Breath Play

So, here is the difference:

Snuff is about fantasies or actions surrounding the idea of killing or being killed. 

Traditional Breath Control Play is about fantasies or actions surrounding the restriction of oxygen that leaves the person healthy and alive during and after the play. 

"New" Breath Control Play is about making someone more conscious of, directing, or using breath in play. It is also the process of roleplaying or bringing about the psychological state of traditional breath play without using traditional methods. Once again, this play expects each participant to remain healthy and alive during and after play. 
 

The most important element in this or any type of play is mutual respect and trust. I would never consider being involved in this sort of thing with anyone I trusted with less than my very life. I think that aside from the basic trustworthiness a person who is interested in being involved in this sort of play should have a good idea of their health and a good working knowledge of CPR and first aid. I also think that an education in the anatomy and the physiology involved in the play should be a priority. 

Traditional Methods and Risks (with a partner)
 

This section is written for people who will be engaging in breath play with a partner. If you intend to engage in solo play please read the solo play section. 

Playing this way with a partner really lessens your chance of experiencing complications and makes more play options available for the simple reason that you will have someone to help you if you pass out. Aside from that, if you have some form of injury occur you will have someone to help you get assistance. The main downside to play with a partner is that you have to spend a lot of time finding the person you will literally trust your life with and if something goes horribly wrong you may end up convicted of a crime or having your lover convicted of a crime. The physiological things mentioned in another section will all still be present so even if you play very "safe" you could end up drawing the short straw and taking the consequences. Out of 25 million people in the US, it is estimated that 250 will die of erotic asphyxiation in a year. Of those 250 almost all of them will be auto-erotic asphyxiation (solo play). Therefore, statistically your chances of partner play going wrong are pretty darn low if you pay attention to avoiding the risks you can control. With that in mind...let's talk about how things could be done and how to lower the risks. 

Some things to consider no matter what kind of method you use is how your partner will signal you if there is a problem and they can't talk. Whatever the signal it should automatically happen if they faint. An example of a signal I've used is having someone hold their hand up...or put it on my hips...or something. It has to be in a place that if they faint...the hand will fall. It is important you pay very close attention to your partner and choose someone you trust with your life. It goes without saying (but I'm gonna say it anyway) that you need to make sure that if your partner faints they don't fall and harm themselves. It may also be a good idea to take into account what would happen to your partner if something were to happen to you during play. For example, you may think a bit before mummifying them (in a way they can't escape) and putting a plastic bag on their head with rubber bands. If you were to faint or something they wouldn't be able to get out and save themselves. I can't tell you what is an acceptable risk, but I thought I better bring the subject up for you to think about. 

For the purpose of this discussion I will refer to the person who is having their air taken away as the "bottom". This is a term used in BDSM that just seems the easiest to use here. 

Having the bottom hold their breath
This is simple and will probably save you from prosecution if anything goes wrong with the play. You can simply tell your partner not to breathe. The most important thing to watch with this would be that if they faint you need to make sure they don't fall and hurt themselves. I think that this is a pretty sexy way to play...and if you have a fetish for objects you can work that into this. For example, if I were doing a scene using this I might hold a ligature loosely around my partners neck and tell them not to breath. If I were involved in playing with them in a BDSM context I might dress it up with some kind of passionate threat that I would strangle them to death with the ligature if they breathed before I gave them permission. Another possibility would be wrapping them in plastic but not covering their mouth and nose. Then telling them not to breathe as I held a feather over their mouth and nose and told them that if they breathed I would punish them. 

NOSE PINCHING
This is my favorite type of breathplay to use. It can be accomplished many ways and I will only name a few here. You can cover your bottom's mouth and nose with your hands. You can put duct tape (I recommend the name brand) over their mouth and pinch their nose closed with your hands. You can put a gag in their mouth and pinch off their nose with a clothespin. You get the idea. This method needs to take into consideration what will happen if the bottom vomits. I recommend that if you use a gag it is one that doesn't have a complicated closure. I recommend Velcro if possible. If you must use a complicated gag then have some heavy duty scissors literally in hand to cut through the bondage if you have to get them out of it fast. The stuff to remember with this is all pretty basic and it has little chance of any real problem developing as long as you restore normal breathing to the bottom if they faint. 

