By Patrick McKeown, MA

Since breathing is such an intrinsic function, it can be hard to recognize that we could do it better, unless there’s an obvious issue that causes regular discomfort.

Even then, we might not realize that the problem could be addressed simply by improving our breathing patterns. To grasp the importance of breath training, we need to understand what the problem is.

Understanding the Problem: Suboptimal Breathing

A breathing pattern disorder, or dysfunctional breathing, is a condition in which breathing is problematic and produces symptoms such as breathlessness. It manifests as a psychologically or physiologically based habit, such as breathing too deeply, breathing too fast (both symptoms of hyperventilation), upper chest breathing during rest, or breathing irregularly with frequent breath holding or sighing.

Breathing pattern disorders affect 9.5 percent of the studied adult population, rising to 29 percent among people with asthma and 75 percent of those with anxiety. These figures are not surprising, given that asthma, anxiety, panic attacks, and stress all negatively influence breathing patterns, feeding back to create a vicious cycle of inefficient breathing.

Chronic hyperventilation, the tendency to breathe too much air, is the most common and extensively studied trait in breathing pattern disorders. One typical characteristic is fast breathing, often through an open mouth. This can occur both during waking and sleeping. Other signs include using the upper chest to breathe and having noticeable breathing patterns. Biochemically, it simply means breathing more air than the body needs, causing blood CO2 levels to drop. Although the term chronic hyperventilation is often used synonymously with dysfunctional breathing, it is just one type of breathing pattern disorder.

In fact, dysfunctional breathing is not a problem confined to the respiratory system. It has a significant impact on overall health. For example, excessive breathing is closely linked to cardiovascular disease. A research study of a Minneapolis intensive coronary unit found that of 153 heart attack victims, 100 percent breathed predominantly using their upper chest, 75 percent were chronic mouth-breathers, and 70 percent demonstrated open-mouthed breathing during sleep.

Looking at the wider impact on health, a 1998 study reported that patients with just 14 common symptoms were responsible for almost half of all primary healthcare visits in the United States. Of those complaints, which include abdominal pain, chest pain, headache, and back pain, only 10 to 15 percent were found to be the result of organic illness. At the same time, every one of those ailments can be made worse by disordered breathing. Put simply, the quality of breathing has significant implications for health and longevity.

A comprehensive list of the symptoms and signs of hyperventilation can be found in the book Behavioral and Psychological Approaches to Breathing Pattern Disorders by Beverly Timmons and Robert Ley. The following list of symptoms was provided by Doctor L C Lum, an Emeritus of the Department of Chest at Papworth and Addenbrooke’s Hospitals, Cambridge, United Kingdom in personal communications in 1991. Faulty breathing can affect any organ or system producing symptoms that include:

• General: fatigue, poor concentration, poor performance, impaired memory, weakness, disturbed sleep, allergies
• Respiratory (breathing): breathlessness after exertion, tight chest, frequent sighing, yawning and sniffing, irritable cough, inability to take a satisfying breath
• Cardiovascular (the heart and blood vessels): irregular or fast heartbeats and palpitations, Raynaud’s Syndrome, chest pain, cold hands, and feet
• Muscles: muscle pain, cramping, twitching, weakness, stiffness, and tetany (muscles that spasm and seize up)
• Gastrointestinal (the digestion): heartburn, acid regurgitation or hiatus hernia, flatulence or belching, bloating, difficulty swallowing or feeling of a lump in the throat, abdominal discomfort
• Neurological (the nervous system): dizziness, headaches and migraines, paresthesia (tingling or numbness, pins, and needles) of the hands, feet, or face, hot flashes
• Psychological: anxiety, tension, depersonalization, panic attacks, phobias

Dysfunctional breathing can exist alongside other conditions. For example, patients with chronic obstructive pulmonary disease (COPD) may have coexisting breathing disorders. The exercise-induced breathlessness that people with conditions such as COPD and asthma experience is not always caused by their disease. More often than not, poor breathing patterns also contribute.

Causes of Unhealthy Breathing Patterns

Remember, three main factors are at play in the development of breathing pattern disorders:

• Biochemical
• Biomechanical
• Psychological

While the underlying causes of problem breathing can vary, environmental factors, lifestyle habits, and genetic predisposition are common triggers. Often, these disorders are simply the result of a lack of awareness and a lifelong habit of breathing through an open mouth.

Biochemical Triggers 

The biochemical aspect of dysfunctional breathing, which has to do with the balance of oxygen and CO2, is often triggered or exacerbated by a common misunderstanding about deep breathing that, paradoxically, sets off the imbalance. Stress counselors, gym instructors, sports coaches, yoga teachers, Pilates coaches, physiotherapists, and media personalities encourage their clients to “take a deep breath” to bring more oxygen into the body.

