Acupuncture HRV

Acupuncture and Sound Assisted
Autonomic Modulation Technique: Part 2 Heart Rate Variability

Heart Rate Variability The heart is never beating at a consistent pace (unless you wear a pacemaker).  The normal fluctuation of heart rate is called heart rate variability (HRV).[1]  Many diseases are known to be associated with decreased HRV.[2-7] A person with high stress, emotional disorders and/or an unhealthy lifestyle also tends to show decreased HRV.[3, 8-10]  Further, HRV declines as we age.[11-14]  The figures below show an example of HRV differences between young and older individuals.

Example of large HRV during deep breathing for a younger and fit individual (29 year old female)

Example of decreased HRV during deep breathing for an older individual (64 year old female)

During most treatment sessions, a blood volume pulse sensor is attached to the patient’s ear lobe (or finger tip).  This device displays the patient’s heart (pulse) rate on a screen.  By monitoring the heart rate changes, we can obtain vital information such as his/her physical status in general, emotional state, how he/she is responding to the breathing exercise, and how diligently he/she is following breathing cues provided.  How is this possible?  Because our heart beating rhythm is greatly influenced by emotions and the way we breathe. Heart rate change influenced by breathing is called respiratory sinus arrhythmia (RSA).[15]  The graph below further illustrates how significantly heart rate changes by simply altering the way we breathe.

A healthy individual’s respiration and heart rate monitored over a 1 minute period 

• In the first 30 seconds, the person was breathing at the rate of approximately 15 breaths per minute (typical breathing rate when resting).  At that time, the heart was consistently beating at approx. 80 beats per minute.

• In the last 30 seconds, the person slows down breathing to approx. 6 breaths per minute (approximately 10 seconds for a full inhale and exhale)*.  You can clearly see that heart rate is largely fluctuating, varying from 62 beats per minute (at the end of exhalation) to 86 beats per minute (at the end of inhalation). The rhythm of the heart and breathing pattern are also in phase with each other during this time period.

Acupuncture and Sound Assisted
Autonomic Modulation Technique: Part 3 Relaxation and HRV

Many people tend to confuse this exercise with relaxation. While most people do find this breathing exercise relaxing and it can certainly be used as a powerful stress management tool, the intention with this breathing exercise and the response it induces is different than with common relaxation methods. The graph below illustrates the difference. The distinct pattern of heart rate seen in the last 15 min. (a larger variability with a more coherent rhythm) cannot be typically induced by practicing commonly used relaxation methods.  A series of recent scientific papers suggested that when the heart is beating in such a pattern (a coherent rhythm and high variability), the autonomic and hormonal reflexes are actively stimulated.[16, 17]  This leads to enhanced modulation in our internal system.

A growing number of scientists and clinicians now emphasize the greater importance of proper physiological Regulation rather than Relaxation for our health. In this age and society, we cannot avoid stress. Rather than only focusing on avoiding stress, it is important to address our innate capabilities to recover efficiently from a stress response.

For example, whenever we need to perform a physical or mental task our nervous systems should be accelerated (sympathetic mode) and then promptly slow down when the task is over (parasympathetic mode).  In general, the sympathetic system should be more dominant during the day for activities and the parasympathetic system should become dominant at night for restful sleep.  Having proper shifts of our sympathetic and parasympathetic nervous system (according to the day/night rhythm) is very important for our health.

For moment to moment regulations, we have a sophisticated homeostatic mechanism in our bodies.  Baroreflex, as an example, regulates blood pressure and heart rate to maintain proper blood flow and to counter various environmental changes. All of us are born with these vitally important physiological internal regulation mechanisms; however, they occasionally get out of order or insensitive. 

This breathing exercise is specifically designed to maximize the variability of a person’s heart rate (instead of primarily aiming to slow it down as in passive relaxation training). Increased heart rate variability, in turn, stimulates our important physiological regulation mechanisms which in turn lead to more optimized nervous and hormonal functioning.[17, 18]

Since most individuals are chronically shifted towards sympathetic dominant mode, it is still recommended to incorporate relaxation activities in their daily lifestyles.  Just like we need to incorporate both stretching and strengthening for physical fitness, it is important to practice both relaxation and self regulation modalities such as HRV based breathing exercise.

According to neur ocardiology research, our heart and brain work in a highly interactive fashion, sending and receiving signals back and forth from one another [19]. It is logical to conclude that the most powerful short and long-term stress management solution would be to approach both our brain and heart simultaneously.

At The Pacific Wellness Institute, the HRV based breathing exercise has been actively used in conjunction with acupuncture since 2002. Our acupuncture system uses specific acupuncture points and needling method that is targeted to provide stimulus to the autonomic nervous system.[20, 21]  Utilizing our custom made CDs,[22] patients are instructed to breathe in a specific rhythm (frequency between 0.08-0.12 Hz) while lying on the table with acupuncture needles inserted.  The heart rate frequency spectrum is evaluated and feedback is provided to the patients.

