Chronic Fatigue Syndrome (CFS): Breathing and the autonomic nervous system

by Blake Graham BSc (Hons)
Clinical Nutritionist 
www.nutritional-healing.com.au 

January 2011

The issues discussed in this article are all heavily inter-related. These include:

• Dysfunction of the autonomic nervous system (ANS).
• The rate and depth of breathing.
• Stress/tension.
   

These issues collectively constitute one very important area which contributes to, and perpetuates, CFS. The practices discussed are designed to break the cycle of these three issues. Some people have a bias against 'low tech', 'mind-body' or free treatments, assuming they are not as potent as other treatments, so please keep an open mind as you read through this.

I have heard about the supposed importance of breathing for many years and never took it very seriously. I read an article in Alternative and Complementary Therapies titled ‘Clinical Roundup: How Do You Treat Chronic Fatigue Syndrome in Your Practice?’. In the article, eight integrative/alternative medicine experts described how they treat CFS in their practice. While they come from a variety of different backgrounds, four of eight mentioned the importance of breathing. This inspired me to look into the role of breathing in more detail. After studying this topic, I became completely convinced that this is a very important area.

One of the sources I read was the book 'Bursting With Energy' by Dr. Frank Shallenberger. In it, he describes ‘Breathing Right’ as one of the ‘Eight Secrets for Improving Energy’. A brief summary of this chapter is found online HERE. While people with CFS have normal blood oxygen, cellular oxygen levels are often inadequate. Optimal breathing improves cellular oxygen concentration and blood flow, including to the brain. Mitochondrial function, a key issue for those with CFS, is highly dependent on oxygen levels for energy production. Shallenberger cites a case study in his book in which a person increased their metabolic energy production 20% after just half an hour of breathing instruction. Dr. Sarah Myhill and Dr. Charles Lapp are two CFS experts who discuss the importance of breathing.

"Hyperventilation – the idea here is that for whatever reason, the patient over-breaths. One cannot increase the oxygen carrying capacity of the blood this way, so oxygen levels are not increased, but carbon dioxide is washed out. This changes the acidity of the blood in such a way that oxygen sticks more avidly to haemoglobin. So oxygen is not released to the mitochondria where it is required and so mitochondria go slow, so cells go slow and this results in fatigue." Dr. Sarah Myhill

"This type of breathing [deep breathing through the lower part of your diaphragm] tends to relieve things like chest tightness, shortness of breath as well as spasms in the postural muscles." Dr. Charles Lapp 

The autonomic nervous system (ANS) is the part of the nervous system which controls involuntary functions. It is composed of two sections, the parasympathetic nervous system (PNS) and the sympathetic nervous system (SNS). The SNS activates our stress response (the 'fight or flight' response) and is associated with higher energy utilization, while the PNS counteracts the stress response and is associated with relaxation, energy conservation, digestion, etc. In many chronic illnesses, including anxiety disorders, the autonomic balance is impaired, with an over-active SNS and under-active PNS. Research on those with CFS suggests both the PNS and SNS are under-active, associated with exhaustion of autonomic nervous system. As the autonomic nervous system is one of the major regulatory systems in the body, this is a huge problem. What does this have to do with breathing? Well, it turns out that the nature of our breathing is a key modulator of the balance between SNS and PNS activation, and certain breathing practices can be used therapeutically to restore balance in the autonomic nervous system. Very specific slow breathing rates (also called 'paced respiration') normalizes and tones activity of both the SNS and PNS. Read the fascinating article ‘The Science of Coherent Breathing’ by Stephen Elliott, author of 'The New Science of Breath', for an in depth discussion of the link between breathing and autonomic nervous system balance.

Breathing more deeply and expanding the diaphragm also stimulates the PNS and influences autonomic status. It's also interesting to note that energy medicine traditions, such as qigong, believe that slow abdominal breathing is critical for the balance and flow of energy in our system. For more information on the profound influence the diaphragm has on our body see:

• Diaphragm Mediates Action of Autonomic and Enteric Nervous Systems, January 8, 2010, Psychophysiology, by Stephen Elliott.
   

Using coherent or resonant breathing

While breathing experts don’t agree on everything they all agree that we generally breath too fast, too shallow and that breathing predominantly through our nose is ideal. While a typical person might have 15-20 breath cycles per minute, an ideal number is 5-10 cycles per minute at rest. For example, five breath cycles per minute = one breath cycle per 12 seconds, or inhaling for six seconds and exhaling for 6 seconds. Breathing at this specific rate is referred to as coherent or resonant breathing. To achieve this a person can listen to an audio track which has a sound cue every six seconds. You simply inhale or exhale at each interval using the track like a metronome. What are the benefits of doing this? On an immediate basis, this is deeply relaxing for most people. Cumulative over many weeks, daily breath training has numerous benefits. It improves the function and balance of the autonomic nervous system which carries with it a host of benefits. Our natural breathing rhythm gradually shifts in the direction of that during the training so we don’t just benefit during the breathing exercises. Coherent breath training is one of the best ways to reduce levels of stress.

