Alternate Nostril Breathing

Alternate nostril breathing (nadi shodhana) is a yoga practice: breathe in through one nostril, out through the other, and switch. It may lower blood pressure [1], but trials are small and it is not clearly better than plain slow breathing [2].

In short
What it is
In through one nostril, out through the other, then switch.
One round
20 seconds at 4 in, 6 out; 5 rounds under 2 minutes.
When it helps
A slow, calming practice. Studies are small and short.
Who should be careful
Blocked nose, asthma, COPD, heart or lung disease: check first.
Ready? 4 round 0 of 5

Left in 4 · Right out 6 · Right in 4 · Left out 6

Breathe gently through your nose. If it is blocked, skip this exercise. Stop if you feel dizzy.

One round: 20 s · 5 rounds = 1 min 40 s

Left nostril Right nostril Thumb Ring finger Index + middle folded into palm
Mirror view: your right is on the right of the picture. Right hand, index and middle fingers folded (often called Vishnu mudra). The lit nostril is the one you close.
  1. 1 Left in
  2. 2 Right out
  3. 3 Right in
  4. 4 Left out

The timer names the nostril for every step and counts the seconds, with no holds. Teachers disagree on where to start and whether to hold, so this order and these counts are our choice.

Quietarium editorial team Updated Sources: 16

How to do alternate nostril breathing, step by step

Use your right hand: thumb by your right nostril, ring finger by your left, and the other two fingers folded away. The timer above names each step by nostril, and the picture inside it lights up the nostril you close.

  1. Sit tall on a chair or the floor and rest your left hand on your left knee.
  2. Fold your index and middle fingers into your right palm. Rest the thumb beside your right nostril and the ring finger beside your left.
  3. Breathe out gently through your nose to empty your lungs.
  4. Close your right nostril with your thumb. Breathe in through the left for 4.
  5. Close your left nostril with your ring finger and lift the thumb. Breathe out through the right for 6.
  6. Breathe in through the right for 4, then close it with your thumb.
  7. Lift your ring finger and breathe out through the left for 6. That is one round.
  8. Repeat for 5 rounds. Keep the breath smooth and quiet, and the pressure of your fingers light.

If your nose is blocked, skip the practice for today. Healthline advises against it when you are sick or congested [3].

Which fingers and which nostril first?

Use your right hand, with the thumb on the right nostril and the ring finger on the left; the sources differ on everything after that. Four popular instructions, side by side:

SourceFingersStarts withHoldTime
Healthline [3]Right thumb on the right nostril, fingers on the left; left hand on the left kneeFull exhale, then breathe in through the leftNone in the basic version; 2‑3 seconds after each inhale for nadi shodhanaUp to 5 minutes, ending with an exhale on the left
Cleveland Clinic [4]Index finger over the left nostril, thumb over the rightExhale through the mouth, then breathe in through the leftA beat or two with both nostrils closed5 minutes a day
WebMD [5]Index and middle fingers out of the way; thumb right, ring finger leftExhale through the left, then breathe in through the rightNone10 minutes
Art of Living [6]Index and middle fingers between the eyebrows; ring and little fingers left, thumb rightExhale through the left, then breathe in through the leftNone; exhale longer than inhale9 rounds

There is no standard. Healthline itself cites a 2017 review that points to the lack of a standard technique as the reason nobody can say which version works best [3]. We chose the simplest one: start with an inhale on the left, no holds, and a longer exhale. It is our design choice; trials have not compared these versions. Many teachers call the folded-finger hand shape Vishnu mudra; resting those two fingers between the eyebrows, as Art of Living does, is the other common version.

How long and how often should you do it?

Start with 5 rounds, about 1 minute 40 seconds at 4 in and 6 out. Add rounds once it feels easy.

The sources ask for more. Healthline says to continue for up to 5 minutes [3], Cleveland Clinic recommends 5 minutes a day [4], WebMD says 10 minutes [5], and Art of Living counts 9 rounds [6]. Those are teaching habits, and the studies in the next section did not compare lengths or frequencies.