However, a deep breath is often confused with a big breath. A deep breath is the sort of breath a baby takes naturally, a gentle, quiet inhalation into the belly, using the diaphragm. In contrast, a big breath is often taken in loudly through the mouth and generally involves upper chest movement. This results in over-breathing, setting off a biochemical imbalance in CO2 and oxygen levels.

A sedentary lifestyle can also have a huge impact on the way the body processes oxygen. When we move our muscles, we generate CO2, an important gas that helps maintain proper oxygenation of the body. A lack of exercise results in lower production of CO2, and this may contribute to over-breathing. This is essentially a modern affliction.

Fifty years ago, people spent an estimated four hours each day doing some sort of physical exercise. Today, as sedentary work has become more common, fewer than 5 percent of adults manage even half an hour of daily exercise. That means that many people are likely to have biochemically unbalanced breathing patterns.

Even the simple act of talking can cause over-breathing. When we speak, it is normal for both respiratory rate and breathing volume to increase. If we speak at length, we overbreathe. People who work in jobs like retail, telesales, and teaching where they are required to talk all day will know all too well how tired and drained, they can feel after work. In addition to its biochemical impact, excessive talking can leave you with a dry throat and a faster heart rate.

Dysfunctional breathing is often associated with poor coordination of the diaphragm, abdominal muscles, and muscles of the rib cage. This is closely related to posture. The most important breathing muscle is the diaphragm. This thin sheet of muscle is located at the bottom of the ribs, separating the chest from the abdomen.

As each breath is drawn into the lungs during rest, the diaphragm moves downward about one or two centimeters. If you regularly slump over your desk at work, you can’t breathe effectively, because there simply isn’t enough space for the diaphragm to move freely.

Effective diaphragm breathing helps maintain the stability of the spine. This means that posture is closely linked to functional breathing patterns. If you breathe well, you will move well. Faulty breathing can result in lower back pain.

Conversely, pain in the lower back and neck can affect the way the breathing muscles work, and tension in these areas often results in upper chest breathing by default. If your movement is impaired, either through injury, illness, or lifestyle, your breathing will suffer. Outside of such chronic conditions, poor posture is the major factor in biomechanical breathing dysfunction. Quite simply, if your breathing is abnormal, your movement will be abnormal, and vice versa.

Psychological Triggers 

Research has shown that symptoms associated with breathing pattern disorders are strongly influenced by anxiety and other emotional states. In some cases, the psychological influences actually cause the physical symptoms. Some of us may be genetically predisposed to breathe badly.

People prone to anxiety, asthma, or panic disorders have a higher risk of dysfunctional breathing because a negative feedback loop develops between the feelings of breathlessness and panic. Deterioration in breathing patterns can trigger the stress response, producing feelings of fear, or worsening anxiety and asthma symptoms. Personality traits such as perfectionism and obsessiveness can also affect breathing patterns.

Stress is a common trigger with serious long-term implications. When the fight-or-flight response is activated, our breathing increases to prepare us for physical activity, just as it did to enable our ancestors to escape a threat.

However, in modern society, we rarely have the opportunity to perform the physical exercise necessary to burn off the extra adrenaline. If you have a big work deadline or a nerve-racking call looming, it would be considered inappropriate to address it by sprinting around the office. What’s more, the type of stress we experience today is more likely to be chronic, whereas stress for our ancestors was typically short-term and immediate.

The biochemistry of breathing involves the exchange and metabolism of gases, including the consumption of oxygen and the production of CO2. As the author of one 2017 review into the biochemistry of yoga breathing exercises explains, “We are taught in our medical schools that oxygen is good and carbon dioxide is bad,” but the fact is that a certain level of CO2 in the blood is always required for maintaining good health.

Most important, “CO2 determines bioavailability of oxygen to the tissues and cells.” Oxygen is the prime nutrient required by every cell in the body. Without CO2, the tissues would become starved of oxygen, even when oxygen is available in the blood. In other words, CO2 is not always a waste gas.

CO2: Not Just a Waste Gas 

The reputation of CO2 has been historically rather mixed. The ancient Greeks and Romans used it as a therapeutic aid, by way of the bubbling waters in their natural thermal baths. These baths contained high levels of CO2 in the form of carbonic acid. The Greek physician, Hippocrates, writing in the fourth century BCE, recommended these thermal spas for headaches, gout, asthma, and the healing of wounds.

