An Amazing Sleep Aid: Cyclic Sighing

A simple breathing technique helps the transition from wake to sleep.

Impaired sleep disrupts both mental and physical functioning, and is amazingly common in the US. A third of adults have frequent trouble sleeping, and more than 20 million Americans take prescription sleep medications most or every night. Millions more take over-the-counter supplements, use sleep apps, or plug in sound machines to try to get adequate rest.

Sleep problems plague those with mental health conditions at even higher rates, as I’ve seen in my psychiatric practice. During the past year, I’ve used cyclic sighing, an anxiety-reducing breathing technique, to produce impressive results for those with trouble falling and staying asleep.

Humans have used breathing techniques for millennia to induce calmness, lower anxiety, and ease the transition to sleep. A study published in early 2023, by neuroscientist Andrew Huberman, psychiatrist David Spiegel, and their Stanford colleagues, kicked off the flurry of interest in cyclic sighing for anxiety and general well-being.

My own experimentation with cyclic sighing led me to stumble across its benefits for sleep. It helped my sleep so much that I shared the approach with dozens of patients, who have been similarly pleased.

Rigorous studies on cyclic sighing remain scant, and we have none on its use for insomnia. But basic medical research, as well as numerous cultural traditions, lend plausibility to its efficacy. Given the huge unmet need for ways to improve sleep, the low likelihood of adverse effects, and the ease and accessibility of this approach, I think that it’s time to let as many people as possible know about cycle sighing for sleep.

The inspiration

The Stanford study compared just five minutes a day of mindfulness meditation to three different breathing techniques. At the end of just one month, cyclic sighing stood out as having a more potent effect on reducing blood pressure and heart rate, and boosting mood, than the other three approaches. When I contacted Dr. Huberman, he acknowledged that this was a “smallish study” but said that “results held up well.”

I started practicing cyclic sighing, but had trouble finding a consistent time during the day. So I shifted to doing it at bedtime. Within a few nights, my chronic problems falling asleep were gone. Some nights I felt sleepy during those five minutes. Other times I couldn’t tell if it was doing much, but every night I drifted off to sleep within a few minutes of completing the cyclic sighing.

Not only did I fall asleep quickly and easily, I stayed asleep. I stopped my nightly journey to the bathroom.

I hadn’t anticipated, nor had I intended to use cyclic sighing to improve sleep, so I can’t attribute the benefits to a placebo effect. I was able to stop my nightly melatonin use. The results from cyclic sighing impressed me so much that I began teaching the approach to patients with either sleep or anxiety problems. They replicated my success.

I won’t pretend that cyclic sighing will guarantee rock-solid sleep, every single night, for evermore. Having that expectation actually contributes to insomnia, because then any little glitch or lapse or deviation promotes worrying. “Will I be rested enough to do a good job tomorrow? Has this stopped working for me? Have I become tolerant to cyclic sighing?” Anxiety is the enemy of sleep.

But like everything in medicine, or in life, individual results may vary.

Be patient with it

I’ve taught cyclic sighing to several dozen patients. Everyone that was willing to try it has seen reductions in daytime anxiety, or ease in falling asleep, or fewer middle-of-the-night awakenings, or all three. Many of them had tried other breathing techniques to relax or sleep, and found cyclic sighing to be the most simple and powerful. I’ve had patients successfully stop their sleep medications. Others have reduced their drugs for anxiety.

One of the most impressive success stories came from a former patient who had depression and insomnia. After a 22-year hiatus, she contacted me saying that her depression was under control but insomnia still plagued her. I taught her cyclic sighing and explained why it might help. She canceled our follow-up visit — she didn’t need to meet again because she was sleeping better than at any time in her 70 years.

Another patient, with both trauma-related anxiety and lifetime ADHD, tried cyclic sighing. She had to stop using it in the daytime, and reserve its use only for sleep. When she cyclic sighed during the day she felt less anxious, but also became immediately groggy and sleepy. Her extreme response may reflect, in part, chronic insufficient nighttime sleep.

One patient, for whom cyclic sighing helped with anxiety, compared it to the soothing effects of singing to herself. Indeed, breathing patterns during singing mimic cyclic sighing.

Most people notice rapid benefit within the first few minutes of trying cyclic sighing. But more pervasive reductions in daytime anxiety or nighttime insomnia probably require many days of sustained practice.

Out of an abundance of caution, don’t try cyclic sighing while driving or operating heavy machinery. Some advise only doing it while sitting or lying down, to prevent falling and injuring oneself.

Not to put you to sleep, but what’s going on here?

Why does a remedy for anxiety help with falling asleep? To begin with, almost nobody with insomnia has a problem with their brain’s sleep network. What? Was I napping and just missed something here?

People with chronic, diagnosable insomnia, and others with frequent sleep struggles, generally have sleep systems that are intact and functional. They’re just not being turned on, or kept on, properly.

Our brain has different circuits for wakefulness and for sleep. Normally these are mutually inhibitory. When one system is on, it keeps the other turned off. A few rare conditions, like narcolepsy, or extreme sleep deprivation, can jumble the two systems, causing fragments of sleep to intrude into wakefulness.

In people with insomnia, the daytime arousal system is too jacked up. They fail to turn off their hyper-arousal. Sleep is waiting, hovering, available. It just needs a nice soft landing pad to alight. Anything that damps down over-arousal helps provide an opportunity for sleep to occur.

