A guide to breathing - Dr Todd Caldecott.

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A couple days ago a discussion came up about anxiety, and the benefitof breathing and meditations such at the buddhist metta bhavana, orloving kindness meditation. In this piece, I would like to addressthe basic features of breathing and what we can do to gain betterawareness and thus control over the breath.***A facet of the hectic pace of modern life is chronic stress and theinduction of the flight or fight response as a coping mechanism,which in Ayurvedic medicine, generally corresponds to an increase inVata. In most cases the induction of these responses are sub-acute,and masked by social conventions. Thus everyday stressors, relatedto relationships, career, finances etc, may promote a similar releaseof adrenalin as almost getting hit by a car or being chased by a wildanimal, but are muted by social conditioning, in which the normalresponse, such as shouting and running, are supplanted by

mechanismswhich attempt to internalize the stress. The effect of this furthervitiates Vata in the body, and its impact can range from weakeningdigestive secretions, increasing muscle spasticity, and suppressingthe immune response. Chronic stress habituates the body to becomeused to the induction of fight or flight responses, and overtime weforget how to relax, and ultimately, how to breathe.In deconstructing the process of breathing it is importance first tobe aware of the way we breathe, to discern if its disordered in anyway. Sit comfortably in a chair with your back upright and feetfirmly planted on the floor, and breathe normally, not holding yourbreath or taking especially deep breaths. As you breathe, askyourself, or if this is part of consultation, ask the patient thefollowing questions:1. Where do I feel my breath? Place one hand on your abdomen andone hand on your chest, and feel where the breath

originates. Thisisn’t a process of determining what is right or wrong, but simplydeveloping the process of becoming conscious of the dynamics ofbreath. As you breathe in and out, does it the breath appear tooriginate in the abdomen, the chest, the ribs, the shoulders, or thenose?2. What does my breathing feel like? What is the quality of yourbreath? Does it feel laboured, difficult, obstructed, rough, jerky,or flowing? Is there any hesitation, even momentary betweeninhalation and exhalation, or between exhalation and inhalation.3. How fast do I breath? Breathing normally, count the number ofbreaths you take per minute (one breath equaling a complete cycle ofinhalation and exhalation).These exercises will help to bring you or your patient more in touchwith the dynamics of breathing.Most problems with breathing, if they aren’t due to a functionaldisturbance of the lungs themselves, relate to the

activities of thediaphragm. In healthy breathing the diaphragm moves withoutrestriction, descending as we inhale and rising with exhalation. Themovement of a natural, normal breath is analogous to filling a bucketwith water: as we breathe in the diaphragm slowly contracts, openingthe lungs and pulling the breath downwards as we inhale, filling thebucket from the bottom (abdomen) upwards (to the chest). Uponexhalation the air contained in the chest is released first, andgradually the air in the abdomen is let out, all in one fluidmovement, as if we are pouring the bucket out.Several patterns that relate to diaphragmatic control are at theheart of understanding breathing problems, and are described as follows.Reverse breathingReverse breathing occurs when the abdomen moves in upon inhalationand out upon exhalation. This often occurs with restrictive clothingor tight belts that inhibits the movement of the

diaphragm. In somecases however these people are simply unconscious of breathing andwhen asked to feel their diaphragm contracting or relaxing they findthey cannot. Reverse breathing is a kind of confused state of thediaphragm and the other muscles of respiration, and produces aconcomitant confusion in the mind. There may be chronic tension inthe upper body, especially around the back of the neck, the uppershoulder, upper back and jaw. Other problems may include poordigestion, gastric reflux, bloating, and flatulence. Reversebreathers often have a difficult time coordinating physicalmovements, and are often clumsy. Reverse breathers may be confusedwhen you ask them to breathe in or out, often doing the reverse, orthey may have no sense of when or how they are breathing. Sincereverse breathers have little kinesthetic knowledge of breathing askthem to look down and visually observe their abdomen when theybreathe.

