Your Breathing Matters

Breakthrough – help for heart attack patients.

Thousands of heart attack victims in Victoria could benefit from a world-first study using carbon dioxide to improve survival rates and reduce brain damage. Intensive care specialists  at the Austin Hospital in Melbourne (Nov 2013) announced that they plan giving patients recovering from a cardiac arrest higher levels of carbon dioxide in a bid to boost their long-term recovery.

What – give them more carbon dioxide?

Yes, contrary to what many people think, we require (the right level of) carbon dioxide in the bloodstream for our bodies to function properly. It is a dangerous myth that we should breathe deeply to remove as much carbon dioxide as possible from our lungs and blood. (Carbon dioxide – CO₂ – is produced in the body as a bi-product of metabolism.)

What is the connection with aiding recovery from heart attacks?

One of carbon dioxide’s important roles is assisting blood flow and oxygen transport by relaxing blood vessels.  Another is facilitating the uptake of oxygen by your cells. The more CO₂ in your blood, the more cells get oxygenated. When blood levels of CO₂ are too low, blood vessels may spasm, circulation is reduced and oxygen clings to red blood cells – resulting in less oxygen getting to your cells, starving them of oxygen.

It’s not hard to see how important CO₂ is then in maintaining oxygenation of the heart (and brain) and how important it may be in recovery from heart attacks.

Austin Hospital ICU research manager Dr Eastwood also talks about other important roles. “Slighter higher CO₂ levels actually have an anti-inflammatory, antioxidant and anti-convulsive properties and these are important for protecting the brain after a heart attack,” he said.

And how about prevention of cardiovascular conditions?

Over-breathing lowers your carbon dioxide levels increasing your risk of high blood pressure, heart attack and stroke (as well as asthma, sleep apnoea and anxiety). It is interesting to note that heavy snorers are at increased risk of hypertension and heart attacks, and that heart attacks may be associated with a prolonged or sudden stressful event and with strenuous physical activity – all of which are accompanied by increased breathing.

The bottom line?         Your breathing matters.

Learning to breathe properly is important for general and cardiovascular health.

See also:  Carbon dioxide is not just a waste gas

by Tess Graham

November 2013

One of the most comprehensive discussions on over-breathing/ hyperventilation is Dr Gregory Magarian’s (1983) aptly titled paper- Hyperventilation syndrome: A diagnosis begging for recognition. He commented that while acute hyperventilation (as in a ‘panic attack’) is fairly easy to see, the chronic form often goes unrecognised. Medical scientist and physician, Professor Konstantin Buteyko coined the term ‘hidden hyperventilation’ because of the often subtle presentation of its chronic form. His exhaustive research in Russia spanning several decades from the 1950s, showed chronic hyperventilation to be very prevalent in the general population. Chest physician, Dr Claude Lum published extensively on the hyperventilation syndrome. In his article, Hyperventilation: the tip and the iceberg (1975) he had this to say. “The many organs involved are often reflected in the number of specialists to whom the patient gets referred, and my colleagues have variously dubbed this the ‘multiple doctor’ or the ‘fat folder syndrome’. Indeed the thickness of the case file is often an important diagnostic clue.” Unfortunately diagnosis of this extremely common disorder does not appear to have improved at all since Magarian, Buteyko and Lum published their findings.

All research that has actually looked at the baseline breathing pattern in people with asthma, anxiety, snoring and sleep apnoea has found it is not normal. However, the significance of this finding is rarely considered and checking someone’s baseline breathing pattern is not part of standard medical diagnosis. People with breathing-related disorders are often steered towards surgical, pharmaceutical or appliance-based interventions without considering what they can do themselves to improve their breathing habits. (Not unlike doing gastric band surgery without first advising a patient to change their eating habits.)

What you may find if you look

My clients with asthma, anxiety or sleep apnoea often tick off more than 20 different symptoms of over-breathing/hyperventilation at their first visit. I can often see and hear them over-breathing as they fill in the form!

Janelle (42) came to see me about her heavy snoring and sleep apnoea.  She also had restless legs, dizziness, chest pains, palpitations, anxiety, lots of mucus and debilitating fatigue. She had already ‘been through the mill’, having undergone a sleep study, an operation on her nose and an exercise stress test with her cardiologist. She was prescribed a range of medication. She had tried but could not adjust to sleeping with a CPAP machine – she felt claustrophobic.

As Janelle sat there completing the questionnaire, I observed her breathing. It was not fast, but was audible, very heavy and upper-chest; she sighed frequently. She marked off over 50 different breathing-related symptoms, ranking many of them moderate to severe. Janelle was amazed that I was so interested in what was happening in the day and how she breathed when awake as she had come to me solely because of her sleep-breathing problems! Eight days into breathing training, Janelle said she was sleeping well, and her husband said she no longer snored. Her chest pain and palpitations had ceased. She was calm and had more energy.

The consequences of over-breathing day after day are far reaching. The body struggles and tires as it tries to maintain equilibrium.

We have a huge problem on our hands. More and more people are mouth-breathing. Large numbers of young children are mouth-breathing. Tragically parents, teachers and health professionals rarely identify and offer advice to help prevent the escalation of this habit to chronic over-breathing with all its consequences, like tentacles reaching out to work their mischief on all body systems. Ignore your breathing at your peril. Believe these common breathing myths at your peril too!

By Tess Graham

A team of researchers led by Dr Adelola from the Department of Otolaryngology at Limerick University Hospital in Ireland, investigated the effectiveness of the Buteyko Method – the Buteyko breathing technique – on the nasal symptoms of patients with asthma.(1)

The patients were surveyed three months after undergoing a breathing retraining program. The symptoms evaluated were:  nasal congestion or stuffiness, poor sense of smell, snoring, nasal blockage or obstruction, trouble breathing through the nose, trouble sleeping, having to breathe through the mouth, unable to get enough air through the nose during exercise or exertion and feeling panic that one cannot get enough air through the nose.

