Human physiology of underwater diving is the physiological influences of the underwater environment on the human ambient pressure diver, and adaptations to operating underwater, both during breath-hold dives and while breathing at ambient pressure from a suitable breathing gas supply. It, therefore, includes the range of physiological effects generally limited to human ambient pressure divers either freediving or using underwater breathing apparatus. Several factors influence the diver, including immersion, exposure to the water, the limitations of breath-hold endurance, variations in ambient pressure, the effects of breathing gases at raised ambient pressure, effects caused by the use of breathing apparatus, and sensory impairment. All of these may affect diver performance and safety. Immersion affects fluid balance, circulation and work of breathing. Exposure to cold water can result in the harmful cold shock response, the helpful diving reflex and excessive loss of body heat. Breath-hold duration is limited by oxygen reserves, the response to raised carbon dioxide levels, and the risk of hypoxic blackout, which has a high associated risk of drowning. Large or sudden changes in ambient pressure have the potential for injury known as barotrauma. Breathing under pressure involves several effects. Metabolically inactive gases are absorbed by the tissues and may have narcotic or other undesirable effects, and must be released slowly to avoid the formation of bubbles during decompression. Metabolically active gases have a greater effect in proportion to their concentration, which is proportional to their partial pressure, which for contaminants is increased in proportion to absolute ambient pressure. Work of breathing is increased by increased density of the breathing gas, artifacts of the breathing apparatus, and hydrostatic pressure variations due to posture in the water. The underwater environment also affects sensory input, which can impact on safety and the ability to function effectively at depth.
Immersion
Immersion of the human body in water has effects on the circulation, renal system and fluid balance, and breathing, which are caused by the external hydrostatic pressure of the water providing support against the internal hydrostatic pressure of the blood. This causes a blood shift from the extravascular tissues of the limbs into the chest cavity, and fluid losses known as immersion diuresis compensate for the blood shift in hydrated subjects soon after immersion. Hydrostatic pressure on the body due to head out immersion causes negative pressure breathing which contributes to the blood shift. The blood shift causes an increased respiratory and cardiac workload. Stroke volume is not greatly affected by immersion or variation in ambient pressure but slowed heartbeat reduces the overall cardiac output, particularly due to the diving reflex in breath-hold diving. Lung volume decreases in the upright position due to cranial displacement of the abdomen due to hydrostatic pressure, and resistance to air flow in the airways increases significantly because of the decrease in lung volume. There appears to be a connection between pulmonary edema and increased pulmonary blood flow and pressure which results in capillary engorgement. This may occur during higher intensity exercise while immersed or submersed. Negative static lung load due to hydrostatic pressure difference between ambient pressure on the chest and breathing gas supply pressure can cause a reduction in compliance of the soft lung tissues leading to increased work of breathing.
Exposure
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