Coherent Breathing

A Stress Busting Breathing Technique You Can Easily Do Every Day
To Switch off Stress Responses, Energise Your System & Promote Heart Health

© Peter Smith –Holistic Medicine Practitioner-

Introduction to Coherent Breathing

When you switch on the relaxation response you completely put an end to your stress responses in which your autonomic nervous system is being held in a sympathetic dominated condition and your HPA axis is actively pumping stress hormones into your bloodstream. Activating the relaxation response you swing your system as far as possible into a deeply relaxed state where your autonomic nervous system is in the parasympathetic dominated condition and your HPA axis stops pumping stress hormones into your bloodstream. With coherent breathing on the other hand you do not go into a parasympathetic dominated condition but rather a neutral condition between the stressed and relaxed states. Despite not changing you into a deeply relaxed condition coherent breathing does nevertheless end stress responses in your system because the nervous system is no longer sympathetic dominant.
The coherent breathing state is a more fluid condition than deep relaxation in that as you inhale you become slightly sympathetic biased and as you exhale you become slightly parasympathetic biased, you swing slightly backwards and forwards between the two states like a pendulum.
The state you achieve with coherent breathing is also more fluid in that you could quickly respond from this position going either more sympathetic or more parasympathetic compared to the condition you are in when you have switched on the relaxation response; it usually take several minutes to rouse oneself from the deep relaxation session, but with coherent breathing you are on the one hand not stressed that the other hand absolutely ready for activity; perhaps you could also say the coherent breathing state is a neutral condition. These characteristics make it ideal for practising during the day.
With coherent breathing induced relaxation rather than feeling completely relaxed you achieve a feeling of inner calm and peaceful balance. The feeling is perhaps closer to the feeling you achieve with some meditation than it is to the feeling you achieve with deep relaxation. In meditation you are relaxed in that you are certainly not stressed however your mind is focused and your posture is perfectly maintained, the art of meditating successfully is to use just the minimal amount of tension required to maintain these things. Posture actually makes a big difference, lying down favours a more purely parasympathetic condition than sitting upright which requires more active sympathetic involvement. Coherent breathing should be practised sitting upright.
As mentioned with coherent breathing your autonomic nervous system is not fixed in a sympathetic (stressed) condition but actually swings gently to and fro becoming slightly more sympathetic active as you inhale and slightly more parasympathetic active as you exhale; your heart beat will significantly increase as you inhale and significantly decrease as you exhale, and believe it or not this is a very desirable healthy condition for the heart to be in.
Both techniques, the relaxation response and coherent breathing will help any stress related illness however training the relaxation response has more direct therapeutic effects for adrenal exhaustion, PMS and IBS, and coherent breathing has more direct therapeutic effects on cardiovascular health problems including hypertension, cardiac arrhythmias and poor peripheral circulation in the hands and feet, it is also a superior method to maintain cardiovascular health and prevent problems developing in the first place.
The above therapeutic differences are only academically interesting; in practice you should learn both and start with learning the relaxation response first. To understand why you should begin with training the relaxation response you could say that as you currently stand you are already highly skilled and adept at producing stress responses, you need no further training in this ability, but you lack skills in and do need to training your abilities to activate your relaxation responses, i.e. you’re currently able to activate your sympathetic nervous system with ease, but you have difficulty switching on your parasympathetic nervous system; this is a typical starting point for most people,
With this unequal ability between moving in a parasympathetic or sympathetic direction it is much harder to achieve the balanced, flexible condition you achieve with coherent breathing, in which you gently oscillate slightly more sympathetic when you inhale and then parasympathetic as you exhale. You will find it much easier to master coherent breathing if you have first mastered the relaxation response.
An exception to this rule is that some people with anxiety disorder find the relaxation response training provokes anxious feelings and they are unable to do it. These people may find the coherent breathing technique does not create this problem and should forego doing the relaxation response training until such times as they have overcome their anxiety sufficiently through a combination of balancing their brain chemistry, hypnotic and NLP techniques. See my book on treating anxiety due out 2013/14 for more on this subject.
