What type of breathing is best for nerve calming?

Joanna is a 43-year-old female who began to experience urinary leakage when outside of her home. It has progressively gotten worse to the point of leaking when pulling into her driveway and reaching for the bathroom door. She used to be very involved with yoga and has a history of focusing on breathwork and meditation, but life has been busy the last few years and her practice has dwindled significantly. She was surprised that her pelvic floor PT started discussing breathwork and meditation early in her treatment sessions. 

Often, patients are so eager to begin working on the pelvic floor that they don’t realize the impact that stress, tension, and anxiety can have on their symptoms. When our body is in more of an anxious, stressed, or prolonged over-excited state, our sympathetic nervous system is engaged. This part of our nervous system is often called fight, flight, freeze. The counterpart to this is the parasympathetic nervous system which is our rest and digest or calm component. When we are in more of a stressed or prolonged excited state, our body naturally holds more tension in preparation or anticipation of what is happening and what is to come. Additionally, patients are often not aware of the physical relationship between the pelvic floor, which makes up the bottom of our core and is often compared to a trampoline, and the diaphragm, which is a dome shaped muscle underneath our lower ribs that makes up the top of our core. The pelvic floor and diaphragm move up and down together like the top and bottom of an elevator.

We know that breathing is essential to staying alive but how we breath is just as important. Those with high blood pressure (hypertension) have been found to have decreased heart rate and blood pressure with slow breathing as compared to higher frequency breathing. Nasal breathing specifically affects the central nervous system differently than mouth breathing as it is more beneficial for stress management and anxiety. 

There are many wonderful techniques that can be used to help bring the body into more of a parasympathetic, or relaxed, state and allow for fuller mobility of the diaphragm and the pelvic floor. Many of these include different forms of meditation and various breath techniques. I always encourage my patients to experiment with different options to find what they gravitate toward the most because the more we gravitate toward something the more likely it will become a habit. However, I often have patients who tell me they are too busy, and it is difficult for them to find the time to allow for this nerve calming. More specifically, they want the most effective option that requires the least amount of time. Luckily, a study was just completed that looked at the outcome of daily 5-minute practices with 3 different breathing exercises and mindfulness meditation over 1 month.¹

The study had four groups that consisted of three types of breathing and one mindfulness meditation. Mindfulness meditation, in this case, was the passive observation of a person’s natural breathing pattern with no active changes. The different types of breathing were as follows:

• Cyclic sighing: when there are deep breaths (typically 2) followed by extended, longer exhales.
• Box breathing: equal inhale, hold, and exhale.
• Cyclic hyperventilation with retention: emphasis on longer inhales and greater intensity, shorter exhales. While hyperventilation has been linked to chronic anxiety and panic, it has a therapeutic effect when performed purposefully in a controlled way.

The outcomes showed that all four groups showed significant daily improvement in positive affect and reduction in anxiety and negative affect.¹ Affect can be described as the expression of emotion outwardly. Positive affect typically means more positive, happy, calm emotions versus negative affect can be anxious, sad, frustrated emotions. Interestingly, breathwork more benefit for improving positive affect as compared to the meditation group.¹ Breathwork, particularly cyclic sighing, was more effective in reducing anxiety and improving mood than mindfulness meditation. Additionally, those who performed cyclic sighing experienced more benefit the more days they performed it, which was not found in the other types of breathing or mindfulness meditation.¹

Controlled breathing is different from mindfulness meditation in that controlled breathing directly influences respiratory rate causing a more immediate calming response on the vagus nerve during slow expiration. Mindfulness meditation reduces sympathetic tone in the long run but does not have as immediate of an effect. The benefit of a faster response is that humans tend to gravitate toward this as compared to something that takes time. Breath work with its immediate results can give us a sense of control.¹

So, what is the point of all this? At the end of the day, choose what technique works best for you! Being consistent over time will yield the best results versus a more “effective” technique that is used sporadically. However, if you are looking for the technique with the most “benefit”, use cyclic sighing for 5 minutes daily (or at least more days of the week than not) to see the most benefit in improved emotions (affect), improved mood, reduced anxiety, and reduced respiratory rate. This is vital when trying to heal your pelvic floor in the long run. Your pelvic floor physical therapist should be discussing and guiding you to find the technique that works best for you. If you don’t have a pelvic floor physical therapist and have been dealing with new or persistent pelvic concerns, reach out and gets those concerns addressed ASAP! Don’t be surprised if they discuss breathing techniques during your plan of care. 

Written by Jordan Schmidt, PT, DPT

References

• Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell reports. Medicine, 100895. Advance online publication. https://doi.org/10.1016/j.xcrm.2022.100895