Glenn White BSc MSc MBIBH BIBH Practitioner/trainer SNORING – SLEEP APNOEA - ASTHMA - CROOKED...

Glenn White BSc MSc MBIBH BIBH Practitioner/trainerwww.buteykobreathing.co.nz

SNORING – SLEEP APNOEA - ASTHMA - CROOKED TEETH ... WHAT’S THE LINK?

www.buteykobreathing.co.nz

BREATHING AWARENESS

1. Count the number of breaths you take in one

minute

2. Place one hand on upper chest, one hand on belly

- take 2 breaths in and out through the nose and

note relative hand movements

- repeat breathing through open mouth

Breathing Parameter Normal characteristics

Route Nose: rest, physical exercise, sleep

Location (dominant) Diaphragm

Respiration rate 8-12 breaths per minute

Minute volume 4-6 litres per minute

Tidal volume 500 ml per breath

Feel of breathing Easy, comfortable, satisfying

Rhythm Regular, smooth

Sound Inaudible; at rest, sleep

Heart rate 60-80 beats per minute

After Graham, T 2012, Relief from snoring and sleep apnoea

FUNCTIONAL BREATHING

Breathing Parameter Characteristics

Route mouth breathing or heavy nose breathing

Location (dominant) Thoracic dominant

Respiration rate > 14 breaths per minute

Minute volume > 9 litres per minute *

Appearance of breathing obvious upper chest or abdominal movement

Feel of breathing Heavy, windy full breaths

Rhythm Irregular: sighs, yawns, coughs, sniffs

Sound Audible; at rest, sleep (snoring)

After Graham, T 2012, Relief from snoring and sleep apnoea

DYSFUNCTIONAL BREATHING

DAYTIME SYMPTOMS OF DYSFUNCTIONAL BREATHING

Blocked or runny nose

Open-mouth breathing

Heavy laboured breathing

Wheezing, asthma, chest

tightness

Sighing or frequent deep

breaths

Frequent yawning

Irritable cough

Throat clearing

Short of breath on exertion

Upper chest breathing pattern

Anxiety/ panic attacks

Dry mouth

Difficulty swallowing

Gastric reflux

Breathing Disordered

Sleep


NIGHT-TIME SYMPTOMS OF DYSFUNCTIONAL BREATHING

• difficulty getting off to sleep

• restless sleep, frequent

waking

• waking up-tired


SYMPTOMS OF BREATHING DISORDERED SLEEP

Snoring

sleep apnoea

insomnia

vivid dreams-nightmares

night-time cramps

frequent urination, bed

wetting

night thirst, dry mouth on

waking

groggy on waking

asthma, night-time coughing

night-time anxiety/panic

attacks

restless sleep

restless leg syndrome

increased nasal congestion

teeth grinding

sleep-walking, sleep-talking

morning headache

blocked nose on waking

morning thirst

high morning pulse

messy bed on waking

MORNING BREATH

One of the lung’s primary

functions is to maintain

optimum levels of O2 and CO2 in

airways and blood

THE LUNGS AND CARBON DIOXIDE (CO2)

Mouth breathing and over-breathing result in

CO2 loss resulting in CO2 deficit (hypocapnia)

• An optimal level of CO2 is essential in airways and

blood for oxygen delivery to brain and body

tissues

• CO2 is a broncho/ vaso dilator 1

• Optimal PaCO2 is essential for the release of

oxygen from blood to body tissues (The Bohr

Effect)

The Importance of CO2

1 DAVIS FREED Am.J.Respir.Crit. Care Med.2001, 785-789

MRI SCANred - yellow = highest oxygen

dark blue = least oxygen

The right hand image shows a 40% reduction in brain oxygen

after one minute of big volume breathing. This explains the

sensation of dizziness that often accompanies a panic attack.

(source Litchfield 1999)

OVER-BREATHING AND CO2 LOSS

REDUCES BRAIN OXYGEN


Dysfunctional breathing = hyperventilationHyperventilation = breathing more than the medical norm

Normal resting minute volume for a 70-kg human

4-6 litres/min for older physiological textbooks

6-9 litres/min for some modern textbooks

> 9 litres/min is defined as hyperventilation

Norm 1929 1939 1939 1950 1980 1990-96 1997 1998-99 2000s0

2

4

6

8

10

12

14

Information sourced from 24 medical studies – Rakhimov 2005

Min

ute

Venti

latio

n, li

tres

per

mni

ute

HUMAN BREATHING VOLUMES HAVE DOUBLED IN FIFTY YEARS

6

4.95.3

4.6

7.86.9

12 121211

Hyperventilation (over-breathing) - a mechanism that is often overlooked in asthma.

