Breathing Pattern Disorder

What Is Breathing Pattern Disorder?

Breathing pattern disorder (BPD) is also known as dysfunctional breathing. This happens when you develop abnormal breathing habits. This makes it hard for the lungs and body to work properly. The process of air moving in and out of your lungs is called breathing mechanics. If you have breathing pattern disorder, you do not have normal breathing mechanics. You use the wrong muscles to take in and exhale air. This can make you feel short of breath or like you are not getting enough oxygen, even when your lungs are healthy.

The causes of breathing pattern disorders are not known. It could be caused by:

• Lung disease
• Muscle weakness
• Neuromuscular disease
• Trauma such as surgery
• Viral illnesses

This type of paradoxical movement is often a sign of underlying neuromuscular issues or serious respiratory stress. Normal breathing mechanics move the diaphragm, the muscle below your lungs, first followed by a natural chest rise. Dysfunctional breathing occurs when this does not happen and can become chronic. With breathing pattern disorder, you have a pattern of over-breathing, even when the body does not require it.

Experts are not sure how many patients are affected. Females with asthma are more likely to develop breathing pattern disorder than males. About 20% to 66% of people with asthma and 20% to 40% of athletes report having some type of breathing pattern disorder. People with severe hard-to-treat asthma have a higher risk, and nearly half of them may develop BPD. About one out of three people with COPD (chronic obstructive pulmonary disease) can also have a breathing pattern disorder.

Types

There are several types of breathing pattern disorders. In most cases this condition is not life-threatening but it can significantly affect quality of life. Evaluation is important to rule out serious heart or lung conditions.

It is possible to have more than one type.

Breath Holding: Shallow or rapid breathing that is often caused by anxiety, chronic illness, or stress. This breathing pattern is often subconscious. It can lead to chest tightness, dizziness, and air hunger.

Forced Abdominal Expiration: Unlike normal breathing this type requires forcing the muscles to work to breathe. Forced abdominal expiration feels like blowing out candles on a birthday cake. forces the diaphragm upward and shrinks the thoracic cavity and forces air out of the lungs. This forced effort can lead to anxiety, fatigue and inefficient breathing.

Hyperventilation Syndrome. This is the most common type of breathing pattern disorder. This type is described by over-breathing (faster or deeper than required). Over breathing causes low carbon dioxide levels, dizziness, and tingling.

Paradoxical Breathing: When the diaphragm and chest wall move in opposite directions when you inhale, it is called paradoxical breathing. Instead of the abdomen expanding when you breathe in, it may move inward. This makes it harder to breathe. It also may cause air hunger, dizziness, or chest tightness. Paradoxical breathing can occur after injury, surgery, nerve dysfunction, or chronic stress.

Periodic Deep Sighing: Sighing is a natural breathing response. Periodic deep sighing causes you to take frequent deep breaths to feel like you are getting enough air into the lungs. It can come from other respiratory conditions and lead to feelings of air hunger. Air hunger makes you feel like you can’t get enough oxygen.

Thoracic Dominant Breathing: This breathing pattern disorder has excessive movement of the upper rib cage and shoulders. It also had too little abdominal movement. This type creates shallow breathing. It may cause muscle pain, respiratory issues, and stress. These symptoms can lead to lightheadedness from low carbon dioxide levels.

Thoraco-Abdominal Asynchrony: This type of breathing pattern disorder where the chest and abdomen do not move in unison. They move in opposite directions during breathing. This makes it harder to breathe normally.

Causes of Breathing Pattern Disorders

Breathing pattern disorders can develop on their own. They also can be a sign of other medical problems. BPDs are commonly associated with asthma, anxiety, chronic lung disease, heart conditions and recovery from respiratory infections. Causes can include:

• Anemia
• Anxiety
• Asthma
• Blood clots in the lungs
• Cardiac issues
• Chronic obstructive pulmonary disease (COPD)
• Depression
• Fibromyalgia
• Fluid in the lungs
• Hormones
• Nasal problems
• Pneumonia
• Stress
• Weak respiratory muscles