People whose nervous system is perpetually held in a sympathetic state because of anxiety and or significant emotional events in their past more or less continuously reactivating stress responses will need fix these problems before they'll be able to achieve the required flexibility in their autonomic nervous system needed to master coherent breathing. Imagine a person with post-traumatic stress disorder whose had a traumatising thought program installed into their subconscious constantly holding them in the fight or flight response, maybe if they had the determination and wherewithal to persist in practising coherent breathing eventually it could hypothetically train them to switch off the strong sympathetic stress response they now live with. This is however a really inefficient and impractical proposition; the solution is to use focused psychotherapy techniques to treat the most dramatic stress disorder first, then train relaxation response and then learn coherent breathing. I really dislike to be critical but in my opinion who suggest that meditation and yoga relaxation training could help treat or cure post-traumatic stress disorder fail to understand the independent existence, power and resilience of learned subconscious programs including unwanted traumatising programs.
Coherent Breathing Vs the Relaxation Response for Insomnia
Coherent breathing is useful for people with insomnia to de-stress their nervous system during the day without falling asleep. When you are sleepy and activate the relaxation response lying down you’re likely to fall asleep; this is forbidden during the latter half of the day when you are treating insomnia.
If you have insomnia practice the relaxation response lying down last thing in the day when you're ready to sleep and optionally in the morning if you want to and if you fall asleep you can allow yourself to have a short nap. Practised coherent breathing during the afternoon and evening after work but do not allow yourself to fall asleep before you're permitted threshold sleeping time.
What Happens to Our Physiology during Coherent Breathing
1/ The Thoracic Pump
When we inhale our diaphragm muscle pulls down on the lungs and the muscles between ribs stretch the lungs upwards and outwards not only does this expansion suck air into the lungs but it also draws blood from the rest of the body including the extremities into the chest area. When we exhale the reverse happens and the pressure in the chest sends a pressure wave out of the chest through the blood throughout the body. The blood pumping effects created by our breathing muscles is called the "thoracic pump" and the pressure wave it creates in our circulatory system is called the "respiratory arterial pressure wave". With the right equipment the respiratory arterial pressure wave can be detected emanating throughout the whole body even in the fingers and toes.
The primary purpose of expanding and contracting the chest is to ventilate the lungs with air; to inhale oxygen rich air, absorbed the oxygen into our blood and to release and exhale carbon dioxide. A secondary benefit of expanding and contracting the chest is that it creates the thoracic pump helping the circulation of our blood thus assisting the action of the heart. When we breathe at the right rhythm the pressure waves generated by our heart and thoracic pump become synchronised and work together in unison. When this happens it optimises their effectiveness and reduces the workload on the heart this is very beneficial for our heart health.
The goal of coherent breathing is coordinating your breathing rate with your heart rate so that the pumping action of the heart and the pumping action of the thoracic pump work in sync and not against each other as can happen with uncoordinated stressful breathing.
When we breathe in this way not only does our heart relax but it has also been shown to relax your autonomic nervous system, the goal of this book.
2/ Heart Rate Variance HRV
Another phenomenon that occurs when we breathe is that our heart rate (beats per minute) changes. As we inhale our heart rate speeds up somewhat and when we exhale it slows down. For example let's say you measure your pulse rate to be 70 beats in a minute approximately half of that minute you will been inhaling and your pulse rate might have been 80 and the other half you will have been exhaling on your pulse rate might have been 60, giving you an average of 70. This phenomenon of our breathing speeding up and slowing down our heart rate is known as "respiratory sinus arrhythmia". This is a is a somewhat misleading sounding name, because one usually thinks of arrhythmias as a bad thing but in this case it is referring to a completely natural and healthy speeding up and slowing down of the heart rate as we inhale and exhale. The difference between the fast pulse rate when we inhale and the slow pulse rate when we exhale is called "heart rate variance" HRV.
Look at the diagrams below.