In the sixteenth century, baths came back into fashion and remained popular for several hundred years. The waters in certain locations were believed to hold a secret life-giving ingredient that we now know to be carbonic acid (H2CO3). The more H2CO3 the water contained, the more revitalizing it was considered to be. According to the History of Industrial Gases, during a 20-minute CO2 bath, the body absorbs around 6 liters of the gas. Dissolved in water, CO2 causes the skin to tingle as the surface blood vessels dilate. You can get an idea of how this feels by taking a drink of carbonated water. In addition, the baths also release mineral salts.

By the 1800s, the thermal baths in what is now the French town of Royat, attracted thousands of visitors seeking relief from obesity, anxiety, asthma, eczema, and other conditions. In a personal email to me, in July 2020, James Nestor, author of the best-selling book, Breath, explained:

After a brief soak in the thermal water, bathers would see their skin become rosy and flushed . . . [Those] with asthma reported a sudden clearness in their breathing. Overweight guests would see flab in their stomach or legs began to tighten and disappear.

Even today, in countries such as eastern Hungary, people travel to use the mofettas—dry spas that harness CO2-rich volcanic gas discharge to help with problems from heart and circulatory diseases to gynecological and skin issues, stress relief, and exhaustion. Treatment involves sitting in the healing gas, inhaling it under the supervision of specialist therapists.

Mofetta is an Italian word, listed by the Oxford Dictionary as an archaic term for a fumarole—an opening in the earth’s crust that emits steam and gases. These volcanic vents are common in areas of France, Romania, and Italy and can be found in the Death Gulch in Yellowstone Park. Mofetta as a treatment for injuries is first mentioned in the work of the sixteenth-century Swiss physician and alchemist, Paracelsus.

By the 1930s, physicians in Royat had begun administering CO2 directly to the lungs. Nestor explains that “this was found to heal respiratory and skin conditions twice as fast as bathing.”

Around this time, CO2 therapy made its way across the Atlantic to the United States. Harvard Medical School and Boston City Hospital ran several innovative studies with the gas, exploring its clinical applications for physical and mental conditions. Disorders of the brain were thought to be caused by low circulation and constricted blood vessels.

Trials of CO2 therapy in epilepsy patients found that, after only a few treatments, onset of seizures was reduced. The Yale physiologist, Yandell Henderson, found that a mixture of oxygen and 5 percent CO2 could generate astonishing results in patients with asthma, stroke, pneumonia, heart attack, asphyxia in newborn babies, and other respiratory disorders, due to the rapid tissue oxygenation it produced. In large quantities, CO2 is also a powerful anesthetic.

The therapy increased its pace during the 1940s and 50s, and much more research was done into its benefits. It was incredibly cheap and easy to administer—a fact that perhaps contributed to its demise. The gas became so popular that circus sideshows would feature public demonstrations of the narcotic effects achieved with high concentrations of CO2, and a campaign began to declare the gas dangerous.

Ralph M. Waters, MD, an Ohio doctor known for professionalizing the practice of anesthesia, made claims about CO2 that included warnings it was a “toxic waste product, like urine.” Either he confused potentially dangerous 30 percent CO2 therapies with highly effective 5 percent CO2 therapies, was concerned about unregulated treatments, or was motivated by private interest—the treatments Waters specialized in were both expert and expensive.

However, Waters’ claims were not without basis. CO2, if administered incorrectly, could kill. One example given was the case of the daughter of famous chemist, James Watt, inventor of the Watt steam engine. Jessie Watt died from tuberculosis after numerous hours of exposure to CO2 therapy. However, according to her physician Thomas Beddoes, who successfully treated many other patients, she was already “too far gone” when she started the treatment. Her father went on to design, with Beddoes, many of the apparatuses and techniques needed to administer various gases to patients.

Whatever Waters’s intention, he succeeded in damning the medical use of CO2. The therapy was forced underground, and its purpose became distorted by false claims, lawsuits, and selective scientific studies. A century’s worth of medical research showing that CO2 has clinical applications for many conditions was almost entirely forgotten.

In 1904, the Danish biochemist Christian Bohr discovered that CO2 facilitates the release of oxygen to the cells. Oxygen is carried around the body in the hemoglobin in red blood cells. Bohr discovered that CO2 acts as the catalyst for hemoglobin to release its load of oxygen for use by the body. When levels of CO2 in the blood are low, the bond between O2 and hemoglobin increases. This means the body cannot access the oxygen in the blood and it leads to poor body oxygenation.

