restricts breathing)
    Examples – Mummification, chest or abdomen sitting, suspension bondage, tight laced corsets! J
    Principal Dangers – crushing ribs or organs, suffocation, PVCs
  • Water Play/ Water Boarding (using water to prevent or restrict breathing)
    Examples – dunking, breathing through wet cloths, scuba, slowly filling bath tub etc
    Principal Dangers – drowning (duh!) J as well as mixed acidosis and/or increased heart rate with resulting dangers such as PVCs noted above.
  • Smothering (restricting air flow through nose & mouth)
    Examples – Hand or other body part or device (cloth, pillow, latex, plastic wrap, duct tape etc) over mouth and or nose. Also: breast smothering, face sitting, forced or “deep” oral sex, gas masks, certain hoods & gags, vacuum bed etc
    Principal Dangers – suffocation and all low blood oxygen risks including mixed acidosis and PVC-induced sudden cardiac arrest.
  • Re-breathing (diminishing oxygen intake)
    Examples – Bagging (paper or plastic), gas mask with tank or similar set up, “shared” breathing, “forced” smoking.
    Principal Dangers – possible carbon-dioxide-induced respiratory acidosis if it goes on “too long” low blood oxygen dangers such as PVCs will appear.
    [Note from Jay:  basic take-home message here is that any process that makes the body as a whole low on oxygen, which includes all forms of suffocation play, will also necessarily make the heart — given that it’s part of the body — start throwing PVCs, and PVCs in a heart muscle that is low on oxygen is a terribly dangerous thing.  As I’ve learned, this is not a popular message, but unfortunately that’s just plain and simply the way it is.  That said, it’s normal for healthy hearts to throw the occasional PVC (you and I will likely each throw a few dozen of them today), and PVCs in a well-oxygenated heart are pretty much benign.  You might want to make the distinction between the well-oxygenated and the not-well-oxygenated heart muscle clear to the audience or you’ll needlessly scare them.  It’s the PVCs that occur while the heart muscle is low on oxygen that are the really dangerous ones.]
  • Strangling / Choking (restricting airflow at the throat)
    Examples – Hands or scarves, rope, neck ties etc on throat, nooses, garrote etc.
    Principal Dangers – (Very high risk!) crushing windpipe, snapping hyoid bone, death by hypoxia caused by strangulation (duh!) & all added dangers of carotid play noted above.
  • Carotid Pressure (restricting blood flow to the brain / technically NOT breath play)
    Examples – Judo hold, “sleeper” hold, scarves, neckties or finger pressure on carotid arteries
    Principal Dangers – (High risk! Especially of vagus-nerve-induced cardiac arrest) stroke, heart attack, fainting / falling

This handout took me quite some time, effort and love to prepare. Please do not duplicate, copy, repost or otherwise “rip it off” without my permission. Thanks!

Copyright SMAntics 2017 / All rights reserved / Suzanne SxySadist Email: Mistress@SxySadist.com

A few bibliography sources:

  1. Wikipedia.
    2.  The breath play essays on Jay Wiseman’s “Submissive Women Kvetch” website: http://members.aol.com/oldrope/
    3.  Forensic Pathology, 2nd Edition, by Bernard Knight, MD
    4.  “Death from Law Enforcement Neck Holds” by Reay and Eisle.  American Journal of Forensic Medicine and Pathology, Volume 3, Number 3, September 1982

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