Some experts say 9 in 10 of us are missing out on the mental and physical benefits of breathing well. Here’s how to take a deep breath, the mindful way.

The story in my family is that a coat hanger saved my life.

I was about 18 months old and was suffering with a horrible case of pneumonia that made it difficult for me to breathe. One night I was struggling so badly, my father called our family doctor and pleaded with her to make a house call. When she arrived, or so the tale goes, she took one look at me, grabbed a wire hanger from the closet, and performed an emergency tracheotomy on the spot.

Everything turned out fine, and within a few weeks I was up and crawling again, but what lingered for years was a feeling of vulnerability—and an ambivalent relationship to breathing—that has shadowed me throughout my life. I was hospitalized again with pneumonia in my teens, and even as an adult I sometimes struggled to exhale or mysteriously stopped breathing altogether. I started meditating years later and listened to teachers rhapsodize about following the breath, which was my idea of hell. I danced around it, focusing on noting thoughts or experiencing bodily sensations—anything except following the breath. But you can only hide from your breath for so long. Eventually, I would have to address the problem head-on. If breathing is the gateway to a happy and peaceful life, as many meditation teachers claim, how could I continue to ignore it?

So, I reached out to Belisa Vranich, the author of Breathe, a classic book on the mechanics of breathing. Vranich, a psychologist who runs a learning program called The Breathing Class, got interested in breathing when she started practicing in New York City and found that many of her patients were so agitated they couldn’t take in anything that she had to say. But when she started looking for some simple breathing techniques to teach them, she found that, even though everyone agreed that breathing was important, the majority of people—including many experts—were doing it all wrong.

Based on her research, Vranich estimates that at least nine out of every 10 people aren’t using their diaphragms as a primary breathing muscle. Instead, they’re breathing vertically, lifting their shoulders and sucking in their guts on the inhale, as if they were striking a Superman pose. “That’s anatomically incongruous,” she said. “There’s no other animal on the planet that breathes like this. We’re taking this beautiful machine and using it in a way that makes no sense based on how it was designed.”

Breathing up and down, instead of out and in, disengages the diaphragm and makes it difficult to take a full breath. It also triggers a shift in the autonomic nervous system, which is made up of two counterbalancing parts: the sympathetic nervous system and the parasympathetic nervous system. The sympathetic system usually kicks in when we’re facing danger or are under a great deal of stress (a.k.a. the “fight or flight” response). In ordinary circumstances, once the initial threat diminishes, the parasympathetic system will step in and set in motion the “rest and digest, restore and repair” functions. But if you’re constantly breathing with your neck and shoulders, it signals the vagus nerve—our internal stress detector—to send a message to the brain that the body is on overload

As a result, many of us spend a good part of our day in low to high fight-or-flight mode. That can play havoc with our nervous system, our digestion, our blood pressure—not to mention our ability to get a good night’s sleep.

The key to preventing this from happening, according to Vranich, is to learn to breathe the way we were designed—horizontally, expanding the belly outward on the inhale and narrowing it on the exhale, which engages the diaphragm and other breathing muscles in the process. The most common breathing techniques focus on counting breaths and inhaling and exhaling according to fixed patterns. There’s nothing wrong with that, said Vranich, “but most people don’t have much success doing that because their diaphragms are in spasm. They’ve been bracing so long their diaphragms don’t stretch anymore. So, I show them how to unlock their diaphragms and they start feeling better immediately.”

The Mechanics of the Breath

To help me understand and get things rolling, Vranich invited me to take a private class with Alyson Khan, one of her senior teachers in Los Angeles. Khan, a cheerful woman in her thirties, watched me take a few breaths and concluded that I had a strong horizontal inhale but an iffy exhale. “You must be bracing somewhere,” she said.

“Bracing” was one of Alyson’s favorite words. In fact, learning to use mindfulness to manage her bracing habit was a key turning point for her. It all started in grade school when her classmates started calling her “Fatty” even though she wasn’t overweight. And soon sucking it in became second nature. “We live in a culture of gut-suckers,” she quipped. “What do we do when we walk into a room? We lift our chest up, throw our shoulders back, and suck our gut in, because, God forbid, you don’t want to look chubby.  In LA, they might even write you a ticket for that.”

