So you think you can breathe? - PowerPoint Presentation

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So you think you can breathe?Breathing Matters: Facts, Myths and Therapeutic Effects Tess Graham BSc. Grad Dip Phty. Dip BM.Physiotherapist, Certified Breathing Educator and Trainer, Canberra AustraliaSlide2

Relief from Anxiety and Panic Attacks

Tess Graham

2012

2016Slide3

Overview What is dysfunctional breathingCauses EffectsBreathing Pattern AssessmentFirst steps to better breathingCase studiesQ & A Slide4

Breathing matters Our most important functionAutomatic  gets ignoredMisunderstoodMisinformation Mis-instructed and mis-practiced Slide5

Physiological normal breathing Rhythmic, regular SilentNasalDiaphragmatic Resp Rate: 8-12 breaths/minute (1)Tidal Volume: 500 mls/breath (1,2)Minute Volume: 4-6 litres/minute (1,2,3)CO2: 40-46mmHg (4-6)

1.

Vander;

2 Webber; 3 Ganong;

4 Anderson; 5 Murray; 6 Xie. Slide6

Dysfunctional breathing

Irregular – yawns, sighs

Audible

Mouth breathing

Upper chest

14 - 38 breaths/minute

High Tidal VolumeHigh Minute Volume (hyperventilation

) Low CO2; respiratory alkalosisDISTURBED PHYSIOLOGY DISTURBED BLOOD CHEMISTRY Slide7

Size matters Slide8

Volume matters Slide9

Relief from Snoring and Sleep Apnoea T. Graham

2012

Illustrator: A.

Calvert

NORMAL BREATHING

8 - 12 breaths / minute

DISORDERED BREATHING 14 - 30 breaths /minuteSlide10

Overbreathing and disease (Normal breathing 4-6 L /min) Minute volumePanic disorder 12 L/min (Pain 1991) Asthma 14 L/min (Bowler 1998 )Heart disease 15 L/min (Dimopoulou 2001)Diabetes 15 L/min (Tantucci 2001)OSA 15 L/min (Radwan 1995 ) Sick people generally breathe more air per minute than healthy people Slide11

Hyperventilation prevalence in modern population

Adapted from: http://www.NormalBreathing.comSlide12

12 What drives up breathing rate?

Lifestyle!

STRESS

Screen technology

Slumped posture

Mouth-breathing habit

Crying, illness, infectionOver-heating

Over-eating, high carb diet (inflammatory)Wrong advice, faulty instructionSlide13

13OVER BREATHINGOVER LOOKED !Slide14

Revved up nervous system

Sympathetic dominant state

Persistent overbreathing primes

you

(short fuse) for

a panic attack and chronic anxiety Slide15

Myths and MisunderstandingsCO2 a waste gas‘Abdominal’ or ‘belly breathing’ Big is best - large ‘deep’, ‘full’ breathsTight absForced exhalesSlide16

The perfect man breathes as if he is not breathing

Lao

Tzu Chinese philosopher

(circa 400BC)

Over

the oxygen supply of the body, carbon dioxide spreads its protecting

wings

Friedrich

Miescher

Swiss physiologist (1885)Slide17

Overbreathing effects (1)Physical / mechanical Dehydration Inflamed nasal passages, sinuses, uvula, tonsils, adenoids Vibration, turbulence, snoring -ve pressure, collapse, apnoea (OSA) Slide18

Overbreathing effects (2)Effects on blood gases and body chemistryIncreased oxygen intake (lungs)Same O2Sat 96-99% (red blood cells)Hypocapnia - low CO2 (lungs, blood)Hypoxia – less O2 (cells, tissues, organs) (Bohr effect)Slide19

Effects of low CO2 on the brain 40% reduction in O2 after 1-minute hyperventilation

MRI Scan: red = most O

2

dark blue = least O

2

Litchfield1999Slide20

Carbon dioxide Rolesregulates breathing balances and regulates pHsynthesis antibodies, hormones, enzymesstabilises mast cellssmooth muscle dilatorfacilitates release of oxygen (Bohr effect) parasympathetic responseSlide21

