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The Importance of Breathing Patterns in CFS (and Fibromyalgia) Symptoms & Recovery





by Blake Graham, BSc, AACNEM

September 1, 2009


I have heard about the supposed importance of breathing in chronic fatigue syndrome (ME/CFS) for many years, and never took it very seriously. Then I read an article in Alternative and Complementary Therapies journal 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 ME/CFS.


While they come from a variety of different backgrounds, four of the eight mentioned the importance of breathing. This inspired me to look into the role of breathing in more detail. After studying this topic, I have become completely convinced that this is a very important issue.


The issues discussed here are all heavily interrelated. These relate to:

- The rate and depth of breathing,
- Dysfunction of the autonomic nervous system (ANS), and - Stress.


These issues collectively constitute a very important [cycle] which contributes to, and perpetuates, ME/CFS. And the treatment I’ll discuss is 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.


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, explaining the difference between chest and diaphragmatic breathing, is found online HERE.



Improper Breathing Retards Metabolic Energy Production
While people with ME/CFS have normal blood oxygen, cellular oxygen levels are often inadequate. Optimal breathing improves cellular oxygen concentration. Mitochondrial function, a key issue for those with ME/CFS, is highly dependent on oxygen levels for energy production. Shallenberger cites a case study in his book in which a person increased his metabolic energy production 20% after just half an hour of breathing instruction.


Dr. Sarah Myhill, MD, a co-author of “Chronic Fatigue Syndrome and Mitochondrial Dysfunction,” discusses the importance of breathing in ME/CFS. (See “Hyperventilation – Makes you feel as if you can’t get your breath.”). She writes:


"Hyperventilation – the idea here is that for whatever reason, the patient over-breathes. 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 hemoglobin.


“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."




Stress and Breathing
The link between stress and breathing goes both directions.

  • Higher stress levels cause faster/deeper breathing,
  • And faster breathing causes higher stress levels.

Read "Breathing Matters - Stress" by ear/nose/throat specialist Dr. Jim Bartley for an excellent article on the relationship between stress and breathing.



The Autonomic Nervous System and Breathing to Restore Balance
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 the PNS counteracts the stress response and is associated with relaxation, energy conservation, digestion, etc.

In many chronic illnesses, this autonomic balance is impaired with an excessive SNS response and under-active PNS response. Research on those with ME/CFS suggests the PNS relaxation response is under-active and SNS 'fight or flight' activity is either depressed, associated with exhaustion of the stress response system, or over-reactive. 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 our breathing rate is a key signal to the autonomic nervous system that SNS activation is needed, and certain breathing practices can be used therapeutically to restore balance in the autonomic nervous system.

  • Even if you feel mentally calm, if your breathing rate is overly fast, as it is for many people, this causes SNS activation.
  • Slow breathing (also called 'paced respiration') tones and normalizes activity of both the SNS and PNS.

Read the fascinating article “The Science of Coherent Breathing” by Stephen Elliott for an in depth discussion of the link between breathing and autonomic nervous system balance.


It's also interesting to note that energy medicine practices such as qigong (which literally means ‘breathing exercise’) believe that slow abdominal breathing is critical for the balance and flow of energy in our system.



Using Coherent or Resonant Breathing - Daily Breath Training
While breathing experts don’t agree on everything, they all agree that we generally breathe too fast and too shallow - and that predominantly breathing through our nose is ideal.


While a typical person might have 15 to 20 breath cycles per minute, an ideal number is 5 to10 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.


While we can’t quickly take up these new habits permanently, what we can do is daily breath training. 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. Breathing at this rate is referred to as coherent or resonant breathing.


What are the benefits of doing this?

  • On an immediate basis, this is deeply relaxing for most people.
  • Cumulative over several 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 ‘breathing pacemaker’ 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 ME/CFS do this breath exercise, combined with the practices described below, for 25 minutes twice daily.


1. 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.


2. While performing the breathing exercise, mentally scan your body and release any obvious areas of tension, e.g., in your jaw, shoulders and chest.


Throughout the day, periodically observe your breathing, slow your breathing rate and make sure you are breathing through your nose and abdominally. Also use this breathing technique, combined with Ujjayi (pronounced "oo-jai") breathing described below, in times of acute stress.


Ten minutes of Ujjayi breathing at five breaths per minute is an excellent stress buster!



Ujjayi Breathing for Calming Anxiety
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, cited above. They also recommend combining this with a simple breathing technique called Ujjayi breathing (literally, 'loud 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. 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 to 6 breaths per minute) ... Ujjayi is physically and mentally calming.


"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."


Type in “Ujjayi breath” at 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 breathe. It shouldn't feel strained or forceful, just relaxed and slow with a partial contraction of your throat muscles.



Complementary Practices – More Options for Banishing Stress
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 mind-body practices such as meditation or qigong for further benefit. A few options are as follows:

  • Heart focus. Fascinating research from The Institute of HeartMath has found that focusing attention on the area of your heart improves the balance and tone of the autonomic nervous system. In the HeartMath coherence exercises, they instruct you to imagine your breath is flowing in and out of the area of your heart.
  • Mantra based or breathing meditation. For example, focus attention on the flow of your breath.
  • Qigong meditation. Qigong traditions believe the abdominal region between your navel and pelvic bone, called the lower dantian, is a key energy reservoir. Qigong practices often involve focusing attention, or meditating, on this area.



Related Articles:


Blake Graham, BSc, AACNEM, is a clinical nutritionist specializing in nutritional and environmental treatments for patients with ME/CFS, FM, and other chronic conditions. He is an Associate of the Australasian College of Nutritional and Environmental Medicine, directs the Nutritional Healing clinic in Perth (WA), and publishes a free Nutritional Healing e-Newsletter.


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