Table Of ContentMULTIDISCIPLINARY APPROACHES TO
BREATHING PATTERN DISORDERS
Healthy brepaatthtienragnr see ssentfioagrlo odp hysicaTlh ei mportaanncdei ncideonfcd ei sordebrreeda thing
andm entahle altDhi.s ordebrreeda thpiantgt ermnasyb e patterhnasv eo nlrye cenbteleyn a cknowledgA ed.
a symptoomr a causoef f requenutnldyi agnohseeadl th consideraamboluen otf r esearhcahs n owb eenp ublished
problemA ss.i gnifipcraonpto rtoifto hne p opulation tov alidtahteer elationbsehtiwpe edni sordebrreeda thing
worldwisduef fferro bmr eathpiantgt edrins ordoerr s patterannsdp erceivpeadil ne velfsa,t igsuter,e asnsd
chronhiycp erventiplaarttiiocnu,il nat rhlemy o re anxieMtuylt.id isciplinary Approaches to Breathing Pattern
developceodu ntrTiheisms.e anst haat w ider angoef Disorders describseism pltee chniqtuheasat r eu sablbey
practitieonnceorusn ttehre sper oblemosf,t ewni thout both medaincdan lo n-medipcraalc titioneprrso.v-aindde s
havinrge ceivaendyp ritorra iniinnt gh eciaru satioor n ther esearch evitods eunpcpeo trhte uisre P.r actitiionn ers
managemenFtr.e quenptaltyi epnrtess ernetq uesthienlgp manyd isciplwiinlfelis n tdh ibso okp rovidtehse mw itah
witpha ins,t ressysm ptomasn,x iety, afnadt igue usefaudld ititootn h epirra ctice.
depressbiuottn h ep ractitmiaoynf earit lor ecognitshea t
disordered brpeaatttheirannrgsea lsion volveeidt,h aesr
parotf t hee tioloorga ys a maintainfiancgt or.
Multidisciplinary Approaches to Breathing Pattern About the Authors
Disorders isi ntendteohd e lhpe althcparraec tititoon ers Leon Chaitow, RegisteOrsetde opatPhriacc titioner
understtahnedc auseasn de ffecotfds i sordebrreeda thing
andS enioLre cturUenri,v ersoifWt eys tminster,
andt op rovisdter ategainedps r otoctoolh se lrpe store
Londoni,sa ni nternatikonnoawlnal nyd r espected
normablr eathiTnhegp .e rspectainvdet se chniqoufe s
lecturwerri,ta enrd o steopatphriacc titioner.
thredei fferdeinstc ipl(ipnheyss iotheprsaypcyh,o therapy
ando steopatahryeo) f ferientd h es piroifct r oss Dinah Bradley, NewZ ealanRde,g isteRreesdp iratory
disciaprlyci onoperattiooc nr,e atae m orec omprehensive
Physiotherwarpoitsteth ,ef irpsatt iehnatn dboookn
understanodfib nrge athpiantgt edrins orders. Hyperventilation Syndrome andi sr ecognised
internatiaosna anla luyt horitbyr eoant hpiantgt ern
Key features disorders.
• Writtbeyna trioofh ighelxyp erienccleidn iciinat nhse Christopher Gilbert isa clinipcsaylc holowgiitsht
field
extenseixvpee rieinncb er eathrienggu la,t ion
• Presenetfsf ecttihveer apfioebrsr eathdiinsgo rdferrosm biofeedbaancdkt ,r eatmoefna tn xiesttya t.e s
thed isciploifpn heyss iotheprsaypcyh,o thearnadp y Formerilnpy r ivaptrea ctiincN ee wJ ersehye,i sn ow
osteopya,at shw elals n utritiaonndoa tlh esrt rategies associawtietdth h eC hronPiaci nM anagement
• Includaensi ntroducttoti hoemn e chanicpsh,y siology PrograamtK aisePre rmanenMteed icCaeln teirn
andb iochemiosftn royr maaln da bnormbarle athing SanF rancisco.
patterns
• Includseesl f-hmeelaps urewsi tchh aratns dw orkbook
materitahlam ta yb ep hotocopfioeurds ew itpha tients.
