Dr. Pamela's Blog

Yogic Breathing for Ease and Calm

Recently the words of Billy Joel’s song “We Didn’t Start the Fire” has been running as a continuous loop through my head, and I find myself wondering what the stanza of this past year would be. It seems we find ourselves living in a curse of interesting times. While strategies for coping with stress and anxiety were at a premium before, they are now more essential than ever, and perhaps even more difficult to achieve. Some of us are turning to meditation and mindfulness practices to mitigate stress. We yearn for the sense of equanimity these traditional practices offer. Yet, sitting cross-legged in silence with an overwhelmed mind is difficult, and takes years of cultivation to reap the full benefits. As a result, meditation can become another “should” with which we beat ourselves up if we don’t do it regularly or meet the bar of our expectations.

I have been exploring mindfulness practices from many different philosophies for over twenty-five years. In this blog, I will focus on a simple but deeply profound pranayama or breath practice from the yogis of ancient India called Nadi Shodhana. Nadi is a Sanskrit word meaning “channel” or “flow” and shodhana means “purification.” Nadi Shodhana can be used to clear and purify the subtle channels of the mind-body, resulting in a more sustained sense of calm. No matter what we’re experiencing in our lives, a peaceful state of mind is always beneficial and Nadi Shodhana is a simple and easy way to achieve this.

I was inspired to write on this particular yogic breathing practice not only because of the stress of our current pandemic, but also because so many of my patients experience anxiety while dealing with a life-threatening illness like cancer and other challenging conditions. In addition to our traditional protocols that combine botanical medicine and clinical nutrition, I regularly prescribe Nadi Shodhana to my patients as an anxiety-reducing technique. Referred to in English as alternate nostril breathing, this breath practice is powerful on its own, and can also be used as a gateway into other practices and techniques. I have provided simple instructions below and there are many short videos available on the internet if you prefer a visual of someone doing the practice.

How to Practice Nadi Shodhana

While some folks get fancy with body position, what I think is most important is to feel comfortable and grounded. It’s fine to be seated in a chair or on the floor, and you can even lie down. Start the breathing exercise once you are comfortable. There are different ways to use the hand position over the nose for the practice, but I like to use my thumb and middle finger. Experiment with what feels most natural to you. 

1. Start with either the right or left side of the nose. For ease of writing, I’m choosing the left.  
2. Use your thumb to occlude or close off the right nostril, then breathe in deeply and evenly on the left.
3. Use your middle finger to close off the left nostril, release the thumb and exhale deeply and evenly through the right nostril.  
4. I like to take a short pause, then inhale deeply and evenly through the right nostril. 
5. Close the right nostril with the thumb and exhale deeply through the left nostril.
6. Pause, then inhale deeply on the left.
7. Repeat this breath flow, alternating nostrils. In essence, you exhale and inhale on one side then switch to exhale and inhale on the opposite side. Again, breathe slowly, deeply and evenly.

Additional Tips for Nadi Shodhana 

Make sure that your lower belly is expanding on the inhale and try to breathe out fully. Shallow breaths or breathing that raises the shoulders, tells our bodies that we are in trouble and increases stress. Deep, full breaths that cause our bellies to rise and fall release signals that we are safe and can rest.  

Start by setting a timer for one minute. We can do anything for a minute! Then slowly increase your time.  Currently, I do three minutes of Nadi Shodhana breathing every night with my oldest son who is nine as part of our bedtime ritual. When big emotions arise, as they always do, we have an effective and practiced tool to use in the moment. I tell him it’s like practicing your swimming before being thrown in the deep end -- your body already knows what to do in an emergency.

What the Science Says

Though this technique is ancient, modern science has recently taken an interest in it. What we see is that forcibly breathing through the right nostril stimulates the left side of our brain and conversely, forcibly breathing through the left nostril stimulates the right side of our brain.¹ By creating a unilaterality to the breathing we activate and balance the two hemispheres of our brain.² This leads to a calmer more balanced mental state. It is easier to relax and even fall asleep, but it also increases concentration and mental acuity because breathing with unilaterality activates both halves of your brain.

