Few will dispute the importance of breathing for sustaining life. Without oxygen, animal and human life processes stop within minutes. But did you know that excessive breathing also comes with a health warning?

How you breathe goes beyond providing oxygen and ridding the body of carbon dioxide, to profoundly affect your digestive, cardiovascular, nervous and other systems, as well as impacting on your emotional wellbeing. And the key to breathing well, or otherwise, is less with oxygen intake, and more with how much carbon dioxide you’re exhaling

This article will deal with the commonest form of dysfunctional breathing in healthy people: breathing pattern disorder or over-breathing:

Where, under normal conditions, exertion quickens the breath to match the body’s energy demands, dysfunctional over-breathing exceeds the body’s energy needs, changing your blood chemistry to produce symptoms such as muscle tension and pain, irregular heart rhythm, digestive complaints, dizziness and anxiety

In this article you’ll learn to recognize healthy and dysfunctional breathing patterns and some their major effects on your health. You’ll explore how you breathe, and address any imbalances by means of

1. Diaphragmatic breathing
2. Breathing pattern retraining
3. Mindfulness of breathing
4. Yoga, and a few simple
5. Life style tweaks

How Does Dysfunctional Breathing Impact Your Health?

Dysfunctional breathing comes in two forms: breathing too little (hypoventilation), and breathing too much (hyperventilation). Underbreathing is a feature of diseases such as chronic obstructive pulmonay disease (COPD). Though sometimes co-existing with underbreathing in COPD, asthma and others, overbreathing is also seen in otherwise healthy individuals, with a  prevalence estimated at around 10%

A normal breathing pattern in human adults consists of

• an average resting breathing rate of 12-18 breaths per minute
• a 1:2 ratio of inhalation to exhalation, with a brief 1-2 seconds pause at the end of exhalation
• breathing is through the nose
• the diaphragm is the principle muscle used in breathing

Over-breathing has strong associations with stress and anxiety, each exacerbating the other to create a self-sustaining cycle

Features of a dysfunctional breathing pattern include

• shallow, rapid, or irregular breathing
• exhalation which is equal to or shorter than inhalation,
• pausing between breaths may be absent
• mouth breathing is common
• high chest breathing is often favoured over diaphragmatic breathing

What follows is a short account of how dysfunctional breathing alters you blood chemistry to produce an array of multi-system disturbances. If you prefer, hit the button to skip this section and come back to it in your own time

The effects of dysfunctional over-breathing come about not so much from an excess of oxygen, but from the excessive loss of carbon dioxide (CO₂ ). An acid when dissolved in water (blood), low CO₂ levels make the blood relatively alkaline, the resultant respiratory alkalosis being the trigger for a host of multi-system dysregulations

Paradoxically, despite overbreathing raising blood oxygen levels, alkalosis keeps the O₂ locked within the red-blood cells, rendering it effectively unavailable

Alkalosis subjects Calcium (Ca²⁺ ) to a similar fate, keeping it tightly bound to the blood protein albumin. Essential for nerve and muscle function, the reduced availability of Ca²⁺ is associated with symptoms such as muscle cramps, tingling / pins-and-needles, dizziness and other neuro-muscular disturbances

Two other common features of dysfunctional breathing are chest and mouth breathing. Strongly associated with tension, stress and anxiety, chest and mouth breathing further exacerbate overbreathing, potentially setting up a vicious cycle

In addition, mouth breathing bypasses an important protective mechanism:

Nitric oxide (NO), released from the mucous membranes of the nose in response to the passage of air, is a powerful chemical mediator of dilatation of the airways (bronchodilation), and blood vessels (vasodilation), facilitating air flow and gas exchange within the lungs

NO also contributes an important anti microbial function. Unsurprisingly, mouth breathing bypasses the protective effects of NO and is associated with a higher propensity for respiratory tract infections

Chest breathing often accompanies forward head and other postural imbalances, leading to muscular pain and fatigue in the neck and upper back regions, and further creating tension to exacerbate overbreathing

Symptoms Of Breathing Dysfunction May Include

• frequent sighing and yawning
• tingling in the extremities. mouth and face
• Muscle pain, especially in the upper back, neck and shoulders
• abdominal pain and digestive disturbance
• racing or irregular heart beat
• anxiety, inability to relax, and sleep disturbance
• physical and mental fatigue
• and others

