An initial assessment, lasting up to 1 hour and including a case history breathing questionnaire, clinical examination and assessment by capnography will allow me to ascertain if you are a good breather or indeed, more likely, that you have a breathing pattern disorder.  People who don’t breathe well fall into 2 groups; the first is intermittent over breathing, which tends to be triggered in certain situations, the second is chronic over breathing, which is generally a long established poor breathing pattern and often needs intensive breathing re-training with a capnometer.

If I decide that biofeedback via the capnotrainer is necessary this usually involves at least 4, 45-minute combo-sessions, spaced weekly, which will include use of the capnotrainer and osteopathic manual treatment.

This often needs to be done in conjunction with some homework or personal capnotraining. Breathing re-education works very well with meditation, learning how to quieten the mind will often have a much faster effect.  Occasionally it may be necessary for the patient, especially if anxiety is a major part of their problem, to also be seen by Dr Brian Roet, an excellent hypnotherapist whom I have worked with for the past 23 years and who also works at The Health Equation.

Capnotraining Package prices:

Initial Breathing Behaviour Evaluation 60 minutes £210 in London and £140 in Amersham

Treatment Packages:

Level 1- £575 in London and £380 in Amersham

4 Combo-sessions @45 minutes (Capnotraining and Osteopathic manual treatment)

Level 2- £875 in London only

4 Combo-sessions @45 minutes (Capnotraining and Osteopathic manual treatment)

2 Consultations with Dr Brian Roet

Purchasing a capnotrainer POA

Leasing a capnotrainer POA

5 personal capnotrainer biofeedback sessions 25 minutes self use paid in advance £175 in London and Amersham.

Please call Kerry O’Gorman, my PA on +44 (0)20 7631 1414 or by email kerryo@thehealthequation.co.uk, to book your initial breathing assessment.

Mr. Gerry Gajadharsingh DO
Osteopath
Diagnostic Consultant-Complementary Medicine
Advanced Breath Practitioner- Lifelogix Inc.
www.thehealthequation.co.uk

Treatment for intermittent over-breathing

At The Health Equation we take an integrated approach to this problem as we do with many other health problems.  Allowing the patient to understand the problem and the cause of the problem can sometimes be enough to make a major change.  The following treatments may be used in conjunction with each other, or in isolation, depending on the complexity of the problem.  Osteopathic hands on work to improve neck function (nerve supply to diaphragm), direct work to the thoracic spine, rib cage and associated soft tissues, muscle and fascia to improve local mechanics and decrease sympathetic arousal.  Cranio-sacral and functional osteopathic techniques to stimulate parasympathetic response and reduce sympathetic arousal.  Techniques to improve thoraco/lumbar function to help adrenal support and release tension in the Iliopsoas muscles (directly connected to the diaphragm). Breathing re-education. Nutritional support to the adrenals, including dietary change, nutritional supplements and stress adaptogens.  Supportive exercise to improve ribcage mechanics, posture, core stability and muscle/fascial flexibility. Hypnotherapy/psychotherapy to look at sub-conscious patterns and situational emotional triggers.

Treatment for chronic over-breathing.

Sometimes, all of the above plus Capnotraining.

Capnometry is a method by which carbon dioxide (CO2) concentration in expired gases can be measured. The process is carried out using a device called a capnometer, and an additional (optional) device, a capnograph, which can plot the levels as a graph for visual aid. Capnometry is used during anaesthesia, intensive care and in lung function studies. As osteopaths, capnometry is of most use as a method of studying lung function and breathing behaviour. Breathing is a unique behaviour that has a major influence on all systems in the body, including body chemistry (pH).

Basic breathing physiology tells us that oxygen (O2) is delivered to where it is needed in the body, and CO2 is removed. O2 is required by the body to release energy in the process of respiration. Movement of blood in the circulatory system plays an important role, with gas exchange occurring at the pulmonary alveoli via passive diffusion between alveolar gas and blood in lung capillaries. When the gases are dissolved in the blood, the heart and circulatory system pump them around the body.

O2 is the essential component of all the breathing gases. Inhaled air is made up predominantly of nitrogen (78%), O2 (21%), argon (0.96%), CO2 (0.04%) and other components (helium, water and other gases). Gases exhaled are approximately 5% richer in CO2 and 5% poorer in O2. The exact amounts of O2 and CO2 exhaled vary, depending on fitness, energy expenditure and diet of the individual in question, and this is where capnometry comes in use.

Good breathing entails proper allocation of CO2 and exhaling too much CO2 can create serious health problems. CO2 regulates the pH level of extracellular body fluids (blood and cerebrospinal fluid), electrolyte balance (sodium and potassium), blood flow (to the brain, heart and body), kidney physiology (bicarbonate regeneration) and vasodilation (delivery of O2 and nitric oxide by haemoglobin). A deficiency in CO2 is known as hypocapnia, or overbreathing.

Overbreathing can have immediate and long-term effects, triggering or exacerbating a wide variety of physical and psychological complaints, such as shortness of breath, chest pain, heart palpitations, anxiety, stress, fatigue, dizziness, blurred vision, confusion, attention deficit, poor concentration, headache and muscle tension, all of which impact on health and performance. In predisposed individuals, overbreathing can trigger or exacerbate phobias (public speaking), migraine, hypertension, attention disorder, asthma, angina, cardiac arrest, panic attacks, hypoglycemia, ischaemia (brain cell death), depression, epilepsy, sleep disturbance, allergy, irritable bowel syndrome and chronic fatigue. From a sports perspective, evaluation of CO2, breathing rate and Heart Rate Variability (HRV) can have significant positive effects on performance enhancement.

