BREATHING BIOFEEDBACK. PROPER BREATHING PATTERN

The importance of breath in the context of health has been understood for millennia. The tradition of using breath for health and healing has been transmitted from generation to generation through a variety of practices, including religion/prayer, meditation, martial arts, yoga, etc. The technique that teaches correct breathing patterns called breathing biofeedback has now become the focus of medical research, with a dramatic rise in the number of publications related to the therapeutic use of breath for multiple pathological states and disorders over the past 20 years.

Table of Contents

The importance of the breathing process is difficult to overestimate. Breathing is one of the vital functions of the body. The parameter of breathing speaks of a person’s condition: the depth, rate of respiration, and ratio of the respiratory cycle phases determine the number of psychophysiological processes. Therefore, it is important to be able to adjust respiration parameters arbitrarily. In general, the respiratory rate, as well as the duration of the individual phases of the respiratory cycle, reflects the state of health and the level of efficiency of the respiratory system, the reserve capacity of the body, that is, its life potential. Respiratory exercises, as they are automated, increase the strength and endurance of the respiratory muscles, increase the respiratory system’s efficiency, and improve lung ventilation. The breathing process can be trained, especially with the use of modern simulators called the breathing biofeedback technique (BFB). We can control the duration and depth of inhalation, exhalation, and the duration of pauses after inhalation and exhalation.
The depth and frequency of breathing also depend on the strength and endurance of the main respiratory muscles (diaphragm muscles, external and internal intercostal muscles). The better these muscles are developed, the more economically the respiratory system works, and the more its reserve capabilities. It is known that there is a correlation between the phase of the respiratory cycle and the heart rate. This phenomenon is called respiratory sinus arrhythmia (RSA). Inhalation causes suppression of the vagus nerve and acceleration of the heart rhythm, and exhalation irritates the vagus nerve and deceleration cardiac activity.
There is a determined dependence between mental activity and respiratory sinus arrhythmia. Mental stresses usually cause an inhibitory effect on the centers of the vagus nerve. For example, when resting after mental fatigue, the respiratory arrhythmia is most pronounced; and vice versa, in a wakeful state, with mental work or agitation, respiratory arrhythmia disappears. Thus, the parasympathetic system plays a decisive role in the origin of this phenomenon.

Two methods are used to quantify respiratory sinus arrhythmia (RSA):

1. Calculation of the average difference between the maximum and minimum values of cardio intervals in the respiratory cycle (absolute value of RSA);
2. Spectral analysis of the heart rhythm (power or amplitude of the spectrum in the frequency range corresponding to the duration of the respiratory cycle).

It was shown that RSA is observed mainly with a slow pulse and slow breathing. When the heart rate or breathing rate increases the RSA became less. Under the influence of physical movements, when the influence of the sympathetic nerve predominates, RSA also disappears. Slow deep breathing contributes to a clear manifestation of respiratory sinus arrhythmia and pauses between exhalation and inhalation enhance it.

The value of RSA directly depends on the psycho-emotional and physical condition of a person. The healthier the person, the greater the RSA value and the lower the biological age. When a solid data bank was accumulated, the following scale of biological age was compiled.

RSA bit/min	*Biological age (years)*
more than 37	0-9
36-33	10-19
32-29	20-29
28-25	30-39
24-21	40-49
20-17	50-59
16-13	60-69
12-9	70-79
8-5	80-89
4 and less	90 and more

THE PRINCIPLES OF PROPER BREATHING TEACHING

Proper human breathing is natural breathing.
Diaphragmatic or diaphragmatic-relaxation breathing is breathing by the abdomen (belly), which was originally inherent in man by nature and is one of the oldest types of breathing. Diaphragmatic breathing is carried out due to the diaphragm, which provides almost 90% of the gas exchange of the body and its abundant oxygenation.

A child is born with a diaphragmatic type of breathing, which persists until the second half of the first year of life. Then in children comes a mixed type of breathing, that is, thoracic and abdominal breathing. By 3-7 years, thoracic breathing begins to prevail, which by the age of 7 becomes predominantly thoracic. With the onset of sexual development in boys, the diaphragmatic type of breathing is established mainly, and in girls – thoracic.

The technique of a person’s breathing changes with age under the influence of many factors: tight clothing, a sedentary lifestyle, everyday worries, stress, and much more. A person begins to breathe exclusively with the chest, which is accompanied by shallow breathing and, consequently, insufficient oxygen saturation of the blood. This, in turn, reduces the adaptive functions of the body and further exacerbates a person’s exposure to stress. Due to improper breathing, hypoxia of the body gradually increases with age, leading to the development of circulatory disorders, heart diseases, metabolic disorders, neurosis, obesity, depression, and many other pathological states and disorders.

