Are you breathing properly? Norwich expert explains why bad breathing is worse than bad breath

Kelly Mitchell is a Respiratory Physiotherapist treating dysfunctional breathing. Her business is called The Breathing PT Byline: Sonya Duncan (C) Archant 2020

It’s easy to assume that just because we’re alive, we’ve got the whole breathing business down to a fine art: we’ve been doing it since day one it’s a skill all of us possess.

But there’s a difference between breathing and breathing properly, The Breathing PT Kelly Mitchell tells me, and bad breathing can cause a whole host of problems that she can help solve.

“Learning how to breathe properly can change your life,” she tells me, “how we breathe lays the foundations for how we feel. If your breathing isn’t great, you can feel off balance both physically and mentally.

“Breathing isn’t spoken about much in the mainstream health arena and I wonder if it’s because it’s gone a bit ‘way-out’ these days, a bit hippy-dippy, mumbo-jumbo, and that it’s lost its medical importance. That’s what I’d like to change.

“Most people take breathing for granted and don’t give it a second thought. In their minds it’s something which happens automatically and therefore their body must be doing it ‘right’.

“Dysfunctional breathing can cause a range of symptoms from chest pain to palpitations to anxiety, reflux, breathlessness, a feeling of not being able to take a breath in, dizziness, panic, pins and needles, neck, jaw and back pain.

“They go tend to go undiagnosed because they mimic so many other medical conditions. That’s why they often get missed.

“Some groups are more at risk of a breathing pattern disorder –it’s present in about 10 per cent of the general population but at around 40 per cent in the asthmatic and anxiety population.”

Kelly qualified as a physiotherapist in 2007 after graduating from the University of East Anglia and her first job was at the Norfolk and Norwich University Hospital where she worked in most areas of the hospital, including women’s health, the stroke ward, orthopaedics, intensive care, older people’s medicine and surgical wards.

She specialised in respiratory medicine in 2014, mainly working with patients with long-term lung conditions such as COPD, asthma, bronchiectasis and cystic fibrosis.

“It was in this role that I really started to learn about breathing and the impact it can have on your life – in the people with a medical condition and those who are fit and well,” said Kelly, whose practice is just outside Norwich.

Kelly has her own experiences of dysfunctional breathing that began after the death of her grandmother from breast cancer when she noticed problems with her own breathing.

There were crippling headaches as a teenager, anxiety and exhaustion following an illness, brain fog and stress waiting for a diagnosis of ulcerative colitis and a burn-out while studying for an MBA and taking on a new role as a departmental manager at the NNUH (while moving house).

“I knew something was wrong when my 65-year-old mother was working harder than me on the house move and I had to go and take a nap,” she says, “I was exhausted. Frazzled. Hanging by a thread.

“Then it happened. I stood there, in my new living room… I leaned against the sofa, waves of anxiety crashing over me, and I burst into tears. I couldn’t stop.

“I will always remember that feeling, a total loss of control. I’d lost who I was. I didn’t even recognise myself anymore. I was frightened and I didn’t know which way to turn.

“On top of that I had all these physical symptoms. I was taking massive breaths in. I felt breathless. My chest hurt. My cranky breathing was driving this show of feelings and emotions. As if I’d let myself get like this. A breathing physio!”

After her GP warned her she was “burnt out”, Kelly realised she needed to take stock of her life: she decided to take a break from studying and a one-year fixed contract in a clinical role for “breathing space”.

“Once I took time off work I spent time rehabilitating my breathing and over the space of about six weeks I started to feel better. I no longer have feelings of anxiety, ever,” says Kelly.

“I exercise. I feel the best I have in years. I’m starting a business in the middle of a pandemic and I’m not stressed even though I should be!

“I take time for daily relaxation and I keep stress in check with good breathing and taking time to relax. Actual relaxation is key to our health and most people never relax - they participate in downtime such as watching TV or exercising but that’s not true relaxation.”

In June, Kelly took the decision to leave the NNUH and set up her own business as The Breathing PT, offering a range of services that range from Breathing Reboots to Breathing Rehab and help to those suffering from chronic conditions including Long Covid.

“There’s no real consensus on what dysfunctional breathing is but commonly used terms are hyperventilation syndrome, breathing pattern disorders or breathing dysfunction. Some people may ‘over breathe’ by breathing quickly or deeply or sighing and yawning. Other people breathe through their mouths or upper chest using their neck and shoulder muscles rather than their diaphragm,” said Kelly.

Up to 12 per cent of the population experience chronic breathing disorders with some more affected than others.

Kelly offers complimentary 20-minute consultations to assess whether she can hep a patient and decide whether a course of physiotherapy is right for them: this can be offered by Zoom or in person at her clinic, which will be open during the second lockdown. Treatment packages will vary depending on a patient’s needs.

There is also a one-off Breathing Basics one-off session for £95 in which Kelly teaches the basics of good breathing and offers tailored advice and guidance – for example, how to deal with discomfort felt about breathing while wearing a face-mask.

