Treating Breathing Disorders
Breath is often called the force of life- and it truly is in both a literal and metaphorical way. However, the power of our breath and its role in healing is often overlooked by both conventional and alternative medicine practices. In their book “Recognizing and Treating Breathing Disorders”, Chaitow, Bradley and Gilbert discuss the function of breath in the mind body system- from the biochemical to anatomical to psychological.
The breath is an integral part linking our emotional and physical health. It is a two way feedback system that both provides and receives information. Breathing is a fluid process, which changes with the shifting needs of our environment. Our patterns of breathing are modulated by the demands on our system depending on what immediate tasks for survival are needed. After these tasks are complete, the breath should return to a calm and steady baseline. Our patterns of breathing become dysfunctional when they are not meeting the moment by moment demands in our environment. When breathing patterns become dysfunctional, it creates a shift in our systemic acid/base levels- meaning our levels of oxygen and carbon dioxide become imbalanced. This can create symptoms that range from irritating to debilitating, and is a major contributor to chronic mental and physical health conditions.
Let’s talk about our breathing patterns, from an anatomical and biochemical stand point.
Most dysfunctional breathing patterns come down to chronic hyperventilation. Functionally, chronic hyperventilation creates an over alkaline state in the body with levels of carbon dioxide that are too low.
A life threatening situation would generally be accompanied by a surge of lactic acid in the blood (through running or other physical exertion). The body prepares to compensate for this by hyperventilating, and increasing the alkalinity of the blood. However, if no evolutionary threat exists, the body often still hyperventilates, again creating an over alkaline state in the body. Anticipation of stress causes the same biochemical shifts in the body as if the stress is actually being experienced (for example, breathing changes in anticipation of exercise has been noted in athletes).
This is also experienced by people who are in a state of high stress all day as they are exerting themselves in work, school, and other activities. If they are not adjusting their pattern of breathing when they get home even though their energy exertion has changed, they may experience symptoms of hypocapnia in the evening while “relaxing”. It feels like a paradoxical response to relaxation, but is really an inflexible nervous system not catching up with a change in environment. Our homeostatic mechanisms can become dysregulated in response to chronic stress, and then does not offset a build up of lactic acid in the body.
Low carbon dioxide levels in the body cause reduced blood flow to the brain which effects the central nervous system. Symptoms include brain fog, poor concentration, memory issues, tunnel vision, headaches/migraines, tinnitus, tremors, sweating, heart palpitations, high and low blood pressure, dizziness, numbness, tingling, fainting, seizures, cramping, anxiety, panic, air thirst, bloating/burping, diarrhea. These symptoms can range from mildly unsettling to debilitating depending on the intensity of symptoms.
How To Breathe
There are some basic principles to healthy breathing patterns. Ideally, this is not something we have to learn. We grow up and experience our development in a safe, secure context where acute hardships may cause our survival mechanisms to kick in temporarily, and then subside. We are exposed to emotionally supportive communities, functional movement patterns and natural environments in which our posture and alignment develops correctly from infancy. Unfortunately, this is no longer the norm and has not been for generations now. Many of us must learn the principles of proper breathing after developing dysfunctional patterns throughout our lives.
Ideally, if we are intentional and retrain our habitual patterns, we no longer have to focus so much on our breathing! Our breath should really be an organic experience that ebbs and flows with our immediate needs. Therefore addressing lifestyle and environmental factors that contributes to being stuck in a state of chronic stress is an important part of treating breathing disorders.
In “Recognizing and Treating Breathing Disorders”, the authors give the following suggestions for beginning to intentionally shift your breathing patterns:
1. Nose: not mouth. In the wild, animals only breathe through their mouth when they are in a state of stress, either from an acute threat or over heating. Some people who are chronic mouth breathers will even tape their mouth shut to help retrain this habit. Breathing in and out through the nose helps to signal your nervous system that there is no immediate threat in your environment. It provides the correct nerve stimulation to activate the central breathing muscles.
If you have chronic nasal blockage which prevents you from breathing with your nose, this is a separate medical issue that needs to be addressed first.
2. Low: diaphragm, not chest. Watch yourself in a mirror while you are breathing. Do your chest and shoulders move? This means you are engaging your accessory breathing muscles rather than your primary ones in your diaphragm, back and core. Another way to tell would be to put one hand on your chest and one hand on your belly, and see which hand moves most when you breathe.
If you find that you are using your accessory breathing muscles more than your primary ones, it can be helpful to visualize bringing the air deep into the bottom of your lungs on your inhale. Placing your hands on your belly and feeling your core muscles push out against your hand as you inhale can be another helpful cue.
3. Slow: 10-14 breaths per minute, 4-6 seconds per breath. In reality, this should not be so rigid. The rhythm of breath should be free to ebb and flow naturally. However, this is a good baseline goal, and sometimes it is helpful to be more specific in the early stages of retraining your breathing patterns. Try counting the length of your breaths and see where you fall. If you notice you are breathing much faster than this, try to slow it down, extending your breath by one second at a time to let your nervous system acclimate. Remember, sometimes improving your breathing habits can actually increase problematic symptoms in the short term as your homeostatic mechanisms rebalance.
4. Let go: Release your shoulders, neck, and jaw. As you begin to improve your engagement of diaphragmatic and core muscles, you can intentionally practice keeping your shoulder, neck and jaw relaxed. Often, especially when in a state of chronic stress, we will take a defensive or guarded posture by keeping these muscles tense. By intentionally relaxing these muscles, we can send a signal to our brain and nervous system that there is no danger. Our breathing patterns will naturally slow and deepen in response to this cue.
