Updated: Oct 12, 2020
What if breathing easier could help decrease your pain and enhance your sleep; there’s good news, it can! A few weeks ago, I posted on social media that manual therapy with an osteopath can improve your sleep and received a couple of questions from curious individuals asking how. As this is a subject that can benefit a lot of people I decided to further explain my claim.
Perhaps you’ve noticed yourself short of breath at times, or still tired after you wake up in the morning? Your posture and breathing habits may be to blame. From a young age your parents likely told you not to slouch as it would cause neck pain, but did they know it would also help you breathe and subsequently sleep better? Perhaps you don’t know that there’s anything off with your breathing, after all, it’s natural and most people without any serious underlying conditions take it for granted. Below, I will explain how breathing better during the day can help you breathe better at night, which has been shown to prevent a long list of health-related conditions as you age. “Sleep disruption is associated with increased activity of the sympathetic nervous system and hypothalamic–pituitary–adrenal axis, metabolic effects, changes in circadian rhythms, and proinflammatory responses. In otherwise healthy adults, short-term consequences of sleep disruption include increased stress responsivity, somatic pain, reduced quality of life, emotional distress and mood disorders, and cognitive, memory, and performance deficits... Long-term consequences of sleep disruption in otherwise healthy individuals include hypertension, dyslipidemia, cardiovascular disease, weight-related issues, metabolic syndrome, type 2 diabetes mellitus, and colorectal cancer” (3). Improve your breathing, improve your sleep and reap the benefits of both short term and long-term effects.
There has been an increased prevalence of sleep disruptions and sleep disorder breathing in adults that has been steadily growing. Not all sleep disruptions are related to breathing but unless otherwise diagnosed, it may be a place to start as for most people it can be relatively straightforward to improve with the help of manual therapy and breathing techniques. Other factors of sleep disruptions can include stress, electronic devises as well as other medical conditions that can be discussed with your doctor.
Manual therapy techniques performed by an osteopath can allow you to expand your thoracic cage more easily and can assist in your breathing. The international Journal of Chronic Obstructive Pulmonary Disease showed among 38 patients with severe Chronic Obstructive Pulmonary Disease (COPD) an improvement in as little as one visit with a manual therapist. “A single session immediately improved pulmonary function, inspiratory muscle strength, and oxygen saturation and reduced dyspnea, fatigue, and heart and respiratory rates in patients with severe COPD. Manual therapy should be added to pulmonary rehabilitation treatment as a new alternative that is fast acting and motivating in patients with COPD.” (7). This doesn’t mean these individuals were cured or even able to reduce their medication; that wasn’t the goal of the study. The goal was to provide a complemental therapy to individuals already following a treatment protocol with their family doctors and to attempt to further provide them with an ease to the already labor some process of breathing.
If you’re someone who suffers from anxiety or depression you may have been told by medical professionals and friends alike to take deep breaths. And it’s true, when you’re feeling depressed or tired or feigning off a panic attack, breathing deeply has been shown to help. Researchers have been investigating this for years and are continuing to report that breathing deeply and performing breathing exercises can help suffers of anxiety and more immediately, can help them during a panic attack. Being able to take these deep breaths can help some people, others find their thoracic cage is too tight that they can’t breathe deep enough. Taking control of your body and having the techniques and resources to feel in control can complement your mental health by reducing the restrictions you feel when you need to be able to breathe most. Allowing your ribcage and diaphragm to fully expand and maximize the efficiency of your breathing is beneficial. There is a surprisingly high level of correlation between anxiety and depression and chronic breathing disorders (2) and vice versa; individuals who find it hard to breathe or are breathing less optimally at night have now been shown to suffer from anxiety and panic attacks (6). When The journal of research in medical sciences studied 178 patients who suffered from Obstructive sleep apnea, they noted that over half of them (53.9%) had anxiety (6).
