Breathe Right! (Part 3): Diaphragmatic and Pursed Lip Breathing
|Vijai P. Sharma, Ph.D., psychologist, RYT
Set a goal to breathe consciously, diaphragmatically for most part of your waking hours. If you experience any breathing problem or irregularity in your breathing, start practicing PLB. Your continued breath awareness and monitoring will prompt you at the earliest sign of irregular breathing. The moment you notice the first sign, start practicing PLB to regulate your breathing.
How to Do "Diaphragmatic Breathing"
Many people equate "diaphragmatic breathing" with abdominal breathing. They assume as long as they experience abdominal expansion and contraction with inhalation and exhalation, they are doing diaphragmatic breathing. In some cases it may prove to be a false assumption because some people only puff their belly without effectively engaging the diaphragm. In order to avoid such a mistake let us identify two components of diaphragmatic breathing and they are:
1. Abdominal breathing
2. "Lower side ribs breathing."
Diaphragmatic breathing involves expansion and contraction of the abdomen as well as expansion and contraction of the lower side ribs.
Simple Test for Diaphragmatic Breathing
The movement of the diaphragm may be weak and limited in case of many people with COPD. There may be several reasons for that. To name a few, muscles in the side ribs may be weak and shortened to move the ribs, lungs may be overinflated at the bottom restricting the movement of the diaphragm and the diaphragmatic muscle itself may be weak and may have limited range of movement. Still some feel the diaphragmatic movement more strongly as it goes up and down in front of the abdomen and some feel more strongly the wing like movement in the lower side ribs.
Where Do You Feel It Most? Can't tell? Here are 3 check points to help you feel the movement of the diaphragm:
1. Place your hands on lower abdomen in such a way that the middle finger tips touch the navel. The tips of the index fingers are above the navel touching each othe,r and the tips of the ring finger and little finger are below the navel touching each other. Take 2 or 3 breaths to feel the movement.
2. Place hands ½ way between navel and breastbone tip, tips of opposite fingers touching each other across the abdomen. Take 2 or 3 breaths to feel the movement.
3. With your thumb and folded index finger on both sides, pinch and separate the skin at the lower ribs. Take 2 or 3 breaths to feel the movement in the sides.
Some of you, the lucky ones, may feel the movement in front of the abdomen as well as the side ribs.
Let us now discuss the abdominal breathing practice and later we will discuss the lower side ribs breathing.
Abdominal Breathing Practice
Abdominal breathing is a term used for convenience. Breathing is done by lungs. What abdomen does is simply expansion and contraction with inhalation and exhalation. When you inhale, diaphragm pushes down and with that it pushes down the abdominal organs and as a result of this action, the abdomen bulges out. When you exhale, diaphragm relaxes and goes up. With such diaphragmatic action, abdomen contracts, the abdominal organs which were pushed down come back up and you see the abdominal wall pulls in towards the back.
Abdominal breathing can be practiced in a seated position or lying down position.
When some people with COPD lie down, they experience trouble breathing. They have a hard time mobilizing the diaphragm in lying down position. They should practice breathing technique while seated in a comfortable position.
Those who don't experience any trouble in breathing while lying down may practice diaphragmatic breathing in a supine position. In order to do that, lie down to put light weights on your abdomen to engage the diaphragmatic muscle. To put light weights, you may use a sandbag, bag of rice, beanbag or a big book on your abdomen. In the beginning, depending on your capacity, place weight on your abdomen anywhere between 1 to 5 pounds. Thus by placing weight on your abdomen, you would be supporting diaphragmatic breathing. Practice diaphragmatic breathing in this manner for 5 to 15 minutes. It would strengthen your diaphragmatic muscle and also promote mental and physical relaxation. Later the weight may be increased from 5 to 10 pounds depending on your capacity. After the weight on the abdomen method is mastered, you can practice diaphragmatic breathing without weights in the sitting and standing positions. Later, as you get more experienced, you may practice diaphragmatic breathing even when walking.
