Shallow and dysfunctional breathing

What it is

A normal breath is driven by the diaphragm, moves the lower ribs outward and happens about twelve to sixteen times a minute. In a dysfunctional breathing pattern the diaphragm is barely used, the neck and upper chest muscles do the work, and the rate is higher than the body needs.

Over-breathing lowers carbon dioxide levels, which changes blood pH and produces a specific cluster of symptoms: tingling in the hands and around the mouth, light-headedness, chest tightness and air hunger. Because the lungs are normal, investigations find nothing, and people are frequently told there is nothing wrong when there is something quite specific and quite treatable.

What it feels like

• Breathlessness with no clear cause, sometimes at rest
• Frequent sighing and yawning, and a sense of not getting a satisfying breath
• Chest tightness that is not relieved by an inhaler
• Tingling in the fingers or around the mouth, and light-headedness
• Neck and shoulder aching from the accessory muscles doing the breathing

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

An underused diaphragm

The diaphragm should do most of the work of breathing. When it does not, the neck and upper chest muscles take over - they are inefficient at it and they fatigue and ache.

Low carbon dioxide from over-breathing

Breathing more than the body requires lowers carbon dioxide, which changes blood pH and constricts blood vessels to the brain. That produces the tingling, light-headedness and air hunger.

Anxiety and stress

Both produce fast, shallow, upper-chest breathing, and the resulting symptoms then feed the anxiety. It is one of the tightest loops in this whole area and it works in both directions.

After a respiratory illness

Breathing patterns commonly become disordered after a chest infection or COVID and do not always reset on their own. It is a very common finding in long COVID.

Coexisting with asthma

Dysfunctional breathing occurs alongside asthma in a substantial proportion of people. The symptoms mimic asthma, do not respond to inhalers, and lead to unnecessary escalation of medication.

Postural factors

A slumped posture with a rounded upper back mechanically restricts diaphragm movement, so the pattern is partly produced by how someone sits all day.

Chronic pain

Pain, particularly in the trunk, ribs or abdomen, alters breathing pattern protectively. The pattern often outlasts the pain that caused it.

Habit and reinforcement

Breathing is largely automatic, and an altered pattern becomes the new automatic. That is why it persists after the original trigger is gone and why deliberate retraining is what changes it.

Mouth breathing

Nasal obstruction from allergy or structural causes forces mouth breathing, which encourages an upper-chest pattern and reduces the natural regulation nasal breathing provides.

Being told nothing is wrong

Normal investigations lead to reassurance that misses the problem. The lungs genuinely are normal - it is the pattern that is not, and nobody looks at it.

Who tends to get it

• Anyone with anxiety or in a sustained stressful period
• People recovering from a respiratory illness, including COVID
• Anyone with asthma, in whom it commonly coexists
• People with chronic pain, particularly in the trunk
• Anyone with a rounded upper back and a habitually slumped posture

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineBreathing & Ribcage

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Breathlessness at rest, chest pain, or hypoxia needs medical assessment before being called a breathing pattern problem

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Breathing retraining produces improvement over four to eight weeks and often much sooner - many people notice a difference within days of practising properly, because the mechanism responds immediately. It requires daily practice until the new pattern becomes automatic, which takes weeks rather than sessions. Breathlessness with chest pain, with exertion, or with any cardiac or respiratory risk factor should always be properly assessed before being attributed to a breathing pattern.

Prevalence basis: Respiratory physiology studies

Others the same routine covers

These share the Breathing & Ribcage routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.