What is a Breathing Pattern Disorder?

Why abnormal breathing patterns affect movement, stamina and performance, and what you can do to improve dysfunctional breathing.

Did you know that the way you breathe every day impacts the way you feel? Poor breathing mechanics affect movement. Injury risk increases and you get tired faster. Oxygen delivery drops and, long-term, your health suffers.

Even if your breathing feels okay, your sporting performance can plateau when breathing is sub-optimal. And too often, the advice to "take a deep breath," given by everyone from sports coaches to yoga teachers, can actually exacerbate dysfunctional breathing. Even when there is an obvious issue like exercise-induced asthma.

What Is a Breathing Pattern Disorder?

"A breathing pattern disorder, or dysfunctional breathing, is a condition in which breathing is problematic and produces symptoms such as breathlessness.

It manifests as a psychologically- or physiologically-based habit, such as breathing too deeply, breathing too fast (both symptoms of hyperventilation), upper chest breathing during rest, or breathing irregularly with frequent breath-holding or sighing.

Breathing pattern disorders affect 9.5% of the studied adult population, rising to 29% among people with asthma and 75% of those with anxiety.

These figures are not surprising, given that asthma, anxiety, panic attacks, and stress, all negatively influence breathing patterns, feeding back to create a vicious cycle of inefficient breathing." — The Breathing Cure, Patrick McKeown

Signs you may have a breathing pattern disorder:

• You experience symptoms that have no obvious organic cause
• You gas out or get tired too soon during exercise
• You breathe fast and hard into your upper chest
• Your levels of blood CO2 drop below normal. You may feel like you can never quite get enough air, or regularly experience cold hands and feet, or feelings of panic and anxiety
• You experience sleep-disordered breathing, including snoring or sleep apnea, and regularly wake in the morning feeling exhausted
• You have frequent or chronic back or neck pain, or repetitive strain injury

All these symptoms can point to chronic hyperventilation, habitually breathing more air than your body needs. Hyperventilation is often fast breathing, normally shallow and through an open mouth. Long-term, it contributes to heart disease, high blood pressure and early mortality.

If you constantly feel unwell, this may already be making sense. A sedentary lifestyle can impact the way your body processes oxygen. And if breathing is hard work, it is likely you do not really enjoy exercise.

But if you are fit and healthy, surely your breathing is functional, right?

Can Athletes Have Breathing Pattern Disorders?

Yes. It is incredibly common for athletes to have dysfunctional breathing. It is possible to be physically fit without breathing well, and we regularly work with athletes whose breathing is sub-optimal when they begin breath training.

Asthma and respiratory infections are more common among athletes. Elite athletes frequently experience high levels of stress. Pro rugby players, boxers and weightlifters are quite likely to have sleep apnea.

Training and travel schedules can lead to sleep deprivation, just when quality sleep is most needed. And most of us do not really understand the science behind how to breathe to alter and optimise physical and mental states.

What Is the Correct Breathing Pattern?

Dysfunctional breathing often involves fast, shallow, upper chest breathing. Mouth breathing is a key factor in any breathing pattern disorder. Just like any movement pattern, these types of breathing become habits.

To address them, we need to replace these habits with new, healthy ones. And the first stage is always awareness.

Healthy breathing is nose, slow and low, 24 hours a day. You can achieve healthy breathing patterns by practising light, slow, and deep (LSD) breathing.

Healthy breathing is through the nose

When it comes to breathing, the nose is an extraordinary organ. It filters and warms air as you inhale. It helps keep you hydrated as you exhale. It sterilises incoming air, eliminating bacteria, viruses and allergens before they reach your lungs.

The mouth has no function in the respiratory system except as a back-up route for air when the nose is blocked, or when exercise is so intensive that a larger volume of air is needed.

As a rule, nose breathing is much better for you. If you experience exercise-induced asthma, mouth breathing may be part of the problem. Open mouth breathing causes you to breathe cold, dry air straight into the lungs. This dehydrates and inflames the airways, causing exercise-induced bronchoconstriction and leaving you vulnerable to infection.

Nose breathing adds greater resistance to breathing. It slows the breath, relieving stress. It engages your diaphragm too. When the diaphragm works properly, lung volume increases.

Nose breathing also reduces sleep apnea. Scientists have proven that when breathing is through an open mouth, sleep apnea symptoms are much more severe.

Sleep-disordered breathing impacts sports performance

When sleep is poor, speed, endurance, strength, executive function, learning, attention, running performance, reaction time, mood, vigour, max bench press, leg press, deadlift and tennis serve accuracy are all affected. If your sleep is less than optimal, you will not be on top form.

By switching to nose breathing day and night, you are less likely to experience insomnia or wake yourself up snoring. Sleep-disordered breathing is serious. Left untreated, sleep apnea can be deadly.

