Breathe!

Updated: Jun 25

January 2022

Breathe. A word I sometimes have to say to myself to remind me, not because I’m not actually breathing, but because I, like many others, often subconsciously tense up and start taking short, shallow breaths when I’m engrossed in a task. In these times of COVID, breathing may be a topic that is more often on the forefront of our minds. You may have or have had COVID, know someone who is currently struggling with it, or are having trouble keeping your breath deep and calm in these times of unprecedented stress.

Do you ever stop and take moment to notice how you're breathing? Or in some cases barely breathing? As I mentioned above, we often find ourselves holding our breath, or taking small, shallow breaths, usually in times of deep concentration or stress. You may wonder why we even have to think about breathing at all, when it is something the body does reflexively, keeping us alive all the time, usually in the background.

Why Breathing Is Important:

Breathing is vital to life, as it allows us to inhale oxygen which helps our body create energy, and exhale carbon dioxide, which is a waste product created by the body. The way we breathe can tell us a lot about

how we are feeling and what we are doing. It can be affected by our mood, and vice versa. Think about a time when you were deep in concentration at a task, and all of a sudden you stop what you are doing

and take a deep breath, or let out a deep sigh. You may feel yourself relax a bit when you allow yourself to focus on your breath and expand your lungs more fully.

The Muscles of Breathing:

All muscles that are attached to the human rib cage have the inherent potential to cause a breathing action.

Diaphragm: The diaphragm, a dome-shaped muscle below the lungs, separating the chest and abdominal cavity, is the main muscle responsible for breathing. Relaxed breathing is a reflex; we do not have to think to breathe. When we inhale, the diaphragm flattens. This expands the chest cavity to create a slight vacuum, which causes air to flow in. During exhalation the diaphragm relaxes and the lungs naturally recoil, and air is gently pushed out. We also have the ability to breathe more forcefully, such as with exercise or singing. With more forceful breathing, we use more muscles in addition to the diaphragm to increase chest volume more dramatically.

Intercostal Muscles: The muscles between your ribs, called intercostal muscles, play a role in breathing during physical activity. They assist with elevating and expanding your rib cage with inhalation, and compressing your rib cage with exhalation.

Abdominal Muscles: Your abdominal muscles help you breathe out when you are breathing fast, or forecefully, such as during physical activity.

Accessory Muscles in the Neck: Muscles in the neck, including your sternocleidomastoid and scalenes, can contribute to breathing, especially in times of stress or physical exertion to the point where your body is not getting enough oxygen. These muscles help elevate the ribs and the sternum to increase the space in the rib cage and thus draw in more air. For a number of reasons, one can move away from a normal, efficient resting breathing pattern. In these abnormal patterns, accessory breathing muscles are recruited and utilized even at rest. When these muscles are used excessively, like any other muscle or tissue, they can become tight, strained, and even painful.

Muscles of the Face, Mouth, and Pharynx: The pharynx is the part of the throat right behind the mouth. These muscles control the lips, tongue, soft palate, and other structures to help with breathing. Problems with these muscles can narrow the airway, making it more difficult to breathe

The Nervous System

Breathing is reflexive, meaning it does not require any thought, because it is controlled by the autonomic nervous system, also called the involuntary nervous system. The parasympathetic system slows your breathing rate. The sympathetic system increases your breathing rate. Your breathing changes depending on how active you are, and the condition of the air around you. For example, you need to breathe more often when you do physical activity. At times, you can control your breathing pattern, such as when you hold your breath, sing, or exercise. To help adjust your breathing to changing needs, your body has sensors that send signals to the breathing centers in the brain.

Sensors in the airways detect lung irritants. The sensors can trigger sneezing or coughing. Sensors in the brain and near blood vessels detect carbon dioxide and oxygen levels in your blood. Sensors in your joints and muscles detect the movement of your arms or legs. These sensors can play a role in increasing your breathing rate when you are physically active.

How Does Your Body Control Breathing?

Metabolic Control:

The respiratory center in the brainstem is responsible for controlling a person’s breathing rate. It sends a message to the respiratory muscles telling them when to breathe. The medulla, located nearest the

spinal cord, directs the spinal cord to maintain breathing, and the pons, a part of the brain very near the medulla, provides further smoothing of the respiration pattern. This control is automatic, involuntary and

continuous. You do not have to consciously think about it.

The respiratory center knows how to control the breathing rate and depth by the amount (or percent) of carbon dioxide, oxygen and acidosis in the arterial blood (Willmore and Costill, 2004). For example, when you exercise, carbon dioxide levels increase significantly which alert the chemoreceptors, which subsequently notify the brain’s respiratory center to increase the speed and depth of breathing. This elevated respiration rids the body of excess carbon dioxide and supplies the body with more oxygen, which are needed during aerobic exercise. Upon cessation of the exercise, breathing rate and depth gradually declines until carbon dioxide in the arterial blood returns to normal levels; the respiratory center will no longer be activated, and breathing rate is restored to a pre-exercise pattern.

