Outpatient Physiotherapy

Department

Disordered Breathing

What you need to know

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Introduction

This booklet aims to inform you what disordered breathing is and explain
some of the symptoms you may experience. With this knowledge and
understanding, it is hoped that you will be able to learn how to manage
this condition and gradually overcome it.

Index

Topic See Page

Introduction ....................................................................................... 1
What is disordered breathing? .......................................................... 2
What are the symptoms of disordered breathing? ........................... 2
How am I overbreathing? .................................................................. 3
What causes these symptoms? ......................................................... 3
What is the normal breathing pattern? ............................................. 4
How to get better............................................................................... 5
Breathing retraining ........................................................................... 5
Breathing retraining technique .......................................................... 6
Daily checks ........................................................................................ 7
Tips for better breathing .................................................................... 8
Response of breathing to exercise..................................................... 9
Managing panic attacks ..................................................................... 9
Further instructions ......................................................................... 10
Suggested reading............................................................................ 10

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What is disordered breathing?
Disordered breathing means breathing more than is necessary to meet
the body’s natural requirements. It is also known as ‘over-breathing’ or
‘hyperventilation’.

You may be well aware of a particular event or experience that triggers

your over-breathing, but this is not always the case.

You can develop an altered pattern of breathing which may be triggered

by:
• Physical illness, for example, chest infections, asthma or other
respiratory condition, or following surgery
• Anxiety, stress or pain.
Usually the normal breathing pattern returns after this initial event.
However over-breathing can continue long term and become a habit.

What are the symptoms of disordered

breathing?
The symptoms are often varied, some of the commons symptoms are:
• Shortness of breath, either at rest or when you become anxious.
• Breathlessness on exercise, out of proportion to your fitness level.
• Feeling of “air hunger” – not able to get enough air in or unable to
get a satisfying breath.
• You may find yourself holding your breath, particularly when
concentrating on other tasks.
• Running out of breath when talking.
• Frequent gasps, sighs or needing to take deep breaths.
• Tightness or feeling of restriction across the chest.

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• Chest pain.
• Dizziness or feeling light-headed.
• Tingling around the mouth or hands.
• Muscle aches and tension around the neck, shoulders or jaw.
• Palpitations.
• Fatigue.
• Headaches.
• Anxiety and panic episodes.

How am I over-breathing?
You may not be aware that there is anything wrong with your breathing
pattern, but signs are:
Breathing from the upper chest. The upper chest muscles are not
designed to be used for breathing at rest, so become very tired, sore and
tight.
Breathing through your mouth. Mouth breathing leads to
overbreathing as large volumes of air can be taken in with each breath.
Breathing fast and shallow. With disordered breathing this can increase
to more than 20 breaths per minutes.
Frequent gasps, sighs, yawns or taking deep breaths to fill your lungs.

What causes these symptoms?

When we over-breathe we eliminate a large quantity of carbon dioxide
on every out breath. The body can adjust to some extent, but if the
disordered pattern of breathing continues over time, this causes a
chemical imbalance affecting many of the body’s systems.

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What is the normal breathing pattern?
“Good breathing” means moving air in and out of the chest with the
minimum of effort and using the right muscles. This is to give you the
correct amount of oxygen and carbon dioxide you need to live and feel
well.

The most important muscle used for your breathing is the diaphragm.
The diaphragm is a strong, flat muscle which is attached to the lower
edges of the ribs.

As you breathe in, the diaphragm contracts and moves downwards,

drawing air into your lungs. This causes your tummy to expand.
Breathing out is a completely passive process, where the diaphragm
relaxes and requires no effort.

Breathing In: Breathing Out:

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Normal breathing is:
• Breathing through the nose.
• The lower chest and stomach expand as the air is breathed in.
• Quiet, regular breaths.
• The shoulders remain relaxed.
• Rate of 10-14 breaths per minute.
• Relaxed breaths out.

How to get better

It is important to learn to recognise what triggers your abnormal breathing and
try to break the cycle.

Trigger →→→→

Over-
Symptoms
breathing

Stress /
anxiety

Breathing retraining
By practising controlled breathing, you can gradually regain a more
normal pattern and have some influence over your symptoms. Changing
a habit of breathing requires regular daily practice, and can take weeks
or months to achieve.

