Buteyko Breathing 101: The Basics & Practical Application of Physiologically Normal Breathing Into Speech Therapy

Transcription

1 Buteyko Breathing 101: The Basics & Practical Application of Physiologically Normal Breathing Into Speech Therapy Hadas Golan,M.S., CCC/SLP, BBE Buteyko Educator and Trainer, Speech-Language Pathologist, Voice Specialist Boston Medical Center Department of Otolaryngology Center for Voice and Swallowing

2 Disclosure My name is Hadas Golan, and I will discuss the basics & practical application of physiologically normal breathing into speech therapy. I am a speech-language pathologist and a voice specialist at Boston Medical Center. I am also a member of the Buteyko Breathing Educators Association (BBEA) and the Training Institute of Buteyko Educators (TIBE). The information I'm presenting today is part of the Buteyko method. I do benefit financially from teaching the Buteyko program and training educators. I do not receive compensation for my roles at the BBEA and the TIBE. 2

3 Agenda Functional and dysfunctional breathing What does poor breathing look like Symptoms of dysfunctional breathing How stress affects breathing and health The physiology of over breathing How to recognize over breathing Over breathing in voice patients Techniques to normalize the breathing 3

4 Dr. Konstantin Buteyko Dr. Konstantin Buteyko was born in 1923 in Ivanitsa (near Kiev) As a medical student he was assigned to monitor the breathing of diseased patients He noticed that illness and deep breathing are correlated Dr. Buteyko developed a breathing program to correct dysfunctional breathing and restore health 4

5 What is the Buteyko Breathing Method Breathing exercises specially designed to restore normal breathing patterns combined with principles about physical exercise, food and sleeping as they relate to healthy breathing habits. Buteyko provides a safe, simple, and natural means of reducing the symptoms of asthma, allergies, chronic bronchitis, emphysema, sleep apnea, hyperventilation syndrome, panic attacks, bronchiectasis, hay fever, chronic sinusitis, rhinitis, and other stress-related diseases. 5

6 Functions of Breathing Primary: Biochemical: it sustains life by optimizing oxygen, carbon dioxide, and ph regulation needed for metabolism Biomechanical: it optimizes neuromuscular respiratory pump 6

7 Functions of Breathing Secondary: Affects motor control and postural stability Plays several roles in physiological and psychological regulation Can influence homeostatic functions in other systemsthe autonomic nervous system, the circulatory system, chemical regulation, and metabolism Rosalba Courtney, The functions of breathing and its dysfunctions and their relationship of breathing therapy, International journal of osteopathic medicine 12 (2009)

8 Functional Breathing Is breathing that performs and adopts its various functions to quickly and appropriately meet the changing needs of the individual and changes in the internal and external environment Efficiently maintains the functions of breathing Rosalba Courtney International journal of osteopathic medicine 12 (2009)

9 Dysfunctional Breathing Its parameters are not clearly defined, difficult to determine prevalence Breathing which is unable to perform its various functions efficiently and is inappropriate for the needs of the individual at that time Results in disturbance or inefficiency of the functions of breathing Affects people s lives Challenges homeostasis Creates symptoms and compromises health Rosalba Courtney International journal of osteopathic medicine 12 (2009)

10 Breathing Therapy Aims to either correct dysfunctions of breathing or enhance its functions Breathing, unlike most physiological functions, can be controlled voluntarily You can re-program your breathing style so that the amount of oxygen that reaches the tissues is greatly increased Can serve as an entry point for physiological and psychological regulation This will lower your risk of various diseases and will powerfully impact your physical and emotional life 10

11 Breathing is Important Good breathing behavior means proper regulation of body chemistry that ensures proper distribution of oxygen Bad breathing behavior means deregulating body chemistry The effects of deregulated chemistry on health and performance can be dramatic and profound causing serious physiological crisis involving system-wide compromises 11

12 Measure your Breathing Count your number of breath cycles in one minute 12

13 Observe your breathing Assume an upright but relaxed posture Put one hand on your chest and one on your solar plexus Feel where you are breathing from Look at your hands to see your breathing Can you hear your breathing? Rhythm- regular/irregular Does your breathing feel easy (satisfying)/ heavy (labored)/restricted? Airflow- warmth, no flow/gentle/strong? 13

