The vagus nerve and polyvagal theory in ME/CFS
Your body jumps between tension and complete exhaustion without you being able to steer it. A large part of that runs through the vagus nerve. This article explains what it does, which three states polyvagal theory describes, and how you can influence them through your breathing.
What the vagus nerve is
The vagus nerve, also called the wandering nerve, runs from the base of the skull to most of the organs. It is one of the main nerves of the parasympathetic system, the part of the nervous system responsible for rest, regeneration and healing.
It controls important functions such as heart rate, breathing and digestion. And it influences how you feel physically and emotionally. That is why it is so central when the nervous system is dysregulated.
The three states of polyvagal theory
Polyvagal theory was developed by Dr Stephen Porges. It describes three responses of the body to what we experience. For me this model explained a great deal of what I have lived through, and it helps me to place my own states.
- Ventral vagal activation, the safety mode. You feel safe, relaxed and socially connected. The body can regenerate and come to rest. This is the basic condition for healing.
- Sympathetic activation, fight or flight. When a threat is perceived, the sympathetic system switches on and puts you into an alert state. Here it is about survival.
- Dorsal vagal activation, freeze or shutdown. When it becomes too much, the body withdraws in order to protect itself. You feel exhausted, sealed off and as if switched off.
These states are not a decision and not a character trait. They are responses of your nervous system. Once you recognise which one you are in, you can choose something that actually helps.
When the body shuts down
Dorsal vagal activation often comes with a dissociative state. Under strong overwhelm, exhaustion or severe pain the body activates this protective mechanism, often described as freezing. Pain plays a role here too, because the nervous system registers it as a threat and withdraws in order to protect the body from further strain.
It feels as if you were beside yourself, as if you perceived yourself and your surroundings from a distance. This response has a biological basis. It serves protection and helps to save energy and create emotional distance in situations of overwhelm, pain or shock.
I felt without emotion, as if wrapped in cotton wool. Knowing that such states are a normal response of the body and not another symptom of the illness helped me a great deal. Since then I meet these phases with understanding instead of fear.
What reaches the vagus nerve: your breathing
One of the most direct ways to regulate the autonomic nervous system is conscious breathing. Deep belly breathing, in which you breathe in slowly through the nose and out through the mouth, activates the parasympathetic system.
What matters is not the deep inhale but the slow exhale. Extended pauses and deep belly breathing strengthen the parasympathetic effect. Your heart rate variability can rise as a result, a central marker for regeneration and resilience.
As part of the CFS-CARE programme at the Charité in Berlin, an autonomic dysregulation was found in me, which means my autonomic nervous system cannot reliably switch between tension and relaxation. There it was tested how certain breathing rhythms affect my heart rate variability. A clear improvement showed during the exercise itself. At the same time it became clear that my system needs support to reach those states without outside guidance.
Coherent breathing
Coherent breathing is a gentle and even technique. Inhale and exhale are exactly the same length, usually five to six seconds per phase. That comes to about five to six breaths per minute.
The slow, even rhythm reaches the vagus nerve and activates the parasympathetic system. This way of breathing is particularly gentle and therefore also works on days when very little is possible.
- Put one hand on your belly and breathe in through the nose so that the belly rises.
- Count to five as you breathe in, and breathe out for the same length.
- Start with two or three minutes. If that is too much, one minute is enough.
- In a crash the same rule applies as everywhere else: keep the dose low, rather short and often than long and once.
You will find more exercises on the page Breathing exercises.
What this means day to day
Breathing exercises are not a cure. They are regulation, and they work best when they stay regular and small. I use them today as an anchor, to remind my nervous system what safety feels like.
Your pacing matters here. A breathing exercise is an activity too and belongs in your baseline. Besides breathing there are devices that stimulate the vagus nerve directly. One of them, Nurosym, I use myself.
📖 More in my book
In Beyond Survival you will find polyvagal theory explained in detail, along with a chapter on stimulating the vagus nerve through breathing and further techniques for regulating the nervous system.
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