175 - Jackie dives into Cold Water Immersion

Cold water immersion - friend or foe?

One of the things that helped Jackie the most in her recovery - cold water immersion - and one of the most commonly asked questions from listeners.

But it doesn't work well for everyone. In this episode, Jackie dives into the science behind the power of cold water, as well as discussing her own expertise and her own journey - why did it work for her? And how could you make it work for you?

As always - this isn't medical advice - always speak to a trusted medical professional before considering cold water, or indeed any new treatment.

Links:

Join breathing courses: www.LongCovidBreathing.com

Work with me options: https://www.longcovidpodcast.com/workwithme

My Insight Timer profile (free): www.Insightttimer.com/longcovidpod 

For more information about Long Covid Breathing courses & workshops, please check out LongCovidBreathing.com

(music credit - Brock Hewitt, Rule of Life)

Chapters

• 0:00 Health Tech Platform Turn2 Discussion
• 15:11 The Challenge of Admitting Uncertainty
• 23:39 Accessible Health Tech Platform Development
• 36:35 Community Health App Development and Promotion

Transcript

Hello and welcome to this episode of the long covid podcast. Today I'm going to be discussing one of the things that helped me the most in my recovery – cold water immersion.

One of the questions I get asked the most is “how did you recover from Long Covid?”

I'm not going to answer that question specifically in this episode – because I already did it in episode 94, which is my recovery story. I'll link that episode in the show notes below. 

What I'm going to talk about in today's episode is the question I get asked, probably the second most – which is around cold water immersion or cold water swimming. This was something that I found hugely beneficial in my own recovery. But I also see others find it not helpful. So why did it work for me, but not for everyone? And how do we know before we try it?

I'm going to pull together my own experiences, what I've learned from research, from my own observations and from my own professional knowledge of the nervous system. This episode is not medical advice. If you are considering trying this out, please consult a medical professional who you trust, and discuss with them before trying it. 

The science

So, why cold water? I mean, cold water is just cold water – why would it have these magical healing powers that people (including me) talk about? 

When our body goes into cold water, there are two main things that affect us – the cold, and the pressure of the water. 

What is called the “cold shock response” is the cardiovascular response experienced by unhabituated cold swimmers – it's a reflex response driven by the sympathetic nervous system (our fight flight response) due to the activation of peripheral cold receptors. 

You might have experienced this if you've stepped into a cold shower by accident, or someone else in your house turned on a hot tap while you were in the shower. The water goes cold, you gasp, followed by increased breathing rate, faster heart rate and blood pressure rises. 

Our sympathetic nervous system is activated, which aloongside the increase in breathing, heart rate & blood pressure, also causes vasoconstriction in our skin, brown adipose tissue thermogenesis & neurons that cause shivering in the muscles to create heat. So the body activates it's response to keeping us warm. 

To get this response, you don't need to be fully immersed in the water – a cold shower will do it too.

However – now to the other side of the equation. The parasympathetic response – our rest & digest. At the same time that our body activates the sympathetic (or FF response), our body also activates the parasympathetic (or rest/digest) system through what is known as the “diving response” - which lowers our heart rate & blood pressure. 

The hydrostatic pressure caused by the water stimulates baroreceptors resulting in bringing down the sympathetic activation and increasing vagal tone. The increase in the vagus nerve activity brings our parasympthetic nervous system back online and brings our body back into regulation. 

So by immersing ourselves in cold water, we get this physiological conflict in the system where these two opposing responses can actually occur at the same time. 

Anyone who has tried cold water immersion – whether recently or in the past – may have noticed that once the initial shock has passed, that the body settles and feels surprisingly comfortable in the water. 

Someone who is habituated (that is to say that they immerse regularly and the body is somewhat used to it) will probably find that the cold shock lasts a shorter time than someone who is swimming for the first time. However, 90-120 seconds should do it. 

Ok, that sounds cold. Why do I want to do this?

