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  • 1. Educational Capnography DYSFUNCTIONAL BREATHING Effects of Compromised Respiration on Physiology and Psychology Peter M. Litchfield, Ph.D. Graduate School of Breathing Sciences Tel: 307.633.9800 Cell: 505.670.2874 www.breathingsciences.bp.edu pl@breathingsciences.bp.edu Copyrighted 2012-2013

2. MISSION Applied Breathing Sciences Our mission is to help people improve health and performance through the application of behavioral learning principles to breathing physiology. 2 3. PROBLEM Self-defeating learned breathing behaviors compromise physiology, psychology, health, and performance. Learned dysfunctional breathing has a major impact on multiple physiological systems, resulting in symptoms and deficits, usually attributed to other causes, by clients and their health practitioners, rather than to learned behaviors and responses that may account for them. 3 4. OBJECTIVE Applied Breathing Sciences Clients learn new breathing habits, and related behaviors, that are consistent with healthy physiology and psychology. 4 5. SOLUTION Applied Breathing Sciences Practitioners offer client-centered learning solutions, based on the principles of: behavioral counseling behavioral analysis behavior modification cognitive learning awareness training applied psychophysiology phenomenological exploration (consciousness) 5 6. RELEVANCE Breathing Learning Services Dr. Robert Fried comments as follows: There are varying reports of its [dysfunctional breathing] frequency in the population at large, ranging between 10 percent and 25 percent. It has been estimated to account for roughly 60 percent of emergency ambulance calls in major US city hospitals. (Fried, Robert Breathe Well, Be Well. 1999, p 45) Fewer than 1 in 100 of my clients show normal PCO2. It has long been known that it is rare among persons with seizure disorders, heart disease, asthma, anxiety, stress, panic disorder with or without agoraphobia, other phobias, hyperthyroidism, migraine, chronic inflammatory joint disease with chronic pain, and so on, NOT to hyperventilate. Were probably looking at half the U.S. population. (The Psychology and Physiology of Breathing. 1993, pp. 43-44.) 6 7. RESPIRATION AND BREATHING are not the same thing. Respiratory physiology is reflexive. Respiration involves the breathing mechanics of gas exchange (external respiration), the biochemistry of gas distribution to and from tissues (internal respiration), and the utilization of oxygen by the mitochondria of cells (cellular respiration). Breathing physiology is behavioral. Breathing is mechanical; otherwise known as external respiration. It is about moving air in and out of the lungs. It is a behavior, however, that serves multiple objectives, such as moving air to create speech. Breathing behaviors that serve these other objectives should operate in concert with its primary objective, respiration. Breathing, as a behavior, is subject to the same principles of learning as any other behavior, including the role of motivation, emotion, attention, perception, and memory. Failure to make this distinction between respiration and breathing has led to fundamental misunderstandings that have prevented the practical union of respiratory and behavioral sciences. 7 8. BREATHING OBJECTIVES Breathing as a set of behaviors serves physiological, psychological, and social needs and motivations. Here is a list of some of them: Delivery and utilization of oxygen (respiration) pH regulation, electrolyte balance Vascular regulation, e.g., cerebral and coronary Buffering metabolic acids, e.g., lactic acid Non respiratory lung functions (filtering and metabolic functions) Muscle regulation, e.g., triggering and dysponesis Defensive posturing, e.g., coping with stress and anxiety Speech and singing Psychological state changes (dissociation), disconnecting Emotional and mood control Secondary gain (benefits from symptoms) Sense of control, security, confidence Access to other responses, e.g., relaxation Meditation, consciousness shifts Yoga, consciousness shifts 8 9. BREATHING BEHAVIORS Breathing behaviors are considered dysfunctional based on their relationship with other behaviors and how together they impact physiological and psychology. Here are examples of some breathing operants, that is, behaviors that may be reinforced: Aborted exhale Accessory muscle breathing Breath holding Deep/shallow breathing Disruptive thoughts Dysponesis Effortful breathing Fast/slow breathing Forced exhalation Gasping, sighing, coughing Intentional manipulations Interpretation of symptoms Mouth/nasal breathing Overbreathing Underbreathing Reverse breathing Self-talk Transition time 9 10. DYSFUNCTIONAL BREATHING Dysfunctional breathing is defined as behavior that compromises physiology and/or psychology, acutely and/or chronically. The reconfiguration principles of physiology, i.e., learning principles, point to the most fundamental, practical, and profound factors that account for: (1) the far-reaching effects of dysfunctional breathing habits (e.g., deregulated plasma pH, chronic contraction of muscles in the jaw), as well as for (2) the surprising benefits of self-regulatory breathing habits (e.g., improved cerebral blood flow for improved attention, learning, and performance, or muscle reeducation that supports jaw realignment). 