The thoracic type of breathing is a tendency to breathe in the upper chest by using the accessory breathing muscles such as the intercostal muscles, the pectoralis, the scalenus, and the trapezius muscles. When you inhale, the chest expands and rises slightly, and when you exhale, it narrows and falls. The typical adult breathing pattern involves shallow thoracic movements with a respiration rate of 15-22 respirations per minute. There is also an absence of respiratory sinus arrhythmia. Thoracic breathing is more superficial and does not provide sufficient oxygen saturation of the blood, which affects the functioning of internal organs, cerebral vessels, and the balance of the sympathetic and parasympathetic nervous systems. Thoracic breathing can cause dyspnea, fatigue, irritation, headaches, and increased muscle tension in the upper chest as well as an increased feeling of anxiety and panic. Thoracic breathing can result in lower CO2 level that leads to hyperventilation. Acute hyperventilation commonly occurs with frightening or stressful events and resolves quickly. Chronic hyperventilation causes significant physical symptoms in every system of the body including dizziness, poor concentration, decreased peripheral temperature, muscle tension and cramps, irregular and rapid heart rate, and gastrointestinal upset.
With a mixed type of breathing, both intercostal muscles and the diaphragm are involved.

With the diaphragmatic type of breathing during inhalation, the diaphragm, which has the shape of a dome, becomes flat. As a result, the volume of the thoracic cavity increases, and the volume of the abdominal cavity decreases. This creates negative pressure in the thoracic cavity and provides a deep breath. When you exhale, the diaphragm relaxes and takes its original position. The respiration rate is 5 to 8 respirations per minute and is associated with a return of normal respiratory sinus arrhythmia. As people slow their respiration rate, the tidal volume tends to go up and the minute volume tends to go down. The tidal volume in diaphragmatic breathing ranges from 750 to 2000 ml of air per inhalation. The exhalation phase is longer than the inhalation phase. There are many theories regarding the physiologic mechanism of diaphragmatic breathing on pain and anxiety.

Breathing in through the nose stimulates the vagus nerve endings resulting in a lowering of the sympathetic response and inhibiting the fight/flight response. Additionally, the air is warmed, filtered, and moisturized as it travels through the nose resulting in less irritation and turbulence in the airway. Hyperventilation is diminished because the nasal passages are small which inhibits over-breathing. Slow breathing results in mild increases in CO2 which causes slowing of the heart rate, dilation of peripheral vessels, stimulation of gastric secretions, depressed cortical activity, and mild somnolence, all characteristics associated with relaxation. The focusing of attention on slow diaphragmatic breathing results in cognitive diversion, which may diminish attention to negative thoughts and increase a sense of personal control.

Diaphragmatic Breathing

What are the benefits of diaphragmatic breathing?

Diaphragmatic breathing, providing optimal oxygen saturation of the body, also has a number of other positive effects on the body:

Stress resistance is developed,
Rapid fatigue disappears and exercises tolerance increases,
Concentration, memory, and mental activity improve,
Biofeedback-assisted diaphragmatic breathing and systematic relaxation are very useful in migraine and had a significantly better long-term prophylactic effect than medications (according to some research data, significant clinical response was seen with biofeedback in 67% and with propranolol in 64% of patients).

The work of the lungs improves, they are cleaned, their volume increases, and shortness of breath disappears, which has a therapeutic effect on the pathological states and disorders of the respiratory system (asthma, respiratory allergies, etc.),
Myocardial blood supply improves, and in patients with coronary disease or hypertension, the strength and frequency of angina pectoris and hypertensive crises are significantly reduced, hemodynamics are improved,
The function of the abdominal organs improves the gastrointestinal tract, pancreas, gall bladder, bile ducts, kidneys (constipation, pain, flatulence, irritable bowel syndrome, etc.),
Hormonal balance and metabolism normalize, providing maintaining of normal weight.

Diaphragmatic breathing activates the parasympathetic nervous system, promoting relaxation, and is a very effective therapeutic tool for panic attacks, anxiety, problems falling asleep, logo-neurosis, asthma, etc.

How to develop diaphragmatic breathing?

It is impossible to constantly observe the correct breathing technique. But if a person develops and consolidates the habit of the correct breathing technique, then it will remain for life.

CHARACTERISTICS OF EACH PHASE OF PROPER BREATHING

The main muscle of proper breathing is the diaphragm. Proper breathing is carried out only through the nose, while the shoulders remain motionless, and the lower ribs diverge forward and to the sides. In addition, the basis of proper breathing is the optimization of the ratio between the inhalation-exhalation phases, which ensures the best supply of oxygen to the body.

