Alternate nostril breathing (nadi shodhana): hand position, rhythm and evidence

Alternate nostril breathing means breathing in through one nostril and out through the other, closing each side in turn with the fingers. It is often called nadi shodhana, from Sanskrit words usually translated as 'channel' and 'cleansing', though some teachers use other names, such as anuloma viloma.

This guide explains the basic pattern, practical hand positions, how the classical version differs from what most modern classes teach, and what research has actually tested.

The classical description

The Hatha Yoga Pradipika describes the practice without using the name nadi shodhana. In Pancham Sinh's 1914 translation, the practitioner sits in lotus pose, fills the lungs through the left nostril while closing the right, holds the breath 'according to one's ability', and releases it slowly through the right; the pattern then reverses (2.7–2.8). The text says the channels (nadis) become clean after three months or more of regular practice (2.10).

Two points are worth noticing. The classical version includes breath retention, and it is framed in terms of purifying the nadis, a concept from yoga's energetic anatomy rather than from physiology. Most modern beginner classes teach a version without holds, and present it simply as a calm, focused breathing exercise.

Choosing a hand position

Traditional teaching often uses the right hand with the index and middle fingers folded down (sometimes called Vishnu mudra), closing the right nostril with the thumb and the left with the ring finger. That is not the only option, and it can be awkward for people with stiff hands or shoulders.

Folded fingers: thumb on one nostril, ring finger on the other; index and middle fingers folded into the palm.
Fingers on the forehead: index and middle fingers rest lightly between the eyebrows; thumb and ring finger close the nostrils. Some find this steadier.
Either hand: using the left hand is a practical choice if the right is uncomfortable, even if a particular tradition specifies the right.
Support the elbow: rest the working elbow on a cushion or a block on your knee, or practise seated with your back supported, so the arm does not tire.
Light pressure: press on the soft part of the nostril just enough to close it. Pushing on the bony part of the nose is unnecessary.

A basic round without holds

This is a common modern beginner pattern. There is no single correct version; follow your teacher's if it differs.

Sit upright and comfortably. Breathe normally for a few breaths.
Close the right nostril and breathe in gently through the left.
Close the left nostril, release the right, and breathe out through the right.
Breathe in through the right.
Close the right, release the left, and breathe out through the left. That is one round.
Continue for a few rounds at a natural pace, then lower the hand and breathe normally.

Pace, counts and retention

Beginners usually breathe at a comfortable, natural pace. Later, some teachers add counts, such as an exhale longer than the inhale. The classical version adds retention after the inhale. Retention changes the practice considerably: it is the part most likely to cause air hunger or lightheadedness, and it is best learned from a teacher who can watch you.

If either nostril is blocked, set this practice aside for the day. The whole technique depends on breathing through each side in turn, and forcing it through a congested nostril tends to cause strain rather than calm.

What research shows

Alternate nostril breathing has been studied mainly for short-term effects on blood pressure, heart rate and self-reported calm. A 2024 systematic review and meta-analysis by Nam and colleagues in Complementary Medicine Research looked at 14 studies and pooled six randomised trials. It found lower blood pressure in the alternate-nostril groups than in controls, but the authors warned that very high variation between studies called for caution and that higher-quality trials were needed.

That is a reasonable summary of the wider field: interesting, small and uneven studies, not established treatment. Alternate nostril breathing is not a substitute for medical care for blood pressure or any other condition.

When to skip or stop

The practice is easy to pause; these are the situations where pausing or skipping makes sense.

Stop and breathe normally if you feel lightheaded, tingling, short of air or anxious.
Skip it when you have a cold, allergy flare or any blocked nostril.
Leave out holds unless you are learning them from a qualified teacher.
Ask a clinician first if you have a heart or lung condition, or if you are pregnant and considering techniques with retention.