Chronic Stress-Relieving Breathing Techniques

Breath is fundamental for the body's physical processes. Yet, most people don’t give this automatic activity much thought –taking air in, letting it out, twelve to twenty times each minute, or about twenty thousand breaths over a day. Combining breathing with other wellness practices, such as yoga and meditation, can benefit a person by positively modifying their breathing. Proper breathing is a powerful healing tool, and with regular integration of these techniques, we empower ourselves to prevent or manage disease conditions.

Stress and other factors of daily life can negatively impact breathing and health. But, on the other hand, effective breathing can help transform health, promoting mindfulness and resilience.


Science of Breathing

Integrating efficient breathing practices with conventional medicine is critical in improving and sustaining health and well-being.

Breathing affects all body systems, which in turn influences breathing. Integrating Eastern Insight & Modern Medical Care, we will discuss the transformative power of Breath to enhance the quality of life through 3 interdependent systems:

  • Biomechanics: Heart tone, diaphragm, posture, yoga
  • Psychophysiology: Autonomic nervous system (ANS), amygdala associated emotions and behaviors, memory
  • Physiology and biochemistry: HRV, homeostasis, pH, temperature regulation, Breath-holding


Optimized breathing has several benefits:

  • Restorative breathing for mental, physical, and spiritual healing, wellness concepts to care for oneself and others
  • Regulation of the Autonomic Nervous system (ANS); Body-Mind Relaxation, Sleep, Meditation
  • Emotions & Breath, Bidirectional Relationship
  • Greater self-regulation, Work-Home balance
  • Enhanced cellular action, metabolism, and mitochondria function
  • Enhanced posture, stability, digestion, and vocal quality
  • Additional impacts are nitric oxide production and vasodilation, body, anti-inflammatory effects, lymphatic and glymphatic flow increase, and waste disposal

However, significant issues can arise with poor breathing habits and comorbidities, including over-breathing, stress, anxiety, breathlessness, and SNS activation. We will analyze this from various angles and share breathing techniques to optimize wellbeing.

"Just by paying attention to breathing, you can access new levels of health and relaxation that will benefit every area of your life." - Deepak Chopra, MD

As we recover from the pandemic, it is evident that proper breathing needs to be a priority. Ongoing research has led to insights into building a solid foundation for good health, such as strengthening the immune system, improving circulation, stress response, and clearing the mind.

Integrating efficient relaxation-breathing practices and intermittent breath-holding techniques with conventional medicine is helpful for health and wellbeing. We will analyze this from various angles, discuss problems associated with poor breathing habits and comorbidities, and provide practical exercises.


Emotions & Breath - A Bidirectional Relationship

Different emotions are associated with varying breathing patterns, and changing our breathing can change our feelings. Breath Intelligent minding changes physiologically in response to emotional states. For example, increased anxiety, sadness, fear, or anger causes a higher respiratory rate, and the breathing is irregular, short, fast, and shallow. The body enters an arousal state. The sympathetic nervous system predominates and provides more oxygen to help fight or flee.

With happiness, as when being with a loving person, smelling a rose or baking bread, the breath is slow, rhythmic, deep, and comfortable. This activates the parasympathetic nervous system, stimulating the vagus nerve, and slowing the heart rate. Conscious, long, slow, diaphragmatic breath is calming because the mind is relaxed. It is also wise to breathe slowly and intentionally and be calm before making critical decisions.

Emotions and breath have a bidirectional relationship. So, by following breathing patterns associated with different emotions, you will begin to feel those corresponding emotions.


Reality of Stress

Stress is "our reaction to events, environmental or internal, that tax or exceed our adaptive resources." Each of us has a certain repertoire of coping skills, and when they are strained or exhausted, stress usually manifests. Stress reactions consist of both physical and emotional responses.

Stress is not inherently wrong. Results from stress depend on coping mechanisms that an individual chooses and uses effectively. In the face of stress, a person selects a coping response. Stress is reduced if the coping mechanism is effective and the goal is achieved. If ineffective, stress is increased. In addition, incessant mental activity, overthinking, analyzing, and worrying interfere with our ability for rest and happiness.