Exercises to train reverse breathers to breathe properlyinclude:1. Slowing down breathing. Reverse breathers often breathe withshallow breaths. Ask them to breathe more slowly so they can beginto become aware of this dysfunctional breathing pattern.2. Relax the abdomen. Ask them to relax the abdomen, andexperiment with having them push the abdomen out upon inhalation, andletting it fall back with exhalation. Another strategy may be to askthem to lie on prostrate on an examination table, place their handsunder 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 thatoccurs when fight or flight mechanisms are induced, or with intensephysical exercise. In the case of the former, something startles us,we gasp, pulling the abdomen in and breathe high into the chest. Theincreased

abdominal tension that can occur with stress prevents thediaphragm from moving down, and thus we take in another quick chestbreathe, and without becoming conscious of the increased abdominalpressure, the breathe continues more or less along this line. Chestbreathers restrict the movement of breathe into the abdomen, causingthe breath to ascend higher into the chest, often accompanied byshoulder movements. When chest breathing is the dominant form ofbreathing there is an excessive reliance upon secondary respiratorymuscles in the upper chest and neck, including the pectoralis,trapezius and scalenes. In normal breathing the diaphragm, theintercostals and abdominal muscles dominate. In chest breathing thereliance upon weaker secondary muscles to breathe can promote chronictension in the thoracic spine, shoulders and neck, often resistant toany kind of bodywork like massage because the cause has not beenaddressed. The

chronic tension with the abdominal muscles can impairpelvic circulation, interfering with the processes of digestion andelimination, and causing problems such as gastric reflux and hiatushernia. In many cases chest breathers are Type A personalities, orover achievers, ambitious, willful and driven, often lacking theability to completely relax and thus can experience a kind ofchronic, free-floating anxiety. From an Ayurvedic perspective thisrelates to either Vata or Pitta, or both, since they both have anupward rising activity.Place your hands on your abdomen and chest, or if this is part ofconsultation, ask the patient to do this. Which hand moves more? Doyou feel the abdomen expanding or not much at all? Is there anyincrease in shoulder and neck tension during inhalation? Do theshoulders rise with inhalation instead of relaxing and broadeningoutwards? Exercises to dismantle a chest breathing pattern

include:1. Releasing the tension in the upper shoulders and neck. Duringbreathing ensure that these areas are completely relaxed. Whensitting for extended periods of time, such as working at thecomputer, make sure that you or your patient regularly stretches theshoulders, neck and arms. Ensure that the workplace is ergonomic.2. Relax the abdomen. As in reverse breathing, ask chestbreathers to practice relaxing the abdomen, allowing it to expandupon inhalation and fall back with exhalation.3. Ground yourself in the present. Chest breathers are oftenseveral steps ahead in their thinking, a feature of fight or flightinduction where planning escape routes become necessary. Chestbreathers need to focus on the present moment, and allow life eventsto unfold naturally.4. Assess body image. Another reason for chest breathing is anunconscious negative body image. Proper breathing cases the abdomento

protrude, which to some people, may seem undesirable, looking likeor adding girth to their waste. While measures should be taken toovercome truncal obesity, a healthy self-image should not come at theexpense of breathing.HyperventilationAlthough hyperventilation is not usually recognized in its chronicform, it can manifest as a subtle and chronic dysfunctional breathingpattern. The normal breathing rate in adults is about 13 breathsper minute, men tending to be a little slower (between 12-14 BPM) andwomen a little faster (14-15 BPM). Hyperventilation refers to a rateof breathing that is higher than normal, and is usually related tothe pattern of chest breathing. The decreased volume of oxygen takenin during chest breathing is typically accommodated by increasing therate of respiration.Hyperventilation syndrome (HVS) is a clinical entity that has beendefined for well over a hundred years, but the

specific medicalcauses have not been identified. Patients with HVS tend to breatheby using the upper thorax rather than the diaphragm, resulting inchronically over-inflated lungs. When stress induces a need to take adeep breath, the deep breathing is perceived as dyspnea. Thesensation of dyspnea creates anxiety, which encourages more deepbreathing, 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 suchas hyperventilating can cause us to lose too much CO2, promoting ageneral shift towards increasing the pH of the body, making the bloodand tissues slight more alkaline. This effect reverberates in avariety of physiological changes:•the arteries in the brain constrict, impairing the flow of blood tothe brain, possible causing headaches, memory problems and difficultyconcentrating•hemoglobin

will retain oxygen, a feature which may perpetuate thehyperventilating pattern, and promote problems such as dizziness andbreathlessness•the peripheral arteries constrict, impairing circulation to theextremities, promoting problems such as cold hands and feet•the increase in alkalinity causes the net movement of calcium ionsinto the muscles, promoting muscle contraction and possible problemsrelating to chronic muscle spasm•low levels of CO2 can promote an increase in nervous systemexcitability, promoting nervous distress and muscular irritabilityIn addition to the symptoms above, hyperventilation can cause avariety of problems including exhaustion, palpitations, dizziness,visual disturbances, peripheral numbness, dyspnea, yawning, chestpain, a feeling of a lump in the throat, abdominal pain, and insomnia.The test to determine for hyperventilation is counting the number ofbreaths per minute. In many cases

