Pranayama Traditions — Yogic Breathing Techniques and the Research

Pranayama, or breath regulation, is one of the practices of the yoga tradition. Patanjali's Yoga Sutras list it as the fourth of the eight limbs of yoga, and hatha yoga texts such as the Hatha Yoga Pradipika and the Gheranda Samhita describe specific breathing techniques. These include slow alternate-nostril breathing (Nadi Shodhana), rapid forceful breathing (Kapalabhati and Bhastrika), breathing against a partly closed throat (Ujjayi), humming exhalation (Bhramari) and mouth-inhalation practices the texts call cooling (Sitali and Sitkari). Laboratory studies have measured what these practices do to heart rate, blood pressure, heart-rate variability, metabolism and lung function, and small clinical trials have tested them in high blood pressure, asthma, COPD, diabetes and anxiety. This page reports how the techniques are described, what the studies found — including results that contradict traditional descriptions — and the adverse events that have been reported.


Table of Contents

  1. Origins — Patanjali, the Hatha Texts, and the Eight-Limb Path
  2. Nadi Shodhana — Alternate-Nostril Breathing
  3. Bhastrika — Bellows Breath
  4. Kapalabhati — Skull-Shining Breath
  5. Ujjayi — Ocean / Victorious Breath
  6. Sitali and Sitkari — Breaths Described as Cooling
  7. Bhramari — Humming Bee Breath
  8. Clinical Evidence — Blood Pressure, Asthma, COPD, Mood, Diabetes
  9. The Nasal Cycle and Nostril-Specific Physiology
  10. Reported Adverse Events and Concerns
  11. Key Research Papers
  12. Connections
  13. Featured Videos

Origins — Patanjali, the Hatha Texts, and the Eight-Limb Path

In the second chapter of Patanjali's Yoga Sutras, the practice of yoga is set out as eight limbs: yama, niyama, asana, pranayama, pratyahara, dharana, dhyana and samadhi, with pranayama fourth (Tripathi 2021, PubMed PMID: 34925910). A 2016 review describes Patanjali as having codified yoga practices into this eight-limbed model, and states that the Yoga Sutras make the mind the primary target of yoga (Varambally 2016, PubMed PMID: 27067548).

Specific breathing techniques are described in the classical hatha yoga texts. A 2022 comparison by Chetry and colleagues set the practice guidelines for Bhastrika, Bhramari and Kapalabhati in the Hatha Yoga Pradipika and the Gheranda Samhita against the methods used in 73 PubMed-indexed studies. It found differences between the texts and the studies in the depth of breathing (Bhastrika), the relative length of the breath phases (Bhramari) and the breath frequency (Kapalabhati), and noted that such differences could change the physiological effects and make results hard to combine across studies.

The tradition's conceptual framework describes the nostrils as representing subtle energy channels called nadis: the right nostril corresponds to Pingala Nadi and the left to Ida, and breathing through one nostril is said to affect the body differently (Saoji 2019). Studies that tested this idea are described in the nostril sections below.

The 2019 narrative review by Saoji, Raghavendra and Manjunath screened about 1,400 references and included 68 studies of yogic breathing practised on its own. The authors found that most of the literature pointed to beneficial effects, but also that the studies lacked methodological rigour and that larger, better-designed trials are needed.

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Nadi Shodhana — Alternate-Nostril Breathing

As summarized in the Saoji 2019 review, Nadi Shodhana (also called Nadishuddhi) is practised by closing the right nostril with the right thumb and breathing in through the left, then closing the left nostril and breathing out through the right, breathing in through the right, and breathing out through the left — one round — repeated for a number of rounds.

In the Telles 1994 study in the Indian Journal of Physiology and Pharmacology (PubMed PMID: 8063359), 48 men were randomly assigned to right-nostril, left-nostril or alternate-nostril breathing, practised as 27 breathing cycles four times a day for one month. Baseline oxygen consumption rose in all three groups — by 37% with right-nostril breathing, 18% with alternate-nostril breathing and 24% with left-nostril breathing. The left-nostril group also showed a rise in skin resistance, which the authors interpreted as reduced sympathetic activity to the sweat glands.

