exhale – Essential Physical Therapy

“Take a deep breath.”

Have you ever been told to do that? I certainly have! “Breathe deep…” that’s what instructors have told me during hard workouts as I sweat and sputter for air. I’ve had kind friends tell me to “just breathe deep!” when I’m going through a stressful moment.

This sounds like a good idea, because deep inhales calm you down, right? Well…actually no.

In fact, taking a deep breath is the last thing you want to do if you’re trying to calm down!

One of the best things you can do to calm and destress is to hold your breath.

Sounds crazy, I know! Because everyone always tells you to breathe, and we’ve all heard that breath-holding is really bad for us. That is true but also NOT True! Okay…let me break this down a bit.

Holding our breath is really unhealthy if we are unaware that we are doing it.

Disorders such as sleep apnea are harmful, unconscious forms of breath-holding. We want to avoid this for sure!

A new form of unhealthy, unconscious breath-holding is becoming more common and leading to all kinds of problems. This type of breath-holding occurs when we are constantly shifting between tasks and never focusing on one thing for a sustained period of time. Without realizing it, we forget to breathe.

Our current lifestyle promotes this scattered attention. With computers, phones, and watches pinging us all day long we can’t stay focused even if we try!

This form of unconscious breath-holding, now dubbed “email apnea” is very problematic- leading to poor digestion, increased stress hormone production, increased blood pressure, a dampened immune system, decreased ability to focus, and interrupted sleep. After months or years of this, your neck and shoulders get tight on top of everything else.

So why am I telling you that you should hold your breath? Because when you consciously hold your breath, all sorts of wonderful things happen.

Breath Holding for Clarity of Mind

Yes, it’s true, when you hold your breath you start to feel anxious, irritable, and hyper-focused on getting air in. But this momentary air hunger results in a state of peace and calm once you are finished with the technique. Over time this relaxed state becomes more and more prominent because your tolerance to carbon dioxide is increasing and your breathing patterns are becoming normalized at rest.

Yogis have been practicing breath-holding techniques for thousands of years.

At that time they already knew that there were health benefits, and now we know the science behind it.

By exposing the chemical sensors in your arteries to greater and greater levels of carbon dioxide by holding your breath, you restore normal breathing patterns that have been disrupted due to minor (or major) stressors in your life.

Yogis would often use breath-holding techniques as a way to prepare for sitting in meditation because as breathing normalizes, thinking becomes clearer.

But don’t worry! You don’t have to meditate to get all the benefits. Just doing the breathing techniques are enough.

Breath-Holding and Anxiety

Breath-holding techniques have been shown to help with anxiety and depression disorders (of which 50% of Americans will suffer one of).

The problem is, patients with anxiety have a much greater fear of holding their breath. To avoid the sensation of air hunger- which is inherently anxiety producing- they over-breathe.

Over time, their chemical sensors tolerate less and less carbon dioxide, and it becomes harder and harder to hold your breath. This cycle creates more anxiety, more over-breathing, and so on.

Slow breathing is taught to people who suffer from panic attacks because it increases carbon dioxide levels without the fear-inducing capacity of breath holding. So, if you know that you tend toward anxiety or panic attacks, try slow breathing first.

If you are feeling stressed, anxious, or panicky, your body is already increasing your oxygen levels and reducing your carbon dioxide levels. If this continues, a panic attack can occur. By increasing and maintaining higher levels of carbon dioxide, the anxiety can be prevented before it even starts.

So, instead of taking a deep breath, try holding your breath!

This will increase your carbon dioxide levels and trigger your chemoreceptors to increase your tolerance to carbon dioxide. At first, while holding your breath, you may feel MORE anxious, uncomfortable, irritable. Your body will scream at you to breathe. But AFTER you hold your breath, the opposite happens. You become relaxed, calm, clear-headed.

Precautions

A word of warning: do NOT try this technique if you are pregnant or if you have cardiac issues or heart problems. This technique is also not appropriate for children under age 12.

How to Do It:

To practice breath-holding, make sure to breathe slowly and smoothly in through the nose and out through the nose. If your breath becomes ragged or uneven, or you are feeling very anxious or panicked, reduce the time of holding until you can perform the exercise comfortably while still reaching the sense of slight urge to inhale.

Here’s what to do:

Slowly inhale to the count of four.
Exhale fully but slowly also to the count of four.
Hold your breath when you are done exhaling for a count of four.
Repeat this breath cycle for 1-2 minutes.
You can increase or decrease the count depending on if it feels easy or too challenging, for example holding each stage for only 2 seconds if it feels very hard, or 5 seconds if it feels easy.
*Aim to hold the breath for the same duration as the inhalation and the exhalation. This is a goal to work toward if holding your breath is hard initially.

A few things to keep in mind:

Don’t over-effort to hold your breath, work within your range of sensing some air hunger but not over doing it.
Practice this technique sitting or laying down. Do not do this technique while standing.
Keep your mouth closed and breathe through your nose as much as possible.
Practice this breathing technique on an empty stomach if possible.

Potential Health Benefits:

Improved diaphragm function.
Increased lung capacity.
Cleared out residual, dead air from the lungs.
Restored function of the respiratory center in the brain (due to the increase in carbon dioxide during breath-holding).
Increased oxygen off-loading to tissues, resulting in improved breathing efficiency and endurance.
Reduced stress and anxiety.
Clearer thinking.
Improved circulation.
May help with relieve digestive problems, allergies, asthma, and auto-immune disorders.

Wait a minute, I already know how to exhale. I do it hundreds of times a day, without even realizing it! Why would I need to learn how to exhale?

Good question.

As I work with my patients, the comment I often get is, “wow, I didn’t realize that I was never really exhaling!”

But how can that be? Read onwards, my friend, and I’ll explain it all.

When we breathe, we have many degrees to which we can move air in and out. There is simple survival breathing, which is just enough air to keep us alive, some may call this a “shallow breath.” This is how many of us breathe when we are still and not moving.

If we spend a lot of time still and not moving, or if we have life events that put our nervous system in a state that tells us we are not safe, and we should be as still as possible as a survival mechanism, we can get stuck in a shallow breath.

“Form follows function and function follows form” is a tenet of how our physical structure adapts to our environment. When we don’t breathe deeply, our ribs and surrounding structures don’t move. When our ribs don’t move, it’s harder to breathe well.

Oh, well the solution to that is easy, just breathe deeper!

For some reason, our common societal belief is that to breathe deeper, we need to take more air in.

While this is true for some people, it’s definitely not true for many. And, almost EVERYONE needs to first get air OUT before you can effectively get air back in.

This Ribcage is Too Big!

Some ribcages are “hyperinflated.” Barrel-chested, military posture, ribs pushed up in the front, all these positions indicate that there is some dead air hanging out in those lungs, for who knows how many years.

How are you supposed to get new fresh air in if your lungs are already full of dead air?

These people can’t get air OUT.

Think of it this way. Your lungs are a balloon (this is a gross analogy, but just go with it 🙂 ). You fill the balloon with air (inhale), then let a tiny bit out (exhale). Next breath, you need to fill the balloon with air again because you need oxygen to survive. But still, you let out just a little. Over time, that balloon will get bigger and bigger, despite feeling like you need more and more air!

Of course it would feel like you need to inhale, because each breath in is so small since those lungs are already packed full. But what you really need to do is get that dead air out!

Getting a complete exhale, all the way to the bottom, gets that dead air out. For these individuals, when they feel that they have exhaled completely, they are often surprised to find that there was still more air in there to exhale.

Once that dead air is out, the ribcage and diaphragm positions can return to normal, and functional breathing can be restored.

This Ribcage is Too Small!

Some ribcages become rigid and small, collapsed in on themselves. They can’t get air in OR out. Their diaphragms can’t do the magnificent action they were designed to do, simply because there is no room to do it.

People with this kind of ribcage absolutely need to invite some expansion into their lives, but in order to do that, a diaphragm needs to be awakened and revitalized.

Achieving a complete, relaxed exhale triggers the reptilian brain to restore the breathing pattern that is primally wired within each of us.

Getting all your air out in a relaxed way is like a reset button for your nervous system.

When you reset in this way, you don’t need to try to get air in, it just flows in! You may need to do some specific exercises to open and expand your chest wall and lungs and bronchi (in certain places and directions, but I won’t get into all that here), but by simply getting your air out, you’ve already done an amazing thing for your whole system.

How does air just “flow in” after a complete exhale?

When you exhale completely, you let all the air out of your lungs. This creates a vacuum- air HAS to flow into that space due to the laws of physics- air will flow from an area of higher pressure to lower pressure.

It’s like when you open a hot oven and all the heat blasts out- the high pressure hot air must flow into the lower pressure cooler room. You don’t have to do anything the make the hot air flow out, you can’t even stop it flowing out! It just happens.

When we try to actively pull air in, we end up using accessory muscles, i.e. your neck. Just trust me on this one, you don’t want to breathe with your neck. Your neck has enough work to do already managing your head on the rest of your body. Using your ribcage to breathe is a much better way to go.

This Ribcage is Juuuust Right.

The human body is an amazing design! Sometimes it’s just hard to get out of our own way and let it do what it needs to do.

Allowing air to move out completely has so many more benefits than simply restoring ribcage and diaphragm position (although the restoration of those contributes to all these other factors I will share with you).

Benefits of Exhaling Well

Decreased heart rate (by stimulating “rest and digest” nerve fibers).
A more balanced inhale to exhale ratio, which reduces stress levels.
Reduced states of hyperinflation.
Improved digestive action of the gut.

So the question is, why wouldn’t you wan to exhale well?

Remember, exhaling is about softening, releasing, and letting go. Sometimes (or a lot of the time?) this can be harder to do than tensing, clinging, and holding on. So give yourself some patience and grace as you work towards a fuller exhale, and eventually a more expansive breath (and life!) as a result.

Here is a short video on how to get some air out, based on the primary breathing method from the Postural Restoration Institute, or PRI for short.

Be well, my friend!

Kindly,

Dr. Derya

Tag: exhale

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