Millions of Americans suffer from mood problems and stress-related issues like anxiety, depression, insomnia, and PTSD. Many take medications with troublesome side effects, withdrawal symptoms, and disappointing efficacy. Stress is difficult to prevent entirely, and therefore we must learn to recognize it better and manage stress to improve outcomes. Over time, unresolved stress leads to burnout. Burnout syndrome is characterized by losing enthusiasm for work (emotional exhaustion), treating people inhumanely (depersonalization), and developing a sense that work is no longer meaningful (low personal accomplishment).

Various problems such as lack of self-care (sleep, exercise), work-life balance (family/parenting) can be partly resolved by appropriate breathing exercises. Proper breathing helps work-life integration, relationships, and social support. The psychological, neurological, and biochemical impacts of stress and trauma can be reversed by proper breathing techniques. We can heal.

Antidotes for excessive stress include exercise, meditation, yoga, laughter, sex, and playing with the kids. These calm-inducing activities help burn up excess cortisol. Increased awareness about holistic health and complementary medicine has brought modern-day medicine closer to yoga and pranayama breathing practices.

Taking air in, letting it out twelve to twenty times each minute adds up to some 25,000 breaths over a day. Yet, most people are not getting the full benefit of this life-sustaining activity. With practice, people can reshape their breathing. Combining breathing with other wellness practices, such as yoga and meditation, enable us to live healthier lives and empower us to help patients prevent or manage disease conditions through enhanced breathing. Breath is a powerful healing tool: knowledge and management of the breath must be part of a robust wellness toolkit.


Management of Chronic Stress

"Life isn't about waiting for the storm to pass. It's about learning how to dance in the rain." - Vivian Greene

Chronic stress is associated with a greater risk of depression, heart disease, infectious diseases, and common cold symptoms. Also, the body loses its ability to regulate the inflammatory response.

One way to relieve stress is by using appropriate breathing practices to leverage one’s mind, body, and emotional health. Breath awareness creates a calm, relaxed, alert, and creative state that is subconsciously perceived by those around us. Conscious breathing is an umbrella term for medical and therapeutic methods to improve breathing function. Conscious breathing affects neurological programming through a state of intentional awareness, affecting individuals biologically, emotionally, and physically in a positive way. Mindful breathing techniques are effectively used to relives stressful situations by mountain climbers and deep sea-divers, Olympic athletes, Zen archers, musicians, performing artists, and healing professionals.

Breathing in, I calm my body & mind

Breathing out, I smile

Dwelling in the present moment, I know this is the only moment

    -Thich Nhat Hanh, author, Being Peace


The Science of Breathing

Amid all scientific and technological advances, it is essential to realize two paths to healing the body and mind. One relies on medicines and external aids. The other enhances the body's capacity to heal itself from within.

a) Deactivate SNS and engage PNS

b) Resonance Breathing & Respiratory Sinus Arrhythmia

  • Nitric Oxide produced: nose, paranasal sinus
  • Balance pH, respiratory conditions like asthma managed by increasing CO2 levels in the blood
  • Reduce stress-related inflammation
  • Improve digestion, muscle tension
  • Avoid over-breathing/hyperventilation


Importance of the Vagus Nerve in Breathing

"Breathe. Let go. Remind yourself that this very moment is the only one you know you have for sure." - Oprah Winfrey

Stimulate Vagus Nerve for Relaxation:

  • Activate PNS, lengthen exhalation
  • Breathing exercises to de-stress, improve mood
  • Meditation, singing, humming, chanting, gargling
  • Cold exposure stimulates dive reflex
  • Neck massage along carotid sinus; throat right-side
  • Balance gut microbiome → brain function → calm
  • Release of Oxytocin, social bonding

The Vagus nerve is a part of the Parasympathetic nervous system (PNS). It stretches from the brainstem down into the abdomen and is involved in heart rate control, gastrointestinal peristalsis, and sweating. When the Vagus nerve gets stimulated, the body turns into "rest and digest” mode and chills out. This causes relaxation of blood vessels, decreasing total peripheral resistance. Lengthening exhalation makes it possible to turn on the rest-and-digest (parasympathetic) nervous system—the opposite of fight-or-flight. Relaxation occurs with prolonged exhalation, leading to calmness<./p>

To optimize health and wellbeing, breathe through your nose: Slow, deep, and low. This activates the body's Vagus nerve, slows your heart rate, lowers blood pressure, and decreases cortisol, putting you on a path to better brain health.


