Right now, it feels like breathing is having a moment. Everyone’s at it, but some people are really putting in the elbow grease. Rather than ‘just’ breathing automatically, a growing number of devotees now practise deliberate exercises.
With fancy names, such as coherent breathing or cyclic sighing, breathwork has become one of the fastest-growing trends in the wellness industry.
Breathing studios are popping up in cities all over the world and breathwork gurus, such as extreme sub-temperature athlete Wim Hof, are becoming household names.
Bold claims are being made. “There’s a lot of hype about breathwork changing your life,” says Dr Guy Fincham from the University of Sussex, who studies the health benefits of breathwork.
Some say it can boost the immune system, banish ill health and, perhaps, even lengthen life. But can it? What’s the truth behind these breathwork fads? And could we all benefit from breathing a little differently?
Breath beginnings
We all take about 20,000 breaths per day, but we don’t all breathe the same. Some people can do extreme things with their breath.
The Danish freediver Stig Severinsen, for example, can hold his breath for more than 20 minutes, while the Haenyeo (translated literally to ‘women of the sea’) of Jeju, South Korea, spend more time underwater – up to 10 hours per day (not all at once) – than some diving animals.
You may think that the way you breathe is nothing special, yet your breath is as unique as your fingerprints.
In a recent study, scientists found that patterns of inhalation and exhalation are so distinct that they can be used to predict people’s identity, as well as health-related factors, such as depression and body mass index.
Now, researchers are becoming increasingly interested in how people’s breathing patterns affect their bodies, as well as their state of mental and physical wellbeing.
“Scientists have been studying breath in the context of meditation for decades,” says Fincham, “but now it’s being studied in its own right. I think we’re at a cusp where the amount of research is going to explode.”
Modern breathwork has ancient roots. Over 3,000 years ago, ancient Hindus described sophisticated breathing systems, known as prānāyāma, that were said to promote health and extend life.
Around 2,000 years ago, a Taoist text called the Liezi emphasised our breath’s ability to heal. Passed down and modified through the years, these breathing exercises are now a staple of many disciplines, including yoga, martial arts and sports training.
Methods fall into one of two broad camps. Slow breathing techniques, such as coherent breathing and alternate nostril breathing, involve fewer than 10 breaths per minute.
Fast-breathing techniques, like those embraced by Wim Hof, involve more than 10 breaths per minute.
Dr Richard Brown first encountered breathwork when he was a child, learning Japanese karate. Here, slow breathing was used to help focus the mind.
Then, when Brown grew up and became a psychiatrist, he started to use breathing techniques in his clinical practice in New York. As did his wife, fellow psychiatrist, Dr Patricia Gerbarg.
Around 20 years ago, the duo started combining breathwork with their standard treatments, such as medication and psychological therapies. The results were transformative. Depression lifted. Anxiety eased.
Patients with entrenched post-traumatic stress disorder (PTSD) found they could talk about and process their trauma. “When PTSD experts looked at our data, they said nothing works like this,” says Gerbarg.
When 9/11 happened, the duo used their approach to help many of those who were affected, including survivors, their families and first responders. In these cases, the pair observed improvements to mental and physical health.
A few rounds of slow breathing each day, for example, helped those with ground-glass lung – a painful, chronic cough caused by the debris – to improve.
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A tale of two systems
Drawing on the latest neuroscientific research, Brown and Gerbarg put forward an explanation for the encouraging results they were seeing.
Breathwork, they said, helps to regulate two key parts of the nervous system: the sympathetic and parasympathetic systems.
The sympathetic system controls the body’s fight-or-flight reaction. It kicks in when we’re stressed and it’s great in small doses. Adrenaline levels spike, the heart rate speeds up and levels of inflammation decrease.
This primes the body for action, but if we stay stressed for too long, pro-inflammatory pathways become activated and inflammation levels rise.
The parasympathetic system, on the other hand, calms the sympathetic system down. Controlled by the vagus nerve, which sends signals from the brain to the body, this system slows the heart rate and eases inflammation.
