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Face masks and Covid-19

Updated: Aug 4, 2020

Face masks are becoming mandatory in more places now which means more people have experience of wearing one. And I will bet that there are two groups of face mask wearers. Actually, there is a third – the “I’m not wearing a mask” group – but I am not covering group three here today!

Back to groups one and two.

1st group – “I’m totally fine, can’t see the issue” “Yeah, it’s mildly annoying but I can deal with it”

To this……..

2nd group – “I can’t breathe” “I feel like I’m suffocating” “It’s giving me anxiety” “I actually feel unwell wearing this”

This post is for the second group. You guys need some help. There’s nothing seriously wrong with you, you just need to understand what’s going on and how to fix it.

During the height of the pandemic I was working in an acute NHS trust. I personally noticed my own breathing change when wearing a mask, and lots of my colleagues had the same experience. As respiratory physios we’re pretty clued up on breathing and the irony of it is that most of us over breathe, in fact I’m a known hyperventilator. If the experts can’t breathe properly it’s totally understandable why non-respiratory specialists struggle.

So……what is over breathing?!

Breathing patter disorder. Dysfunctional breathing. Hyperventilation syndrome. These are terms which get thrown around a lot but in summary they mean your natural breathing rhythm is knocked off - maybe because of stress, anxiety or a period of illness, and it doesn’t go back to normal after the event. In other words, you chronically (for a long time) over breathe – the severity of this varies enormously. You can also over breathe for a short time, maybe because of pain or fear and this is acute hyperventilation. In acute hyperventilation your breathing returns to normal after the event.

Most people don’t even know they are doing it, and it’s horribly underdiagnosed, but it’s estimated that 10% of the healthy population have a breathing pattern disorder. In certain groups such as asthmatics and people with anxiety or depression that rate is much higher.

The main behaviour that happens is that you start to breathe more – either faster, deeper or through yawning or sighing. If you breathe in more, you also breathe out more and this is where the problem lies. The more you breathe out the more carbon dioxide (CO2) you lose. I’m not going to go into the physiology here, but if you’re interested, I’ll be writing a post on over breathing soon.

It is the effects of a low CO2 which causes the symptoms you get with a mask. You have enough oxygen, but your CO2 is just lowered. 1st myth - masks do not stop you breathing in enough oxygen. That is not the cause of these symptoms.

Why do masks make it worse?

When you have a chronically lower CO2 your body adapts, which then keeps your CO2 lowthrough various mechanisms. It’s not dangerous to you but you can have physical symptoms – tiredness, anxiety, palpitations, poor sleep, shortness of breath to name a few.

Although CO2 molecules are tiny and will disperse easily out of the mask my theory is there will be a small amount of CO2 trapped in the mask. In other words, you are breathing in slightly higher levels of CO2.

2nd myth – you are not rebreathing dangerously high levels of CO2. But, if you’re a person sensitive to CO2 rises because your CO2 is chronically low, your body will respond by increasing your breathing rate/depth to keep your CO2 low – boom you have your symptoms and feelings of ‘air hunger’. You have too little CO2 not too much. In a person with ‘normal’ breathing these small CO2 rises won’t cause any issues or symptoms. You just need to look at healthcare workers who are wearing them all day.

I also think some people are reacting acutely, i.e. they don’t ‘usually’ have disordered breathing but because putting on a mask can increase the rate or depth of breathing, it can lead to these symptoms of acute hyperventilation. It’s hot. It’s not normal. It’s claustrophobic. It’s totally understandable.

I suppose the question is….. how do we stop over breathing?

1 – Breathe through your nose. Practice at home, without a mask on.

There’s lots of reasons to nose breathe but in this case it’s to keep the heat and moisture out of the mask. Don’t believe me? Try it! Cup your hands and breathe in and out of your nose. Not that bad right? Now try breathing in and out of your mouth for a few breaths. Much warmer and wetter! When wearing a mask that heat will make you feel worse and whack your breathing rate right up. The humidity will also mean that your mask gets wet really fast. So, nose breathe! For more information on nose breathing see my other posts.

2 – Tummy breathe.

Relax your shoulders – drop them away from your ears! Relax your jaw.

Place one hand on your breastbone and one on your belly button. Your top hand should be still and your bottom hand should be rising on your in breath and falling on your out breath.

Breathing like this means you are using your diaphragm which is a much more efficient way to breathe. If your upper chest is moving you need to get your diaphragm working. Try laying on your back with your hands on top of your head – it’s called ‘beach pose’ so make sure you look relaxed! This should automatically kick your diaphragm into action. Once you can do this easily, try without your hands up then move to sitting practice and then standing.

Breathing through your nose helps you to use your diaphragm, encouraging slower and calmer breathing.  If your shoulder muscles are tense your body already feels like it’s in ‘fight or flight’ mode. RELAX!

Diaphragmatic breathing can take a bit of practice. For tips and tricks to get your diaphragm working check out more of the blog.

3 – Breathe gently.

No large volume breaths. Try to avoid sighing and yawning. Big breaths put your body back into action mode, reinforcing the over breathing cycle. If you take a big breath in hold it for a slow count of 5 and gently breathe out through your nose and go back to your slow, calm nose breathing.

4 – Put your mask on at home first and just have a practice.

Wear it whilst you’re just sitting, then try when you’re up and about. Start with short periods and increase the time as you feel able. If you have any adverse symptoms, take it off and stay calm. You’re ok. You’re going to be fine, go back to your calm, gentle breaths.

5 - Take your time.

Don’t rush around the shops. If you arrive stressed and flustered, take 10 minutes. Have a sit down or a slow walk to chill out a bit. You want to keep your breathing calm and steady to make sure you nose breathe and don’t take big volume breaths.

6 – Take it off when it’s not necessary.

If you’re outside, socially distanced and it’s safe to do so, take a break.

7 – Keep your mask clean and dry.

Change it or wash it regularly if it’s reusable.

If you can’t nose breath or doing so makes you feel short of breath or induces panic then you may need further assessment or guidance. If that’s the case and you want to have a chat head to the contact page or email me at

Final thoughts…..Wearing a mask is not dangerous for your health but for some people they may have unpleasant symptoms from wearing one. The focus has got to be on establishing good breathing habits without a mask. Nose breathe. Calm, quiet breathing. Use your diaphragm. Slowly desensitise yourself to wearing a mask in a way that feels safe and controlled for you. If you need more help please get in contact.

I do feel concerned that we may end up with many healthy people developing dysfunctional breathing patterns. My hunch is there’s a lot of people out there who have been over breathing but the addition of wearing face masks and the general stress caused by covid-19 is tipping the balance. So even if you’re fine with a mask make sure you’re practicing good breathing habits!

Breathe well!


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