5. Quiet: No effort. This one should be qualified by the reality that changing any pattern does in fact require effort. However, after some intentional practicing, these new breathing patterns should become effortless. “Trying” to breathe is often what creates symptoms of tension and hyperventilation. Instead, imagine your breath flowing in and out of your body with ease.
So how do we put this all together? Pace your breath at 4-6 seconds per breath. When you inhale, air should be drawn into the lungs as your diaphragm expands downwards into the belly- your accessory breathing muscles which are the upper chest, shoulders, neck muscles should stay relaxed. When you exhale, there should be no effort, and you should feel the abdominal wall relax and the diaphragm ascends into its original position. A relaxed pause at the end of the exhalation fully releases the diaphragm before the next breath.
Additional Supportive Practices:
Sometimes there are additional practices that can help support your breathing patterns. I’ve listed and described them below:
Humming/chanting: this is a practice very effective in stimulating the vagus nerve and the parasympathetic branch of the nervous system. Physiologically, humming and chanting appears to vibrate the nerves as they pass through the back of the throat, which increases their “tone” or strength and flexibility. A well regulated nervous system works in tandem with proper breathing patterns: both must be addressed.
Breath holding (Buteyko method): this can help you increase tolerance for a more acidic state in the body, and in the long term reduce your sensitivity to lactic acid and therefore your likelihood of experiencing panic attacks and other unpleasant symptoms. This is done by intentional increasing your capacity to hold your breath after your exhale. The ability to hold your breath for 60 seconds is a good indicator of nervous system health.
Meditation: we know that the anticipation of stress causes a change in breathing patterns, even if the stressful thoughts are totally inaccurate and invented by the mind. Meditation allows for the practice of non reactivity, where we can notice our thoughts without being carried away by them. We can even have a stressful or negative thought, notice it, not respond to it, and move on with our lives. Retraining your thought patterns and your habitual responses to stressful thoughts through meditation can be an important component of retraining the breath as well.
Feldenkrais style “interoception” awareness building: Feldenkrais was a doctor of physics who applied his knowledge of mechanics to a profound understanding of the body and anatomy. He developed a program of exercises to increase awareness of how our own bodies move and align. His theory was that the more deeply aware of these mechanisms we are, the more we can use subtle to organically realign and heal themselves. Some examples of his exercises are: Lie on your back and breathe. Cough 30 times. Swallow 30 times. Open your mouth and breathe several times. Breathe through each nostril 30 times. While doing these activities, the goal is to become deeply aware of every muscle and tissue fiber involved in these actions. This deepening awareness of your own body (also known as interoception) will allow you to develop more effective habits of movement and thereby improve your breathing patterns.
Tai chi and yoga: not only have these practices been shown to improve the health of the nervous system and promote tension release in the body, they also use intentional patterns of breath as a part of their structure. Learning to breathe in particular rhythms can help develop a greater sense of control over habits that have potentially been automatic in the past.
Posture, strength, alignment
While learning skills of tension release and relaxation are essential for retraining the breathing patterns, we also want to create appropriate strength and tension where necessary. Stabilizing the core and diaphragm while simultaneously keeping the shoulders, neck and face muscles relaxed is the key to healthy breathing patterns. The psoas and hip flexors can also carry unhelpful amounts of tension which effects breathing- again, strengthening the core and glutes can improve the ability of other muscles to relax appropriately. With disordered breathing these muscles become tight and short due to poor alignment and stabilization.
Strength actually begins with proper body alignment. Imagine your pelvis is like a bowl of water. In a correct neutral position, this water does not spill out of the front or back of the bowl. Once your pelvis is in a neutral position- the rest of the body can more easily fall into place. Place your ribcage so it is aligned over your pelvis. Engage your core muscles gently by pulling your bottom ribs down without caving in your chest. Allow your shoulders to relax down away from your ears. Now balance your head over your ribcage, chin slightly tucked. All breath work should begin with this alignment “check”. Anatomically, this is the most efficient position for the body to be in to facilitate air flow.
While traditional strength training that targets the core, back and glute muscles can be beneficial, relearning basic functional patterns of movement can be an easier place to start. This begins with re learning how to sit up and then crawl. Our physical alignment is already becoming defined by 4-6 months of age! Therefore “going back to the beginning” can be a helpful practice. Lie on your stomach and then come up to a “sphinx” type yoga position. From here, start to explore twisting and stretching of the neck and side body. Getting up into a crawling position would be next, giving yourself time to explore these movements like you are a baby. From there, try gorilla walking. Re experiencing this developmental progression can be very profound.
As you start to bring more awareness into your day to day movement habits, you will begin to notice what us keeping you in a chronic state of stress. For example, if you are sitting up straight in a chair, what angle are your legs at? There are certain ways of sitting that are more in preparation for getting up quickly versus staying relaxed, which sends a message to our nervous system about our current level of danger. Our spine changes position and our breathing patterns shift as a result. Also notice:
How fast do you move when you walk?
How fast is your speech?
How wide do you open your eyes?
All of these actions send a signal to your nervous system about how fast and shallow you should be breathing in response to a perceived stress.
I hope this brief foray into the science of breath helps fill in a missing piece for your own healing journey. You can see why breath is so integral to our whole body health. While changing habitual patterns is a difficult task that takes time and discipline, these practices can make an immense difference in your quality of life.