Guide to Breathing

A facet of the hectic pace of modern life is chronic stress and the induction of the flight or fight response as a coping mechanism. In most cases the induction of these responses are sub-acute, masked by social conventions. Thus everyday social and financial stressors, which may promote a similar release of adrenalin as almost getting hit by a car or being chased by a wild animal, are muted by social conditioning, in which the normal response, such as shouting and running are supplanted by mechanisms which attempt to internalize the stress. Apart from down-regulating digestive secretions, increasing muscle spasticity, and inducing compensatory secretions from the adrenal cortex that can have an immunosuppressant activity, chronic stress has a significant impact upon the way we breathe. Chronic stress habituates the body to become used to the induction of fight or flight responses, and overtime we forget how to relax, and ultimately, how to breathe.

Ayurveda places an enormous importance on the function of the lungs, as the source of prana which regulates all life processes. When we obstruct the flow of breath through stress-induction we cut ourselves off from the most accessible and renewable source of energy we have. Although the title of this article, A Guide to Breathing; is somewhat tongue-in-cheek, it also demonstrates how unconscious many of us are when it comes to something as basic and simple breathing. This section discusses necessary skill of being able to deconstruct something most of us take for granted. Imagine what it would be like to be trapped under water without a tank of oxygen: suddenly the importance of breath comes to the forefront.
In deconstructing the process of breathing it is importance first to be aware of the way we breathe, to discern if its disordered in any way. Sit comfortably in a chair with your back upright and feet firmly planted on the floor, and breathe normally, not holding your breath or taking especially deep breaths. As you breathe, ask yourself, or if this is part of consultation, ask the patient the following questions:

  • Where do I feel my breath? Place one hand on your abdomen and one hand on your chest, and feel where the breath originates. This isn’t a process of determining what is right or wrong, but simply developing the process of becoming conscious of the dynamics of breath. As you breathe in and out, does it the breath appear to originate in the abdomen, the chest, the ribs, the shoulders, or the nose?
  • What does my breathing feel like? What is the quality of your breath? Does it feel laboured, difficult, obstructed, rough, jerky, or flowing? Is there any hesitation, even momentary between inhalation and exhalation, or between exhalation and inhalation.
  • How fast do I breath? Breathing normally, count the number of breaths you take per minute (one breath equaling a complete cycle of inhalation and exhalation).

These exercises will help to bring you or your patient more in touch with the dynamics of breathing.

Most problems with breathing, if they aren’t due to a functional disturbance of the lungs themselves, relate to the activities of the diaphragm. In healthy breathing the diaphragm moves without restriction, descending as we inhale and rising with exhalation. The movement of a natural, normal breath is analogous to filling a bucket with water: as we breathe in the diaphragm slowly contracts, opening the lungs and pulling the breath downwards as we inhale, filling the bucket from the bottom (abdomen) upwards (to the chest). Upon exhalation the air contained in the chest is released first, and gradually the air in the abdomen is let out, all in one fluid movement, as if we are pouring the bucket out. Several patterns that relate to diaphragmatic control are at the heart of understanding breathing problems, and are described as follows.

Reverse breathing

Reverse breathing occurs when the abdomen moves in upon inhalation and out upon exhalation. This often occurs with restrictive clothing or tight belts that inhibits the movementof the diaphragm. In some cases however these people are simply unconscious of breathing and when asked to feel their diaphragm contracting or relaxing they find they cannot. Reverse breathing is a kind of confused state of the diaphragm and the other muscles of respiration, and produces a concomitant confusion in the mind. There may be chronic tension in the upper body, especially around the back of the neck, the upper shoulder, upper back and jaw. Other problems may include poor digestion, gastric reflux, bloating, and flatulence. Reverse breathers often have a difficult time coordinating physical movements, and are often clumsy. Reverse breathers may be confused when you ask them to breathe in or out, often doing the reverse, or they may have no sense of when or how they are breathing. Since reverse breathers have little kinesthetic knowledge of breathing ask them to look down and visually observe their abdomen when they breathe. Exercises to train reverse breathers to breathe properly include:

  • Slowing down breathing. Reverse breathers often breathe with shallow breaths. Ask them to breathe more slowly so they can begin to become aware of this dysfunctional breathing pattern.
  • Relaxing the abdomen. Ask them to relax the abdomen, and experiment with having them push the abdomen out upon inhalation, and letting it fall back with exhalation. Another strategy may be to ask them to lie on prostrate on an examination table, place their hands under their abdomen, and ask them to breathe into their hands, becoming aware of the contraction and relaxation of the diaphragm.

