Don’t hold your breath ’cause we’re running in circles…

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. But as we progress into toddlers, children and adulthood, our life experiences and emotions influence our unique breathing pattern, and more often than not, this a negative influence. It is estimated by experienced clinicians that approximately 70% of patients seen do not breathe properly, as we did when we were babies. This may appear unusual, as breathing is a subconscious activity, and as such, unless we have an obvious breathing problem (e.g. asthma) we do not usually notice our breathing. We need torealise that our emotions influence our breathing patterns, but just as importantly, our breathing affects our emotions and performance.

You may notice in yourselves or others that we may sigh frequently, find it difficult in catching our breath or we may talk to fast, (like Laura from The Apprentice). 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 to a negative event. It is, therefore, 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.

Those of us suffering with complaints and ill health, with medically unexplained symptoms, will often have breathing pattern disorder as part of the problem. These are usually functional disturbances in our bodies, affecting one or a combination of the levels listed here – biomechanical, nutritional, and emotional. All three levels are linked by breathing.

We all know basic breathing physiology and that when we breathe in, we are breathing in oxygen and when we breathe out, we are breathing out carbon dioxide. However, as I recently discovered myself, it is not as simple as that! The main aim of respiration is to get oxygen into cells to help with energy production, and the many cellular reactions required by the body to survive, depend on adequate levels of carbon dioxide being present in our body.

When we don’t breathe properly, the issue is almost always one of over-breathing. The result is that we breathe out too much carbon dioxide (not to be confused with the potentially poisonous carbon monoxide), and so the level of carbon dioxide in our body drops, known as hypocapnia. This reduces the ability of oxygen to be delivered to the cells of the body, known as hypoxia. The irony is that trying to breathe in more oxygen does not necessarily help this situation. 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 of this is to hold a brown paper bag over their mouth and nose, so that they re-breathe their own breath, which is mostly carbon dioxide. They return to normal as cellular levels of oxygen then increase, as a result of carbon dioxide levels returning to the required level.

So how is a breathing pattern disorder diagnosed? Aside from the history and habits described above, correct clinical examination can be very revealing, including:

  • Breath pause – patients with a breath pause of less than 30 seconds may be suggestive of a disorder

  • Observation – patients displaying upper ribcage breathing and poor diaphragm use may be suggestive of a disorder

  • Breathing rate – optimum breathing is at a rate of 6 cycles per minute, an average patient breathes at around 12 cycles per minute. A rate of more than 15 breaths per minute may be suggestive of a disorder

  • Nijmegen questionnaire – a validated questionnaire, which can be suggestive of a breathing pattern disorder if the patient scores highly

  • Capnography – a specialised piece of equipment that measures carbon dioxide levels and breathing rate

Once a breathing pattern disorder has been diagnosed,it can be subdivided into two categories, intermittent over-breathing (dependent on the situation) or chronic over-breathing. This disorder can be treated, taking an integrated approach:

  • Structural osteopathy – to improve neck function (where the nerve supply to the diaphragm is situated), direct work to the thoracic spine (upper back), rib cage and associated soft tissues, muscles and fascia, helping to improve local mechanics and release tension in the iliopsoas muscle (directly connected to the diaphragm)

  • Breathing re-education

  • Nutritional support

  • Exercise to improve ribcage mechanics, posture, core stability and muscle/fascial flexibility

  • Psychotherapy to look at sub-conscious patterns and situational emotional triggers

  • Capnotraining for chronic over-breathing (in addition to above work)

If you have breathing difficulties, or are unsure whether osteopathy can help, it may be worthwhile coming to see us at Atlas Osteopathy (with clinics in East Finchley and Moorgate, as well as the option of home visits), where we can explain your problems to you, why they occur and whether or not you are suitable for osteopathic treatment. Often this can be done via email or on the phone.