Resonance Breathing

Slow breathing helps with respiratory muscle activity, ventilation efficiency, chemoreflex and baroreflex sensitivity, heart rate variability, respiratory sinus arrhythmia, cardiorespiratory coupling, and sympathovagal balance. Enhance HR variability & baroreflex sensitivity by synchronizing inherent CV & Respiratory system arrhythmia (RSA).


Resonance Breathing/Cardiorespiratory Coherence

Yogis knew this long ago, Science validates

  • Balance SNS-PNS, decrease anxiety, stress
  • Increase pulmonary function
  • Improve baroreflex gain
  • Hi HRV: healthy heart, nervous system
  • Increase resiliency
  • Emotional balance


Coherent Breathing

Most people breathe at a rate of about two or three seconds per inhale and exhale. In Coherent breathing, the goal is to extend the length of both the inhale and exhale to around six seconds. In “The Healing Power of the Breath,” Dr. Richard Brown and Dr. Patricia Gerbarg provide a practical way to treat stress by proper slow breathing. Drawn from yoga, Buddhist meditation, the Chinese practice of qigong, and other sources, their science-backed methods activate communication pathways between the mind and body to impact the brain positively and calm the stress response.


Cardiac Coherence/Rhythm Training (CCT)

CCT involves biofeedback to control heart rate variability (HRV) — the moment-to-moment change in heart rate. Cardiac coherence exercises involve inhaling for 6-seconds, then exhaling for the same amount of time (for a 12-sec respiratory cycle). For relaxed breathing, it's better to have a longer exhale than inhale. Coherent breathing is helpful for insomnia, anxiety, depression, stress, immune system response, alertness, concentration, vitality, post-traumatic stress disorder (PTSD), and attention deficit disorder (ADD). One study showed that the anti-anxiety gamma-aminobutyric acid (GABA) levels increased after controlled breathing. Another study showed cytokines (linked to inflammation and stress) are lowered after coherent breathing. As many employees will now be set to work from home for an extended period, taking care of their mental health and learning how to deal by themselves with feeling stressed is especially important. So how can we deal with “fight or flight” stress-related responses?


Diaphragmatic Breathing Exercises

Diaphragmatic Breathing is a deep breathing technique in which you breathe with your abdomen instead of your chest. Slow, deep ‘belly’ breathing helps reset the nervous system and, if incorporated into daily life, helps to lower the body’s response to stress, regulates the autonomic nervous system by lowering heart rate, blood pressure, and the stress hormone cortisol, which helps relaxation. (see Ujjayi breathing, below) Invigorating breathing is like using the diaphragm as the second engine of life after the heart. The diaphragm’s back and forth movement also assists in digestion and food transit; its pump effect helps venous circulation. Abdominal breathing is youthful breath. It is the natural breathing of babies!


The Wisdom of the East and Modern Science

"Where the breath goes, so the mind goes, and vice versa. We must lasso our breath to keep our mind still." -

Ancient doctrines from India, well over 2000 years ago, describe controlled breathing methods to influence body, mind, and spirit. For example, Pranayama means the ability to expand or stretch our life force (prana) by controlling our breath. Prana means vital force, energy, or internal breath that flows through the body. Breath is a gross manifestation of this cosmic/universal life force that keeps us alive. 'Ayama' means control/restraint and to stretch/elongate/expand.

Breathing, Pran Tatva is essential for all living forms. Several breathing techniques are used to allay apprehension and restore tranquility. In the 1970s, Swami Rama was a consultant in a research project at the Menninger Foundation, Topeka, KS investigating the voluntary control of the so-called involuntary muscles like the heart and lungs. Swami Rama applied his expertise to link body and mind through an understanding of the breath. With increased awareness and control of the subtle aspects of breathing, he could effectuate physical and psychological changes to master the mind’s roaming tendencies.