• temporarily impairs cognitive function. This doesn't sound like a good idea – why is this helpful? For those of us who have very busy brains, getting into the water can be a wonderful way of taking that “step to the right” - a phrase coined by the wonderful neuroscientist Jill Bolte Taylor – where we get out of our logical overthinking part of the brain and into the relaxed, creative, flow side.
• Increased habituation to the cold
• Increases dopamine which helps us feel happier
• Increases endorphins which reduce pain & improve our mood
• Increases noradrenaline which activates our brown fat for an energy boost, as well as making us more resilient
• Stabilises cortisol (our stress hormone) & seratonin (which regulates mood, sleep, appetite, and digestion )
• Increases our immune response
• decreases blood pressure & reduces inflammation
• Increases insulin sensitivity
• Reduces swelling & joint pain

Sweeeeeet – that sounds amazing. Where do I sign up?! 

The nervous system – the science relative to LC & ME/CFS

So, bringing it back to the long covid & mecfs community. If this is such a miracle cure, why can't I try it?

Ok – so I'm not saying do or don't here. I'm just saying it's important to understand what happens and why it might need some adaption, preparation & care. 

So as much as the science says about the sympathetic/parasympathetic working together when we immerse ourselves, what we do know is that getting into the cold water is a stressor. We get into the cold, and our body effectively goes “holy shit that's cold” and it senses danger. 

Now, with LC & MECFS, our system is already feeling unsafe. Generally that danger-survival response is on overdrive. The problem isn't generally stressing up – the body is probably already there. It's stressing down that is a struggle – bringing the body back to regulation. 

So I would suggest to you – don't stress up if you don't know how to stress down. 

Do you have tools that you have learned & practised that enable you to bring your body back to that regulated state? Or do you stay activated for hours/days or even weeks if the doorbell goes? 

Understanding our own nervous systems is so key to recovery. What works, what doesn't? How much do I do a thing? How do I understand the signs that it's working (or not?) A lot of the work that I do with people is sussing this out, so we can judge things for ourselves. We can understand the signals our body is giving us and attend to our body's needs. Therefore bringing ourselves into that state of regulation by creating a sense of safety in the body. 

Safety is felt, not thought. 

So I think it's important to understand where you are in your journey – is the time right? Or should you focus on other strategies to stabilise things first? 

I would definitely recommend stabilising first. 

My experiences

So, what did I do?

I didn't really know any of this information – I had seen some improvement through the breathing strategies, using a lot of yoga nidra & targeted rest, doing less and generally managing things much better. I still overdid things, I still crashed. But things were a little more stable. But I felt a bit stuck. I'd plateaued in my recovery. 

Someone had mentioned cold water to me previously, and I'd thought it sounded like a horrible idea and dismissed it. But it was April, the weather was warming up a little, and I decided to give it a go. If it didn't help, I didn't have to do it again. Maybe this was my eyeballs to eat – this was a phrase that I heard from (I think) Lorrie Rivers later on. That we would get to the point where we would do literally anything to recover – even eating eyeballs!

So I went down to Loch Ness, which is a short distance from where I live (I appreciate I'm very lucky with that!) and eased myself super slowly into the water. It made for an awesome photo. My goodness it was cold. I stayed in a few seconds, and then got out. Got my clothes back on. And sat on the beach. And I felt amazing. A little chilly, but amazing. 

Of course the effects didn't last. But I kept doing it. Several times a week, sometimes more. Over time I was able to stay in a little longer – it helped that we came into summer and the water was warming up a bit. And over time, the effects lasted longer. So I would have more energy for longer, and longer. After a swim I was able to do more. So I started being tactical about it – go for a swim before a walk, because my body could do more after. 

I was also able to swim bigger distances – at first pootling along the bank, but over time longer. Swimming is a great form of exercise because it's supported by the water. Also the compression – for those who utilise compression leggings etc – swimming (not necessarily in the cold!) could be a safer way into movement when the time is right for you to try, because of the natural compression from the water. Take care getting out afterwards though!

Although recovery wasn't linear from this point, I never felt worse for being in the water. I wouldn't always feel amazing afterwards, but it would always help a bit. 

I think another reason it really resonated with me was because I'm an outdoors person. If you are someone who hates the outdoors, then it's probably not very appealing to you. And that's fair! For me, being outdoors, in nature, having adventures is so important to me. I couldn't go up the mountains at the time, but I could look at some of them from below. It allowed me to be out in nature in a different way. It also allowed me to meet some new people – eventually. People who didn't judge me against who I was before, because they didn't know me before. I could do a little swim and then chat for a bit afterwards if they stayed in longer. Physically it was huge. Mentally it really helped too. 

So why did it work for me, but not others? 