Queening or Kinging
Okay, so I don't know if Kinging is the proper term but it is the one I'm going to use because I like it. Queening is basically when a woman smothers a person by pressing her sex into their face so that they can't breath. Kinging is basically when a man uses his sex to keep a woman from breathing as he pinches her nose closed somehow. I think it is fun to wear a harness with a dildo and use that method of domination myself. Obviously you could smother people with other body parts too, but I won't go into every part you could use. The risks are all about the same. If anything is in a person's mouth that could spark a gag reflex I think it is important not to insert it too deep or someone could throw up and inhale their own vomit. Many of us have faced that fear even when we weren't doing breath control..haha. If you are sitting on someone's face it is really important to have some nonverbal signals since you may not notice if they faint. 

Gasmasks or Hoods
I love these. They are some of my personal favorites but they are a tad riskier than the options I mentioned earlier. You can put the bottom in a gasmask (my favorite is the Israeli style) and cover the air inlet. If you are really creative you can attach a tube to the air inlet and cut the air off by placing the tube opening against the body of the Top or bottom. It is hard to describe how delicious it is to be gasping from lack of air and have the tube placed against one of my nipples so that I am literally sucking on it with each gasp. Be very familiar with the gasmask and how to get it off quick if the bottom vomits from lack of oxygen. In the case of hoods, the first thing I would mention is that you need some way to monitor the bottom's state while they are in it. Depending on what style hood you are using you will need to adjust your play style accordingly. I recommend a hood with a mouth opening that you can cover so that it could be open if the person gets sick. If you choose to use some kind of discipline hood that uses tubes in the nose and mouth of your bottom you may want to be especially careful that if your bottom passes out the tubes won't get jammed into them too far if they fall. It is also important that you can remove the hood fast if the need arises. As much as I love inflatable hoods they are slow to remove and I think them poorly suited for breath control play. When you restore breathing to your bottom it is important that you make sure there is nothing in the air that may hinder their breathing or harm them to inhale through the tubes. I've inhaled latex polish and baby powder and I can tell you it isn't fun. 

Bags/Plastic wrap
The main things to keep in mind are all pretty obvious. Remove the bag or plastic if the person faints. I would recommend that the material be held in place by hand. If you opt for another way of holding it in place try to avoid any pressure to the larynx. 

Rebreathing bladders
These are usually attached to gasmasks or hoods. If you use them that way see my comments above. If you use these with tubes or something just remember to make sure the tubes don't go too far down the bottom's throat or up their nose. 

Pressure on the Trachea and/or Hanging
This form of play requires a lot of caution. If you are somehow compressing the trachea it is important to do so by slowly applying pressure and making sure not to apply pressure to the larynx. One method is to take a curved finger and place it at the part of the throat where it meets the chin and pushing up and back slowly. Another method is to apply pressure below the larynx (sometimes with a scarf). A lot of injuries can occur to the trachea this way if you press too hard. If you are going to use a ligature or noose it is safer if you use one that doesn't constrict. If it does, make sure it is wide and padded. If it is too narrow it will cut or twist the skin causing bruising and damage to things such as blood vessels, nerves, the cervical spine, and the windpipe. It may also be a good idea to use a dry lubricant such as baby powder and a soft type of rope or ligature. If you are hanging someone it is important never to drop them into place. That could break their spine. I think a really nice form of rigging for hanging is when a person is raised into place with their feet still on the ground. If you decide to try airwalking there is a significant possibility of damage to the spine. 

Compression of the chest
I like to simply have a lover lay on me and make it impossible for me to breathe. I'm rather teeny so if I have a big partner they can accomplish this pretty easy. Another form of chest compression is corseting. I can personally attest to how wonderfully hot it is to barely be able to breath in when wearing one. If you pursue corseting you should do some research on that particular topic. However you compress the chest you need to go slowly and carefully. It would be easy to break a person's ribs. It is my understanding that when you ease up on someone you should do it slowly or they may faint. 

