Every breath you take

We live in an age when we have to do things increasingly quickly just to keep up with the modern pace of life - we talk faster, we move more quickly, and many of us may even be breathing too rapidly for our own good.

Thanks to our complex respiratory system, breathing even a little too quickly actually reduces the oxygen getting to the brain, leading to a host of psychological and physical problems. A classic sign of hyperventilation syndrome is a tendency to sigh - this is the body’s way of trying to compensate for unhealthy breathing.

Hyperventilation is the process of moving more air through the chest than the body can deal with. Most people have experienced hyperventilation - also called over-breathing - to some degree, usually in the form of an acute attack. It’s a normal reaction to danger, excitement or stress, so breathing and heart rates speed up as adrenaline pours into the bloodstream, putting the nervous system on red alert as muscles tense up ready for action.

More subtle is chronic hyperventilation - a disorder that is probably much more common than realised, in which over-breathing becomes a habit - usually in response to prolonged stress or tension.

Medical researchers have recently described hyperventilation syndrome as a silent epidemic with British figures suggesting up to 40 per cent of people in GPs’ waiting rooms have disordered breathing patterns. Thirty to 40 per cent suspected heart attack victims have nothing wrong with their hearts and instead are suffering chest pain, palpitations and nausea - symptoms that are really produced by hyperventilation.

The list of problems hyperventilation could be responsible for includes nightmares and insomnia. For example, if you breathe too rapidly the brain gets so used to altered levels of oxygen and carbon dioxide in your blood stream that any changes produced by the more relaxed breathing of sleep causes the brain to send alarm signals to the body. This leads you to wake up and return to hyperventilating, or the body is so alarmed the tension produces nightmares.

Over-breathing dramatically increases the excitability of the nervous system - useful in a dangerous situation, but unhelpful chronically, leading to such surges in excitability of the brain that hyperventilation can even by itself produce epilepsy.

A new study published by Dr George Leonhardt and neurologist colleagues from the University of Essen in Germany using the latest brain-imaging technology has confirmed that the brain blood flow alters dramatically in response to hyperventilation. In particular, the researchers established that over-breathing was responsible for the brain changes that lead to epilepsy, and that minor brain abnormalities that might otherwise produce no symptoms, were likely to induce epilepsy if there was over-breathing.

Besides chronic stress, anxiety or inheriting bad breathing habits, common causes of the start of over-breathing include prolonged talking, fever, common illnesses such as diabetes, liver or kidney disease, or taking caffeine, aspirin and nicotine.

Oxygen and carbon dioxide levels in our blood are kept in healthy balance by 12 regular breaths a minute (ten to 14 is the normal range for adults). But chronic over-breathers can easily double that rate, partly because they switch from nose breathing - which is healthier - to mouth breathing. One of the commonest findings in people who over-breathe are untreated nasal or sinus problems leading to a tendency to breathe through the mouth.

Breathing through the nostrils draws air over filtering hairs, which is then filtered, warmed and humidified in preparation for the lung. Air breathed in through the mouth misses out on this "air-conditioning", so a common sign of hyperventilation is repeated throat clearing: "the ahrrrrrm bug" produced by the irritable upper airways, leading to an increased risk of repeated infections such as sore throats.

When over-breathing becomes chronic, the balance between the oxygen-rich air we breathe in and carbon-dioxide dense air we breathe out is upset: carbon dioxide levels in the body start to drop. But far from being just a waste gas, carbon dioxide is a powerful governor of many vital systems including blood flow to the brain. With chronic over-breathing, the body becomes less acid. Nerve cells are the first to respond to this drop and dizziness, tingling and numbness are early signs of over-breathing.

The next thing that happens is the body is put on continuous red alert and eventually muscles ache and become twitchy. In particular, muscles lining the respiratory system, blood vessels and the gut tighten, leading to problems such as bowel irregularities and a feeling of "air hunger" so that although the victim is over-breathing they try to breathe more.

When carbon dioxide levels are too low, the muscle lining blood vessels causes them to tighten, so reducing blood flow. As a result, the brain can have its oxygen supply cut by up to 50 per cent, making it difficult to concentrate. Once the brain detects a drop in oxygen supply, it stimulates the body to breathe more rapidly to compensate, so the chronic nature of hyperventilation is established.

Healers in most ancient cultures understood that good breathing underpins good health. Adherents of Buddhism, which originated in India in the fifth century BC, and Taoism from ancient China, combined breathing with relaxation and exercise to harmonise heart rate, breathing, digestion and circulation. Yoga and t’ai chi are modern versions of these.

Westerners give precedence to the in-drawing of the breath. Yoga maintains that all good respiration begins with a slow and complete exhalation, for the very simple reason that, until a receptacle is emptied, it cannot be filled.

Normal respiration in yoga begins with a slow calm exhalation carried out by relaxing of the inspiratory muscles. The chest is depressed by its own weight, expelling the air. At the end of the expiration, the abdominal muscles help the lungs to empty to their fullest extent, by means of a contraction, which expels the last traces of tainted air. The spongy make-up of the lungs does not allow them to be emptied completely - there is always a residue of impure air. Yoga attempts to minimise this "residue". The more complete the exhalation, the greater the quantity of fresh air to enter the lungs. Tough cases of hyperventilation should be referred to a respiratory physiotherapist for breathing retraining. However, it is possible to teach yourself how to breathe properly again, according to respiratory physiotherapist Dinah Bradley, whose self-help book Hyperventilation Syndrome is published by Kyle Cathie.

Bradley says the problem is that we have been taught from school that good posture involves sticking out our chests and sucking in our stomachs, like we are soldiers or Baywatch stars. But healthy breathing involves reversing this habit. This means that when you breathe correctly, your stomach should move outwards first and with a bigger movement than your chest. At first the correct breathing will feel peculiar and some people describe it as "back to front" breathing.

Others report feelings of air hunger but this is a good sign, because it indicates that your brain is being challenged to accept normal carbon dioxide levels. It is trying to get you to breathe in deeply again.

The best way to learn abdominal breathing is to practise lying comfortably on your back. Start with your hands clasped behind your head to relax the upper chest muscles and breathe in gently through your nose with your lips together but your jaw loose, think of breathing into your belt or waistband and feel your stomach puff up. Let go straight away and allow the elastic recoil of your diaphragm and lower chest to breathe air out effortlessly and quietly. It is strangely ironic that the first thing we do in life - take a breath - and what must be the most natural activity of all, breathing, seems to be something we now have to "learn".

Perhaps the prevalence of hyperventilation is really teaching us how out of step we have now been driven by modern life from our own bodies.

Dr Raj Persaud is consultant psychiatrist at the Maudsley Hospital in south London. Hyperventilation Syndrome, by Dinah Bradley, 6.99.

What to watch out for

Signs that you could be suffering from over-breathing:

Breathlessness at rest for no apparent reason

Frequent deep sighs or yawning

Chest-wall pains

Palpitations

Light-headedness and feeling "spaced out"

Tingling or numb lips or extremities

Stomach upsets or irritable bowel syndrome

Achy muscles or joints or tremors

Fatigue, weakness, broken sleep, nightmares

Sexual problems

Clammy hands and high anxiety or phobias