Overbreathing effects (3)Physiological allergic response, asthma, dyspnoea tissue hypoxia, dizzinesspalpitations , arrhythmiabrain fog, learning problemsadrenaline, cortisol increase sympathetic nervous system stimulated anxiety, panic, insomniasweating, clamminessfrequent urination; bedwetting (children) Slide22

Symptoms of overbreathing (1)

Neurovascular

:

Central:

disturbances of consciousness, faintness, dizziness, unsteadiness, impairment of concentration and memory, feelings of unreality, "losing mind"

Peripheral:

Paraesthesia, numbness, tingling and coldness of fingers, face and feetMusculoskeletal: diffuse or localised myalgia (muscle pain

) arthralgia (joint pain), tremors and coarse twitching movements, carpopedal spasm and generalised tetany (infrequent)Respiratory: cough, chronic throat tickle, shortness of breath, atypical asthma, tightness in or about chest, sighing respiration, excessive yawning Fried R. The Breath Connection,1990Slide23

Symptoms of over-breathing (2)

Cardiovascular:

palpitations, skipped beats, tachycardia, atypical chest pains

, sharp precordial twinges, dull precordial or lower costal ache, variable features of vasomotor instability

Gastrointestina

l:

oral dryness

, globus (sensation of lump in throat), dysphagia (difficulty swallowing), left upper quadrant or epigastric distress, aerophagy, belching, bloating, flatulence

Psychological: variable anxiety, tension and apprehension, inappropriate pseudocalmness (hysterical subjects)General: easy fatigability, generalised weakness, irritability and chronic exhaustion, frightening dreams, sleep disturbances Fried R. The Breath Connection,1990Slide24

What is breathing retraining?Restoring a physiologically normal breathing patternbreathing at the correct rate, rhythm and volumethrough the nosecorrect use of diaphragmat rest, during activity, speech, sleep and sportretraining brainstem response / ‘set point’

The

normalisation of breathing in every

aspectSlide25

Breathing retraining is VERY powerfulWhen you get your breathing right the changes have their source at a deep level. You have changed your physiology.You switch off the flight-fight centre.Slide26

Assessment – observation (1) Rhythm Route Chest movementSoundPosture Questionnaires:Location # Symptom trackerLips and Tongue # Overnight obsMuscle tension # Food diary Slide27

Assessment – measurement (2) Respiration rateHeart rate‘Comfort’/ ‘Control’ Pause End Tidal CO2 (ETCO2)Nose-breathing tolerance (Rosenthal test)Slide28

Breathing retraining process EducationIdentify faulty breathing habitsPractice the 9 Healthy Breathing HabitsImplement into normal lifeSymptom relief - exercises / strategiesPrevention – normalise and ‘reset’ breathingLifestyle recommendationsReferralSlide29

Nine Healthy Breathing Habits 1. Awareness 2. Nose-breathing 3. Upright posture 4. Regular breathing 5. Diaphragm breathing 6. 8-12 breaths per minute 7. Silent invisible breathing 8. Breathing control during speech and singing 9. Breathing well during exerciseRelief from Snoring and Sleep Apnoea ©Tess GrahamSlide30

How it’s taught ConsultationsClinic, skype, phone2 – 6 sessionsSmall-group sessionsChildren’s classesAdults classes6 – 8 sessionsSlide31

31 How it’s taught (2)

Books Coming soon! Audio

BreatheABILITY.com TessGraham.com.au

Amazon

Online Course

12 lessons

4 hrs contentExtended access Phone supportBreatheAWAY.com.au

Relief from Anxiety and Panic Attacks

Tess Graham

Sollievo dal russamento e apnea del

sonno

Tess GrahamSlide32

Results (1)Based on clinical observation and data: > 23 years, 6000 people 1Typically reported:Day 2 Nose-breathing is more comfortableSatisfying breathing, “feeling calmer”Quieter breathing at night, less snoring, sleeping betterSymptom score 30-40% Day 3Activity without breathlessnessAble to calm (‘slow’) the mind; slower heart and breathing rateAble to abort anxiety and panic attacks1. Graham T. Breathing Training PL. 1993-2016 Clinical records, observation, analysis of sleep

studies,

personal communication (unpublished).