PRESSURE ON THE CAROTID ARTERY
It takes about 15 seconds of pressure on the carotid arteries to cause unconsciousness. If you use this method bare in mind that you are cutting blood off from the brain and physically stimulating baroreceptors that will cause the vagus nerve to fire off impulses that could cause cardiac arrest. Other than that it is important to avoid pressure to the larynx and damage to the blood vessels. Do not ever twist the skin or underlying structure of the neck while doing this. It could cause injury to the spine or internal trauma to the neck. A simple way to accomplish this is to stand behind the bottom and place the bend of your elbow in front of your partners throat. Then slowly bend your arm applying pressure on the carotid arteries but not on the front of the throat. Many police forces use this hold but most classify it as a form of deadly force. 

DRUGS
This is so incredibly dangerous that it amazes me that anyone is trying it. There are drugs that can induce asphyxia. I don't recommend them and I won't list them. I will list the problems with them. First, no one knows the safe dosage for you or your partner. Second, you can't reverse it quickly if things start to go wrong. Please remember that anesthesiologists train a very long time to be able to knock someone out safely and even when they use the best equipment and drugs available they can lose a person. 
 

I never recommend playing alone, but if a person chooses to accept that risk I respect their choice. 

Solo play is far more dangerous because if something goes wrong you have to be able to solve the situation yourself. This may be impossible if your problem is unconsciousness...a very natural part of our play. Most of the people who have died of breathplay were solo players. The upside to solo play is that if you do happen to die you will not leave behind a partner to possibly stand trial for assisting you in a consensual sexual act. 

Here are some of the methods that people use in SOLO PLAY...as with any form of asphyxiation play all the physiological dangers will be present as will the dangers of vomiting, fainting, and seizuring. The cardinal rule of solo play is to have a failsafe that automatically activates the instant you faint! Do not think that you will be able to operate the failsafe yourself when you are groggy or beginning to faint. 

HOLDING YOUR BREATH
This is simple enough. You can hold your breath and have both hands free for other things. The problem with this method is that unless you are really good at resisting your urge to breath you could let up before you really want to. Also, if you have a particular fetish for certain types of items (such as bags or nooses) I know this may not fulfill you. You might try holding, touching or wearing the item in question but I don't know if that would work for you. I have a latex fetish and just touching it is wonderful...your mileage might vary on that one. This style of play is going to be for people who are into the physiological feeling of asphyxiation and not so much into the objects that cause it. If that is you, then this is one of the best choices. Your body will naturally faint when you run dangerously low on oxygen and your main worry is making sure that when you faint you won't fall and injure yourself. The physiological dangers inherent in breath control will still be there and so will injuries related to fainting and vomiting but it is relatively safe. Many children hold their breath till they faint all the time and doctors don't seem to be too worried about it. 

NOSE PINCHING
If you find that you have a hard time resisting the urge to breath one of your options might be to wear an easily removable gag or duct tape over your mouth while you pinch your nose shut with your hand. I don't recommend pinching your nose shut with anything like a clothespin because when you faint you will probably not have enough time to remove the clothespin. It would only take one mistake of leaving the clothespin on to end up dead. So, use your hand. If you faint it will fall away and you will be able to breathe through your nose. Don't play this way if you have a cold or other problem breathing through your nose. The advantage of this play is that it doesn't take as much will power. I hear that the name brand duct tape is easier to remove then the generic brand but be aware that it may irritate the skin or hurt when coming off. If you use a gag, use one that you can take off in a second. I wouldn't recommend the use of any gag with a buckle closure. In fact, it may be useful to just hold the gag in your mouth without closing it in the back. The reason for this precaution is that if you vomit from lack of oxygen you will need to get the gag off quick. 

