From my experience, it is a very common idea among yoga teachers and practitioners alike that most people’s breathing is suboptimal. Additionally, yoga teachers often advertise their breathing workshops with messages like “Learn how to breathe properly” or rather authoritatively “You have been breathing incorrectly your whole life,” a message that might scare almost anyone into handing over their money. Dysfunctional breathing is a recognized medical condition, but are we all suffering from it?
Dysfunctional breathing is defined as an alteration in the normal biomechanical patterns of breathing that result in intermittent or chronic symptoms. The condition has also, problematically, been described as hyperventilation syndrome, disproportionate breathlessness, behavioral breathlessness, anxiety-related breathlessness, psychogenic functional breathing disorder, and somatoform respiratory disorder—all describing essentially the same problem (Barker and Everard 2015). Many of these terms have a significant psychological component, and this perceived link between psychological dysfunction and dysfunctional breathing probably causes many physicians to avoid diagnosing the condition (Barker and Everard). Being poorly understood, dysfunctional breathing is often underdiagnosed or misdiagnosed in clinical practices worldwide, which can deprive a person of adequate treatment (Vidotto et al. 2019).
Dysfunctional breathing is most common among individuals with asthma, and a central component of it is pattern-disordered breathing, in which a person uses the upper chest wall and accessory muscles as the primary respiratory pump instead of using the diaphragm as with normal relaxed breathing. This is the same type of breathing so many yoga teachers seem to be concerned with and leading breathing workshops about. But when someone is truly suffering from dysfunctional breathing, they know.
Someone with dysfunctional breathing will experience one of the following:
sporadic bouts of hyperventilation
periodic deep sighing
thoracic dominant breathing
forced abdominal expiration
or, thoracoabdominal asynchrony, meaning there is a delay between rib cage and abdominal contraction, resulting in ineffective breathing mechanics.
With those breathing patterns, a person will experience symptoms such as:
increased breathing rate
breathlessness
light-headedness
Dizziness
tingling sensations
muscle spasms
or, numbness.
The prevalance of dysfunctional breathing has not been well studied. According to one survey, an estimated 9.5% of the general population might have dysfunctional breathing (Thomas et al., 2015). Other than that one survey, there is not much solid epidemiological evidence on how prevalent dysfunctional breathing is. In fact, because the diagnostic criteria for dysfunctional breathing is not yet widely accepted, it is impossible to make firm conclusions on the prevalance of the condition. It is known, however, that dysfunctional breathing is far more common in people with asthma and chronic obstructive pulmonary disease than in healthy people (Law et al. 2018). So the evidence does not support the notion that most of us are breathing poorly.
While yoga teachers might be trying to be helpful, they should probably stop telling their students that they do not know how to breathe. While it is entirely possible that someone might enter a yoga studio with dysfunctional breathing, it is not the place of the yoga teacher to diagnose it. Furthermore, using fear-based language to suggest that everyone is breathing incorrectly can contribute to someone’s anxiety instead of helping to relieve it—the opposite of the goal of someone whose aim is to help others.
Though yoga teachers do not have the authority to diagnose, they still have an important role to play in guiding their clients’ breathing. In fact, when done well, this is probably the best gift we can impart to someone else; few other movement modalities focus on breath awareness to the extent that yoga does. Indeed, simply bringing someone’s awareness to their breath is a powerful tool. The simplest meditation we can offer our clients is to simply relax and observe their breathing free of judgment about the quality of their breathing and free of language that they are not using their diaphragm correctly. (A sample breath meditation, “Slow, Relaxed Breath of Gratitude,” is provided at the end of this article.) While a controlled breath practice or slowed breath can be beneficial, perhaps sometimes all we need to do is relax and get out of the way of the breath.
We are still a long way from fully understanding dysfunctional breathing. The classifications, definitions, and diagnostic criteria for DB were still being discussed in a review as recently as 2019 (Vidotto et al.). Considering that medically trained professionals are misdiagnosing and underdiagnosing dysfunctional breathing, clearly it is not the role of the yoga teacher to assess people for the condition or to tell them they have been breathing incorrectly their whole life. Yoga teachers are, however, well placed in guiding their clients through pranayama, slow-breathing practices, and general breath awareness, all of which can have profound benefits to well-being.
-----
Want to learn more cool physiology facts to make you an even better yoga teacher? Join our 8-week Physiology of Yoga book club which begins in September 2023.
—--
References:
Barker, Nicki, and Mark L. Everard. "Getting to grips with ‘dysfunctional breathing’." Paediatric Respiratory Reviews 16, no. 1 (2015): 53-61.
Law, Natalie, Laurence E. Ruane, Kathy Low, Kais Hamza, and Philip G. Bardin. "Dysfunctional breathing is more frequent in chronic obstructive pulmonary disease than in asthma and in health." Respiratory Physiology & Neurobiology 247 (2018): 20-23.
Thomas, Mike, Robert K. McKinley, Elaine Freeman, Chris Foy, and David Price. "The prevalence of dysfunctional breathing in adults in the community with and without asthma." Primary Care Respiratory Journal 14, no. 2 (2005): 78-82.
Vidotto, Laís Silva, Celso Ricardo Fernandes de Carvalho, Alex Harvey, and Mandy Jones. "Dysfunctional breathing: what do we know?." Jornal Brasileiro de Pneumologia 45 (2019).