In 2017, a doctor at Subharti Medical College in India wrote a detailed review of the benefits of CO2. The paper’s author, Singh, MBBS, DTCD, is a yoga practitioner and has dedicated much time to researching how yoga works. Singh discovered that CO2 stimulates the vagus nerve, an important cranial nerve. He discovered that increased levels of CO2 in the blood could activate the vagus nerve and slow the heart rate. He describes CO2 as a “natural sedative.” It soothes the irritability of the brain’s conscious centers, promoting our ability to use logic, reason, and common sense. Without CO2, we can become anxious, depressed, and angry.

CO2 also controls aspects of the homeostasis of blood. Generally, it concerns the regulation of blood gases and acidity of the blood to keep everything working within healthy parameters. Singh explains that if CO2 is so good for us, we should work to increase the level of the gas in our bodies. When you practice a breath hold, CO2 gradually builds up in the blood. With practice, you can reduce your sensitivity to CO2, allowing you to tolerate greater concentrations of the gas in your blood to, as Singh puts it, “supercharge your overall health.” Contrary to the alarming claims made by Waters, Singh cites research that shows increasing CO2 within safe limits in the blood does not cause any harmful effects. He goes so far as to say that “carbon dioxide is truly the breath of life.”

Biochemistry of Breathing Restored 

Modern science suggests that the body’s sensitivity to CO2 plays a significant role in dysfunctional breathing. When breathing receptors (called chemoreceptors) are overly sensitive to CO2, breathing patterns are more strongly affected as the concentrations of blood CO2 rise and fall. This high “ventilatory response” to blood gas makes breathing harder to control. People who are highly sensitive to CO2 tend to breathe faster than normal, often from the upper chest. 

Conversely, people who have developed a higher threshold of tolerance and are less sensitive to CO2 generally breathe in a calm, healthy way. Breathing remains relatively light both during rest and sleep and during more intense and longer periods of exercise. Lower sensitivity to CO2 is beneficial both for sporting performance and for general well-being. In fact, studies have shown that this is one thing that separates outstanding endurance performers from the crowd.

During strenuous physical exercise, the body’s consumption of oxygen increases. This slightly reduces the concentration of oxygen in the blood. At the same time, the increased muscle activity and metabolic rate produce more CO2. Normally, as CO2 increases, the respiratory rate accelerates proportionately. This ensures that enough CO2 is exhaled to keep levels of the gas more or less regular in the blood.

A study published in the journal Medicine & Science in Sports & Exercise in 1979 concluded that the light breathing typical among endurance athletes might explain the link between low chemoreceptor sensitivity to CO2 and exceptional performance. In 2007, a trial undertaken by the French biologist and physical education specialist Xavier Woorons showed that lower respiratory rates in trained men at both sea level and high altitudes (where atmospheric oxygen is lower) were linked to reduced blood sensitivity to CO2.

Endurance athletes typically have lower ventilatory responses to changes in blood oxygen and CO2 than nonathletes. However, this study put into question the widely held belief that the impulse to breathe (and therefore the feeling of breathlessness) might only be lowered by intense physical training.

Another important biochemical benefit is offered by nasal breathing. Nasal breathing enables the body to make use of nasal nitric oxide (NO), and CO2 in the blood. Both chemicals are vasodilators, meaning that they relax blood vessels, causing them to expand. While the importance of CO2 in blood flow and oxygen metabolism has been long understood, the role of nasal nitric oxide in dilating blood vessels in the lungs has only recently been realized.

Biomechanics of Healthy Breathing

The movement of air in and out of the airways is achieved by cyclic changes in the volume of the lungs. As the diaphragm and chest wall moves, pressure within the chest varies, causing the inhalation and exhalation of air. Ideally, when we take a deep breath, we should engage the diaphragm to draw the air deep into our lungs. However, if we take in a big gasp of air through the mouth, the air tends to get no farther than the upper chest. It is really only possible to achieve effective long-term diaphragm breathing through the nose. 

As well as being central to breathing, the diaphragm plays an important role in controlling posture. During an inhalation, the diaphragm moves downward. As it descends, a positive pressure is generated in the abdomen, which contributes to posture control and stability. The pressure acts like an inflating balloon, supporting the front of the spine and the pelvis. Conversely, good posture improves breathing. 

Breathing from the diaphragm accomplishes several important things. It will:

• Slow respiration
• Calm the mind
• Draw air deep into the lungs
• Improve gas exchange
• Support functional breathing for functional movement
• Generate intra-abdominal pressure (IAP) for control of posture and spinal stability

—

Well Being Journal adapted this passage with permission from The Breathing Cure: Develop New Habits for a Healthier, Happier, and Longer Life, copyright 2021 by Humanix Books.

Patrick McKeown has helped thousands of people around the world to breathe better and is the bestselling author of The Breathing Cure, director of education and training at Buteyko Clinic International, and master instructor of the Oxygen Advantage®.