SUFFOCATING YOURSELF W/ OBJECTS
Pressing your face into something so you find it hard to breathe is another method. I think this can work out if you are standing or kneeling and pressing something into your face, such as a pillow or something. The main thing to be aware of is that you have to make sure that if you faint the thing will fall away from your face and give you air. It is also important that if you fall you won't harm yourself too badly. 

GASMASKS/HOOD
I happen to have a major gasmask fetish. I love to wear them and hear my breathing. I love the feeling of all-inclusive bondage I get from them. If you decide to use a gasmask on your own and cover the opening so you don't get any fresh air please consider just using your hand rather than taping it shut. If you use your hand it will fall away when you faint. If you use tape or any other method that will not remove itself in case of fainting you could die after a miscalculation of how close you were to unconsciousness. I think this method of self-play is a bit more dangerous than the other's above because if you throw up you will have it trapped in the mask until you can manage to remove it and it will be easy to inhale it. 

If you wear a hood, such as a discipline hood that encloses your face and has tubes for the mouth and/or nose areas I think you are taking a big risk doing solo play. If you are dead set on wearing one I would suggest one with a mouth opening that you cover with your hand or place a gag into while shutting off the tubes for the nose with your hands (not by using clips...but just by covering the openings with your hands). That way if you throw up you can spit out the gag. If you faint you will have a chance that your hands will fall away and you will land in a way that does not block the tubes. Many of the discipline hoods have tubes that actually are placed up into the nostrils and mouth....and are independent of the mask itself (so they can slide) this is important to remember because if you faint you could easily jam those tubes very far up your nose or into your throat. Many hoods are difficult to remove and the latex inflatable ones that I am fond of can be near impossible to put on or take off properly without a partner, so I don't recommend them for solo play. 

BAGS
One of the ways that many people have died is by placing bags over their heads and fastening them there with rubber bands. They poke holes in the bag when they feel as if they are going to faint. This method allows for zero mistakes. More experienced and more knowledgeable people than you have died doing this. The bad news is that if you fainted in that situation described above you couldn't survive. The good news is there is a way to get the same type of high...and even carry it to fainting...while having an excellent chance of it not causing a life threatening situation. I'm sure that if you have ever hyperventilated you have held a paper bag over your nose and mouth and experienced "therapeutic rebreathing". Well, if you use a plastic bag instead you can do the same thing and even carry it to fainting while sitting up or in some other position that allows for the bag falling away automatically when you faint. 

AIR BLADDERS
This is a tricky one to play with safely in a solo scene. I would say that if you could absolutely secure the air bladder and tube so that it could not move you could then put your mouth on the tube and pinch off your nose (with your hands preferably). It would have to be done so that if you fall you would fall away from the tube and onto something that would not harm you. My instinct would be to hook something to the ceiling that you would have to reach up to slightly to put your mouth on. 

PRESSURE ON THE TRACHEA/HANGING
I think that most of us would find this method a tad tricky as a solo practice. It is natural for us to release ourselves and panic when something presses into our windpipe. I imagine that a person could do this sort of play by taking a curved finger and pressing it into the trachea (up and back) where the neck meets the chin or by pressing into the windpipe below the larynx. Either way, the major downside to playing like this alone is that if you injure your windpipe or larynx you are going to be in big trouble if you are all alone. As long as the pressure is applied with your own hands you do not have to worry about strangulation itself that much because your hands will fall away when you faint. If you use something like a ligature that tightens around the neck you are really taking a big risk though. In that case you could easily injure your cervical spine, trachea, or larynx and even more importantly...if you pass out the ligature may not ease up and could strangle you after you faint. This is one of those behaviors that has led to a lot of deaths when done solo. It is usually when someone opts for a ligature device that tightens and does not automatically release when they faint. Hanging is a practice I cannot ever recommend as a solo experience. It was designed to snap the spine and it is important to understand that if you are airwalking you must not drop into position. Even a drop of 1 inch could break your neck or cause serious injury. If you are doing a solo hanging you are taking a very very big risk of all kinds of injury and if you faint you are dead unless someone finds you in time. Some ways you can manage some of the injuries involved in hanging are by padding the noose, adding a dry lubricant to the skin of the neck, and always keeping your feet touching the floor. Once again this play and Bagging are the two forms of auto-erotic asphyxiation that lead to the most reported fatalities.

