You asked for “what happens physiologically” and that doesn’t really appear to have been answered.
When you press on the carotid arteries to stop the flow of freshly oxygenated blood into the brain, it creates a low pressure zone in the head. Your veins are still trying to pull blood out of the head, but the arteries are no longer feeding blood in, and that causes blood pressure in your head and brain to lower significantly. This changes the balance of pressure between your brain and the blood vessels in your head, which increase the onset of symptoms like narrowing vision, heavy or light headedness, loss of hearing, and loss of motor/muscle control. Most people, when being choked out, will make a gurgling or snoring sound as they loose consciousness, which is related to the loss of motor control in the mouth, nose, and throat.
One concern and consideration when choking someone out is that the stoppage of blood flow to the head can create the possibility for the formation of a clot. Similarly, the increased pressure in the lower portion of the body and at the point of constriction can also create a clot. When the hold is released, these clots can then move to the brain where they get stuck and cause a stroke.
Generally speaking, carotid chokes increase in danger exponentially when held, so a choke of only a second or two is much safer than a choke lasting 5 seconds or more. Either way, it should always be done in an environment with proper supervision and medical treatment available nearby in case of emergency, and it should never be performed on someone who is at high risk of clotting.
I’ve practiced a small amount of Brazilian jiu jitsu. They way my instructor explained it is as such: There are three straws in your neck. On brings oxygen to the lungs, one brings blood to the brain, one removes blood from the brain. The goal of a choke hold is to pinch all three straws.
It takes a bit of technique to accomplish, but if you can pinch off the arteries on the sides of the neck unconsciousness can happen in seconds. It happened to me once. One minute I was rolling with a partner, the next I was waking up on the mat with my instructor sitting near me watching me to make sure I came back. I don’t remember any sensation of loosing consciousness. There was no perception of a problem. There were no thoughts “I am being choked, I need to do something or I am going to loose consciousness. ” I was just out.
In very basic terms
**A Choke** stops a person getting air into their lungs. It’s pretty dangerous and not usually allowed by the rules.
**A Sleeper** on the other hand blocks off the veins in the neck causing the person to black out. As long as the sleeper is removed quickly afterwards, the person is totally fine and unharmed.
The major difference being that while the brain might be starved if oxygen, the rest of the body is unaffected. The end result is supposed to be the same (the person passes out), but a choke puts the rest of the body at risk as well.
There’s two things that can happen. What you see in martial arts such as jui jitsu is pressure being applied to both sides of the neck stopping blood flow to the brain. That can cause someone to black out. If you held it long enough, you could kill them. You’ll see referees checking for if someone is actually out.
The other could be actually choking someone in a way to cut off airflow. You woudln’t see that in article arts as you don’t want to mess with hurting someone trachea.
The sleeper hold in wrestling is basically a play on the the first option. They make it seem like someone is being choked out. The ref will raise their hands a few times for dramatic effect. When they “go out” (they pretend) they often seem like they’re unconscious for as long as needed for the story.
In reality if you’re choked out like above, you came back quickly. People will sometimes raise your legs move blood around.
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