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Breathing retraining technique

• Lie comfortably on your back with a pillow under your head and
knees.
• Place a 1kg bag of rice, or a wheatbag on your stomach.
• Put your hands above your head in the ’beach pose position’ as
picture above.
• Gently close your mouth, lips together and keep your jaw loose.
• Relax your chest and shoulders. Try and “switch off” the muscles in
this area.
• Breathe in gently through your nose, feeling your tummy rise or
swell, like a balloon half filling up with air.
• Breathe out lightly through your nose, without pushing, keeping your
tummy relaxed.
• Make sure you relax and pause at the end of each breath out.
• It normally takes about 2 seconds to breathe in and 3 seconds to breathe
out, with a short pause before the next breath in.

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• Remember you should be taking gentle breaths, not deep breaths.
• Breathing should not be forced, it should be silent and regular.
• Be aware of any areas of tension in your body and concentrate on
“letting go” of this tension, particularly in the jaw, neck, shoulders
and hands.

Aim to practice ___________times daily for ___________minutes.

It may take many weeks for this to feel natural. As you gain better
control, progress the practice in other positions - sitting, standing,
driving the car. Check your breathing occasionally during the day.

Daily checks
• Remember to nose breathe.
• Try to stop sighing and taking deep breaths. Swallowing can often
help if you find it difficult to stop a sigh or deep breath.
• Focus your breathing gently into your tummy area, avoiding
excessive upper chest movement.
• Maintaining a good posture is essential to good breathing. Sitting or
standing straight (avoiding slouching) will enable you to sure your
diaphragm and breathe more effectively.
• Learn to recognise and ‘let go’ of areas of tension in your body.

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Tips for better breathing
• Have frequent breaks if you are sitting for a long period, or working
at a computer.
• A regular sleep pattern and eating regular balanced meals, are
important. Avoid drinks such as Coffee, Coke and Energy Drinks that
contain stimulants such as caffeine, as these can trigger over-
breathing. Limit your alcohol intake. One unit can help you to relax,
but more than this can worsen your symptoms.
• Avoid tight clothing around the tummy area.
• Speaking quickly and taking large gasps between long sentences can
make your breathing worse. Try and slow down your speech,
pausing and taking a small breath after each sentence.
• Taking time to relax can be a very effective way to gain control of
your breathing.
• If you have a blocked nose due to allergies or sinusitis, try using a
sinus rinse or talk to your Doctor about using nasal spray medication.
• Neck, chest or shoulder stretches may be recommended by your
Physiotherapist if you have become very stiff in this area.
• If you have difficulty maintaining nose breathing, your
Physiotherapist may recommend mouth taping.
• If you have difficulty managing anxiety, please discuss this with your
Physiotherapist or Doctor.

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Response of breathing to exercise
Regular exercise is important for good health. As a general guide, aim
for 30 minutes of exercise such as walking, on 5 days per week at a
moderate intensity. This means you should be breathing more deeply as
you exercise, however you should be able to talk whilst exercising.

• Incorporate rests into your exercise programme if your breathing

becomes uncomfortable.
• Try to keep nose breathing into your tummy for as long as possible.
You may revert to mouth breathing to your upper chest as the
exercise intensity increases, but try to delay this for as long as
possible.
• As you breathe out, blow the air out over your bottom lip as if
blowing out through a straw. Allow your out breath to become more
forceful as exercise intensity increases.
• Try to keep your mouth opening as small as possible, for as long as
possible.

Managing panic attacks

Identify the symptoms:
Get into a comfortable position which makes breathing easier
1. Hold your breath for 6 seconds
2. Breathe out gently and hold for 3 seconds
3. Breathe in gently through your nose and hold for 3 seconds

Continue using steps 2 and 3 until the symptoms pass.

Remember do not take deep breaths.

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Further instructions

Suggested reading

Hyperventilation Syndrome, by Dinah Bradley, Tandem Press ISBN: 1-877178-

18-7

www.physiohypervent.org

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 Classification: No Issued by: HoD Allied Health
Date Issued: RP: 36mths

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