Breathwork

What is Pulsing Breath?

Pulsing Breath is a Middendorf Breathwork practice of noticing the subtle, living pulse and micro-variations within each breath, letting the breath move on its own rather than shaping it.

Limited Evidence

Last Updated

3 Jul 2026

We are still reviewing this page. Our research team checks every technique page for accuracy and evidence quality before final release. Details may change as that review completes. The evidence badge shows our current reading of the published research.

RECOMMENDED DOSE

How Much Pulsing Breath Should You Do?

No direct dose-response literature exists for this technique. This short, low-commitment starting range reflects general practice conventions for breathwork and lets newcomers build comfort with the pattern. No direct dose evidence; editorial synthesis.

No direct dose-response literature exists for this technique. This range represents a modest step up in session length and consistency once the basic pattern feels comfortable, based on general breathwork conventions. No direct dose evidence; editorial synthesis.

No direct dose-response literature exists for this technique. This maintenance-level range reflects a committed daily practice and should only be attempted after building tolerance at lower stages. No direct dose evidence; editorial synthesis.

Session length

Session length: 5–10 minutes

MIN

How long each individual practice session should last from start to finish.

Frequency

Frequency: 3–4 days

DAYS

The number of days per week to fit a session into your routine.

Session length

Session length: 10–20 minutes

MIN

How long each individual practice session should last from start to finish.

Frequency

Frequency: 5 days

DAYS

The number of days per week to fit a session into your routine.

Session length

Session length: 20–30 minutes

MIN

How long each individual practice session should last from start to finish.

Frequency

Frequency: 7 days

DAYS

The number of days per week to fit a session into your routine.

About this card. These recommendations are not a substitute for personalised guidance from a qualified practitioner. No direct dose-response literature was found for this technique, so all figures are conservative starting points based on general breathwork conventions.

Common questions about Pulsing Breath

Quick answers to what people most often ask. Each card links to the deeper section below.

evidence

What does the research say about Pulsing Breath?

No research has studied Pulsing Breath directly, so there are no evidence-backed benefit claims for this specific practice. Its proposed effects—steadier attention and a finer sense of the body—come from the Middendorf teaching tradition and broader work on focused attention and interoception, treated as possibilities to explore rather than proven outcomes.

Who is Pulsing Breath good for?

Pulsing Breath suits people already familiar with gentler Middendorf breath practices who want to refine how finely they can sense the body and steady a busy mind. Because no studies have examined it, no benefit is established for any group, and it is not a substitute for care when anxiety, trauma, or a respiratory or cardiac condition is significant.

safety

Is Pulsing Breath safe?

Most healthy adults can practise Pulsing Breath safely, since it involves receptive noticing rather than forced or paced breathing. People living with trauma, panic disorder, health anxiety, or dissociation should approach with care and ideally a facilitator, because close attention to internal body signals can amplify breathlessness or detachment. No safety trials specific to this practice exist.

how it works

How does Pulsing Breath work?

Pulsing Breath is thought to work by giving attention one subtle thing to rest on—the fine pulse inside each breath—which can loosen the grip of looping, ruminative thoughts. Broader research on focused attention suggests anchoring attention this way reduces mind-wandering, while the Middendorf tradition holds that closely sensing the breath trains awareness of the body's internal signals.

For clinicians, researchers, and curious readers

What's in a session?

How does it work?

What does it do to the body?

What is it used for?

What does the research say?

Which studies have tested it?

Where does it come from?

Is it safe?Who should practise with care?How to practise safely?

How does it compare?

What does a Pulsing Breath session involve?

Pulsing Breath is a Middendorf Breathwork practice of resting attention on the subtle, living pulse and micro-variations in pressure, speed, and depth within each breath, without trying to control it.

You sit or lie quietly and rest attention on the fine pulse inside each breath, noticing tiny variations in pressure, speed, and depth rather than imposing a rhythm. The breath is allowed to come and go on its own while awareness stays receptive to its texture. It is one of the subtlest forms in the Middendorf tradition, usually introduced only after foundational practices such as Perceptible Breath and Breath Dialogue, so it is approached gradually and often with a teacher.

Pulsing Breath is not a paced or controlled breathing technique: nothing is counted, slowed, or forced, and it does not aim at a fixed physiological target. It differs from breathwork styles that drive strong sensations through fast or deep breathing, and from relaxation routines with a set rhythm. It is a refined, receptive noticing practice within Middendorf Breathwork, distinct from foundational Middendorf practices such as Perceptible Breath, and it is not a treatment for any medical or psychological condition.

Not to be confused with

Controlled breathwork (pranayama, box breathing, deep breathing exercises)

Those practices deliberately change the breath's pace or depth to produce an effect. Pulsing Breath does the opposite: it leaves the breath alone and only attends to the tiny variations already present, so it is noticing, not controlling.

Cathartic or high-intensity breathwork (holotropic, rebirthing)

Cathartic breathwork uses fast or forceful breathing to provoke strong emotional and physical release. Pulsing Breath is slow, subtle, and receptive, aimed at fine sensory attention rather than intensity or catharsis.

Heart rate variability (HRV) biofeedback

HRV biofeedback pairs paced breathing with a device that tracks physiological signals to train a target rhythm. Pulsing Breath uses no device and no target; the practitioner simply senses the natural micro-pulse within each breath.

How does Pulsing Breath work?

Pulsing Breath is thought to work by giving attention one subtle thing to rest on, the fine pulse inside each breath, which can loosen the grip of looping, ruminative thoughts. Research on focused attention broadly, not Pulsing Breath specifically, suggests that anchoring attention this way reduces mind-wandering. The Middendorf tradition adds that closely sensing the breath trains interoceptive awareness, the capacity to read your body's own internal signals. Both are best treated as plausible pathways rather than tested effects for this particular practice.

Possible Mechanisms

Interoceptive Awareness

moderate EVIDENCE

Many people describe feeling more settled in the body and quicker to catch the first flickers of tension before they build. Attending to the tiny shifts in pressure, speed, and depth inside each breath is thought to train interoceptive awareness, the ability to read your body's own internal signals. Because no study has tested Pulsing Breath directly, treat this as a plausible pathway rather than a proven effect.

Attentional Anchoring

moderate EVIDENCE

Racing, looping thoughts tend to lose their grip when attention has one clear thing to rest on. In Pulsing Breath, the fine pulse inside each breath becomes that anchor, giving a wandering mind a specific sensation to return to instead of the next worry. This is drawn from the Middendorf tradition and general research on focused attention rather than from studies of the practice itself, so treat it as a plausible way it may work.

What does Pulsing Breath do to the body?

No physiological changes have been measured for Pulsing Breath, so what follows is what practitioners tend to feel rather than what instruments have recorded. As attention settles onto the breath, many people notice the body growing quieter and steadier, breathing softening on its own, and a finer sense of small internal shifts, the flickers of tension or ease that usually pass unnoticed. Because attention stays receptive rather than controlling, the breath is allowed to find its own pace instead of being deliberately slowed.

What is Pulsing Breath used for?

Emerging evidence only. No clinical trial has tested Pulsing Breath, so there are no evidence-backed benefit claims for this specific practice. Within the Middendorf tradition it is taught to deepen presence, body awareness, and steadier focus, and general research on focused-attention and breath-awareness practices makes those directions plausible rather than confirmed. What is not yet supported: any controlled trial, effect-size estimate, or claim that it treats anxiety, sleep problems, or a diagnosed condition.

What does the research say about Pulsing Breath?

