Glenn White BSc MSc MBIBH BIBH Practitioner/trainerwww.buteykobreathing.co.nz
SNORING – SLEEP APNOEA - ASTHMA - CROOKED TEETH ... WHAT’S THE LINK?
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BREATHING AWARENESS
1. Count the number of breaths you take in one
minute
2. Place one hand on upper chest, one hand on belly
- take 2 breaths in and out through the nose and
note relative hand movements
- repeat breathing through open mouth
Breathing Parameter Normal characteristics
Route Nose: rest, physical exercise, sleep
Location (dominant) Diaphragm
Respiration rate 8-12 breaths per minute
Minute volume 4-6 litres per minute
Tidal volume 500 ml per breath
Feel of breathing Easy, comfortable, satisfying
Rhythm Regular, smooth
Sound Inaudible; at rest, sleep
Heart rate 60-80 beats per minute
After Graham, T 2012, Relief from snoring and sleep apnoea
FUNCTIONAL BREATHING
Breathing Parameter Characteristics
Route mouth breathing or heavy nose breathing
Location (dominant) Thoracic dominant
Respiration rate > 14 breaths per minute
Minute volume > 9 litres per minute *
Appearance of breathing obvious upper chest or abdominal movement
Feel of breathing Heavy, windy full breaths
Rhythm Irregular: sighs, yawns, coughs, sniffs
Sound Audible; at rest, sleep (snoring)
After Graham, T 2012, Relief from snoring and sleep apnoea
DYSFUNCTIONAL BREATHING
DAYTIME SYMPTOMS OF DYSFUNCTIONAL BREATHING
Blocked or runny nose
Open-mouth breathing
Heavy laboured breathing
Wheezing, asthma, chest
tightness
Sighing or frequent deep
breaths
Frequent yawning
Irritable cough
Throat clearing
Short of breath on exertion
Upper chest breathing pattern
Anxiety/ panic attacks
Dry mouth
Difficulty swallowing
Gastric reflux
Breathing Disordered
Sleep
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NIGHT-TIME SYMPTOMS OF DYSFUNCTIONAL BREATHING
• difficulty getting off to sleep
• restless sleep, frequent
waking
• waking up-tired
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SYMPTOMS OF BREATHING DISORDERED SLEEP
Snoring
sleep apnoea
insomnia
vivid dreams-nightmares
night-time cramps
frequent urination, bed
wetting
night thirst, dry mouth on
waking
groggy on waking
asthma, night-time coughing
night-time anxiety/panic
attacks
restless sleep
restless leg syndrome
increased nasal congestion
teeth grinding
sleep-walking, sleep-talking
morning headache
blocked nose on waking
morning thirst
high morning pulse
messy bed on waking
One of the lung’s primary
functions is to maintain
optimum levels of O2 and CO2 in
airways and blood
THE LUNGS AND CARBON DIOXIDE (CO2)
Mouth breathing and over-breathing result in
CO2 loss resulting in CO2 deficit (hypocapnia)
• An optimal level of CO2 is essential in airways and
blood for oxygen delivery to brain and body
tissues
• CO2 is a broncho/ vaso dilator 1
• Optimal PaCO2 is essential for the release of
oxygen from blood to body tissues (The Bohr
Effect)
The Importance of CO2
1 DAVIS FREED Am.J.Respir.Crit. Care Med.2001, 785-789
MRI SCANred - yellow = highest oxygen
dark blue = least oxygen
The right hand image shows a 40% reduction in brain oxygen
after one minute of big volume breathing. This explains the
sensation of dizziness that often accompanies a panic attack.
(source Litchfield 1999)
OVER-BREATHING AND CO2 LOSS
REDUCES BRAIN OXYGEN
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Dysfunctional breathing = hyperventilationHyperventilation = breathing more than the medical norm
Normal resting minute volume for a 70-kg human
4-6 litres/min for older physiological textbooks
6-9 litres/min for some modern textbooks
> 9 litres/min is defined as hyperventilation
Norm 1929 1939 1939 1950 1980 1990-96 1997 1998-99 2000s0
2
4
6
8
10
12
14
Information sourced from 24 medical studies – Rakhimov 2005
Min
ute
Venti
latio
n, li
tres
per
mni
ute
HUMAN BREATHING VOLUMES HAVE DOUBLED IN FIFTY YEARS
6
4.95.3
4.6
7.86.9
12 121211
Hyperventilation (over-breathing) - a mechanism that is often overlooked in asthma.
