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Glenn White BSc MSc MBIBH BIBH Practitioner/trainerwww.buteykobreathing.co.nz
SNORING – SLEEP APNOEA - ASTHMA - CROOKED TEETH ... WHAT’S THE LINK?
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
HOW BREATHING CAN DISRUPT
SLEEP
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• 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
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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
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
• 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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MOUTH BREATHING
• The teeth sit in the neutral position between the cheeks and the tongue.
• During nasal breathing the tongue rests in the roof of the mouth.
• During mouth breathing the tongue drops to the floor of the mouth and the cheeks then exert force on the teeth causing constriction of the maxilla.
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
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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
MOUTH BREATHING AND UPPER- AIRWAY DISORDERS
Uncorrected open-mouth
breathing can result in:
• enlarged adenoids
• tonsillitis
• nasal polyps
• sinusitis
• chronic nasal
congestions
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 Pellegrino R, J Appl Physiol 111: 343-4 20114 Chan C, Woolcock A, Sullivan C. Am Rev Respir Dis 1989
Asthma improves with breathing control, through application of Continuous Positive Airways Pressure 3, 4
CPAP reduces hyperventilation while applied 2
HYPERVENTLATION – SLEEP APNOEA - ASTHMA
MRI scanred - yellow = highest oxygen dark blue = least oxygen
This might also provide a clue to the higher incidence of cancer 1 and Alzheimer’s 2 in people with sleep apnoea.
SNORING - SLEEP APNOEA AND BRAIN HYPOXIA
1 Dr. F. Javier Nieto2 Osorio et al 2013
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
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A BRIEF HISTORY OF ASTHMA
Asthma from the Greek aáζɛιν (aazein), which
translates as “to breathe with open mouth or to
pant”.
Asthma was not considered to be associated with
increased mortality until the 1930s with the
advent of bronchodilator medications
It first appeared in Homer's Iliad and the term was
probably first used in a medical sense by
Hippocrates.
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ASTHMA
• stronger thicker smooth muscle lining airways 1
• five times as many mast cells as non-
asthmatics 2
• more mucus producing cells lining the airways 3
Epigenetic Factors:Anything that promotes hyperventilation
1 Dail DH & Hammar SP. Pulmonary Pathology, 19882 Jurasek G. Respiratory Reviews V 7 No. 9 3 Lamb AB. Nunn’s Applied Respiratory Physiology, 2000
Genetic Factors:
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
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BREATHING - BUTEYKO AND ASTHMA
CO2 deficit
(hypocapnia)
compensationASTHMA
increased hyperventilation
airways cool & dry out
trigger
bronchoconstrictionincreased mucus
productionincreased histamine
inflammation
increased exposure to
irritants
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BUTEYKO STUDIES FOR ASTHMA Published studies 1998 - 2012
- Reductions in asthma reliever medication of 85-100%
- Reductions in inhaled steroid medication of 40-50%
- Symptom reduction (improved quality of life scores)
- No deterioration in lung function despite medication
reduction
Links to published Buteyko studies: http://www.buteykobreathing.nz/webapps/i/76035/133168/579348
Bowler et al., Medical Journal of Australia 1998 169
Opat et al., Journal of asthma 2000 37
McHugh, et al., New Zealand Medical Journal Dec 2003 V 116
Cooper et al., Thorax 2003 58
McHugh et al., New Zealand Medical Journal May 2006 V 119
Slader et al., Thorax 2006 61
Cowie et al., Respiratory Medicine, May 2008 V 102
Zahra et al., Egyptian Journal of Chest Diseases and Tuberculosis (2012) 61
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A small clinical study of Buteyko Method shows a 70 per cent reduction in Rhinitis symptoms
Adelola O.A etal Clinical Otolaryngology 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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OVER- BREATHING -WHAT TO LOOK FOR:
• 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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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
Keep your mouth closed throughout the exercise
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
HOW MUCH AIR DO YOU BREATHE?
• Hold your 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.
Try this test to see how much air you are breathing
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 speaking:
• 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
• Instruct to nasal breathe if possible
• Slow the breathing rate and try to reduce breathing
volume
• Instruct on diaphragmatic breathing
• Reduce or eliminate 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
ASTHMA AND SPORT
• Instruct to breathe through the nose, whenever
possible to help maintain the natural broncho-
dilating effects of CO2 in airways
• Adjust intensity to allow comfortable nasal
breathing
• Drop shoulders and breathe from diaphragm
• Slow the rate and volume of breathing during
breaks in play and after physical exertion to boost
cellular O2 and
reduce lactic acid
• Buteyko practitioners 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 exercises
BUTEYKO BREATHING CLINIC PROGRAM *
• Four 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 WhitePractitioner
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
BUTEYKO BREATHING CLINICS
For information about the Buteyko breathing retraining programme:
• Consultations• Introductory seminars• Courses• Workshops for health professionals Tel: 09-360 6291 [email protected]
www.buteykobreathing.co.nz
Glenn White BSc MSc MBIBH BIBH Practitioner/trainerwww.buteykobreathing.co.nz
SNORING – SLEEP APNOEA - ASTHMA - CROOKED TEETH ... WHAT’S THE LINK?
REFERENCES Abnormal facial development linked to mouth breathinghttp://www.buteykobreathing.nz/webapps/i/76035/133168/579346
Asthma stress and hyperventilationhttp://www.buteykobreathing.nz/uploads/76035/files/Asthma_stress_and_hyperventilation.pdf
Supporting evidence for the use of breathing training for asthmahttp://www.buteykobreathing.nz/webapps/i/76035/133168/579348