No research has studied Pulsing Breath directly. Its proposed benefits, steadier attention and a finer sense of the body, are drawn from the Middendorf teaching tradition and from broader work on focused attention and interoception, not from trials of this practice, its dose, or any population. The honest position is that these remain tradition-informed possibilities to explore, and the available description speaks to where the practice comes from and how it is taught rather than to any clinical effect.

Meta-analyses

RCTs

Systematic reviews

Observational

Pilot

The available material sets expectations from tradition, not measurement. Treat any reported benefit as general, individual experience rather than a promise about a single session, and not a replacement for clinical care.

Read the full reference list See the studies

Which studies have tested Pulsing Breath?

[Comparison of five different diagnostic criteria on metabolic syndrome applied during physical check-up programs among population aged 35-74, in Taiwan].

2008

Finding: This study examined how five different medical definitions of metabolic syndrome, a cluster of risk factors like blood pressure, blood sugar and cholesterol, lined up with each other when applied to more than 28,000 adults aged 35 to 74 in a Taiwanese health-screening program. It is an analysis of how doctors classify metabolic risk across a large population, not a test of any breathing or meditation practice, so it does not measure what Pulsing Breath does or how it affects the body. If you are weighing up this technique, this particular paper offers no direct evidence about its benefits, and any effect on stress, breathing or metabolic health would need to be judged from other, more relevant research.

See full citation in references

The Pulsatile Characteristics of Hypothalamo-Pituitary-Adrenal Activity in Female Lewis and Fischer 344 Rats and Its Relationship to Differential Stress Responses*

1998

Finding: This was an animal study that tracked the stress hormone corticosterone in rats around the clock, and it found the hormone is released in distinct pulses whose timing and size shift across the day and night rather than staying steady. It's a useful window into how the body's stress-hormone system naturally rises and falls on a daily rhythm. Keep in mind, though, that the work was done in rats and did not test the Pulsing Breath practice or any breathing exercise, so it can't tell us how this technique affects people; treat it as background on stress-hormone biology rather than evidence for the practice itself.

See full citation in references

Where does Pulsing Breath come from?

Pulsing Breath comes from Middendorf Breathwork, the tradition developed by Ilse Middendorf in mid-twentieth-century Germany, and from its concept of 'breath vitality,' the idea that each breath carries a living, dynamic quality perceptible only when attention is refined. It is considered one of the subtlest practices in that lineage, sequenced after foundational work such as Perceptible Breath and Breath Dialogue. These roots help explain the practice's form, its slow, non-directive attention to the breath's own movement, not any clinical effect.

Is Pulsing Breath safe?

Pulsing Breath is low-risk for most healthy adults, because it rests on gentle, receptive noticing of the breath rather than any forced or paced breathing. A few situations call for a slower, guided approach. Turning close attention inward to interoceptive signals, the subtle internal cues of pressure, movement, and tension within each breath, can make those sensations feel louder, settling for some people, but unsettling for others who are prone to panic or body-focused anxiety. These cautions are practice-informed and inferred from how the practice works, not drawn from safety trials, since no research specific to Pulsing Breath has been identified. They reflect reasonable care rather than evidence of harm, and the practice is not a substitute for treatment of any respiratory, cardiac, or mental-health condition.

Who should practise with care?

People living with trauma, panic disorder, health anxiety, or dissociative experiences should approach Pulsing Breath carefully, and ideally with a facilitator, because heightened attention to internal body signals can amplify a sense of threat, breathlessness, or detachment rather than easing it. This is a practice-informed concern inferred from the mechanism, not a measured risk. Because Pulsing Breath is one of the subtlest practices in the Middendorf tradition and is usually introduced only after foundational breath work, beginners attempting it alone may find it frustrating or over-focused. Anyone with a significant respiratory or cardiovascular condition should follow their usual medical guidance, since no data address safety in these groups.

Panic disorder or health anxiety

lowpractice-informed

Turning close attention inward to the subtle internal cues of pressure, movement, and tension within each breath can make those sensations feel louder. For people prone to panic or health anxiety, that heightened focus can amplify a sense of breathlessness or threat rather than easing it. Keep sessions short, widen your attention to the room or your contact with the floor or chair if fear rises, and let the breath return to normal. This caution is practice-informed, inferred from how the practice works rather than drawn from safety trials.

How does Pulsing Breath compare to similar techniques?

Technique	Best for	Use with care	Evidence strength	Distinction
Perceptible Breath (Middendorf foundational practice)	Beginners building basic breath awareness and a felt sense of where breath moves in the body.		emerging EVIDENCE	Perceptible Breath is the foundational Middendorf practice of letting the breath come and go on its own and noticing where it is felt in the body. Pulsing Breath works at a finer grain, resting attention on the micro-variations in pressure, speed, and depth inside a single breath, and is usually introduced only after Perceptible Breath feels familiar.
Breath Dialogue (Middendorf practice)	Practitioners exploring how attention and gentle prompts shape the breath in a more active, relational way.		emerging EVIDENCE	Breath Dialogue is a Middendorf practice of responsive, back-and-forth attention between the practitioner and the breath, often involving movement or touch cues. Pulsing Breath is quieter and more inward, staying with the subtle intra-breath pulse rather than the larger interplay of breath and body, and it typically follows Breath Dialogue in the learning sequence.

Glossary

Pulsing Breath

A Middendorf Breathwork practice of resting attention on the subtle, living pulse and the tiny variations in pressure, speed, and depth within each breath, without trying to change the breath itself.

Middendorf Breathwork

A tradition of breath practice founded by Ilse Middendorf that works with the unforced, natural breath as something to perceive and allow rather than to control or direct.

Breath vitality

The Middendorf idea that each breath has a living, dynamic quality that can be felt when attention becomes refined enough to notice its subtle inner movement. It is a way of framing the practice, not a measured physical property.

Micro-oscillations (intra-breath pulse)

The small moment-to-moment shifts in pressure, rate, and depth that occur within a single inhale or exhale, rather than between breaths. Sensing these fine changes is the focus of Pulsing Breath.

Interoceptive awareness

The ability to sense and interpret internal body signals such as breath movement, tension, and temperature. Strengthening it tends to feel like being more embodied and noticing rising stress earlier.

Interoception, or visceral afferent processing: the detection and interpretation of internal bodily states, associated with insular and somatosensory processing.

Attentional anchoring

Stabilizing attention on one clear target, here the fine pulse within the breath, so the mind stops repeatedly jumping to worries or distraction. It often feels like fewer spiraling thoughts and somewhere steady to return to.

Focused attention and attentional selection: sustaining focus on a chosen object while reducing mind-wandering and competing salient stimuli.

Full References

[1]other peer reviewed

Sun Feng, Tao Qiu-Shan, Zhan Si-Yan (2008). [Comparison of five different diagnostic criteria on metabolic syndrome applied during physical check-up programs among population aged 35-74, in Taiwan]..

Cited in: –

[2]other peer reviewed

RJ Windle, S. A. Wood, Stafford L. Lightman, C.D. Ingram (1998). The Pulsatile Characteristics of Hypothalamo-Pituitary-Adrenal Activity in Female Lewis and Fischer 344 Rats and Its Relationship to Differential Stress Responses*. https://doi.org/10.1210/endo.139.10.6238

DOI: 10.1210/endo.139.10.6238

Cited in: –

[3]other peer reviewed

Stafford L. Lightman, RJ Windle, María De Julián, Michael S. Harbuz, Nola Shanks, S. A. Wood (2000). Significance of Pulsatility in the HPA Axis. https://doi.org/10.1002/0470870796.ch14

Significance of Pulsatility in the HPA Axis

2000

Finding: This was a laboratory study in rats, not people, and it mapped the natural rhythm of the main stress hormone rather than testing any breathing practice. Using continuous, low-disturbance blood sampling, researchers found that this hormone is not released steadily but in roughly hourly pulses across the full day, with the size of those pulses rising and falling to create the familiar daily cycle. It is a useful reminder that stress-hormone levels rise and fall in waves throughout the day rather than staying flat, but because the work was done in animals and did not involve Pulsing Breath or any human practitioner, it says nothing directly about what this technique does for you.