Other studies summarized in the Saoji 2019 review report reductions in blood pressure after Nadishuddhi in people with essential hypertension, an increase in skin resistance after 20 minutes of alternate-nostril breathing, and shifts toward parasympathetic measures with longer practice. Not every study found a change: in the Raghuraj 1998 study of 12 men (PubMed PMID: 10874345), heart-rate variability showed no significant change after Nadishuddhi.

The Pal 2014 study (PubMed PMID: 24741554) compared single-nostril practices: 85 students practised right-nostril breathing, left-nostril breathing or nothing, one hour a day for six weeks. Heart-rate-variability measures of sympathetic activity rose in the right-nostril group, and measures of parasympathetic activity rose in the left-nostril group.

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Bhastrika — Bellows Breath

Bhastrika ("bellows") is described in the Saoji 2019 review as quick, forceful breathing in and out with flapping of the abdomen, for up to 100 breaths. The Chetry 2022 comparison found that studies of Bhastrika did not always match the traditional texts in the depth of breathing they used, and some studies use a slow form.

The Pramanik 2009 study in the Journal of Alternative and Complementary Medicine (PubMed PMID: 19249921) tested such a slow form: 39 volunteers breathed in through both nostrils for about 4 seconds and out for about 6 seconds (6 breaths a minute) for 5 minutes. Systolic and diastolic blood pressure fell significantly, with a slight fall in heart rate. In a separate group of 10 who first took a parasympathetic-blocking drug, the same breathing produced no significant change, and the authors attributed the effect to parasympathetic activation.

Studies of faster forms summarized in the Saoji 2019 review report a reduction in anticipatory responses on a reaction-time test after 18 minutes of Bhastrika, and reduced reaction times in children after nine rounds of a rapid form called Mukha Bhastrika. A 12-week trial of Mukha Bhastrika training reported changes interpreted as increased parasympathetic activity.

The traditional distinction between the two forceful practices, as summarized in the Saoji 2019 review: in Bhastrika both the inhalation and the exhalation are quick and forceful; in Kapalabhati the exhalation is rapid and driven by the abdomen after an inhalation through both nostrils. How forceful yogic breathing relates to the Wim Hof Method's cyclic hyperventilation is discussed on the Wim Hof Method page.

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Kapalabhati — Skull-Shining Breath

Kapalabhati ("skull-shining", also called "breath of fire") is described in the Saoji 2019 review as sitting upright, breathing in through both nostrils and breathing out rapidly by flapping the abdomen at each exhalation, at 60–120 breaths a minute. The Chetry 2022 comparison found that published studies did not always use the breath frequency given in the traditional texts.

The Saoji 2019 review found that most yogic breathing practices shift autonomic activity toward the parasympathetic side, with high-frequency yoga breathing (Kapalabhati) the exception. The studies behind that finding:

A 2004 case report in Chest (Johnson 2004, PubMed PMID: 15136413) described a healthy 29-year-old woman who developed a spontaneous pneumothorax (collapsed lung) attributed to Kapalabhati; the authors wrote that it was the only such report known to them. Further reported adverse events are listed under Reported Adverse Events and Concerns.

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Ujjayi — Ocean / Victorious Breath

Ujjayi ("victorious") is described in the Saoji 2019 review as breathing in and out through the nose at a normal pace with a partial contraction of the glottis, which produces a light snoring sound, while staying aware of the breath passing through the throat. Within the yoga tradition, slow breathing is often paired with this contraction (Mason 2013).

The Mason 2013 study (PubMed PMID: 23710236) tested whether Ujjayi adds anything to plain slow breathing in 17 healthy young people new to yoga, all breathing at 6 breaths a minute. Baroreflex sensitivity rose with slow breathing with or without Ujjayi on the out-breath, but not when Ujjayi was used on both the in-breath and the out-breath. The largest rise in baroreflex sensitivity and the largest fall in blood pressure came from slow breathing with equal inhalation and exhalation and no throat contraction. Ujjayi gave a similar rise in oxygen saturation but slightly less improvement in baroreflex sensitivity and no change in blood pressure; the authors linked this to the extra effort and raised pressure in the chest that Ujjayi requires.