10 11. RESPIRATORY FITNESS The fundamental objective When breathing allows for reflex-regulated gas exchange, its external respiratory function is serving its purpose. Respiratory fitness is about reflex-regulated gas exchange based on: extracellular pH, extracellular partial pressure carbon dioxide (PCO2), and blood plasma PO2. It is about moment to moment regulation of: extracellular pH, electrolyte balance, blood flow, hemoglobin chemistry, and kidney function. Respiratory fitness is optimal when fundamental feedback reflex mechanisms are permitted to serve their function. 11 12. COMPROMISED MECHANICS Dysfunctional habits not only seriously compromise respiration, but may also directly disturb physiology and psychology on many levels. Breathing habits may be dysfunctional as a result of triggering: PHYSICAL CHANGES in local physiology SOMATIC CHANGES (muscles) and their associated effects AUTONOMIC CHANGES and their associated effects CENTRAL CHANGES (cerebral) and their effects on motivation, emotion, and cognition 12 13. COMPROMISED RESPIRATION When external respiration is disturbed by breathing habits it may result in an unbalanced extracellular acid-base chemistry and failure to meet metabolic requirements. Respiratory fitness is vital to health and performance, and must be regulated despite the breathing acrobatics of talking, emotional encounters, and professional challenges. Respiratory fitness needs to be in place regardless of whether or not one is relaxed or stressed, excited or bored, active or inactive, working or playing, focused or distracted. Learned breathing mechanics that preempt basic brainstem respiratory reflexes and decouple regulatory feedback mechanisms, constitute respiratory compromise. The respiratory chemical axis, of breathing, i.e., acid-base regulation, needs to remain relatively stable despite significant changes in breathing mechanics, e.g., changes in rate, that may be serving parallel objectives. 13 14. MEDIATED CONSEQUENCES The impact of dysfunctional breathing on physiology is far reaching. Dysfunctional breathing habits can cause, trigger, exacerbate, and perpetuate symptoms and deficits of all kinds , ones that typically go unexplained or are mistakenly attributed to other causes, e.g., stress. From a learning perspective these breathing mediated outcomes become behavioral consequences, rather than the effects of external factors. When respiration is compromised as a consequence of breathing habits, it may have profound immediate and long-term effects that trigger, exacerbate, perpetuate, and/or cause a wide variety of emotional (anxiety, anger), cognitive (attention, learning), behavioral (public speaking, test taking), and physical (pain, asthma) changes that may seriously impact health and performance (Fried, 1987; Laffey & Kavanagh, 2002). 14 15. PHASES OF RESPIRATION There are 3 phases of respiration, the physiology of each one being important to the understanding of how breathing behaviors, habits and their patterns may be dysfunctional, adaptive, or embracing. External respiration: the breathing mechanics of gas exchange. Internal respiration: the chemistry of moving gases to and from the cells Cellular respiration: O2 utilization for synthesis of ATP molecules ATP is adenosine triphosphate, the molecule broken down by cells for energy. 15 16. EXTERNAL RESPIRATION is about the mechanics of breathing, moving gases (air) in and out of the lungs. Specifically, it is about oxygen acquisition and proper carbon dioxide (CO2) allocation. Retaining the right level of CO2 in the alveoli of the lungs is fundamental to good respiration; the presence of CO2 is responsible for the regulation of acid-base balance. This is normally regulated by brainstem reflex mechanisms. Breathing mechanics include the following kinds of behavior: locus of breathing (diaphragm, accessory muscles), rate (fast, slow), depth (deep, shallow), intake (nasal, mouth), transition time of exhale to inhale (preempting the reflex), exhalation (aborted), inhalation (holding), and rhythmicity (e.g., gasping, breath holding). 16 17. GAS EXCHANGE Outgoing blood PULMONARY CAPILLARY Incoming blood (Arterial levels) (Venous levels) 40 mmHg PaCO2 40 mmHg 46 mmHg PCO2 95 mmHg PaO2 102 mmHg 40 mmHg PO2 Diffusion PAO2 PaO2 PAO2 = [PIO2 - 1.2 X PaCO2) Differs 5 to 15 mmHg because V-Q 1 (gravity effect) 40 mmHg 102 mmHg PA = alveolar gas PACO2 PAO2 Pa = arterial gas ET = End Tidal gas PI = inspired gas (at trachea) P = partial pressure ALVEOLUS PetCO2 (38 mm