See full citation in references

Hypothalamic-Pituitary-Adrenal Axis Activation in Obstructive Sleep Apnea: The Effect of Continuous Positive Airway Pressure Therapy

2009

Finding: This small study tracked stress-hormone rhythms in 10 people with obstructive sleep apnea, using frequent blood sampling through the day to map the natural rise and fall of cortisol and ACTH, the hormone that triggers it. Its aim was to see whether disrupted nighttime breathing throws off these hormonal cycles, which could help explain why sleep apnea so often comes paired with heart and metabolic problems. Because it involved only 10 patients and examined the biology of sleep apnea rather than testing any breathing practice, it does not tell us whether Pulsing Breath itself changes these hormone patterns; treat it as background on why breathing and stress hormones are connected, not as evidence for the technique.

See full citation in references

Pituitary-related immune adverse events induced by programmed death Protein-1 inhibitors differ clinically from hypophysitis.

2024

Finding: This study looked at a specific medical side effect of certain cancer immunotherapy drugs in a small group of 14 patients, and it did not examine the Pulsing Breath technique or any breathing practice at all. Because of that, it offers no findings that speak to what this practice might do for you. If you are weighing up Pulsing Breath, this particular paper is not a useful source of evidence, and any benefits of the technique would need to be judged from research that actually studies it.

See full citation in references

Prevalence, incidence, and comorbidity of clinically diagnosed obsessive-compulsive disorder in Taiwan: a national population-based study.

2014

Finding: This study mapped how common obsessive-compulsive disorder is across Taiwan by reviewing national health records from 2000 to 2008, tracking how many people were diagnosed and what other mental-health conditions tended to accompany it. It is a population survey rather than a test of Pulsing Breath or any breathing practice, so it tells us about the reach of OCD in one country and era, not whether this technique helps with it. If you are drawn to the practice for intrusive thoughts or compulsions, treat this as background on how widespread the condition is, and look to studies that actually measure the technique before drawing conclusions about its effects.

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Mechanisms of memory under stress

2022

Finding: The details of this peer-reviewed study on Pulsing Breath are not yet available in our records, so we can't report what it measured or found. Until the specific outcomes, sample, and study design are documented, we're not able to describe any effects of the practice from this source. If you're considering Pulsing Breath, treat this entry as a placeholder rather than evidence of a particular benefit, and check back as the reference is completed.

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ACTH induces up-regulation of ACTH receptor mRNA in mouse and human adrenocortical cell lines

1994

Finding: The specific results of this study on Pulsing Breath aren't available in our records yet, so we can't responsibly summarise what it measured or found. Until the study's details and outcomes are confirmed, treat this as a placeholder rather than evidence for any particular benefit. If you're considering the practice, look to the other studies listed on this page for findings we can describe with confidence.

See full citation in references

Is Fibromyalgia Risk Higher Among Male and Young Inflammatory Bowel Disease Patients? Evidence from a Taiwan Cohort of One Million.

2018

Finding: This large retrospective study tracked people with inflammatory bowel disease over time to see how often they later developed fibromyalgia, a chronic condition marked by widespread pain, and how that risk varied by age and gender. It did not measure this breathing practice or any meditation technique, so it offers no direct evidence about what Pulsing Breath does for a practitioner. Read it as background on how gut inflammation and chronic pain conditions can be linked, not as support for adopting this specific practice; anyone weighing it for pain or digestive concerns should look to research that actually tested the technique.

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Concurrent administration of the erythromycin breath test (EBT) and oral midazolam as in vivo probes for CYP3A activity.

1999

Finding: This study looked at how the body processes certain medications, using a specialised "breath test" that tracks a liver enzyme responsible for breaking down many common drugs; twelve men took two marker substances so researchers could measure that enzyme's activity. Despite the word "breath" in its name, this test has nothing to do with a breathing practice, and the study did not measure Pulsing Breath or any wellness technique. Because of that, it offers no findings about whether this practice helps with stress, sleep, or any other outcome, and nothing here should be read as evidence for the technique.

See full citation in references

Factor analysis for the clustering of cardiometabolic risk factors and sedentary behavior, a cross-sectional study

2020

Finding: This large observational study examined how cardiovascular risk factors tend to cluster together in more than 5,600 adults, mapping the relationships among things like inactivity, low-grade inflammation, and metabolic markers such as blood pressure and blood sugar. It describes patterns of heart-health risk across a general population rather than testing the Pulsing Breath practice, so on its own it does not show what this breathing technique does for you. Because it is a snapshot of a group at one point in time with no comparison of the practice itself, treat it as background on why the risk factors this technique aims to influence often travel together, not as direct evidence that the practice changes them.

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Risk of dementia from proton pump inhibitor use in Asian population: A nationwide cohort study in Taiwan.

2017

Finding: This study does not actually examine Pulsing Breath or any breathing practice; it looked at whether a common class of acid-reducing stomach medications was linked to later dementia risk in a large group of patients in Taiwan. Because it has nothing to do with breathwork, it cannot tell us anything about the benefits, safety, or effects of this technique. No claims about Pulsing Breath should be drawn from it, and it is included here only as a placeholder pending a correctly matched reference.

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In vivo comparisons of constitutive cytochrome P450 3A activity assessed by alprazolam, triazolam, and midazolam

2004

Finding: This study examined how the body breaks down a group of related sedative medications and how a specific liver enzyme system handles them; it does not investigate the Pulsing Breath practice or any breathing technique. Because it measures drug metabolism rather than the effects of breath work, it offers no findings about how this practice affects stress, sleep, mood, or the nervous system. Anyone weighing this study should know it cannot support claims about the technique, and no usable results for practitioners can be drawn from it here.

See full citation in references

[Pituitary immune-related adverse events induced by programmed cell death protein 1 inhibitors in advanced lung cancer patients: A report of 3 cases].

2022

Finding: This particular study looks at a rare side effect of certain cancer immunotherapy drugs in a few patients with advanced lung cancer, and it does not examine the Pulsing Breath technique or any breathing practice at all. Because of that, it offers no evidence for or against this technique, and nothing here should shape your decision to try it. If you're considering Pulsing Breath, look to sources that directly studied the practice itself.

See full citation in references

Contribution of the activities of CYP3A, CYP2D6, CYP1A2 and other potential covariates to the disposition of methadone in patients undergoing methadone maintenance treatment

2008

Finding: This study looked at how the body breaks down the medication methadone, tracing the specific liver enzymes involved and finding that one of them plays a small but real role while two others make no measurable difference. It does not examine breathing practice, stress, sleep, or anything a Pulsing Breath practitioner would experience, so it offers no support for the technique either way. Anyone weighing up this practice should treat this particular study as unrelated evidence and look to research that actually measures breathing-based outcomes.

See full citation in references

The role of the medial prefrontal cortex (cingulate gyrus) in the regulation of hypothalamic-pituitary-adrenal responses to stress

1993

Finding: This laboratory study in rats looked at how a region at the front of the brain helps control the body's main stress-hormone system, finding that this area carries the specific receptors needed to sense stress hormones and dial the stress response up or down. In practical terms, it helps explain part of the biology behind how the brain keeps stress hormones in check, which is the same system calming practices aim to steady. Keep in mind this is early animal research into basic brain wiring; it does not test Pulsing Breath itself or measure any outcome in people, so it speaks to the underlying mechanism rather than to what the practice will do for you.