Pick 5 rounds today. The timer also offers 9 rounds and 5 minutes, and an easier 4-in, 4-out pace if the longer exhale makes you gasp.

Does alternate nostril breathing work? What did the trials find?

It may lower blood pressure and feel calming, but the studies are small, short and often done on young, healthy volunteers. A 2021 systematic review described its participants as mostly Asian Indian and predominantly male [7]. What each abstract reported:

StudyWho and howWhat it foundWhat it did not show
Nam 2024 [1]Meta-analysis of 6 randomized trials, 525 people. It sits inside a review of 14 studies and 1,377 people.Systolic pressure 7.16 mmHg lower and diastolic 5.16 lower than with no intervention or placebo.The trials disagreed a lot (I² 93 % and 87 %). Most were not blinded.
Garg 2024 [8]Meta-analysis of 15 studies of any breathing exercise.Systolic 7.06 mmHg lower, diastolic 3.43 lower, heart rate 2.41 beats a minute lower.Not specific to alternate nostril breathing. The authors say the studies are "not deprived of bias."
Telles 2017 [9]15 healthy men, 15 minutes, crossover.Systolic pressure fell and a vigilance test got faster.Sitting quietly also sped up the test.
Upadhyay 2023 [10]100 people with high blood pressure, nadi shodhana vs bhramari (humming breath), 20 minutes.Reaction time shortened in both groups.No difference in heart rate variability, and no rest-only group.
Mittal 2025 [11]Exploratory trial in people with high blood pressure on medication. 10 minutes of nadi shodhana plus 2 minutes of belly breathing, for 6 weeks.Blood pressure was lower right after, and systolic was lower at 6 weeks than in the control group.The abstract gives no group size. It is exploratory.
Ghiya and Lee 2012 [2]20 healthy adults, alternate nostril vs paced breathing.Heart rate variability rose after alternate nostril breathing.It rose after paced breathing too, with no difference between the two.
Gandharva 2026 [12]45 adults, 15 minutes, 5 sessions, crossover.Systolic pressure fell with alternate nostril breathing.Anxiety fell after it and after quiet rest. Clear effects appeared only when nostril dominance was taken into account.

It is worth trying as a calm, slow-breathing practice. Most trials were small and unblinded. Where a study added a plain slow-breathing or quiet-rest condition, that condition did about as well, so nothing here shows that switching nostrils adds anything to slow breathing itself. The strongest number is the pooled systolic drop of 7.16 mmHg, and it comes with an I² of 93 % [1]. For other styles, see all breathing techniques.

Alternate nostril breathing for anxiety and stress

It may take the edge off before a stressful moment, such as a talk in ten minutes, but the evidence is thin. In the Kamath pilot, 30 medical students did 15 minutes of it before a simulated public speech. Their anxiety scores showed a trend toward lower, yet the group effect was not significant, and the authors say a larger sample is warranted [13].

A crossover study of 38 men with yoga experience found lower state anxiety after 18 minutes of alternate nostril breathing, and lower than after plain breath awareness [14]. In Gandharva's 45 adults, anxiety fell after the breathing and also after quiet rest [12].

Kamath's students were healthy volunteers and Sharma's men already practiced yoga, so neither group tells you much about an anxiety disorder. For a tense hour, the nervous system page has quicker options.

Does alternate nostril breathing lower blood pressure?

In a 2024 meta-analysis of 6 randomized trials, systolic pressure fell by about 7 mmHg, but the trials differed widely [1]. The authors wrote that attention is needed because "heterogeneity exceeds 75%."

Breathing exercises of any kind gave a similar drop in another meta-analysis, 7.06 mmHg systolic [8], so the data cannot separate nostril switching from slow breathing. The one trial in people already on medication tested it as an add-on [11]. Keep taking your blood pressure medicine, and ask your clinician before you change anything.