COMPRESSION OF THE CHEST
I cannot currently think of a way to induce asphyxia through crushing the chest of a person that would allow a failsafe feature that would automatically be in effect if the person faints. I can say that corseting is a form of specialized breath control and if you have an interest in that you can see websites specific to that. Otherwise, I just don't have a clue how to make this safer other than never have anything apply pressure to the chest suddenly and violently. It must be slow and avoid trauma to the ribs. It is important that when someone feels faint while wearing a corset they are slowly unlaced and have the corset slowly let out. If it is too rapid they will generally faint or go into a form of shock. An interesting aside...in early America if a lady died from her corset she was said to have be "screwed to death." What a thing to have printed in the newspaper. 

Pressure on the carotid artery
This would be tricky to achieve while getting off. I suppose you could put pressure on your carotid arteries yourself with your hands because they would fall away when you fainted. If you have some form of device do it you are taking one heck of a deadly chance though. It takes about 15 seconds of proper pressure to the arteries of the neck to cause unconsciousness and if the blood flow isn't restored you are dead. 

DRUGS
This is so incredibly dangerous that it amazes me that anyone is trying it. There are drugs that can induce asphyxia. I don't recommend them and I won't list them. I will list the problems with them. First, no one knows the safe dosage for you. Second, if you over react or have an odd response to the drug and you are alone you are basically dead. Third, you can't reverse it quickly if things start to go wrong. I would advise against this even if you happened to be a trained anesthesiologist with the best equipment money could buy. It shouldn't be done alone, no matter what. 
 

I can say that long term brain damage is a risk of this play. Whenever the brain is without fresh oxygen or the oxygen level is lowered substantially there will be brain damage. This damage is fairly generalized. Depending on the duration and amount of oxygen in the blood the damage will be different. To my knowledge there is no formula for determining an exact amount of damage per second of hypoxia or anoxia. 

I can say that many people with long term sleep apnea (one of the most common health concerns) usually only experience slightly detectable brain damage over many years of struggling with apnea. To be categorized as someone with sleep apnea they must experience at least 10 apneas + hypopneas per hour of sleep. An "apnea" is defined as a cessation of airflow that lasts at least ten seconds. A hypopnea is defined as a significant reduction in airflow lasting at least ten seconds and usually associated with a decline in a person's oxygen level. 

The findings in such cases seem to suggest that some sleep apnea patients will perform worse on certain types of neurophsychological tests (especially those involving memory). They generally have complaints about their level of concentration and some are said to have undergone personality changes and have shorter tempers or depression. This may be attributed to brain damage, but there is no direct causality proven in the research I have seen. This all may just be attributed to poor quality of sleep the patients have. I have seen these very same symptoms appear in many studies of those experiencing sleep deprivation. 

Therefore, while brain damage is certain whenever the brain experiences hypoxia or anoxia it has not been proven that noticeable brain damage has been noted in anyone due to breath control play involving lack of oxygen lasting under a minute (many apnea patients will experience apneas of this length). There have been some studies done on rats being deprived of oxygen for two minutes and then given air for half an hour before being deprived of air for two minutes again that resulted in heavy brain damage in the animals. I think that we could infer from this that repeatedly depriving someone of air till they faint and repeating the procedure over and over again is going to cause heavy brain damage. It is difficult to say, however, because people are a heck of a lot different from rats. 

An important thing to know about the brain is that it does not grow new brain cells. Once you lose one, you lose it. Another important thing to understand is that the brain does not store oxygen as some of the other tissues in the body do. If your oxygen level is compromised, the damage starts close to immediately. 

Now, I would like to add a little perspective. You lose brain cells all the time, our brain is set up so that we can endure a lot of brain damage without any real consequences. Drinking, drugs (even prescription drugs), aging, and many contact sports lead to regular brain damage. Once again, it is all a matter of being conscious of the risk and deciding what level of damage you are comfortable with. I happen to feel very comfortable with absences of oxygen that are under 30 seconds (but that is a personal choice). 

