DRAFT2
Explain the difference between awareness of uncontrolled habitual breathing and conscious controlled breathing. Discuss how you would introduce breath awareness to your students in a class situation, including a variety of possible basic breathing techniques
Limit 1000-3000 words 2582 words
Ginny Clother
Introduction
In order to consider the difference between awareness of uncontrolled and controlled breathing patterns it is helpful to reflect on the importance of breathing. While it is possible to live for days without food or water the human body can survive only minutes without breathing. Without oxygen the brain rapidly ceases to function and can no longer drive cardio respiratory function resulting in death. Breathing is a fundamental requirement for human life, providing oxygen to all the cells of the body and expelling carbon dioxide.
During the process of breathing ambient air is filtered, warmed and humidified by the nose. Air is drawn in to the lungs by air pressure differential due to change in lung volume. The change in lung volume is produced by muscular activity. Inspiration involves contraction of the diaphragm and external intercostal muscles. Exhalation is largely due to the elastic recoil which takes place on relaxation of these muscles. Vigorous physical activity or ill health may require additional muscle contraction of accessory muscles which can facilitate more rapid action and splinting of the chest wall to assist inhalation and compression of thorax and abdominal contents to assist exhalation. Muscles assisting strong inhalation include Sternocleidomastoid, Levator Scapulae, Scalenes, Trapezii, Pectoralis Major and Minor and Serratus Anterior and Posterior muscles. Muscles assisting forced exhalation include Internal Intercostals, Transversus Abdominis, Transversus Thoracis, Rectus Abdominis, External and Internal obliques and Levator Ani. Strenuous exercise can increase oxygen uptake and carbon dioxide removal by 25 times. Age and gender do not cause any major changes in the mechanics of breathing. Although with advanced age there can be decreased elastic recoil and loss of compliance of the chest wall due to calcification of costal cartilage. This can decrease expiratory force. Severe osteoporosis and resultant thoracic kyphosis can also reduce optimal inhalation due to reduced rib and spinal excursion. Arteriosclerosis can affect the cerebrovascular sytem with adverse effects on the medulla.
The medulla (positioned in the brain stem at the seat of the brain) contains cell bodies that control the activity of the muscles of respiration. The medulla is modulated by feedback from other areas of the brain, which includes the pons. Chemoreceptors in the aorta and carotid arteries monitor blood gas levels, stretch receptors in the lungs evaluate lung inflation, input from locomotor areas in the cerebral cortex determines oxygen need due to movement and central chemoreceptors in the medulla itself sample pH levels of blood. This information is integrated with neural feedback regarding mechanical and chemical change in muscles, tendons and joints throughout the body. Drugs such as barbiturates and opioids can depress the medulla. Overdose can lead to ventilation ceasing.
The peripheral nerves C3-5 innervate the diaphragm. Spinal cord injury above this level therefore interrupts diaphragm function resulting in a need for artificial ventilation to ensure survival. Breathing can continue without conscious thought as long as the medulla, pons and spinal cord above C5 are intact.
The autonomic nervous system describes the peripheral nervous system that controls the body’s internal environment. It ensures that the body can respond accurately and immediately to internal and/ or external change. Firing up sympathetic or parasympathetic neural pathways can increase or decrease respiratory activity (these involve the involuntary reflex ‘fight or flight’ response to perceived or actual threat). These processes facilitate breathing without conscious control but provide immediate response to the body’s actual or perceived demands. Intense emotion can affect breath through the sympathetic pathway. For example anger or feeling scared can promote a shallow rapid and irregular breath. Hyperventilation describes the condition when alveolar ventilation is too great so that too much carbon dioxide is blown off and the trigger to breathe is then depressed. This can happen acutely but can also become a chronic habitual pattern that produces hormonal and muscular imbalance, which can lead to back and pelvic pain and urinary incontinence.
Uncontrolled habitual breathing and conscious controlled breathing
People who are feeling anxious, depressed or stressed can exhibit characteristic posture, which may also affect the volume of their breath, and their breathing patterns may well be disordered. Irregular breath can cause hormonal changes that then reproduce or intensify the symptoms of panic and anxiety. Coulter (2007) suggests (page 89) that one of the aims of yoga is to maintain ‘even-tempered states’ and that breathing control can facilitate this. Desikachar (1995) (page 55) concurs that ‘the quality of our breath influences our state of mind and vice versa’ and states that the purpose of asana is to allow focus on the breath rather than the body.
Conscious breath control can therefore not only calm the mind but enables us to speak, shout, sing, avoid bad smells and to lift heavy objects. The glottis is the narrowest part of the larynx. Air passes through the larynx both towards and returning from the trachea. The trachea leads to the lungs. Forced exhalation against a closed glottis is often employed to increase intrathoracic pressure rapidly and maximally. This technique potentiates the action of the chest muscles for use in weight lifting. This technique can be employed both consciously and unconsciously. There is an associated risk of fainting when performing this action due to a rapid increase in blood pressure swiftly followed by a significant fall in blood pressure. These changes in blood pressure are related to the intra thoracic change in pressure and its effect on the circulatory system.
The control of breath not only includes addressing inhalation and exhalation but also breath retention. Strength and endurance of the ventilatory muscles can be improved which can enhance capacity for exercise and decrease feelings of breathlessness and pulmonary discomfort on prolonged exercise.