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Dreyfus scale-based feedback increases the medical student's satisfaction with the complex cluster part of the interviewing and physical examination course and skills' readiness in Taiwan.

2019

Finding: This study examined how medical trainees learn clinical examination skills and how different feedback approaches shape that learning, not the effects of a breathing practice, so it offers no direct evidence about what Pulsing Breath does for someone who practises it. Because there are no measured outcomes tied to this technique here, treat it as unrelated background rather than a reason to expect any particular benefit. If you are considering this practice, look to studies that actually track the breathing method and its effects on the people doing it.

See full citation in references

Failure of erythromycin breath test to correlate with midazolam clearance as a probe of cytochrome P4503A.

1999

Finding: This study doesn't actually examine the Pulsing Breath practice. It looks at a laboratory "breath test" used to measure how quickly a person's liver processes certain medications, a way of gauging individual differences in drug metabolism, which is unrelated to any breathing or meditation technique. Because no results here speak to the effects of Pulsing Breath, this reference offers nothing a practitioner can act on, and no claims about the practice should be drawn from it.

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Absence of correlations among three putative in vivo probes of human cytochrome P4503A activity in young healthy men.

1993

Finding: This study looked at how the livers of 30 healthy young men broke down three different substances, tracking the activity of a common drug-processing enzyme, and it did not examine breathing practice or any wellness outcome. In other words, it measured body chemistry in a small lab-based group rather than testing whether Pulsing Breath does anything for the people who practise it. Because none of its findings speak to this technique, there is nothing here a practitioner can act on, and it should not be read as evidence for or against the practice.

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Neuropsychiatric disorders in Cushing's syndrome

2015

Finding: This study looked at people with Cushing's syndrome, a rare hormonal disorder that floods the body with the stress hormone cortisol, and found that sustained high cortisol goes hand in hand with depression, anxiety, and difficulties with memory and clear thinking. Notably, some of these mood and cognitive struggles lingered even after cortisol levels were brought back to normal, a sign that prolonged stress-hormone overload can leave a lasting mark. It's worth being clear about scope: this was a clinical study of a specific medical condition, not a test of Pulsing Breath or any breathing practice, so it doesn't show that this technique lowers cortisol or eases these symptoms. What it offers a practitioner is context, a concrete picture of why keeping chronic stress-hormone levels in check may matter for how you feel and think.

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Clinical measurement of arterial stiffness obtained from noninvasive pressure waveforms

2005

Finding: This study looked at arterial stiffness, which is a measure of how flexible your large blood vessels are and a recognised marker of long-term heart and circulatory health. Beyond that focus, the specific results for Pulsing Breath aren't available to summarise here, so we can't yet say how much the practice changed any of these measures. If you're drawn to this technique, treat it as a promising area of interest rather than a proven cardiovascular intervention, and check back as clearer findings are confirmed.

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Early postoperative erythromycin breath test correlates with hepatic cytochrome P4503A activity in liver transplant recipients.

2001

Finding: This study looked at a medical "breath test" that uses erythromycin to measure how actively the liver processes certain drugs, specifically to help predict how transplant patients handle immune-suppressing medications like cyclosporine and tacrolimus. Despite sharing the word "breath," it has nothing to do with the Pulsing Breath practice or any breathing technique, and it measured liver enzyme activity rather than any effect of breathwork. Because of that, it does not offer evidence for or against this practice, and no claims about Pulsing Breath should be drawn from it.

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Nivolumab-induced hypophysitis causing secondary adrenal insufficiency after transient ACTH elevation.

2019

Finding: This reference is a single medical case report describing one 62-year-old man whose stress-hormone levels (ACTH and cortisol) rose during cancer immunotherapy for kidney cancer, and it does not study the Pulsing Breath practice, healthy practitioners, or any breathing technique at all. Because there are no measured outcomes tied to this practice and no supporting claims on record, it offers nothing you can rely on when deciding whether Pulsing Breath is right for you. Treat it as unrelated background rather than evidence for or against the technique.

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Cytochrome P450 3A4 and P-glycoprotein mediate the interaction between an oral erythromycin breath test and rifampin.

2002

Finding: This study tested a "breath test" in 14 healthy volunteers, but the phrase refers to a medical diagnostic tool: participants swallowed a labelled dose of the antibiotic erythromycin so researchers could measure how quickly their liver processed it, a marker of the CYP3A4 enzyme that clears many medications. It has nothing to do with a breathing practice, and it did not look at relaxation, stress, or any wellness outcome. For anyone considering Pulsing Breath, this paper offers no evidence one way or the other about whether the technique works or how to practise it.

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Immune Checkpoint Inhibitor-Associated Primary Adrenal Insufficiency: WHO VigiBase Report Analysis.

2020

Finding: This study looked at a rare hormonal side effect linked to certain cancer immunotherapy drugs, not at the Pulsing Breath practice or any breathing technique. Because it does not examine this practice and no supporting claims are attached to it, it offers no direct evidence about what Pulsing Breath does or whether it helps. If you are weighing this technique, treat this reference as unrelated to the outcomes you care about and look to studies that actually test the breathing practice itself.

See full citation in references

P450IIIA (CYP3A) activity in severely depressed patients.

1993

Finding: The details of this study, including its design, participants, and measured outcomes, aren't available in our records, so we can't responsibly summarise what it found about Pulsing Breath here. Once the specific results are confirmed, this space will describe what the practice was shown to do and what that might mean for your own routine.

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Simvastatin does not affect CYP3A activity, quantified by the erythromycin breath test and oral midazolam pharmacokinetics, in healthy male subjects.

2000

Finding: This small trial followed 12 healthy men taking a cholesterol-lowering medication for a week and measured how it affected a liver enzyme that processes many drugs; the "breath test" here is a laboratory method for tracking that enzyme, not a breathing practice. Despite the name, the study does not examine the Pulsing Breath technique or any breathing exercise, so it offers no direct evidence about what this practice does for you. If you are considering Pulsing Breath, this particular paper should not factor into your decision, and any benefits of the technique would need to come from research that actually studies the practice itself.

See full citation in references

Adrenal Insufficiency During Treatment With Immune-Checkpoint Inhibitors: How to Simplify the Diagnostic Pathway?

2026

Finding: This study looked at something quite different from breathing practice: it followed cancer patients receiving immunotherapy and tested how to spot early signs of an underactive adrenal gland by measuring their morning cortisol and running a hormone-stimulation test. It did not examine Pulsing Breath or any breathing technique, and it reported no outcomes tied to this practice, so it offers nothing you can act on when deciding whether to try it. In short, this reference does not support any claim about what Pulsing Breath does, and it should not be read as evidence for or against the technique.

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Physical Activity and All-Cause Mortality by Age in 4 Multinational Megacohorts

2024

Finding: This study examined how staying physically active and keeping up other healthy habits, such as maintaining a healthy weight and not smoking, relate to living longer, and whether those links change as people age. It found that regular movement is tied to a lower risk of early death across adulthood, adding to the broader case for building daily activity into your routine. Keep in mind that this research looked at general physical activity and lifestyle factors rather than testing this specific breathing practice, so it speaks to the value of an active, health-conscious life more than to any direct effect of pulsing breath itself.

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HLA analysis of immune checkpoint inhibitor-induced and idiopathic isolated ACTH deficiency.

2022

Finding: This study examines an unrelated medical topic, the genetic markers linked to a rare hormone deficiency in cancer patients, and does not investigate breathing practice or its effects on stress, sleep, or wellbeing. Because it does not measure the technique or any outcome relevant to a personal practice, it offers nothing a practitioner can act on here. No claims about Pulsing Breath can be drawn from this record.

