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The anatomy and process of breathing

This is an excerpt from Instructing Hatha Yoga 3rd Edition With HKPropel Access by Diane M. Ambrosini.

Human breathing structures are centered within a crowded part of the body—the torso, where most of the body’s major organs are located adjacent to one another. The heart resides near the middle of the chest, with the bulk of its mass shifted toward the left side. As a consequence, this fist-sized organ’s position leaves the left lung room for only two lobes, whereas the right lung has three.

The diaphragm, a parachute-shaped muscle, is located below the heart and lungs and attaches to the lumbar spine, the lower six ribs, and the sternum. As this powerful muscle contracts, it moves downward toward the pelvis. This downward movement causes the space in the chest cavity to expand, changing the pressure in the thorax. This pressure change creates a vacuum that allows air to be drawn in, and the lungs to fill. Concurrently, the intercostal muscles, located between the ribs, also contract to expand the rib cage upward and outward. Exhalation occurs when the diaphragm relaxes, moves upward toward the chest cavity, and the increased pressure in the lungs moves the air out through the respiratory tract (see figure 4.1).

Additional organs are located beneath the diaphragm—the liver to the right and the stomach and spleen to the left. The diaphragm has three openings to allow passage of the esophagus, the inferior vena cava, and the aorta. As you can imagine, then, when the diaphragm is activated, it causes movement, massage, and stimulation of the surrounding tissues and organs. These rhythmic movements also regulate intra-abdominal pressure, which aids the organs in functions such as digestion and elimination.

When the diaphragm does not contract fully, the lungs do not expand to capacity, and as a result, air is moved only into the upper chest, causing a person to breathe shallowly. This truncated respiration shifts the nervous system into fight-flight-freeze-fawn mode, causing even more rapid and shortened breaths while also placing increased tension on the neck and shoulder muscles. If the sympathetic nervous system remains continuously activated, it increases the production of the stress hormones adrenaline, noradrenaline, and cortisol, shifting the body into what endocrinologist Hans Selye labeled general adaptation syndrome (Selye 1946). The resulting hormonal overload places undue strain on the body and immune system and can diminish the body’s overall functional capacity, potentially leading to one of many the causes of premature death, such as heart disease, cancer, and stroke (Jerath et al. 2006).

The calming effect of deep, slow, mindful breathing is brought about by the parasympathetic nervous system, which, when activated, allows the body to rest, recover, and conserve energy. At the same time, this effect essentially deactivates the sympathetic nervous system’s self-protection mode. According to research reported in the International Journal of Preventive Medicine (Sengupta 2012), the regular yogic practice of deep, slow nostril breathing—a type of pranayama—produces a multitude of health benefits: reduced anxiety, healthier blood pressure, balanced brain waves, and improved physical endurance. So, the more fluidly and fully one breathes, the more tension is diminished in the rest of the body. Pranayama practices can help to keep the physical and energetic body healthy and slow the cellular decay that occurs when the body is under constant stress.

Pranayama

Prana [PRAAH-nuh] is considered the vital energy, or force, that animates life and is inherent in the breath. In turn, the term pranayama [praah-naah-YAAH-muh] refers to breathwork, which connects the mind and body in a shared consciousness. By targeting attention on the breath, one can more easily bypass mental chatter and the effects of the ego, thus allowing for a deeper awareness of the present moment. When a student begins to notice and consciously regulate their breath, circulation improves, delivering more oxygenated blood throughout the body and enhancing concentration (Esposito et al. 2016). This seemingly effortless action also helps to decrease internal inflammation and lower mental stress levels.

People generally breathe automatically, without conscious effort or thought. However, this does not mean that we cannot control our breath. In fact, for thousands of years, yogis have developed ways to bring what were once considered strictly involuntary bodily systems under conscious control. Noticing the rhythm and sensations of the breath provides a relatively simple and convenient way to connect with one’s inward self. The breath can be heard, felt, counted, and consciously altered without the need for specialized equipment—unlike measuring blood pressure, brain waves, immune cells, electrolytes, or digestion, none of which can be intentionally modified. The importance of breathing cannot be overemphasized because each of the body’s systems is positively affected when breathing becomes more stable.