I can tell you that it is always important to return a person to normal breathing if they are passing out from oxygen deprivation. I can tell you that anoxia is more dangerous than hypoxia. I can tell you that the longer the breath play continues the more damage will be done. I cannot tell you what is acceptable for you. 
 

COMMON INJURIES

Trachea 
 

The trachea is commonly known as the windpipe and is essentially a cartilaginous tube. Some people who practice breath control put pressure on the trachea during play. There are a few important injuries that can come of that. 

The trachea can rupture. This will cause intense pain, gasping for air, and thick secretions in the throat. This is a medical emergency and proper medical care must be sought immediately. 

Another less immediate condition that can occur is Tracheitis. It is an inflammation of the trachea. The signs of tracheitis are thick and purulent secretions of the throat, swelling, croupy cough, sore throat, and fever. This may seem minor at first and it may correct itself if the throat is rested and you use a humidifier to help with the secretions. This can ultimately turn deadly very quickly, however and I would feel uncomfortable with only doing this. Usually a hospital will deal with this condition by administering humidified oxygen, suctioning the throat, giving antibiotics, and monitoring a person's vital signs. 

In either of these cases there is always the possibility of an emergency tracheotomy and need for medical attention. This involves an incision that is made through the skin and muscles into the trachea to get air to the lungs. If you do a lot of play that involves pressure on the trachea, I would suggest you know how to perform an emergency tracheotomy. 

I do not have information on whether repeated attempts of tracheal compression will weaken the trachea but I would personally recommend that if you are going to play in this way you go about it with a slow even pressure. This is not something to do violently and it could easily get a bit rough in the heat of passion. 
 

Larynx 
 

The larynx is the enlarged upper end of trachea below the root of the tongue. It is the organ of voice and consists of nine cartilages bound together by elastic membranes and moved by muscles. It is a very intricate structure and can be easily injured. Pressure to the larynx should always be avoided. Here are a few of the injuries that can occur. 

A Fracture of the Larynx is an incredibly serious injury that needs immediate medical attention. Some signs of fracture or compression of larynx are loud breathing, choking and gasping respiration, weak and fast pulse, and blue skin. If left untreated it will usually lead to death. It can also seriously effect the voice if a person does manage to survive the injury. 

I would say that if you do any type of compression of the neck it is important to do some research into emergency tracheotomy. If this type of injury occurs it will at least give your partner some chance of survival if the air is completely cut off with this injury. 

The best way to avoid this injury is to learn where the larynx is and never do any form of play that places pressure upon it. If you practice some form of breath control that is going to press on the larynx then at least apply it slowly and carefully and try to pad any apparatus that could be used around the neck. I really cannot stress enough how dangerous the consequences of this type of compression could be. 

Laryngitis is also a complication of any form of compression of the larynx. It is essentially an inflammation of the larynx. Some symptoms of laryngitis are loss of voice, hoarseness, pain, and sometimes coughing. 

It is usually harmless and doctors recommend that you rest your voice, take cough suppressants, and inhale steam. I would personally look into seeing a doctor for it just in case there is a slight fracture or other problem present causing the symptoms. 

The best way to avoid this injury is to not put pressure on the larynx. 
 

Blood vessels 
 

At times play puts stress on the blood vessels of the neck, especially the carotid arteries. This can cause several problems but I'm going to focus on dissection. There are two types, post-traumatic dissection and spontaneous. For our purposes I will speak to the post-traumatic type. 

Post-traumatic carotid dissection is essentially stretching and small tearing of the artery brought on by trauma such as strangulation. 

The symptoms of this tearing are visual loss, weakness, numbness, or speech difficulties. These events may be transient or permanent. 

The only treatment is to get to a doctor and have it evaluated. They usually test using MRI or angiography. If they find that you are suffering from it you will probably be given anticoagulation (blood thinning) drugs for a total of 8-12 weeks. They will also do repeated angiography before stopping treatment to ensure that the vessel has healed. 