Now she finds she often braces when she’s racing to beat a traffic light or navigating a tense social situation or spotting a text from someone she’s trying to avoid. “Bracing is the body’s natural way of protecting itself,” she said. “If you’re not aware of that, you’re going to carry that stress in your body throughout the day, and it will affect how you relate to others.” It wasn’t until she started paying attention to her breathing that things began to change. The key, she said, was being attuned to when she was on the verge of bracing and then asking herself, “Do I really want to be doing that all day?”

Next, Alyson showed me how to calculate my Breathing Intelligence Quotient (or BIQ for short), a tool Vranich developed to measure what she calls your “vital lung capacity.” It involves using a measuring tape to determine the expanse of your ribs when you inhale compared with when you exhale. In my case, the difference was two inches (40-inch inhale/38-inch exhale). That translated into 52% capacity, or a letter grade of D. I was crestfallen, but Alyson reassured me, saying most of her students “fail miserably on their first try, so you must be doing something right.”

Then she said, “Do you want to see what your diaphragm looks like?” and pulled out a vegetable steamer basket—the kind with flaps that expand and contract. I was flabbergasted. When you look at anatomy charts in a doctor’s office, the diaphragm is usually portrayed as a thin red line, but it’s the biggest breathing muscle in your body, about the size of a small pizza, and it will expand four or five inches when you inhale (if you let it) and shrink back into place when you exhale. “The digestive organs are right below the diaphragm and they get really happy when you’re breathing the way you’re supposed to breathe,” Alyson said. “And so does your heart. Everything gets really happy, and if you do it long enough, your body will remember and want to breathe that way all the time.”

To bring my sorry diaphragm back to life, Alyson put me through an exhausting series of exercises, including Rock ‘n’ Roll (shifting back and forth between powerful belly breaths and crunching exhales while seated), Diaphragm Extensions (lying with my back on the floor and lifting a 20-lb. weight up and down with my belly muscles), and Exhale Pulsations (exhaling rapidly as if blowing out a candle 40 or 50 times). By the end, I felt bone weary, but strangely exhilarated. My lips, fingers, and toes were tingling, and the buzz lasted for hours. I don’t think my cells had ever been bathed in that much oxygen before.

Just before I left, Alyson had me do another BIQ reading. This time the gap was 2.75 inches, which translated into 72%, or a strong C+.

Maybe there was still hope.

My Breathing Regimen

The next day Dr. Vranich and I met on a video call. She was in her apartment in New York City, where she spends most of her time when she isn’t traveling the world teaching firefighters, pregnant women, extreme athletes, and other folks how to get more intimate with their diaphragms. She told me I was a rare specimen: a horizontal inhaler (good) and a vertical exhaler (not so good). She speculated that I’d conditioned myself after the tracheotomy to brace on the exhale and, as result, had a lot of stale CO2 stored in my body. “You’ve never had the muscle memory of a good exhale,” she said, “so we have to teach you a new way of moving your muscles.”

Her solution was to train me to relax my front abdominal muscles on the exhale and squeeze out the air with my diaphragm, lower abs, intercostals, obliques, and the muscles of my pelvic floor. Essentially, she figured that if I learned to breathe correctly with those muscles, my front abs would start mimicking the movement by association. “Your belly muscles are going to do it because your side muscles are doing it,” she explained.

So, over the next several weeks, Belisa put me through a grueling regimen aimed at strengthening my intercostals (the small muscles attached to the ribs) and my obliques (my side abdominals) and getting them to work in harmony with my other breathing muscles. She also taught me how to tilt my hips forward on the inhale and backward on the exhale to engage my glutes and pelvic floor muscles. “I want you to feel as if you’re being scooped out in the middle and your belly button is getting closer and closer to your spine,” she said.

It was hard mastering this motion, at first. But eventually, after several weeks of daily practice, it started to feel virtually automatic. My breath suddenly became fuller and more relaxed, and, every now and then, I could feel myself slipping into a natural breathing rhythm without even thinking about it. In the beginning, Belisa said my goal should be an 100% BIQ score, and by the end of week four, the readings began to climb into the high 80s.

Keywords; mental and physical health, Restorative Breathing