however the patient mayconsciously slow the rate of respiration down during assessment, andthus this may not be the most effective method for assessinghyperventilation. Ask the patient to pull the abdomen in and chestbreath – if they regularly hyperventilate this will be a familiarpattern. Another clue is determining whether or not they allowexhalation to reach its maximum completion before the next breath.Normal breathing manifests a quick pause after exhalation – inhyperventilation there is no pause. Does the patient appear to“pull” the inhalation in the body, as opposed to letting theinhalation to come naturally into the body. Remember, the firststages of inhalation are a passive process, only if exhalation hasbeen sufficient enough to reduce the lung pressure to slightly belowthat of the atmosphere, allowing air to move in passively, which isthen continued by the contractions of the diaphragm andintercostals.

The process of dismantling the hyperventilationpattern consists of practicing the techniques outlined under chestbreathing, in addition to:1. Slowing down. Breathing patterns compliment physicalmovements – try to slow down, reducing the speed at which you move,walk, and drive.2. Meditation and menial tasks. Practice regular meditation, orjust “sitting,” focusing on the complete in and out breath, fullyextending and slowing inhalation and exhalation. Another method isto engage in menial tasks such as gardening, washing dishes orfolding laundry. Very often fun, creative endeavors that requiresyour 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 aboutand hence hyperventilate is an imagined need – base on the inductionof fight or flight mechanisms. Instead, prioritize what is

mostimportant to accomplish, and what cannot be done in a relaxedpeaceful manner can wait for another time. Of course there willalways be times when we are rushed and need to move quickly, but ifthis becomes a chronic pattern then this needs to be addressed.Imagine that if today was your last day, what things would be mostimportant to accomplish, and what things don’t really matter.4. Address anxiety and fear. In many cases the hyperventilationpattern represents emotional issues that cause the patient to be in amore or less constant of fear, essentially being afraid of taking adeep breath, a kind of plunge into their own physical consciousness.In such cases it may be important to refer the patient to a therapistto work some of these issues out.Collapsed breathingCollapsed breathing is essentially the same pattern as chestbreathing, but looks substantially different. Instead of the chestrising and

expanding with each breath, the chest in collapsedbreathers the chest is drawn inwards, the shoulders hunch and theabdomen protrudes forward and downwards. Nonetheless upon inhalationthe abdomen doesn’t change position but the shoulders and upper chestrise to accommodate the inhalation. In many cases collapsedbreathers 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 ispoor, and the circulation is stagnant, leading to prolapsed organsand hemorrhoids. It is a pattern that often accompanies depression,shame or a poor self-esteem. This may be the result of a certaindisconnectedness between the mind and body, where the mind looks foran escape beyond the confines of physicality. In such cases theperson may appear lively and motivated, but only from the head up:the body tells

the truth of the matter. Collapsed breathing is alsoa pattern that can manifest in emotional trauma, where ignoring orsuppressing sensations and memories becomes an important copingstrategy.In a sitting position place one hand on the abdomen and the other onthe chest. Collapse your shoulders forward, leading the head comedown and forward and the sternum downward. Does this feelcomfortable? If so, you may be a chest breather. Now push with yourfeet and straighten your back, allowing the chest to expand, thevertebrae to balance upon one another like there is wire that pullsyour head up, allowing the shoulders to roll back. Does this feeluncomfortable? If the answers are yes to both questions, you may bea collapsed breather.Dismantling the collapsed breathing pattern consists of using thelower body, the legs and the knees, to take on the burden of bearingthe weight, creating a kind of rebounding force that

lifts andelongates the vertical axis of the spine. When we move normally thehead should be up and eyes forward, like the prototypical Russianaristocrat of the 19th century. If this is too difficult it may bethat the patient needs to be referred to a therapist that can helpthem work through their emotional issues.As we can see, the three basic dysfunctional breathing patternsdiscussed relate to chronic tension in the diaphragm, intercostals,abdomen and the muscles of the shoulder in neck. Beyond the methodsalready discussed there are a variety of herbal remedies that can beused to help relax these areas. Some of these herbs can be used inlarge, 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 (dropdoses), 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/magnesiumsupplement (800-1000 mg ea.) may be helpful to reduce muscle spasm,as well as vitamin B complex to support nervous function.***Todd Caldecotttoddwww.toddcaldecott.com "Our ideal is not the spirituality that withdraws from life but the conquest of life by the power of the spirit." - Aurobindo.

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