A Guide To Breathing

[Guest guest]

A couple days ago a discussion came up about anxiety, and the benefit

of breathing and meditations such at the buddhist metta bhavana, or

loving kindness meditation. In this piece, I would like to address

the basic features of breathing and what we can do to gain better

awareness and thus control over the breath.

 

***

 

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,

which in Ayurvedic medicine, generally corresponds to an increase in

Vata. In most cases the induction of these responses are sub-acute,

and masked by social conventions. Thus everyday stressors, related

to relationships, career, finances etc, may promote a similar release

of adrenalin as almost getting hit by a car or being chased by a wild

animal, but 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. The effect of this further

vitiates Vata in the body, and its impact can range from weakening

digestive secretions, increasing muscle spasticity, and suppressing

the immune response. 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.

 

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:

 

1. 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?

 

2. 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.

 

3. 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 movement of 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:

 

1. 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.

 

2. Relax 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 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. From an Ayurvedic perspective this

relates to either Vata or Pitta, or both, since they both have an

upward rising activity.

 

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:

 

1. 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.

 

2. 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.

 

3. 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.

 

4. 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:

 

1. Slowing down. Breathing patterns compliment physical

movements – try to slow down, reducing the speed at which you move,

walk, and drive.

 

2. 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 endeavors that requires

your full attention, such as writing, painting, knitting or drawing,

is a highly effective way to change this pattern.

 

3. Assess the need to hurry. Very often the need to rush about

and hence hyperventilate is an imagined need – base 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.

 

4. 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. When we move normally the

head should be up and eyes forward, like the prototypical Russian

aristocrat of the 19th century. 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. Some of these herbs can be used in

large, physiological doses (for e.g. as capsules or teas) or small,

drop doses of the tincture (1-3 drops).

 

•over-thinking, circular thinking: Reishi mushroom, Red root (drop

doses), Horsechestnut (drop doses),

•anxiety and fear: Ashwagandha, Valerian, Wood Betony, Pulsatilla

(drop doses)

•too busy, no time: Vervain, Skullcap, Agrimony (drop doses),

Bugleweed (drop doses), Motherwort, Chamomile

•environmental and social sensitivities: Yarrow (drop doses), St.

John's Wort (drop doses), Reishi mushroom, Gotu kola

•depression and poor self-esteem: Barberry, Gentian (drop doses),

Reishi mushroom, Calendula, St. John's Wort (drop doses)

 

In addition to the above-mentioned herbs, 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.

 

***

Caldecott

todd (AT) toddcaldecott (DOT) com

www.toddcaldecott.com