Clinical results obtained with this combined approach are noteworthy, not only on autonomic dysfunction disorders but also when the condition is associated with chronic stress or disturbance in chronobiological rhythms (e.g., IBS, menstrual irregularities, certain forms of insomnia, back pain and headaches).

Acupuncture and Sound Assisted
Autonomic Modulation Technique: Part 4 References

References

1. Heart Rate Variability: Standards of Measurement, Physiological Interpretation, and Clinical Use. Circulation 1996; 93(5): 1043-1065.

2. Kleiger RE, Miller JP, Bigger JT, Jr., Moss AJ: Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 1987; 59(4): 256-62.

3. Kupari M, Virolainen J, Koskinen P, Tikkanen MJ: Short-term heart rate variability and factors modifying the risk of coronary artery disease in a population sample. Am J Cardiol 1993; 72(12): 897-903.

4. Guzzetti S, Piccaluga E, Casati R, et al.: Sympathetic predominance in essential hypertension: a study employing spectral analysis of heart rate variability. J Hypertens 1988; 6(9): 711-7.

5. Langewitz W, Ruddel H, Schachinger H: Reduced parasympathetic cardiac control in patients with hypertension at rest and under mental stress. Am Heart J 1994; 127(1): 122-8.

6. Novak V, Novak P, de Champlain J, Nadeau R: Altered cardiorespiratory transfer in hypertension. Hypertension 1994; 23(1): 104-13.

7. Bernardi L, Ricordi L, Lazzari P, et al.: Impaired circadian modulation of sympathovagal activity in diabetes. A possible explanation for altered temporal onset of cardiovascular disease. Circulation 1992; 86(5): 1443-52.

8. Yeragani VK, Balon R, Pohl R, et al.: Decreased R-R variance in panic disorder patients. Acta Psychiatr Scand 1990; 81(6): 554-9.

9. Kawachi I, Sparrow D, Vokonas PS, Weiss ST: Decreased heart rate variability in men with phobic anxiety (data from the Normative Aging Study). Am J Cardiol 1995; 75(14): 882-5.

10. Sloan RP, Shapiro PA, Bigger JT, Jr., Bagiella E, Steinman RC, Gorman JM: Cardiac autonomic control and hostility in healthy subjects. Am J Cardiol 1994; 74(3): 298-300.

11. De Meersman RE: Aging as a modulator of respiratory sinus arrhythmia. J Gerontol 1993; 48(2): B74-8.

12. Kohara K, Igase M, Maguchi M, Fukuoka T, Kitami Y, Hiwada K: Autonomic nervous function in essential hypertension in the elderly. Evaluation by power spectral analysis of heart rate variability. Am J Hypertens 1996; 9(11): 1084-9.

13. Waddington JL, MacCulloch MJ, Sambrooks JE: Resting heartrate variability in man declines with age. Experientia 1979; 35(9): 1197-8.

14. Yo Y, Nagano M, Nagano N, et al.: Effects of age and hypertension on autonomic nervous regulation during passive head-up tilt. Hypertension 1994; 23(1 Suppl): I82-6.

15. Yasuma F, Hayano J: Respiratory sinus arrhythmia: why does the heartbeat synchronize with respiratory rhythm? Chest 2004; 125(2): 683-90.

16. Lehrer PM, Vaschillo E, Vaschillo B: Resonant frequency biofeedback training to increase cardiac variability: rationale and manual for training. Appl Psychophysiol Biofee dback 2000; 25(3): 177-91.

17. Lehrer PM, Vaschillo E, Vaschillo B, et al.: Heart rate variability biofeedback increases baroreflex gain and peak expiratory flow. Psychosom Med 2003; 65(5): 796-805.

18. Bernardi L, Porta C, Spicuzza L, et al.: Slow breathing increases arterial baroreflex sensitivity in patients with chronic heart failure. Circulation 2002; 105(2): 143-5.

19. Davis AM, Natelson BH: Brain-heart interactions. The neurocardiology of arrhythmia and sudden cardiac death. Tex Heart Inst J 1993; 20(3): 158-69.

20. Tanaka TH: The possibilities for optimizing acupuncture treatment results through synchronization with somatic state: Examination of autonomic response to superficial needling during exhalation. American Journal of Acupuncture 1996; 24(4): 233-239.

21. Nishijo K, Mori H, Tsukayama H, Yamashita H: Scientific approach for acupuncture. Journal of the Japan society of acupuncture and moxibustion 1995; 45(3): 177-191.

22. Tanaka TH: The creation and efficacy of a HRV-Autonomic Trainer CD in assisting heart rate variability biofeedback training: preliminary report. Appl Psychophysiol Biofeedback 2003; 28(4): 326.