I think I should add some perspective about this injury. It most often occurs by people simply turning their head at the wrong time or by going to a chiropractor. It is a pretty common injury that doesn't necessarily need a lot of stress to come about. 

The best advice I can offer to avoid this injury is that if you do hanging you should pad the noose. If you have your partner strangle you they should apply pressure to your neck slowly and never twist the neck. Also, any bondage around the neck should be wide enough that it doesn't dig into the flesh easily and twist against the skin...I'd say a good rule is to not use anything less than 1/2 inch wide. If I were going to use a ligature of some sort directly against the skin it would be soft and lubricated with a dry lubricant such as baby powder. I would be careful not to apply so much dry lubricant that I ended up inhaling it, however. That wouldn't be fun. 
 

Stroke 
 

This could have gone under Blood Vessels but I thought it deserved separate attention. A stroke is basically a sudden loss of consciousness and paralysis caused by a hemorrhage into the brain, blockage of a blood vessel with a blood clot or foreign object, or a rupture of an artery in the brain. 

Sometimes during strangulation play plaque (a fatty substance in the blood vessels) is dislodged. If that happens it can lodge itself in the blood vessel and lead to a stroke. 

Strokes are unfortunately very common in this society and a few symptoms of one are loss of consciousness, paralysis, unequal pupils (large one on side of stroke), paralysis usually on one side, sweating, slightly lowered temperature, and speech disturbances. 

I would think that a person would be more prone to stroke if they have had one before, they have a history of heart or blood pressure problems, they are overweight, in poor physical condition, or they have a cholesterol problem. 

If your partner has a stroke they need immediate medical attention. While you wait for the ambulance you can help them in a couple of ways. Handle them very carefully, especially their paralyzed parts. Keep them lying on their back, head and shoulders slightly raised. Turn the person's face carefully to the side if they are having a hard time breathing. That will let the secretions drain out. If they have anything in their mouths, remove it. Keep them warm and quiet but don't overheat them. Do not move your partner more than necessary. Do not use any stimulants or smelling salts. The person may be unconscious but able to hear what you say...so don't say things to panic them. Don't try to give them anything to drink or eat. 

Some things that may help you to avoid this problem are regular aerobic activity and good diet (if you like to bottom to strangulation). It is important that if you bottom to this sort of play you get regular physicals that evaluate your general health. If you have a risk factor such as high cholesterol, then perhaps avoid strangulation play. If you do strangulation play be sure that pressure is applied slowly and that no twisting occurs. If you lessen the trauma to the vessel you lessen the risk of dislodging something. Do whatever you can to avoid trauma to the vessels. 
 

Cervical Spine 
 

The cervical spine is made up of the first 7 bones of the spinal column. There are several things that can happen to injure this area. I will cover a couple of them. 

A Fracture in the Cervical Spine will usually cause pain, possible paralysis, fainting, and suppression of reflexes. 

A pinched nerve in the area of the cervical spine will mimic a lot of the symptoms of a fracture and is also very serious. In the long term, if left untreated, it can cause constant pain and loss of muscle tone. 

The most important thing to do in the case of spinal injury is to make sure the person does not move. Calm them and tell them to lay still while you call for medical assistance. It is important to reassure them that everything will be well as long as they do not move around. 

The treatment of these injuries usually involves putting a person in some form of traction so they will not move while the bone(s) are healing. In the case of a nerve being pinched it is possible that surgery will be needed. 

There are several things you can do to avoid this injury. The first being that if you are involved in hanging with your feet off the floor (or being an "airwalker") it is important that you do not allow yourself to drop into position. That can lead to serious spinal injury even if the drop is as little as an inch. Remember, hanging was originally not used to strangle someone but instead used to break their neck. Any ligature is going to be more likely to cause a spinal injury, especially if it is a thin one. Another risk is if you apply a police style choke hold when your bottom is struggling or if you twist the neck slightly while applying it. It is very easy to cause injury that way. 
 

