If a catheter is used, stages 1 and 2 can be completed in a short time, much less than five minutes. If you use a cotton thread sutra, then stages 1, 2 and 3 can be completed in less than ten minutes. This of course does not include preparation which should be done at another time. Under no circumstances should the practice be hurried.
In each stage pull the sutra to and fro a suitable number of times. At first there may be a little uneasiness, for the nerves and mucus membranes will not be accustomed to the extra stimulation. If this is the case, slowly increase the number of movements of the sutra over a period of time, thus allowing the nerves and membranes to become more resistant and stronger. At first only a few movements (which should not cause discomfort) and certainly not more than fifteen times. With practice the number of movements can be increased to fifty.
This technique should not be done every day. Once every few days or every week is more than sufficient. The best time for practice is in the morning before breakfast; this is particularly relevant to those persons who tend to retch as they reach into the mouth to recover the end of the sutra.
After completing sutra neti one should then do jala neti, as this will flush out all the impurities and particles in the nose, including those that have been dislodged by performing sutra neti, and leave the nasal passages in the cleanest possible condition.
After performing both sutra and jala neti, the nasal passages may feel a little sore and raw, and perhaps very dry. For this reason, it is a good idea to conclude your practice by doing either dugdha neti (neti with milk) or ghrita neti (neti with ghee). These are very simple techniques which merely involve introducing a few drops of milk or ghee (clarified butter) into the nasal passages. To do this, hold the head back and sniff the fluid into the nose from a suitable vessel. Remember only a small amount of milk or ghee is required; don’t flood your nose. Ghrita or dugdha neti will temporarily replace the natural protective film of mucus in the nose that has been rubbed or washed away by sutra and jala neti. However, this practice is optional, for the body will manufacture and replace the old film with a new film, within a short period of time.
The nasal passages are extremely delicate; as such no undue force should be used to push the sutra through the nostrils. As you push the sutra into the nostril, it should be slowly twisted so that it more easily overcomes obstructions. If you find, even after persistent attempts, that you are unable to push the sutra into the nose, then seek expert advice from an experienced teacher.