Anxiety and Panic Attacks In Emphysema/ Chronic Obstructive Pulmonary Diseases (COPD)
|Vijai P. Sharma, Ph.D., psychologist
Learn correct breathing and relaxed breathing. Avoid incorrect breathing. Correct breathing and physical and mental relaxation, the two master skills which can make a big difference in your quality of life. Make sure you also read the section on Physical and Mental Relaxation for a more enjoyable and relaxed life.
Signs of Irregular Breathing
When you are not exerting and you still experience any of the following:
Negative effects of chronic hyperventilation (over breathing)
Breathing Pattern Disorder (BPD)
A faulty or incorrect breathing pattern such as habitual over breathing, breath holding or shallow breathing may be may be genetically acquired, learned or affected by physical or psycho-emotional factors.
Here are some of the factors associated with BPD:
Potential Benefits of Breathing training
Therefore, if possible seek breathing training.
Many (not all) teachers of eastern exercise systems such as Yoga, Tai Chi, Qui Gong provide breathing training.
Find a teacher who has some experience of working with a person with COPD.
Tips For Correcting Breathing
Signs of regular and relaxed breathing
The following tend to relax the body and the mind:
Correct Process of Breathing
Neck and shoulders remain relaxed. As the breath goes downward, the chest expands, the rib cage elevates, diaphragm goes down and the belly comes out. The area between sternum, navel and perineum stretches. The upper back widens and the lumbar arch slightly deepens.
Neck and shoulders remain relaxed. Diaphragm relaxes, chest and ribcage retract to their pre-inhalation size and position, the belly goes in, navel slightly pulled in towards the back and the lumbar arch in the low back slightly flattens.
Check and Improve Your Own Breathing
Use the "Hand Technique"
Sit in a quiet place and just settle down for a minute or two. Put your hand, horizontally, about one inch above your navel. Close your eyes. Breathe normally without trying to influence your breathing one way or the other. Observe how your belly moves every time you breathe in and breathe out. If you are breathing correctly, you should find that the hand over the tummy moves as you breathe in and out.
This is called "abdominal breathing." Abdominal breathing is good but don't deliberately puff your belly out, let the belly be relaxed. Also, if upper chest and/or shoulder and neck go up and down as you breathe in and out, let your neck and shoulder relax.
Having checked yourself for the abdominal breathing, you may now check if your belly is moving in the right pattern.
Close your eyes again and track your hand on the belly.
Belly should bulge OUT when you breathe IN
Belly should pull IN when you breathe OUT.
Tips for Correcting Belly Movement
If the belly does not move correctly as for example, belly moves in when you inhale, you need to correct it. Here is how to:
"Take a slow, deep breath in and breathe out slowly and steadily. The next breath will come in automatically, that is without your effort. Your tummy will move outward as you breathe in and move inward as you breathe out."
If your tummy begins to move incorrectly or not move at all or only chest moves but not belly, relax and reestablish correct breathing. Take a deep, slow, easy breath and blow it out, slowly and steadily. Do it as many times as you need to. It will get better.
Form the Habit of Conscious Breathing
As you begin to pay steady attention to your breathing, it will be easier for you to monitor your breathing. Any time you find yourself holding your breath or having a jerky breath, breathing irregular or faster, go back to belly breathing
Pay attention to your breathing. While inhaling move your attention downward and follow the lungs filling, chest expanding horizontally and vertically and the belly bulging out. While exhaling, move your attention upward from abdomen to chest, notice the belly and solar plexus slightly contracting and the breath finally exiting through the nostrils.
Make it a habit to breathe consciously. Conscious breathing can be very beneficial. Develop positive and relaxed awareness of your breathing.
While driving, even when you use the cruise, you continue to monitor the road conditions all the time. Likewise, you should monitor your breathing. When you monitor the breath, you can decide when you want to leave your breathing on the "automatic pilot" and when to take charge and regulate your breath with awareness
Beneficial for COPD, anxiety and depression
One of the most beneficial breathing techniques for people with COPD is belly breathing.
When you breathe in, abdomen should expand and protrude.
When you breathe out, abdomen should go in towards the back.
While breathing in, the focus should be on the descending diaphragm and expanding lower ribs and abdomen
During exhalation, attention should be on the diaphragm ascending, the lower ribs squeezing and the belly contracting.
Pay gentle attention to this process and not get frustrated if the lower ribs don't move at all.
In light of the relatively flattened diaphragm and shortened intercostals in the case of many people with COPD, when you gently contract the abdomen and lower ribs during exhalation, you are assisting your diaphragm to move upward and empty the lungs.
During inhalation, simply allow the expansion of the belly and lower ribs during so the diaphragm moves down,.
How to Do "Diaphragmatic Breathing" or "Lower Ribs Breathing"
"Diaphragmatic breathing" which is also called "lower ribs breathing" may be done in a seated position or lying down position.
Some people with COPD experience aggravation of their breathing problem when lying down. They have a hard time mobilizing the diaphragm in that position. They should practice breathing technique in comfortable seated position.
Those who don't have this problem can practice diaphragm breathing in a prone position. Lying down with a sandbag, bag of rice, beanbag or a book weighing one or two pounds on the abdomen while practicing diaphragm breathing for 5 to 15 minutes strengthens the diaphragm and also promotes relaxation. Later the weight can be increased to 5 or 10 pounds. After the sandbag method is mastered, they can practice diaphragm breathing in the sitting and standing positions and then while walking.
Walking is a highly beneficial exercise for people with COPD, and if they can do diaphragm breathing while walking, the benefits are likely to be even greater. One should learn both techniques of diaphragm breathing: (1) abdominal breathing--pressing the belly in for exhalation and expanding the belly for inhalation and (2) side rib breathing--squeezing the side ribs with the hands while exhaling and releasing them while inhaling.
Pursed-Lip Breathing (PLB) for Shortness of Breath
Pursed -Lip Breathing (PLB) is one of the most helpful things you can do when you are feeling breathless. Pursed lips help to keep the breathing tubes (bronchi) open and maintain right pressure in those tiny, tiny air sacs. Mouth is closer to lungs than the nose is, so it's easier to blow the breath out through the mouth.
Benefits of PLB
Instructions for PLB
Lean slightly forward and s-l-o-w-l-y blow out through pursed lips as if gently blowing a kiss at someone or cooling hot soup in a bowl.
You may breathe in through the nose, if possible, and breathe out through the pursed lips. The action of leaning slightly forward and blowing out against pursed lips encourages the contraction of abdominal muscles, thereby forcing the diaphragm upward to empty the lungs more completely. People with COPD tend to cut short exhalation and rush to swallow more air, making breathlessness even worse.
Pursed-lip breathing slows down exhalation and assists with the action of emptying the lungs and may also help strengthen the breathing muscles.
Lengthen your exhalation. Silently counting while exhaling and inhaling can help. At first they should inhale for a count of three or four and exhale for the same count.
Over time, you may aim to increase the exhalation to a count of perhaps six or eight. An ideal ratio for the length of inhalation to exhalation is 1:2.
10 Steps of PLB
Remember about the length of inhalation and exhalation
Continue to Chapter 10
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Copyright 2008, Mind Publications