UCLH Respiratory Outpatient Physiotherapy - Breathing Pattern Disorder : University College London Hospitals NHS Foundation Trust

What is a Breathing Pattern Disorder (BPD)?

A breathing pattern disorder is an alteration/ abnormal pattern of breathing. We don’t often think about the way we breathe but it can be affected by how we think and function. Our breathing can change in response to a range of stimuli which might include triggers such as illness, stress or a traumatic event with our breathing pattern remaining altered after the trigger has occurred.

BPD can present differently in ways which can include over- breathing, using the wrong muscles, breathing from the upper chest, mouth breathing, fast respiratory rate, bigger breaths and sometimes hyperventilation. You might experience symptoms such as breathlessness, chest tightness and the feeling of not being able to get enough air into your lungs. This is called air hunger, which is the need or sensation to take a deeper breath, sighing or yawning.

Breathing

At rest, breathing should be in and out through your nose. You should be able to “tummy breathe” using your diaphragm (muscle that sits under your ribs) allowing your tummy to rise and fall gently with each breath. Your shoulder and neck muscles should be relaxed, and your upper chest remains still.

Possible signs and symptoms of BPD:

breathlessness
yawning
fainting
throat clearing
chest pain
sighing
difficulty talking
headaches
tight chest
dizziness
panic attacks
pins and needles
blurred vision
coughing
palpitations
air hunger – the need or sensation to take a deeper breath (yawning, sighing, coughing).

Improving breathing pattern

Respiratory physiotherapists play a key role in the diagnosis and management of breathing pattern disorders. Retraining breathing pattern starts with an exercise called breathing control. You can complete this in slumped sitting or crook lying.

Breathing control may feel difficult and strange to begin with. You might experience air hunger, which is the need to take a deeper breath, sighing or yawning which happens because your brain is getting used to the correct way of breathing. Try to resist the urge to take a deeper breath, it will ease with time.

Place one hand on your chest and one hand on your tummy below your ribcage.
Breathe in and out through your nose silently. If you can hear your breath, try to slow it down.
When you breathe in, feel your belly lift and when you breathe out, feel your belly lower. Make sure your upper chest remains still.
If you can feel both your chest and tummy rising and falling, try to make your breaths smaller.

Aim to practice this regularly, aiming for 5 minutes 4 times a day.

Watch our Respiratory outpatient physiotherapy patient videos, available on the UCLH website.

Other useful tips

Lifestyle changes and relaxation techniques such as meditation can help to manage stress which in turn can help your breathing.

Try to nose breathe for as long as you can when walking, particularly on the flat. On exertion, for example when climbing stairs or walking up an incline, maintain nose breathing for as long as you can. Try to maintain lower chest breathing; imagine breathing into the sides of your lower ribs, keep your upper chest, jaw, neck, and shoulders relaxed for as long as possible. It is okay to open your mouth, try not to upper chest gasp.

Prioritise rest, recovery, and sleep. Sleep hygiene is important to ensure you are getting good quality of sleep if it is disturbed by your breathing. This might include avoiding caffeine later in the day, reducing screen time before bed and make sure to go to sleep and wake up at the same time every day.