/1\
�� CHURCHill
LIVINGSTONE
-
A Harcourt Health Sciences Company
Harcourt
Health Sciences ISBN
II
Visit our website for
additional outstanding products
www.harcourt-international.com
See inside for more information 9 780443
./
MultidiscipAlpipnraorayc hteosB reathiPnagt teDrins orders
ForC hurchLiilvli ngstone:
EditoDriarle cHteoarl,Pt rho fessMiaornyLs a:w
Heado fP rojMeacnta gemeEnwta:n H alley
ProjeDcetv elopmMeannta geKra:t riMnaat her
DesigDni rectGieoonr:g Aej ayi/JuWdriitghh t
Multidisciplinary
ApproachetsoB reathing
PatteDrins orders
Leon Chaitow
NO DO
RegisteOrsetde opatPhriacc titiaonndSe ern ioLre cturer,
UniversoiftW ye stminstLeorn,d onU,K
Dinah Bradley
DipPhys NZRP MNZSP
PrivaCtoen sultaRnets piratPohryys iotherapist,
B reat h iW onr kg,s R emuerAau,c kladn,N ew Zealand
Christopher Gilbert
PhD
PsychologCihsrto,n iPca iMna nagemenPtr ogram,
KaisePre rmanenMteed icaCle nteSra,n F rancisco,
CaliforUnSiAa ,
Foreword by
Ronald Ley
ResearPcrho fessUonri,v ersoiftA yl bany,
StatUen iversoiftN ye w YorkN,e w YorkU,S A
/�\
.L�
CHURCHill
LIVINGSTONE
&
EDINBURGH LONDON NEW YORK PHILADELPHIA ST LOUIS SYDNEY TORONTO 2002
CHURCHILLL IVINGSTONE
An imprionftH arcouPrutb lishLeirmsi ted
e HarcouPrutb lishLeirmsi t2e00d2
D
isa registetrreadd emaorfHk a rcouPrutb lishLeirmsi ted
Ther ighotfsL eonC haitoDwi,n aBhr adlaenyd C hristopGhielrb etrot
bei dentiafska >d.u thoorfst hiwso rkh asbe en assertbeytd h emi n
accordawnicteth h eC opyright, DaensdiP gantse,nA tcst1 998.
Allr ighrtess erve0d p.a rotf t hipsu blicamtaiyob ne r eproduced,
storeinda retriesvyaslt eomr,t ransmititnae ndy f ormo rb ya nym eans,
electromneicch,a nical, photroeccooprydioinrngo g,t herwiwsiet,h out
eithtehrep riopre rmissoifot nh ep ublish(eHrasr coPuurbtl ishers
LimiteHda,r couPrlta c3e2,J amestoRwona dL,o ndon WI 7BY)o,ra
licenpecrem ittirnegs triccotpeydi nignt heU niteKdi ngdoims suebdy
theC opyrigLhitc enSAignegn c90y ,T ottenhCaomu rRto adL,o ndon
W1POLP.
Firpsutb lish2e00d2
ISBN0 4430 70593
BritiLsihb raCrayt aloguiinnP gu blicatDiaotna
A catalorgeuceo rfdo rt hiboso k isa vailafbrloemt heB ritiLsihb rary.
LibraorfyC ongr5e C atalogiinnP gu blicatDiaotna
A catalroegc orfdo rt hibso oki sa vailafbrloemt heL ibraorfyC ongress.
Note
Medickanl owledigsec onstancthlayn ginAgs.n ewi nformation
becomesa vailacbhlaen,g eisnt reatmepnrtoc,e dureesq,u ipmeanntd t he
useo fd rugbse comnee cessaTrhye,a uthoarnsd tphueb lishhearvse
takecna rteo e nsure tthheia ntf ormatgiiovnei nn t hitse xitsa ccurate
andu pt od ateH.o weverr,e adearrses trongaldyv isteodc onfitrhma t
thei nformation, ewsipterhce igaalrtldoyd rugu sagceo,m pliweist ht he
latelsetg islaatnidso tna ndarodfps r actice.
