A number of studies have shown that proper breathing techniques can help in lowering your blood pressure, and in fact there is an excellent FDA approved breathing control device marketed for this precise purpose. See: RESPeRATE at: http://www.resperate.com/
Most of the available breathing control devices simply control the Respiratory Rate (or frequency) of breathing, to slow respiration and induce anxiety reduction and relaxation. (For more details on stress and anxiety reduction, see the module on this web site regarding same.) Slow breathing is indeed a major component of breathing relaxation to reduce hypertension, but it is not the complete story. We will show you how to use the Breathing Trainer™ to control your blood pressure by additionally adjusting your breathing pattern to include a longer expiration time, and to have end-inspiration and end-expiration breath hold pauses.
The manner in which you use your respiratory muscles to make your chest move is an important component of relaxation breathing. We will provide you with instructions as to proper chest movement, so-called "Diaphragm Breathing" to be used in conjunction with the Breathing Trainer™.
Furthermore, breathing control of hypertension appears to be linked to a technique originally called "RSA training" (Respiratory Sinus Arrhythmia training) or more recently called "Resonant Frequency Training" (RFT) or "Heart Rate Variability Training" (HRV). We will instruct you how to use the HRV technique as part of the Breathing Trainer™ program.
You will appreciate the convenience of this training at any time, with only visual prompting from your computer, and with no additional inconvenient attachments to connect.
Feeling stressed? Turn on the Breathing Trainer™ and relax, while your blood pressure falls.
We suggest you have the program conveniently running in the background and available for immediate use. And if you have a scheduling program, set it for a reminder every hour to take a break, relax, stretch with some ergonomic exercises, and use the Breathing Trainer™.
Essentially controlled slow breathing produces relaxation, and a calming effect, to reduce the stress and tensions of daily living. This in turn induces a reduction of hypertension. There is also evidence that slow breathing appears to directly reduce overactive sympathetic nervous system activity, and overactivity of the sympathetic nervous system causes constriction of the blood vessels, thereby increasing blood pressure. And typically with sympathetic overactivity there is also an increased level of alertness and tension. The relationship between alertness, tension and anxiety with the constriction of blood vessels and resulting hypertension is apparent, as is the influence of slow breathing to help reverse the hypertension situation.
Breathing control to produce deep relaxation, as a condition for meditation, has been practiced by various Eastern religious for the past three to four thousand years. For example, breathing control is an integral component of Yoga exercises, and much of Yoga is oriented to enhancing mind-body harmony and tranquility. It is well established that with breathing and relaxation techniques there are induced Brain Wave (Electroencephalogram or EEG) changes characteristic of a relaxed condition. The precise mechanism whereby these EEG changes are induced is debated.
But there is more to breathing benefits for hypertension than just calming and relaxation. For over a century it has been known that when one inhales the heart rate speeds-up slightly, and on exhaling there is a slight slow-down of the heart rate. This is known as Sinus Arrhythmia. Recent research using Fast Fourier Transformation (FFT) of the beat to beat cardiac interval has revealed spectral analysis patterns which reveal autonomic nervous system links to cardiac activity and blood pressure, as well as a peak associated with high anxiety states.
Reducing the breathing rate to close to five or six breaths per minute appears crucial to induce so-called "resonance" of the interacting heart and blood pressure homeostatic control systems, and this coincides with relaxation. Clearly, the cardiac, central blood pressure and pulmonary systems are linked through an interacting autonomic nervous system. And likewise, these interactions may be optimally trained by the technique of "Respiratory Sinus Arrhythmia Training" ( RSA training), or more recently called "Resonant Frequency Training" (RFT) or "Heart Rate Variability ("HRV") training. Unfortunately true HRV biofeedback training requires expensive equipment. However, a close approximation to direct HRV training can be achieved with the aid of the Breathing Trainer™.
It must be clearly understood, hypertension control is a medical management situation between you and your doctor. There are a number of diseases that produce hypertension, and a correct diagnosis and therapy program is essential. Breathing training is only an adjunct, mainly to the common so-called "Essential Hypertension" which has a substantial stress factor. HRV is a valuable adjunct to a hypertension program, but it will only reduce your blood pressure a moderate degree. For mild to even somewhat moderate levels of hypertension, HRV training may reduce blood pressure sufficiently to stop medications. Moderately severe to severe hypertension therapy of necessity will require medication management, but HRV training is still usefull in helping to reduce the amount of medication needed for optimal control.
The main control of high blood pressure involves medications, and often combination of medications, adjusted by your doctor, depending on your therapy response. In addition there are other important adjuncts to standard hypertension management such as smoking cessation, obesity correction, regular exercise, and proper diet, including salt and alcohol moderation.