Incidentally, walking is a highly beneficial exercise for people with compromised breathing such as in COPD, and if you can do diaphragmatic breathing while walking, the benefits are likely to be even greater.
Lower Side-Ribs Breathing
Diaphragm is attached to the lower six ribs, but actually it is the lowest four or five ribs where you can feel the action when you inhale. This action of the lower side ribs is often described informally as the "side ribs flaring out" or "fanning out" when you inhale. In the medical circles the side ribs action is called the "bucket handle" movement. In case you are wondering what bucket handle movement is, get hold of a bucket with handle. Lift the bucket handle from the side to the top and bring it down. The lower ribs move in a bucket handle like motion when you inhale.
Practice of lower side-ribs breathing
First you want to place your hands on your lower side ribs in such a way that you can feel the expansion and relaxation of these ribs as you breathe in and out. For that purpose, cross elbows in front of your navel and place your hands on lower side-ribs. In this way, your left hand will be on the lower right side ribs and the right hand on the left ones. Breathe in and feel side ribs expanding. Breathe out and feel the side ribs retracting.
If you feel very subdued or no action in the side ribs during breathing, take a wide belt or a belt that people wear to protect their low back and wrap it around your lower side ribs. When you exhale, tighten the belt as much as comfortably possible and then release as you inhale. With continued practice, you might start feeling the side ribs action as you breathe in and out.
After practicing the belt technique, you may use your hands to do the squeeze action. For this purpose, place your right hand on your lower right side ribs and left hand on the left ribs. Now, when you exhale, your hands squeeze the lower ribs and when you inhale, lower ribs push the hands out. In other words, your hands tightening and release the ribs, which the belt was doing for you in the earlier example. To put it succinctly, during exhalation, hands squeeze the lower side ribs and during inhalation, ribs push the hands away.
It is best to learn both techniques of diaphragmatic breathing:
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. PLB helps to keep the breathing tubes (bronchi) open and maintain right pressure in those tiny, tiny air sacs. Furthermore, 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 the hot soup in the spoon for the baby, gently and steadily.
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 in a hurry and rush to swallow more air, which can make breathlessness even worse. PLB slows down exhalation and assists with the action of emptying the lungs and may also help strengthen the breathing muscles.
Lengthen your exhalation. Silent counting while exhaling and inhaling can help. To begin with, you may inhale for a count of three or four, and exhale for the same count. As you progress and the breath stabilizes, you may lengthen the exhalation to a count of six or eight. An ideal ratio for the length of inhalation to exhalation for some people is 1: 1.1/2 and for some it is 1:2
Remember about the length of inhalation and exhalation
It is generally better to exhale longer than inhale
Under some situations such as when breath is unsettled, if it is not possible to exhale longer than inhale, exhale and inhale for equal length
But, do not inhale longer than you exhale.
Pursed Lip Breathing (PLB)
1. "Imagine smelling a rose (Inhaling slowly) blowing at the candle like you are bending or flickering the flame but not so forcefully as to put out the candle. Imagine blowing softly, gently and slowly."
2. "Relax your shoulders and neck."
3. "Pucker your lips as if you were going to whistle or kiss a baby."
4. "Breathe in slowly through your nose."
5. "Do not force air out of your lungs. Blow out the breath softly."
6. "Make your exhalation longer than inhalation. However, increase the length of exhalation gradually. Exhaling longer than your capacity could make the next breath jerky. If your breathing gets agitated, take a break.
7. Count in your head as you inhale and exhale so you can keep track of the length of breath. Always breathe slowly and softly.
8. When possible, breathe in through the nose and breathe out through the pursed lips.
9. The ratio of inhaling to a count of 4 and exhaling to a count of 6 is good for most of the time. However, if lungs are hyper inflated, you may gradually make your exhalation twice longer than inhalation. For example, if possible, inhale to a count of 5 and exhale to a count of 10.
10. Never try to inhale longer than exhale!
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