The breath is also a metaphor for life. Not only can breathing patterns affect a person’s physiological well-being, but they can also affect—and be affected by—one’s thoughts and emotions. When someone is frightened, angry, grief-stricken, or stressed, the diaphragm, abdominal, and intercostal muscles tend to tighten up. This bracing results in shallow, labored breathing. Conversely, smooth, flowing breaths help to stabilize thoughts and relax the diaphragm, and in turn, an overall calm may follow.

Types of Pranayama

If you watch a young child sleep, you will notice the smooth, rhythmic rise and fall of their abdomen and the gentle expansion of the upper torso and chest. This is how all human beings begin breathing—free from worries about constantly needing to “suck in our gut” and simply allowing the fullness of prana to flow easily into and through our bodies. Over time, however, we pick up stresses and carry them through our life’s journey. This internal vigilance leads to the physical trussing of our breathing mechanisms. Therefore, we often need to retrain ourselves to breathe more expansively and efficiently with a softer abdomen.

The simplest pranayama is merely observing the breath. Breath awareness is often practiced during Shavasana (Corpse Pose) to redirect attention inward when the mind begins to wander. Yet sometimes one needs more of a hook, so softly counting the breath cycles can train the mind to remain focused on the rhythm of breathing. Over time, this practice becomes a habit, and the efficiency of each breath increases so that we can take in sufficient oxygen with fewer breaths. Animals that take fewer breaths generally live longer. For example, a tortoise breathes four times per minute and lives up to 300 years. The average human, in contrast, takes 16 to 20 breaths per minute and usually does not reach their 100th birthday!

Pranayama practices use conscious breathing through the nose, with very few exceptions. The nose is uniquely designed to filter and warm the air as it is inhaled, preventing many possible pathogens from reaching the lungs. Nostril breathing also tends to draw air farther down into the lower lungs, allowing more oxygenated blood to flow into the system. Not only can we practice yoga more efficiently and easily, but we can also walk, run, and even swim at a good pace while breathing deeply and relatively slowly—all without taking oxygen in through the mouth, which is dehydrating, reduces oxygen uptake, and decreases energy and concentration (Lörinczi et al. 2024).

In addition to the simple breath awareness used in Shavasana, there are many pranayama styles and techniques. The following subsections outline three of the most commonly practiced methods: deep abdominal breathing, complete yogic breath, and ujjayi [oo-JAAHY-ee] breathing. A fourth subsection addresses the alternate-nostril breathing technique nadi shodhana (NAAH-dee SHOH-duh-nuh), which instructors can teach at either the beginning or end of a class session or separately from asana as a preparation for meditating. The last subsection outlines simple breath techniques to help those experiencing long COVID; these techniques also benefit everyone. All of the methods are easy to teach; however, it is best to receive hands-on training from a qualified instructor before offering these styles in any great depth.

Deep Abdominal Breathing

As the name suggests, this simple form of pranayama practice involves drawing the breath deeply into the lower abdomen. Teaching this breathing form gives students the opportunity to become more fully aware of their current breathing patterns and shows them easy ways to actively control their breath. One way to teach deep abdominal breathing is to instruct students to place their hands on the lower abdomen over their navel. Invite them to breathe slowly and deeply so that they feel their hands gently rise from the expansion of the breath and lower as they exhale.

This practice may be done while standing, sitting, or (most easily) lying on the ground, either supine (faceup) or prone (facedown). Students should feel their abdomen expand while their ribs, chest, and shoulders remain as relaxed as possible (see figure 4.2). For additional feedback when lying supine, a small sandbag or folded blanket can be placed on the abdomen to produce a slight feeling of resistance, which can help students draw the breath deeper into the expanse of the abdomen.

Another option for this practice is to instruct students to lie prone, placing their hands beneath their forehead for comfort. Direct the students’ attention to the sensation of the abdomen pressing against the ground as they inhale. To further guide students, ask them to imagine being a small boat drifting on the gentle sea of their breath. They can visualize their torso rising and falling on small waves. Once a person becomes comfortable with deep abdominal breathing techniques, it tends to be easier to grasp and perform other breathing styles.

As a side note, the prone positioning in deep abdominal breathing is useful in creating a strong tactile feedback loop for retraining the breathing pattern in individuals who, essentially, “breathe backward.” This condition is called paradoxical breathing, and it causes the person to expand the abdomen when exhaling and draw the abdomen inward during inhalation. While some martial arts practices use this breathing pattern in the short term—in the long term it creates the same negative results as upper-chest breathing, discussed earlier.