Hyperventilation whether spontaneous or exercise induced, is known to cause asthma 2, 3, 4
Average MV measured for asthmatics in Brisbane Buteyko trial - 15 litres per minute (normal 10 litres) 1
1 Bowler S, Green A, Mitchell C, Medical Journal of Australia 1998; 169: 575-5782 Demeter & Cordasco The American Journal of Medicine, (1986), vol 81 pp 989. 3 Clarke PS, Gibson, JR Aust Fam Physician. 1980 4 Sterling, GM., Clin Sci, (1968), vol 34, pp 277-2855 van den Elshout, FJJ et al., Thorax, (1991), vol 46, pp 28-32
Loss of CO2 through hyperventilation can trigger bronchoconstriction in asthmatics 4, 5
HYPERVENTLATION - HYPOCAPNIA AND ASTHMA
Hypocapnia is the rule in asthma until respiratory failure sets in 3
Hyperventilation and hypocapnia (CO2 deficit)are common in asthma 1, 2, 3
1 Tobin, MJ et al. Chest, 1983; 84:287-294.2 Hormbrey, J. et al., European Respiratory Journal, 1988;1: 846-852.3 Clarke, PS., Australian Family Physician. 1980; Vol 9, October
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Hypocapnia can trigger mast cell de-granulation and histamine release
Kontos et al. American Jnl of physiology 1972Coakley et al. Jnl of Leukocyte Biology 2002:71Strider et al., Allergy 2010
• airways – asthma, hay fever
• skin – eczema
• gut – food allergies, irritable bowel (IBS)
Perera, J. The hazards of heavy breathing. New Scientist, Dec 1988
HYPERVENTLATION - HYPOCAPNIA - INFLAMATION
Average tidal volumes of 950ml and average minute volumes of 15 litres per minute during the day were recorded in males diagnosed with sleep apnoea 1
1 Radwan et al., Eur Resp J 19952 Naughton M, Benard D, Rutherford R, Am J Respir Crit Care Med 1994; 3 Chan C, Woolcock A, Sullivan C. Am Rev Respir Dis 1989
Asthma improves with breathing control, through application of Continuous Positive Airways Pressure 3
CPAP reduces hyperventilation while applied 2
HYPERVENTLATION – SLEEP APNOEA - ASTHMA
• carbon dioxide deficit – hypocapnia
• dehydrated and inflamed airways
• increased mucus production
• disruption in breathing regulation
• smooth muscle constriction
• - bronchial, cardiovascular, gastrointestinal,
urinary
• reduced oxygenation
• - broncho-spasm, vaso-constriction, Verigo-Bohr
Effect
• pH disturbance
• bigger breathing volume = more inhaled irritants
• histamine production
CONSEQUENCES OF OVER-BREATHING:
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OVER- BREATHING CHECKLIST • habitual mouth breathing
• audible breathing
• nasal congestion/ mucus
• upper chest breathing pattern
• poor posture, shoulders high, forward, slouching
• frequent sighing or yawning
• large inhalations through mouth when speaking
• rapid breathing rate > 15 breaths/minute
• paradoxical (reverse) breathing
• irregular breathing pattern, breath-holding
• cold hands and feet
• dry skin: face, lips, hands and feet
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STRESS MAKES US BREATHE MORE
If the stress is prolonged over-breathing becomes habitual
• stress in workplace, school, home, bereavement, financial
• illness, infection
• lack of exercise, athletes over-training
• over-eating, skipping meals, too much refined carbs, low
protein
• some medications; e.g. bronchodilator medications
• caffeine, nicotine, alcohol, recreational drugs
• promotion of deep breathing techniques
• computer games, excessive use of personal technologies
IN SUMMARY LIFE
MOUTH BREATHING AND TONGUE POSITION
• Nasal breathing with tongue in the roof of the mouth helps iiiensure wide dental arches and straight teeth
• The tongue is one of the strongest muscles in the body, capable of exerting 500 grams of pressure.
