Breathing is an important and effective skill for leveraging our biology within the polyvagal informed paradigm.
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Amongst the tools included in the polyvagal informed toolbox, breathwork is amongst the most commonly discussed. Breathing training is a particularly powerful tool, at least in part because this skill provides a direct connection between the nervous system, heart, and lungs. The extent to which changes in our breathing can directly impact our nervous system, heart rate, and ventral vagal tone is as significant as any of the other mind-based and body-based skills, if not more so. While we typically breathe without conscious or deliberate input, we are also able to intentionally change our breathing patterns, mechanics, and cadence to evoke specific changes within our biology. It is for these reasons that breathwork is such an important tool to understand and skill to develop.
While breathing is an essential process that is automatically controlled, it is not necessarily the case that our usual manner of breathing is optimized. Patrick McKeown provides important insights into this issue. It is common that the majority of us breath through our mouths using our chest and do so at a greater frequency than is physiologically ideal. There are many reasons why this is the case and for the purposes of this article a full discussion of this topic is beyond the scope of interest. It is, however, highly recommended that interested readers learn more about Patrick McKeown’s work through Oxygen Advantage.
To summarize some of the important aspects related to mechanics, cadence, and physiology of breathing which are detailed in Patrick McKeown’s work, it is advantageous for us to develop the ability to predominantly breath through our nose using our diaphragm. Furthermore, breathing at a slower cadence with lighter breaths is preferred over the common high respiratory rate with greater tidal volumes which are common amongst many people. Developing the ability to change our breathing patterns can provide several advantages which can optimize health and athletic performance.
From a polyvagal informed perspective, there are three primary purposes underlying the importance of awareness of breathing. Michael Allison has described these as using breathing as a tool to shift our biological state, a method to become aware of our current state, and a strategy to train our nervous system. When we adjust our breathing pattern in an intentional and deliberate fashion, we are able to evoke specific shifts in our physiological state, which will be described in further detail. In addition, becoming aware of our specific breathing patterns, such as whether we are breathing with a prolonged inhalation or exhalation can help with identification of the current physiological state. We can also utilize specific breathing techniques to challenge and train our nervous system, thereby increasing capacity and flexibility.
As described in past articles, ventral vagal states are associated with breathing patterns that include prolonged exhalation relative to inhalation utilizing the diaphragm for breathing. In contrast, sympathetic states are typically associated with a more rapid respiratory rate, breathing through the mouth and use of the chest. A dorsal vagal state is usually indicated by a depressed breathing rate that is particularly shallow. By developing an understanding of these patterns, it is possible to increase awareness of the current state and, also, inform strategies whereby we can adjust our breathing pattern to shift into a different state. For instance, if we are looking to increase ventral vagal stabilization, a powerful method by which to achieve this state is through intentionally adjusting breathing to a prolonged exhalation relative to inhalation while breathing through the nose using the diaphragm. Conversely, if we wanted to increase our energy level and mobilize towards a more sympathetic state, a more rapid rate with prolonged inhalation relative to exhalation and breathing through the mouth is ideal.
From the perspective of training our nervous system, breathing can be particularly effective. There are many strategies for using this skill to improve nervous system capacity and flexibility. Regardless of the specifics, the underlying concept is to use breathing patterns to either strengthen ventral vagal tone or to challenge the nervous system with subsequent recovery through return to ventral vagal activation.
If we are attempting to increase ventral vagal activation, one commonly utilized breathing pattern is termed resonance breathing. In this pattern, the ratio between inhalation and exhalation is either equal or there is a prolonged inhalation. The specific ratio for any individual can be determined through observation of the impact on heart rate variability (HRV). The ratio that is desired is that which optimizes HRV.
There are also many breathing patterns designed to challenge the nervous system, thereby increasing capacity and flexibility of the nervous system. Breath holds are an example of such a strategy. In this method, following exhalation, breath holds of varying lengths are performed until a state of air hunger is reached at which point regular breathing is resumed. This develops tolerance for carbon dioxide and helps train nervous system capacity and flexibility. It is strongly encouraged that everyone consult with their healthcare professionals prior to starting any breathing training programs to ensure that it is safe and appropriate to do so.
The preceding discussion has included description of how to shift biological state through breathing. In situations in which we seek to maintain our current state, we can also use our breathing. In this scenario, a pattern with a symmetric length of inhalation and exhalation is ideal. Breathing with such a ratio does not evoke shifts towards either ventral vagal or sympathetic states, thereby maintaining the current state.
It is important that adequate time is spent training and developing the breathing patterns for maintaining as well as shifting biological states. Unless these breathing patterns are well trained, like any skill, our proficiency may not be sufficient to fully implement and benefit from the strategies during situations in which we are most in need of applying these patterns.
Particularly during times of training these various breathing patterns, it can be highly instructive and informative to include use of a device that provides real time HRV measurements so that the direct impact of the various patterns can be observed. Increases in HRV are associated with increased ventral vagal activation whereas decreases in HRV accompany shifts towards sympathetic states. Furthermore, if breathing patterns, such as breath holds, are being used to challenge the nervous system, not only can the impact on HRV be determined but recovery following completion of the training can be appreciated.
The direct application of these strategies for using our breathing can be realized amongst healthcare professionals. We can use training breathing strategies to increase nervous system capacity and flexibility, thereby enhancing our tolerance to higher demand situations. We can use awareness of our breathing patterns to identify our biological state, thereby affording the opportunity to determine whether or not our current physiology is best matched to the situation. It is also possible to utilize breathing skills to shift our biological state as necessary. Each of these attributes are much needed on a regular basis while working within the high demand nature of the healthcare system. In addition, biological states can be readily and efficiently shifted using the appropriate breathing pattern, once sufficient proficiency with this skill has been attained.
Implementation of breathing practices provides important benefits for the polyvagal informed Practices of the Healthcare Athlete. Intentional and deliberate use of breathwork is a core component of the polyvagal informed toolbox and a highly applicable aspect to embodying a polyvagal informed life.
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Allison, M. The Play Zone: A Neurophysiological Approach to our Highest Performance. https://theplayzone.com.
Dana, D. Polyvagal Practices: Anchoring The Self in Safety. New York: W.W. Nortan & Company, 2023.
McKeown P. The Oxygen Advantage: The Simple, Scientifically Proven Breathing Technique That Will Revolutionize Your Health and Fitness. London: Piatkus, 2015.