Breathing for Relaxation & Sleep, Yog Nidra

Proper breathing influences physiological factors (primarily by stimulating the parasympathetic nervous system) and psychological factors (diverting attention from negative thoughts). It induces relaxation, reduces stress, regulates emotion, and prevents insomnia. Practical guided meditations, breathing exercises, relaxation techniques, and self-hypnosis help calm the mind and relax the body in preparation for sleep.

Effective Breathing for Relaxation & Sleep:

  • Wind down, sleep meditation practice
  • Relaxation poses before bedtime, relaxed body-mind
  • Be calm and peaceful, guided visualization
  • 4,7,8 + Resonance breathing
  • Guided meditations → deep sleep
  • Circadian Rhythm, the optimum time to sleep

Daytime vs. Night-Time Breathing: By practicing breathing at the correct rate, rhythm, and volume during the day, it is possible to boost energy levels for the daytime. Then, reset to deliver quieter, softer, and more regular breathing at night. The goal is to get deep, peaceful sleep, fully relaxed for physical and mental rest.


Breath-Body-Mind Relaxation

Taking air in, letting it out. Twelve to 20 times each minute, or some 25,000 breaths over the course of a day. Breath is fundamental for the body's physical processes, yet most people don’t give this automatic activity much thought.

Stress and other factors of daily life can negatively impact breathing and health. Effective breathing, on the other hand, can help transform health, and promote mindfulness and resilience. With practice, a person can reshape their breathing. Combining breathing with other wellness practices, such as yoga and meditation, can bring additional benefits. Regular integration of these techniques can enable physicians to live healthier lives and empower them to help patients prevent or manage disease conditions through enhanced breathing. The breath is a powerful healing tool; knowledge and management of the breath can be part of a robust wellness toolkit.

Breath is fundamental to yoga practice and creating mind-body transformation. Where the breath goes, so the mind goes, and vice versa. We must lasso the breath and rein it in to keep the mind still. Most people know the concept of stopping and counting to 10 before speaking when stressed. What is equally important is what occurs during that “time out.”

Introduce imagery suggestive of the R-State (Relaxed Breathing with Stretching). For example, inhale when stretching arms to the sky, imagining a tree with branches reaching high into the sky. Exhale while gradually bowing down and touching the floor. End imagery by imagining a warm, relaxing pond of water, feeling the warmth and heaviness.


Meditation with Breathing

"Without full awareness of breathing, there can be no meditative stability and understanding." - Thich Nhat Hanh

The contemporary forms of mindfulness meditation emphasize breathing-based exercises.

Benefits of Mindful Breathing and Meditation:

  • Conscious regulation of breathing → Bridge gap between the mind & ext environment
  • Increase PNS, Endorphins, Immune System
  • Reduce cortisol, fear, anxiety, activity of amygdala
  • Improve concentration, stillness, unity
  • Reduce Default Mode Network activity responsible for self-focused rumination and daydreaming
  • Improve interoception → contemplate, go inside
  • Progressive muscle relaxation → Hypo-metabolic state
  • Increase telomere length

"Feelings come and go, like clouds in a windy sky. Conscious breathing is my anchor. If you want to conquer the anxiety of life, live in the moment, live in the now." - Thich Nhat Hanh

Meditation is a relaxed state of consciousness, not doing anything. Think Reassuring Thoughts While Breathing: With each breath, think soothing thoughts (I am inhaling calm). Imagine expelling your fears and worries (I am exhaling stress). Progressive muscle relaxation, Yoga helps with Hypo-metabolic state.

Meditation is for mental hygiene, just like dental and body hygiene. The external dimensions of life can bring comfort and convenience. But the inner dimension can bring fulfillment. Introspection- meditation is to contemplate, go inside. Insight, not excite.


Proper Breathing Techniques: Better Health with Each Breath

"Changing your breathing patterns can affect and improve you mentally, emotionally, and physically." - Andrew Weil, M.D.