Hyperventilation whether spontaneous or exercise induced, is known to cause asthma 2, 3, 4

Average MV measured for asthmatics in Brisbane Buteyko trial - 15 litres per minute (normal 10 litres) 1

1 Bowler S, Green A, Mitchell C, Medical Journal of Australia 1998; 169: 575-5782 Demeter & Cordasco The American Journal of Medicine, (1986), vol 81 pp 989. 3 Clarke PS, Gibson, JR Aust Fam Physician. 1980 4 Sterling, GM., Clin Sci, (1968), vol 34, pp 277-2855 van den Elshout, FJJ et al., Thorax, (1991), vol 46, pp 28-32

Loss of CO2 through hyperventilation can trigger bronchoconstriction in asthmatics 4, 5

HYPERVENTLATION - HYPOCAPNIA AND ASTHMA

Hypocapnia is the rule in asthma until respiratory failure sets in 3

Hyperventilation and hypocapnia (CO2 deficit)are common in asthma 1, 2, 3

1 Tobin, MJ et al. Chest, 1983; 84:287-294.2 Hormbrey, J. et al., European Respiratory Journal, 1988;1: 846-852.3 Clarke, PS., Australian Family Physician. 1980; Vol 9, October


Hypocapnia can trigger mast cell de-granulation and histamine release

Kontos et al. American Jnl of physiology 1972Coakley et al. Jnl of Leukocyte Biology 2002:71Strider et al., Allergy 2010

• airways – asthma, hay fever

• skin – eczema

• gut – food allergies, irritable bowel (IBS)

Perera, J. The hazards of heavy breathing. New Scientist, Dec 1988

HYPERVENTLATION - HYPOCAPNIA - INFLAMATION

Average tidal volumes of 950ml and average minute volumes of 15 litres per minute during the day were recorded in males diagnosed with sleep apnoea 1

1 Radwan et al., Eur Resp J 19952 Naughton M, Benard D, Rutherford R, Am J Respir Crit Care Med 1994; 3 Chan C, Woolcock A, Sullivan C. Am Rev Respir Dis 1989

Asthma improves with breathing control, through application of Continuous Positive Airways Pressure 3

CPAP reduces hyperventilation while applied 2

HYPERVENTLATION – SLEEP APNOEA - ASTHMA

• carbon dioxide deficit – hypocapnia

• dehydrated and inflamed airways

• increased mucus production

• disruption in breathing regulation

• smooth muscle constriction

• - bronchial, cardiovascular, gastrointestinal,

urinary

• reduced oxygenation

• - broncho-spasm, vaso-constriction, Verigo-Bohr

Effect

• pH disturbance

• bigger breathing volume = more inhaled irritants

• histamine production

CONSEQUENCES OF OVER-BREATHING:



OVER- BREATHING CHECKLIST • habitual mouth breathing

• audible breathing

• nasal congestion/ mucus

• upper chest breathing pattern

• poor posture, shoulders high, forward, slouching

• frequent sighing or yawning

• large inhalations through mouth when speaking

• rapid breathing rate > 15 breaths/minute

• paradoxical (reverse) breathing

• irregular breathing pattern, breath-holding

• cold hands and feet

• dry skin: face, lips, hands and feet


STRESS MAKES US BREATHE MORE

If the stress is prolonged over-breathing becomes habitual

• stress in workplace, school, home, bereavement, financial

• illness, infection

• lack of exercise, athletes over-training

• over-eating, skipping meals, too much refined carbs, low

protein

• some medications; e.g. bronchodilator medications

• caffeine, nicotine, alcohol, recreational drugs

• promotion of deep breathing techniques

• computer games, excessive use of personal technologies

IN SUMMARY LIFE

MOUTH BREATHING AND TONGUE POSITION

• Nasal breathing with tongue in the roof of the mouth helps iiiensure wide dental arches and straight teeth

• The tongue is one of the strongest muscles in the body, capable of exerting 500 grams of pressure.

• It only takes 1.7 grams of pressure to move a tooth.