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Results (2)Based on clinical observation and data: > 23 years, 6000 people 1Typically reported:Day 5“Great sleep”; less waking/insomniaEnergy up - on waking, all day“Thinking straight”, “feeling stronger”, more resilientIncreased exercise capacity Resting heart rate 20% Symptom score 65%Day 10-14Symptom score 80% 1. Graham T. Breathing Training PL. 1993-2016 Clinical records, observation, analysis of sleep studies, personal communication (unpublished).

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Case study - Anxiety Male, age 49Anxiety, Depression, Panic Attacks, Social Anxiety – 7 yrsAnti-anxiety and anti-depressant medications – 5 in 6 yrsHypertension, Snoring, Sleep Apnoea, IBSBreathing pattern:Upper chest, audible, fast, heavySighs, yawns, mouth-breathingRespiration Rate 20Heart Rate 80Slide35

Symptom Tracker - Case study - Anxiety

Day 1

Day 5

Day 14

Feeling faint, in social situations

XXXX

X

X

Feeling of unreality

XXX

X

X

Sense of losing mind

XXX

Spaced out

XXX

X

X

Poor concentration and memory

XXX

X 

X

Anxiety

XXXX

X

X

Panic attacks

XXXX

XX

X

Feeling revved up

XXX

X

x

Waking tired, daytime fatigue

XXX

X

x

Excessive sweating

XXX

X

Upper chest , fast, heavy, erratic breathing

XXX

X

X

Mouth-breathing day, activity

XXX

X

Yawning, signing

XXX

XX

X

TOTAL SYMPTOM SCORE

42

16

8

% REDUCTION SYMPTOMS

62%

81%

Blank = no symptoms; X = occasional; XX = part of each day XXX = all day or all night; XXXX = continuous / severe

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Heart rate changes Resting Heart Rate Before AfterClient 1 92 72Client 2 96 68Client 3 104 82

3 pregnant women suffering from chronic

anxiety

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What you can do (1) Assess Breathing pattern – route, rate, rhythm, volume, breathing muscle usageSymptoms of chronic overbreathingEducateBasic physiology AwarenessGentler breathing (nose or mouth) Slide38

38Panic Control Exercise NOT 3 x 3 exerciseSlide39

What you can do (2) Refer Breathing Educator BREATHING EDUCATOR ASSOCIATIONS BIBH – Australia, NZ, UK BBEA – USA, CA, UK, EU +www.BreatheABILITY.com

Recommend

Book CD Online CourseSlide40

What you can do (3) Train BREATHING WORKSHOPS for HEALTH PROFESSIONALS Informative and experiential learning Teaching a step-by step process Contact:admin@BreatheAbility.com.auTessGraham.com.auSlide41

41Summing up

Breathing retraining

brings

ease and control of breathing

better sleep

balanced blood and brain chemistry

downregulation of ANSrelaxation – muscular and nervous systemimproved oxygenation

increased mindfulness Enhanced therapeutic benefit, stability and ‘holding’ power of psychological therapySlide42

“Breathing retraining has been an important tool in my repertoire of treatment strategies for over twenty years.  However, completing Tess’s course has completely changed the way I understand and address breathing issues amongst my clientele.  Adopting her techniques has led to rapid progress in symptom relief early on in treatment, contributing to greater gains in therapeutic progress overall.”  Fiona S - clinical psychologistSlide43

BreatheAbility - Basics of Healthy Breathing WORKSHOPAnxiety and Breathing TechniquesDevelop skills in working with breathing to enhance clinical outcomes1- Day workshop for psychologists with Tess Graham 22nd November 2016, Byron Bay NSW

Information and Registration:

hello@kevents.com.au

kevents.com.auSlide44

44Q & ASlide45

45Slide46

46Photo and image credits

ABOUT TESS GRAHAM :

IMAGES:

Logos – Source: Internet

Photos - Prof Buteyko and Dr Weston A Price – Internet sources.

