One Technique-Eleven Exercises Measurement appraisals: Body Oxygen - - PowerPoint PPT Presentation

One Technique-Eleven Exercises

• Measurement appraisals: Body Oxygen Level Test

(BOLT) & Maximum Breathlessness Test (MBT)

• Functional breathing pattern training
• Functional breathing pattern training
• Simulation of high altitude training

Functional Breathing Pattern Training

• Improve blood circulation & oxygen delivery to the cells
• Dilate the upper airways (nose) and lower airways

(lungs) (lungs)

• Significantly reduce exercise induced bronchoconstriction
• Improve sleep, focus, concentration and calm

Functional Breathing Pattern Training

• Reduce onset and endurance of breathlessness
• Posture and spinal stabilization (poor breathing function

reduces movement function)

• Reduce risk of injury
• Reduce energy cost associated with breathing

Simulation of High Altitude Training

• Improve aerobic capacity (some non-responders)
• Improve anaerobic capacity
• Stimulate anaerobic glycolysis without risk of injury
• Increase VO2 max and running economy
• Increase maximum tolerance to breathlessness

Simulation of High Altitude Training

• Improve respiratory muscle strength
• Improve muscle injury repair (New studies)
• Help maintain fitness during rest or injury
• Reduce free radicals and oxidative stress
• Reduce ventilatory response to hypercapnia and hypoxia

TRAITS OF DYSFUNCTIONAL BREATHING

• Dysfunctional Breathing Patterns:

no precise definition Generally includes any disturbance to breathing including; disturbance to breathing including; hyperventilation/over breathing, unexplained breathlessness, breathing pattern disorder, irregularity of breathing.

NORMAL BREATHING VOLUME

• Normal minute ventilation: 4- 6 litres
• Hyperventilation- breathing in excess of metabolic

requirements of the body at that time. requirements of the body at that time.

TRAITS OF DYSFUNCTIONAL BREATHING

• Breathing through mouth
• Hearing breathing during rest
• Regular sighing
• Regular sniffing
• Large breaths prior to talking
• Large breaths prior to talking
• Yawning with big breaths
• Upper chest movement
• Paradoxical breathing
• Noticeable breathing movement

during rest

Breathing During Stress

• Faster
• Sigh more (irregular)
• Noticeable breathing
• Oral breathing
• Upper chest breathing

BREATHING TO EVOKE RELAXATION

• Slow down
• Regular
• Soft breathing
• Faster
• Sigh more (irregular)
• Noticeable breathing
• Soft breathing
• Nose breathing
• Diaphragm breathing
• Noticeable breathing
• Oral breathing
• Upper chest breathing

HOW SHOULD WE BREATHE?

• Breathing is light, quiet, effortless, soft, through the nose,

diaphragmatic, rhythmic and gently paused on the exhale. exhale.

• This is how human beings breathed until the comforts of

modern life changed everything, including our breathing

HOW SHOULD WE BREATHE?

• If you took a run alongside an elite athlete in good health,

would you expect her to be huffing and puffing like a train? train?

HOW TO MEASURE

HOW TO MEASURE BREATHLESSNESS

MEASURE BREATHLESSNESS

Demonstration

BREATHLESSNESS

BOLT (COMFORTABLE BREATH HOLD TIME) MEASUREMENT

• Take a small silent breath in through your nose.
• Allow a small silent breath out through your nose.
• Hold your nose with your fingers to prevent air from

entering your lungs.

• Count the number of seconds until you feel the first

distinct desire to breathe in.

BOLT (COMFORTABLE BREATH HOLD TIME) MEASUREMENT

Body Oxygen Level Test (BOLT)

• Holding of the breath until the first definite desire to

breathe is not influenced by training effect or behavioural characteristics, it can be deduced to be a more objective measurement of breathlessness. measurement of breathlessness.

• Nishino T. Pathophysiology of dyspnea evaluated by breath-holding test: studies of furosemide
• treatment. Respiratory Physiology Neurobiology.2009 May 30;(167(1)):20-5
• Voluntary breath holding duration is thought to provide an

indirect index of sensitivity to CO2 buildup.

SCREENING TOOL FOR DYSFUNCTIONAL BREATHING

• Dysfunctional breathing (DB) has been linked to health

conditions including low back pain and neck pain and adversely effects the musculoskeletal system.