Changing the habit of mouth breathing

• Begin to pay attention to your breathing. Notice when you breathe through an open mouth. Train yourself to walk and exercise using only nasal breathing.
• Recreational athletes can maintain nose breathing 100% of the time. If air hunger becomes too strong during your workout, slow down until your breathing is under control.
• Competitive athletes should maintain nose breathing during low-to-moderate intensity training. For intensive muscle conditioning, you may need to breathe orally.
• Use MyoTape to ensure nose breathing at night and MyoTape Sport to help train nose breathing during exercise. If you notice your mouth is open when you concentrate, at work, driving or watching TV, spend time wearing lip tape during the day.
• Use MyoTape along with breathing exercises to resolve sleep-disordered breathing. You will experience better recovery and less stress.

Healthy breathing is light breathing

When you exercise, your body needs more oxygen for energy. As the muscles warm up, they begin to produce carbon dioxide. CO2 is important because it is the catalyst that causes red blood cells to release oxygen to your cells and organs, where it is used to make energy. CO2 provides the body's primary stimulus to breathe in.

When breathing is fast and hard, you can blow off too much CO2. When CO2 is low, oxygenation will never be optimal, even if your blood is fully saturated with oxygen.

It is therefore important to develop greater tolerance to changes in CO2. If you can tolerate the feeling of air hunger caused by rising CO2, your breathing will become more efficient.

We reduce sensitivity to CO2 by practising the Breathe Light exercise. This provides optimal oxygen delivery while reducing your breathing volume, acclimatising you to feelings of air hunger. When you understand that breathlessness indicates changes in blood carbon dioxide levels, not a lack of oxygen, it becomes easier to work with the discomfort. In time, your body adapts, reducing your sensitivity to CO2. Stamina improves and breathlessness decreases.

Healthy breathing is slow breathing

When breathing is inefficient, your breathing muscles can become exhausted trying to meet the body's demand for oxygen. The body will always prioritise breathing. As breathing muscles tire, your body diverts blood from your legs to support the diaphragm. This means your stamina and capacity for intensive exercise is limited by your breathing. When the diaphragm tires, you will get jelly legs, even if your leg muscles still have more to give.

Slow breathing enhances breathing efficiency. It improves arterial oxygenation because less air remains in dead space, and more air gets to the alveoli in the lungs, where oxygen and carbon dioxide are exchanged.

It activates the parasympathetic nervous system, your body's rest-and-digest response, balancing stress and building resilience.

When you use the Breathe Slow exercise to train yourself to breathe at an ideal rate of 4.5 to 6.5 breaths per minute, you will experience less breathlessness and stress. You will sleep better. And breathing will be more efficient, leading to performance gains [1].

Breathing light and slow also allows nitric oxide to accumulate in the nasal cavity and travel to the lungs. Nitric oxide helps sterilise the air and opens the airways and blood vessels in the lungs, improving oxygen uptake to the blood.

Learn more about the 30 functions of the nose and why nasal breathing matters far beyond just filtering air.

Healthy breathing is deep breathing

Breathing patterns play an important role in the mechanical stability and mobility of the spine and trunk. When you breathe from your diaphragm, every breath creates pressure within the abdomen.

This intra-abdominal pressure (IAP) supports your spine and pelvis. The diaphragm is integral to core strength, not just the abs.

This is why athletes with abnormal breathing patterns may experience musculoskeletal conditions and compromised motor control. The ideal breathing pattern is driven by the diaphragm with expansion of the lower ribs [2].

According to an article in the International Journal of Sports Physical Therapy, dysfunctional breathing, such as chronic hyperventilation, can cause musculoskeletal pain. Musculoskeletal injury is quite common amongst athletes. One study reports that around 14 collegiate athletes are injured during competitive season for every 1000 competing [3].

Moreover, upper chest breathing requires effort from smaller accessory muscles. These muscles are not designed to be active all the time. Just as muscular imbalance in the joints can lead to repetitive strain injury, this overuse contributes to trigger points, back and neck pain and strain.

The bottom line: if breathing is not functional, movement cannot be.

How to Check Your Breathing Pattern: What the Science Says

Healthy breathing is light, slow and deep (LSD) and through the nose. Breathing pattern disorders involve three dimensions: biochemical, biomechanical and psychological.

1. Biochemical — the balance of blood carbon dioxide, which can become too low during chronic hyperventilation. When carbon dioxide is depleted, your cells and organs will struggle to get enough oxygen, regardless of how much oxygen is available in the blood.
2. Biomechanical — the proper functioning of your breathing muscles, especially your diaphragm.
3. Psychological — the two-way connection between the emotions and the breath. For example, anxiety causes breathing to become fast and shallow, and fast shallow breathing causes anxiety.

Until recently, there was no single screen to identify dysfunctional breathing patterns that acknowledged all three dimensions.

In 2017, Dr. Kyle Kiesel, Professor and Program Director of Physical Therapy at the University of Evansville, developed a breathing screening tool for coaches, instructors and healthcare professionals. Here is a quick summary:

• Kiesel tested 51 subjects.
• For biochemical results, he measured end-tidal carbon dioxide (ETCO2), the percentage of CO2 in exhaled air, which gives a good indication of blood CO2.
• For biomechanical results, he used the Hi-Low test, a simple measure of abdominal movement during breathing.
• He tested psychological components using the self-evaluation of breathing (SEBQ) and Nijmegen (NQ) questionnaires.