Alternate nostril breathing vs 4-7-8

In the one head-to-head study, neither technique changed heart rate variability more than rest did [15]. It had 34 students, each doing 4-7-8, nadi shodhana and quiet rest for 10 minutes.

On how people felt, 4-7-8 did better in women and nadi shodhana in men. The authors conclude that acute autonomic changes remain limited. Pick the one you can do smoothly. Our 4-7-8 page has the steps, and box breathing is a third option with a different shape. If you want a longer exhale without any finger work, try belly breathing or the physiological sigh.

Who should not do alternate nostril breathing?

What if one side of your nose is blocked? Skip the practice for now. The same goes for the cases below:

  • If your nose is blocked or you have a cold, wait until you can breathe through both sides. Healthline says not to practice when sick or congested [3]. No trial tested this, so it rests on one source.
  • If you have asthma, COPD or another lung or heart condition, talk with your doctor first [3]. WebMD adds to go slowly and keep your inhaler nearby [5].
  • If you feel short of breath, dizzy or nauseous, stop [3]. If you also have chest pain, faint or vomit, stop and see a doctor [5].
  • If you are pregnant, ask your own clinician. A systematic review in pregnant abuse survivors called the practice minimal risk but said the data were limited [7]. NCCIH advises pregnant women and people with health conditions to talk with a provider before yoga [16].

Frequently asked questions

Can I do alternate nostril breathing before bed?

Maybe not. Cleveland Clinic calls it a poor choice before bed, because one study found it lowered blood pressure while raising alertness [4]. That study had 15 men, and sitting quietly also sped up the same alertness test [9], so treat the advice as a cautious guess. For bedtime, Cleveland suggests 4-7-8 instead; ours is on the 4-7-8 page.

Can I do it with a cold?

Skip it. Healthline says not to practice when you are sick or congested [3]. No trial we read tested practice during a cold, so this rule rests on one source.

Is anulom vilom the same as nadi shodhana?

Nearly. Healthline describes anulom vilom as breathing in through one nostril and out through the other, and nadi shodhana as the same pattern with a short hold after each inhale [3]. The timer on this page has no holds, so it matches the basic pattern.

Does alternate nostril breathing lower cortisol?

The abstracts we read report blood pressure, heart rate variability, reaction time and anxiety scores. None of them reports cortisol, so we cannot say it lowers cortisol.

When to see a professional

Get medical advice before you continue, or instead, if:

  • you take blood pressure medicine or your readings run high, and you want to use this alongside;
  • you have asthma, COPD, or a heart or lung condition;
  • you feel short of breath, dizzy or sick while practicing, or you have chest pain or faint;
  • worry or low mood is there most days and does not ease.

This page is general information, not medical advice.

Lower your hand and let your nose breathe on its own. If you feel dizzy, sit back and rest your eyes on something steady until it passes. 5-4-3-2-1 grounding is a gentler place to go next.

If you feel very bad right now

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Author
Quietarium editorial team
Updated

This page does not replace advice from a doctor. Medical disclaimer · Editorial policy