Complete Yogic Breathing (Dirga Breathing)

Some refer to full, deep breathing as dirga breathing. Not to be confused with the Hindu goddess Durga, the term dirga [DEER-guh] translates from Sanskrit as “complete” or “long.” It is the practice of fully inflating the lungs from bottom to top. Here, in a full, deep inhalation, the lungs are filled by focusing on three parts of the torso. First, the breath is drawn deeply into the space of the lower abdominal area, and while continuing to inhale, the mid-rib section fills, until the entire torso is filled to the collarbones. At the end of this deep inhalation, the sternum is slightly lifted, and the collarbones (clavicles) expand forward and upward while the shoulders remain relatively still and relaxed.

When teaching the complete yogic breathing technique, repeat the following cue: “Chest up, shoulders heavy.”

Just as the inhalation fills the trunk space in three parts, the exhalation empties the lungs in three parts. Direct students to release the breath from the top of the torso to the bottom—from the upper chest to the base of the abdomen. At the end of the exhalation, instruct students to gently squeeze the abdomen inward to expel as much residual air as possible, thus enabling an even deeper inhalation on the next in-breath. If students have difficulty remaining relaxed during this technique, begin by focusing on the exhalation, which is the most relaxing stage of breathing.

Ujjayi Breathing

Ujjayi breathing (also called victorious, or ocean, breath) is a slightly more sophisticated pranayama technique that is used most often in Ashtanga hatha yoga classes. Basic ujjayi breath tends to expand the lungs and chest more fully and slowly and with more control than most other pranayama practices. It also may generate a bit of internal heat as a result of the energy required to move the breath through a slightly restricted throat. The breath produces a noise that resembles something like a whispering roar as it vibrates in the back of the throat and sinus areas, making a sibilant “ssss” on inhalation and a “hhhh” sound during exhalation. To achieve the sound, the back of the throat is slightly constricted, creating resistance in the breath flow in both phases of the breath cycle. When students synchronize their breathing in this manner, it sounds like a pod of dolphins breathing together.

An easy way to introduce ujjayi breathing is to invite students to begin by first breathing through an open mouth while they also slightly tighten the back of their throat. This action makes the breath more audible and makes it easier to sense the associated resistance. Instruct students to whisper as they inhale and exhale. For the more difficult inhalation sound, you might also invite them to practice making an “ash” sound while slowly breathing in. The exhalation is easier because they can usually get a good sound by trying to whisper a prolonged “ha.”

Although breathing through an open mouth makes it easier to feel the breath and hear the sound, as previously mentioned, mouth breathing can be very dehydrating. As students become more comfortable with the breathing rhythm, instruct them to shift to breathing through the nose. They should strive to keep and emphasize the sound vibrations.

This breathing method is quite efficient at helping students focus not only on breathing but also on the flow of asana movements. The distinct sound made with ujjayi automatically draws students’ attention to their breath. When a whole class uses this pranayama technique, they become a community, helping each other focus through the sounds they emanate. For example, on a day when a certain accomplished ujjayi breather was absent, the other students commented on how much they missed her audible breathing to help them stay present and focused on their own breathing during class.

Alternate-Nostril Breathing

Known as nadi shodhana, alternate-nostril breathing increases and balances the prana flow in both nostrils and throughout the whole body. The term nadi shodhana means “to clean the nadis,” or nasal passages, which are channels through which the energy, or prana, circulates. Chapter 5 provides more information about the energy system; meanwhile, this section acquaints you with the basic technique and main benefits of alternate-nostril breathing.

According to Drs. Gordon Dryden and Jeannette Vos, (1999) experts in education and brain research, as well as co-authors of The Learning Revolution, people retain five times more information when both hemispheres of the brain are active. By opening both nasal passages, alternate-nostril breathing engages both brain hemispheres, allowing for more mental clarity and focus.

The clearing and balancing effects of nadi shodhana on both nostrils make it easier for students to breathe overall. Unlike ujjayi breath, nadi shodhana is a quiet practice. It comes in many variations and styles of hand and finger positioning; the most traditional way is to use the thumb and the ring and little finger of the right hand to alternately close and release the nostrils. The index and middle fingers are typically folded inward toward the palm (see figure 4.3a). Another option is to instead make a V with the index and middle fingers and place the finger pads just above the eyebrows (see figure 4.3b).

