Breathing is the most basic and essential function by which we live and function, both physically and mentally. As babies, we are born with the inherent knowledge of how to breathe correctly, through our diaphragm. As we progress into toddlers, children and adulthood, our life experiences and emotions influence our unique breathing pattern, and more often than not, this is a negative influence. It is estimated by experienced clinicians that approximately 70% of patients seen do not breathe properly. This may appear unusual, as breathing is a subconscious activity, and unless we have an obvious breathing problem (for example asthma) we do not usually notice our breathing.
We need to realise that our emotions influence our breathing patterns, but just as importantly, our breathing affects our emotions and performance.
Signs that something is off
You may notice in yourself or others that we sigh frequently, find it difficult to catch our breath, or talk too fast. These are all signs of not breathing properly. As children, our parents often told us when we were upset or angry to "take a deep breath and count to 10" before reacting. It is no coincidence that disciplines such as Tai Chi, Pilates, Yoga and meditation all pay particular attention to breathing as their main way of helping people to relax. Many of these approaches have validated scientific evidence of their effectiveness in helping many medical conditions, from pain to cardiovascular disease.
Over-breathing: what actually happens
When we don't breathe properly, the issue is almost always over-breathing. The result is that we breathe out too much carbon dioxide, and so the level of carbon dioxide in our body drops (hypocapnia). This reduces the ability of oxygen to be delivered to the cells of the body (hypoxia). The irony is that trying to breathe in more oxygen does not necessarily help. Someone who is hyperventilating (breathing fast and deep), often with symptoms of breathlessness and panic, is breathing in lots of oxygen but at the same time expelling more carbon dioxide than they should. The treatment for an acute episode is to hold a brown paper bag over the mouth and nose so they re-breathe their own carbon dioxide, returning oxygen-haemoglobin balance.
How a breathing pattern disorder is diagnosed
Aside from the history and habits described above, correct clinical examination can be very revealing:
- Breath pause less than 30 seconds may suggest a disorder.
- Observation of upper ribcage breathing and poor diaphragm use.
- Breathing rate: optimum is around 6 cycles per minute, an average patient breathes at around 12. More than 15 may suggest a disorder.
- Nijmegen questionnaire: a validated questionnaire.
- Capnography: specialised equipment that measures carbon dioxide levels and breathing rate.
Treatment
Once a breathing pattern disorder has been diagnosed, an integrated approach works best:
- Structural osteopathy to improve neck function (the diaphragm's nerve supply originates there), direct work to the thoracic spine, rib cage and associated soft tissues.
- Breathing re-education.
- Nutritional support.
- Exercise to improve ribcage mechanics, posture, core stability and flexibility.
- Psychotherapy where useful, to look at sub-conscious patterns and situational triggers.
- Capnotraining for chronic over-breathing.