According to their theory, breathwork helps these two systems to become balanced so that everything becomes optimal. Not too much sympathetic activation and just the right amount of parasympathetic activity.
The theory made sense, but there was just one problem. At the time, scientists thought it was impossible for a person to control these systems consciously. The generally held belief was that the two systems operated automatically, beyond conscious control.
But then two studies came along which challenged that view.
In 2015, Gerbarg and Brown taught 16 patients with inflammatory bowel disease a handful of slow-breathing methods that they then practised for six months.
Compared with a control group, who didn’t learn breathing methods, they went on to experience less pain, stress, anxiety and depression.
Critically, their symptoms improved and they had significantly lower levels of a protein called CRP, which is a marker of inflammation.
Some of these patients went on to have exploratory colonoscopies, where a camera is used to look inside the large intestine. Much to everyone’s surprise, the red, inflamed tissue that had been the source of so much misery had gone.
“These were people who had been on heavy medications. Some had had sections of their bowels removed,” says Gerbarg. “To see this sort of improvement was exciting and validating.”
Around the same time, Dutch researchers enlisted the help of ‘the Iceman’ Wim Hof for a different study. Hof taught his fast-breathing methods to a group of healthy volunteers, who were then deliberately injected with a bacterial toxin to cause some inflammation.
The team wanted to see if breathing exercises could help to calm this inflammation down and, sure enough, it did.
Compared with a control group, who didn’t do the exercises, Hof’s students had a stronger anti-inflammatory response and increased levels of noradrenalin – both signs of an acutely active sympathetic nervous system.
Both studies hinted at the previously unthinkable: that breathing is a way to directly communicate with the nervous system.
Deliberate breathwork can be used to control the activity of the sympathetic and parasympathetic systems, influence the activity of the immune system and rein in unwanted inflammation.
Chronic inflammation is like a smouldering fire. Left unattended, it can cause serious harm. Low-level, persistent inflammation has been implicated in many diseases, including depression, diabetes and heart disease, where it often precedes the onset of symptoms.
So, the question that arises is this: can breathwork be used to help prevent or treat inflammatory conditions like these? And if it can, what’s the best type of breathwork to use?
Breathing for the body
Gerbarg and Brown shy away from fast-breathing methods, because they’ve found they can be triggering for some of their patients. Some bipolar patients, for example, can become manic.
Wim Hof himself says that his method, which involves three to four cycles of 30 fast, deep breaths followed by a long breath hold and then a 15-second recovery breath, should not be done near water or while driving, because it can cause temporary loss of consciousness.
This method can be really helpful for some people, but it comes with risks and isn’t for everyone.
Slow-paced breathing practices offer a safer, less intensive alternative. Gerbarg and Brown recommend coherent breathing, which involves breathing at a rate of five to six breaths per minute.
This is best done through the nose, rather than the mouth. “The nose is made for comfortable respiration,” says nasal surgeon Dr Jayakar Nayak from Stanford University.
“It’s constantly filtering, humidifying and warming the air.” In addition, when you breathe through the nose, nitric oxide produced in the sinuses is carried to the lungs, where it dilates the blood vessels and leads to better circulation.
Mouth breathing, in contrast, doesn’t have this effect.
Anders Olsson, founder of Conscious Breathing, points out that when you breathe slowly and rhythmically through the nose, you exhale less carbon dioxide and so retain more in the body. This can be a good thing.
“We think of oxygen as a hero and carbon dioxide as a villain,” says Olsson, but that’s not right.
“Carbon dioxide is much more than ‘just’ a waste gas,” he adds. It’s not a lack of oxygen, but a build-up of carbon dioxide that prompts us to take our next breath.
Optimal carbon dioxide levels help to keep the airways open and prompt the release of oxygen from the haemoglobin molecules where they’re lodged.
Carbon dioxide also helps to protect mitochondria, the cells’ power plants, from being damaged and keeps them working effectively.
Multiple studies have now shown that the slow breathwork practice of coherent breathing can help those suffering from anxiety, stress, depression, PTSD, insomnia, burnout and binge eating disorders.