I tell Kelly that since reading about her business six weeks ago, I have endeavoured to breathe through my nose only (even to the point where I set regular alarms to remind myself to do so!) and have tried to regulate my breathing as per her instructions.

And then I tell her that it has made a considerable difference: from being someone who yawned and sighed almost constantly and who felt exhausted, I feel very noticeably better – can it really be down to breathing?

“It can make a massive difference to lives,” she tells me, “I want everyone to understand the impact breathing has on your physical and mental health and understand what breathing well means.

“I’d like it to become part of the health and wellbeing world like diet and exercise, part of the management of stress and anxiety problems as standard. I’d like to see breathing techniques taught to children at school.

“Life will be tough at times but we don’t need to make it tougher. Stress has become a normal part of this busy, crazy world. But managing how we breathe during these periods of stress is key: I honestly believe it’s a game changer.

“Our feelings and our breathing are intertwined and the sooner we realise this the better we’ll all feel.”

* Find out more at www.thebreathingpt.co.uk

Breathing Q&A

What happens when you breathe?

We breathe in air containing a mixture of oxygen (O2) and carbon dioxide (CO2). When you breathe out, the air contains less oxygen and more carbon dioxide. This is because the body uses some of the inhaled oxygen to help support its processes and creates carbon dioxide as a result. CO2 isn’t just a waste product, however, it has a vital role in the body’s processes.

What happens when you hyperventilate?

Your breathing will become faster and deeper which results in more CO2 being exhaled from the lungs and less being available throughout the body. Lower levels of CO2 promote hormones such as adrenaline to stimulate the body and increase the heart and breathing rate. If this overbreathing becomes a habit, the brain recognises the lower level of CO2 and accepts it as normal, leaving the body on constant alert.

What are the possible signs and symptoms of breathing pattern disorders?

Everyone will experience different symptoms, but common symptoms include headache, feeling as if you’re not getting enough air, sighing and yawning regularly, a tight chest, panic attacks, reflux or an upset tummy, cramps or tremors, dizziness or fainting, pins and needles, irritability, exhaustion, feeling on edge, poor sleep, a dry throat, palpitations, chest pain, anxiety, weakeness and brain fog. These can also be symptoms of a more serious illness, please consult your doctor if you are worried. If you have symptoms such as chest pain, palpitations or shortness of breath, your GP must rule out any serious underlying cause. Don’t just assume it’s breathing dysfunction.

What are the potential causes of breathing pattern disorders?

Such disorders can be a sign of other underlying problems which include depression, anxiety, stress, the use of some drugs, alcohol, caffeine or nicotine and medical conditions such as anaemia, asthma, pneumonia, blood clots, fluid on the lungs or COPD. High altitude, fever, hormones or exercise can also be at the heart of such disorders.

How many times should you breathe per minute?

At rest, optimal breathing is approximately 10 to 14 breaths per minute – the air should enter and leave your nose in a gentle and controlled manner and you should breathe using your diaphragm (the muscle under your ribcage).

How can I tell if I have a normal breathing pattern?

Sit in a comfortable position with your feet flat on the floor and your back supported. Place one hand on your chest and one on the top of your tummy. Watch and feel which of your hands moves most as you breathe in and out which will help you to understand which part of your lungs you are using the most - you should be breathing from your diaphragm. Ask friends and family if you have habits such as frequently yawning, coughing or sighing.

What is ‘Long Covid’ and what can you do help people who are suffering from it?

Long COVID is the term given to a group of symptoms people experience weeks or months after their initial infection. It’s been estimated 10 per cent of people who’ve had coronavirus develop Long COVID and it is presenting in people who were considered to have a ‘mild’ initial infection. I have been able to help those who have been struggling with on-going breathlessness . I am unable to review anybody who has not sought medial intervention first. I will also refer to a GP if I feel further investigation is warranted. I’ve found the techniques I use to manage breathlessness have reduced these feelings in the first session. It also helps reduce feelings of anxiety. Physiotherapists are also well placed to manage lingering, irritable coughs or secretions and fatigue with pacing strategies.

I’ve heard of sleep apnoea, but what is screen apnoea?

It’s when people concentrate on their screens to the point where they start breath holding. This increases shoulder and neck tension and causes pain and upper chest breathing patterns. Lifestyle affects breathing: corsets, extreme dieting, tight clothing – all can affect how well you can breathe.

Why is nose breathing so important?

The nose cleans, warms and wets (humidifies) the air. This is best for the lungs. Nose breathing has shown to improve oxygenation compared to mouth breathing. The nasal sinuses also produce nitric oxide which is our first line of defence against viruses and bacteria as it sterilises the air. It is also a potent vasodilator and bronchodilator, so it opens up the blood vessels and airways, improving blood flow and oxygenation.

Is there one easy tip you can offer to help us breathe better?

Relax your shoulders and jaw. Breathe through your nose. Breathe from your diaphragm. Let your body and mind rest. Let yourself feel well again.