The grey shaded area is the pressure wave and volume of blood pumped out of the heart. The first diagram is a person doing coherent breathing, in the second diagram the person is breathing in a stressed in-coherent way.

Look at the spikes on the top of the grey shaded area, notice how these spikes change as we inhale and exhale. In the first diagram you can see the effects of coherent breathing, as we exhale the spikes become bigger and more spread out i.e. the heart beat slows down and the pressure wave increases. As we inhale the spikes are smaller and closer together i.e. the heart beat speeds up and the pressure wave decreases. This is the healthy heart rate variation we want to achieve.
In the second diagram you see the effects of irregular stressed breathing. Notice how the heart rate and volume (spikes on the top of the wave) hardly change at all as the person inhales and exhales. This is inefficient and if it is the person’s normal breathing pattern they have a higher rate of mortality from all causes than a parson who routinely breathes in a coherent way, de-stresses and increases their HRV.
Diagram from also see

[The physiological connecting between our breathing, heart rate and autonomic nervous system (cardiopulmonary resonance) is fascinating but far too complicated to be fully explained in a self-help book. The interested reader should start with: The New Science of Breath by Stefan Elliott.]
It‘s actually healthy and desirable to have a large heart rate variation of as much as 20-30 beats difference when we inhale and exhale, and this is one of the goals of coherent breathing. A diminished HRV has been shown to be associated with an increased risk of mortality particularly from heart disease. When people are stressed their breathing is not relaxed and coherent and their HRV becomes diminished. Interestingly HRV has been found to be reduced in people suffering from post-traumatic stress disorder, presumably because they're autonomic nervous system is frequently stuck in sympathetic fight or flight mode.
So coherent breathing coordinates the heart and thoracic pumps, it improves heart health, increasing HRV and switches off sympathetic dominance in the autonomic nervous system, ending stress responses which is the primary goal of this book.
In theory if you just sat still, rested and completely let go of stress for long enough eventually your breathing rate, your thoracic pump and heart rate would fall in sync with each other and set up a strong heart and respiratory arterial pressure wave, increasing HRV and efficient circulation. This condition may also occur as a natural by-product of some silent sitting types of meditation. However now that we have the advantage of knowing the precise coherent breathing rhythm that creates this resonance state in our physiology, you can learn to induce this healthy condition directly and easily even while doing other things at the same time.
Once you master this technique you will have an antidote to your stress responses that you can switch on regularly throughout the day. You can do it when sitting at your desk, working on the computer, watching television, while listening to someone talk, reading, washing the dishes, chopping the huge amount of vegetables I hope you’re eating etc. etc. An especially good time to practice coherent breathing for people with insomnia is in the evening as part of their winding down of the body ritual before going to bed.
Once learnt coherent breathing is very simple to perform, the balanced state it creates is something the body naturally wants to achieve, you just have to create the conditions and let your body settle into it. Both the coherent breathing state and the relaxation response create powerful therapeutic effects that are almost completely overlooked in conventional medicine. Even in alternative medicine these techniques are underutilised by most practitioners. Perhaps these techniques seem so simple and basic that it's hard to believe they could be as medically useful as they are.
How to Perform Coherent Breathing
The key components of coherent breathing are to simultaneously:
•        relax the mind and body a little and
•        regulate one's breathing rate to about 5 breaths per minute, i.e. inhale for about 6 seconds then exhale for about 6 seconds so that a single breath takes about 12 seconds and you end up doing about 5 breaths per minute. 
Many breathing meditation techniques impose a specific breathing rhythm from the outset, often a slow rhythm that activates a parasympathetic relaxation response, for example a basic breathing meditation technique is to inhale for 10 seconds then exhale for 10 seconds starting from the first minute and continuing to the end of the session. What makes coherent breathing different is that you must only gently guide your breathing into the ballpark but then allow your own internal physiology adjust itself to find the ball and its own internal rhythm. You have to ease into the breathing rhythm the only gradually and take the time and space your body needs to set up heart and lung resonance (cardiopulmonary resonance).