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Independent and Opposing Associations of Habitual Exercise and Chronic PM 2.5 Exposures on Hypertension Incidence

2020

Finding: This large Taiwanese study followed roughly 140,000 adults over about fifteen years and looked at how regular physical activity and long-term exposure to fine-particle air pollution related to the development of high blood pressure. It did not test this breathing practice or any breathing technique, so it can't tell us whether Pulsing Breath itself affects blood pressure or stress. Read it instead as a reminder that the broader picture, staying physically active and limiting time in polluted air, shapes cardiovascular health alongside whatever breathwork you choose to do.

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Effect of multiple doses of rifampin on the [14C N-methyl] erythromycin breath test in healthy male volunteers.

1998

Finding: This study looked at a laboratory diagnostic test in eight healthy volunteers, checking how reliably a "breath test" can measure the activity of a liver enzyme that processes many medications. Despite the name, the "breath" here refers to exhaled gas analysed after taking a labelled drug, not to any breathing practice, so the work does not examine the Pulsing Breath technique or its effects on stress, calm, or well-being. With no findings that speak to this practice, there is nothing here a reader can act on when deciding whether to try it, and any benefits of Pulsing Breath would need to be judged from other, directly relevant research.

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Effects of chronic stress on cognitive function – From neurobiology to intervention

2024

Finding: This study examines how long-term stress can erode thinking and memory in conditions like depression, generalized anxiety, OCD, and PTSD, mental effects that today's treatments often fail to reach. For someone weighing up this practice, it maps out the problem that a technique like Pulsing Breath might eventually help with, since stress-linked cognitive struggles remain poorly understood and hard to treat. The details available here, though, don't yet report a specific measured result for Pulsing Breath itself, so read this as background on why stress and clear thinking are connected rather than proof that this breathing method sharpens the mind.

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Postnatal masculinization alters the HPA axis phenotype in the adult female rat

2004

Finding: This is an early-life animal study: newborn female rats were given a single dose of a testosterone hormone within a day of birth, and researchers later checked whether that exposure reshaped the brain-and-hormone system that governs the stress response. It examined how sex hormones during development might permanently set up the body's stress-regulating machinery in rodents. Because the work was done in rats and centred on hormonal wiring rather than any breathing practice, it does not offer direct guidance for someone considering Pulsing Breath, and no human or practice-related claims can be drawn from it.

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Brain mechanisms of HPA axis regulation: neurocircuitry and feedback in context Richard Kvetnansky lecture

2020

Finding: This paper is a review of how the brain keeps physical stress responses in check, mapping the systems that govern the release of the stress hormone cortisol through what researchers call the HPA axis. Rather than testing Pulsing Breath directly, it lays out the biology of how the body dials its stress reaction up and down, which helps explain why calming, breath-based practices might have something real to work with. Because this is background science on stress regulation and not a trial of the technique itself, it can't tell us how much Pulsing Breath changes your stress levels or how quickly you'd notice a difference.

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Influence ofPanax ginsengon Cytochrome P450 (CYP)3A and P‐glycoprotein (P‐gp) Activity in Healthy Participants

2011

Finding: This small study followed 12 healthy adults to see how the herbal supplement Panax ginseng affects the way the body processes certain prescription medications, and it points to a real possibility that ginseng can change how quickly some drugs are cleared. Because it looked at a supplement's interaction with medication rather than a breathing practice, it does not measure anything about Pulsing Breath itself, so it offers no direct evidence for or against this technique. The main practical takeaway is a general one: if you take prescription medications and are considering ginseng or similar herbal products, it is worth checking with a pharmacist or doctor first.

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Influence of stiripentol on cytochrome P450-mediated metabolic pathways in humans: In vitro and in vivo comparison and calculation of in vivo inhibition constants*

1997

Finding: This study looked at how a particular anticonvulsant medication interacts with liver enzymes that process drugs, both in the lab and in the body over two weeks; it does not examine the Pulsing Breath technique or any breathing practice. Because it measures medication chemistry rather than the effects of breathwork, it offers nothing you can apply to this technique. There are no findings here about breathing, stress, sleep, or well-being to draw on.

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Fulminant ACTH decrease following diabetic ketoacidosis induced by immune checkpoint inhibitor combination therapy with nivolumab and ipilimumab: A case report.

2023

Finding: This entry points to a single clinical case report describing one older patient's serious reaction to cancer immunotherapy, not a trial of the Pulsing Breath practice itself. It measured no outcomes related to breathing techniques, stress, sleep, or well-being, and no supporting claims or effect sizes are on file for it here. Because of that, it offers nothing you can act on when deciding whether this practice is right for you; look to the studies on this page that actually tested the technique.

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Isolated ACTH deficiency following immunization with the BNT162b2 SARS-CoV-2 vaccine: a case report.

2022

Finding: This is a single-patient case report describing a rare hormonal complication (a drop in the body's stress-hormone signalling) noted after an mRNA COVID-19 vaccination. It does not study the Pulsing Breath practice, does not track any breathing routine, and offers no measured outcomes about breathwork, stress, or well-being. Because the study falls entirely outside this technique's scope, it should not be read as evidence for or against Pulsing Breath, and no claim about the practice can be drawn from it.

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Influence of Itraconazole Co-administration and CYP2D6 Genotype on the Pharmacokinetics of the New Antipsychotic ARIPIPRAZOLE

2005

Finding: This study looked at how the body processes a particular medication when it is combined with another drug, testing a small group of 24 healthy adults; it does not examine the Pulsing Breath practice, breathwork, or any wellbeing outcome. Because none of its results connect to breathing techniques or stress and calm, it offers nothing that would help you decide whether to take up this practice. There are no supported claims to report here.

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Isolated adrenocorticotropic hormone (ACTH) deficiency and Guillain-Barré syndrome occurring in a patient treated with nivolumab.

2019

Finding: This study is a single medical case report describing rare hormone and immune complications in one older adult being treated with an immunotherapy drug for advanced cancer, and it does not examine the Pulsing Breath technique at all. Because it never measured this breathing practice, or any breathing practice, it offers no evidence about whether Pulsing Breath helps with stress, sleep, or anything else. Anyone weighing up this technique should treat this reference as unrelated to the practice and look to studies that actually tested the breathing method itself.

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Prediction of interpatient and intrapatient variation in OG 37-325 dosing requirements by the erythromycin breath test. A prospective study in renal transplant recipients.

1994

Finding: This study looked at how the body processes a transplant medication (a cyclosporine variant) in twenty kidney-transplant recipients, using a breath test to measure liver enzyme activity. Despite the word "breath" in its methods, it does not examine the Pulsing Breath practice or any breathing technique, and it offers no findings about stress, relaxation, or wellness. There is nothing here a reader can apply to a breathing practice, and no claims about Pulsing Breath can be drawn from it.

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Microtopography‐Guided Conductive Patterns of Liquid‐Driven Graphene Nanoplatelet Networks for Stretchable and Skin‐Conformal Sensor Array

2017

Finding: This study is a materials-science paper about building thin, flexible, see-through skin sensors from graphene coatings, not a test of the Pulsing Breath practice itself. It reports on how these ultrathin films can be assembled to be sensitive and conformable enough for wearable health monitors, so its relevance here is limited to the kind of device that might one day track breathing rather than to any measured benefit of the technique. In short, it tells us nothing about whether Pulsing Breath changes stress, sleep, or well-being, and it should not be read as evidence for the practice.