Behavioral Control

Breathing is very unique as compared to other visceral functions, such as digestion, endocrine, cardiovascular, in that it can also be regulated voluntarily. The behavioral, or voluntary control of breathing is located in

the cortex of the brain and describes the aspect of breathing with conscious control, such as a self-initiated change in breathing before a vigorous exertion or effort. Speaking, singing and playing some instruments

are good examples of the behavioral control of breathing. The behavioral control of breathing also allows for changes in breathing such as those from stress and emotional stimuli. The differentiation between voluntary and automatic (metabolic) breathing is that automatic breathing requires no attention to maintain, whereas voluntary breathing involves a given amount of focus (Gallego, Nsegbe, and Durand, 2001).

Respiratory Rate:

Your respiratory rate is how fast you are breathing. It can tell you a lot about how you are feeling and/or how hard your body is working. A normal resting respiratory rate is 12-20 breaths per minute. When we increase our

activity, such as with exercise, our respiratory rate increases to meet our body's increasing oxygen demands. We also increase our breathing rate at times of stress or anxiety. In fact, increases in anxiety can be accompanied by increased respiratory rate, or conversely, breath holding.

Respiratory rate is a fundamental vital sign that is sensitive to different pathological conditions, including cardiovascular status and deconditioning, as well as stressors, including emotional stress, cognitive load,

heat, cold, physical effort, and exercise-induced fatigue.

Deep Breathing Exercises:

Practicing deep breathing exercises can have a profoundly positive effect on your physical, mental, and emotional health. There are many types of deep breathing exercises that can help relax the body and mind, while at the same time, improve our efficiency of breathing.

Deep breathing exercises help to activate the Relaxation Response, which is a physical state of deep rest that can change the physical and emotional responses to stress, including decreases in heart rate, blood pressure, rate of breathing, metabolism, and muscle tension. Deep breathing increases the supply of oxygen to your brain and stimulates the parasympathetic nervous system, which promotes a state of calmness.

Pursed Lip Breathing

Pursed lip breathing (PLB) is a technique that we utilize often in the inpatient/hospital setting. I have worked as an inpatient physical therapist at Boston Medical Center since 2008. I treat a vast range of conditions, and in many, breathing is affected, sometimes significantly. Pursed lip breathing is not only for use in the inpatient setting, it can be used wherever you are. It consists of breathing in through your nose for a 2 count, then exhaling through your mouth with lips pursed for a 4 count. A phrase we often say is, “Smell the roses, and blow out the birthday candles”. You want to prolong both the inhale and the exhale, making your exhale time double your inhale time. You can increase to in for 3, out for 6, etc. PLB can:

· Decrease heart rate and respiratory rate, helping to calm the body and decrease work of breathing

· Increase the lungs’ tidal volume, which can help relieve shortness of breath and improve exercise tolerance

· Help open the airways during exhalation to improve gas exchange and increase excretion of volatile acids in the form of carbon dioxide

· Help regain a sense of control over breathing, while simultaneously increasing relaxation

Diaphragmatic Breathing

With diaphragmatic breathing the initial focus of attention is on the expansion of the abdomen, sometimes referred to as abdominal or belly breathing. Place one hand on your upper chest, and your other hand on your abdomen, just below your rib cage. Breathe in through your nose, feeling the air flow deeply into your belly. The hand on your chest should remain still; the hand on your stomach should rise. Tighten your abdominals muscles inward as you exhale through pursed lips.

Diaphragmatic breathing also includes the expansion of the rib cage during inhalation. Try placing the edge of the hands along side the rib cage (at the level of the sternum); correct diaphragmatic breathing will elicit a noticeable lateral expansion of the rib cage. Diaphragmatic breathing should be practiced in the supine, prone and standing positions, as these are the functional positions of daily life.

Pranayama Breathing

Pranayama breathing is often performed in yoga and meditation. It means the practice of voluntary breath control and refers to inhalation, retention and exhalation that can be performed quickly or slowly (Jerath et al., 2006). In fact, much of the aim of pranayama breathing appears to shift the autonomic nervous system away from its sympathetic (excitatory) dominance. Pranayama breathing has been shown to positively affect immune function, hypertension, asthma, autonomic nervous system imbalances, and psychological or stress-related disorders (Jerath et al., 2006). Breath training includes the ability to sustain relaxed attention on the flow of breath, to refine and control respiratory movements for optimal breathing, and to integrate awareness and respiratory functioning in order to reduce stress and enhance psychological functioning (Sovik, 2000).

Jerath and colleagues hypothesize that “the voluntary, slow deep breathing functionally resets the autonomic nervous system through stretch-induced inhibitory signals and hyperpolarization (slowing electrical action potentials) currents…which synchronizes neural elements in the heart, lungs, limbic system and cortex.”

There are many types of pranayama breathing techniques, including 478 Breathing, Lion’s Breath, Alternate Nostril Breathing, Humming Bee Breath, Three Part Breath, Ocean Breath, and Cooling Breath, to name only some.

Here is a link to an article discussing and demonstrating some of these breathing techniques: https://www.healthline.com/health/breathing-exercise

In the videos below, I demonstrate Pursed Lip Breathing and Diaphragmatic Breathing

PURSED LIP BREATHING

DIAPHRAGMATIC BREATHING

Conclusion

Hopefully you’ve learned a little bit about the mechanisms of breathing, types of breathing, and why breathing is so important for our physical, mental, and emotional health. I encourage you to take some time each day, even a couple of minutes, to focus on your breath, to help sync your brain with your body, and bring oxygen, blood flow, and life to all your precious body parts.