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Sitali and Sitkari — Breaths Described as Cooling

Traditional yoga texts describe Sitali (also spelled Sheetali) and Sitkari as cooling practices (Telles 2020). In the methods of the Telles 2020 study, Sitali was performed by rolling the sides of the protruded tongue into a tube and breathing in slowly through it, then closing the mouth and breathing out through the nose; Sitkari was performed by breathing in through the gaps between clenched teeth with the lips drawn aside, then breathing out through the nose.

That study (PubMed PMID: 31907342) measured 17 healthy young men during 18 minutes of each practice, of breath awareness and of quiet lying, on separate days. Axillary body temperature rose significantly during Sitali and Sitkari, while it fell after breath awareness and quiet lying. Oxygen consumption rose by 9.0% during Sitali and by 7.6% during Sitkari. The authors concluded that the results do not support describing these practices as cooling, and that they may induce a mild hypermetabolic state.

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Bhramari — Humming Bee Breath

Bhramari is named for the humming of the female honeybee. The Saoji 2019 review describes it as breathing out with a soft humming sound after a full inhalation, with the ears closed by the index fingers.

Humming itself changes nasal nitric oxide. In the Weitzberg and Lundberg 2002 study (PubMed PMID: 12119224), nasal nitric oxide rose 15-fold during humming compared with quiet exhalation in 10 healthy people. The paranasal sinuses are major producers of nitric oxide, and in a model of the nose and sinus the oscillating airflow of humming greatly increased gas exchange between the two. The authors proposed the measurement as a test of sinus ventilation and wrote that any therapeutic effects of the improved sinus ventilation should be investigated. The follow-up by Maniscalco and colleagues in 2003 (PubMed PMID: 12952268) found that the nitric oxide peak fell step by step with repeated consecutive hums and recovered after 3 minutes of silence, and that the size of the sinus opening was the most important factor. These studies measured humming, not Bhramari as a yoga practice, and did not test effects on infection or sinus disease.

Studies of Bhramari itself, summarized in the Saoji 2019 review, report non-epileptic bursts of gamma waves in the EEG during practice, a shorter stop-signal reaction time after 10 minutes of practice in 31 healthy men, and, in a heart-rate-variability study, a parasympathetic withdrawal during the practice that returned to normal afterwards.

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Clinical Evidence — Blood Pressure, Asthma, COPD, Mood, Diabetes

A 2020 systematic review (Jayawardena 2020, PubMed PMID: 32669763) found 18 controlled trials of pranayama on its own, with 16 to 160 participants and practice lasting from 4 days to 6 months. It reported benefits mostly in respiratory disease such as asthma, and concluded that further high-quality randomized trials are required for definitive evidence.

Proposed mechanisms remain hypotheses. Jerath and colleagues (2006, PubMed PMID: 16624497) proposed that slow deep breathing shifts the autonomic nervous system through inhibitory signals from stretch receptors in the lungs; the paper is a hypothesis article, not a trial.

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The Nasal Cycle and Nostril-Specific Physiology

The nasal cycle refers to spontaneous, reciprocal changes in how freely air passes through each nostril. Kayser first reported these changes in the scientific literature in 1895 (Flanagan 1997). A 1996 review by Eccles (PubMed PMID: 8777979) describes the cycle as periodic congestion and decongestion of the nasal venous sinusoids.

Practices that breathe through one nostril, as described in the Saoji 2019 review:

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Reported Adverse Events and Concerns

The Saoji 2019 review considered pranayama generally safe when practised under the guidance of a trained teacher, and found few reports of harm. What the studies and case reports describe:

The Saoji 2019 review noted that studies of yogic breathing lack methodological rigour. Decisions about breathing practices alongside a medical condition belong with a clinician.

