Biofeedback Training for a Healthy Heart

Healthy breathing is effortless, continuous, and slow. You mainly move air by expanding your stomach as you inhale and contracting it as you exhale. This allows the dome-shaped diaphragm muscle in your chest cavity to fully inflate your lungs, maintain an optimal level of carbon dioxide (CO2) in your blood, deliver needed oxygen to your body’s tissues, and increase the healthy variability of your heart.

What is respiratory biofeedback therapy?

Biofeedback uses biofeedback instruments to enhance your awareness and control of rapidly-changing physiological responses. A therapist’s biofeedback instructions are guided by feedback provided by biofeedback devices. Respiratory biofeedback can help you learn to breathe effortlessly.

How does respiratory biofeedback measure your breathing?

In respiratory biofeedback, strain gauge sensors placed around your chest and stomach detect outward movement as you inhale and inward movement as you exhale. Biofeedback equipment can measure breathing depth and respiration rate.

Breathing depth or excursion is the difference between a stomach strain gauge’s outward and inward movement during each breathing cycle. In healthy breathing, the stomach effortlessly expands and contracts to more completely ventilate your lungs.

Respiration rate is the number breathing cycles that you complete each minute. In healthy breathing, you learn to slow your breathing down to 5-7 breaths per minute to increase the healthy variability in your heart rhythm and ensure sufficient CO2 in your blood.

Personal respiratory biofeedback training can teach you to increase your awareness of your breathing, to fill your lungs more completely, and to breathe slowly and continuously during everyday activities.

Which breathing problems can respiratory biofeedback correct?

Apnea, or breath-holding, is a common breathing behavior. Patients who exhibit apnea suspend their breathing during routine activities like talking or writing a check. Apnea disrupts the delivery of oxygen to your tissues, can make you feel starved for air, and can raise your blood pressure. A strain gauge can show stomach movement “flat-lines” during an apnea episode instead of showing regular waves of stomach expansion and contraction.

Biofeedback providers also use respiratory biofeedback to correct three problem breathing patterns:

• In thoracic breathing, your chest muscles expand and contract your ribs to move air. This inefficient pattern causes shallow rapid breathing, reduced ventilation of your lungs, less oxygen delivery to your tissues, minimal variability in your heart rhythm, and wasted energy.
• In clavicular breathing, your accessory muscles raise and lower your chest and collarbones to move air. This pattern is often combined with chest breathing and exaggerates its problems.
• In reverse breathing, your chest and stomach contract when you inhale and expand when you exhale. This pattern is also seen with chest breathing and also magnifies its negative effects.

What is effortless breathing?

Dr. Erik Peper observes that breathing is effortless when your body seems to breathe itself. Since effortless breathing feels like you are only using about 70% of maximum effort to fill your lungs, you may forget that you are breathing.

What are some effortless breathing tips for beginners?

You can quickly master effortless breathing if you:

• sit upright so that your stomach can relax
• wear clothing that allows your stomach to move freely
• breathe 5-7 breaths per minute
• exhale twice as long as you inhale

How does breathing affect your heart rhythm?

The autonomic nervous system controls your heart rhythm through its sympathetic and parasympathetic branches. The sympathetic branch accelerates your heart rate to prepare you for emergencies like fighting or fleeing snarling saber-toothed tigers. Think of the sympathetic branch as your heart’s gas pedal. In contrast, the parasympathetic branch slows your heart rate when you eat a meal. Think of the parasympathetic branch as your heart’s brake.

When you inhale, you take your foot off the parasympathetic brake and your heart rate accelerates. When you exhale, you press down hard on the parasympathetic brake and your heart rate slows. This rhythmic change in your heart rate is called heart rate variability (HRV).  A simple measure of HRV is the difference between your fastest and slowest heart rate.

What else influences heart rate variability (HRV)?

Aerobic exercise and positive emotion can increase HRV. Aging, heart disease, physical inactivity, and negative emotion can reduce HRV.

How can you increase your heart’s healthy variability?

You can maximize heart rate variability (HRV) when you breathe from 5-7 breaths per minute because this combines the effects of your autonomic nervous system, blood pressure control system, and respiratory system on the variability of your heart rhythm. Researchers also believe that experiencing heartfelt emotions, like a parent’s love for a child, increases HRV.

How do biofeedback therapists monitor heart rate variability (HRV)?

In heart rate variability biofeedback, biofeedback electrodes detect your heart’s rhythmic contraction and relaxation. Clinicians use two biofeedback devices to monitor the heart. An electrocardiogram (EKG) uses sensors placed on your wrists and torso to detect the electrical signal generated by the heart. Alternatively, a photoplethysmograph (PPG) uses sensors placed on your earlobe or fingers to detect the pulse waves created by your heart’s pumping action.

HRV biofeedback can display both your breathing pattern and heart rhythm back to you to teach you to increase your heart’s healthy variability. You can learn to increase the difference between your fastest and slowest heart rate many times more than the average 3 beats-per-minute difference seen in adults.

How does increasing heart rate variability (HRV) protect your health?

Some researchers believe that HRV biofeedback instructions increase the balance between the two branches of the autonomic nervous system and that this can reduce your risk of dying from a heart attack.

How effective is HRV biofeedback therapy?

Biofeedback clinical trials have shown that HRV biofeedback techniques can help you control problems like anxiety, asthma, depression, high blood pressure, panic attacks, unexplained abdominal pain, and stress. HRV training is a promising form of stress management biofeedback for both children and adults.

Who should provide HRV training?

Biofeedback practitioners who are experienced in HRV biofeedback and certified by the Biofeedback Certification Institute of America (BCIA) in General Biofeedback are qualified to provide this training.

Is there insurance coverage for biofeedback?

Biofeedback reimbursement depends upon your insurance provider and state. Psychologists may code biofeedback services as psychotherapy to increase your chance of reimbursement.