• Mouth breathers carry the tongue in the floor of the mouth potentially leading to narrow dental arches, crowded teeth, receding chin, smaller jaw and risk of sleep apnoea

Normal wide archesNarrow arches

No room for tongue here

Lateral airway views of a Mouth breather Nasal breather

Note low tongue posture Note correct tongue posture

nose breather mouth breather

CT SCANS

Mandibular advancement showing opening of airway

MOUTH BREATHER

Uncorrected open-mouth

breathing is likely to result in:

• crooked teeth

• narrow dental arches

• receding chin

• protruding nose

• narrow airway

• and high risk of developing

obstructive sleep apnoea

by the age of thirty

Anterior open bite, narrow upper arch

Bolton standar

d

Mouth breathing at an early age can effect dental arch development. Narrow jaws can lead to crooked teeth and a distorted facial profile. If the underlying mouth breathing habit is not corrected features become more exaggerated with age.


DENTAL DISORDERS LINKED TO OPEN MOUTH BREATHING

• dental decay

• malocclusion

• narrowing of dental arch

• dental crowding, crooked teeth

• cross-bite

• anterior open bite

• gum disease, bad breath

• inflammation of adenoids and tonsils

• TMJ dysfunction

SNORING AND SLEEP APNOEA EXPLAINED- it’s your breathing

breathing stimulatedsnoring

over-breathing

blood pH normalisingO2 release to cells

inflame/narrow airways vibration noise

suction effect

CO2 increase

CO2 deficit

(hypocapnia)

centralsleep apnoea

CO2 < apnoeic thresholdcellular hypoxia

obstructivesleep apnoea

MRI scanred - yellow = highest oxygen dark blue = least oxygen

This may might help explain the link between sleep apnoea and a higher incidence of cancer 1 and Alzheimer’s 2

SNORING - SLEEP APNOEA AND BRAIN HYPOXIA

1 Dr. F. Javier Nieto2 Osorio et al 2013


BUTEYKO BREATHING RETRAINING

• Asthma

• Chronic nasal congestion

• Allergic rhinitis

• Sleep apnoea, chronic snorers

• Panic attack

• Dental disorders resulting from open-

mouth breathing

Who are our clients:


BUTEYKO BREATHING RETRAINING

• Rate

• Rhythm

• volume

• Mechanics - correct use of breathing muscles

• Use of the nose - inhale/exhale

To normalise each aspect of the breathing

pattern:

Tess Graham – Relief from Snoring and Sleep Apnoea p 80

- For all situations: awake, asleep, at rest, when

eating,

speech and physical exercise


THE NOSE YOUR PORTABLE AIR CONDITIONER

• warms

• filters

• humidifies

• disinfects (germicidal action of

NO in paranasal sinuses 1

• nasal breathing increases

arterial CO2 by 20% and O2 by

8% 2

2 Swift et al Lancet

1988

1 Lundberg Anat Rec

2008


NOSE UN-BLOCKING EXERCISE

1. Breathe in and out normally through nose

2. Hold on the out breathe for as long as is

comfortable

3. Then gradually resume very gentle breathing

It may help to pinch the nose

and nod your head a few times In stubborn cases or when the

blockage is due to a cold, the exercise may need to be repeated several times


DIAPHRAGM BREATHING EXERCISE

• sit with upright posture on a stable firm

chair

• move to the front edge of the chair,

upper legs parallel with the floor, knees

directly over the ankles

• practise breathing gently into the belly

Breathe slowly, rhythmically and gently

making each breath as small as you can

• Do this for 3-5 minutes a few times a

day to help tone the diaphragm and

reduce upper chest breathing

Small movements

REDUCING BREATHING VOLUME

• Hold the index finger under your nose to feel how much air goes in and out.

• When you are breathing normally you will feel warm air across your finger on the out-breath and cool air on the in-breath.

• Try slowing your breathing down until you can hardly feel any air across your finger.

• If you have a healthy breathing pattern you should be able to maintain this sensation of no air on your finger for five minutes or more.

An exercise to help habituate to reduced breathing volume

FEATHER BREATHING

Soft invisible breathing as practised by the Samurai

TWO TO FIVE BREATHING EXERCISEYou can use this breathing exercise to de-stress, help

overcome an anxiety/panic attack, relieve breathlessness,

chest tightness or asthma and to help you sleep.