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Key Research Papers

  1. Telles S, Nagarathna R, Nagendra HR (1994). Breathing through a particular nostril can alter metabolism and autonomic activities. Indian Journal of Physiology and Pharmacology, 38(2):133-7. — PubMed PMID: 8063359 · Search PubMed
  2. Sharma VK, Trakroo M, Subramaniam V, Rajajeyakumar M, Bhavanani AB, Sahai A (2013). Effect of fast and slow pranayama on perceived stress and cardiovascular parameters in young health-care students. International Journal of Yoga, 6(2):104-110. — PubMed PMID: 23930028
  3. Pramanik T, Sharma HO, Mishra S, Mishra A, Prajapati R, Singh S (2009). Immediate effect of slow pace bhastrika pranayama on blood pressure and heart rate. Journal of Alternative and Complementary Medicine, 15(3):293-5. — PubMed PMID: 19249921 · Search PubMed
  4. Cooper S, Oborne J, Newton S, Harrison V, Thompson Coon J, Lewis S, Tattersfield A (2003). Effect of two breathing exercises (Buteyko and pranayama) in asthma: a randomised controlled trial. Thorax, 58(8):674-9. — PubMed PMID: 12885982 · Search PubMed
  5. Telles S, Singh N, Balkrishna A (2011). Heart rate variability changes during high frequency yoga breathing and breath awareness. BioPsychoSocial Medicine, 5:4. — PubMed PMID: 21486495
  6. Brown RP, Gerbarg PL (2005). Sudarshan Kriya Yogic Breathing in the treatment of stress, anxiety, and depression: Part I-neurophysiologic model. Journal of Alternative and Complementary Medicine, 11(1):189-201. — PubMed PMID: 15750381
  7. Brown RP, Gerbarg PL (2005). Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression: Part II-clinical applications and guidelines. Journal of Alternative and Complementary Medicine, 11(4):711-7. — PubMed PMID: 16131297
  8. Saoji AA, Raghavendra BR, Manjunath NK (2019). Effects of yogic breath regulation: A narrative review of scientific evidence. Journal of Ayurveda and Integrative Medicine, 10(1):50-58. — PubMed PMID: 29395894
  9. Streeter CC, Whitfield TH, Owen L, Rein T, Karri SK, Yakhkind A, Perlmutter R, Prescot A, Renshaw PF, Ciraulo DA, Jensen JE (2010). Effects of yoga versus walking on mood, anxiety, and brain GABA levels: a randomized controlled MRS study. Journal of Alternative and Complementary Medicine, 16(11):1145-52. — PubMed PMID: 20722471 · Search PubMed
  10. Jerath R, Edry JW, Barnes VA, Jerath V (2006). Physiology of long pranayamic breathing: neural respiratory elements may provide a mechanism that explains how slow deep breathing shifts the autonomic nervous system. Medical Hypotheses, 67(3):566-71. — PubMed PMID: 16624497
  11. Pal GK, Velkumary S, Madanmohan (2004). Effect of short-term practice of breathing exercises on autonomic functions in normal human volunteers. Indian Journal of Medical Research, 120(2):115-21. — PubMed PMID: 15347862
  12. Maniscalco M, Weitzberg E, Sundberg J, Sofia M, Lundberg JO (2003). Assessment of nasal and sinus nitric oxide output using single-breath humming exhalations. European Respiratory Journal, 22(2):323-9. — PubMed PMID: 12952268
  13. Pal GK, Agarwal A, Karthik S, Pal P, Nanda N (2014). Slow yogic breathing through right and left nostril influences sympathovagal balance, heart rate variability, and cardiovascular risks in young adults. North American Journal of Medical Sciences, 6(3):145-51. — PubMed PMID: 24741554
  14. Raghuraj P, Ramakrishnan AG, Nagendra HR, Telles S (1998). Effect of two selected yogic breathing techniques of heart rate variability. Indian Journal of Physiology and Pharmacology, 42(4):467-72. — PubMed PMID: 10874345