Neithtehre p ublisnhoerrt hea uthowrisl ble l iabfloear n yl ososr
damagoef a nyn aturoec casiotnoeo drs ufferbeyad n ype rsona ctionrg
refrainfirnomga ctiansga resulotf r eliaonnct eh em atericaoln tainiend
thipsu blication.
Befotrree ating brpeaattthedirnin sgo rdietir ssi mportafnotpr ractitioners
andt heraptiose tnss urteh aatv aliddi agnoesxiiss itnsc a sem ores erious
patholoigsay l soa factDoirf.f erednitaiganlo bsyia ss uitaqbulayl ified
andl icenhseeda lthcparrocv idoefrf ear dse greoefs afettoybo tht he
patieanntdt he practitionere/stpheecriawaphlielnsyp t a,t iehnatvse
self-refNeorc rleadi.ma sr em adei nt hibso okt ot eacmhe dicdaila gnoses
othetrh atno o ffegru ideliannedst ,oe ncouraignet erprofelsisaiiosnoanl
(witthh ep. lticnpetr'msi ssiobent)w,e ent hep ractitioner/atnhde rapist
thep atient's primac.lrrey p rhoevaildtehr /gepnrearcatli tioner/specialist.
Iti si mportanfto prr actitioners/ttohc ehreactpkhi esirtres g ional Tho
pubIisher 'l
professiomneadli csatla ndarredqsu iremienno trsd etroes tablish poi:y.IOUH
appropripaatteie nt/theprraoptiocsotl s. ""'N"""""'"
!rom IUltIInIbie iofHII
I
PrintiendC hina
1���jl4\"fI,'��
,i!�. ! , .! •' ,'I 1,"""1 ,1, ' � .', � \;.,. � ' " 1� , � " � � �� �i � �, . h;I -!� � _ ",,_� rl I� I�
Contents
Foreword ix
5. Interaction of psychological and emotional
Preface xi
effects with breathing dysfunction 111
Acknowledgments xiii
6. Osteopathic assessment and treatment of
Glossary/Abbreviations xv thoracic and respiratory dysfunction 131
7. Physiotherapy breathing rehabilitation
1. The structure and function of breathing 1 strategies 173
2. Patterns of breathing dysfunction in 8. Self-regulation of breathing 197
hyperventilation syndrome and breathing
pattern disorders 43 9. Other breathing issues 223
3. Biochemical aspects of breathing 61 10. Self-help approaches 241
4. Biomechanical influences on breathing 83 Index 273
THIS PAGE INTENTIONALLY LEFT BLANK
Foreword
Breathing is a complicated dynamic process with startle, and rendered the patient momentarily
some crucial parameters that were until recently incapable of speech. After a very brief period of
difficult to measure non-invasively. It may be for recovery (about one minute), the patient
this reason that respiration has taken so long to regained control of breathing and speech; the
come to the attention of scientists who study muscles of the face relaxed, the stiffened posture
psychophysiology and clinicians who treat of the upper torso relaxed, and the patient
psychophysiological disorders. Although the reported a pleasant sense of relaxation and
International Society for the Advancement of release from anxiety. Why?