14 What is Normal/Functional Breathing? Gentle wave pattern- smooth/regular, even timing and similar-sized breaths Silent- day, night, light/moderate activity 4-5 liters of air per minute with about 500ml each breath at rest 8-12 breaths per minute at rest Breathing in and out through the nose Using diaphragm No upper chest movement Initiated at 40 mm Hg of CO2 in the arteries (paco2) 14

15 What Does Poor Breathing Look Like? How do you compare with normal? Fast breathing- often, not always Upper chest breathing- using the rib and accessory (shoulder& neck area) muscles more Upper chest moves before or more than solar plexus May see shoulders and collarbones lifting Paradoxical breathing-abdomen is drawn in on inhale 15

16 What Does Poor Breathing Look Like? How do you compare with normal? Irregular breathing- very common, varying breath sizes and timing During the day: yawning, sighing, throat clearing, extra deep breaths, irritable coughing, and breath holding During the night: bouts of snoring, snorting, gasping and choking breaths, periods of breath holding of varying lengths 16

17 What Does Poor Breathing Look Like? How do you compare with normal? Mouth breathing- mouth is a bigger opening than the nose- resulting in over breathing Common in people with snoring and sleep apnea, asthma and allergies, common in kids and athletes 17

18 What Does Poor Breathing Look Like? How do you compare with normal? Over breathing- breathing more air in and out of your lungs than is needed for the current level of activity. Very common! Can be significant and yet unnoticeable My observation- majority of my clients have excessive volumes most of the time, even when nose breathing 18

19 What Does Poor Breathing Look Like? Normal breathing 5 LPM Heavy snorer- 15 LPM This is extra 10 liters of air breathed every minute Over an 8-hour night of heavy snoring: 600x8= extra 4800 liters of air 19

20 Signs and Symptoms of Dysfunctional Breathing Chronic over breathing is associated with a wide array of symptoms in any organ or system and can mimic serious disease Affects tissue lining of the nose, sinuses, throat, and lungs Alters normal blood chemistry Psychological effects Affects respiratory, cardiovascular, neurological, GI, and musculoskeletal systems May hold the explanation for a wide range of health problems 20

21 BAD DREAMS 21

22 Do you experience effects of over-breathing? Shortness of breath, chest tightness and pressure, chest pain, nausea, coughing, excess sighs/yawns, snoring sweaty palms, cold hands, tingling of the skin, numbness heart palpitations, irregular heart beat anxiety, apprehension, emotional outbursts, tenseness fatigue, weakness, exhaustion, headache, poor sleep lightheadedness, dizziness, fainting, confusion, black-out poor concentration, poor memory, blurred vision Muscle spasms, stiffness, trembling, twitching Abdominal cramps, bloating, flatulence, indigestion, irritable bowel, belching, bad breath, dry mouth 22

23 Over breathing Related to Symptoms? Are you starting to see how your symptoms could be connected with the way you breathe? Many of them may improve if you learn to breathe correctly Breathing retraining directly addresses faulty breathing habits 23

24 Fight or Flight Response 24

25 Stress When we feel stressed F&F is activated. Adrenaline revs up the body to survive a threat to life - a body that is pumped up and a mind that is hyper alert. Saves us from life threatening events. For some of us stress hormones wash through the body almost continuously 25

26 Stress Environmental stress e.g. pollution or pollen Physical stress e.g. illness, poor posture, or not enough physical exercise Mental/emotional stress e.g. major financial loss, workrelated, pace of events, worry about self or close ones, ongoing stressful situations 26

27 Hyperventilation Dr. Buteyko considered the 'Disease of Deep Breathing' to be the root cause of many health conditions Hyperventilation simply means breathing more than metabolism requirements He recognized chronic low grade over-breathing (hyperventilation) that goes unnoticed most of the time The Buteyko breathing method is designed to normalize ventilation minute volume to normal levels, leading to improvement of symptoms 27

28 Hyperventilation Da Costa, L.C Lum, Magarian describe the Hyperventilation Syndrome- a collection of bizarre, apparently unrelated symptoms at any organ or system This is a profound biochemical disturbance. Patients labeled with anxiety and implication that they are inadequate Symptoms can be reproduced by voluntary hyperventilation Hyperventilation Syndrome: A Diagnosis Begging for Recognition; GREGORY J. MAGARIAN, MD; DEBORAH A. MIDDAUGH, MD, and DOUGLAS H. LINZ, MD, Portland; Topics in Primary Care Medicine HYPERVENTILATION: THE TIP AND THE ICEBERG; L. C. Lum* Journal of Psychosomatic Research, Vol. 19, pp. 375 to 383. Pergamon Press, Printed in Great Britain 28