The regulation of the ratio of inhalation and exhalation is one of the important factors in ensuring the optimal functioning of the respiratory system. The most effective in physiology is the respiratory cycle, in which the exhalation is longer than the inhalation. On average, the exhalation phase should be twice as long as the inhalation phase.

Exercise your proper breathing 4/6 with video-guide.

Exercise your proper breathing 4/8 for prolonged exhalation

The first phase is the exhalation.

A properly organized exhalation activates the respiratory muscles and provides a further optimal breathing pattern. Exhalation should be natural, and effortless. Exhalation is performed through the nose. It should occur without jerks, in an even long stream. You should not try to exhale all the air from the lungs to the end, the remaining part is necessary for the next pause after exhalation. A pause must be natural and non-violent. It is a pause that determines the amount of air required for inhalation, depending on the state of the body. A pause after exhalation should suggest a moment of the natural desire to inhale, and then air due to the spontaneous movement of the ribs and diaphragm will enter the lungs and fill them as much as required. If in the first 2-3 weeks after the start of breathing exercises the pause is still consciously controlled, then in the future it becomes natural, not determined by consciousness, and will depend on the magnitude of the load and the functional state of the human body. That is why a pause is extremely dynamic, inconsistent, and sometimes – for the duration of the execution of a certain task that faces a person, it can disappear completely.

The second phase is inhalation.

Inhalation should be natural and only through the nose. Inhalation should be carried out by lowering the diaphragm, smooth and silent, before the expansion of the lower ribs of the chest, i.e. due to abdominal breathing. Inhalation is carried out smoothly, silently, without the slightest tension in the respiratory tract.

Respiratory techniques can be performed in any position. Only one condition is mandatory: the spine must certainly be in a strictly vertical or horizontal position. This makes it possible to breathe naturally, freely, and without tension, and to fully stretch the muscles of the chest and abdomen. If the back is straight, then the respiratory muscles (mainly the diaphragm) can function easily and freely. The position of the head is also very important: in the sitting position, it should be fixed straight on the neck. This pulls up the chest and other parts of the body. Attention: under no circumstances should the neck be strained!

When performing a breathing exercise, you should breathe through the nose; lips are slightly closed (but not clenched). It is necessary to pay attention to the fact that when you inhale, the shoulders do not straighten or rise.

USING BREATHING BIOFEEDBACK TECHNOLOGY TO DEVELOP PROPER BREATHING SKILLS

The main goal of the breathing biofeedback method is the formation of skills of voluntary self-regulation of breathing.
The following biofeedback modalities are used for respiratory training: Breathing biofeedback, HRV biofeedback, and EMG biofeedback.

Breathing biofeedback training includes the following stages.

Preparation for the training course.
The preparatory phase includes testing to take parameters of abdominal breathing, thoracic breathing, and heart rate. During the test, such important indicators as the duration of the respiratory cycle, the ratio of inspiratory and expiratory time, and the ratio of thoracic and abdominal breathing are determined. These indicators will be used later in the training process.

Effective breathing training
Biofeedback training can conditionally be divided into three key stages.
1) Skilling in abdominal (diaphragmatic) breathing.
2) Training in rhythmic breathing with extended exhalation.

It is known that the rhythm of breathing and the depth of inhalation/exhalation can affect the emotional state of a person. For example, rhythmic, calm breathing reduces the excitability of not only the respiratory center but also some other centers, for example, the emotional one. The basis of this phenomenon is the following psychophysiological mechanism. Inhalation is associated with excitation of the sympathetic nervous system. Exhalation is associated with its inhibition. During inhalation, the person’s mental state is activated, and during exhalation, the whole organism calms down and relaxes. Thus, in order to bring oneself to rest and emotional balance with the help of breathing, one should gradually increase the expiratory phase (including pause) in the respiratory cycle.

3) Actually training effective breathing.

The purpose of the training is the predominance of the expiratory phase over the inhalation provided that breathing exercises do not lead to an increase in sympathetic activity. Therefore, at this stage, respiratory training is conducted under the control of heart rate and EMG of the frontal muscles. With proper breathing, heart rate and EMG of the frontal muscles should not increase.

At the end of the training session, a monitoring session is recommended. During a monitoring session, in a calm state, all signals used in the training are recorded too. This session is used to compare respiration, heart rate, and EMG before and after training.

Controlled breathing is a powerful physiological mechanism for supporting emotional self-control, and for achieving focus and calm. Breathing biofeedback training is very easy to perform: from 10 to 15 sessions in total, each for 25-30 minutes.