Respiratory Accessory Muscles:
Most of us know the importance of the diaphragm and its role in breathing, but are you aware of the other set of muscles that assist in breathing? The Respiratory accessory muscles help you breathe; there are insertion points on the ribcage and they help lift and expand your ribcage as you breathe. And their release allows for full expiration. These muscles: the intercostal muscles, the scalene muscles, the sternocleidomastoid muscle and the pectoralis major play an important roll in breathing. Breathing is not limited to these muscles and the muscles engagement during quiet breathing can be different from active breathing, but it can be shown that tight muscles in the neck and especially of the respiratory accessory muscles can contribute to a reduced quality of breathing. If you breathe with your mouth while you are doing a forced exercise, you may already have tight respiratory accessory muscles. If you work in an office setting and have anteprojection of the neck (forward head posture) you may have reduced function of the respiratory accessory muscles and that could make them feel tight and tense as well. There has been a direct correlation shown between forward head posture, respiratory function and respiratory accessory muscles; the conclusion: “Forward head posture may act to lower respiratory functions, and thus, the maintenance of correct head posture is required to prevent such functional reductions” (1). So it is a bit cyclical; Forward head posture, lower respiratory function, tight cervical muscles, continued forward head posture.
Headaches and pain
Because some of the respiratory accessory muscles insert not only on the ribs, but also in the neck, the tension that is felt is not restricted to the ribcage. Headaches can be relieved by elimination of these restrictions and promoting circulation. A study in 2016 showed that there was “a high comorbidity of craniofacial pain (chronic face pain, temporomandibular disorders, and primary headaches) with obstructive sleep breathing disorders and obstructive sleep apnea (OSA). This study was not limited to adults: children with primary headaches were shown to have obstructive sleep apnea as well” (3). Breathing better has been shown to reduce the body’s inflammatory response as well. As mentioned earlier, a reduction in sleep allows for a somatic body response with the sympathetic nervous system being more prevalent and creating a proinflammatory response.
What if releasing the restrictions you have in your thoracic cage and neck and engaging the proper muscles could help you breathe better, sleep better, reduce inflammation and give you the ability to prevent additional medical issues as you age? A manual therapy session with an osteopath will consist of gentle techniques on your diaphragm, rib cage, thoracic and cervical spine, muscles of the neck and throat as well as anything further that is found to be causing a restriction or will benefit you immediately and reduce your discomfort, tension, pain and headaches. Breathing better is not always a simple case of removing the restrictions in your rib cage and neck and seeing a manual therapist should not be replaced with treatment for severe illnesses already diagnosed and being treated by your family doctor.
The answers to better breathing and better sleep are not always simple and should always be discussed with your family doctor to rule out any major illnesses. Osteopathy does not replace medical advice nor attempts to remove you from any current medications you may take to enhance your breathing due to already diagnosed medial conditions treated by your doctor and pharmacist.
1). Kim, M.S., Cha, Y.J., Choi, J.D. (2017). Correlation between forward head posture, respiratory functions, and respiratory accessory muscles in young adults. Journal of back and musculoskeletal rehabilitation. 30. 4: 711-715
2). Kunik, M. et al (2004). Surprisingly High Prevalence of Anxiety and Depression in Chronic Breathing Disorders. Chest Volume 127, Issue 4, 1205-1211
3). Medic, G., Wille, M., Hemels, M.EH., (2017). Short- and long-term health consequences of sleep disruption. Nature of Science and Sleep. 9: 151–161.
4). Olmos, S.R. (2016). Comorbidities of chronic facial pain and obstructive sleep apnea. Sleep and Respiratory Neurobiology; Current Opinion in Pulmonary Medicine November 2016 - Volume 22 - Issue 6 - p 570-575
5). Peppard, P.E. et al (2013). Increased Prevalence of Sleep-Disordered Breathing in Adults. American Journal of Epidemiology, Volume 177, Issue 9, 1006–1014
6). Rezaeitalab, F,. Moharrari, F. et al (2014). The correlation of anxiety and depression with obstructive sleep apnea syndrome. Journal of research in medical sciences 2014 Mar; 19(3): 205–210.
7). Yilmaz Yelvar, G.D et al (2016). Immediate effect of manual therapy on respiratory functions and inspiratory muscle strength in patients with COPD. International Journal of COPD, 11: 1353–1357
Amelia is a member in good standing with the Association des Osteopathes Ritma. She practices at Ostéopathie Lennoxville in Sherbrooke, Quebec.
Amelia Kingsley BSc. D.O.