29 Chronic Hyperventilation is Subtle Litres of air breathed per minute when resting: 12 x 0.5 = 6 (Normal) 20 x 0.5 = 10 Add effort: 20 x.75 = 15 Unrecognised because of the lack of obvious overbreathing and minimal discussion in medical school and textbooks 29

30 12 breaths per minute of 0.5 litre of air equals: 20 breaths per minute of 0.5 litre of air equals: 6 litres of air breathed each minute 360 litres per hour 8,640 litres per day 60,480 litres per week. 720 breaths per hour 17,280 breaths per day 120,960 breaths per week 10 litres of air breathed each minute 600 litres per hour 14,400 litres per day 100,800 litres per week breaths per hour 28,800 breaths per day 201,600 breaths per week 30

31 Normal breathing minute volume is 4-6 litres (W.H.O.) Minute Volume for asthma -14.1, 12, 15 litres. (Bowler, McFadden, Johnson) 1. Loss of CO2? 2. Cooling of airways? 3. Drying of the airways? 31

32 "Noisy and deep" breathing of an asthmatic had always been considered an outcome of the disease. Nobody could even suspect that "deep breathing" was the cause of bronchial asthma, and increased depth of breathing could provoke the appearance of the symptoms of the disease. K P Buteyko MD 32

33 Breathing too much air maintains the normal pressure of oxygen, but it lowers carbon dioxide in both the lungs and the bloodstream 33

34 The Physiology Is based on the importance of CO2 in many of the functions of the body, including: Triggering the breathing mechanism Maintaining the correct ph (acidity or alkalinity) Smooth muscle function o Low levels constrict, high levels relax o Smooth muscle constricts at 30 mm Hg PaCO2 o Affecting airway, blood vessels, and guts 34

35 As CO2 Levels Fall, ph Rises As your ph goes higher than 7.45 Hemoglobin (oxygen- carrying blood cells) form a tighter bond with oxygen. (Bohr effect) Less oxygen is released to the tissues. Tissues begin anaerobic respiration, creating lactic acid and lowering the ph Kidneys extract bicarbonates to help lower ph 35

36 MRI of the Brain Brain uses 25% of our oxygen intake. 36

37 Present Day Chronic Fight or Flight Response Sighing, yawning, gasping, dry mouth, blocked nose, runny eyes Brain fog, irritability, anxiety, fear, lack of concentration, light-headed, dizziness High blood pressure, palpitations, cold hands and feet, headaches Poor digestion, constipation, IBS, flatulence Aching muscles, stiffness, fatigue 37

38 Recognize Chronic Hyperventilation: Mouth Open Hearing breathing during rest Sigh regularly Sniff Taking large breaths prior to talking Yawning with big breaths Upper chest movement Lots of visible movement 38

39 Rest and Digest Response We have another choice When activated heart rate drops, blood pressure falls, respiration slows down, blood flow to the core of the body is re-established improving digestion, immune system function, sense of well being Breathing is the easiest way to activate the R&D system This should be our normal mode and F&F for emergencies 39

40 How Does Buteyko Work? Buteyko reverses the process by changing the level those chemo-receptors trigger The breathing exercises slowly get the body to adapt to trigger at higher levels of CO2 By reversing the process and sending messages of increased CO2 levels, it is possible to reset the trigger and return the breathing pattern to normal The result is breathing less air per minute and improved oxygenation of tissues- less symptoms 40

41 Breath Work in Voice Therapy Rationale for inclusion: o Respiration a component of P-S-F o Voice disorders disrupt normal speech breathing behaviors (Hillman, Holmberg, Sperry) o Abnormal breath management cause & result o Breathing patterns influence neck & Shoulder tension o Breathing can be used to relax, center o Self regulation for a balanced physiology 41

42 Dysphonia The vast majority of injured singers present in clinic employing excessive respiratory effort Excessive respiratory effort can manifest as both cause and effect in a disordered voice. The vast majority of injured singers say that they are trying to use more support 42

43 Over Breathing in Voice Patients Sapienza and Stathopoulos: a greater amount of lung volume was used by women with vocal nodules than women without vocal nodules during syllable train production The larger lung volume excursions were highly correlated to a greater rate of glottal airflow during voicing. 43

