The Hidden Epidemic: Why Many Healthy Adults Breathe Dysfunctionally
Breathing is often considered an automatic bodily function, akin to blinking or the steady rhythm of the heart. Yet, a surprising number of otherwise healthy adults suffer from dysfunctional breathing, a condition where breathlessness or difficulty breathing occurs without an underlying disease. According to Dr Stephen Fowler, a professor of respiratory medicine at the University of Manchester, dysfunctional breathing, also known as breathing pattern disorder, involves feeling breathless or struggling to breathe, sometimes disproportionately to any existing conditions like asthma.
Because we rarely give breathing much thought, many people remain unaware that their breathing is problematic. For instance, one individual experienced panic attacks for over a decade, often at night, waking up exhausted and out of breath. Initially attributed to anxiety, it was later discovered that their physical pattern of inhaling and exhaling was out of sync, indicating dysfunctional breathing rather than a purely psychological issue.
How to Identify Correct 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. The hand on your belly should rise upon inhalation, indicating diaphragmatic breathing, not your chest. Correct breathing is slow, quiet, and nasal, whereas improper breathing is shallow, rapid, through the mouth, or involves shoulder movement.
The Complex Choreography of Regular Breathing
Breathing may seem simple, but it relies on 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 for the lungs to expand. Oxygen enters the bloodstream via alveoli, while carbon dioxide is expelled on the exhale. This rhythm involves the nervous system, muscles, and personal perception of breathing.
The way we breathe can influence emotions and cause physiological symptoms. For example, rapid or mouth breathing can induce stress or anxiety. Conversely, emotions like fear or joy can alter breathing patterns, highlighting the bidirectional relationship between breath and mental state.
Understanding Dysfunctional Breathing
Dysfunctional breathing is a respiratory impairment that can occur independently or alongside conditions like asthma or chronic obstructive pulmonary disease (COPD). Dr Mora notes that up to 12% of adults experience dysfunctional breathing, characterized by abnormal breathing problems such as chronic breathlessness, hyperventilation, mouth breathing, over-breathing, or shallow breathing that impacts health.
Even with aligned physical and emotional elements, one's perception of breathing can lead to disorder. This explains how dysfunctional breathing can arise without an underlying condition, as in the case of the individual mentioned. It often starts with a feeling of breathlessness, prompting the body to breathe deeper, faster, or harder, potentially exacerbated by respiratory issues like COPD or asthma.
Dr Fowler describes a vicious cycle: negative feelings about breathlessness cause anxiety, which leads to hyperventilation and more breathlessness, worsened by underlying lung disease. Dr Robert Cuyler, a psychologist, adds that the body dislikes under-breathing, with unpleasant sensations arising quickly if breath is held. When carbon dioxide levels rise, the brain signals for faster breathing, and if sensors become reset, even normal levels can trigger inappropriate responses, causing people to breathe more forcefully than needed.
Dysfunctional breathing is more frequent in adults with asthma, with up to 30% prevalence, and is often underdiagnosed, according to Dr Mora.
Consequences of Disordered Breathing
Dysfunctional breathing can lead to various health issues, including:
- Sleep problems and chronic fatigue
- Mental health conditions like depression and anxiety
- Tension in the shoulders and neck
- Dizziness and shortness of breath due to altered blood gases and muscle strain
- Exacerbation of conditions like asthma, irritable bowel syndrome (IBS), and cardiovascular issues
Treatment Approaches 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 assessment for otherwise healthy adults.
Dr Fowler works with a multidisciplinary team including doctors, nurses, speech and language therapists, physiotherapists, and psychologists to assist patients, though such teams are rare and often see only complex cases. Treatment varies based on underlying concerns, focusing on breathing exercises, lifestyle changes, and devices that measure carbon dioxide output or help retrain breathing patterns.
Dr Garner emphasizes the importance of mindful breathing: I encourage people to at least think about their rate of breathing. Mindfully slowing down can help control their nervous system's stress response. Reducing stress lowers heart rate, promoting healthy, regular breathing.
For the individual with dysfunctional breathing, a behavioral approach has been effective. Instead of breathing more forcefully when feeling out of breath, they focus on something joyful while slowing their breath, avoiding counting inhalations or exhalations to prevent worsening anxiety. While challenges persist, understanding the power to interrupt the cycle is key to eventually breathing well again.