Sources: 16
  1. Nam TG, Jeong H, Kim KH, Jang I. Effectiveness of Alternative Nostril Breathing on Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Complement Med Res. 2024;31(5):449-460. doi:10.1159/000539707. PubMed 39008954. Meta-analysis.
  2. Ghiya S, Lee CM. Influence of alternate nostril breathing on heart rate variability in non-practitioners of yogic breathing. Int J Yoga. 2012;5(1):66-69. doi:10.4103/0973-6131.91717. PubMed 22346069. Lab study.
  3. Cronkleton E, Walters O. What Are the Benefits and Risks of Alternate Nostril Breathing? Healthline, updated May 24, 2023. healthline.com (accessed October 19, 2026). Cited for what it advises, not as evidence. Patient information.
  4. Cleveland Clinic. How and Why To Try Alternate Nostril Breathing. September 7, 2022. health.clevelandclinic.org (accessed October 19, 2026). Cited for what it advises, not as evidence. Patient information.
  5. WebMD. Nadi Shodhana: Alternate-Nostril Breathing Benefits and Risks. webmd.com (accessed October 19, 2026). Cited for what it advises, not as evidence. Patient information.
  6. The Art of Living. Nadi Shodhan Pranayama: Alternate Nostril Breathing Technique. artofliving.org (accessed October 19, 2026). Cited for its instructions only. Patient information.
  7. Rung O, Stauber L, Loescher LJ, Pace TW. Alternate Nostril Breathing to Reduce Stress: An Option for Pregnant Women Survivors of Intimate Partner Violence? J Holist Nurs. 2021;39(4):393-415. doi:10.1177/0898010120983659. PubMed 33461386. Systematic review.
  8. Garg P, Mendiratta A, Banga A, et al. Effect of breathing exercises on blood pressure and heart rate: A systematic review and meta-analysis. Int J Cardiol Cardiovasc Risk Prev. 2024;20:200232. doi:10.1016/j.ijcrp.2023.200232. PubMed 38179185. Meta-analysis.
  9. Telles S, Verma S, Sharma SK, Gupta RK, Balkrishna A. Alternate-Nostril Yoga Breathing Reduced Blood Pressure While Increasing Performance in a Vigilance Test. Med Sci Monit Basic Res. 2017;23:392-398. doi:10.12659/msmbr.906502. PubMed 29284770. Lab study.
  10. Upadhyay J, Nayak NS, Shetty S, Saoji AA, Yadav SS. Effects of Nadishodhana and Bhramari Pranayama on heart rate variability, auditory reaction time, and blood pressure: A randomized clinical trial in hypertensive patients. J Ayurveda Integr Med. 2023;14(4):100774. doi:10.1016/j.jaim.2023.100774. PubMed 37499590. Randomized trial.
  11. Mittal G, Pathania M, Bhardwaj P, Dhar M, Khapre M, Mittal S. An Exploratory Randomised Trial to Assess the Effect of Nadi Shodhan Pranayama as an Adjunct Versus Standard Non-pharmacological Management in Hypertensives. Ann Neurosci. 2025 (online April 14). doi:10.1177/09727531251318810. PubMed 40242728. Randomized trial.
  12. Gandharva K, Sharma SK, Balkrishna A, Telles S. Short-Term Effects of Nostril-Regulated Yoga Breathing on Autonomic Variables: A Randomized Crossover Trial. Int J Yoga Therap. 2026;35(2025). doi:10.17761/2025-D-25-00026. PubMed 41765327. Randomized trial.
  13. Kamath A, Urval RP, Shenoy AK. Effect of Alternate Nostril Breathing Exercise on Experimentally Induced Anxiety in Healthy Volunteers Using the Simulated Public Speaking Model: A Randomized Controlled Pilot Study. Biomed Res Int. 2017;2017:2450670. doi:10.1155/2017/2450670. PubMed 29159176. Pilot trial.
  14. Sharma SK, Kala N, Telles S. Volitional Yoga Breathing Influences Attention and Anxiety: An Exploratory Randomized Crossover Study. Complement Med Res. 2022;29(2):120-126. doi:10.1159/000519715. PubMed 34784592. Randomized trial.
  15. Avcık FE, Koç F, Aktop A. Acute Psychophysiological Effects Of 4-7-8 And Nadi Shodhana Breathing: A Randomized Crossover Study. Appl Psychophysiol Biofeedback. 2026 (online September 22). doi:10.1007/s10484-026-09811-8. PubMed 42771122. Randomized trial.
  16. National Center for Complementary and Integrative Health. Yoga: Effectiveness and Safety. nccih.nih.gov (accessed October 19, 2026). General yoga guidance, not specific to this technique. Patient information.