It is important to note that throughout the day we experience a natural rhythm between dominance of brain hemisphere and correlated nostril (again right side of brain to left nostril and left side of brain to right nostril). This is called the ultradium rhythm. We naturally switch from right to left every one and a half to three hours.³ Since our bodies are doing this naturally, we are supporting and re-enforcing what our bodies inherently want to do to keep us in balance.

Benefits of Alternate Nostril Breathing

Usually when we have sustained concentration or vigilance, we increase our sympathetic nervous system with a correlated increase in blood pressure, stress, and anxiety. Remember, increases in sympathetic nervous tone is associated with the fight or flight response and stress. However, when utilizing alternate nostril breathing for fifteen minutes, we see increases in cognition, concentration, and performance without triggering the stress response or sympathetic nervous system.⁴ In fact we see the opposite -- Nadi Shodhana is a powerful inducer of the parasympathetic nervous system and of a calm and relaxed state.⁵

What’s wonderful about Nadi Shodhana is that you don’t need to be a yogi with years of experience to enjoy these benefits. A study in 2008 showed that with only 15 minutes of practice for four weeks, there was a significant increase in lung function and cardiac function with a corresponding decrease in blood pressure.⁶ Study after study, we see that regular practice with alternate nostril breathing increases parasympathetic tone.

Traditionally, Nadi Shodhana has been utilized for calming a busy or anxious mind. Studies utilizing EEG measurements show that alternate nostril breathing is associated with greater calmness and is useful for stress and anxiety reduction.⁷ Its effectiveness has even been seen in more acute situations such as decreasing anxiety during public speaking.⁸ Overall, what we see with regular use of Nadi Shodhana is improved cognitive performance, increased attention to tasks, increased sense of calmness, and decreases in blood pressure and anxiety. Can you imagine how popular a pill would be if it could do all of that!

References

1. Thakur GS, Kulkarni DD, Pant G. Immediate effect of nostril breathing on memory performance. Indian J Physiol Pharmacol. 2011;55(1):89-93.
2. Price A, Eccles R. Nasal airflow and brain activity: is there a link? J Laryngol Otol. 2016;130(9):794-799. doi:10.1017/S0022215116008537
3. Shannahoff-Khalsa DS, Boyle MR, Buebel ME. The effects of unilateral forced nostril breathing on cognition. Int J Neurosci. 1991;57(3-4):239-249. doi:10.3109/00207459109150697
4. Telles S, Verma S, Sharma SK, Gupta RK, Balkrishna A. Alternate-Nostril Yoga Breathing Reduced Blood Pressure While Increasing Performance in a Vigilance Test. Med Sci Monit Basic Res. 2017;23:392-398. Published 2017 Dec 29. doi:10.12659/msmbr.906502
5. Levin CJ, Swoap SJ. The impact of deep breathing and alternate nostril breathing on heart rate variability: a human physiology laboratory. Adv Physiol Educ. 2019;43(3):270-276. doi:10.1152/advan.00019.2019
6. Upadhyay Dhungel K, Malhotra V, Sarkar D, Prajapati R. Effect of alternate nostril breathing exercise on cardiorespiratory functions. Nepal Med Coll J. 2008;10(1):25-27.
7. Telles S, Gupta RK, Yadav A, Pathak S, Balkrishna A. Hemisphere specific EEG related to alternate nostril yoga breathing. BMC Res Notes. 2017;10(1):306. Published 2017 Jul 24. doi:10.1186/s13104-017-2625-6
8. Kamath A, Urval RP, Shenoy AK. Effect of Alternate Nostril Breathing Exercise on Experimentally Induced Anxiety in Healthy Volunteers Using the Simulated Public Speaking Model: A Randomized Controlled Pilot Study. Biomed Res Int. 2017;2017:2450670.