In the beginning of the training programme you will only impose an occasional 6 second exhalation, then relax and let your breathing do what it wants for a few breaths. Gradually you will add more and more 6 second exhalations, keep relaxed and allowing ample time for your nervous system and heart rate to adjust into the coherent state. Once you are able to feel relaxed and make each out-breath last 6 seconds you repeat the same process with your inhalation, i.e. occasionally imposed a 6 second inhalation then relax and allow your nervous system and heart rate to adjust.
Often in breathing meditations the priority is to maintain the breathing rhythm and push through feelings of strain that often occur in the beginning; such a method would not induce the same cardiopulmonary resonance and balance between your parasympathetic and sympathetic nervous systems that we are trying to achieve.
With coherent breathing induced relaxation the priority is to create a relaxed feeling and as soon as we feel any strain at all, we do not push through it, we just let the breathing rhythm go. If at any point you find it demanding or a strain to maintain the breathing rhythm you give up controlling the breath let it do whatever it wants and concentrate on maintain the feeling of relaxation.
In the beginning it may take many minutes to gently align your autonomic nervous system, breathing and heart rate into the coherent state, with enough practice however you may be able to switch into this balanced state in under a minute while doing other things at the same time.
The Coherent Breathing Procedure
Step 1
Your body needs to be in an upright position not reclining more than 45°.
With practice you will be able to initiate the balance effect in your autonomic nervous system even when standing.
Your eyes can be open, you may want to fix your gaze in one direction.
Prepare your session by stretching out tension from your breathing muscles. Take three or four very deep breaths using your diaphragm and primarily breathing into your belly, inhale so deeply that you completely fill the belly and it starts to put up the rib cage, you should feel a stretching in the sides of your rib cage. Obviously don't strain yourself if you have a relevant medical condition. The goal you're trying to achieve here is to stretch out tension that has built up in the diaphragm, it's just like stretching the muscles in your legs and back prior to going for a run. If you do the diaphragm stretch correctly you'll notice that your breathing naturally deepens straightaway afterwards.
Step 2
Choose to consciously relax all unnecessary tension in your muscles and adopt a relaxed mental state. Remembering the feeling you get when you practice the relaxation response can help.
Step 3
You can use a clock or just count seconds in your head, if you have a clock that ticks loudly at one second intervals or a metronome you can use the sound as a pacemaker.
Inhale fairly deeply and then time your exhalation to be about 6 seconds long. Everyone’s system is a little different and it's impossible to tell you exactly how deep your breathing should be, it should be a bit deeper than normal requiring a little gentle effort but still relaxed; this is not a very deep breathing pattern that requires any strain on the other hand you should have some sensation of breathing into your belly and using your diaphragm so that you are not performing a shallow breathing. In the beginning when you're learning coherent breathing you only control the timing of your exhalation once in every few breaths, so you do a 6 second exhalation and then just completely relax and let your breathing carry on normally, uncontrolled in any way for a few breaths. Then do another 6 second exhalation, do not try and control every breath in the first few minutes. You may be impatient to do the whole thing from the beginning but take your time and ease yourself into it, the technique will get much easier and quicker with practice.
Step 4
The breathing must not be jerky or have any pauses between inhaling and exhaling, it must be smooth like a pendulum swinging back and forth or a sine wave going up and down.
Step 5
As you continue with the above breathing induces or just imagine physical relaxation spreading throughout your body every time you exhale. Some people imagine a wave of relaxation propagating throughout the body as they exhale, others imagine a sinking down heavy feeling, do use whatever method that feels the most natural for you. If you previously learnt how to switch on your relaxation parasympathetic response you may simply try to reproduce that feeling as you breathe.
Step 5
Continue doing what you're doing and pay attention to the sensations of breathing and your body relaxing. There can be a little variation in the exact length of time the breath should be from individual to individual but 6 seconds is a fairly consistent average time that is correct for most people. If you come from a background of having done a lot of slow breathing meditations and pranayama you may actually find this step quite difficult, as you may keep spontaneously dropping into a slow breathing pattern that you have previously mastered, you must give this up for now.
