• Meditation and Breathing Exercises - Meditation and diaphragmatic (deep) breathing can be incredibly helpful to strengthen vagal tone and restore the parasympathetic response. A literature review included slow-breathing exercises, mindfulness meditation, and loving-kindness meditation in a compilation of natural interventions to improve heart rate variability (HRV) and vagal tone [1]. The key to using breath for parasympathetic activation is to make your exhales longer than your inhales. You can inhale for 4 counts and exhale for 8. Most people take about 10 to 14 breaths each minute. Taking about 6 breaths over the course of a minute is a great way to relieve stress. You should breathe in deeply from your diaphragm. When you do this, your stomach should expand outward. Your exhale should be long and slow. This is key to stimulating the vagus nerve and reaching a state of relaxation. 

• Baths & Ice Baths - Taking a bath can stimulate the parasympathetic nervous system and especially when you pair it with aromatherapy (essential oils) and soothing music (there are some great sound bath meditations on Insight Timer).  Ice baths are becoming popular for activating the parasympathetic nervous system if you want to take things to the next level! More on that below…

• Cold Exposure - Acute cold exposure has been shown to activate the vagus nerve and activate cholinergic neurons through vagus nerve pathways. Researchers have also found that exposing yourself to cold on a regular basis can lower your sympathetic “fight or flight” response and increase parasympathetic activity through the vagus nerve. Dip your face in a bowl of icy water or if a full ice bath is too much for you, splash your face with cold tap water in the morning and evening. Try finishing your next shower with at least 30 seconds of cold water and see how you feel. Then work your way up to longer periods of time.

• Singing or humming - A nonrandomized clinical trial found that singing, humming, and chanting all increased vagal tone [2]. They also noted that music is known to increase the “happy” hormone oxytocin, improving mental health and decreasing feelings of stress and anxiety, so this could also be a factor in strengthening vagal tone. Try humming with “Om” or “Vm” sound when you’re driving or in the shower. Gargling is also known to improve vagal tone.

• Laughter - Studies show that laughter has a significant effect on improving mood, HRV, and anxiety (not shocking!). 

• Walking - Simply walking has been shown to improve HRV in a study of 33 adults who were assigned to a walking program for five days per week over 12 weeks. Compared to a group that performed their usual daily activities, the walking group had significant improvements in HRV/vagal tone [3]. 

• Yoga & Mindful Movement - A randomized, controlled trial found that people who regularly practiced yoga had a higher HRV, better vagal tone, and speedier recovery from a major stressor vs. those who didn’t practice yoga [4]. I believe other mindful movement practices would have a similar effect, like Pilates, Qigong, Tai Chi, even Barre class. 

• Candlelight and dim light in the evening - for the last couple of hours before bed (this means putting the phone down) can help improve your sleep by positively affecting your circadian rhythm. Sleep is essential for misophones and for nervous system health. Prioritize it! If you must look at a screen in the evening, try blue blocker glasses—they make them with and without prescriptions, so if you don’t normally wear glasses or need vision correction, you can still use them.

• EFT or Meridian Tapping - You can learn more about meridian tapping o and there are lots of guided videos online as well. 

• Medications - Some people with misophonia find some relief with the use of SSRIs, but it really depends on each individual as people have really varied responses to them. Beta blockers like Propranolol have been shown to help reduce some of the physical ANS (autonomic nervous system) responses to trigger sounds. Some research has been and is being done on beta blockers for Misophonia. Best to discuss with your doctor. Here’s a Journal Article that you could bring with you to your doc.

• Supplements - Disclosure: I am not a medical doctor so please refer to your PCP for more information. Certain vitamins and supplements have been shown to help with things like reducing anxiety and aiding sleep. It’s becoming increasingly clear to researchers that gut bacteria improve brain function by affecting the vagus nerve. In one study, animals were given the probiotic Lactobacillus Rhamnosus, and researchers found positive changes to the GABA receptors in their brain, a reduction in stress hormones, and less depression and anxiety-like behavior. The researchers also concluded that these beneficial changes between the gut and the brain were facilitated by the vagus nerve. When the vagus nerve was removed in other mice, the addition of Lactobacillus Rhamnosus to their digestive systems failed to reduce anxiety, stress, and improve mood). Another study found that the probiotic Bifidobacterium Longum normalized anxiety-like behavior in mice by acting through the vagus nerve. 

• Omega-3 fatty acids are essential fats that your body cannot produce itself. They are found primarily in fish and are necessary for the normal electrical functioning of your brain and nervous system. Researchers have discovered that omega-3 fatty acids increase vagal tone and vagal activity. Studies show that they reduce heart rate and increase heart rate variability, which means they likely stimulate the vagus nerve. 

• Magnesium -

• Diet - What we put in our bodies affects our whole system–including our brain health. Here are Five Ways to Calm your Body with Food, according to the Children's Hospital Colorado…

1. Choose whole fruits and vegetables. While processed foods can be convenient for busy households, they may lack phytochemicals available in fresh fruits and vegetables. These invaluable nutrients, some of them listed below, do more work than we even know to regulate our stress.

2. Look for foods with vitamins B, C and D. When you experience stress, you may be more susceptible to becoming sick. These vitamins act as antioxidant and anti-inflammatory agents in your body, which supports your immune system and keeps you from getting sick. Good sources of these vitamins include citrus fruits, berries, dark chocolate and herbal teas such as lavender or chamomile (avoid teas with caffeine). For the B vitamins in particular, choose whole grains and nuts.

3. Eat and drink foods with calcium. Along with vitamin D, calcium can help fight the stress hormone cortisol. Nab recommends drinking low-fat milk or eating yogurt. If you don’t eat or drink dairy, dark leafy greens are another good source of calcium and vitamin D.

4. Increase your intake of omega-3 fatty acids. Depression is often associated with stress, and research shows that omega-3 fatty acids can reduce depression. You can find these nutrients in fish such as tuna, salmon and halibut as well as in avocados and flaxseed.

5. Choose complex carbohydrates over simple sugars. Carbohydrates increase the brain chemical serotonin, which helps reduce stress. Complex carbs provide sustained energy, whereas simple sugars tend to make us feel more drastic changes in mood. Choose whole-grain pastas and breads and brown or wild rice.

6. Avoid low-nutrient foods. High on the list are simple sugars (candy, cookies) and caffeine. Stress tends to sap energy, so the instinct is to choose easy stimulants to perk us back up. The problem with simple sugars and caffeine, though, is they boost our energy quickly but only for a short time. After the effects of sugar and caffeine have subsided, you might feel more depleted than before. “In an hour, you can be dragging,” Nab says. So instead, “choose foods that both nurture and nourish your mind and body.” *Link to reference.

People with misophonia tend to have issues with nervous system regulation and spend an inordinate amount of time in a sympathetic state (“fight of flight”) due to the stress of responding to trigger sounds, as well as the hyper-vigilance associated with monitoring for potential trigger sounds. These tools are suggestions for my clients with misophonia to nurture the nervous system and increase the body’s time spent in a parasympathetic, ventral vagal (“rest & digest”) state.