Nadi shodhana is typically practiced in a seated position. However, another way to teach the technique is to direct students to lie supine with their legs in a comfortable position—either on the ground or up against a wall or chair. In either case, invite students to find a comfortable position and to allow the abdomen to be as soft and relaxed as possible. Instruct students as follows:

Begin by closing your right nostril with your right thumb and exhaling through your left nostril. At the end of the exhalation, begin to inhale through your left nostril. At the end of your inhalation, use the ring and little finger of your right hand to close your left nostril. Release your right nostril and exhale. Inhale through your right nostril. Close your right nostril with your thumb. Open your left nostril by releasing your ring and little finger, and exhale through your left side.

This process completes one breath cycle. For students new to the practice, start with 7 to 10 cycles. Remind students that if they feel dizzy or uncomfortable, they should stop and resume regular abdominal breathing.

These are simple, guided breathing techniques that you can introduce to students of all levels of yoga experience. There are many variations, including different hand positionings and breathing cycle durations. The key is to help students understand the importance of mindful breathing, not only during asana practice but also throughout their daily lives.

Breathing Techniques for Long-COVID Syndrome

The pranayama techniques previously outlined are suitable for most individuals, including those affected by the deleterious effects of long-COVID syndrome. Preliminary research suggests that specific breathing practices can help alleviate respiratory issues related to COVID-19 (Jagadeesan et al. 2022). When combined with mindful and restorative asanas, these techniques may offer relief from some of the respiratory issues and other symptoms associated with long COVID (Kaminsky et al. 2025).

Bhramari [brah-mah-REE] pranayama is a technique that adds a vibrational component to a prolonged exhalation. The sound, resembling the buzzing of bees, is where the pranayama gets its name. Like other pranayamas, bhramari taps into the parasympathetic nervous system to regulate stress hormones, and the long, slow exhalation also helps to strengthen the respiratory musculature. For some, the buzzing sound provides an audible focus that can literally drown out excessive mental chatter. Bhramari is often practiced by placing the thumbs on the tragus (front flap of the ear), the index fingers lightly on the eyelids, and the other fingers lightly on the face. However, it is best to begin with the simplest form of the practice without the hands.

Begin by coming to a comfortable seated position, and if it feels appropriate to do so, close your eyes while softening your forehead. Relax your lips and let your top and bottom teeth part slightly. Take a smooth, deep inhalation through your nose, and as you breathe out, make a low humming sound for the entirety of the exhalation. Draw your awareness to the sound and the vibration filling your head and throat. Practice six breath cycles, then breathe naturally for two cycles and begin bhramari for six additional rounds. Be sure to inhale smoothly, and if you feel agitated or uncomfortable, come back to normal breathing.

The American Lung Association promotes a simple practice of pursed-lip breathing as a means to improve shortness of breath, often a symptom of long COVID and other respiratory maladies. Similar to the long exhalation of bhramari pranayama, exhaling through pursed lips creates a resistance that slows the flow of breath, allowing for more effective gas exchange. The increased time to expel the air can reduce the sensation of breathlessness and help to decrease anxiety.

Start by taking a slow, easy breath in through your nose. To exhale, pucker your lips as if you were blowing out a candle and breathe out slowly and steadily. Breathe in again through your nose and repeat for six to eight cycles.

Sama vritti, or box breathing, is a technique that promotes focused, deep breathing and also helps to manage stress and anxiety. The term sama vritti [sum-uh VRIH-tee] translates from Sanskrit to mean “equal flow”; in this technique, the rate of inhalation, the rate of exhalation, and the pauses between them are the same. This breathing practice is used by U.S. military special forces to help them remain focused and calm during the execution of their duties. This pranayama is beneficial for those with long COVID and other respiratory ailments because it can help them mindfully shift the nervous system from “fight or flight” to a calmer, more regulated state.

Begin in a comfortable, supported seated position and inhale through the nose for a count of four, filling your lungs as completely as you can without strain. Hold the breath in your lungs for a count of four. Slowly exhale, either through your nose or through pursed lips, for a four count. There should be no extra force as you exhale. With your lungs emptied, hold for another count of four, and then initiate your next inhalation in the same manner. Many people envision drawing a square in their minds at each point of the breath cycle. Notice the sensations that show up during the holding phase of the practice. Repeat four to eight cycles initially, working up to a five- to six-minute practice.

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