The human body is marvelous. Think about its design and engineering – how it functions. And the more those of us with a mood or anxiety disorder learn about it, the better we’re going to feel. Let’s get back to the vagus nerve…

But then there’s low vagal tone. It’s been associated with conditions, such as depression, fatigue, anxiety…

We began our two part series last week with “The Vagus Nerve: What you need to know.” It provides information about what the vagus nerve is, what it does, and how it can cause problems.

If you haven’t already, be sure to give it a read.

So let’s do something with what we’ve learned. How ‘bout we discuss how to make the vagus nerve work for us.

But before we take the plunge, it’s crucial to keep in mind that the vagus nerve is our primary parasympathetic – “rest and digest” – nerve. That’s why it’ll always merit, and receive, attention.

What is vagal tone?

The first order of business is to learn a little bit about vagal tone. Simply, it’s an indicator of the activity of the vagus nerve. Breathing and heart rate are used to calculate vagal tone.

When our vagal tone is higher, we’re better able to manage stress and anxiety – even relax. It also helps with regulating blood sugar and reducing the risk of heart disease.

But then there’s low vagal tone. It’s been associated with conditions, such as depression, fatigue, anxiety, cognitive compomise, diabetes, heart disease, and inflammatory and autoimmune disorders.

Okay, let’s get into how to make the vagus nerve work for us – aka increasing vagal tone, aka vagus nerve stimulation…

Vagus nerve stimulation

Vagus nerve stimulation (VNS) is stimulation of the vagus nerve (green in our featured image) using a device that delivers electrical impulses or self-performed maneuvers.

Conventional VNS is done with a surgically implanted pulse generator and wiring. VNS can also be done with noninvasive transcutaneous devices.

The U.S. Food and Drug Administration (FDA) has approved conventional VNS for the treatment of medication-resistant focal epilepsy and treatment-resistant depression.

Transcutaneous VNS (tVNS) devices have been approved in Europe for the treatment of epilepsy, depression, and pain. A tVNS device has been approved by the FDA for the treatment of cluster headaches.

But there’s more. Conventional VNS and tVNS are being studied as potential treatments for conditions, such as migraine headaches, atrial fibrillation, rheumatoid arthritis, inflammatory bowel disease, anxiety and mood regulation, bipolar disorder, schizophrenia, tinnitus, obesity, Alzheimer’s disease, and autism spectrum disorder.

Fact is, though, as great as all this is, VNS may not work well for everyone and positive results may take time to present.

Conventional VNS

how does vagus nerve stimulation work

Conventional vagus nerve stimulation

In conventional VNS a pulse generator is surgically implanted under the skin of the chest and a wire is threaded under the skin which connects with the left vagus nerve.

Interesting: the right vagus nerve isn’t used because it’s more likely to carry fibers that supply nerves to the heart.

The procedure typically takes 60-90 minutes. Though it’s most often done on an outpatient basis, an overnight stay may be necessary. .

As with any surgical procedure there are risks and the potential for side effects. Upping the risk ante in this case is the location of the pulse generator and the dissection of the vagus nerve from the carotid artery

The modulator is activated at the doctor’s office a few weeks after the procedure. It sends mild and painless electrical signals through the vagus nerve to the brainstem. From there, signals are sent to specific brain areas to calm irregular electrical activity.

Adjustments to the electrical signals’ duration, frequency, and current can be made. Occasional office follow-ups are required.

Transcutaneous VNS

transcutaneous vagus nerve stimulation

Auricular on left, Cervical on right

Transcutaneous VNS (tVNS) is believed to have similar therapeutic effects to conventional VNS. Being noninvasive, electrical currents are applied through surface electrodes at select locations – typically the ear (auricular branch of the vagus nerve: taVNS) and neck (cervical branch of the vagus nerve (ctVNS).

You can see two brand name tVNS devices in the image. This is not an endorsement of either (and I’m not being paid a dime).

In addition to the devices manufactured specifically for tVNS, the job can be handled by transcutaneous electrical nerve stimulator (TENS) devices.


Using tVNS can certainly be considered self-stimulation; however, there’s more to the story.

Here are 10 vagus nerve maneuvers you can do on your own – without a device – to stimulate your vagus nerve…

  • Diving reflex: Splash your face with very cold water – lips to scalp. Or fill a sandwich bag with ice cubes, briefly holding it to your face while you hold your breath.
  • Valsalva maneuver: It’s also referred to as “bearing down.” Yep, bear down as if you’re having a bowel movement. Then hold your nose, tighten your lips, and expel air. It’s supposed to be difficult. You may find it easier to use an occluded straw. 15-20 seconds at a time ought to do it.
  • Humming or chanting: The vagus nerve runs through the inner ear and vocal cords. The vibrations caused by humming or chanting are stimulating. So pick a song and hum away. Or maybe use an “Om” chant. I find making soft and low-tone chanting/moaning vocalizations very soothing. I used to wonder why.
  • Gag reflex: You know how to flip the switch.
  • Coughing: You have to do it hard to generate enough pressure in your chest to stimulate the vagus nerve.
  • Gargling: Gargle with water in the morning and evening when you brush your teeth. Aim for 30 seconds to one minute.
  • Breathing exercises: The goal is to move your diaphragm and belly with each breath and to slow your breathing. See if you can get down to 5-7 breaths a minute or about half your normal rate. Inhale while counting to 5, then hold your breath before exhaling slowly to a count of 10. Slightly constricting the back of your throat, as though you’re cleaning your glasses, further stimulates the vagus nerve.
  • Massage: You may find that massaging certain areas of your body provides stimulation. For instance, massaging your neck along the carotid sinus may do the trick. However, don’t look up carotid sinus massage and attempt to give it a go, because that’s not what this is. That maneuver needs to be handled by a physician. Massaging your feet is another popular option.
  • Applied abdominal pressure: Lie on your back and fold your lower body toward your face until your feet are past your head – knees as close as possible to your chest.
  • Handstand: I’m serious. If you can do it for 30 seconds, it may work for you.

I intentionally kept details like repetitions and duration to a minimum. As you give any of these a go, see what works best for you.

Now, some of these maneuvers may pose a health risk for you. Think it over before moving forward and touch base with your doc if you need to.

By the way, plenty more where these came from. Just do an internet search.

Work it

Depression, mania, generalized anxiety, panic, agoraphobia, you name it – it’s our responsibility to do all we can to find management techniques – beyond meds and therapy – and put them to work.

Absolutely, the human body is marvelous. And the more we learn about it, and how to work it to our advantage, the better we’ll feel. The vagus nerve is a great place to start.

Work it.

Once again, be sure to read part one: The Vagus Nerve: What you need to know.

Thanks for the info: Cleveland Clinic Healthy Focus Frontiers in Psychiatry Mayo Clinic

Conventional VNS image: Mayo Clinic Devices image: ResearchGate

If you’re looking for more Chipur mood and anxiety disorders info and inspiration articles, I know where the titles are.

Bill White is not a physician and provides this information for educational purposes only. Always contact your physician with questions and for advice and recommendations.

Skip to content