Kiesel concluded that a BOLT score of 25 seconds, along with answers to four simple questions, can be used to accurately screen for dysfunctional breathing patterns.

Breathing Pattern Disorder Signs and Symptoms

The four questions in the dysfunctional breathing screen are:

1. Do you feel tense?
2. Do you feel a cold sensation in your hands or feet?
3. Do you notice yourself yawning?
4. Do you notice yourself breathing through your mouth at night?

If you answer "no" to these questions, and your breath-hold time after exhalation is greater than 25 seconds, there is an 89% chance that dysfunctional breathing is not present [4].

Symptoms of an ineffective breathing pattern

A BOLT score of less than 20 seconds indicates that breathing is dysfunctional, or lung function is poor. But there are other physical breathing pattern disorder symptoms to look out for too.

Dysfunctional breathing patterns, including hyperventilation syndrome and fast breathing, can produce respiratory alkalosis — a condition in which breathing causes the blood to become too alkaline. It can trigger changes in physiological, psychological and neuronal states. These can negatively affect health, performance and the musculoskeletal system.

Alkalosis results in an array of symptoms including headache, dizziness, chest pain, trouble sleeping, breathlessness, light sensitivities, exhaustion, muscle pain and cramps. Athletes with abnormal breathing can experience muscle fatigue and excessive breathlessness during physical exercise [5].

How common is dysfunctional breathing?

In one study of 34 healthy men and women, over 70% had irregular breathing patterns. Studies have linked dysfunctional breathing and hyperventilation with many health conditions, including epilepsy, diabetes, osteoporosis, chronic fatigue, back pain, jaw and neck pain, and PMS.

When you have a breathing pattern disorder, pain can be accentuated due to the relationship between the diaphragm and pain perception. You can read more about the connection between abnormal breathing patterns and health in Patrick's 2021 book, The Breathing Cure.

In the study mentioned above, those with an irregular breathing pattern scored worse on the Functional Movement Screen (FMS) compared to those with normal breathing patterns. The FMS is used to predict injury risk in athletes. Notably, 87.5% of participants who passed the FMS exhibited abdominal or diaphragmatic breathing. They moved correctly because they breathed correctly [6].

Is a breathing pattern disorder curable?

Breathing pattern disorder treatment involves re-education of breathing habits. It is easily possible to retrain irregular breathing patterns by consistently practising a handful of simple breathing exercises. As you work with the exercises, your biochemistry, biomechanics, and physical and mental states will adapt.

Because breathing is such an important motor function and is so connected with your nervous system, correction of dysfunctional breathing can result in new neural connections in the central nervous system. This can restore normal motor control patterns [5]. Sort your breathing out, and your body will naturally revert to healthy movement patterns.

5 Steps to Restore Functional Breathing

1. Start by restoring functional everyday breathing and correcting dysfunctional patterns before moving to more advanced exercises. Steer clear of any breathing exercise that involves deliberate hyperventilation until you have balanced your blood chemistry, normalised your everyday breathing pattern, and achieved a BOLT score of 25 seconds or more.
2. Measure your BOLT score to see where you are today. The BOLT score measures your tolerance to carbon dioxide and gives you an objective measure of breathlessness. If your score is less than 25 seconds, there is room for improvement.
3. Practise breathing light, slow and deep (LSD) to improve your BOLT score.
4. Breathe only through your nose, even during exercise. Use nasal dilators if airflow feels restricted.
5. Reduce your breathing volume before bed and use MyoTape to ensure nasal breathing during sleep. This will help you sleep deeper for better recovery and mental focus.

Fix Your Breathing Pattern with Oxygen Advantage

The Oxygen Advantage method was built on the understanding that dysfunctional breathing is the root cause of many chronic health problems, poor performance and unnecessary fatigue.

By retraining breathing through nasal breathing, light breathing and breath hold exercises, the method addresses all three dimensions of breathing pattern disorder: biochemical, biomechanical and psychological.

If you are interested in trying the OA method for yourself, why not try our online breathing course, become a certified breathwork instructor, or find an Oxygen Advantage instructor near you.

References

1. Bernardi L et al. Effect of breathing rate on oxygen saturation and exercise performance in chronic heart failure. Lancet. 1998;351:1308-1311.
2. Hansen-Honeycutt J et al. A clinical guide to the assessment and treatment of breathing pattern disorders in the physically active: part 2, a case series. International Journal of Sports Physical Therapy. 2016;11(6):971.
3. Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007;42(2):311-319.
4. Kiesel K et al. Development of a screening protocol to identify individuals with dysfunctional breathing. International Journal of Sports Physical Therapy. 2017;12(5):774.
5. Chapman E et al. A clinical guide to the assessment and treatment of breathing pattern disorders in the physically active: part 1. International Journal of Sports Physical Therapy. 2016;11(5):803.
6. Bradley H, Esformes J. Breathing pattern disorders and functional movement. International Journal of Sports Physical Therapy. 2014;9(1).