• It only takes 1.7 grams of pressure to move a tooth.
• Mouth breathers carry the tongue in the floor of the mouth potentially leading to narrow dental arches, crowded teeth, receding chin, smaller jaw and risk of sleep apnoea
Normal wide archesNarrow arches
No room for tongue here
Lateral airway views of a Mouth breather Nasal breather
Note low tongue posture Note correct tongue posture
MOUTH BREATHER
Uncorrected open-mouth
breathing is likely to result in:
• crooked teeth
• narrow dental arches
• receding chin
• protruding nose
• narrow airway
• and high risk of developing
obstructive sleep apnoea
by the age of thirty
Bolton standar
d
Mouth breathing at an early age can effect dental arch development. Narrow jaws can lead to crooked teeth and a distorted facial profile. If the underlying mouth breathing habit is not corrected features become more exaggerated with age.
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DENTAL DISORDERS LINKED TO OPEN MOUTH BREATHING
• dental decay
• malocclusion
• narrowing of dental arch
• dental crowding, crooked teeth
• cross-bite
• anterior open bite
• gum disease, bad breath
• inflammation of adenoids and tonsils
• TMJ dysfunction
SNORING AND SLEEP APNOEA EXPLAINED- it’s your breathing
breathing stimulatedsnoring
over-breathing
blood pH normalisingO2 release to cells
inflame/narrow airways vibration noise
suction effect
CO2 increase
CO2 deficit
(hypocapnia)
centralsleep apnoea
CO2 < apnoeic thresholdcellular hypoxia
obstructivesleep apnoea
MRI scanred - yellow = highest oxygen dark blue = least oxygen
This may might help explain the link between sleep apnoea and a higher incidence of cancer 1 and Alzheimer’s 2
SNORING - SLEEP APNOEA AND BRAIN HYPOXIA
1 Dr. F. Javier Nieto2 Osorio et al 2013
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BUTEYKO BREATHING RETRAINING
• Asthma
• Chronic nasal congestion
• Allergic rhinitis
• Sleep apnoea, chronic snorers
• Panic attack
• Dental disorders resulting from open-
mouth breathing
Who are our clients:
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BUTEYKO BREATHING RETRAINING
• Rate
• Rhythm
• volume
• Mechanics - correct use of breathing muscles
• Use of the nose - inhale/exhale
To normalise each aspect of the breathing
pattern:
Tess Graham – Relief from Snoring and Sleep Apnoea p 80
- For all situations: awake, asleep, at rest, when
eating,
speech and physical exercise
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THE NOSE YOUR PORTABLE AIR CONDITIONER
• warms
• filters
• humidifies
• disinfects (germicidal action of
NO in paranasal sinuses 1
• nasal breathing increases
arterial CO2 by 20% and O2 by
8% 2
2 Swift et al Lancet
1988
1 Lundberg Anat Rec
2008
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NOSE UN-BLOCKING EXERCISE
1. Breathe in and out normally through nose
2. Hold on the out breathe for as long as is
comfortable
3. Then gradually resume very gentle breathing
It may help to pinch the nose
and nod your head a few times In stubborn cases or when the
blockage is due to a cold, the exercise may need to be repeated several times
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DIAPHRAGM BREATHING EXERCISE
• sit with upright posture on a stable firm
chair
• move to the front edge of the chair,
upper legs parallel with the floor, knees
directly over the ankles
• practise breathing gently into the belly
Breathe slowly, rhythmically and gently
making each breath as small as you can
• Do this for 3-5 minutes a few times a
day to help tone the diaphragm and
reduce upper chest breathing
Small movements
REDUCING BREATHING VOLUME
• Hold the index finger under your nose to feel how much air goes in and out.
• When you are breathing normally you will feel warm air across your finger on the out-breath and cool air on the in-breath.
• Try slowing your breathing down until you can hardly feel any air across your finger.
• If you have a healthy breathing pattern you should be able to maintain this sensation of no air on your finger for five minutes or more.