• The International Journal of Sports Physical Therapy | Volume 12, Number 5 | October 2017 | Page

774

SCREENING TOOL FOR DYSFUNCTIONAL BREATHING

• No single test or screen identifies DB, which is multi-

dimensional, and includes biochemical, biomechanical, and psychophysiological components.

• The International Journal of Sports Physical Therapy | Volume 12, Number 5 | October 2017 | Page

774

SCREENING TOOL FOR DYSFUNCTIONAL BREATHING

• The purpose of this study was to develop a breathing

screening procedure that could be utilized by fitness and healthcare providers to screen for the presence of disordered breathing. disordered breathing.

• The International Journal of Sports Physical Therapy | Volume 12, Number 5 | October 2017 | Page

774

SCREENING TOOL FOR DYSFUNCTIONAL BREATHING

• 51 subjects (27 females, 27.0 years, BMI 23.3)
• Biochemical dimension- end-tidal CO2 (ETCO2)
• Biomechanical dimension, the Hi-Lo test
• Psychophysiological dimension, the Self Evaluation of Breathing

Symptoms Questionnaire (SEBQ) and Nijmegen questionnaires

• The International Journal of Sports Physical Therapy | Volume 12, Number 5 | October 2017 | Page 774

SCREENING TOOL FOR DYSFUNCTIONAL BREATHING

• No strong correlations between the three measures of
• DB. Five subjects had normal breathing, 14 failed at least
• ne measure, 20 failed at least two, and 12 failed all

three. three.

• The International Journal of Sports Physical Therapy | Volume 12, Number 5 | October 2017 | Page

774

SCREENING TOOL FOR DYSFUNCTIONAL BREATHING

• Easily obtained clinical measures of BHT (25 seconds)

and four questions (FMS) can be utilized to screen for the presence of DB.

• The International Journal of Sports Physical Therapy | Volume 12, Number 5 | October 2017 | Page

774

SCREENING TOOL FOR DYSFUNCTIONAL BREATHING

• Do you feel tense?
• Do you feel cold sensation in you hands or feet?
• Do you notice yourself yawning?
• Do you notice yourself breathing through your mouth at

night?

• The International Journal of Sports Physical Therapy | Volume 12, Number 5 | October 2017 | Page

774

SCREENING TOOL FOR DYSFUNCTIONAL BREATHING

• If the screen is passed, there is an 89% chance that DB

is not present. If the screen is failed, further assessment is recommended.

• The International Journal of Sports Physical Therapy | Volume 12, Number 5 | October 2017 | Page
• The International Journal of Sports Physical Therapy | Volume 12, Number 5 | October 2017 | Page

774

Maximum Breathlessness Breathlessness Test (MBT)

Maximum Breathlessness Test (MBT)

• Exhale normally through nose
• Walk at a normal pace while holding the breath
• Count the maximum number of paces that you can hold

your breath your breath

• Goal 80 to 100 paces
• Less than 60 paces- significant room for improvement

• Psychological willpower and endurance influence the duration
• f the breath holding.
• The breakpoint of breath holding is preceded by the onset of

respiratory movements.

Maximum Breathlessness Test (MBT)

respiratory movements.

• These irregular contractions of the inspiratory muscles reduce

the unpleasant sensation in the lower thorax and abdomen that occurs progressively through a breath-holding period.

• Discomfort signals are sent from the diaphragm to the brain-

terminates the breath hold

Respiratory Physiology Physiology

Definitions

• Tidal volume: the normal volume of air

entering the lungs during one inhale at rest

• Respiratory rate: The number of
• Respiratory rate: The number of

breaths per minute

• Minute ventilation: the volume of air

which enters the lungs over one minute.