When you are learning how to do coherent breathing use a 6 second breathing pattern. In the future once you have identified the sensations or felt sense of coherent breathing when you achieve a significant speeding up and slowing down of your heart rate (heart rate variation) and a balanced flow and ebb in your autonomic nervous system you can allow your breathing rate to adjust a little to exactly what's right for you. You do this simply by cultivating and deepening the feelings of balance and letting your breathing rate adjust slightly to cause this. Making adjustments like this is quite advanced so stick to 6 seconds for at least a month and a half. What you're looking for is subtle, you're looking for a felt sense of what feels most relaxing. When you find the right rhythm you feel your body settling into it, finding its rhythm.
Once mastered you will be a will to switch on this state in many everyday situations and significantly improve the way you manage unhealthy stress responses. You will be able to use it before a meeting or interview for example and be the calmest person in the room.
Step 6
Continue adding more 6 second exhalation s and relaxing until you are able to make every exclamation 6 seconds long and a distinct sensation of relaxation throughout your body each time you exhale. When this happens you are successfully coordinating your exhalation with the parasympathetic phase of your heart rate variability cycle and inducing or coordinating an effective parasympathetic response. Congratulations you've already learned how to do something therapeutic to your stress responses.
Step 7
Now you repeat the same process with your inhalation i.e. make an inhalation 6 seconds long and then just relax your body and your breathing dude wants to do, and then do another 6 second inhalation, gradually doing more and more while maintaining a state of relaxation until you can continue doing each information and a 6 second place and staying relaxed at the same time. While you're focusing on your inhalation you can more less that the exhalation do what it wants for the time being.
Step 8
Start to combine 6 second inhalation with 6 second exhalations, a gain you don't try to make every inhalation/exhalation 6 seconds long, instead you do one or two and then take a break and letting your breathing do whatever it wants. Gradually do 2, then, 3 timed inhalations/exhalations, stringing more together without strain until you can maintain this pace of breathing continuously.
In the beginning of training to do coherent breathing it may take you 10 to 20 minutes before you can complete step 8. Spend about 20 minutes a day practising coherent breathing until you are able to get to step 8 within five minutes. YOU HAVE NOW SUCCESSFULLY COMPLETED YOUR TRAINING PROGRAM, YOU CAN REMOVE YOUR LEARNER PLATES AND PRACTICE THE TECHNIQUE OUT IN THE REAL WORLD :-)
At the least two or three times per day even while you're doing something else like working at the computer practice 5 to 8 minutes of coherent breathing and you should be able to prevent stress responses negatively impacting on your health.
During phases of heightened stress, moving house or starting a new job for example, or if you want to maximise your immunity, set aside 20 to 25 minutes and perform either a dedicated session of switching on your relaxation response or some form of control breathing meditation. For the breathing meditation you could do coherent breathing, or a breathing meditation with a slower pace such as inhaling for 15 seconds then exhale in 15 seconds, which makes one breath cycle 30 seconds and therefore you take to breaths per minute; or do a combination of half the time slow breathing to induce a deep parasympathetic response and the other half of the time doing coherent breathing to induce a balanced condition in your autonomic nervous system.
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I treat and coach people with mental health problems at my London clinic and via Skype how to use natural remedies, diet, brain training meditations, sleep and specific physical exercises to treat the health of the brain for mental health problems including:
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 © –Holistic Medicine Consultant-
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Over the years I’ve trained in Nutritional /naturopathic medicine, Cognitive Hypnotherapy and NLP, body-centred psychotherapy, Chinese herbal medicine, Acupuncture, Bicom resonance therapy, meditation and Kundalini yoga, in the past I specialised in digestive health problems including IBS, bloating, candida, parasites, constipation, Heavy metal detoxification and chronic fatigue syndrome including adrenal exhaustion. I practice at the Hale Clinic (central London) and via Skype as a holistic medical practitioner and have been in practice since 1988.
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