A peer-reviewed journal that offers evidence-based clinical information and continuing education for dentists.

Breathe Your Way Calm

Terri Patrick, RDH, MS, CHES—an orofacial myofunctional therapist—is blogging for Decisions in Dentistry about COVID-19.

In previous blogs the challenges of breathing while wearing N95 masks and the benefits of nasal breathing to reduce the risk of SARS-CoV-2 infection were discussed. This post will present the concept of functional breathing to influence the autonomic nervous system to invoke relaxation, therefore making it easier to breathe behind the mask and to more fully rest and recuperate outside of work.

The autonomic system controls heart rate, digestion, respiratory rate, salivation, perspiration, pupillary dilation, and urination among other things. Most autonomous functions are involuntary, but breathing is also in our conscious control. Disordered breathing, if left untreated, can result in debilitating symptoms such as breathlessness, dizziness, a feeling of pins and needles, and chest pain.1 Oral breathing activates the sympathetic nervous system, creating stress on the body. This hyperventilation leads to high blood pressure, sleep disorders, respiratory infections, and brain fog. As such, healthy breathing is worth some attention to improve our immediate and long-term health.

It was formerly thought that our autonomic nervous system was beyond our conscious control. But we now know that our breathing can influence both the sympathetic and parasympathetic nervous systems. Our sympathetic nervous system is considered “fight or flight,” and is activated in response to an urgent, immediate need.2 Sympathetic nervous activity increases the flow of blood to the working skeletal muscles. This response was more appropriate many years ago when our bodies responded with large physical movements to evade threats or fight to survive. We rarely need such physiological responses today, yet this survival instinct remains. When we are not able to run or otherwise release the adrenaline in a physical way, it results in a delayed physical response, which, if accumulated long term, can result in anxiety and depression.3

Stressful Breathing

Breathing patterns can instigate a sympathetic response or result from sympathetic activation. In a state of stress, the sympathetic system ramps up, directing blood flow from organs, such as the stomach and bladder, to the muscles and brain. Heart rate increases, adrenaline surges, blood vessels constrict, and palms sweat. This physiological reaction is appropriate only on occasion and in short bursts. Response to a stressor can be immediate, but returning to a state of relaxation and restoration can take an hour or more.4 Patterns of dysfunctional breathing can cause an individual to remain in sympathetic dominance, which places demands on the cardiac and respiratory systems, resulting in fatigue. Frequency and duration of the sympathetic state may explain why some oral health professionals experience chronic fatigue symptoms even on days off. Signs of stressful breathing include: faster breathing, erratic breathing, oral breathing, upper chest breathing, noticeable breathing and frequent sighing.

Restful Breathing

The parasympathetic nervous system is activated during quiet, resting conditions. Known as “rest and digest,” its primary purpose is to conserve and store energy, as well as to regulate digestion and urination.5 Signs of restful breathing include: slower breathing, nasal breathing, diaphragmatic (belly) breathing, quiet breathing, steady light, slow, deep breathing, and few or no sighing.

Mindful attention to breathing can activate either the sympathetic or the parasympathetic nervous systems due to the influence of respiration on the heart. For example, during inhalation, the sympathetic nervous system precipitates a brief acceleration of heart rate. Conversely the heart rate slows during the exhalation.6 This heart rate variability (HRV) is a measure of physical and emotional resiliency. Higher heart rate variability demonstrates an ability to respond to the body’s external and internal needs.7 HRV is driven by breathing, allowing conscious control over this autonomic function. Slowing respiration shifts the balance of the nervous system toward the parasympathetic nervous system, which lowers heart and respiration rates and enhances digestion. Slower breathing supports greater HRV and toning of the vagus nerve, which, in turn, influences resiliency of the central nervous system.8

Functional breathing may be assessed by measuring breath hold time.9 The following exercise can help you determine your level of functional breathing:

  1. Rest for 5 minutes.
  2. Sit straight without crossing your legs and breathe comfortably and steady.
  3. After an exhalation, pinch your nose.
  4. Hold your breath and start stopwatch.
  5. When you feel a slight discomfort, resume your breathing and note the time.

Breathing is considered functional if the breath hold time is 25 seconds or greater. Lower levels correlate with heavier breathing, which activates the sympathetic nervous system, accelerating the heart and respiration rates. Higher breath hold times correspond with nasal breathing, which is lighter, slower, and diaphragmatic, and stimulates the parasympathetic nervous system while reducing anxiety.

Exercises to Improve Your Functional Breathing

Exercises to learn how to slow down breathing, engage the diaphragm, and breathe deeply for better oxygenation and parasympathetic nervous system activation are available.4,9–12 Results may be achieved more efficiently by working with a breathing specialist who begins with an assessment to develop a treatment plan tailored to individual need.

The following exercise can help calm the mind during periods of anxiety:9

  • Exhale as normal through the nose.
  • Hold your breath for 2 seconds to 5 seconds.
  • Breathe normally through the nose for 10 seconds.
  • Repeat the first three steps until you feel calm.
  • Resume regular breathing.

The way we breathe is as important as what we eat and drink. Developing healthy breathing habits can help oral health professionals move through these challenging times with less anxiety and a greater sense of confidence.


  1. Jones M, Harvey A, Marston L, O’Connell NE. Breathing exercises for dysfunctional breathing/hyperventilation syndrome in adults. Cochrane Database Syst Rev. 2013;5:CD009041.
  2. Brown TM, Fee E. Walter Bradford Cannon: pioneer physiologist of human emotions. Am J Public Health. 2002;92:1594–1595.
  3. Harvard Health Publishing. Understanding the stress response: chronic activation of this survival mechanism impairs health. Available at: https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response
  4. Nestor J. Breathing Videos. Available at: https://www.mrjamesnestor.com/breath-vids
  5. McCorry LK. Physiology of the autonomic nervous system. Am J Pharm Educ. 2007;71:78.
  6. Zaccaro A, Piarulli A, Laurino M, et al. How breath-control can change your life: a systematic review on psycho-physiological correlates of slow breathing. Front Hum Neurosci. 2018;12:353.
  7. Lehrer PM, Gevirtz R. Heart rate variability biofeedback: how and why does it work? Front Psychol. 2014;5:756.
  8. Gerritsen RJS, Band GPH. Breath of life: the respiratory vagal stimulation model of contemplative activity. Front Hum Neurosci. 2018;12:397.
  9. McKeown P. The Oxygen Advantage: Simple, Scientifically Proven Breathing Techniques. New York: Harper Collins; 2015:32–50.
  10. Buteyko Clinic International. Free Buteyko Method for Children. Available at: https://buteykoclinic.com/buteykochildren/
  11. McKeown P. Coronavirus Free Breathing Exercises. Available at: https://www.youtube.com/watch?v=AiwrtgWQeDc
  12. Ankrom S. Deep breathing exercises to reduce anxiety. Available at: https://www.verywellmind.com/abdominal-breathing-2584115


Leave A Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.

This website uses cookies to improve your experience. We'll assume you're ok with this, but you can opt-out if you wish. Accept Read More

Privacy & Cookies Policy