Most of our older sleep medications are sedatives that just strengthen the signal to sleep. In contrast, the newest class of sleep agents, called dual orexin receptor antagonists (Belsomra, Dayvigo, Quviviq), actually work on the relevant brain physiology. They shut off the daytime arousal circuit. They’re not directly sedating, but they help with sleep.

So it shouldn’t have surprised me that a technique like cyclic sighing, by helping to reduce daytime anxiety and arousal, would also improve nighttime sleep. But how does cyclic sighing change arousal?

Something vague about the vagus nerve

The sympathetic nervous system, part of our autonomic nervous system, generates the “fight or flight” response to threats. (Autonomic just means automatic, because we don’t have to think about engaging these nerves.) We feel panic when the sympathetic nerve system is engaged full force. The heart pounds, breathing is rapid and shallow, pupils dilate. We sweat and tremble. We feel queasy and extremely anxious. At lower levels of sympathetic activation we may just be aware of body tension, with jaw clenching, or tooth grinding, or occasional chest palpitations.

The counterbalancing part of the autonomic system doesn’t have as good a press agent. More people are familiar with the sympathetic nervous system than with the parasympathetic nervous system, which some call the “rest and digest” system. It slows heart rate and breathing, shunts blood away from big muscles and to the digestive system, and induces a feeling of calmness.

The vagus nerve is the major element of the parasympathetic nervous system within the body. The vagus nerve gets its name because it wanders throughout the chest and abdomen, innervating the heart, lungs, digestive system, and other organs. The same Latin root gives us the word vagrant. The vagus nerve carries information from the brain to the body, as well as from the body back up to the brain.

Within a few breaths, cyclic sighing activates the parasympathetic nervous system. Many of the breathing exercises used in meditative traditions also activate the parasympathetic nervous system. Slow breathing, and having exhalations at least twice as long as inhalations, seem to be the common factors for potently engaging the parasympathetic system, and deactivating the sympathetic nervous system.

Some research finds that electrically triggering the vagus nerve can improve sleep. Vagal nerve stimulation influences the connectivity of brain circuits in the frontal cortex. But with cyclic sighing you engage the parasympathetic system without needing any electrodes.

Both in healthy adults and those with chronic sleep problems, a switch from sympathetic to parasympathetic nervous system dominance accompanies the normal transition from wake to sleep .

In our hectic lives, filled with constant bombardment from electronic devices that hijack our attention, many of us are in states of chronic sympathetic hyper-arousal. Getting good sleep, immersion in nature, meditation, breathing exercises, and rest after exercise, can all help restore a more balanced interaction between parasympathetic and sympathetic nervous systems.

How to cyclic sigh

Cyclic sighing is easy. It has only two components, the inhalation and exhalation, with no pauses in between. Inhale a quick, full breath through the nose. Top it off with another half inhalation. You want your lungs full. But you don’t want to be stressed out and over-inflating like a balloon about to burst. Then exhale, slowly, steadily, audibly releasing air through your mouth. I usually count to about five or six. Then cycle right back to the next inhalation.

Video examples of cyclic sighing can be found here.

Nobody has published rigorous studies defining the important parameters of cyclic sighing. Is inhalation through the nose necessary? We don’t know. Limited research indicates that nasal breathing activates different brain centers than does mouth breathing. Yogic nose breathing can activate the parasympathetic nervous system.

Is five minutes necessary? Many people start to feel more relaxed with as little as three cyclic sighing breaths. But it probably takes many more cycles to strongly lock in parasympathetic nervous system activation. Presumably, the longer the session, the more one will benefit through the course of the day, but we don’t know what duration is optimal. While five minutes a day results in changes in blood pressure, heart rate, and mood, it is likely that we will find both individual, and day-to-day variation, regarding the best dose of cyclic sighing.

I’ve been telling my patients with anxiety to start with one five-minute bout of cyclic sighing each day. But if it feels that it would be useful at other times, add in a few minutes then too. It’s likely that a regular cyclic sighing practice at any time of day will provide some benefit for sleep. But if your focus is treating insomnia, then I strongly encourage five minutes of cyclic sighing at bedtime. If you’re trying to resume sleep after awakening during the night, then repeat the cyclic sighing until you fall back asleep.

I’ve worked with some individuals whose inattention from ADHD was so severe, or whose PTSD-driven anxiety was so intense, that they could initially only stay on track for a minute or less of cyclic sighing. I recommend starting with what you can do. With practice most people will be able to build up to five minutes at a time.

Don’t worry about cyclic sighing for exactly five minutes. And don’t bring your phone to bed to time it! I usually count about twenty cycles. If I lose track, I just return to the last number I clearly remember. Try to stay in the spirit of diminishing arousal, and letting go.

Cyclic sighing is not a replacement for other elements of sleep hygiene. Go to bed at the same time each night. Allow yourself close to eight hours a night. Have a dark, cool, quiet place to sleep in. Seek regular physical activity and lots of time outside — natural daylight is vital to keeping your body clock properly synched. But then avoid bright lights, heavy exercise, and activating activities immediately before sleep. Keep cell phones and other distractors in a separate room.

Cyclic sighing has been a breath of fresh air to my life and my psychiatric practice. I’ve been inspired to share it with others. Don’t wait until your expiration date to try it!