With the benefit of hindsight, the 2 biggest mistakes I see people making, are trying it too soon, and staying in too long. Let me explain why.

• beginning too soon – as I mentioned above, the cold water is a stressor. If we stress up before we have any stability, and before we have the strategies in place to stress down, our bodies may not cope with it. Instead of the nice activation/relaxation response, the body may just go stratospheric and then straight off the cliff into a crash.
• staying in too long – now I get this. You've made the effort to travel to somewhere you can swim. So you're damn well going to make it worth it. However, as I said earlier, those max benefits are around the 90 second to 2 minute mark. Staying in longer will only allow the body to get colder, which will then require more energy to warm back up afterwards. Energy you may not be able to afford to spend. And whereas someone without a health challenge may be able to run up and down the beach and do star jumps to warm back up – that's probably not something that would help you. Not just yet anyway! 

Why it worked for me

• I unwittingly started at the right time – I'd seen a lot of improvement, things we more stable and I had a lot of strategies to regulate my body.
• I was very gentle with myself – started with a very short immersion and gradually worked up as my body allowed.
• Breathing – you knew I'd get to this didn't you?! Using the breath as a guage of how slow to go in. So walking into the water at the pace my breath could handle. If the breath started speeding up – slow down, or abort if necessary!
• If my body felt more activated or maybe shutdown – I'd stay in less time. 
• Always listening to the signals my body was giving me – what does my body need? 
• Interestingly when I chatted to Dan Neuffer (we've done 3 episodes together on the podcast) he reckoned that the cold water was like hard-core brain training. Maybe he's right – that it helped me in that way too. 

Ways to test yourself gently

• how is your breath when you get stressed? Do you have techniques to calm it? Do you know how to bring activation down – do you know how to recognise activation in your body? Make a list of strategies that you like and practise them. If you need assistance, then work with someone – a coach or therapist may be a good shout. You can work with me if you like.
• Try putting cold water on your face
• Turn your shower cold for a few seconds at the end. How does your body respond? 
• Are you physically able to get to somewhere you can fully immerse? Over-exerting to get there will not help you.

Why it's important to consult with a medical professional

It's important to speak to a medical professional before starting cold water immersion. There are certain conditions for which it's contraindicated – for example heart disease, arrythmias & epilepsy, to name a few. If you experience raynauds you may need to consider extra gloves, or even if it's a good idea. I do know people who swim with raynauds, but always check with your doctor. There are also some medications which can change the body's abilities to cope with the cold or the cold stress. This isn't an exhaustive list. Cold water can feel like total magic if you get it right for your body. But it's a poweful thing – and if done in a way (or at a time) that isn't right for you, can cause danger. So please don't take it lightly. 

Cold water and the breath

As I've said so far, when we enter the cold water, our body senses the cold and feels like it's in danger, bringing on our fight or flight activation or danger response. 

The natural reaction is that our breath speeds up – we sometimes gasp. Oooooh! Be mindful of your breath. Make sure you can control it. Please don't go into cold water if you can't control your breath. 

Take slow deep breaths into the diaphragm. Stay calm. Slow down and take longer to get in if you need to. And don't be afraid to turn back if the breath feels out of control. 

If we breath too fast and start hyperventilating, we can get dizzy or even black out. This is dangerous in any situation, but particularly in the water. 

So learn to control your breath first. 

If you want to work with me, I'll put a link in the show notes. Controlling the breath will help with all manner of things, but will also make it safer to enter the cold water. 

Safe swimming tips

Safe swimming is so important – for anyone doing cold water immersion. 

• please don't get into the water if you can't swim
• don't swim alone. At the very least have someone next to the water to keep an eye on you. Preferably in the water with you. 
• Wear something on your feet – partly to keep them a little warmer, but so you don't cut or hurt your feet on rocks or anything sharp in the water.
• Stay in less time than you think – get out before you start to shiver. 
• Take care with your entry/exit points – don't get into something you can't easily get out of 
• if you go out of your depth, have a lifebuoy or float
• keep your breath slow as you enter the water. If the breath starts to speed up more than a little, slow down or stop. 
• Stay in for only a few seconds the first time.
• Be aware of any tides or currents in the water, as well as the wind direction. If there are other local swimmers, they are great sources of information. 
• Have warm stuff to put on quickly afterwards – maybe someone could help you to dress faster afterwards by handing you things. 
• Avoid swimming in the dark (using a torch if you have to and don't leave the bank) and don't put your head under as it increases the autonomic conflict and speeds up heat loss. 
• Warm the body up naturally – never get straight into a hot shower or bath (the blood will rush to the skin and you'll feel dizzy). Same with car heating – don't turn it up full blast! Lots of layers and a warm drink will work much better.
• Don't go in the water if you are acutely unwell or if you have consumed alcohol! 
• Beware the afterdrop! This is where the body will feel colder after you get out of the water. This is why it's important to get out before you feel cold. You may find yourself shivering 10 minutes after you got out, despite feeling fine in the water. This is your body trying to warm itself up – but it will take energy.