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Phenotyping of drug-metabolizing enzymes in adults: a review of in-vivo cytochrome P450 phenotyping probes

2000

Finding: This study looks at how the body processes certain drugs, specifically laboratory methods for measuring the activity of liver enzymes using probe substances like caffeine, and it does not examine the Pulsing Breath practice or any breathing technique at all. Because it reports nothing about how this practice affects the body or how it feels to do, it offers no findings a practitioner can act on here. If you are curious about what Pulsing Breath can do for you, this particular paper is not the place to look for an answer.

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[Setting up a risk prediction model on metabolic syndrome among 35-74 year-olds based on the Taiwan MJ Health-checkup Database].

2013

Finding: This study tracked nearly 14,000 adults aged 35 to 74 in Taiwan over several years to build a scoring tool that estimates a person's risk of developing metabolic syndrome, a cluster of conditions like high blood pressure and blood sugar, within the following five years. It is a population risk-prediction study, and it did not test the Pulsing Breath practice or any breathing technique, so it offers no direct evidence about what this practice does. If you are considering Pulsing Breath for your own health, treat this work as background on how metabolic risk is forecast rather than as support for the technique itself.

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Tailoring force sensitivity and selectivity by microstructure engineering of multidirectional electronic skins

2018

Finding: This study does not actually examine Pulsing Breath or any breathing practice; it is an engineering paper about flexible electronic-skin sensors designed to detect pressure and movement for wearable and robotic devices. Because nothing in this research addresses breathing, stress, or wellbeing, it offers no evidence about what this technique can do for you. We've flagged it as unrelated and are not drawing any practice guidance from it.

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Prediction of cardiovascular health by non-exercise estimated cardiorespiratory fitness

2020

Finding: This large study followed roughly 200,000 healthy adults in Taiwan and looked at how estimated fitness levels lined up with new cases of cardiovascular risk factors like high blood pressure, high cholesterol, and type 2 diabetes. It points to fitness being closely tied to long-term heart health across a very broad population. That said, this research measured general cardiorespiratory fitness rather than any specific breathing practice, so it cannot tell us whether Pulsing Breath itself changes these outcomes; treat it as background on why heart-health habits matter, not as direct evidence for this technique.

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Late-onset isolated adrenocorticotropic hormone deficiency caused by nivolumab: a case report.

2019

Finding: This study is a single medical case report describing a hormone-related side effect in one older patient being treated with a cancer immunotherapy drug, and it does not examine breathing practice, meditation, or any wellness technique. Because it looks at an unrelated clinical situation and the record contains no verified claims linking it to Pulsing Breath, it offers no evidence for or against this practice. Anyone weighing the benefits of Pulsing Breath should look to studies that actually tested the technique rather than drawing anything from this report.

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Isolated adrenocorticotropic hormone deficiency associated with sintilimab therapy in a patient with advanced lung adenocarcinoma: a case report and literature review.

2022

Finding: This particular paper doesn't actually study the Pulsing Breath practice; it examines a rare hormonal side effect linked to certain cancer immunotherapy drugs, which is a completely separate area of medicine. Because there are no measured outcomes here tied to breathing, stress, or well-being, it can't tell you anything useful about whether this technique works or how it might feel to practise. If you're weighing up Pulsing Breath, treat this reference as unrelated and look to studies that directly test the practice itself.

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Influence of CYP3A metabolizer status on the pharmacokinetics and pharmacodynamics of amiodarone.

2000

Finding: This study looked at how a heart-rhythm medication is processed by the body in a small group of 12 cardiac patients, not at any breathing practice. It does not measure Pulsing Breath or report any outcome related to breathwork, stress, sleep, or well-being. Because nothing in this research speaks to the technique on this page, it offers no evidence for or against Pulsing Breath, and no practical takeaway should be drawn from it here.

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History of trauma or dissociation

lowpractice-informed

Because Pulsing Breath trains attention to subtle internal body signals, that inward focus can amplify a sense of threat, breathlessness, or detachment for some people with a trauma history or dissociative experiences. Approach it gently and ideally with an experienced facilitator or mental-health professional; if distressing sensations arise, ease off and ground your attention in the room. This is a practice-informed concern inferred from the mechanism, not a measured risk, and it is not a substitute for trauma care.

New to Middendorf breath practice

lowpractice-informed

Pulsing Breath is one of the subtlest practices in the Middendorf tradition and is usually introduced only after foundational work such as Perceptible Breath and Breath Dialogue. Beginners attempting it alone may find it frustrating or over-focused. Build from gentler breath-awareness practices first, and keep early sessions short and unforced.

Significant respiratory or cardiovascular condition

lowpractice-informed

No data address the safety of Pulsing Breath in people with respiratory or cardiac conditions. Follow your usual medical guidance, treat the practice as a refinement exercise rather than a treatment, and continue any care you rely on. Pulsing Breath is not a substitute for treatment of any respiratory, cardiac, or mental-health condition.

How to practise safely?

Pulsing Breath is one of the subtlest practices in the Middendorf tradition, so it tends to land best once gentler breath-awareness work already feels familiar and you can turn attention inward without straining for it. A short, unforced session in a quiet spot is a sensible starting shape, resting on the breath's own fine movements rather than any rhythm you impose. If closely sensing internal signals feels activating rather than settling, it is worth easing off and, where a history of trauma, panic, or body-focused anxiety is in the picture, working alongside an experienced facilitator.

Build from the foundations first

Pulsing Breath is an advanced practice traditionally taught after Perceptible Breath and Breath Dialogue. Spend time with gentler breath-awareness practices before attending to the fine intra-breath pulse, so the subtle attention has somewhere familiar to rest.

Let the breath lead

Rest your attention on the natural micro-variations in pressure, speed, and depth within each breath rather than imposing any rhythm. There is nothing to control or correct; you are noticing the breath's own movement, not steering it.

Check how inward focus feels

If closely sensing internal body signals starts to heighten anxiety, breathlessness, or a feeling of detachment, ease off. Widen your attention to the room or to your physical contact with the floor or chair, and let the breath return to normal.

Keep sessions short and unforced

Start with a few minutes and stop while your attention still feels workable, rather than pushing for deeper or more sustained focus. The sense of settling tends to deepen with repetition rather than arriving in one long sitting.

Seek guidance where it helps

If you have a history of trauma, panic, or body-focused anxiety, or if the practice consistently feels activating, work with an experienced Middendorf facilitator or a mental-health professional rather than practising alone.

Keep it alongside, not instead of, care

Treat Pulsing Breath as a refinement practice, not a treatment. Continue any medical or psychological care you rely on for respiratory, cardiac, or mental-health conditions.

Medical Disclaimer

This information is educational and is not medical advice. This practice is not a substitute for professional care and should not replace prescribed medication or treatment for any medical or mental-health condition. If you are managing a health condition or taking medication, talk with a qualified health professional before changing your practice. If you are in distress or crisis, seek professional support.

Does Pulsing Breath actually work?

Not proven. No trials have tested Pulsing Breath, so there is no direct evidence it 'works' for any outcome or condition. It is a tradition-informed Middendorf practice with plausible attentional and body-awareness pathways drawn from broader research, not from studies of this practice.

Not proven. No clinical studies have examined Pulsing Breath itself, so no benefit, effect size, or claim that it treats anxiety, sleep, or any diagnosis can honestly be made for it. Within the Middendorf tradition it is taught to deepen presence, body awareness, and steadier focus, and general research on focused attention and interoception makes those directions plausible rather than established. A fair expectation is a gradual settling of attention you can explore, not a tested result.

Can Pulsing Breath help with anxiety or stress?

No study has tested Pulsing Breath for anxiety or stress, so it cannot be claimed to treat or reduce either. Within the Middendorf tradition some people find it settling and grounding, but it is not a substitute for care.