And while there are no direct studies linking breathwork with chronic physical diseases or longevity, there are indirect links.
Through its ability to hack the nervous system, coherent breathing is known to increase something called heart rate variability (HRV), which is the variation in time between consecutive heartbeats.
Higher HRV, in turn, is associated with lower blood pressure, lower levels of inflammation and improved heart health.
Lower HRV, meanwhile, is predictive of poor heart health and early death.
The more scientists learn about the effects of breathwork on the body, the more reasonable it seems that breathing techniques really could help to stave off diseases that have an inflammatory component, such as heart disease and Alzheimer’s, and, perhaps, even help to lengthen life.
Further research is needed, but in the meantime, no one is denying the calming effects that slow breathwork can bring.
As Olsson says, “Breathe slowly and rhythmically through the nose and engage your diaphragm – it’s not just about health. It’s about peace.”
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Do try this at home
Here are five simple breathing exercises you can try for yourself. They’re all slow-breathing techniques, chosen for their soothing effects.
Unless stated otherwise, they’re best done through the nose. If you have any relevant health concerns, such as asthma or a deviated septum, please check with your doctor before trying these exercises.
Coherent breathing
Coherent breathing, also known as resonant breathing, is a slow, rhythmic pattern of breathing designed to place the heart, lungs and circulatory system into a state of coherence, where the systems of the body work at peak efficiency.
This is one of the easiest breathwork methods to do and has been shown to have many health benefits, including reducing stress and calming anxiety.
How to do it…
- Breathe in slowly and gently through the nose for five to six seconds. Focus on using your diaphragm and lower belly to create a deep, full breath.
- Breathe out slowly through the nose for five to six seconds.
- Repeat at least 10 times. Each breath should feel like a continuous cycle, with no pauses.
Cyclic sighing
Every five minutes or so, we all naturally take a deeper breath – called a sigh – which is larger than our typical breaths. These involuntary sighs help to maintain the fine structure of the lungs.
Cyclic sighing, which starts with a double inhale, builds on this phenomenon. A 2023 study found that cyclic sighing is better at improving mood and reducing stress than mindfulness meditation.
How to do it…
- Breathe in deeply through your nose until your lungs are almost full.
- Take a second, quicker top-up breath. Your lungs should now be full.
- Exhale fully through the mouth in a slow, controlled manner. This should take about twice as long as the inhales.
- Repeat the cycle for around three to five minutes daily.
Alternate nostril breathing
Alternate nostril breathing, also known as Nadi Shodhana, is an ancient yogic breathing technique. Due to its calming effects, the method can be helpful in stressful situations or as a way to help drift off to sleep.
How to do it…
- Use the thumb on your right hand to close your right nostril. Inhale slowly and deeply through your left nostril.
- Close your left nostril with your right ring finger. Release the right nostril and exhale slowly through the right nostril.
- Inhale slowly through the right nostril.
- Close the right nostril with your thumb. Release the left nostril and exhale slowly through it.
- Repeat five to ten times.
Nasal walking
Go on a walk, but breathe only through your nose. Nasal breathing helps to warm, humidify and pressurise the air while improving respiratory efficiency and building tolerance to carbon dioxide.
Pick up the pace a little and this becomes more difficult. Alternatively, keep at your original pace, but take twice as long to exhale as to inhale. For example, breathe in to the count of four, but breathe out to the count of six.
As carbon dioxide levels increase, this can create a feeling of deep relaxation, described by some as being like a runner’s high. It’s also a bit like training at altitude, but without the hike up a mountain.
4-7-8 breathing
Rooted in the ancient yogic practice of prānāyāma, 4-7-8 breathing can be used to help reduce anxiety, improve sleep and promote a state of deep relaxation.
A 2022 study found that 4-7-8 breathing lowered blood pressure and improved heart rate variability (a measure of sympathetic and parasympathetic balance, predictive of future health) in healthy young adults.
How to do it…
- Inhale through your nose for a count of four.
- Hold your breath for a count of seven.
- Exhale through your mouth, with a whoosh sound, to a count of eight.
- Repeat this cycle another three times. Practise twice a day.
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