Respiratory Psychophysiology, an organization While the effects of CO2 inhalation on breath
whose membership includes both scientists and ing were clearly a consequence of the CO2-
clinicians, was founded less than a decade ago, sensitive chemoreceptors that drive respiration,
there is a considerably longer history of individ why should the dissipation of CO2 following a
ual scientists and clinicians, sometimes in infor single inhalation of a colorless and odorless com
mal groups but usually in individual efforts, who bination of CO2 and O2 have such rapid and pro
have pondered the complications of breathing in found effects on muscle tension and mood? I was
a quest for knowledge and a quest for applica intrigued, as was Herb Walker, a clinical pro
tions designed to help those who suffer respir fessor of psychiatry at the New York University
atory diseases or suffer disorders associated with School of Medicine. Together, with Wolpe's
dysfunctional breathing. approval and encouragement, we conducted an
Although my training in experimental psy experiment in Wolpe's lab. The study, published
chology included the rudiments of neurophysio in 1973, documented the anxiolytic effects of the
logy and the physiological substratum of sensa CO2 inhalation, provided data on changes in
tion and emotions, my first encounter with what heart rate and blood pressure, and ultimately
would come to be known as respiratory psy (1994) led to a satisfactory theoretical explan
chophysiology was in 1971 at the Temple ation of the anxiolytic effects in terms of Dick
University School of Medicine on the occasion of Solomon's opponent-process theory of emotion.
a demonstration by Joseph Wolpe of the anxio Most important, for the purpose of this foreword,
lytic effects of single inhalations of large concen Wolpe's demonstration and the ensuing experi
trations of carbon dioxide mixed with oxygen ment conducted with Walker left me with a new
(65% CO2 with 35% O2). The procedure required found interest in the study of breathing.
that the patient put an inhalation mask to the My new interest led me to the works of Claude
face and take a full capacity inhalation of the Lum and to others who had written seminal
CO2-02 mixture. Although the patient was told papers on hyperventilation and its production of
what the resulting sensation would be, the sharp a broad range of psychosomatic complaints.
respiratory response driven by the CO2 inhala With metabolism relatively constant (i.e.
tion (rapid cycles of full capacity ventilation) insignificant variance from moment to moment),
elicited a wide-eyed mouth-agape expression of an increase in ventilation (the volume of air
ix
x FOREWORD
breathed from respiratory cycle to respiratory physiological barriers that can not be overridden,
cycle) will increase the rate of flow of CO2 from hyperventilation is not. Additional complica
tissue cells to the point of diffusion of CO2 from tions result from the fact that breathing is the
the pulmonary artery to the alveoli of the lungs. only vital function under voluntary as well as
If this rate of flow is too fast, the concentration of involuntary control. Although voluntary control
CO2 in blood will be too lean, acid level of blood is limited by physiological mechanisms, the
will drop, the crucial ratio of base to acid will breathing behavior within these limits can be
increase, and the unbalanced pH will be alkal modified by learning. The conditionability of
otic. If the rate of flow of CO2 is too slow, its con breathing behavior has a negative and a positive
centration in blood will be too rich, acid level will side. The negative side is that unhealthy dys
rise, the crucial ratio of base to acid will decrease, functional habits of breathing can be acquired.
and the unbalanced pH will be acidic. In healthy The positive side is that bad habits can be extin
individuals under non-stressful conditions, the guished and replaced with good habits.
self-regulatory mechanisms of breathing will Leon Chaitow, Dinah Bradley, and Christopher
automatically calculate the amount of O2 needed Gilbert have written a thorough and highly read
for metabolism and increase or decrease the vol able book that provides detailed information on
ume of air breathed per unit of time so that the the relevant physiological and psychological
rate of flow of CO2 from cells to lungs will be processes that underlie breathing. The unique
just right, neither too fast nor too slow, and a backgrounds that each of the authors bring to the
stable level of balanced pH will be maintained. study of breathing and the treatment of its dis
And what a delicate balance it is. orders provide a vast amount of information that
Disease aside, the delicate balance is upset is nicely synthesized in their vivid description of
when problems of everyday living arise. breathing pattern disorders and their detailed
Breathing is exquisitely sensitive to stress. explanation of how these patterns of breathing
Apneusis, apnea, and hyperventilation occur in disorders can be remedied. This book marks a
different stages of the respiratory response to singular advancement in clinical respiratory
stress, depending on the qualitative and quanti psychophysiology.
tative nature of the stress. While apneusis and
apnea are limited to relatively brief periods by Albany, NY 2002 Ronald Ley
x
