The Valsalva maneuver is a breathing technique that can be used to help diagnose a problem with the autonomic nervous system (ANS). It can also be used to help restore a normal heart rate if your heart starts beating too fast.

Named after 17th century Italian physician Antonio Maria Valsalva, the technique requires you to try exhaling when your airways are blocked. A version of the Valsalva maneuver can also be used to help balance the air pressure in your ears.

In addition to closing your mouth and pinching your nose, you bear down as if having a bowel movement. The maneuver causes several rapid changes in your heart rate and blood pressure.

You should first try this technique under a doctor’s supervision to make sure you’re doing it correctly, and for a safe, but effective amount of time.

To perform the Valsalva maneuver, follow these steps in order:

  1. Pinch your nose closed.
  2. Close your mouth.
  3. Try to exhale, as if inflating a balloon.
  4. Bear down, as if having a bowel movement.
  5. Do this for about 10 to 15 seconds.

The Valsalva maneuver can be done sitting or lying down. Ask your doctor which approach is right for you.

The Valsalva maneuver can be divided into four phases.

Phase one

Blowing air against closed airways as you bear down causes the pressure in your chest to increase. That’s because blood is being forced out of your heart to your limbs and the rest of your body. This first phase causes a temporary spike in your blood pressure.

Phase two

The second phase causes a steady drop in blood pressure as a limited amount of blood in the veins returns to the heart. When the brain senses this change, the parasympathetic nervous system, the part of the ANS that helps slow the heart rate, releases norepinephrine. Norepinephrine is a chemical that increases the rate and force of each heart contraction. It’s part of the body’s “fight-or-flight” response.

Phase three

At the end of the maneuver, you relax and your blood pressure falls for a few moments. This is the third phase.

Phase four

Soon, blood starts rushing back to the heart. After a few heartbeats, blood flow should be back to normal, and your blood pressure will rise because your blood vessels are still constricted. The blood pressure increase ideally causes the heart rate to come back to normal. That’s phase four.

This simple procedure is used for a number of different reasons. Two important purposes are related to how the Valsalva maneuver affects your blood pressure and heart rate.

Restoring heart rhythm

The shifts in blood pressure and heart rate as you move through the four phases of the maneuver can often restore a normal heart rhythm when your heart is experiencing tachycardia. Tachycardia is an abnormally fast heart rate. If one Valsalva maneuver doesn’t do the trick, your doctor may recommend you try it a second time.

Diagnosing an ANS disorder

In addition to treating an abnormal heart rate, the Valsalva maneuver can also be used to help diagnose an ANS disorder. The pattern of your heart rate and blood changes through the various phases of the Valsalva maneuver can help your doctor identify problems with your sympathetic and parasympathetic nerve functions.

If you have a condition called postural orthostatic tachycardia syndrome (POTS), you will experience significant increases in your blood pressure during phases two and four. POTS is a condition in which your blood pressure drops dramatically when you stand after you’ve been sitting or lying down. It can be a very serious health problem, leading to fainting, falls, and other complications.

Treating clogged ears

The Valsalva maneuver can also help with relatively harmless problems, such as air temporarily blocking the Eustachian tube in your inner ear. You may have experienced this feeling during takeoff or landing on an airplane.

The Valsalva maneuver can often be used to help your ears “pop” open by forcing air through your sinuses and Eustachian tube.

The Valsalva maneuver shouldn’t be used to treat all types of cardiovascular problems. Don’t try this technique if you have high blood pressure and are at high risk for a stroke or heart attack.

Talk to your doctor before trying this technique if you have a heart rhythm problem, also known as an arrhythmia.

If you try the maneuver several times to slow a racing heart, but get no relief from your tachycardia, go to an emergency room. You should also go to an emergency room if you have an unusually rapid heartbeat and you have chest pain, shortness of breath, or you feel faint.

Trying the Valsalva maneuver to clear your ears should also be done with caution. If you try exhaling too hard, you could rupture an eardrum.

The Valsalva maneuver can be a helpful treatment and diagnostic tool, but it should always be done first with the instructions of your doctor. If you’re able to do it safely, it can be a quick and easy way to get your heart beating at a safe and normal rate.

If your doctor has never suggested it, go ahead and ask. It may turn out to be a great help to your heart and your quality of life.