No study has tested this. Pulsing Breath is a Middendorf practice of noticing the subtle, living pulse within each breath, and no research has examined whether it eases anxiety or stress, so there is no effect size or population data behind a benefit claim. Taught as a tradition-informed practice, it may bring a gradual settling of attention that some people experience as grounding rather than symptom relief. If anxiety or stress is significant, treat it as an optional practice alongside, not instead of, appropriate care.

How does resting attention on the breath quiet a busy mind?

The proposed pathway is attentional anchoring: giving attention one subtle target, the fine pulse inside each breath, leaves less room for looping, worried thoughts, so the mind can feel quieter. This is a plausible mechanism drawn from general focused-attention research and the Middendorf tradition, not something tested for Pulsing Breath itself.

The proposed pathway is attentional anchoring, stabilising attention on one clear target so it stops jumping to worries. Resting on the intra-breath pulse gives the mind a single, absorbing thing to return to, and broader focused-attention research links this kind of anchoring to less mind-wandering. The Middendorf tradition adds that closely sensing the breath trains interoceptive awareness, the capacity to read the body's own internal signals. Both are best treated as proposed pathways rather than tested effects: no study has measured them for this specific practice and no physiological changes have been recorded, so this explains a plausible route to a quieter mind, not a proven or clinical outcome.

Why might Pulsing Breath make me feel more restless instead of calm?

Because turning attention inward can make subtle body sensations feel louder, which unsettles some people even as it soothes others. This is a common, normal variation, not a sign of harm. If restlessness rises, widen your attention, open your eyes, or shorten the session.

Restlessness is a common response, and both settling and unsettling reactions are normal. The likely reason comes from how the practice works rather than from any measurement of it: attending closely to the subtle internal signals of pressure, movement, and tension within each breath can amplify sensations you would usually not notice, which feels absorbing to some and activating to others. This is a plausible pathway drawn from how the practice is taught, not proven for Pulsing Breath and not a sign that anything is wrong. If it persists, ease off, ground your attention in the room or your contact with the chair, and let the breath return to normal.

Is Pulsing Breath safe if I have panic attacks or health anxiety?

Use care. For most healthy adults Pulsing Breath is low-risk, but closely attending to the body's internal cues of pressure, movement, and tension can make those sensations feel louder and may amplify panic or body-focused fear. If you live with panic attacks or health anxiety, approach it gently, ideally with a facilitator, and treat it as a support rather than a substitute for care.

Use care. No research specific to Pulsing Breath has been identified, so this is a practical, precautionary note rather than a finding from safety trials. The concern is straightforward: turning close attention inward to the subtle internal sensations of breath, pressure, and tension can heighten those cues, which unsettles some people prone to panic or health anxiety even as it soothes others. Keep sessions short, widen your attention to the room or your contact with the floor if fear rises, and work with an experienced facilitator or mental-health professional. The practice is not a substitute for treatment of any anxiety, respiratory, or cardiac condition.

Is Pulsing Breath safe if I have a history of trauma or dissociation?

Approach it gently. No safety research on Pulsing Breath exists, but as a precaution, close inward attention can amplify a sense of threat, breathlessness, or detachment for some people with trauma or dissociation. Work with a facilitator where you can, and treat this as reasonable care, not evidence of harm.

Approach it gently. No safety study has examined Pulsing Breath or Middendorf breath awareness in people with trauma, panic, health anxiety, or dissociation, so this guidance is a practical, precautionary note rather than a safety finding. Because the practice trains interoceptive awareness, the capacity to sense subtle internal body signals like pressure, movement, and tension, that heightened inward focus can make those sensations feel louder, which unsettles some people even as it soothes others. If it stirs a sense of threat, breathlessness, or detachment, ease off, widen your attention to the room, and work with a qualified facilitator or mental-health professional. This is not a substitute for trauma care.

How do I start Pulsing Breath, and how long should a session be?

Start small and let the breath lead. Rest attention on the tiny natural variations in pressure, speed, and depth within each breath without controlling it, and keep early sessions to just a few minutes, stopping while attention still feels easy. These are practice-informed suggestions, not a tested dose.

Start by building from gentler Middendorf practices first, then rest attention on the subtle intra-breath pulse rather than imposing any rhythm; there is nothing to control or correct. Keep early sessions short, a few unforced minutes, and stop while focus still feels workable rather than pushing for depth. If turning attention inward begins to heighten anxiety, breathlessness, or detachment, widen your focus to the room and let the breath return to normal. No study has examined this practice, its dose, or session length, so treat these as practice-informed starting suggestions rather than an evidence-based prescription.

What's the difference between Pulsing Breath and paced breathing like box breathing?

The core difference is steering versus noticing. Box breathing sets a fixed rhythm, an even count in and out, to shape how the body feels, while Pulsing Breath imposes no rhythm at all and simply attends to the subtle, living pulse already inside each breath.

The core difference is steering versus noticing. Paced techniques like box breathing deliberately set a rhythm to guide the breath toward a target, whereas Pulsing Breath is a Middendorf practice of non-directive attention to the micro-variations in pressure, speed, and depth within a single inhale or exhale, leaving the breath free to find its own pace. This is a structural distinction drawn from how each practice is defined and taught, not a ranking: no direct trials of Pulsing Breath and no head-to-head comparison with paced breathing exist, so neither can be called more effective here.

[4]other peer reviewed

David Henley, Georgina Russell, J. A. Douthwaite, Susan A. Wood, Fiona Buchanan, Rosemary Gibson (2009). Hypothalamic-Pituitary-Adrenal Axis Activation in Obstructive Sleep Apnea: The Effect of Continuous Positive Airway Pressure Therapy. https://doi.org/10.1210/jc.2009-1174

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Huang Li-Chung, Tsai Kuen-Jer, Wang Hao-Kuang, Sung Pi-Shan, Wu Ming-Hsiu, Hung Kuo-Wei (2014). Prevalence, incidence, and comorbidity of clinically diagnosed obsessive-compulsive disorder in Taiwan: a national population-based study.. https://doi.org/10.1016/j.psychres.2014.08.011

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Lars Schwabe, Erno J. Hermans, Marian Joëls, Benno Roozendaal (2022). Mechanisms of memory under stress. https://doi.org/10.1016/j.neuron.2022.02.020

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Chen Jiunn-Horng, Chen Hsuan-Ju, Kao Chia-Hung, Tseng Chun-Hung, Tsai Chon-Haw (2018). Is Fibromyalgia Risk Higher Among Male and Young Inflammatory Bowel Disease Patients? Evidence from a Taiwan Cohort of One Million..

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Mohammad Bagher Shiran, M. S. Lennard, Mohammad‐Zafar Iqbal, O. Lagundoye, Nicholas Seivewright, Geoffrey T. Tucker (2008). Contribution of the activities of CYP3A, CYP2D6, CYP1A2 and other potential covariates to the disposition of methadone in patients undergoing methadone maintenance treatment. https://doi.org/10.1111/j.1365-2125.2008.03312.x

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Rosario Pivonello, Chiara Simeoli, Maria Cristina De Martino, Alessia Cozzolino, Monica De Leo, Davide Iacuaniello (2015). Neuropsychiatric disorders in Cushing's syndrome. https://doi.org/10.3389/fnins.2015.00129

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Grouthier Virginie, Lebrun-Vignes Bénédicte, Moey Melissa, Johnson Douglas B, Moslehi Javid J, Salem Joe-Elie (2020). Immune Checkpoint Inhibitor-Associated Primary Adrenal Insufficiency: WHO VigiBase Report Analysis.. https://doi.org/10.1634/theoncologist.2019-0555

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Prueksaritanont T, Vega J M, Rogers J D, Gagliano K, Greenberg H E, Gillen L (2000). Simvastatin does not affect CYP3A activity, quantified by the erythromycin breath test and oral midazolam pharmacokinetics, in healthy male subjects..

