Are you breathing properly?

Consultant Respiratory Physiotherapist Julie Moore [pictured below], Guy’s and St Thomas’ NHS Foundation Trust, sets out some simple steps to improve your breathing.

She explains the importance of nose breathing in maintaining lung health, and how over-breathing is bad for your internal regulation.

Breathe through your nose

Breathe through your nose as much as you can. Your nose is your natural mask to the world. It filters out the pollution and bugs that are all around us and so cleans the air, it also prepares the air for your lungs by warming it and adding some moisture.

Your lungs are approximately 90% water, which is important for them to function properly. If you mouth breathe too much you can lose moisture in the lungs, causing irritation. This irritation can create a sensation in your airways that is uncomfortable, and can aggravate symptoms of asthma or chronic obstructive pulmonary disease (COPD).

It is normal to breathe through the mouth when you walk up a flight of stairs or you do something that exerts you, but as soon as you have recovered close the mouth again. Breathing through your nose at night can help you get better quality sleep and usually means you don’t wake up with a dry throat and mouth!

Mouth breathing is often habitual and may have been adopted due to chronic nasal problems or just because it’s easier to breathe through it. However, because it feels easier it doesn’t mean it’s better for you. If you have a blocked nose it may just be because you have not used it properly in a while so it loses its normal function.

The good news is if you start using your nose it can open up inside naturally. Humming with your mouth closed is a great way to get the nose working again. However, if you suffer with chronic nasal stuffiness despite trying to keep your mouth closed then talk to your GP or pharmacist, as you may benefit from a nasal spray that will help to reduce inflammation or manage any allergies that might be causing the blocked nose. Don’t just think you can use your mouth instead!

It is easier to use your mouth and often feels easier but this is part of the problem. Breathing is a sensation and the more you ‘feel’ your breathing the more you want to feel it… we shouldn’t really ‘feel’ our breathing too much. Breathing is automatic, feeling it all the time can lead to overload of the sensation and create a sense of wanting to breathe more which can in some lead to feelings of panic and anxiety that they can’t get enough air in, which then makes you breathe more and a cycle begins.

Avoid over-breathing

Breathing can feel addictive as the more we breathe the more we want to breathe. Over breathing is not good for your body’s internal regulation - it disrupts everything at a cellular level. The key is to breathe to meet your body’s requirements, your body should do this automatically but what we think and feel can disrupt this automatic process. For most people, I tell them to breathe less!

Use the right muscles

To check which muscles you are using to breathe when you are relaxed and resting, place one hand on your tummy, and the other on your upper chest region. Feel which hand moves as you breathe in and breathe out – ideally it should just be your tummy and not much if any upper chest movement. Your upper chest moves more when you move around and you need a bigger breaths.

When you are sitting or lying down your tummy should moveout as you breathe IN and relaxes back when you breathe OUT this means you are using your diaphragm to breathe, which is good as it’s the main breathing muscle. It’s important that you do not force this movement as it’s not the stomach muscles that are working.

If you can feel your upper chest moving when sitting relaxed it means you are using muscles that get tired easily and this is a waste of energy. 

What is a good resting breathing pattern?

• Quiet – no sound whatsoever (you shouldn’t be able to hear anything);
• In and out through the nose – only a trickle of air that you can barely feel going in and out;
• The chest does not move – the breath at rest is so small that you just feel your tummy move (the diaphragm sits at the bottom of the chest, and as it contracts down it makes your tummy come out);
• The breath out is relaxed and effortless – the diaphragm relaxes and the air comes out gently (no muscles used);
• There is a pause at the end of the out breath which is like a mini rest – just for one to two seconds before the next breath comes in. Feel the pause – it’s very relaxing and a good thing to focus on when trying to relax your breathing;
• You breathe approximately 10-14 breaths per minute when you’re sitting or lying still, so if you find it’s faster than this, try adding the pause at the end for one to two seconds and it will slow it down.

The success of altering your breathing to an optimal pattern is to not try too hard. Breathing should be automatic so just tweak it gently but do it little and often throughout the day, so it becomes habitually better and automatic rather than forced.

And finally, what about mouth taping?

There’s been lots of attention about this, but before you think about taping your mouth, try simply closing you mouth as much as possible. No need for tape!

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Useful resources:

• Test your breathing - Physiotherapy for breathing pattern disorders (physiotherapyforbpd.org.uk)
• Physiotherapy for breathing pattern disorders resources for physiotherapists (physiotherapyforbpd.org.uk)
• Self Help - Physiotherapy for breathing pattern disorders (physiotherapyforbpd.org.uk)

Julie Moore is the Consultant Respiratory Physiotherapist for the South East London Long COVID Programme. Over the past 18 months the team, funded by NHS Charities Together and Guy’s & St Thomas’ Charity, has been collaborating with patient advisers about what has helped in their recovery, and what has not. Find out what they had to say here.