The researchers found a 71% reduction of rhinitis symptoms at the three month follow up.

Best Tips:

• To begin to reduce rhinitis/stuffy nose symptoms, first become aware of how much mouth-breathing you are doing.
• Now try to reduce it: breathe through your nose whenever it is comfortable to do so – simply by being aware and ‘checking in’ and giving it a try.(The more you mouth-breathe, the heavier you breathe, the more the nasal tissues swell.)
• Slow your walking down to a pace where you are comfortable to nose-breathe.(2)
• If you find nose-breathing uncomfortable to keep up, aim for just a 1-5% increase in total nose-breathing time each day. (2)

You will be surprised at the difference this can make.

By Tess Graham

1) ‘Role of Buteyko breathing technique in asthmatics with nasal symptoms’,    Adelola O.A., Oosthuiven J.C., Fenton J.E. Clinical Otolaryngology.2013, April;38(2):190-191

2) ‘Relief from Snoring and Sleep Apnoea’ , Tess Graham 2012 (Penguin)

About one in four women report frequent snoring; another 25% report occasional snoring by the last week of their pregnancy. For a small number of these women, snoring may be a symptom of obstructive sleep apnoea – fragmented sleep and excessive sleepiness during the day.

This is not good news. Generally women try to be as healthy as possible throughout their pregnancy, eating well, exercising appropriately. But if they are snoring, they are not breathing well, and the mother’s breathing during pregnancy can affect not only her own health and energy levels but also that of the baby.

Research has suggested that heavy snoring or sleep apnoea in pregnancy may be associated with high blood pressure, pre-eclampsia, low birth weight babies, and low Apgar scores. The Apgar score is used to assess a baby’s health immediately after birth.

Snoring can be related to weight gain – which is part of a normal pregnancy – but that does not make snoring normal.

What you can do to improve your breathing

Heavy breathing by day sets you up for heavy breathing by night. By being mindful to breathe through your nose during the day whenever it is comfortable to do so, or to breathe more gently through your mouth when you cannot manage nose-breathing, you will be setting yourself up for more gentle breathing at night- and therefore less likelihood of snoring. Another advantage is that breathing slowly and gently is also very calming.  It also allows your body to better use oxygen.

You don’t need to stop exercising – simply try walking or cycling for example, at a slower pace, where you keep your breathing comfortable and in control, and preferably through your nose (or more gently through your mouth).

Three best tips to reduce likelihood of snoring:

• Sleep on your side rather than your back and try elevating your upper body/head end of the bed slightly using a special wedge-shaped pillow or a folded blanket placed between mattress and base.
• Avoid or reduce mouth-breathing in the daytime and in bed – breathe through your nose whenever you comfortably can, or at least try to breathe more gently through your mouth.
• Avoid any activity that makes you breathe heavily, puffing and panting through your mouth.

A common comment several days after applying these suggestions is: “I had the best sleep in decades last night.”

NB: If there is concern about snoring or apnoea, it is important the person checks with their doctor to determine whether further medical evaluation is necessary.

By Tess Graham

From Channel 7 Today Tonight January 30, 2013 Snoring causes couples stress

“Snoring has been identified as one of greatest causes of stress in relationships, creating huge problems for sufferers and their partners.”

“Chronic snorers can have their sleep disrupted 80 times and hour. So what is it that causes half of all Australians to snore, and what can be done to stop it?”

Unfortunately the answer to this question didn’t come out in this segment.

The two male snorers featured in the show had sleep studies done, verifying they snored and had sleep apnoea – but there was no mention about having their habitual breathing pattern checked.

If it had been checked, this is probably what would have been found: the speed and volume of air they breathed were above the ‘physiological’ normal. Adults should breathe between 4 and 6 L of air per minute, awake and asleep. Men with sleep apnoea have been found to breathe 15 L per minute.

So what?  Well, it doesn’t cause a noticeable problem during the day but during sleep when the throat muscles are relaxed, fast high-volume breathing creates vibration and turbulence (snoring) and can draw the sides of the throat closer together obstructing airflow (apnoea). Not easy to do when breathing just 5 L of air per minute!

Unfortunately checking for this ‘over-breathing’ habit is not part of standard medical diagnosis for sleep-breathing disorders. Therefore, this fundamental cause of snoring for millions of sufferers is missed. Sure both these men ended up ‘solving’ their problems – one wearing a dental appliance to bed and the other a CPAP machine. But what would happen if these devices weren’t tolerated? Around 50% of people prescribed CPAP do not persist with it.

Few sleep apnoea sufferers know of the option of changing the way they breathe – through breathing retraining.

The Ch 7 interview quoted Dr Yee from the Woolcock Sleep Institute as saying breathing retraining is unproven. While it has not as yet been trialled specifically for sleep apnoea, breathing retraining has in fact been proven in many studies to ‘normalise’ dysfunctional breathing patterns. Breathing educators who are members of the Buteyko Institute of Breathing and Health have clinical evidence of its effectiveness -based on over 11,000 sleep apnoea sufferers – and are very keen for research to be done. Sleep medicine researchers throughout Australia, including at the Woolcock Institute have been approached on several occasions to get a trial done. We wait, patiently……………..

In the meantime, the US federal Agency for Healthcare Research and Quality,  has issued a general advisory commending the efficacy of hyperventilation-reducing breathing retraining techniques.

By Tess Graham