  15. Mason H, Vandoni M, Debarbieri G, Codrons E, Ugargol V, Bernardi L (2013). Cardiovascular and respiratory effect of yogic slow breathing in the yoga beginner: what is the best approach? Evidence-Based Complementary and Alternative Medicine, 2013:743504. — PubMed PMID: 23710236
  16. Weitzberg E, Lundberg JO (2002). Humming greatly increases nasal nitric oxide. American Journal of Respiratory and Critical Care Medicine, 166(2):144-5. — PubMed PMID: 12119224
  17. Telles S, Gandharva K, Sharma SK, Gupta RK, Balkrishna A (2020). Body temperature and energy expenditure during and after yoga breathing practices traditionally described as cooling. Medical Science Monitor Basic Research, 26:e920107. — PubMed PMID: 31907342
  18. Goyal R, Lata H, Walia L, Narula MK (2014). Effect of pranayama on rate pressure product in mild hypertensives. International Journal of Applied and Basic Medical Research, 4(2):67-71. — PubMed PMID: 25143878
  19. Jyotsna VP, Joshi A, Ambekar S, Kumar N, Dhawan A, Sreenivas V (2012). Comprehensive yogic breathing program improves quality of life in patients with diabetes. Indian Journal of Endocrinology and Metabolism, 16(3):423-8. — PubMed PMID: 22629512
  20. Kaminsky DA, Guntupalli KK, Lippmann J, Burns SM, Brock MA, Skelly J, DeSarno M, Pecott-Grimm H, Mohsin A, LaRock-McMahon C, Warren P, Whitney MC, Hanania NA (2017). Effect of yoga breathing (pranayama) on exercise tolerance in patients with chronic obstructive pulmonary disease: a randomized, controlled trial. Journal of Alternative and Complementary Medicine, 23(9):696-704. — PubMed PMID: 28714735
  21. Jayawardena R, Ranasinghe P, Ranawaka H, Gamage N, Dissanayake D, Misra A (2020). Exploring the therapeutic benefits of pranayama (yogic breathing): a systematic review. International Journal of Yoga, 13(2):99-110. — PubMed PMID: 32669763
  22. Johnson DB, Tierney MJ, Sadighi PJ (2004). Kapalabhati pranayama: breath of fire or cause of pneumothorax? A case report. Chest, 125(5):1951-2. — PubMed PMID: 15136413
  23. Chetry D, Telles S, Mahadevan J, Prasoon K, Gandharva K, Agrawal M, Balkrishna A (2022). A comparison of practice guidelines for yoga breathing from the traditional texts and PubMed-indexed research. International Journal of Yoga Therapy, 32:Article 17. — PubMed PMID: 36669770
  24. Tripathi V, Bharadwaj P (2021). Neuroscience of the yogic theory of consciousness. Neuroscience of Consciousness, 2021(2):niab030. — PubMed PMID: 34925910
  25. Varambally S, Gangadhar BN (2016). Current status of yoga in mental health services. International Review of Psychiatry, 28(3):233-5. — PubMed PMID: 27067548
  26. Werntz DA, Bickford RG, Bloom FE, Shannahoff-Khalsa DS (1983). Alternating cerebral hemispheric activity and the lateralization of autonomic nervous function. Human Neurobiology, 2(1):39-43. — PubMed PMID: 6874437
  27. Flanagan P, Eccles R (1997). Spontaneous changes of unilateral nasal airflow in man. A re-examination of the 'nasal cycle'. Acta Oto-Laryngologica, 117(4):590-5. — PubMed PMID: 9288218
  28. Eccles R (1996). A role for the nasal cycle in respiratory defence. European Respiratory Journal, 9(2):371-6. — PubMed PMID: 8777979

PubMed Topic Searches

  1. PubMed: Pranayama autonomic
  2. PubMed: Alternate nostril breathing
  3. PubMed: Humming nitric oxide
  4. PubMed: Yoga breathing hypertension

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Connections

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