You can order a CD called 'Respire I' or download the audio tracks as MP3s (free audio samples are available). I enjoy track 2 which has Tibetan bells as the breath cue. I recommend that people with CFS do this breathing exercise, combined with the practices described below, for 25 minutes twice daily. Commit to two months of daily practice and then evaluate your response. Plan and make time. Intending to 'find the time' never works. Breathe through your nose and you should be able to feel your abdominal region expand with each inhalation. Breaths should be gentle and relaxed, not forceful or high volume. This exercise is also preferably done with eyes closed, as having ones eyes open favors sympathetic activation. While performing the breathing exercise, mentally scan your body and release any obvious areas of tension, e.g. in your jaw, shoulders and chest.

Use this breathing technique, combined with Ujjayi breathing described below, in times of acute stress. Ten minutes of Ujjayi breathing at five breaths per minute is an excellent stress buster! When done in bed the combination of coherent breathing, Ujjayi breathing and progressive muscle relaxation described below is very beneficial for many people with insomnia.

Ujjayi breathing

In the excellent book ‘How to Use Herbs, Nutrients, and Yoga in Mental Health Care’ written by three psychiatrists affiliated with universities in New York, the authors recommend 'Respire I' from www.coherence.com. They also recommend combining this with a simple breathing technique called Ujjayi breathing, a yogic breathing technique. They write:

"Those who are able to learn Ujjayi breathing can be instructed to use the Respire I CD with Ujjayi for even greater effects... In clinical practice, the authors find that basic Ujjayi breathing is the single most rapidly effective breath intervention for anxiety symptoms in patients diagnosed with anxiety disorders... The patient who is taught Ujjayi breathing will usually experience a profound sense of physical and mental calmness within five to 10 minutes of doing this technique."

"Ujjayi breathing creates a sound using contraction of laryngeal muscles with partial closure of the glottis, permitting fine regulation of the respiratory rate while increasing airway resistance, intrathoracic pressure, baroreceptor stimulation, HRV, RSA (Calabrese, Perrault, Dinh, Eberhard, & Benchetrit, 2000), and stimulation of somatosensory afferents in the pharynx, lungs, chest wall, and diaphragm. When done at a slow rate (2-6 breaths per minute) ... Ujjayi is physically and mentally calming."

Basically Ujjayi breathing amplifies the autonomic nervous system balancing influence of coherent breathing. Type in Ujjayi breath at www.youtube.com to watch videos on this breathing technique. Incorporate Ujjayi breathing along with the coherent breathing for the duration that suits your body and complete the duration of the breathing time by simply breathing along to the sound cues. You may need to start with just 5 minutes of Ujjayi breathing and build up over time as is comfortable. Make sure you keep your neck, throat, shoulders and chest relaxed as you breath. It shouldn't feel strained or forceful, just relaxed and slow with a partial contraction of your throat muscles.

Complementary practices

Start with the combination of coherent/resonant and Ujjayi breathing until it feels natural and easy. At this point, you can add aspects of other practices for further benefit. Two excellent options are as follows:

• Progressive muscle relaxation. Created by Stephen Elliot of coherence.com and Stephen Hawley, The Six Bridges is a form of progressive muscle relaxation, focused on autonomic balance, which complements the basic Coherent breathing exercises. Also see the June 2009 Coherence Newsletter for more information. The Six Bridges audio is available as an MP3 download or as a CD.

"The Six Bridges is the "progressive relaxation" method of Coherent Breathing. When we combine the practice of Coherent Breathing with the practice of the Six Bridges, muscles throughout the body gradually relax including those of the spine and the vascular system. Blood flow throughout the body increases, knots in the muscles gradually disappear, "granthis" in the nervous system are unraveled. The body moves more freely, the mind is relieved of hindrances."

• Energy medicine practices by Valerie Hunt, PhD. If you are open minded to energy medicine then I would strongly encourage you to look into the following. Valerie Hunt, PhD is a Professor Emeritus of Physiological Science, UCLA, and director of the Bioenergy Fields Laboratory. Since 1970 she has been doing pioneering research into the electromagnetic field of the human body and it's relationship with health. Hunt writes "Chronic fatigue syndrome isn't a chemical imbalance, but an energy field problem." In her CD 'Mind Mastery Meditations', on disc 1, track 1, she outlines simple exercises for optimizing the strength and coherence of the bioenergetic field. From Australia you can fax your order to 0011 1 310 457 2717, call 0011 1 310 457 4694 or email This email address is being protected from spambots. You need JavaScript enabled to view it.. If you trial this do the exercises daily for a minimum of two months.

Happy breathing!

Blake Graham, BSc (Honours)
Clinical Nutritionist
Perth, Western Australia