Each individual develops their own breathing frequency and volume due to myriad different influences. For example trained athletes tend to utilise a deepened breath rather than increase their breathing rate on moderate exertion. The untrained athlete will tend to increase their breathing rate, which is a less energy efficient or economic adaptation. Normal respiratory rate for an adult at rest is approximately 12-16 breaths a minute. A respiratory rate of above 20 breaths a minute at rest is known as tachypnoea and may be produced by anxiety states or metabolic acidosis. Bradypnoea describes a respiratory rate below 10 breaths a minute and is usually the result of central nervous system depression by narcotics or trauma.
It is always possible to change breathing habits and optimise function as long as involuntary stimuli are not deranged. Examples of deranged stimuli that would resist change include experience of asthma in the acute phase, which involves massive involuntary constriction of the smooth muscle of the airways and requires urgent administration of inhaled bronchodilators. Similarly the later stages of pregnancy can involve mechanical constriction of the diaphragm which can make conscious change of breath difficult.
Introducing breath awareness to students
In order to change breathing it is necessary to first develop conscious awareness of the breath. The first step in breath awareness can be to encourage the student to monitor the breath while resolving not to change it. The student can observe if they are breathing through the nose or mouth or both. They can monitor the length of their inhalation, exhalation and any pause between. They can observe which muscles they are actively contracting and which they are releasing. They may notice that their breath is noisy or that it changes as they watch. It is often very difficult not to begin to change the breath during observation. Therefore it is necessary to reassure the students that most people find this a deceptively difficult exercise.
Knowledge empowers- if students are not aware of how their body functions and explicitly what muscles are involved in the ventilatory process it is more difficult for them to identify, recognise and intervene effectively. Explanation- verbal, visual and practical, of the mechanics of breathing can help with the process of exploration and discovery of the breath and enhance awareness.
Movement with the breath in the cat posture on all fours can encourage students to recognise the rhythm of their breath. Gravity exerts a pull on the viscera and thus a stretch on the frontal musculature that can enhance sensation and sensitivity. The spine is free to move anterior to posterior in association with the breath.
It is not unusual for habitual movement patterns and postures to be adopted that the individual may be entirely unaware of. Drawing attention to the effect of posture on the breath can help students to make these important connections. The teacher can encourage the students to recognise that when in a slumped and slouched posture it is more difficult to inhale as the chest is constricted. It is also more difficult to breathe out actively as the abdominal muscles are restricted. The reverse can then be experienced in an upright posture.
Coulter 2007 (page 119-20) recommends lying supine as the prime starting position for beginners focusing on the breath as he considers this to be the easiest position and less likely to provoke anxiety. This is because the chest and spine are fixed and contraction of the diaphragm draws air in to the lungs but also compresses the abdominal contents so that the abdominal wall moves forwards and this can be palpated by the students own hands.
In an upright position the bucket handle movement of the lower ribs (increase in the lower thoracic transverse diameter due to external intercostal muscle contraction) can be palpated by each student, adding to their understanding of the anatomy of breathing.
A variety of basic breathing techniques
Other techniques that can be helpful for the beginner are to watch the inhalation and the exhalation and the pause between. Or to count the breath in and out, taking care not to provoke any stress reactions. Stress is likely to be counter productive to physiological control, usually increasing the respiratory rate and decreasing the depth of inhalation. However as the student feels increasing confidence the plus one technique can be used. This involves counting the breath in and at maximum inhale adding on one more count. The same technique can be employed with the exhalation and then applied to both in and out breath.
Step breathing can focus the attention utilising a three part breath focusing on inhalation to the lower thoracic region, mid thoracic region and finally clavicular region. Exhalation is accomplished in reverse. This practise can serve as a useful analogy to focus awareness and mindfulness of the lung volume. This can be enhanced by using mental imagery to divide the trunk into eight parts- the initial separation of the three part breath are retained but the lower and middle regions are divided into front, mid and back portions and the top most portion into front and back. Numbers are assigned running caudad to cephalad, anterior to posterior. Inhalation involves counting and focusing from one to eight, exhalation the reverse.
Posture can be tied in with the rhythm of the breath, with the student being encouraged to open the chest, rib cage and shoulders on the inhalation and relax on the exhalation. It is important to keep such movements moderate and almost imperceptible in order not to promote hyperventilation or stress.
Visualisations can be very helpful for some students and suggestions can include key words for inhalation such as breathing in ‘energy’ or ‘calm’ and breathing out ‘toxins’ or ‘clutter’. It is probably best if students are encouraged to pick the words that resonate with their own circumstances, and be aware that any students with mental health issues may struggle with this kind of imagery. Possibly a less provocative technique would be to encourage students to even and smooth their breath or to notice temperature change of the inhaled breath (cool) compared to the exhaled (warm) or the expansion of the airways on inhalation and their relaxation on exhalation.
Ujjayi breathing
Ujjayi breathing could be considered beyond the scope of this essay as many teachers consider it to be pranayama (breath control) and as such not suitable for being taught to beginners. However not all teachers agree. Ujjayi is explained by Desikachar (1995) as a technique where a slight noise is made by gently contracting the vocal chords so that it is possible to listen to the breath (page 56). Iyengar (2001) cautions that improper use can cause adverse effects (page 363). Coulter (2007 page 131-2) also warns of a risk of negative consequences of breathing control, such that teachers need to proceed with care. However Desikachar (1995 page 59) states there is nothing to fear as long as close attention is paid to the body during the activity and natural urges are not suppressed. I feel that I have benefited from the short exposure I have had to ujjayi breathing. It has deepened my practise and introduced another dimension. I consider that as long as it is taught with care ujjayi breathing is suitable for beginners’ practise.