My cold water routine

I'll give you what was my routine – still is on some level, although I'm now able to stay in a lot longer when I want to, as well as being more active in my warm up! 

• I listen to my body. Does it want to go in the water? If I'm not sure, a great tip from my therapist was to visualise it. See how it felt in my visualisation, and then I'd be able to tell if it was what I wanted. Or if the sofa and a cup of tea was more my jam. Usually the water was what I wanted!
• Choosing somewhere out of the wind to leave my stuff. If it was raining, under a tree was a good shout, or putting a jacket over my things to keep them dry. 
• Setting my things out ready – if I was using a float, blow it up first. Get my hat and if I was using them, gloves and shoes out. Towel. Hot drink. So they were all easy to hand. 
• I'd always put my swimsuit on before I went – one less thing to change into. I used a bikini because it was much easier to get in and out of. I've witnessed people fighting for 10 minutes to get out of a wetsuit and it just didn't appeal to me. No judgement if you want to – but for me it was about getting in, getting the benefits and getting out, rather than using a wetsuit to stay in longer. It was about making it easy. 
• I take my clothes off and place them down in reverse order. So outer layers (or extra layers) first, then bottoms, then tops, then underwear on top. So when I got out, it was all in the right order. Ladies – keep it simple. Some people don't bother with underwear afterwards. I'm a big fan of those tops that have the bra built in – one less thing for cold fingers to deal with. Bra straps and cold hands are not your friend, believe me! You want your stuff as close to the water as possible so you don't have to walk distance to and from. If you're sea swimming though, please be aware of which direction the tide is going.... we nearly got caught out by this in the dark a few months ago, which would have been somewhat ironic...
• I get into the water slowly. Control my breath. If it's been a stressful day I'll have to go in slower. Depending on where I am in my cycle, my body will respond in a different way. (Some people say don't swim on your period. I do and I find it helps. But everyone is different)
• Afterwards, I pat myself dry, I put clothes on my top first – adding extra layers. You may wish to sit down to dry feet and do shoes. Don't overthink it – get it on quickly. If you're not perfectly dressed it doesn't matter. 
• Enjoy a warm drink, and possibly a sugary snack which is supposed to help the body temperature increase. Movement will help warm the body up gently if that's something you're able to do. Snow angel arms are a good one because you can do it sitting or lying down. Keep the breath slow and allow the body to come gently back to temperature. It might take a couple hours to be truly back to temperature. Don't worry – but add plenty of layers and get snuggly. 
• Feel amazing! I always do anyway. 

So hopefully this has answered some of those questions around cold water and it's potential in recovery. Please don't take this as medical advice, or any other sort of advice. I DIYed it and got lucky – it's something I'm hugely grateful for because it changed my life. But if I'd done it less carefully or at a different time in my journey, it might have had different results. 

If you're interested in learning more – I've interviewed a couple of experts on this – I'll drop the links in the show notes. 

I'm also a huge fan of Dr Susanna Soeberg – she's a danish scientist who is doing research into cold water immersion and I fact checked a lot of this information from her publishings. She has a wonderful book called “winter swimming”

“Chill” by Dr Mark Harper from episode 87 also has lots of useful information. 

Please don't try this without medical advice. 

If you do try it – please go gently!

And let me know how you get on – or if you have tips & tricks of your own.

I think the most important thing is recovery is having the right tools for you, and the right tools for the situation. 

Maybe cold water isn't for you just now – maybe it's something you'll be able to access further down the road in your recovery.

As always, thankyou for the questions – please keep them coming! I'll be back next time with another fabulous guest. 

Until then, I wish you safe onwards travels on your recovery journey.