Seizures and Fainting 
 

Seizures and Fainting take similar first aid so they will be described together. 

Seizures fall into three categories. 

Grand Mal seizures involve a sudden loss of consciousness followed by board like rigidity that changes to jerking muscle movements that gradually disappear. The victim usually wants to sleep afterwards. When they awake they are usually cranky and have no memory of the seizure. There may be incoherent speech, extreme restlessness, and confusion. 

Petit Mal seizures last about five to twenty-five seconds. You will usually notice the person's skin go a bit pale and also notice them begin stare off into space. The eyes may roll back and the head, eyes and upper extremities may jerk slightly. The victim is usually alert right afterwards and able to function normally. 

Psychomotor seizures include automatic stereotyped movements of the body combined with partial amnesia. The victim may become angry and act out or have a temper tantrum after experiencing it. 

Whatever seizure a person experiences they may find that they a strange feeling, smell, pain, or visions beforehand that signal the beginning of an attack. 

Fainting is a sudden loss of consciousness due to insufficient supply of oxygenated blood to the brain. It is also common to faint out of an emotional response to something unpleasant or scary. Fainting is more common as you get older. 

A few things that you may notice in someone before they faint are weakness, dizziness, paleness, sweating, and cold skin. The victim may notice spots before the eyes, numbness, tingling of extremities, nausea, disturbances of vision, shallow breathing (in our case...sometimes no breathing *wicked grin*), and a feeling of lightheadedness. The pulse is usually rapid and weak. 

Both of these conditions in and of themselves are not considered medical emergencies and both are treated similarly. 

If your partner faints or seizures be sure to make sure they don't fall and harm themselves. Keep calm. There is no way you can stop a seizure. Do not forcefully restrain your partner and loosen any clothing or restraints that may limit their circulation. Make sure that they have an open airway. In the case of a seizure you might place a pillow under your partner's head so they don't hurt themselves. In the case of fainting elevate the legs so that the head is lower than the feet. If you can, you might want to gently turn their head to the side so they don't choke on saliva or vomit. Sometimes in the case of a seizure a person will stop breathing. Monitor your partner's condition carefully and make sure that you follow up with first aid for any secondary situation that might arise. 

There is very little we can do to avoid these things and still play like we enjoy. The important thing is how we handle it after it happens. You need to restore air as soon as possible when a person faints or seizures and give them proper first aid. 
 

The main cause of death involving breath play is that someone is playing by themselves and faints or seizures while unable to remove the device restricting their air. 

Airway Obstruction by the Tongue 
 

A simple thing to overlook is that if your partner passes out their tongue might fall back in their throat and continue to suffocate them. 

If your partner passes out you can prevent this problem by tilting your partner's head, chin pointing up. Place one hand under the person's neck and gently lift while pushing with one hand on the victim's forehead. This should move the tongue away from the back of the throat and clear the airway. 
 

Aspiration of vomitus, mucus, or saliva 
 

Sometimes a person can inhale his or her own vomit, mucus, or saliva. This is very dangerous. 

Usually a person will not actually draw the materials completely into the lungs. The symptoms of aspiration of foreign materials is coughing, unconsciousness, cyanosis, cardiac arrest, and cessation of breathing. 

If the person begins to develop a problem the very first thing to do is to position them so they can vomit and keep an open airway. Remove all gags or bondage immediately. Sometimes the Heimlich maneuver can help to clear their airway if something is lodged within it. If they are coughing make sure to monitor them while you get emergency medical attention. I do not have enough information yet on what else might be helpful. I have heard that some people have successfully helped in this situation by plugging the victim's nose and using their own mouths to suction the airway. 

There are some things that will probably lower your risk of having this happen in play. Do not gag the person you are choking. If you do gag them have a way to release the gag in a second (literally). Do not put the bottom into such tight bondage that you couldn't turn them to the side if they needed to throw up. Don't play with someone when they have a head cold. If you have a partner who gets nauseous during play it may be a good idea to stick to shorter times of asphyxiation. 
 

This information was found at
http://breathplay.mybdsm.com/