The Power of Breathing



Case managers are an integral part of the healthcare team. Their roles are crucial in preventing readmissions and coordinating services for patients and their families.

During the COVID-19 pandemic, inadequate resources in the community, overloaded caseloads and intensive care units being at maximum capacity have put an extra burden on case managers. As case complexity has increased, experiences of moral distress have heightened among case managers. The unresolved moral distress builds over time, and the symptoms escalate and intensify, compromising clarity and focus and leading to burnout. The consequences of moral distress can have physical effects on the health of the case manager. These include elevated heart rate and blood pressure, inadequate sleep, indigestion, anger and frustration. This can result in disengagement from work and withdrawal from patient care. The ongoing stressors can weaken the immune response and activate pro-inflammatory cytokines. Sustained elevation of pro-inflammatory cytokines can lead to chronic mental illness and physical diseases.1 Any threat, real or perceived, can elevate inflammation in the body. Recognizing the signs and symptoms of stressors and how to handle the stressors can help lower inflammation and burnout.

When events happen in life, they are recorded by the brain.1 They create a certain level of shock on the mind, which sends distress signals to the nervous system, which in turn will tell the endocrine system to increase adrenaline and cortisol. When the levels of these hormones are increased, our immune system weakens.2 Even though the initial stress is unhealthy, it is the continual stress that records in the subconscious mind. Enough of these recordings over time can be destructive as an overstressed nervous system will respond with an overproduction of stress hormones and suppression of immune function.2


Our bodies have an innate self-repair mechanism.2


The first step in harnessing the body’s healing power is to stop thinking that the body is not your business. Take your power and stop handing it over to other healthcare providers. Your body is your business, and your mind has tremendous power to communicate with your body, so that your body can heal itself.

Case managers are facing stress and anxiety due to job expectations, family obligations, relationships and many other factors. Stress is the physiological response in which the demand is greater than the energy reserve in the body. As a result, the scale is off balance.


One option is to reduce the demands, but that is not always possible. The other option is to raise the energy level. Energy can be raised by food, sleep, positive state of mind and breathing. Of these four options, breathing is the most important source of energy, but it is also the most neglected.

Let us bring our awareness to our emotions and breathe. When we are either sad or depressed, exhalation is longer than the inhalation. When we are happy, it is reversed: Inhalation is longer than the exhalation. When we are angry, the breathing is rapid and short. This explains how our breathing and our emotions are connected. For every emotion, there is a corresponding rhythm in the breathing cycle.

Our thoughts react to the amazing world of reality each and every day. However, they are also the root cause of most of the problems in our lives. When we escalate our thoughts, we lose control and are unable to remain calm. Our mind cannot stop thinking, but we can learn to tame our thoughts by yoga practice and by the exercise of mental calmness.

A typical day in a case manager’s world has thousands of thoughts racing. That is the tendency of the mind. As case managers are running around making arrangements for patients, distraction can present itself in many forms. Before they know it, the mind can easily start thinking about something else. That is the level of control we have over our mind. But if you are asked to hold your breath for 5 seconds, can you do that? Yes, you can. So, we have some say over the breathing.

On any given day, we have thousands of thoughts; the mind keeps racing, and these thoughts have corresponding rhythms in the emotions.

Earlier, we established that every emotion has a rhythm in the breath.

So, what’s the smart thing to do in order to reverse this relationship?

We use the breathing to influence the emotions, and that, in turn, influences the mind. When we are aware of our breathing, we can tame our thoughts and choose whether to respond to our thoughts or not.

Evidence shows that breath work practice can lower anxiety and can have a calming effect on our mind and body.3

Let’s learn three simple techniques to manage the mind and manage negative emotions that overpower case managers throughout the day.

  1. Breathe in deeply for a count of four seconds, hold for a count of four seconds and exhale slowly for a count of six seconds. This is one cycle. Repeat four times. Regular practice can help regulate your nervous system and take you out of crisis mode. You can do this practice before entering your patient’s room while washing your hands.3
  2. When you need clarity and focus, as well as more energy, you can practice right nostril breathing. Using your right hand, block off your left nostril by putting gentle pressure on it with your right index finger. Using your right nostril, take a slow deep inhalation and slow long exhalation. Repeat this for five to six times. Once completed, relax your body, and feel the energy smoothly and gracefully building in your body. You can practice this mid-day, when you feel like you need some caffeine. Instead of caffeine, practice this right nostril breathing and notice how you can bring new life into your body.4
  3. Alternative nostril breathing practice helps balance the left and right brain, by balancing the flow of energy.4 To start this practice, sit in a comfortable chair with your back straight, close your eyes and take a few deep breaths in and out. Place your left hand on your left knee with palm facing upwards. Fold your index finger and middle finger of your right hand, use your right thumb and ring finger to open and close right and left nostrils.4 Take a deep breath in and exhale through both nostrils, using your right thumb to gently close the right nostril, breathe in deeply through your left nostril, then gently close the left nostril with your ring finger and slowly exhale through the right nostril.5 Then inhale through the right nostril, close the right nostril, exhale through the left nostril, then inhale through the left nostril, close the left nostril and exhale through the right. Repeat this for five to nine rounds.5 Always complete the practice by finishing with an exhalation on the left side. Aim for smooth, controlled rhythm of breathing, keeping focus on the air moving in and out of the nostrils. This practice can be done any time of the day. When you need to focus and relax, then practice this breathing technique for better focus and relaxation.5

These simple breathing practices will stimulate your parasympathetic nervous system, make you feel calmer, less stressed, sleep better and lower your blood pressure and heart rate.3

These are non-pharmacological interventions for emotional enhancement, including anxiety, depression and stress.3

In order to keep your battery fully charged, look inward and see where the fuel gauge on the meter is. If you are low, the quickest way to charge and refuel is to slow your breath, focus inward on your breath and do breathing exercises that will charge you and keep your battery full at all times.

Use the power of breathing to calm the anxiety and cultivate peace. A regular practice can boost your mood, improve your lifestyle and reduce anxious and stressful experiences. These simple practices will build resilience in case managers, so that they can be more present and productive daily.


1. Rumende CM, Susanto EC, Sitorus TP. (2020). The management of cytokine storm in COVID-19. Acta Med Indones. 52(3):306-313. PMID: 33020343.
2. Gustafson C. (2017). Bruce Lipton, PhD: The jump from cell culture to consciousness. Integrative Medicine (Encinitas, Calif.), 16(6), 44—50.
3. Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., & Gemignani, A. (2018). How breath-control can change your life: A systematic review on psycho-physiological correlates of slow breathing. Frontiers in Human Neuroscience, 12, 353.
4. Kamath, A., Urval, R. P., & Shenoy, A. K. (2017). 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 Research International, 2017, 2450670.
5. Telles S, Nagarathna R, Nagendra HR. Breathing through a particular nostril can alter metabolism and autonomic activities. (1994). Indian J Physiol Pharmacol. 38(2):133-7. PMID: 8063359.
rajitha bommakanti

Rajitha Bommakanti, BSN, RN-CCM, has been practicing nursing for over 30 years in various medical specialties. She currently works as an ER case manager. In her nursing journey, Rajitha has seen gaps in patient care and the impact chronic medical conditions had on her patients’ quality of life. She wanted to make a difference, so she moved into a health coaching/transformation space where she is a health partner in educating, inspiring and empowering people to make small changes to their lives to improve their health. She is a founder of Healthy You Lifestyle Center; You may contact her at .


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