Breathwork is one of the fastest growing modalities in the Health and Wellbeing industry. Debate over “right” and “wrong” breathing is a hot topic. This may seem a bit ridiculous as breathing is a subconscious act that we have done since birth. Our Director, Helen van Praagh discusses how it may not be just a passing fad, and offers insights as to how breathing pattern disorders can occur and what you can do about them.

What is Normal/ Optimal Breathing?

A healthy adult should have 12-18 breaths per minute at rest. The ratio of inhalation to exhalation is 1:2. Optimal breathing at rest uses the diaphragm, a dome shaped muscle at the bottom of your ribs. Your lungs do not have the ability to expand and contract on their own so instead, they change shape in response to the shape of their container. When we inhale, the diaphragm contracts and flattens down, lengthening the lung space and creating a vacuum which pulls in air. The intercostal muscles (found between the ribs) act like handles that lift the ribs up and out as you inhale, which further increases space in the chest cavity. Exhalation is a relaxed process using the elastic recoil of the chest cavity as the diaphragm and intercostal muscles release the contraction and decrease the space in the chest cavity. 

What is Dysfunctional Breathing?

Instead of using the diaphragm to breathe, dysfunctional breathing uses an apical breathing pattern, which means that most of the breathing is done in the upper chest area. This pattern uses the accessory breathing muscles which include the pectorals, scalene muscles, trapezius, sternocleidomastoid and upper intercostal muscles. 

Over time, these muscles shorten and the diaphragm is unable to return to it’s optimal resting position causing dynamic hyperinflation, alteration in the length-tension ratio of the muscles and pressure change, further compounding the disorder. It can also lead to trigger point development, pain and fatigue in these muscles.

What is a breathing pattern disorder?

A breathing pattern disorder is a chronic pattern of overbreathing in which the depth and rate of breath exceed the metabolic needs of the body at that time. It occurs in absence of disease and can cause seemingly unrelated symptoms. The prevalence of serious breathing pattern disorders is as high a 6-10% in the general population however, far more people are likely to have a more subtle, yet clinically significant, breathing pattern disorder. The disorders are also more prevalent in women (14%) than in men (2%).

Habitual shallow breathing causes hypocapnia, which basically means a state of reduced carbon dioxide in the blood. This occurs as C02 is eliminated too quickly, resulting in a reduction in arterial CO2 (PaCO2) levels. Once the arterial CO2 levels drop below 35mmHG, increased alkalinity in the body’s PH arises, causing respiratory alkalosis. 

It has been proposed that respiratory alkalosis creates a state of sympathetic dominance, which invokes a ‘fright-flight’ response throughout the body. This leads to a heightened neuronal, physiological and psychological state, causing increased muscle tone, paraesthesia and altered rate and depth of breathing. 

Acute hyperventilation is normal in times of exercise, however if this respiratory alkalosis continues, it can trigger a multisystem cascade of effects that creates a variety of seemingly unrelated or unexplained symptoms.

The mechanisms underlying disordered breathing involve physiological, psychological and biomechanical components that cannot be completely separated. Stress, anxiety, pain and trauma have all been shown to contribute to the development of a breathing pattern disorder.

What are the symptoms of a breathing pattern disorder?

Typical symptoms of a breathing disorder are;

·              Frequent sighing and yawning

·              Breathing discomfort*

·              Disturbed sleep

·              Erratic heartbeats*

·              Feeling anxious and uptight

·              Pins and needles feeling in the limbs

·              Upset stomach/nausea

·              Clammy hands

·              Twitches or tremors*

·              Chest Pains*

·              Shattered confidence

·              Tired all the time

·              Achy muscles and joints

·              Dizzy spells* or feeling spaced out

·              Irritability or hypervigilance

·              Feelings of 'air hunger'

·              Reflux 

* If you have these symptoms - it is advised that you seek urgent medical care.

How can I be diagnosed with a breathing pattern disorder?

Sufferers often take a long time to be diagnosed, under-go continual tests and seek aid from multiple health professionals. Diagnosis can be difficult as breathing is a complicated and dynamic process. It involves biochemical, biomechanical and psychophysiological components, of which there is not one standardised test.  A thorough subjective and objective assessment is required by a trained Physiotherapist including looking at respiratory rate, breathing pattern, breath hold and the completion of the Nijmegen Questionnaire.

Treatment of a breathing pattern disorder

Management consists of removal of causative factors and rehabilitation of the habitual acquired dysfunctional breathing pattern. As with the assessment, treatment often needs to be multi-dimensional. Breathing retraining and respiratory muscle strengthening are completed by a trained Physiotherapist. Manual therapy and postural strengthening exercises may be required to improve thoracic mobility and muscle tone and length to allow the diaphragm to work optimally.  Relaxation methods, mindfulness or meditation are used to reduce the associated stress and anxiety along with sleep and diet advice. 

If this sounds like you, or you have been experiencing the symptoms above, we recommend you book in for a breathing assessment with Niamh Knightly, our Senior Physiotherapist and breathing expert. Click HERE to book an assessment. You can also book a complimentary 15 minute phone call with Niamh to decide if an assessment is recommended. Click HERE to book a complimentary 15 minute phone call.