This exercise can be done sitting, standing or lying down.

Try to breathe gently through your nose and breathe from

the belly.


Breathe well by day and you will breathe well by night

BREATHE WELL – SLEEP WELL

• Nose breathing by day and you are more likely to nose

breathe during sleep; try to sleep with mouth closed

• Do some nose clearing and breathing exercises prior to

sleep

• Sleep with upper body slightly elevated

• Avoid sleeping on back, left is best

• Avoid stimulating foods, drinks and activities at least

90-minutes before sleep

• Turn screens off at least 60 minutes before sleeping

• Sleep in a dark, well ventilated room, do not get over-

heated

• Foods containing refined white flour, sugar:

refined breakfast cereals, pasta, noodles,

cakes, cookies

• Drinks with added sugar: soft drinks, fruit juice ...

• Milk and milk products, goats milk, soy milk, protein

shakes

• Soft cheeses, cottage cheese, ice cream, yoghurt

• Chocolate

• Caffeine, alcohol

• Food additives; MSG, sulphites, sodium benzoate, nitrites,

aspartame

Foods that adversely affect breathing and may trigger asthma, nasal congestion, snoring, poor sleep or headache

Note: over-eating leads to over-breathing

BREATHING AND SPEAKING

Breathing tips for talking:

• Try to talk less

• Talk more slowly

• Breathe in through your nose at the start of

each sentence

• Do not take a big breath in before speaking

• Breathe more gently and quietly when talking

• Speak in shorter sentences


• Instruct to nasal breathe if possible

• Slow breathing rate and try to reduce breathing

volume

• Try to breathe diaphragmatically

• Reduce or eliminate consumption of dairy products

• Reduce or eliminate refined carbohydrates especially

foods and drinks with added sugar

• Sleep on the left side with head elevated

BREATHING GUIDELINES FOR ASTHMA RELIEF

Guidelines for reducing minute volume and normalisation of the breathing pattern


ASTHMA AND SPORT

• Instruct to breathe through the nose, whenever

possible to help maintain the bronco dilating effects

of CO2 in airways

• Adjust intensity to allow comfortable nasal

breathing

• Drop shoulders and breathe from diaphragm

• Slow the rate and reduce breathing during breaks

in play and after physical exertion to boost cellular

O2 and

reduce lactic acid

• We instruct not to pre-dose with reliever

medication but to carry at all times and use if

needed. 11 Any changes to prescription medication, where appropriate, are undertaken by the clients’ prescribing doctor.

SIX THINGS YOU CAN DO:

1. Instruct on the importance of nasal breathing for ADL

2. To maintain nasal breathing at rest, during physical

exertion, sleep

3. Correct tongue posture; with tongue in roof of the mouth

4. To supress yawns and the urge to sigh, gasp, cough, snort,

sniff

5. Instruct on nasal clearance using the nose un-blocking

exercise

6. Instruct on diaphragmatic breathing


BUTEYKO BREATHING CLINIC PROGRAM *

• Four initial, consecutive 90-minute

breathing retraining sessions

• Two follow up sessions within six weeks

• Telephone support and additional sessions if

required for six weeks

• Breathing exercises practised for six weeks

• Life-long awareness of the concepts is

recommended

• course fee $605

• Ages four and up

• Referral not essential* Buteyko clinic practitioners teach the Buteyko Institute Method of breathing retraining.

THE TEAM- BIBH PRACTITIONERS

Glenn WhitePractioner

trainer Auckland

Tricia Enriquez-Gault

Auckland

Olga Horne Auckland

Susan Allen Wanaka

Viv SmithQueenstown

Arisa Shioda DSJapan

Eddie Johnson Auckland

Pia Schroeter Auckland

Melody Sloggett Auckland

Dina Ceniza Auckland

Our practitioners teach to Buteyko Institute of Breathing and Health (BIBH) standards. The BIBH is ISO 9001:2008 Certified

Ines Steward Auckland

OUR TRAINEES

http://www.buteykobreathing.nz/webapps/i/76035/130755/575544

Glenn White BSc MSc MBIBH BIBH Practitioner/trainer SNORING – SLEEP APNOEA - ASTHMA - CROOKED...

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Transcript of Glenn White BSc MSc MBIBH BIBH Practitioner/trainer SNORING – SLEEP APNOEA - ASTHMA - CROOKED...