Breathing Inefficiently Impacts Sleep, Exercise, Mental Health, Appetite, Relationships & Addiction

By Dr Louise Oliver

12th Aug, 2024

I hope this blog helps health professionals and patients consider how inefficient breathing (dysfunctional breathing, breathing pattern disorders or sleep disordered breathing) impacts the six pillars of lifestyle medicine.

Breathing is generally automatic however it is not automatically efficient.

We can breathe efficiently, inefficiently or anywhere in between.

Breathing affects every cell, tissue, organ and system in the body.

Breathing efficiently provides the basic foundation for every cell, tissue, organ & system in the body to work efficiently

Modern living is pushing us away from living as we have been biologically programmed to live and as a consequence increasing number of individuals are not breathing as nature intended. Breathing at rest should use the nose, be quiet, slow and driven by the diaphragm – this is how we have been designed to breathe. Consider how the individual breathes whilst resting, moving and sleeping over a 24-hour period.

In 2019 a paper1 highlighted 1 in 10 adults in primary care in the United Kingdom breathe inefficiently and in individuals with asthma one third of women and a fifth of men do not breathe efficiently. Personally I believe rates are much higher now due to increased rates of stress and mask wearing during the pandemic encouraging a fast, upper chest, mouth breathing habit. This paper explains inefficient breathing has been investigated for decades, it remains poorly understood because of a lack of high-quality research and an absence of a gold standard to diagnose this condition. Also inefficient breathing is often underdiagnosed or misdiagnosed as symptoms are similar to other conditions (e.g. asthma) or sometimes the symptoms are labelled as a form of anxiety.

When we sleep the fight, flight (sympathetic) response should turn down and the relaxation (parasympathetic) response turn up so the body feels safe and can perform all the wonderful repair processes required for long term survival. Unfortunately, an increasing number of individuals are breathing inefficiently whilst sleeping. Sleep disordered breathing (SDB) refers to a wide spectrum of sleep-related conditions including increased resistance to airflow through the upper airway, heavy snoring, marked reduction in airflow (hypopnea), and complete cessation of breathing (obstructive sleep apnoea = OSA)2 If breathing is compromised during sleep the individual will generate a fight, flight (sympathetic) response to maintain breathing and survival however this reduces sleep quality and the ability of the body to repair leading to increased mortality and morbidity.

In the research the prevalence of SDB varies widely and has been reported to range between 17 and 49% for all severities of OSA (mild, moderate & severe)3 Generally more men than women have SDB4 however the Wisconsin Sleep Cohort Study demonstrated that there is a 3 times greater risk of moderate or worse OSA in post-menopausal women compared to pre-menopausal women.5 Women with OSA are less likely to report snoring or witnessed gaps in breathing (apnoea) but are more likely to complain of daytime fatigue, lack of energy, insomnia, morning headaches, mood disturbance and nightmares compared to men.6 Consider asking your patient:

‘Sometimes the symptoms you describe are related to the way we breathe whilst sleeping. Do you sleep with your mouth open, snore, have noisy breathing or gaps in breathing whilst asleep?’

I have seen a hidden epidemic of SDB since I started asking this question. Observe how your patient breathes whilst resting and moving.

The only role the mouth has in breathing is making breathing inefficient.

The body has been designed for survival therefore it will make adjustments within the systems of the body to cope with inefficient breathing however this may lead to a cascade of inefficiencies which can impact the six pillars of lifestyle medicine such as:

  • Excessive breathless on exercise (affecting the physical exercise & mental health pillar)
  • Reducing sleep quality (affecting the sleep, mental health, minimising harmful substances, healthy relationships & healthy eating pillars)
  • Higher sympathetic drive (fight, flight, freeze response) increasing feelings of anxiety (affecting the mental health pillar)

In this blog I highlight the features that increase the likelihood of inefficient breathing with the aim to help the health professional or patient consider whether inefficient breathing is a possibility.

My mission is to raise AWARENESS that how we breath matters, encouraging individuals to ASSESS their breathing efficiency & empowering individuals to take ACTION to improve their breathing efficiency. In my blog on medically unexplained symptoms I explain how a patient followed this approach which resulted in resolution of their medically unexplained symptoms.

I encourage you to:

AWARE – increase your knowledge on breathing efficiency. Lots of zero cost information on my website.

ASSESS – notice how you and your patients breathe whilst resting, moving & sleeping.

ACTION – re-establishing nasal breathing whilst resting, moving & sleeping is the foundation of efficient breathing.

How we breathe whilst resting, moving and sleeping matters.

We can change how we breathe.

Dr Louise Oliver

GP, Functional Breathing Practitioner & Therapeutic Life Coach

References

  1. Vidotto LS, Carvalho CRF, Harvey A, Jones M. Dysfunctional breathing: what do we know? J Bras Pneumol. 2019 Feb 11;45(1):e20170347. doi: 10.1590/1806-3713/e20170347. PMID: 30758427; PMCID: PMC6534396.
  2. American Thoracic Society https://qol.thoracic.org/sections/specific-diseases/sleep-disordered-breathing.html
  3. Khokhrina A, Andreeva E, Degryse JM. A systematic review on the association of sleep-disordered breathing with cardiovascular pathology in adults. NPJ Prim Care Respir Med. 2022 Oct 17;32(1):41. doi: 10.1038/s41533-022-00307-6. PMID: 36253378; PMCID: PMC9576790.
  4. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993 Apr 29;328(17):1230-5. doi: 10.1056/NEJM199304293281704. PMID: 8464434.
  5. Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA. 2004 Apr 28;291(16):2013-6. doi: 10.1001/jama.291.16.2013. PMID: 15113821.
  6. Saaresranta T, Anttalainen U, Polo O. Sleep disordered breathing: is it different for females? ERJ Open Res. 2015 Nov 3;1(2):00063-2015. doi: 10.1183/23120541.00063-2015. PMID: 27730159; PMCID: PMC5005124.

About the Author

Dr Louise Oliver is a GP, Functional Breathing Practitioner & Therapeutic Life Coach. She became a perimenopausal snorer which led her to recognise her 24-hour breathing was inefficient. She improved her breathing efficiency, her snoring stopped, her sleep, exercise tolerance & stress resilience improved. She now splits her time between working as a GP & Functional Breathing Practitioner teaching others to breathe efficiently on her individual and group breathing re-education programmes.

Website: https://www.drlouiseolivertherapeuticlifecoaching.com/

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