Risk Factors for Breathing Pattern Disorders

• Chest wall injury
• Diaphragm paralysis
• Severe asthma or COPD
• Neurological disorders
• Severe electrolyte imbalances

These lifestyle habits may increase the risk of developing a breathing pattern disorder:

• Alcohol
• Caffeine
• Chronic stress and anxiety
• Exposure to air pollution
• Lack of physical exercise
• Low levels of calcium and other nutrients
• Nicotine use
• Poor posture
• Tight clothing

Signs and Symptoms

Breathing pattern disorders may have different symptoms depending on the individual. Symptoms can include:

• Achy muscles and joints
• Anxiety
• Breathlessness (air hunger)
• Chest pains
• Clammy hands or feet
• Discomfort while breathing
• Dizziness
• Dry throat
• Headache
• Heart palpitations
• Fatigue
• Frequent sighing or yawning
• Inability to take a deep breath
• Irritability
• Nausea
• Sleep disturbances
• Tingling fingers

You may be able to tell if your breathing pattern has been affected if you are:

• Breathing more from the upper chest than diaphragm
• Breathing through the mouth
• Breathing too fast or shallow
• Experiencing muscle tension or pain around the shoulders, neck and jaw
• Feeling exhausted all the time
• Having difficulty managing breathing while talking or eating

Diagnosis

Breathing pattern disorders can have the same symptoms as other more serious conditions. Your doctor will take your medical history and conduct a physical exam. Diagnostic tests may include:

Breathing and Exercise Tests

Capnography: This test provides monitors how much carbon dioxide (CO2) is exhaled. This can show how well you are breathing and how well the blood circulates.

Cardiopulmonary Exercise Test (CPET): During this test, you will exercise on a treadmill or stationary bike while wearing a mask. This test measures exhaled oxygen and carbon dioxide. Heart rate and blood pressure are also monitored to determine the cause of shortness of breath.

Manual Assessment of Respiratory Motion (MARM): Your doctor will assess your breathing patterns. They will watch the motion between the upper and lower parts of the rib cage.

Oximetry: A small device called a pulse oximeter is placed on your finger. It is used to measure oxygen levels in the blood.

Respiratory Induction Plethysmography (RIP): This test uses two wire coils placed around the rib cage and abdomen. The frequency from the wire coils provides information on breath volume.

Treatment

There is no cure for breathing pattern disorders, but they are treatable. The first step is to be aware of and recognize over-breathing. This will help you identify triggers of over-breathing. Working with a respiratory provider can help you learn your optimal breathing pattern and breathing retraining techniques.

Breathing Retraining

Breathing retraining is the most common treatment for breathing pattern disorders, including paradoxical breathing. This can also be important for patients with asthma that is not fully controlled by medication. During breath retraining, you learn to maintain abdominal/lower chest breathing patterns and relax the jaw, upper chest and shoulders. Improvement may begin within weeks, but consistent practice is required.

Treating Underlying Conditions

Managing allergies, asthma, COPD, reflux and other conditions can help improve breathing.

Lifestyle Management

In addition to breathing retraining, some lifestyle changes may be helpful in managing dysfunctional breathing.

• Exercise: To exercise well, your heart and lungs need to work together. Once you are breathing properly, you can slowly do more physical activity.
• Relaxation: Over-breathing can be related to anxiety and stress. Relaxation techniques can help maintain normal breathing patterns. Relaxation can help you focus on optimal breathing.
• Sleeping: Sleep is often disturbed by breathing pattern disorders. Reducing stress, avoiding alcohol and caffeine, and not napping during the daytime can help improve sleep. Breathing retraining during the day also helps to maintain CO2 tolerance while sleeping.

Clinical Trials

Clinical trials help determine new treatment options for diseases and conditions. Patients with breathing pattern disorder have access to clinical trials and should speak with their physician to determine what trials might work best for them.

When to See a Specialist

If you or a loved one has symptoms of a breathing pattern disorder, it is important to be evaluated by a pulmonologist.

National Jewish Health in Denver, Colorado provides expert care for breathing pattern disorders. Learn more about our Exercise and Performance Breathing Center or use the button below to make an appointment.