Woman – 65 y.o. Suffering from: Anxiety – prone to anxiety regularly. Her osteopath (who referred her to me) says that she has an extremely tense body to touch – especially shoulders. Also IBS < stress. Takes a probiotic daily. Stiffness and pain in neck and shoulders – unable to turn head around without pain. Polymyalgia rheumatica -> discomfort. Arthritis in hands. Member of weight watchers. Recently has had lots of sinusitis, and congestion in upper chest/throat. Gets tired very easily. Also psoriasis – very itchy. Read my book on breathing and thinks she over-breathes. As a 14 y.o. had severe asthma – in children’s hospital for a year. Did postural drainage (was called nervous asthma) and lots of deep bx. No longer has asthma. Sleep – thinks she bx’s rapidly – almost panic. Thinks it affects sleep. Sometimes has trouble with sleep. Wakes with a dry mouth. Definitely snores. Sleeps on side. Dry mouth in am and during the night. Night time toilet trips – at least 2 per night (for the last 20 years since menopause). No water at night. Supplements – Magnesium and a probiotic. I suggested also a fish oil (for anti-inflammatory properties, and glucosamine for the arthritis). Medication – Voltaren cream for arthritis when needed. Previously on steroids for her arthritis, but she discontinued as she gained too much weight.
My thoughts
Looking at her symptom presentation and history, she has a history of issues that can be related to dysfunctional breathing – asthma, sinusitis, anxiety, IBS, poor sleep quality. As such, it is possible that breathing is a major contributor to her current health picture. Her nutrition is quite good (compared), with very little indication of hypoglycaemia, or fluctuating blood sugar levels, and no clear or significant excesses or deficiencies. Therefore, correcting her breathing function could go a long way to resolving many of these issues. Her breathing patterns at night; snoring, dry mouth, frequent night time toilet trips, tired in the morning; all indicate mouth breathing whilst she’s sleeping, which is dysfunctional breathing. Linked is an article discussing the importance of breathing for health:
As such, I felt the first priority to assess her breathing efficiency using the capnometer – a biofeedback driven technology used in hospitals to monitor whether a patient is breathing, that measures breathing rate and exhaled carbon dioxide (measured as the volume of CO2 in the lungs at the end of exhalation – end tidal carbon dioxide – ETCO2). My blog, linked below, will discuss the importance of ETCO2 as a parameter in measuring breathing efficiency; however, in short, CO2 in our blood stream governs how efficiently we get oxygen (O2) from the air in our lungs, to the cells of our body for energy production (the purpose of respiration). Whilst oxygen is essential for energy production, without CO2 being present in our arterial blood stream, the oxygen would not be able to get to our cells in sufficient quantity. And given there is only 0.03% CO2 in our atmosphere, we must store it to have access to it. Therefore, it could be argued that CO2 is the limiting factor in respiration. CO2 is a by-product of energy production, so we make it, and whilst some CO2 is available to us in our venous blood supply (as it makes its way to the lungs to be exhaled), there is not enough here for efficient energy production, so we ideally have a store of 6.5% CO2 in our lungs at the end of exhalation (ETCO2), which translates to 40mmHg partial pressure of CO2 as a minimum ideal for efficient respiration, and energy production. This ETCO2 permeates back into our blood stream to allow the O2 to get to our cells. So, ideal levels on the capnometer for functional breathing, based on medical diagnostic norms, are 8-10 breathes per minute and an ETCO2 of 40mmHg.
This client’s initial base reading was between 13-16 breaths per minute, which is at least roughly 50% higher than the ideal average of 8-10 bpm. And her ETCO2 was 30.8-32.0mmHg, so around 25% lower than the minimum ideal of 40mmHg. This suggests that she breathes at 25-50% below what is considered as functional – which is not at all uncommon. But is sufficient that it will definitely result in reduced energy production, and is likely that it will start to result in symptoms in the body.
On further investigation, I also determined that we needed to address both breathing rate and volume in this client.
Treatment
Based on these thoughts and the breathing analysis, her only treatment after this initial session involved retraining her breathing so that she could breathe closer to functional levels at all times, including whilst sleeping. The objectives of treatment were: 1. Breathe through the nose at all times (unless exercising at high levels). 2. Use the diaphragm at all times. 3. Increase tolerance to elevated CO2 (hypercapnia). 4. Reduce rate and volume of breathing to optimise O2 delivery to cells for energy production and allow dilation of airways, blood vessels, GIT etc. 5. Regulate the autonomic nervous system (via the diaphragm) to increase the parasympathetic (PSNS – relax, rest and digest): sympathetic (SNS – fight or flight) ratio.