So how can these problems be overcome? Often we are told to “breathe deeply”. This is a concept that has been taught in yoga, meditation and biofeedback for many years, and often leads a person to a state of drowsiness, a state mistaken for a relaxed meditative state. The individual is actually becoming lethargic and inducing hypoxia, as too much air is being inhaled, and not enough exhaled. This can be demonstrated using capnometry. When CO2 levels are measured, a decrease in CO2 can be seen, meaning that the body is being shorted of O2. Shortage of CO2 in the body reduces cellular uptake of O2, leading to a reduction of O2 in the bloodstream travelling to the brain and muscles of the body. This induces a state of hypoxia, and can often be mistaken for this relaxed meditative state that yoga and meditation aim to achieve. Deep breathing feels ‘relaxed’ to many people, and this is for a number of reasons. Firstly, we expect it to help, due to being told it will if practiced in situations of stress, as it takes our awareness inwards and because deep breaths usually slow down breathing rates, calming the system. The latter is what we aim to achieve, however, the deep breath is actually reducing oxygen supply, so this is not the correct method.

Capnometry is one way that is scientifically accurate in measuring CO2 levels, which also measures heart rate variability (HRV) and can be used to help breathing retraining, capnotraining. HRV is the variance between our heart rate at rest and at exertion. When at rest, when we breathe in, heart rate increases, and when we breathe out, heart rate decreases. This variance is HRV. A low HRV is a predictor of all causes of death, and from a scale of 0 (dead) – 30 (elite athlete), the average person will range somewhere between 8 – 12. A low HRV will often combine with negative emotions and poor health, with the converse also holding true. The role good breathing physiology plays in maximising HRV is not to be underestimated.

Apart from the history and habits described above, the right clinical examination can be very revealing.

The Breath Pause – Patients with a breath Pause of less than 30 seconds may be suggestive of BPD.

Observation – Upper ribcage breathing and poor diaphragmatic use may be suggestive of BPD.

Breathing Rate – The Optimum breathing rate during relaxation, for most people, is about 6 cycles per minute; an average patient breathes about 12 cycles per minute. A BR of more 15 per minute may be suggestive of BPD.

Nijmegen Questionnaire – This validated questionnaire can be suggestive of BPD if the patient scores highly.

Capnography – This specialised piece of equipment measures CO2 levels and breathing rate and is the most scientific method of diagnosing BPD.

Once diagnosed BPD can be subdivided into intermittent over-breathing (mostly situational) and chronic over-breathing.

Breath and life are obviously intertwined, as are breath and thought.  It is by means of breath that we remain physically alive.  We are born with the inherent knowledge to breathe correctly through our diaphragm.  However, our own unique breathing patterns are influenced by many life events, especially during childhood.  Our emotions influence our breathing patterns and just as importantly, our breathing affects our emotions.

I estimate that 70% of patients that consult me do not breathe properly.  At first this may seem strange, as breathing is a subconscious activity.  Unless we have an obvious breathing problem (asthma, lung disease etc) we do not usually notice our breathing.  You may notice, in other people or indeed yourselves, that we may sigh a lot, find it difficult to catch our breath or talk very fast, which are all signs of not breathing properly. 

When I see a new patient, their history will often alert me to a suspicion of a breathing pattern disorder, BPD.  Many patients with medically unexplained symptoms (a majority of those attending GP practices) will have breathing pattern disorder as part of if not, sometimes, the main part of their problem.  We need to understand that in the normal medical model, diagnosis tries to find pathology, an obvious disease process.  Luckily for us, in the majority of cases, no defined pathology exists.  However, there is usually a cause of peoples’ problems, the answer can often be found in what we call functional disturbance. This can occur on a biomechanical, biochemical/nutritional/hormonal, psycho/social/emotional level or indeed a combination of all of these levels.  What links all 3 levels is breathing.

You will probably know that when we breathe in, we breathe in oxygen (O2) and when we breathe out, we breathe out carbon dioxide (CO2).  However, it is not as simple as that! Whilst the main aim of respiration is to get O2 into cells to help with energy production and the many cellular reactions that our bodies need to survive, this action is dependent on an adequate level of CO2 being present in our bodies.  Almost always, when people are not breathing properly, the issue is one of overbreathing.  The effect of this is to breathe out too much CO2 and so the levels of CO2 in our body drop (hypocapnia) and so reduce the level of O2 delivered to the cells of the body (hypoxia). 

Ironically trying to breathe more O2 in DOES NOT necessarily help this situation.

Somebody, who is classically hyperventilating (deep and fast breathing), often with symptoms of breathlessness and panic, is breathing in lots of O2 but is actually expelling more CO2, then they should.  So the treatment for acute hyperventilation is to hold a brown paper bag over their mouth and nose, so that they re-breath their own breath (mostly CO2) and they return to normal because cellular O2 increases.  Whilst most of us do not classically hyperventilate, our pain, anxiety/panic, depression, insomnia, OCD, hyperactivity, asthma, gut problems, increased blood pressure etc can at least be partly caused by not breathing well.