The Hidden Epidemic of Dysfunctional Breathing: A Silent Health Crisis
Breathing is often considered an automatic bodily function, akin to blinking or the heartbeat, requiring little conscious thought. However, a significant number of otherwise healthy adults experience dysfunctional breathing, a condition where breathlessness and difficulty breathing occur without an underlying disease. Dr. Stephen Fowler, a professor of respiratory medicine at the University of Manchester, explains that dysfunctional breathing, also known as breathing pattern disorder, involves feeling breathless or struggling to breathe, which can happen independently or alongside conditions like asthma.
Because we rarely reflect on our breathing, many individuals remain unaware that their respiratory patterns are problematic. For instance, one person suffered from panic attacks for over a decade, often waking up exhausted and out of breath at night. Initially attributed to anxiety, it was later discovered that their physical breathing rhythm was out of sync, indicating a genuine dysfunctional breathing issue rather than a purely psychological one.
How to Identify Proper Breathing
To determine if you are breathing correctly, Dr. Juanita Mora, a spokesperson for the American Lung Association, recommends a simple test: place one hand on your chest and the other on your belly while lying down or sitting. Upon inhalation, the hand on your belly should rise, indicating diaphragmatic breathing, rather than the chest moving. Correct breathing is characterized by being slow, quiet, and nasal, whereas improper breathing tends to be shallow, rapid, through the mouth, or accompanied by shoulder movement.
The Complex Choreography of Regular Breathing
Breathing may seem straightforward, but it involves intricate coordination. Each breath begins with air intake through the nose or mouth, traveling down the trachea. The diaphragm contracts and moves downward, creating space in the chest cavity for the lungs to expand. Oxygen enters the bloodstream via alveoli, while carbon dioxide is expelled on exhalation. This process requires synchronization among the nervous system, muscles, and personal perception of breathing.
The way we breathe can significantly impact emotions and physiological symptoms. For example, rapid or mouth breathing can induce stress or anxiety, while emotions like fear or joy can alter breathing patterns. Dysfunctional breathing is a respiratory impairment that can occur alone or with conditions such as asthma or COPD, affecting up to 12% of adults, according to Mora. It includes abnormal patterns like chronic breathlessness, hyperventilation, mouth breathing, over-breathing, or shallow breathing that detrimentally affect health.
Understanding Dysfunctional Breathing
Even with aligned physical and emotional elements, one's perception of breathing can lead to disorder, causing dysfunctional breathing without an underlying condition. This often starts when individuals notice feeling out of breath, prompting the body to breathe deeper, faster, or harder, potentially worsening with respiratory issues like COPD or asthma. Dr. Fowler describes a vicious cycle where negative feelings about breathlessness trigger anxiety, leading to hyperventilation and increased breathlessness, especially in those with lung diseases.
Once in this cycle, it becomes self-perpetuating. Dr. Robert Cuyler, a psychologist, notes that the body dislikes under-breathing, causing discomfort quickly if breath is held. Some people become unsettled by imbalances in carbon dioxide and oxygen levels, with rising carbon dioxide prompting faster breathing rates. This can result in individuals breathing more forcefully than necessary, even at rest, as if sustaining physical activity.
Dysfunctional breathing is more prevalent in adults with asthma, with up to 30% affected, and is often underdiagnosed. Consequences include sleep problems, mental health issues like depression and anxiety, shoulder and neck tension, chronic fatigue, dizziness, and shortness of breath. It can also exacerbate conditions such as asthma, irritable bowel syndrome, and cardiovascular problems.
Treatment Options for Dysfunctional Breathing
Breathing assessments can be conducted by primary care doctors, respiratory therapists, pulmonologists, or exercise physiologists like Dr. Dena Garner, who has studied breathing mechanics in athletes for over 15 years. However, there is no gold standard for assessment in otherwise healthy adults. Treatment often involves a multidisciplinary approach, with teams including doctors, nurses, speech and language therapists, physiotherapists, and psychologists collaborating to assist patients.
Focusing on breathing exercises and lifestyle changes is common, with devices available to measure carbon dioxide output or retrain breathing patterns. Dr. Garner emphasizes the importance of mindfully slowing breathing to control the nervous system's stress response, which can help maintain healthy, regular breathing. For some, behavioral approaches have proven effective, such as avoiding forceful breathing when feeling out of breath and instead focusing on joyful thoughts while slowing breath, without counting inhalations or exhalations to prevent worsening anxiety.
While challenges may persist, understanding the power to interrupt the dysfunctional breathing cycle is crucial for recovery. With proper awareness and treatment, individuals can work towards breathing well again, improving overall health and wellbeing.
