3 Simple Breaths to Share

On nervous system co-regulation

There are three simple, quick, and effective breathwork techniques I use to bring calm to patients on the ambulance, to my kids, and to myself. The first two practices work in times of more significant overwhelm, and the third practice is for everyday anxious moments.

First, I want you to feel how purposefully altering your breath quickly and directly influences your nervous system. 

So let’s try this right now. It takes less than a minute.

1. Find your radial pulse at your wrist. Using the first two fingers of one hand, apply light pressure at the thumb side of the wrist, about half an inch from the base of your palm. You should be able to feel a slight pulsing with each heartbeat. If not, adjust hand and finger position until you do. Keep your fingers on your pulse during the next steps.

2. Slow your breathing down: long slow inhale, long slow exhale. Through the nose, ideally. Don’t worry about counting.

3. Continue for a few cycles like this.

4. Notice: toward the end of the inhale, your pulse quickens. As you exhale, feel your pulse slowing down. It can be subtle, but this effect is powerful.

SOS: Practices for Distress

4-8 Breathing (a.k.a. Extended Exhale)

This is a simple, powerful practice that’s easy to lead people through. I use it on the ambulance and with our kids most frequently.

• Breathe in for 4 seconds, out for 8 seconds. Repeat for as many cycles as needed. Note that the longer exhale is slowing the pulse, as we felt above. Repeating longer exhales brings the overall heart rate down.

• Breathe low, into the belly. Putting a hand over the belly button helps, feeling that hand move with the breath. We want to feel that inhale low in the belly, ideally, rather than up in the chest.

• In through the nose, out through the mouth. It can be hard for people who’ve never done breathwork to exhale slowly through the nose—especially kids, and/or folks in distress. Exhaling through the mouth makes that long, slow exhale much easier.

• Trust and continue. People in distress will often struggle to extend both inhales and exhales at first. Their breathing is often fast and ragged for the first 30-60 seconds. Just calmly do it with them, having them follow you until they slow down and match you. If you’re doing it on your own, just know it might take a few (or more) cycles to calm down. That’s perfectly fine.

I had a twenty-something patient on the ambulance not long ago with minor injuries from an auto accident. She was quite understandably shaken, so we did some 4-8 breathing together en route to the hospital. She could watch on the heart monitor as her pulse rate ticked reliably downward.

I’ve shown my kids this same effect by having them feel their own pulse. Seeing or feeling this promotes a sense of control and capability: I’m doing something, and it’s working. 

Counting the breath also helps to get one’s mind off of the initial stressor. This technique usually slows the pulse significantly in less than 90 seconds. If it takes a bit longer, that’s fine, too. There’s no rush.

4-7-8 Breathing

This technique is slightly more effective than 4-8 breathing, and slightly harder to do. That’s the trade-off. The only difference is a pause after the inhale:

• 4 seconds in through the nose

• 7 second pause

• 8 seconds out through the nose or mouth

I sometimes use this variation with patients experiencing a panic attack—if the patient can tolerate the 7-second pause. If they can’t, I go with 4-8 breathing, which works wonderfully.

With kids, I find the pause is often too much, and stick with 4-8. Both work great, so if the pause isn’t well-tolerated, 4-8 is the way to go.

Why the pause?

That pause allows more CO2 to build up. We often think of CO2 as a waste product, but it’s essential. People having panic attacks feel like they can’t breathe, but they actually have plenty of oxygen, and not enough CO2. We need CO2 to put the oxygen to use.

This is why the old trick of breathing into a paper bag works, by the way – by raising one’s CO2 level. The brief breath hold in this practice accomplishes the same thing. 

4-7-8 is also weirdly effective for falling back asleep. If I wake up during the night, I do a few cycles of this, and am usually drifting back to sleep by the third cycle. 

Relief for Everyday Anxious Moments

The Physiological Sigh
I first learned of this practice via Andrew Huberman. You’ll see young children naturally do this after a period of sobbing—that sniff-sniff-exhale. It’s one of the body’s natural, adapted responses to a CO2 imbalance, and one that we all do in deep sleep.

Unlike the previous two practices, my experience is that this one is not the go-to during overwhelm, but better used before lift-off.  I don’t use it on the ambulance, and I find that although kids will do this naturally, 4-8 is much easier to guide them through, and works better during distress.

That said, I use this one myself the most, whenever I feel any free-floating anxiety. It feels so good.

• Swift inhale through your nose to ~95% full lungs

• An additional sniff of air to 100% full

• Slow, complete exhale through the mouth, dropping the shoulders

Do 2-3 of these whenever you notice anxiety creeping in.

.Our teen daughter, who has found great relief in 4-8 breathing in the past, recently helped a younger kid avoid a full-blown panic attack. She took him into a quiet room and helped him breathe his way back. The younger kid reemerged a few minutes later, teary, but calm. 

“It gave me hope,” my daughter told me later. “Seeing it work on someone else made me feel more confident about using it for myself.” 

This is just how I felt, the first time I led someone through 4-8 breathing. There’s something powerful in a moment like that, where someone else’s nervous system is taking a calming cue from yours—co-regulation, as it’s known. Both your pulse and theirs are slowing in tandem, this shared recognition and relief that right now, everything can be just that little bit more okay.

As with any practice, see what works for you, and trust your own experience above all else.

If you enjoyed this post, please tap the heart ❤️ and share it with someone else who might find them useful. I’d also love to hear how it goes for you. Either way, I appreciate your being here.

Big thanks to

Jack Dixon

from

Longevity Minded

for comments and feedback on a draft, and

Emily’s Newsletter

for helpful feedback on the initial idea.

For further deep dives and techniques to manage the nervous system, I highly recommend

Jonny Miller

’s essential course, Nervous System Mastery. I was a student and then a mentor in previous cohorts, and can’t recommend it highly enough.