The western medicine conception of breath and breathing focuses on moving air into and out of the lungs to facilitate the exchange of gasses (mostly oxygen, nitrogen, and carbon dioxide) between the internal and the external environment. The rhythmic inhalation/exhalation is one of the key vital signs of life. The physiology of breath and breathing is complex and deeply rooted in the brain and nervous system. The connections between breathing and mental and physical health are becoming better understood by Western scientific medicine.
Spiritual traditions worldwide have recognized the significance of breath as the “life force.” Both Western and Eastern traditions encompass breath work in their meditative practice. The breath is associated with connections to spiritual energies that defy scientific, physiologic explanation.
While there is wide variation in breath techniques, they all focus on bringing one’s awareness to the unconscious and automatic process of inhale/exhale that happens thousands of times each day. The benefits of conscious breathing are many. It is simple, requires no technology, and the benefits are immediate. Teaching breath techniques to our patients can make a difference in many challenging clinical conditions from chronic pain to sleep disorders, anxiety, stress, functional bowel problems, and many others.
Some of the basics are:
Breath focus: Slow down and pay attention to your breath. Breathing is generally automatic under the control of brain-stem level mechanisms and at that point, out of conscious control. However this built-in automatic vegetative function can be modified by higher centers of brain at the cortical and limbic levels. Neurophysiologic research has shown that bringing awareness to the unconscious breath cycle and consciously modifying the breath cycle causes changes throughout the brain and nervous system leading to relaxation, decreased arousal, lowered heath rate and blood pressure, and improved sense of wellbeing. All breath techniques begin with focusing on breathing.
Belly breathing: Diaphragm breathing basics
- Sit in a comfortable position or lie flat on the floor, your bed, or another comfortable, flat surface.
- Relax your shoulders.
- Put a hand on your chest and a hand on your stomach.
- Breathe in through your nose for about two seconds. You should experience the air moving through your nostrils into your abdomen, making your stomach expand. During this type of breathing, make sure your stomach is moving outward while your chest remains relatively still.
- Purse your lips (as if you’re about to drink through a straw), press gently on your stomach, and exhale slowly for about two seconds.
- Repeat these steps several times for best results.
Paced breathing: There are many styles and techniques of paced breathing. There is a tremendous amount of information on the Internet about breath work. And, naturally, there’s an app for that. There are few adverse effects and contraindications. The benefits are real, often immediate, and can be shared with your patients.
One technique that is both easy to learn and to use is cardiac coherent breathing. The goal in this approach is to align the breath with the heart rate and to achieve a respiratory rate of 6 breaths per minute. To get started:
- Focus on your natural breaths. Count the length of each inhale and exhale to obtain a baseline.
- Find a comfortable position to practice coherent breathing. Place one hand on your stomach.
- Breath in for four seconds and then out for four seconds. Do this for one minute.
- Repeat, but extend your inhales and exhales to five seconds.
- Repeat again, extending further to six seconds.
Incorporating breath work into routine clinical evaluation and patient care planning makes a tremendous amount of sense and, increasingly, is supported by scientific understanding and evidence from clinical research.
“If I had to limit my advice on healthier living to just one tip, it would be simply to learn how to breathe correctly.” ~ Andrew Weil
 Herrero J, Khuvis S, Yeagle E, Cerf M, and Mehta A. Breathing above the brain stem: volitional control and attentional modulation in humans. Journal of Neurophysiology 2018 119:1, 145-159
 Andre C. Proper breathing brings better health. Scientific American, Jan 15, 2019. https://www.scientificamerican.com/article/proper-breathing-brings-better-health/