For a fuller account of the mechanisms behind the symptomatolgy of dysfunctional breathing check the related article on breathing pattern disorder

Identifying Breathing Pattern Disturbances

Dysfunctional breathing can mimic other medical conditions, making diagnosis challenging. Symptoms such as shortness of breath, rapid breathing, and alteration in heart rhythm, may be due to respiratory or cardiac disease. Sensory disturbance and muscular pain may have a rheumatological or neurological origin; while causes of anxiety may be due to hormonal imbalances, such as with overactivity of the thyroid gland, needing the attention of an endocrinologist, as well as professional psychological support

If you are experiencing these or any other symptoms suggestive of breathing pattern disorder, first consult your doctor to rule out organic disease requiring specific attention

PRACTICAL – How Do You Breathe?

Breathing is automatic. And it can also be consciously directed. Looking at your breathing, how do you breathe?  Do you breathe through your nose? Do you mainly use your diaphragm, upper chest, or a combination of the two? How does your posture and position affect your breathing? Here are a handful of really simple ways to help you get better acquainted with your breathing habits:

1 – SNIFF TEST

This is a great way to see whether you habitually breathe using the diaphragm or the upper chest

Sit or stand with one hand on your belly and the other on your breast bone. Breathing through your nose take in a sharp, fast lungful of air. Can you tell which of your hands moves first? Try it a few times. This tells you a lot about where you breathe when you’re under stress: belly = diaphragm, breast bone = chest breathing

2 – PRACTICAL

Lie comfortably on your back, your knees bent, and feet on the floor at hips’ width. Place one hand on the middle of your belly, and another over the breast bone

How comfortably are you able to breathe through your nose? Is one nostril clearer than the other?

Breathe quietly and comfortably. Which hand do you feel moving the most? Which hand moves first?

Now, place the hands on the sides of the lower ribs. Do your ribs expand sideways as you inhale?

3 – PRACTICAL

Now rest the back of your head on a soft (paperback) book a couple of hundred pages thick

Does this change the way you breathe? Is it more or less comfortable?

4 – EXERCISE

Sit on a chair. Maybe at your home or office work station? Adopt a comfortable sitting posture. Check how you’re breathing. Use your hands to help you

Now try to imagine yourself sitting at work. What sort of posture might you adopt? In that posture, how does breathing behave?

Breathing well at rest, however, does not guarantee you won’t overbreathe when stressed, tired, or just plain busy

Blood CO₂ levels may be measured by capnography, a device that measures CO₂ in expired air. other common clinical tests of breathing function include manual assessment,  cardio-pulmonary exercise testing and hyperventilation provocation testing, all of which require professional expertise and specialist equipment

Fortunately, there are simpler ways of testing for breathing dysfunction which require no equipment and correlate well with capnography and other findings

A fimr favourite for its ease of use and reliability, the Nijmegen Questionnare consists of 16 questions yielding scores based on frequency of symptoms. Each answer scores a number 0-4. Simply answer the questions and add up the scores

Though a score of 23+ is diagnostic of full-blown hyperventilation syndrome, scoring 15 or higher puts you on the dysfunctional breathing spectrum 

Yoga And Mindfulness Exercises
For Healthier Breathing

1 – Diaphragmatic Breathing

The diaphragm is a dome shaped muscle sitting at the base of the chest cavity. It spans from to the lower margin of the rib-cage and tip of the breast bone to a central tendon at the apex of the dome. It also has connections to the upper half of the lumbar spine (lower back vertebrae), but that needn’t concern us here

As the diaphragm contracts it tends to flatten. This changes the dimension of the chest cavity, lowering its pressure, which is equalized by air rushing in. You can see how inhalation is an active process involving muscle contraction

During exhalation the diaphragm simply relaxes and, being elastic, it recoils to its resting dome shape

The diagram below shows the relationship of the diaphragm, ribs and lungs

The diagram above also shows the lower ribs remaining fixed while the central part (tendon) of the diaphragm moving down on inhalation. This downward motion of the diaphragm presses down into the abdominal organs. With the belly wall relaxed, the organs are pushed forward – this is belly breathing