With established hypertension, generally defined as greater than 140 systolic and 90 diastolic ("140/90"), breathing therapy has two advantages. First, it may provide a sufficient reduction to permit lower doses of medication, or in mild cases to avoid medication. And second, as a stress reducer, this provides a tool to reduce acute spikes in blood pressure that typically come when you are angry or upset. These acute spikes in blood pressure have been linked to strokes and heart attacks, and minimizing these acute blood pressure elevations is therefore desirable.
Recently the new concept of "prehypertension" has been officially promoted by the National Heart, Lung and Blood Institute. The previous disputed systolic grey area of concern at 120 to 139 mm mercury is now considered significant and worthy of intervention. Likewise the previous disputed diastolic pressure greater than 90 has been lowered to 80 to 90 mm mercury. People within these newly defined ranges are identified as having "prehypertension" and at risk of progressing to actual hypertension. It is estimated this involves approximately 50 million Americans. The therapy guidelines recommend lifestyle changes (i.e. smoking cessation, obesity correction, regular exercise, and proper diet including salt and alcohol moderation). And if these interventions are not successful, hypertension medications would seem indicated. Prehypertension patients would seem ideal candidates for breathing control strategies and HRV training, from both a medical and economic point of view.
We would like to suggest that breathing control with the Breathing Trainer™ would fit well with the lifestyle intervention paradigm, both as to stress reduction and the more direct anti-hypertensive effects. And this may be an attractive option for those who dislike taking medications.
An average sized adult with normal lungs has an approximate resting breathing pattern as follows:
Tidal Volume - 600 to 900 cc.
Respiratory Rate - 10 to 12 breaths per minute.
Inspiration Time 40% (therefore Expiration Time set to 60%).
End-inspiration Breath Hold - 3 to 4 %
End-expiration Breath Hold - 7 to 10 %
Set up the Breathing Trainer ™ and inhale in a steady manner so that the time of inspiration exactly matches the prompting signal. If you do so you should achieve an approximation of your actual breath volume.
Practice with this pattern, and experiment with and adjust the parameters until you are optimally comfortable. First adjust the Tidal Volume, and next the Respiratory Rate. The Inspiration and Expiration Times and the Breath Hold Times should require minimal, if any adjustments. A longer than usual expiration time is more effective in promoting relaxation. The Tidal Volume size of breath should then give you an indication as to whether you need to set a relatively larger or smaller breath volume for hypertension training.
An average sized adult approximate anti-hypertension breathing pattern is as follows:
Tidal Volume - 1500 to 2000 cc.
Respiratory Rate - Less than 10, and gradually working down to 5 to 6 breaths per minute.
Inspiration Time 30 - 35% (therefore Expiration Time set to 65 - 70%).
End-inspiration Breath Hold - 10 to 15 % (or more)
End-expiration Breath Hold - 10 to 20 % (or more)
On inspiration you will need smooth and gentle effort to increase your inspiration lung volume. This should end exactly at the beginning of the end-inspiration breath hold pause. This breath hold pause should be a distinct pause (which you may want to extend even longer than 15 %) and it should be very relaxed. Inspiration is associated with sympathetic nervous system dominance, and it is important to quiet this activity. Begin exhalation just before the end of the end-inspiration pause, to allow for mechanical lag of the breathing apparatus and permit coordination with the expiration prompting signal.
On expiration you should focus on relaxation of your entire body. Expiration is associated with increased parasympathetic nervous system activity. Exhalation should be completed exactly at the start of the end-expiration pause. During the end-expiration pause you should try to achieve a deep and profound state of relaxation. With practice, you may even wish to extend this pause longer than 20 %. Begin the next inspiration just slightly before the end of the end-expiration pause, to coordinate your breathing with the next inspiration prompting signal.
You may also use this breathing pattern to reduce stress, or to help you fall asleep. For more details, see the module on stress reduction, relaxation and sleep induction on this web site.
To understand what this is all about, you need to have an understanding of how the chest wall "bellows mechanism" that pumps air in and out of the lung works. There are two distinct but overlapping mechanisms.
The major organ of inspiration is the diaphragm, a dome shaped muscle on both sides of the chest between the chest and abdomen, that are attached to the back and lowest ribs. On inspiration these muscles contract, and the dome shaped structure is pulled down into the abdominal cavity, thereby making the chest cavity larger, and pulling air into the lungs. On expiration the diaphragm relaxes, and rises upward into the chest, pushing air out of the lungs.
