Identification and Management of Dysfunctional Breathing Patterns with Capnography
How often, when in the midst of pain or stress, have you been advised to “take a deep breath?” What does that truly mean and how is that “deep breath” different from your breathing in other situations? Countless breathing techniques exist throughout the world, whether in the practice of yoga or meditation, the management of asthma and other pulmonary conditions, or in the world of exercise and performance. But how effective are these breathing techniques and which is the “right” way to breathe?
We are taught in school that we inhale oxygen and exhale carbon dioxide (CO2), implying that CO2 is a waste product. The exchange of oxygen and carbon dioxide, however, is closely involved in balancing the body’s chemistry, with CO2 directly regulating pH, electrolyte balance, blood distribution, and hemoglobin chemistry in every system and organ. Unlike most physiologic processes, however, breathing can be consciously controlled, meaning that learned breathing behaviors can trigger, exacerbate, perpetuate, or cause a wide variety of symptoms and deficits, including chronic pain, muscle tension, and headaches. Breathing is, therefore, driven not only by physiology but by psychology as well.
As Physical Therapists, we encounter a variety of symptoms each day which may be associated with poor breathing habits, including chest tightness and pressure, tingling in the hands or feet, heart palpitations, anxiety, exhaustion, lightheadedness/dizziness, impaired coordination and reaction time, and muscle spasms. It can often be difficult to differentiate the root cause of these symptoms and break the cycle of dysfunction. Fortunately, advances in diagnostic technology, such as capnography, are helping us identify breathing dysfunctions more quickly, leading to better outcomes.
What is Capnography?
Capnography is the measurement of the concentration of carbon dioxide (CO2) in our exhaled breath, a reflection of the partial pressure (PCO2) in the alveoli of the lungs. Capnometers (the devices used to monitor and record) have become essential tools in a variety of clinical settings, from emergency care to ICUs, and outpatient PT clinics. At KNOSIS, we use the CapnoTrainer(R) Go device (pictured below) to provide real-time insight into both the chemistry and mechanics of breathing. By assessing respiratory chemistry during a variety of activities and situations, we can differentiate which symptoms may be related to a purely musculoskeletal condition versus those which may be driven by inefficient breathing behaviors.
CapnoTrainer(R) Go; Better Physiology, Ltd.
Capnography in Identifying Breathing Dysfunction
Breathing dysfunctions can manifest in various ways (chronic shallow breathing, forced exhalation, excessive pauses between breaths, etc) and most typically cause drops in PCO2 (hypocapnia). These dysfunctions may be linked to several underlying conditions, such as anxiety, respiratory disease, or musculoskeletal issues, including injuries to the neck and upper back, TMJ, and headaches. While some of these behaviors can be directly assessed through standard clinical observation, capnography provides a more objective, continuous, and precise way to monitor a client’s respiratory status and identify impairments which are not visible to the eye. This information can then be correlated with other physiologic measures, including HRV, SpO2, and data from sleep studies, and compared directly, in real time, to the client’s reported symptoms and experiences.
What to Expect During a Capnography Assessment
At KNOSIS, we begin capnography assessment with a brief questionnaire, inviting you to reflect on the symptoms and areas of concern you experience around your breathing. Sitting comfortably, a nasal cannula is donned which samples the air you breathe out through your nose for analysis. We begin by taking a baseline of your natural, relaxed breathing, observing both the raw data (PCO2, respiratory rate, etc), behaviors and patterns observed in the wave form displayed, and observations of your posture and body mechanics.
Example capnogram, or wave form image, of PCO2; CapnoTrainer Professional; Better Physiology, Ltd.
Through a process of interviewing and analysis, the client describes their own observations and experiences of their breathing, including any changes in symptoms, recurrent thoughts or feelings, or any areas of concern or anxiety. Based on findings and the client’s concerns, the therapist guides each client through an individualized series of “challenges” or conditions to tease apart the breathing habits, behaviors, and motivators which may be contributing to the learned dysfunction. We also assess your typical breathing techniques, whether learned from yoga, meditation, or from other providers, to ensure that these specific techniques are effective in optimizing respiratory chemistry.
Once the faulty pattern is identified, our certified therapists help clients to learn how to release dysfunctional habits, facilitate natural breathing reflexes, and learn to breathe intuitively, from the inside-out rather than from outside-in.