44 Dysphonia Excessive respiratory effort: Dries out the vocal folds results in phlegm Compromises efficiency of phonation (increased effort, more vocal fatigue) May cause phonotrauma due to increased collision forces 44

45 Dysphonia Excessive respiratory effort: o Invites excessive perilarygneal muscle tension to manage the excessive pressure o Exacerbates anxiety, cough, asthma, stuttering o Results in poor breathing pattern (and symptoms) and breath management for speech/singing 45

46 How To Retain your CO2? The fastest and best way to retain your CO2 is to BREATHE ONLY THROUGH YOUR NOSE! This means ALL THE TIME! Day and Night During Exercise In fact, you should breathe through your mouth only as often as you eat through your nose! 46

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48 Speech Breathing Fight for Flight kicks in when we take a breath through our mouths It triggers the sympathetic nervous system to activate quicken heart rate, faster breathing, pale, etc. 48

49 Talking Like the Queen Minimizes hyperventilation of speech Decreases gasping and anxious presentation Calming Improves dry/burning throat and mouth, laryngeal irritation, and phlegm Decreases effort of breathing and speech (fatigue) Helps to achieve resonant voice 49 49

50 Talking Like the Queen Improves sense of control Reduces upper chest involvement Allows the speaker to re-center and gives processing time for the listeners Is safer for the vocal folds Helps maintaining 24/7 nasal breathing Great fluency- shaping technique 50 50

51 Talking Like the Queen - Practice Count to 50 breathing every 5 numbers When you need to breathe close your lips first Pause and allow the air to come in without sucking it in (take your time) Continue Practice reading the Rainbow passage 51

52 Talking Like the Queen - Practice Practice the same with: Count to 50 at a comfortable rate. Take breaths as needed Sequence of events (daily activities, instructions, directions) Reading aloud Structured conversation 52 52

53 The Rainbow Passage When the sunlight strikes raindrops in the air, they act like a prism and form a rainbow. ^ The rainbow is a division of white light into many beautiful colors. ^ These take the shape of a long round arch, ^ with its path high above, and its two ends apparently beyond the horizon. ^ There is, according to legend, a boiling pot of gold at one end. ^ People look, but no one ever finds it. ^ When a man looks for something beyond his reach, ^ his friends say he is looking for the pot of gold at the end of the rainbow. 53

54 Breath Retraining Faulty breathing patterns are characteristic of people with respiratory disorders The aim is to achieve physiologically normal breathingto retrain/reprogram the respiratory center Normalize each aspect of breathing (rate, rhythm, volume, mechanics), for all situations (awake, asleep, at rest, during exercise, during eating, and speech) Breathing is re-trainable- habits can be changed Correcting the breathing will improve related symptoms 54

55 Breath Retraining First step is developing awareness to poor breathing habits- pay attention to breathing in different daily situations: how often do you breathe from your mouth, clear your throat, sigh, yawn, sniff, cough, breath hold, gasp when talking? Work towards a full-time nose breathing Work on relaxed, lengthened, upright posture Teach diaphragmatic breathing Work on breathing control during speech and exercise 55

56 Further information is available from: Hadas Golan Phone: Website: 56

57 Backup Slides 57

58 Dentistry- Craniofacial Implications From Habitual Mouth Breath For the face and consequently teeth to develop correctly: Mouth closed with lips gently together; Three quarters of the tongue resting in the roof of the mouth, with the tip of the tongue placed behind the front teeth; Breathing through the nose; Correct swallowing; 58

59 Facial Structure Children whose mouth breathing is untreated may develop long, narrow faces, narrow mouths, high palatal vaults, dental malocclusion, gummy smiles, and many other unattractive facial features, such as skeletal Class II or Class III facial profiles. These children do not sleep well at night due to obstructed airways; this lack of sleep can adversely affect their growth and academic performance. Many of these children are misdiagnosed with attention deficit disorder (ADD) and hyperactivity General dentist: Mouth breathing: adverse effects on facial growth, health, academics and behaviour. Jefferson Y, 2010 Jan- Feb; 58 (1):

60 Facial Structure If mouth breathing is treated early, its negative effect on facial and dental development and the medical and social problems associated with it can be reduced or averted. General dentist: Mouth breathing: adverse effects on facial growth, health, academics and behaviour. Jefferson Y, 2010 Jan- Feb; 58 (1):

61 Primate Experiments on Oral Respiration 61

62 Facial Characteristics 62

63 Face and Jaw Development 7 years 8 ½ years 63

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