An exercise to help habituate to reduced breathing volume
TWO TO FIVE BREATHING EXERCISEYou can use this breathing exercise to de-stress, help
overcome an anxiety/panic attack, relieve breathlessness,
chest tightness or asthma and to help you sleep.
This exercise can be done sitting, standing or lying down.
Try to breathe gently through your nose and breathe from
the belly.
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Breathe well by day and you will breathe well by night
BREATHE WELL – SLEEP WELL
• Nose breathing by day and you are more likely to nose
breathe during sleep; try to sleep with mouth closed
• Do some nose clearing and breathing exercises prior to
sleep
• Sleep with upper body slightly elevated
• Avoid sleeping on back, left is best
• Avoid stimulating foods, drinks and activities at least
90-minutes before sleep
• Turn screens off at least 60 minutes before sleeping
• Sleep in a dark, well ventilated room, do not get over-
heated
• Foods containing refined white flour, sugar:
refined breakfast cereals, pasta, noodles,
cakes, cookies
• Drinks with added sugar: soft drinks, fruit juice ...
• Milk and milk products, goats milk, soy milk, protein
shakes
• Soft cheeses, cottage cheese, ice cream, yoghurt
• Chocolate
• Caffeine, alcohol
• Food additives; MSG, sulphites, sodium benzoate, nitrites,
aspartame
Foods that adversely affect breathing and may trigger asthma, nasal congestion, snoring, poor sleep or headache
Note: over-eating leads to over-breathing
BREATHING AND SPEAKING
Breathing tips for talking:
• Try to talk less
• Talk more slowly
• Breathe in through your nose at the start of
each sentence
• Do not take a big breath in before speaking
• Breathe more gently and quietly when talking
• Speak in shorter sentences
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• Instruct to nasal breathe if possible
• Slow breathing rate and try to reduce breathing
volume
• Try to breathe diaphragmatically
• Reduce or eliminate consumption of dairy products
• Reduce or eliminate refined carbohydrates especially
foods and drinks with added sugar
• Sleep on the left side with head elevated
BREATHING GUIDELINES FOR ASTHMA RELIEF
Guidelines for reducing minute volume and normalisation of the breathing pattern
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ASTHMA AND SPORT
• Instruct to breathe through the nose, whenever
possible to help maintain the bronco dilating effects
of CO2 in airways
• Adjust intensity to allow comfortable nasal
breathing
• Drop shoulders and breathe from diaphragm
• Slow the rate and reduce breathing during breaks
in play and after physical exertion to boost cellular
O2 and
reduce lactic acid
• We instruct not to pre-dose with reliever
medication but to carry at all times and use if
needed. 11 Any changes to prescription medication, where appropriate, are undertaken by the clients’ prescribing doctor.
SIX THINGS YOU CAN DO:
1. Instruct on the importance of nasal breathing for ADL
2. To maintain nasal breathing at rest, during physical
exertion, sleep
3. Correct tongue posture; with tongue in roof of the mouth
4. To supress yawns and the urge to sigh, gasp, cough, snort,
sniff
5. Instruct on nasal clearance using the nose un-blocking
exercise
6. Instruct on diaphragmatic breathing
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BUTEYKO BREATHING CLINIC PROGRAM *
• Four initial, consecutive 90-minute
breathing retraining sessions
• Two follow up sessions within six weeks
• Telephone support and additional sessions if
required for six weeks
• Breathing exercises practised for six weeks
• Life-long awareness of the concepts is
recommended
• course fee $605
• Ages four and up
• Referral not essential* Buteyko clinic practitioners teach the Buteyko Institute Method of breathing retraining.
THE TEAM- BIBH PRACTITIONERS
Glenn WhitePractioner
trainer Auckland
Tricia Enriquez-Gault
Auckland
Olga Horne Auckland
Susan Allen Wanaka
Viv SmithQueenstown
Arisa Shioda DSJapan
Eddie Johnson Auckland
Pia Schroeter Auckland
Melody Sloggett Auckland
Dina Ceniza Auckland
Our practitioners teach to Buteyko Institute of Breathing and Health (BIBH) standards. The BIBH is ISO 9001:2008 Certified
Ines Steward Auckland
OUR TRAINEES
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