Now take a look at the diagram below. The first diagram shows belly breathing, with the lower ribs staying fixed while the central tendon moves down

If, on the other hand, the central tendon is fixed the diaphragm again flattens as it contracts, but this time the lower ribs are moved up. Because the lower ribs move like bucket handles, upward motion is accompanied by side-ways expansion. This is lateral rib breathing

In belly breathing the muscles of the waist anchor the ribs down while the belly remains soft. In lateral rib breathing the belly muscles pull in, pushing the viscera up against the central tendon to stabilize it, allowing the margin of the rib cage to expand 

If you find it hard visualize, don’t worry: just try it:

Diaphragmatic Breathing 2 Ways

PRACTICAL 1: Belly Breathing

First, let’s practice pure belly breathing:

Lie on your back, the soles of your feet flat on the floor at hips’ width apart, your knees bent upwards. Or, if you prefer, lie with your legs straight, placing a cushion or rolled up blanket behind your knees. Put one or both hands on your belly, a little to the side of the navel

As you inhale, imagine you’re sending the air through the chest and beyond into your belly. Notice how the belly rises. As you let the breath out, slowly and quietly, notice how the belly falls. During exhalation the diaphragm and rib muscles all relax. Let the exhalation fully finish, to ensure maximal relaxation

Don’t be in a hurry to breathe in. Let the breath come to you. When it does, simply guide the air into the belly and let your body take care of the rest

practice this for at least a minute

PRACTICAL 2: Lateral Rib Breathing

Lying on your back as before, place your hands a comfortable distance apart onto the front-side of your lower ribs

Now, place an imaginary object weighing just couple of pounds on the underside of the navel

With your hands on your lower ribs, gently hold your belly back to keep the inhalation in the lower chest. Avoid tensing the belly, just softly hold it back to prevent it from rising. Relax the lower lateral ribs, softening them to receive the breath

Exhale, long and quiet, waiting at the end of the outbreath for the inhalation to begin spontaneously

Practice breathing this way for further minute

PRACTICAL 3: Full Diaphragmatic Breathing

Lying on your back as before, place your hands a comfortable distance apart onto the front-side of your lower ribs

Now, place an imaginary object weighing just couple of pounds on the underside of the navel

With your hands still on your lower ribs, inhale, sending the air down into the belly. Notice how, as the belly rises there is a soft holding back. Look for a feeling of your belly falling back while remaining very soft. Does this soft holding back send the air into the lateral ribs? Relax the ribs, soften them so they can receive the breath

Exhale, long and quiet, waiting at the end of the outbreath for a new breath to begin

Stay with this for one more minute

2 – Developing A Healthy Breathing Pattern

Though not the whole story, breath retraining plays a key role in managing dysfunctional breathing, with studies showing a positive association between slow breathing, stress and mental wellbeing_{13 14}

An average healthy adult at rest will breathe through the nose and use the diaphragm to take around 12-18 breaths per minute, with an inhalation – exhalation ratio of 1:2, spontaneously pausing for 1-2 seconds at the end of exhalation

From the exercises you’ve practiced so far, how closely does your breathing pattern reflect this “norm”?

The exercise below will encourage you to slow your breathing while giving you plenty of elbow room to breathe in a way that’s natural to you. Try it:

PRACTICAL 4 – Breathing Pattern Retraining

• Sit or lie comfortably, bearing in mind that lying is usually more comfortable, but sitting helps keep you alert to your breathing. Try both, then decide which works best for you
• Unless your nasal passages are seriously blocked, breathe through your nose
• Aim to breathe as quietly as possible, staying within your comfort range
• Gently guide the breath into your belly if you can. If that’s difficult, don’t worry for now. Belly breathing is not the only, or even the best way to use your diaphragm! What we’re really concerned with here is the breathing rhythm
• Let your body take an in-breath, short or long, shallow or deep, into the belly or the chest
• Now, let the breath go, slowly and quietly. Take your time. Let the exhalation fully finish
• Now wait. Does the in-breath come right away? or is there a pause, short of long at the end of the out-breath? Either way, it’s fine. There is no right or wrong. Let your body decide

As you breathe, quietly, mindful of your breath, following it’s rhythm, your mind and body will feel calmer, and your breath retraining firmly underway