Other photos are owned by Tess

GrahamPHYSIOLOGICAL NORMAL BREATHING - FUNCTIONAL BREATHING IMAGES: Tess Graham

©SIZE MATTERS: IMAGES:Tess Graham © photoVOLUME MATTERS: IMAGES:Man sleeping: Dollarphotoclub_78923530 Lisa F. YoungWoman sleeping: Tess Graham © photoWHAT DRIVES UP BREATHING : IMAGESUpper from Clip Art Lower, boy texting: Dollarphotoclub_73436211 PhotoeffectbyMarchaOVERBREATHING EFFECTS (1) IMAGES:Image Dollarphotoclub_69281379

QUOTES: BACKGROUND http://www.photos-public-domain.com/2012/01/12/blue-sky-with-sun-clouds-and-airplane-trail/.CARBON DIOXIDE – ROLES: IMAGE: Dollarphotoclub_71004419 –valentintSlide47

47Photo and image credits (2)

OVERBREATHING EFFECTS (3)

PHOTO – FEMALE ANXIOUS

Dollarphotoclub

-

anx

5743 blanchePHOTO – MALE INSOMNIA - Dollarphotoclub_65259413 - Innovated CapturesBREATHING

PATTERN ASSESSMENT-OBSERVATION (1) IMAGES: Profile boy sitting: Tess Graham © Young man :Dollarphotoclub_5485267CHILD ASLEEP: Dollarphotoclub_28773546 Crowding of teeth: dollarphotoclub_8131144BREATHING PATTERN ASSESSMENT- MEASUREMENT (2) IMAGES::Stopwatch: Dollarphotoclub_64455855 Stepan BormotovBREATHING RETRAINING PROCESS : IMAGES: Tess Graham ©HOW IT’S TAUGHT: IMAGES:

GLOBE: Dollarphotoclub _ 80139683 Art studio GLOBE WORLDWOMAN SKYPE: Dollarphotoclub_70195357-1Pregnant women class: dollar photo club_6327688Children’s class: dollar photo club_6327688WHAT YOU CAN DO (3) IMAGE:Dollarphotoclub - rawpixel 76520905Slide48

48References

PHYSIOLOGICAL NORMAL BREATHING - FUNCTIONAL

BREATHING

:

REFERENCES

Vander A, Sherman J, Luciano D. Human Physiology. 5th ed. New York: McGraw Hill; 1990.

Webber AB, Pryor JA. Physiotherapy for respiratory and cardiac problems. Singapore: Churchill-Livingston; 1994. Ganong WF. Review of Medical Physiology. 6th ed. Los Altos, CA: Lange Medical Publications; 1973.Anderson Price S, McCarty Wilson L. Physiology of Disease Processes. 4th ed. St Louis: Mosby Year Book Inc; 1992.

Murray J F. The normal lung: The basis for diagnosis and treatment of pulmonary disease. 2nd ed. Philadelphia: W.B. Saunders Company; 1986. Xie A et al. Effects of inhaled CO2 and added dead space on idiopathic central sleep apnea. J Appl Physiol 1997; 82: 918-26.OVER BREATHING AND DISEASE: REFERENCESPain MC, Biddle N, Tiller JW, Panic disorder and respiratory variables, Psychosom Med 1988 Sep-Oct; 50(5): p. 541-548. Bowler SD, Green A, Mitchell CA. Buteyko breathing techniques in asthma: a controlled trial. MJA.1998; 169:575-578Dimopoulou I, Tsintzas OK, Alivizatos PA, Tzelepis GE, Pattern of breathing during progressive exercise in chronic heart failure, Int J Cardiol. 2001 Dec; 81(2-3): p. 117-121.Tantucci C et al. Cerebrovascular reactivity and

hypercapnic respiratory drive in diabetic autonomic neuropathy, J Appl Physiol 2001, 90: p. 889–896.Radwan L et al, “Control of breathing in obstructive sleep apnoea and in patients with the overlap syndrome”, J. Eur Respir J. Vol 8, 1995, 542–545.RESULTS (1) and RESULTS (2) REFERENCES: 1. Graham Tess. Breathing Training PL. 1993-2016; Clinical records, observation, analysis of sleep studies, personal communication (unpublished). Some data published in:Graham, T. Relief from Snoring and Sleep Apnoea; Penguin 2012. ISBN 9780670076499; Graham, T. Relief from Snoring and Sleep Apnea; CreateSpace 2014; ISBN-13: 978-1500413712Adelola OA, Oosthuiven JC, Fenton JE. Role of Buteyko Breathing Technique in asthmatics with nasal symptoms. Clinical Otolaryngology 2013; 38(2):190-1