Chest breathing

Chest breathing is a naturally occurring breathing pattern that occurs when fight or flight mechanisms are induced, or with intense physical exercise. In the case of the former, something startles us, we gasp, pulling the abdomen in and breathe high into the chest. The increased abdominal tension that can occur with stress prevents the diaphragm from moving down, and thus we take in another quick chest breathe, and without becoming conscious of the increased abdominal pressure, the breathe continues more or less along this line. Chest breathers restrict the movement of breathe into the abdomen, causing the breath to ascend higher into the chest, often accompanied by shoulder movements. When chest breathing is the dominant form of breathing there is an excessive reliance upon secondary respiratory muscles in the upper chest and neck, including the pectoralis, trapezius and scalenes. In normal breathing the diaphragm, the intercostals and abdominal muscles dominate. In chest breathing the reliance upon weaker secondary muscles to breathe can promote chronic tension in the thoracic spine, shoulders and neck, often resistant to any kind of bodywork like massage because the cause has not been addressed. The chronic tension with the abdominal muscles can impair pelvic circulation, interfering with the processes of digestion and elimination, and causing problems such as gastric reflux and hiatus hernia. In many cases chest breathers are Type A personalities, or over achievers, ambitious, willful and driven, often lacking the ability to completely relax and thus can experience a kind of chronic, free-floating anxiety.

Place your hands on your abdomen and chest, or if this is part of consultation, ask the patient to do this. Which hand moves more? Do you feel the abdomen expanding or not much at all? Is there any increase in shoulder and neck tension during inhalation? Do the shoulders rise with inhalation instead of relaxing and broadening outwards? Exercises to dismantle a chest breathing pattern include:

  • Releasing the tension in the upper shoulders and neck. During breathing ensure that these areas are completely relaxed. When sitting for extended periods of time, such as working at the computer, make sure that you or your patient regularly stretches the shoulders, neck and arms. Ensure that the workplace is ergonomic.
  • Relax the abdomen. As in reverse breathing, ask chest breathers to practice relaxing the abdomen, allowing it to expand upon inhalation and fall back with exhalation.
  • Ground yourself in the present. Chest breathers are often several steps ahead in their thinking, a feature of fight or flight induction where planning escape routes become necessary. Chest breathers need to focus on the present moment, and allow life events to unfold naturally.
  • Assess body image. Another reason for chest breathing is an unconscious negative body image. Proper breathing cases the abdomen to protrude, which to some people, may seem undesirable, looking like or adding girth to their waste. While measures should be taken to overcome truncal obesity, a healthy self-image should not come at the expense of breathing.

Hyperventilation

Although hyperventilation is not usually recognized in its chronic form, it can manifest as a subtle and chronic dysfunctional breathing pattern. The normal breathing rate in adults is about 13 breaths per minute, men tending to be a little slower (between 12-14 BPM) and women a little faster (14-15 BPM). Hyperventilation refers to a rate of breathing that is higher than normal, and is usually related to the pattern of chest breathing. The decreased volume of oxygen taken in during chest breathing is typically accommodated by increasing the rate of respiration.
Hyperventilation syndrome (HVS) is a clinical entity that has been defined for well over a hundred years, but the specific medical causes have not been identified. Patients with HVS tend to breathe by using the upper thorax rather than the diaphragm, resulting in chronically over-inflated lungs. When stress induces a need to take a deep breath, the deep breathing is perceived as dyspnea. The sensation of dyspnea creates anxiety, which encourages more deep breathing, and a vicious cycle is created.

The excretion of CO2 is absolutely crucial to maintaining to the acid-base balance of the body, and dysfunctional breathing patterns such as hyperventilating can cause us to lose too much CO2, promoting a general shift towards increasing the pH of the body, making the blood and tissues slight more alkaline. This effect reverberates in a variety of physiological changes:

  • the arteries in the brain constrict, impairing the flow of blood to the brain, possible causing headaches, memory problems and difficulty concentrating
  • hemoglobin will retain oxygen, a feature which may perpetuate the hyperventilating pattern, and promote problems such as dizziness and breathlessness
  • the peripheral arteries constrict, impairing circulation to the extremities, promoting problems such as cold hands and feet
  • the increase in alkalinity causes the net movement of calcium ions into the muscles, promoting muscle contraction and possible problems relating to chronic muscle spasm
  • low levels of CO2 can promote an increase in nervous system excitability, promoting nervous distress and muscular irritability