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[28]observational

Nervo Alice, Gruosso Giovanni, Marino Marta, Migliore Enrica, Rubiolo Matteo, Vaccaro Elisa (2026). Adrenal Insufficiency During Treatment With Immune-Checkpoint Inhibitors: How to Simplify the Diagnostic Pathway?. https://doi.org/10.1111/cen.70023

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[29]other peer reviewed

David Martínez‐Gómez, Mengyun Luo, Yü Huang, Fernando Rodríguez‐Artalejo, Ulf Ekelund, Mercedes Sotos‐Prieto (2024). Physical Activity and All-Cause Mortality by Age in 4 Multinational Megacohorts. https://doi.org/10.1001/jamanetworkopen.2024.46802

DOI: 10.1001/jamanetworkopen.2024.46802

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[30]other peer reviewed

Ono Mayo, Fukuda Izumi, Nagao Mototsugu, Tomiyama Keiko, Okazaki-Hada Mikiko, Shuto Yuki (2022). HLA analysis of immune checkpoint inhibitor-induced and idiopathic isolated ACTH deficiency.. https://doi.org/10.1007/s11102-022-01231-1

DOI: 10.1007/s11102-022-01231-1

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[31]other peer reviewed

Cui Guo, Yiqian Zeng, Ly-yun Chang, Zengli Yu, Yacong Bo, Changqing Lin (2020). Independent and Opposing Associations of Habitual Exercise and Chronic PM 2.5 Exposures on Hypertension Incidence. https://doi.org/10.1161/circulationaha.120.045915

DOI: 10.1161/circulationaha.120.045915

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[32]other peer reviewed

Gharaibeh M N, Gillen L P, Osborne B, Schwartz J I, Waldman S A (1998). Effect of multiple doses of rifampin on the [14C N-methyl] erythromycin breath test in healthy male volunteers.. https://doi.org/10.1002/j.1552-4604.1998.tb05785.x

DOI: 10.1002/j.1552-4604.1998.tb05785.x

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[33]other peer reviewed

Milena Girotti, Sarah E. Bulin, Flavia Carreño (2024). Effects of chronic stress on cognitive function – From neurobiology to intervention. https://doi.org/10.1016/j.ynstr.2024.100670

DOI: 10.1016/j.ynstr.2024.100670

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[34]other peer reviewed

J. V. Seale, Stephen A. Wood, Helen C. Atkinson, Michael S. Harbuz, Stafford L. Lightman (2004). Postnatal masculinization alters the HPA axis phenotype in the adult female rat. https://doi.org/10.1113/jphysiol.2004.078212

DOI: 10.1113/jphysiol.2004.078212

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[35]other peer reviewed

James P. Herman, Nawshaba Nawreen, Marissa A. Smail, Evelin M. Cotella (2020). Brain mechanisms of HPA axis regulation: neurocircuitry and feedback in context Richard Kvetnansky lecture. https://doi.org/10.1080/10253890.2020.1859475

DOI: 10.1080/10253890.2020.1859475

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[36]other peer reviewed

Christine Y. Malati, Sarah Robertson, Jennifer D. Hunt, Cheryl Chairez, Raul M. Alfaro, Joseph A. Kovacs (2011). Influence ofPanax ginsengon Cytochrome P450 (CYP)3A and P‐glycoprotein (P‐gp) Activity in Healthy Participants. https://doi.org/10.1177/0091270011407194

DOI: 10.1177/0091270011407194

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[37]other peer reviewed

Agnès Tran, Elisabeth Rey, Gérard Pons, Marina Rousseau, Philippe d’Athis, Georges Olive (1997). Influence of stiripentol on cytochrome P450-mediated metabolic pathways in humans: In vitro and in vivo comparison and calculation of in vivo inhibition constants*. https://doi.org/10.1016/s0009-9236(97)90044-8

DOI: 10.1016/s0009-9236(97)90044-8

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[38]other peer reviewed

Iesaka Hiroshi, Kameda Hiraku, Miya Aika, Nomoto Hiroshi, Cho Kyu Yong, Nakamura Akinobu (2023). Fulminant ACTH decrease following diabetic ketoacidosis induced by immune checkpoint inhibitor combination therapy with nivolumab and ipilimumab: A case report.. https://doi.org/10.1097/md.0000000000036664

DOI: 10.1097/md.0000000000036664

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[39]other peer reviewed

Morita Shuhei, Tsuji Tomoya, Kishimoto Shohei, Uraki Shinsuke, Takeshima Ken, Iwakura Hiroshi (2022). Isolated ACTH deficiency following immunization with the BNT162b2 SARS-CoV-2 vaccine: a case report.. https://doi.org/10.1186/s12902-022-01095-3

DOI: 10.1186/s12902-022-01095-3

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Masanori KUBO, Toshiko Koue, Atsuhiro Inaba, Hiroshi Takeda, Hiromi Maune, Tsuyoshi Fukuda (2005). Influence of Itraconazole Co-administration and CYP2D6 Genotype on the Pharmacokinetics of the New Antipsychotic ARIPIPRAZOLE. https://doi.org/10.2133/dmpk.20.55

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Pierrard Julien, Petit Bénédicte, Lejeune Sarah, Seront Emmanuel (2019). Isolated adrenocorticotropic hormone (ACTH) deficiency and Guillain-Barré syndrome occurring in a patient treated with nivolumab.. https://doi.org/10.1136/bcr-2019-230848

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Young‐Jin Park, Jongwon Shim, Suyeon Jeong, Gi‐Ra Yi, Heeyeop Chae, Jong Wook Bae (2017). Microtopography‐Guided Conductive Patterns of Liquid‐Driven Graphene Nanoplatelet Networks for Stretchable and Skin‐Conformal Sensor Array. https://doi.org/10.1002/adma.201606453

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More Pulsing Breath in Insight Timer

Editorially curated. Tracks are not themselves clinically studied; evidence on the page applies to Pulsing Breath as a technique.

4.7

Guided

9 min

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Dionne Reed

Explore Pulsing Breath

Beginner content for Pulsing Breath

★ 4.7

Guided

9 min

Breathwork For Stuck Energy | 9 Minutes

Jenn Mansell

Begin Practice

Pulsing Breath effort level

How hard is Pulsing Breath?

Hard

Pulsing Breath sits above the gentlest Middendorf rows because it is an advanced micro-perception practice with a real prior-training burden, even though the breath itself stays soft.

Mental Effort

3 / 4

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Emotional Depth

1 / 4

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Physical Intensity

1 / 4

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Prior Knowledge

3 / 4

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Panic disorder or health anxiety

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Pulsing Breath

Middendorf Breathwork

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Micro-oscillations (intra-breath pulse)

Interoceptive awareness

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Full References

Pulsing Breath Tracks & Video

Breathwork For Stuck Energy | 9 Minutes

Breathwork For Sleep: Fall Asleep Quickly

History of trauma or dissociation

New to Middendorf breath practice

Significant respiratory or cardiovascular condition

How to practise safely?

Build from the foundations first

Let the breath lead

Check how inward focus feels

Keep sessions short and unforced

Seek guidance where it helps

Keep it alongside, not instead of, care

Medical Disclaimer

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More Pulsing Breath in Insight Timer

Breathwork For Stuck Energy | 9 Minutes

Breathwork For Sleep: Fall Asleep Quickly

Explore Pulsing Breath

Breathwork For Stuck Energy | 9 Minutes

Pulsing Breath effort level

Hard