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Inhale, Hold, Exhale, Pause

While I was looking at rhythms of breathing over the past months I kept bumping up against the idea of stopping the rhythm. We often look at what happens as the oscillation moves or flows in one direction, and then in the other direction, but what happens when the driving force stops?

In breathing, we have 4 different actions. We have inhalation, we have exhalation, and we have holding after inhalation, and pausing or holding after exhalation. There are Sanskrit words for these 4 parts as well, because if you're paying attention to the breath you will discover all 4 (no matter if you are in a modern clinical setting or ancient India). I tend to differentiate between the two types of spaces after the breath as retention after inhalation and pausing after exhalation. Retention after inhalation is holding the air, the Prana, the flow in the body, in the torso. Pausing is the space between the breaths that happens after exhalation. You can extend that pause into a different kind of holding which is more like retention as well, a retention of the air, the Prana, the flow out of the body.

There are relationships between different oscillating systems in the body. The most obvious to people, the most often talked about, is the relationship between breathing and heart rate. We usually refer to this as the Respiratory Sinus Arrhythmia, and it's a part of our heart rate variability. When we inhale, our heart rate tends to increase as the sympathetic drive rises. And as we exhale, our heart rate tends to decrease as the parasympathetic drive increases. There are arguments about how much the vagus nerve plays a role in this (it can, but it can also be uncoupled), so I'm going to just leave vagal tone out of this discussion. I mention it, though, so you don't think I missed that important note.

But what happens when we stop the breath? How does holding change the autonomic nervous system's influence on heart rate? We practice retention a lot in yoga and other esoteric or experiential breathing practices. We also pause breathing, although usually after exhalation, in some therapeutic breathing practices.

One of the many common ways that we experience this is in Square Breathing. In yoga we might refer to this as sama vritti pranayama (equal state breathing practice). In this practice we inhale for a count, then we hold for the same count, exhale for that same count, and then hold again for the same count. We often use the number 4 as the count (4:4:4:4). I was curious about what was happening, so I hooked myself up to my emWave Pro to see.

Wait, what is the emWave Pro? There is a method of breathing called HeartMath™ (I'm not going to write the ™ after every iteration of HeartMath, but we all know it's there now). HeartMath looks at the relationships between breathing and heart rate, but also incorporates focus on emotions and their impact on our heart rate variability. There is quite a lot of research that has been done to support this work, and HeartMath is actively involved in research. HeartMath developed some tech that can be used to see the variations in heart rate — you need both the app and the appropriate hardware from HeartMath. The app for a phone (IOS or Android) is called Inner Balance. The app for a computer is called emWave.

Here is a screen grab from my session. You can see the wave going up (with my inhale) and the wave going down (with my exhale). I start the 4:4:4:4 breathing pattern, and you can see the impact on my heart rate.

Inhale: the heart rate increases. Hold: the heart rate starts to decrease, because inhalation is over, but WAIT something is happening, there's no exhalation, so the heart rate resumes increasing. Then exhalation, heart rate decreases. Pause after exhalation, heart rate continues to decrease.

Because of this relationship between retention (after inhale) and pausing (after exhale) with the autonomic nervous system, when we are working with people to help them calm, we recommend only pausing after exhale. Retaining will heighten the sympathetic nervous system, and along with it anxiety.

So why is it that people prefer to hold after inhalation?

(Yes, that was a long walk to that question.)

There are other things that happen in the body when we retain the breath. For example we create tension at the throat and in the pelvic floor. We also slow or stop the flow of cerebrospinal fluid and therefore also of the glymphatic system. Why would it be that people, and in my experience often people who have a lot of stress or a history of traumatic stress, prefer holding after inhalation?

I suspect the following. Particularly for those among us with traumatic stress, being sympathetically aroused feels more familiar. When we are in the fight/flight/freeze state, we feel as though we are doing something. When we pause after exhalation we are doing nothing. We are become more relaxed, we are waiting to see what might autonomically happen, without really knowing when it will occur. Inhale + hold = familiar stress of action. Exhale + pause = the emptiness of not knowing.

How does that land in your body when you hear it?

In Buteyko breathing techniques, which are very effective at helping with lung conditions such as asthma, COPD, bronchiectasis, and others, we only hold or pause after an exhale. The reason for this is that the breathing dysfunction is caused, in part, by stress. Part of how we heal the breathing pattern disorder is by also helping people shift into a more relaxed state.

Of course, when we are in a stressed state, that is not the time to try to change your breathing. We need to act, to do something to help alleviate the stress first. I often call on movement practices, but sometimes we need to be practical. If the house is on fire, please don't close your mouth, nose breathe, and start doing some hip rotations. CALL EMERGENCY‼️ Do what you can to change the situation, and that will help you feel better in your body. If the stress is from an historic event you'll likely need to get some professional help and dig into that with some depth psychology. If it's a habit of breathing that is a hold over from some other situation, that's where I can help.

But perhaps you will want to start with an inhale + hold. That might feel more accessible to you in slowing down the breathing. The more I learn about this, the more I see that there are so many different paths to the goal of well being. And they often don't go the route you might think they will.

So, should you breathe in a 4:4:4:4 pattern?

Maybe. I don't know what's always right for you. Check in with your body, and notice what it's telling you. What is it saying before you change your breathing? And how do you feel afterwards? Do your patterns shift? Or do they just feel familiar? These are some of the questions I ask myself, and I would ask you. If you'd like to learn more, join me in a breath retraining course. We can work together to help you restore good patterns in all four parts of your breath.

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