Mindfulness Of Breath
For Stress Relief & Relaxation

Essential for managing breathing pattern disorders is to develop better breath awareness. By being more mindful of how you breathe you can begin to recognize patterns and triggers that contribute to dysfunctional breathing

Mindfulness is often referred to as an acceptance-based approach. By practicing calm observation, without judgement, accepting things things as they are, and not as you imagine they should be, the regular practice of mindfulness can help you break the cycle of stress, anxiety and maladaptive breathing

Mindfulness Of Breathing

Mindfulness of breathing is a traditional body meditation from the Buddhist tradition. While the simple act of paying attention to the breath comes naturally to some, for others it’s not always a breeze. If imposing an overly strict breathing pattern on your body can meet with resistance, forcing your mind concentrate is by far the most effective for getting you tense and stressed! Fortunately there are tools out there to help you stay mindful while remaining happy and calm

PIPER

A mnemonic spelling Posture, Introspection, Purpose, Energy, and Resolve, PIPER is a really useful tool to help you navigate your mindfulness journey. Particularly helpful are the first two: posture and introspection

Posture is straightforward enough. Sit comfortably, on the floor, on a chair, or an arm-chair or settee with plentiful cushions to indulge your body’s every whim. It needn’t be complicated of profound, but it can make the difference between staying mindful or being constantly distracted by discomfort

Introspection is key to working with that endless flow of thoughts that take you from being in the here-and-now.

Take a few moments to think about how you’re feeling. Where are your thoughts? What is your mind most preoccupied with as you sit, be-cushioned, and very, very comfortable?

The 5 Hindrances To Staying Mindful

This is an attempt to classify all those thoughts, feelings, memories and desires that disturb your peace and happiness into 5 categories. They’re not meant to be strict – they are guidelines to help identify, contain and let go of whatever is distracting you from contemplating the breath. The 5 hindrances or distractions are

1. Sense Desire: your mind is drawn to pleasant things: an interesting idea that we want to follow, people you like, pleasant memories, exciting plans for the future…
2. Ill-will, annoyance and anger: you’re annoyed by something – a particular person, an irritating sound, a real or imagined situation …
3. Restlessness and anxiety: Your mind is occupied by things you feel you ought to, or would rather be doing. You have an itch, or feel physically restless and want to fidget or move around …
4. Doubt: you have doubts about the meditation, or your ability to do it satisfactorily, or whether it will really work for you …
5. Sloth. Mental dullness, fatigue and torpor. Feeling sleepy is an absolute obstacle to being mindful …

Connecting with your current mental state, can you decide which of the hindrances best describe how you feel? Pick one or two which seem uppermost. If you can’t decide, don’t worry, just move move on with you mindfulness practice. As you practice the mindfulness exercise below if your mind stays focused that’s great. Or, if you meet with a distraction see what which of the above 5 categories you think it belongs to. Then simply name it, and let it go, returning to the breath. Remember, the moment you notice you’re not being mindful is the moment you begin to be mindful

The mindfulness exercise itself is staged into four phases. The first two use breath counting, while the later stages simply follow the breath’s continuous ebb and flow.

If you find a particular phase difficult, return to the previous one. There is only one objective to this practice, and that is to be mindful of the breath

Decide beforehand how long you want to practice, and set a timer to prompt you to cycle through the phases. Traditionally each phase is of equal length, but initially you can shorten the later, more challenging phases. Try downloading a meditation timer onto your PC, tablet or phone

PRACTICAL 5: Mindfulness Of Breathing

Stage 1: Sitting comfortably watch your body inhale, then slowly and quietly exhale – count 1. When you reach 10, return to 1. If you stop counting or count past 10, stop: where are your thougts? Can you name the distraction? Irrespective, let the though go and start counting from 1

Stage 2: Now count the breath just before the start of the inhalation. Follow the same procedure. Counting has no importance other than to serve as an aid to staying present and mindful. When you become mindful that you’ve been distracted, return to counting from 1

Stage 3: Let go of the counting. Follow the breath, sensing where in the body you can detect the movement of the breath. If you find it difficult to stay focussed, consider going back to stage 2

Stage 4: focus on the tip of the nose. Feel the sensation of the air touching the nostrils. If you find it difficult to stay focussed, consider going back to stage 3, or even 2