Awareness of breath and synchronizing breath to movement is an integral part of yoga. Breath awareness means being aware and observing breath’s qualities, whether long or short, smooth or uneven, deep or shallow, easy or labored. Incorporate conscious breath into daily life situations. Focusing on slow inhales and prolonged exhales leads to calmness and relaxation. Integrating a positive resolve or mantra during yoga sessions helps the breathing process. This can be a single word or phrase. So, during inhalation, gather up the stress and worries; during exhalation, visualize tension flowing out of the entire body.

Proper breathing involves observing the flow of breath and respiratory movements. Being aware of each inhalation and exhalation helps focus attention. It is essential to feel the sensations as the air passes through the nose and throat while expanding the abdomen like a balloon. When thoughts drift (which is natural), redirecting attention to breathing is helpful.


Slow Breathing

Breathe light to breathe right mile. A healthy mind has an easy breath.

Slow Breathing, Benefits:

  • Increase CO2 → Increase O2 absorption > cellular O2
  • Calm nervous system → relax, sleep
  • Reduce tension, stress, anxiety, depression
  • Stimulate Vagus nerve → blood vessels dilate
  • Enhance HR variability and exercise tolerance
  • Activate hypothalamus-pituitary → inhibit Cortisol
  • Enhance HR variability and exercise tolerance

A proper slow, diaphragmatic breath is an integral part of any workout. In addition, the physiological effects of slow breathing help respiratory, cardiovascular, cardiorespiratory, and autonomic nervous systems. This includes ventilation efficiency, chemoreflex and baroreflex sensitivity, heart rate variability, blood flow dynamics, respiratory sinus arrhythmia, cardiorespiratory coupling, and sympatho-vagal balance.

Slow breathing enhances HR variability & baroreflex sensitivity by synchronizing inherent CV & Respiratory system arrhythmia (RSA.) Slow breathing techniques activate the hypothalamus connected to the pituitary gland that sends out neurohormones that inhibit stress-producing hormones and trigger a relaxation response in the body.

  • Over-breathing and mouth breathing cause excess air inhalation and exhalation. It depletes the body of CO2 and increases stress.
  • CO2-O2 exchange imbalance → slow breathing stimulates mucus production → nasal congestion
  • Often caused by emotional problems, anxiety, or panic attacks → breathless
  • RX: Slow, horizontal belly breathing into a paper bag or cupped hands. Hold breath 15 seconds

Awareness, Consciousness

Breath is the bridge that connects life to consciousness, which unites your body to your thoughts. So, whenever your mind becomes scattered, use your breath as the means to retake hold of your mind - Thich Nhat Hanh.

Benefits of Conscious Breathing:

  • Biological: The medulla controls breathing during most of the day while breathing unconsciously. The cerebral cortex (the more evolved brain area) switches to conscious breathing. This has a relaxing and balancing effect on emotions. Synchronizing with the heart beats calms down parts of the brain, like the amygdala, which handles anxiety and agitation.
  • Emotional: Controlled breathing leads to decreased emotional stress, random thoughts, and panic. The body’s energy flows freely, disrupting any emotional and physical blockages and freeing the body and mind. This results in the feel-good effect experienced after a yoga practice.
  • Physical: In physical yoga practice, breathing exercises and movement release happy chemicals such as endocannabinoids, oxytocin, and endorphins.


Dysfunctional Breathing Habits

Recognizing sub-optimal breathing patterns and utilizing types of breathing that promote health helps medical practitioners provide non-invasive health management methods. In addition, it can be medicine for health maintenance.

Pervasive faulty breathing habits that erode our health are:

  • Shallow, irregular breathing, using upper chest and neck muscles
  • Mouth breathing and over-breathing (hyperventilation) of more than 20 breaths per minute. Inhalations that are unnecessarily forceful and heavy
  • Tightly laced clothing, belts, and corsets restrict breathing and compress abdominal organs, causing poor digestion, back muscle atrophy, and rib cage deformity

By identifying dysfunctional breathing habits, we can systematically replace them with healthy breathing patterns mitigating comorbidities.

Better Health with Each Breath - Proper Nose-breathing is the Gateway to our Wellbeing.

Proper breathing starts with gentle inhalation through the nose as the diaphragm contracts and the belly expands for air to flow into the lungs. This improves lung sac capacity.

