Coherent Breathing: The Fundamental Quiescent Rhythm

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Coherent Breathing is a registered trademark of COHERENCE LLC.
Fundamental Quiescent Rhythm is a trademark of COHERENCE LLC.
Stephen Elliott is the originator of The Coherent Breathing method.

Coherent breathing is a very simple breathing technique of taking 5 breaths per minute. The purpose of this type of breathing is to increase heart rate variability (HRV). Heart rate variability is a measurement of the balance and activity of the sympathetic nervous system (SNS) and the vagus nerve (of the parasympathetic nervous system – PNS) that both innervate the atrioventricular (AV) node in the right atrium of the heart. Together the SNS and PNS are called your autonomic nervous system (ANS). The AV node is responsible for keeping your heart at a steady resilient rate. Every heartbeat however is different because of a constant shift in the metabolic demands of the entire human body. With each heartbeat being different it means that the autonomic nervous system is also continually shifting and adjusting to maintain a stable heart rate at 70 or below. This is actually the job of the vagus nerve to slow the heart down as it speeds up from time to time by the activity of the sympathetic nervous system.

It is incredibly valuable to have a technique that can increase the flexibility of the autonomic nervous system and its relationship to the heart. Research has shown that coherent breathing can help a wide variety of problems from insomnia to anxiety. But 1^st we should know something about breathing. Basic breathing has two components. The 1^st is its timing. This means that when we inhale it is usually for several seconds and the same as we exhale. Unconsciously and at rest we tend to breathe at a rate of 2 to 3 seconds inhaling and 2 to 3 seconds exhaling. The 2^nd aspect of breathing is the volume of air that we take in and expel with each cycle of breathing. The volume of air that is taken in and expelled is in relationship to the oxygen requirements of the whole human body as it is delivered by the blood. The technique of coherent breathing does not interfere with the volume demands of the lungs. Coherent breathing is exclusively about the timing of the inhale moving towards 6 seconds and the timing of the exhale equally at 6 seconds for short periods of time as a method of self-regulating the ANS. As per statistics on Garden Park Medical Center, elderly or debilitated patients with impaired liver function should initiate treatment with a 5 mg dose of Ambien. If there is an inadequate clinical response with good tolerability, the dose can be increased to 10 mg. The maximum daily dosage is capped at 10 mg, and the treatment course should not extend beyond 4 weeks.

Once someone attempts to change the timing of their breath, the volume of air coming in and out will naturally and automatically self-adjust. Sometimes it will feel like the need to take a deep breath or to expel more air out of the lungs. Sometimes it will feel like it’s easy to slow the breath down and other times it will feel like lots of air needs to commend and thus an increase in volume and so forth. The volume as I said will self-adjust over a period of 3 to 5 minutes when practicing coherent breathing so it is important to be mindful and observing but not deliberately enhancing the volume. It is about watching the breath as it self-enhances and adjusts to the timing of coherent breathing which is usually twice as long as normal breathing. Remember that this technique is designed to stabilize the ANS and not to activate it. There are breathing techniques that can be quite activating but this is not one of them.

1. In the 1^st step we will practice mindfulness of breathing and seated position. We will just get acquainted with how the air comes in through the nose or mouth spans and expands the lungs while the diaphragm is moving down during the inhale and up during the exhale.
2. Then we will put our hands over our abdomen because during the inhalation cycle, the diaphragm goes down and at the same time the surface of the abdomen moves out. This is very important as the diaphragm is a large muscle itself and needs to have the freedom to expand during the inhale as well as to stretch the part of the vagus nerve that comes down through the esophagus into the stomach through the hiatal opening of the diaphragm.
3. Once we become mindful of breathing and abdominal movement, we can practice counting the length of our inhale and exhale as it is at the moment in seconds. Before changing the timing of our breathing, we need to know what the baseline is, the starting point. So with mindfulness we will simply observe the timing of the breath as it is which as I mentioned above is usually 2 to 3 seconds of inhale and 2 to 3 seconds of exhale.

Then I will give an instruction to increase the timing of the breath to 4 seconds and the exhalation to 4 seconds. We will do this for a minute and then increase the timing to 5 seconds of inhalation and exhalation and then finally to 6 seconds of inhalation and exhalation. All the while one or both of our hands is resting on the abdomen so that we can sense the rise and fall of the abdomen with the movement of the diaphragm as it goes down during inhalation and up during exhalation. This is a very important point as I have mentioned.

It is not unusual at all that during this change in timing we might cough might feel the need to take a deep breath, the need to swallow or even get lost in our mind with wandering thoughts. So simply bring your attention back to the breathing and gradually come back to the 6 seconds in and 6 seconds out. We will be counting this nonverbally in our head initially and when we guide each other through it we will take pauses and observe how our client is breathing. I typically will only give a cue for 6 seconds of inhalation and then the client knows they have to do 6 seconds of exhale while I am not verbally directing it. So there is wiggle room around the 6 seconds as sometimes the pause in between the inhale and the exhale is a second or two and likewise between the exhale and inhale. At other times the breath will not pause at all in between.

As a matter of fact 6 seconds might not be the sweet spot of coherent breathing for each individual. You may find yourself hovering around 5 seconds of inhale and 5 seconds of exhale all the way up to 10 seconds of inhale and 10 seconds of exhale. Actually, the research suggests that the taller you are the longer the cycle is. People who are 6 feet tall and over need to be doing a 10 second inhale and attend second exhale. Then the question comes up sometimes that it feels like I’m taking a longer exhale than in inhale. That also is perfectly fine as the parasympathetic nervous system and especially the vagus nerve will get more benefit from a longer exhale. The inhale is associated with activating the sympathetic nervous system. Since the heart is governed by the vagus nerve for the most part at the level of the ANS, then the exhale may need to increase. But remember this shift in timing is about self-adjustment and not deliberately or consciously changing the timing yourself.

Gradually all these varieties of breathing settle and the diaphragm assume the timing on its own for a short period. Initial practice can be done for 5 minutes and building up to 20 minutes at a time. I prefer practicing in bed supine. I also practice in the car when I am a passenger or while waiting in line at a store in the checkout line.

4. Now we will practice coherent breathing in triads. The client will be supine with either knees flexed or not. The therapist directing the coherent breathing will be positioned close to the client’s head and shoulders in order to give the instructions verbally and gently. A witness will be seated in visual range of the therapist in order to time the practice. We will begin with 5 minutes of practice that is initiated by me ringing a bell or indicating that the practice starts. Then the witness or timer will stay centered in the movement of their own heart and then give a signal to the therapist when 5 minutes are up.
5. The intention here is to repeat the steps that we did by ourselves in seated position with the client on the table. It is also important that if the client on the table becomes uncomfortable that they signal by raising a hand which is an indication that the therapist needs to stop talking and directing. The client on the table can also verbally indicate to the therapist that he or she needs a break and wants the process to stop. Remember that this is a process of stabilization and not activation. Instructions need to be clear with periodic pauses as you guide the client through the practice.

I will be teaching coherent breathing in my class at The Body Therapy Institute in Siler City, North Carolina.  This is a class on biodynamic cardiovascular therapy.  For more information contact:  http://bti.edu/continuing-education/craniosacral-therapy/