The Air We Breathe

How many breaths do you take every minute? An interesting question from my amazing yoga guru last month. It’s not something most of our class had considered counting before. When you breathe it is just something that happens naturally, or is it…

In medical school we are taught that a normal breathing rate for adults is 10-20 breaths per minute. We also learn about the physiology of gas transfer in the lungs in relation to disease. Fast breathing is a clinical sign of respiratory distress, sepsis or heart trouble and we diligently count breaths in patients to diagnose this. Sadly, we are not taught anything on breathing techniques.

Meanwhile, yoga practitioners are well versed in voicing the health benefits of slow, purposeful nose breathing. Their knowledge has been passed down through centuries of teaching, with social media and the popularity of some high profile practitioners (e.g. Wim Hof), only further growing its adoption. There are many different types of breathing practice that yoga enthusiasts use, potentially causing confusion. Should we breath solely through our nose or through our mouth? Should we breathe through one nostril or both? How many seconds should we count for each breath and should we pause in between breaths? There are so many different versions of breathing techniques to follow its its hard to know where to start.

The medical profession does not have a great record in taking centuries of knowledge seriously either. Normally they take a randomised controlled trial to base our practice on, even though much can be learned from age old practices. In recent years, there have been interesting studies looking at physiological changes that occur when slowing our breathing. What’s more, science can finally explain the benefits yoga enthusiasts already knew.

We now know the optimum rate of breathing is 6-10 breaths per minute. When you breathe at this rate it can optimise our lung inflation and improve oxygen perfusion. This in turn reduces our heart rate and blood pressure and improves venous return. Breathing at this rate improves our exercise performance, energy levels and motivation. Our autonomic nervous system which controls our response to stress works best at this rate of breathing too¹.

A recent study conducted during the pandemic on health workers ² revealed that yogic breathing intervention significantly reduced anxiety, stress and depression scores. It also improved quality of life, resilience to stress and quality of sleep in participants. Evidence also shows that deep slow breathing reduces pain perception and emotional responses to pain whilst enhancing our mood ³. Another study revealed a significant reduction in blood pressure in pregnant women with yogic breathing. None of the participants in the slow breathing group required medication to lower blood pressure, whilst 60% of those in the control arm did ⁴.

You would think that slow breathing techniques would be adopted to enhance our patient’s health with all this evidence alongside the centuries of teaching on how to breathe. Sadly not yet. Perhaps we do not understand the practice ourselves and feel it is too difficult for patients to adopt. Maybe we are driven by quick fixes in tablet form, after all there is no profit in slowing our breath.

Over the last few years I have been trying breathing techniques, initially triggered by reading the brilliant book, “Breath” by James Nestor. I started off with relaxing 10 minute breathing exercises. However, I could not commit to 10 minutes distraction-free time most days with my hectic lifestyle. The Wim Hof method of breathing I then attempted required even greater dedication so didn’t last long. I did find the yoga class breathing exercises enjoyable but unfortunately can only manage to attend once a week. Eventually, I relieved tension or stress by concentrating on slowing my breathing and breathing through my nose.

Gradually, I have built up my practice and most of the time naturally slowly nose breathe. I aim for 4-5 seconds of inhalation and 4-5 seconds exhalation, slightly pausing between each breath. My sleep is good and I feel relaxed most of the time. This has energised me despite my busy home life and the pressures within my profession. Although I can’t attribute all this to just a change in breathing technique, it definitely plays a big role in controlling my stress. My breathing rate is 6 breaths per minute.

1. The Physiological effects of slow breathing in the healthy human. Marc A. Russo et al; Breathe 2017; 13: 298-309
2. Impact of a yogic breathing technique on the wellbeing of healthcare professionals during the Covid-19 pandemic. Kanchibhotla Divya et al; Glob Adv Health Med 2021 Apr 17; 10:2164957×221098214
3. The effect of deep and slow breathing on pain perception, autonomic activity and mood processing – an experimental study. Volker Busch et al, Pain Medicine 21 Sep 2011; Vol 13, Iss 2: 215 – 228.
4. The effects of progressive muscular relaxation and breathing control technique on blood pressure during pregnancy. MMahboobeh Aalami et al; Iranian Journal of Nursing and Midwifery Research 2016 May Jun; 21(3): 331-336