In addition to the symptoms above, hyperventilation can cause a variety of problems including exhaustion, palpitations, dizziness, visual disturbances, peripheral numbness, dyspnea, yawning, chest pain, a feeling of a lump in the throat, abdominal pain, and insomnia.
The test to determine for hyperventilation is counting the number of breaths per minute. In many cases however the patient may consciously slow the rate of respiration down during assessment, and thus this may not be the most effective method for assessing hyperventilation. Ask the patient to pull the abdomen in and chest breath; if they regularly hyperventilate this will be a familiar pattern. Another clue is determining whether or not they allow exhalation to reach its maximum completion before the next breath. Normal breathing manifests a quick pause after exhalation; in hyperventilation there is no pause. Does the patient appear to “pull” the inhalation in the body, as opposed to letting the inhalation to come naturally into the body. Remember, the first stages of inhalation are a passive process, only if exhalation has been sufficient enough to reduce the lung pressure to slightly below that of the atmosphere, allowing air to move in passively, which is then continued by the contractions of the diaphragm and intercostals. The process of dismantling the hyperventilation pattern consists of practicing the techniques outlined under chest breathing, in addition to:

  • Slowing down. Breathing patterns compliment physical movements: try to slow down, reducing the speed at which you move, walk, and drive.
  • Meditation and menial tasks. Practice regular meditation, or just “sitting”; focusing on the complete in and out breath, fully extending and slowing inhalation and exhalation. Another method is to engage in menial tasks such as gardening, washing dishes or folding laundry. Very often fun, creative endeavours that requires your full attention, such as writing, painting, knitting or drawing, is a highly effective way to change this pattern.
  • Assess the need to hurry. Very often the need to rush about and hence hyperventilate is an imagined need based on the induction of fight or flight mechanisms. Instead, prioritize what is most important to accomplish, and what cannot be done in a relaxed peaceful manner can wait for another time. Of course there will always be times when we are rushed and need to move quickly, but if this becomes a chronic pattern then this needs to be addressed. Imagine that if today was your last day, what things would be most important to accomplish, and what things don’t really matter.
  • Address anxiety and fear. In many cases the hyperventilation pattern represents emotional issues that cause the patient to be in a more or less constant of fear, essentially being afraid of taking a deep breath, a kind of plunge into their own physical consciousness. In such cases it may be important to refer the patient to a therapist to work some of these issues out.

Collapsed breathing

Collapsed breathing is essentially the same pattern as chest breathing, but looks substantially different. Instead of the chest rising and expanding with each breath, the chest in collapsed breathers the chest is drawn inwards, the shoulders hunch and the abdomen protrudes forward and downwards. Nonetheless upon inhalation the abdomen doesn’t change position but the shoulders and upper chest rise to accommodate the inhalation. In many cases collapsed breathers sigh upon exhalation, and frequently gasp to obtain more air.

The collapsed breathing pattern has numerous effects upon the body. In most scenarios the muscular tone of the abdomino-pelvic cavity is poor, and the circulation is stagnant, leading to prolapsed organs and hemorrhoids. It is a pattern that often accompanies depression, shame or a poor self-esteem. This may be the result of a certain disconnectedness between the mind and body, where the mind looks for an escape beyond the confines of physicality. In such cases the person may appear lively and motivated, but only from the head up: the body tells the truth of the matter. Collapsed breathing is also a pattern that can manifest in emotional trauma, where ignoring or suppressing sensations and memories becomes an important coping strategy.

In a sitting position place one hand on the abdomen and the other on the chest. Collapse your shoulders forward, leading the head come down and forward and the sternum downward. Does this feel comfortable? If so, you may be a chest breather. Now push with your feet and straighten your back, allowing the chest to expand, the vertebrae to balance upon one another like there is wire that pulls your head up, allowing the shoulders to roll back. Does this feel uncomfortable? If the answers are yes to both questions, you may be a collapsed breather.

Dismantling the collapsed breathing pattern consists of using the lower body, the legs and the knees, to take on the burden of bearing the weight, creating a kind of rebounding force that lifts and elongates the vertical axis of the spine. The head should be up, eyes forward, like a Russian aristocrat. If this is too difficult it may be that the patient needs to be referred to a therapist that can help them work through their emotional issues.
As we can see, the three basic dysfunctional breathing patterns discussed relate to chronic tension in the diaphragm, intercostals, abdomen and the muscles of the shoulder in neck. Beyond the methods already discussed there are a variety of herbal remedies that can be used to help relax these areas:

  • over-thinking, circular thinking: Ganoderma, Ceanothus, Aesculus, Passiflora
  • anxiety and fear: Withania, Valeriana, Stachys, Anenome
  • too busy, no time: Verbena, Scutellaria, Agrimonia, Lycopus, Leonorus, Matricaria
  • environmental and social sensitivities: Achillea, Hypericum, Ganoderma
  • depression and poor self-esteem: Mahonia, Gentiana, Calendula, Hypericum, Cimicifuga

In addition to the above-mentioned remedies, a calcium/magnesium supplement (800-1000 mg ea.) may be helpful to reduce muscle spasm, as well as vitamin B complex to support nervous function.