Chapter 1: What are Breathing Pattern Disorders?

This is a chapter 1 summary of “Recognizing and Treating Breathing Disorders” by Leon Chaitow.

It’s Been A While

I know it has been a while for some Therapy Notes (©™®#zacistheshizzy), but I decided to revisit some Chaitow as I read his new edition. The chapters have changed quite a bit so far, and many new things have been added. Here is the updated chapter one.

A Lotta History

Hyperventilation disorders have been through the ringer, and to this day are hardly diagnosed. Some of the biggest classifications in my eyes arrived in 1908-09 from phsyiologists Haldane, Poulton, and Vernon. These fellows classified symptoms of overbreathing to include:

  • Numbness
  • Tingling
  • Dizziness
  • Muscular hypertonicity.

This symptom cluster occurred with respiratory alkalosis.

In 1977, Lum, Innocenti, and Cluff developed assessment and treatment programs for breathing disorders in the UK, which spearheaded breathing disorder literature.

Despite these scientific advancements, many physicians do not diagnose hyperventilation as a legitimate problem. Some of these patients even go so far as to being accused as malingering. Hearing this problem is quite unsettling, as I am seeing more and more people who overbreathe; and possibility correlating, more and more people with chronic pain. A future post is in order to show how I think the two are connected.

Breathing Pattern Disorders (BPD) and Symptoms

So many symptoms could occur with BPDs. The most extreme of these symptoms is hyperventilation syndrome, defined by the following:

  • Breathing in excess of metabolic requirements.
  • Reducing CO2 concentrations in the blood below normal levels.
  • Altered blood pH towards alkalinity.

Other definitions that ought to be known with these disorders include:

  • Hypoventilation: Increased CO2 levels due to shallow breathing.
  • Hypocapnia: CO2 deficiency in the blood due to hyperventilation; leading to respiratory alkalosis.
  • Hypoxia: Reduced oxygen supply to tissues.

Just How often Should We See This?

Probably more than you think. Hyperventilation Syndrome (HVS) is estimated to occur in about 6-10% of adults.

Of that group, women are 7 times more likely to exhibit these symptoms than men.


Many different changes occur when breathing is dysfunctional. Most notably, increased accessory muscle use and corresponding decreased tidal volume occur.

When accessory muscles are overactive, the head and shoulders are pulled forward. We also see an increase in lordosis and anterior pelvic tilt. To summate, an anterior weight shift.

Other possibilities that may occur include:

  • Visceral stasis
  • Pelvic floor weakness
  • Fascial restriction in diaphragm’s central tendon.
  • Elevated upper ribs.
  • Affected thoracic spine mobility and altered symptathetic outflow.
  • Accessory muscle hypertonia.
  • Cervical and lumbar spine become progressively rigid.
  • Function is affected in muscles that attach to the diaphragm; including the quadratus lumborum, psoas, and transversus abdominis (cough PRI cough).

With these changes, we may see a shift in body homeostasis to heterostasis if the body exhausts in attempts to adapt. It is these folks that we ought to treat.

A Clinical Case

A fellow coworker/PRI junkie of mine called me over to check out one of his patients.

This gal was complaining of neck pain, headaches, dizziness, nausea, and tingling. She had no vestibular issues at the time. She would flare up with any manual techniques to the neck or traditional headache-based therapies.

Upon observation, she presented with the above general anterior weight-shifted/extended posturing. PRI testing supported this observation.

She was given breathing exercises utilizing a balloon and straw. However, she could not breathe without extending her back. So we decided manual intervention was indicated.

Basically all we did was guide her ribs down and in to assist with exhalation; keeping the ribs down while she inhaled. The interesting thing during this intervention was that she was taking very little air in, but the amount she was exhaling was a ton. Even she was surprised by this finding.

After performing this intervention for about 5 minutes, she got up and had no neck pain. The nausea, tingling, and dizziness were also gone.

This example shows me what power breathing can have in either a positive in negative direction. This girl seemed to be in more of a hyperventilated state. By altering her breathing pattern we were able to influence this status.

Normally this drastic case is not often seen, but I feel that impaired breathing is becoming and will continue to be more prevalent.

Look forward to sharing more.

  1. Hey Zac,

    overbreathing really is an interesting topic.

    Have you looked into buteyko?


    1. Indeed it is Philip. Just familiar with the bit I have come across with PRI. There is a chapter in this book on it which I will cover 🙂