With the diaphragm attached to the lowest ribs, proper diaphragm action is a complex interaction dependant on coordination with proper rib movement. The lower rib movement on inspiration is one of swinging outward and upward, pivoting about the anterior rib attachment of the Sternum ("Breast Bone") and posterior spine. This is the so-called "bucket handle" movement, as indeed this movement resembles the excursion of a bucket handle. This movement enlarges the chest, and puts the diaphragm into a position of more efficient operation. Overall, this is called "Diaphragm or Diaphragmatic Breathing."
The other major chest movement involves the upper ribs, with a movement that swings straight upward and forwards, the so-called "pump handle" movement. This is an emergency accessory chest movement, which can be easily seen in someone short of breath after heavy exertion, with a heaving chest movement as they try to regain their breath.
This same type of upper "pump handle" chest movement is typically seen in people who are tense, anxious or angry, even though they are physiologically not short of breath. In some uncertain manner this seems psychologically linked to the physiologic emergency accessory function. Empirically it has long been known that eliminating this type of chest movement by breathing training is associated with improvement of tension, anxiety and anger.
Therefore, eliminating the upper chest "pump handle" movement and switching to a dominant lower chest "bucket handle" movement, i.e. "diaphragmatic breathing" has an independent benefit in stress reduction, regardless of the slowing of the respiratory rate or other components of the breathing pattern.
This proper diaphragmatic chest movement may be learned by placing your finger tips or the palms of your hands directly over the lowest ribs beneath your arm pits. You should be able to feel the ribs and the top of the abdomen. As you breathe, feel the chest move laterally and slightly upward, and encourage and expand that movement until it feels natural. With a little practice you should be able to feel and reproduce this movement without having to place your hands on the ribs.
A common method to teach Diaphragm Breathing involves placing one hand over the upper-anterior chest, and one hand on the upper abdomen, with instructions to stop the upper hand from moving, and to make the abdominal hand rise on inspiration. It is suggested you not attempt Diaphragm Breathing in this manner, as it may induce a so-called "trick movement" of inefficient "Belly Puffing." Concentrate on the lateral chest movement as noted above and the upper chest movement will usually stop naturally. And with proper lower chest movement as noted above, the lower ribs will first move, and slightly later the abdominal expansion should be natural.
The recent discoveries of Resonant Frequency Training (RFT), or more recently called Heart Rate Variability Training (HRV), show promise as to understanding some of the mechanisms whereby slow / deep breathing is effective in relieving anxiety and reducing hypertension. Indeed, the related Resonant Frequency phenomenon appears to be a "window" into the central autonomic nervous system, and the complex interactive homeostatic feedback mechanisms of the heart, lungs and central blood pressure regulation. And through the vagus nerve there appears to be favorable influence in the limbic portion of the brain, which is associated with anxiety and depression.
First, empirical evidence from several clinical and research sources indicates that "resonance" between respiratory and heart / blood pressure interaction is strongly associated with a respiratory rate close to five to six breaths per minute. You should therefore eventually train your therapy breathing pattern down to a rate of 5 or 6 bpm.
Second, you need to expand, or widen the Sinus Arrhythmia phenomenon, i.e. the normal speeding-up and slowing down of the heart rate with breathing. This is best done with special cardiac biofeedback equipment that gives an appropriate direct beat to beat rate signal. Unfortunately this equipment is complicated and expensive.
However, with practice you should be able to achieve "resonance" by breathing with the Breathing Trainer™ with a breathing pattern as noted and at a rate of 5-6 bpm by monitoring your pulse continuously.
While doing so, ON INSPIRATION, and particularly during the end-inspiratory pause, concentrate and feel and voluntarily will your pulse and heart to beat faster.
Then, ON EXPIRATION, and particularly during total relaxation during the end-expiration pause, feel and voluntarily will your pulse and heart to beat slower.
You will not be able to tell for certain whether or not you have achieved partial or full "resonance." But if you find you are settling into a deep calming state, and your blood pressure after a training session has reduced significantly (e.g. 15 to 20, or even up to 30 mm mercury systolic) then probably you have achieved resonance.
If uncertain about RFT / Heart Rate Variability training, you might consider inquiring if there is a local Clinical Psychologist or Biofeedback Practitioner with the equipment to directly study this phenomenon. This would permit definition of the precise optimal respiratory heart rate for "resonance" as well as evaluate the extent of the resonance itself.
We hope this lengthy discussion has been informative, and that it helps you to achieve maximal stress reduction and blood pressure reduction using the Breathing Trainer™. Indeed, there is rather more than just slower breathing involved.