This included: 1. Diaphragmatic breathing rhythms that aimed at having her breathe only through her nose, using her diaphragm only (not chest and shoulders) at rhythms designed to retrain her day to day breathing rhythm. 2-3 x 10 minutes each per day. 2. Preventing mouth breathing at night by keeping the tongue at the roof of the mouth, and/or taping the mouth closed at night using 1 inch porous paper tape; i.e. Micropore tape. 3. Practising breath holds to increase the brain’s tolerance to higher CO2 levels which will result in the body accepting lower breathing rate and volume (and therefore more efficient breathing) more permanently. 3-5 per day at least. I didn’t make any nutritional changes or add any herbs and supplements at this stage as I wanted her to focus on the breathing retraining. Plus I didn’t want to overwhelm her.
Outcome 1 – 3 Weeks Later
She said she is snoring much less, although she didn’t tape her mouth at night as the adhesive on the tape made her itch. She did concentrate on keeping her tongue on the roof of her mouth as she went to bed prior to sleeping. In addition, she did plenty of breathing rhythms and breath holds – at least the specified amount. Her overall report was: • Hasn’t had a night time toilet trip since. • No dry mouth in the morning. • She feels much better – more energetic. Much less fatigue at 3pm also. • She also feels much calmer – less anxiety. • No hyperventilating or feeling panic when going to bed. • No clenching of her jaw. • IBS symptoms much better – no cramps, pain, diarrhoea or constipation. • Her psoriasis hasn’t been itchy at all, and the scabs on her head have mostly cleared up. • Her arthritis was bad for 3 days last week – she thinks she overdid it with the gardening. It felt better after a warm shower and Voltaren cream. Overall, I am not surprised to see results given her history of dysfunctional breathing, but these scope of the results were a very pleasant surprise. I expected to see results with her sleep related symptoms and quality, anxiety, and possibly with energy levels and her IBS symptoms. Linked is an article and video on IBS and breathing.
However, I was surprised to see such significant results with her psoriasis. It makes sense that functional breathing can help with psoriasis symptoms, as it will create more vasodilation, and therefore more blood and lymph flow to the scalp; plus the diaphragmatic rhythms will help decrease sympathetic (or fight and flight) nervous system activation and dominance, and therefore improve immune function. A bonus. But we need to see what happens over time. Will these improvements persist? Capnometry results were also significantly improved – much closer to functional breathing. Treatment as is.
Outcome 2 – 7 weeks from the start
A persistence in all improvements from last session. For example: • Still no night time toilet trips or dry mouth in the morning. • Sleep quality is still good, and no snoring. • Psoriasis nearly all cleared up – she’d had this for 20 years!! • No jaw clenching. • Also, significantly reduced tightness and pain in her neck and shoulders – her osteopath (who referred her to me) is amazed. • IBS stable – no issues. • No hyperventilation or panic when she goes to bed. • Definitely calmer, more relaxed and better energy still. She feels quote distant from her worries now – she was in a family situation that would previously have wound her up, and she didn’t care. She used to have pain in her ribs that musculoskeletal practitioners had said was cartilage damage, but it has cleared up, so it may have been an issue with tightness in her previously underused diaphragm. She did have a cold for 3 days that blocked her up and she couldn’t nose breathe, which h she did not enjoy. But she was fine once it cleared up. Her arthritis is still not great on a cold day however. I advised her to continue with treatment as is, and take a fish oil, glucosamine, and turmeric for her arthritis.
Outcome 3 – 12 Weeks from the start.
Continuation of all improvements experienced thus far, so she’s very happy. • Still no night time toilet trips – no urgency even on waking. Her husband is shocked. • Also, still no jaw clenching at night or dry mouth in the am. • She thinks he psoriasis is gone – only one tiny spot left. • Still able to turn her neck around, and no pain in shoulders. • No IBS symptoms – however if she overeats, gut is not happy with her. The only thing that has not shifted is her arthritis – although this is manageable using Voltaren cream, or the occasional Panadol osteo if it flares up. Unfortunately she didn’t take the glucosamine, and fish oil I recommended. She has maintained her breathing exercises now for 3 months, and the improvements in symptoms have now continued, so I am confident that her practice will continue and that she has established a pattern of breathing that will continue to yield these results.
It does not take long to see improvements in clients when implementing functional breathing practices, however it takes 3-4 months of continuous practice to make long term change in the way a client breathes. Once this is achieved, improvements in breathing and associated symptoms (with dysfunctional breathing), are likely to stick. In this client’s case, I believe she has reached this point, so she no longer needs to see me. Whilst we do not see such significant and widespread changes in all clients when retraining their breathing, I do commonly see similar results, so I was very confident of seeing good results with this client, given her history of symptoms and conditions associated with breathing dysfunction. I am not legally allowed to make claims that breathing retraining will resolve certain ailments, however I can report on how the client presented at each visit and the treatment strategies I implemented. – as I have done in this case. I’ll let you make your own conclusions on whether the treatment strategy was responsible for the change in symptoms.
And, I am very comfortable in saying again I regularly see similar outcomes or improvements by addressing dysfunctional breathing. Not surprising given that most people breathe dysfunctionally, or over-breathe – twice as often as we should, with far too much volume, using mouth and nose (instead of nose only), and using shoulders and chest instead of the diaphragm.