Nose breathing provides a myriad of crucial benefits:

  • Filter, warm, and humidify the air, protecting the lungs in cold or dry environments
  • Defends against viruses and other microorganisms
  • Improves lung capacity and helps the diaphragm to work properly
  • Increases oxygen uptake and circulation
  • Slow nasal breathing increases the amount of oxygen entering the bloodstream by about 15%
  • Stimulates the release of nitric oxide and endorphins

Proper Breathing Enhances Almost Every Aspect of Our Life:

  • Breathing consciously while stretching, walking, and exercising develops muscles to increase lung capacity and oxygenation while stimulating blood flow and decreasing inflammation
  • Improved respiratory health will encourage better lifestyle choices such as adequate sleep, healthy relationships, proper diet, regular medical checkups, and immunizations
  • Attention to breath will lead to erect and proper posture. It reverses the ill effects of prolonged working at the computer or watching TV
  • Proper breathing slows down the aging process, arresting the decline in lung capacity and cardiac output (due to the loss of rib cage elasticity)
  • Breathe Light to Breathe Right. Practicing slow, light, nose abdominal breathing day in and day out could reduce breathing difficulties during sleep and minimize snoring. It also decreases stress, anxiety, and agitation
  • Practice self-care and preventive measures with every breath
  • Conscious breathing is our anchor during meditation. Inhale and exhale with mindful awareness—the mind-body connection. Psycho-neuro-immunology (PNI) focuses on how our nervous system, hormones, and immune system interact with one another. Our innate self-healing abilities modulate the immune system by regulating its natural inflammatory response and increasing natural killer cells
  • Mind-body techniques (MBT), with mindfulness, and yoga, reduce mental stress and inflammatory conditions. Unlike other bodily functions, breath can be controlled consciously. Through rhythmic, diaphragmatic breathing and Kumbhaka (breath holds) reduce anxiety, oxidative stress and focus your mind
  • Deep, slow, belly breathing through the nose facilitates the movement of lymph through the body, helping remove metabolic waste and toxins. In addition, it strengthens the immune response
  • Breathing practices with intention and attention aid removal of unnecessary thoughts, helping with meditation and inner peace
  • People with allergies and/or asthma can reduce the excess mucus buildup by using a saline nasal spray or Jal Neti
  • Hot shower and chest percussion help to thin out the mucus, facilitating removal
  • Incentive spirometry facilitates slow, sustained deep inhalations, supporting lung expansion
  • Long-term exposure to polluted air increases the risk of infection. To improve respiratory health, stop smoking, and avoid indoor and outdoor air pollution. Air purifiers and wearing a mask will help, especially if you continue to breathe in and out through the nose



Improve lifestyle of people with an emphasis on healthy breathing habits.

Although breathing is intuitive, many of us do not pay attention to the way we breathe. Chronic stress, sedentary lifestyles, and an unhealthy diet lead to adverse respiratory conditions. The breathing methods and behavioral strategies outlined should be introduced in our educational systems, societal institutions, occupational settings, and workplaces.

Learn to breathe intentionally and increase awareness of the body and mind. Focus on breathing with a sense of gratitude. The goal for Meditation and Breathing is to create a sense of space between you and your stress. It is the perfect way to wind down after a long day and welcome a night of deep, restorative sleep and appreciate the graces we have received.

Let’s express gratitude for the air we breathe, with a song in our heart and a spring in our step. Chanting mantras, humming, and bhramari are motivating and stress-relieving. Then, when things get tough, optimize breathing, and adopt a gratitude hand-washing ritual, thinking of 10 things to be grateful for - one for every finger washed.


A Parting Word of Caution:

  • One should practice breathing techniques on an empty stomach. The correctness of the methods should be verified with a yoga expert since each person’s body and health circumstances may vary.
  • Go easy, go slow. Always listen to your body but be willing to go a little bit beyond your comfort zone. Strive to be “comfortably uncomfortable.”
  • This article does not constitute or substitute for medical advice but may complement conventional care.
  • Work with your healthcare team to develop a fitness plan that works for you, especially if you have shortness of breath while resting, an irregular heartbeat, chest pain, or related symptoms.

            - Nick Nipan Shroff, MD, ERYT