Mentally return to your physical environment. Open your eyes and continue with your day

Yoga And Other Mindfulness-Based Movement Therapies

Together with Tai Chi, Qiqong, Pilates and others, yoga is a mindfulness-based movement therapy. In contrast with most sports, the focus is not on achieving an external functional “goal”, but in the process of movement itself

While Western cultures, polarized on outward appearances, often present yoga as a form of exercise, yoga is an ancient Indian system of meditation for the purpose of spiritual development

The effects of exercise, breath-work and mindfulness have all been rigorously studied and shown to benefit dysfunctional breathing. Yoga combines all three into a single holistic practice

Numerous studies, including systematic reviews, the research gold standard, have found positive outcomes from practicing yoga and breath retraining for asthma₈, fibromyalgia₁, cardiovascular health₁₁ including blood pressure and heart rate₂, stress markers₇, anxiety, and depression_{3 4 5 6}, to name just a few

PRACTICAL: Free Live Yoga Class Online

The final proof is in the pudding: for our last practical you are cordially invited to join us for a free interactive yoga class, live online. Opt for yoga for musculoskeletal fitness or yoga to rest and replenish. All classes have a wellbeing orientation and incorporate the classical triad of movement & postures, breath-work and mindfulness

Classes are limited to 5 participants max. Get class info, schedule, and book your place on the online yoga classes page. Or contact me, quoting #free-yoga-practical

Life-Style Tweaks For Preventing And Managing
Stress Related Breathing

Integrating the insights gained in your formal mindfulness practice into your daily routine will help you enjoy a calmer life and maintain a healthier breathing pattern

Practicing breath awareness with exercise and movement is also greatly beneficial. Practices such as yoga, tai chi and Pilates all combine movement with breath-work and mindfulness to help you move, breathe and think with less tension and enhance your whole well-being

Simple changes, such as practicing good posture, going for a walk and taking regular breaks between periods of sitting can also prevent the buildup of tension and fatigue and help break the cycle of stress, while adequate sleep, a healthy nutritious diet, and proper hydration are essential components for staying healthy

Conclusion: Embracing A Healthy Breathing Pattern

The journey toward better breathing is not just about addressing a disorder; it is about cultivating a deeper connection with yourself. How you breathe profoundly affects you feel, and how you feel profoundly impacts your breath

By recognizing the symptoms, features and triggers of dysfunctional breathing, and making time for self-care with the help of some simple yoga and mindfulness techniques, you can break free from the cycle of stress and maladaptive breathing and embrace new habits for a fuller and happier life

References

1 – J Martín Nuñez et al, 2024: The effectiveness of breathing exercise in fibromyalgia syndrome: a pain meta-analysis

2 – Piyush Garg et al, 2024: Effect of breathing exercises on blood pressure and heart rate: A systematic review and meta-analysis

3 – Y Wu et al, 2023: Effectiveness of yoga for major depressive disorder: A systematic review and meta-analysis

4 – J Martinez Calderón et al 2023: Yoga-based interventions may reduce anxiety symptoms in anxiety disorders and depression symptoms in depressive disorders: a systematic review with meta-analysis and meta-regression

5 – Holger Cramer et al, 2018: Yoga for anxiety: A systematic review and meta-analysis of randomized controlled trials

6 – Lindy L. Weaver et al, 2015: Systematic Review of Yoga Interventions for Anxiety Reduction Among Children and Adolescents

7 – M C Pasco et al, 2015: A systematic review of randomised control trials on the effects of yoga on stress measures and mood

8 – J A Burges, 2011: Systematic review of the effectiveness of breathing retraining in asthma management

9 – J L Barrows et al, 2016: Systematic Review of Yoga Interventions to Promote Cardiovascular Health in Older Adults

10 – H Cramer et al, 2015: A systematic review of yoga for heart disease

11 – J L Barrows et al, 2016 : Systematic Review of Yoga Interventions to Promote Cardiovascular Health in Older Adults

12 – M Thomas et al, 2005: The prevalence of dysfunctional breathing in adults in the community with and without asthma

13 – G W Fincham et al, 2023: Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials

14 – A Zaccaro et al, 2018: How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing