Breathing is incorporated into our treatment plans at Spot. It helps us produce better outcomes and results. For example, working on breathing can support the therapy progress of a lisp in speech, musculoskeletal release, voice, fluency, feeding and emotional regulation. 

Breathing ties the body and mind together, and links to regulation. It relates to theories such as attachment theory, relationship theories and also treatment approaches including DIR floortime and theraplay. 

Education on breathing training may be seen as odd, however, breathing disorders are very prevalent in children, newborns and adults. It definitely has a place in a therapeutic setting. 

Healthy breathing should be easy, smooth, relaxed and regular. In addition, it should be silent even with light activity. Sometimes you may not notice a person’s abnormal breathing if you regularly see them. Therefore, it is important that a therapist gives their opinion of an individual’s breathing. For example, during therapy games, we would make observations of a child’s breathing to see if there were any changes in the transition of a sedentary to a light movement activity. Breathlessness is a sign of dysfunctional breathing.

When we nasal breathe, our nostrils are smaller, and air flow is slower. Inside our nose is a big system of ‘caves’ called turbinates where the air swirls around. During the process, the air is warmed and humidified. When the air goes down into our lungs, it is warm and moist. Our lungs like this and they are less likely to become inflamed or irritated. Our nose also filters the air through our nose hairs! 

When we use our mouths, it increases the amount of air we inhale and exhale. The volume of air is important as it impacts the exchange of oxygen and carbon dioxide. If you are a mouth breather you are more likely to have bad breath, cavities etc. The main purpose of breathing is to bring the exchange of oxygen and carbon dioxide for optimal function in the body. When we mouth breathe, we are over breathing and expel too much carbon dioxide. We need carbon dioxide to entice the oxygen to jump off the red blood cells and to go into our muscles, brain and other organs. Some people picture carbon dioxide as a waste product, but really it is a relaxant and ‘the good guy’. Carbon dioxide which exists in our body should be higher in our body than what we breathe out to the atmosphere. 

Top marathons in the world nasal breathe. This can even be possible when swimming! It is Kate’s long-term goal to nasal breathe when swimming. Mouth breathing is not observed in nature and therefore can be seen as ‘unnatural’. For example, a cheetah in full flight is breathing through their nose. 

Dysfunctional breathing habits can contribute to many symptoms e.g. inflammation of the nose. If you don’t have air passing through your nasal passage, they can become stuffy or inflamed. Over breathing is not usually diagnosed as a medical issue but its symptoms can be quite severe. For example, over breathing can exacerbate asthma symptoms. Overtime, without addressing over breathing and therefore not fixing symptoms of dysfunctional breathing, anxiety can start to creep in and affect quality of life.

Snoring, nightmares, restlessness, panic attacks, insomnia and sleep apnoea are all related to dysfunctional breathing. Irritable bowel syndrome is another symptom of dysfunctional breathing. When your diaphragm is not moving as much, it affects digestion and can cause irritation in the bowels. Finally, fatigue is also a symptom of dysfunctional breathing. When you have less oxygen, you will be less energetic. 

Breathing retraining can help to manage these significant health issues and prevent these signs and symptoms from occurring.

While we strongly promote breathing retraining, we never negate a client’s medical advice to use splints or CPAP machines which help the clients maintain oxygen levels when sleeping. Rather, we would also recommend breathing retraining during the day in adjunct to CPAP at night to gradually promote healthy and functional breathing during the day which will influence breathing at night. There is opportunity to correct the underlying dysfunctional breathing habits in order to wean off machines such as CPAP.

Sleep apnoea can be neurological or obstructive (something obstructing the nasal passage e.g. adenoids/tonsils or a deviated system) and we can work together in a multidisciplinary team to change structures (e.g. with ENT’s). Ear infections also affect breathing.

Some children’s breathing are corrected after structural changes via surgery (e.g. removing tonsils) and don’t require follow up. However, it is not a guarantee as dysfunctional breathing may have already become habitual over the years. As such, we always need to keep an eye and ear out on children post-surgery to see if they need breathing retraining. A speech pathologist specialising in breathing will be able to work with you to design the best approach and order of intervention e.g. whether therapy is needed before and/or after surgery. 

Focusing on breathing is something that is seen in many cultures e.g. tai chi. Some instructors tell us to breath in through the nose and out through the mouth, but this is not our approach. Rather we want breathing to be in and out of the nose, and at a pace which is comfortable to you. Everyone’s pace of counting and breathing is different, so an instructor’s count may be uncomfortable for some people in their class. If you picture breathing in for a count of 4 and exhale for a count of 6, this means you are breathing out too much. This idea may stem from wanting to encourage us to exhale slowly, which is good because it helps us increase our carbon dioxide levels. However, breathing for a longer count may negate its benefits. The bottom line is to breathe at a pace that is comfortable for you. At any given time in a day, your metabolic needs, your amount of sleep the previous night, your clothing and levels of stress, will be different to the person next to you. Breathing is very personal. If you don’t feel comfortable to practice breathing in a group setting, it is important to know that that is okay. 

At Spot, we work with children and adults to support functional breathing. Therapy is tailored to the individual. For example, it is not realistic to set the goal for children to nasal breathe during sport. They often live very active lifestyles so we would instead identify more appropriate times when the child is calm such as watching TV, to work on nasal breathing. Even for adults, life is constantly changing and so does our breathing. While you may be a nasal breather, you might become a mouth breather during acute illness. If you return to nasal breathing then that is fine, but if you find yourself being stuck as a mouth breather, it is possible to have breathing retraining to regain functional and optimal breathing.

To find out more, please contact us on spottherapyhub@gmail.com. Our Podcast ‘The Spot Therapy Hub’ also covers breathing and other interesting topics. Available on Spotify, Apple Podcast and our website www.spottherapyhub.com.au.