Are you breathing properly? How I found out I wasn’t

We’re often taught that breathing is automatic. We barely think about it, as with blinking or the quiet, constant work of the heart. But many otherwise healthy adults have dysfunctional breathing.

“Dysfunctional breathing, also known as breathing pattern disorder, is when breathlessness and/or difficulty in breathing is felt,” said Dr Stephen Fowler, a professor of respiratory medicine at the University of Manchester. It can occur outside the context of any disease. If a related condition is present, like asthma, the breathlessness might feel disproportionate to that condition, he said.

Because we often don’t think much about it, many people do not know their breathing is problematic.

For instance, I had panic attacks for more than a decade. They usually happened at night, and I woke up feeling exhausted and out of breath. When I was eventually diagnosed with panic and anxiety, I thought feeling out of breath was linked. I found out later that my physical pattern of inhaling and exhaling itself was out of sync. It wasn’t just in my head – my breathing was dysfunctional.

Here’s what to know about dysfunctional breathing.

How can you tell if you’re breathing correctly?

“Place one hand on your chest and the other on your belly while lying down or sitting: the hand on your belly should rise upon inhalation [which indicates diaphragmatic breathing], not your chest,” said Dr Juanita Mora, a spokesperson for the American Lung Association.

“Correct breathing is slow, quiet and nasal, whereas improper breathing is shallow, rapid, through the mouth or causes shoulder movement.”

How does regular breathing happen?

Breathing feels simple, but it relies on surprisingly complex choreography.

Each breath begins with intake of air through the nose or mouth. That air travels down the trachea, or windpipe. The diaphragm, a large muscle beneath the lungs, contracts and moves downward. This creates space in the chest cavity, and allows the lungs to expand and fill with air. Oxygen travels into the bloodstream through millions of tiny air sacs called alveoli, while carbon dioxide moves out on the exhale.

As a speech-language pathologist, I analyze my clients’ breathing patterns all day. This rhythm includes coordination among the nervous system, the muscles and one’s own perception of breathing.

The way we breathe can affect our emotions as well as causing physiological symptoms. For instance, breathing too fast or through the mouth instead of the nose can cause feelings of stress or anxiety.

Conversely, emotions and physical function can change how effectively we breathe. Feelings of fear or joy, for instance, make breath patterns different.

What is dysfunctional breathing?

Dysfunctional breathing is a type of respiratory impairment that can happen alone or combined with other diagnoses like asthma or chronic obstructive pulmonary disease (COPD).

“Up to 12% of adults experience dysfunctional breathing, which is defined by different forms of abnormal breathing problems like chronic breathlessness, persistent hyperventilation, mouth breathing, over-breathing or shallow breathing to a degree that impacts one’s health,” said Mora.

Even when all of the physical and emotional elements are aligned, your perception of your own breathing can cause it to become disordered. That’s how dysfunctional breathing occurs without an underlying condition, and that’s how it happened to me. It can happen when you subconsciously or consciously notice you feel out of breath; the body responds by breathing deeper, faster or harder. An underlying respiratory condition like COPD or asthma can make it more severe.

In other words, chronic breathlessness (the specific kind of dysfunctional breathing I was eventually diagnosed with) and other improper breathing often happen because of a pattern: an out-of-breath feeling, then attempts to fix it.

“There is certainly a vicious cycle that occurs in many people with dysfunctional breathing,” said Fowler, describing how negative feelings about it can lead to anxiety. “Anxiety can also cause hyperventilation, causing more and more breathlessness. This is exacerbated even more when someone has an underlying lung disease.”

Once one is in the cycle, it can be self-perpetuating. “The body doesn’t like to under-breathe,” said Dr Robert Cuyler, a psychologist who has studied the way respiration and mental health intersect. “If you hold your breath, you start feeling unpleasant pretty quickly, within 15 to 30 seconds.”

Some people are unsettled by the balance of carbon dioxide and oxygen in their lungs when their breathing pattern is skewed by nervousness or environmental factors. When carbon dioxide levels rise, the brain signals for breathing rate to increase, said Fowler: “If the sensors become reset, and become more sensitive to carbon dioxide, then in theory even normal levels of carbon dioxide could lead to inappropriate signalling of faster breathing rate.”

“The result is that people may breathe more forcefully than they need to,” Cuyler told me. “You may be sitting comfortably in your chair, but you’re breathing enough to sustain a brisk walk or a light jog.”

“It is more frequent in adults with asthma – up to 30% prevalence – and often underdiagnosed,” Mora said.

What are the consequences of disordered breathing?

Dysfunctional breathing can contribute to sleep problems; mental health conditions like depression and anxiety, tension in the shoulders and neck, and chronic fatigue; and “dizziness and shortness of breath (‘air hunger’) due to altered blood gases and muscle strain”, Mora said. It can also exacerbate conditions like asthma, irritable bowel syndrome (IBS) and cardiovascular issues.

How do you treat dysfunctional breathing?

Breathing assessments can be done by primary care doctors, respiratory therapists, pulmonologists or some exercise physiologists, like Dr Dena Garner, who has been studying breathing mechanics in athletes for more than 15 years. “There’s really no gold standard of assessment in otherwise healthy adults,” she said.

“Breathing well is so critical,” Garner said. “Sometimes treating it is a multiteam approach, and we need more research to help patients better.”

Fowler, professor of respiratory medicine at the University of Manchester, works on a team that comprises doctors, nurses, speech and language therapists, physiotherapists and psychologists. They collaborate to assist patients.

“There aren’t many specialist multidisciplinary teams like ours around unfortunately, and as a result we usually see only patients with very complex health problems, and a mix of lung disease and severe breathlessness,” he said. “However, there are many people out there with much less severe problems that nevertheless still impact their day-to-day life.”

The treatment for respiratory problems may be different depending on the underlying concerns, with a focus on breathing exercises and/or lifestyle changes. There are also devices that can measure carbon dioxide output or help patients retrain their inhale/exhale pattern or their mouth and tongue position.

“I encourage people to at least think about their rate of breathing,” said Garner. “Mindfully slowing down can help control their nervous system’s stress response.” The less stressed one feels, the slower the heart rate, which can help maintain a cycle of healthy, regular breathing.

For me, this type of behavioral approach has worked so far. My doctors have taught me not to breathe more forcefully when I feel out of breath. “Once you notice your breathing, this can in fact then make you feel more breathless,” said Fowler.

Instead, I think about something unrelated and joyful while slowing down my breath. I don’t count how long I inhale or exhale – too much attention makes my anxiety and breathing patterns worse.

Sometimes, I still feel like I’m chasing my own breath. Knowing that I have the power to interrupt the cycle is key, and I trust that over time, I will breathe well again.