• RR * TV= MV

Definitions

• PO2
• Partial pressure of oxygen, which reflects the amount of
• xygen dissolved in the blood. Small 2% of total O2.
• SpO2
• Percentage of oxygenated hemoglobin versus total

hemoglobin in arterial blood. (allows 70 times more O2 to be carried)

Definitions

• Normoxia: normal levels of oxygen

(SpO2 95- 99%)

• Hypoxia: deficiency in the amount of
• xygen entering the tissues

(SpO2 less than 91%)

• Hyperoxia: when cells, tissues and
• rgans are exposed to higher than

normal partial pressure of oxygen

Definitions

• Normocapnia: normal arterial CO2,

about 40mmHg

• Hypocapnia: below normal arterial
• CO2. Less than 37mmHg
• CO2. Less than 37mmHg
• Hypercapnia: abnormally elevated

levels of CO2. Greater than 45mmHg

PRIMARY STIMULUS TO BREATHE

• The regulation of breathing is

determined by receptors in the brain stem which monitor the concentration of carbon dioxide concentration of carbon dioxide (CO2) along with the pH level and to a lesser extent oxygen in your blood.

PRIMARY STIMULUS TO BREATHE

• Among these, CO2 provides the

strongest stimulus to ventilation. For example, a slight increase (e.g., 2–5 mmHg) in arterial blood (e.g., 2–5 mmHg) in arterial blood pCO2 can more than double the ventilation

Journal of Psychosomatic Research 60 (2006) 291– 298

PRIMARY STIMULUS TO BREATHE

• There is a large reserve of oxygen

in the blood stream, such that

• xygen levels must drop from

100mmHg to about 50mmHg 100mmHg to about 50mmHg before the brain stimulates breathing.

HOW SHOULD WE BREATHE?

• The threshold for the hypoxic ventilatory response is

approximately 60mmHg (Loeschcke & Gertz, 1958), which is reached during exercise at an altitude of about 2500m (Ferretti et al., 1997; Cardus et al) 2500m (Ferretti et al., 1997; Cardus et al)

• X. Woorons1, P. Mollard1, A. Pichon1, C. Lamberto1,2, A. Duvallet1,2, J.-P. Richalet. Moderate exercise in hypoxia

induces a greater arterial desaturation in trained than untrained men. Scand J Med Sci Sports 2007: 17: 431–436

PRIMARY STIMULUS TO BREATHE

• Chemical sensors of breathing

(chemoreceptors)

• Brain stem- controls regular
• breathing. Responsive to CO
• breathing. Responsive to CO2
• Carotid arteries- underneath the

angle of the jaw. Responsive to CO2 and low levels of O2

PRIMARY STIMULUS TO BREATHE

• The brain stem is the most

primitive part of the brain. It begins at the base of the skull and extends upwards 6-8 cm. extends upwards 6-8 cm.

• In the lower portion of the brain

stem is the medulla containing the respiratory center with separate inspiratory and expiratory centers.

Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing

• Disorders. 1st ed. . Springer; 1994

PRIMARY STIMULUS TO BREATHE

• Normal PCO2 is 40mmHg
• An increase of PCO2 above this

level stimulates the medullary inspiratory center neurons to inspiratory center neurons to increase their rate of firing. This increases breathing to remove more CO2 from the blood through the lungs.

Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing

• Disorders. 1st ed. . Springer; 1994

PRIMARY STIMULUS TO BREATHE

• The inspiratory center sends impulses

down the spinal cord and through the phrenic nerve which innervates the diaphragm, intercostal nerves and external intercostal muscles- producing external intercostal muscles- producing inspiration.

• At some point the inspiratory center

decreases firing, and the expiratory center begins firing.

Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing

• Disorders. 1st ed. . Springer; 1994

PRIMARY STIMULUS TO BREATHE

• On the other hand, a decrease in the

PCO2 below 40mmHg causes the respiratory center neurons to reduce their rate of firing, to below normal- their rate of firing, to below normal- producing a decrease in rate and depth of breathing until PCO2 rises to normal.

Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing

• Disorders. 1st ed. . Springer; 1994

PRIMARY STIMULUS TO BREATH

• However, breathing more than

what the body requires over a 24 hour period conditions the body to increased breathing volume. increased breathing volume.

CARBON DIOXIDE NOT JUST A NOT JUST A WASTE GAS!

pH CO2 Link

pH CO2 Link

• Normal pH is 7.365 which must remain within tightly

defined parameters. If pH is too acidic and drops below 6.8, or too alkaline rising above 7.8, death can result.

Blood, Sweat, and Buffers: pH Regulation During Exercise Acid-Base Equilibria Experiment Blood, Sweat, and Buffers: pH Regulation During Exercise Acid-Base Equilibria Experiment Authors: Rachel Casiday and Regina Frey

CO2 in blood carried three ways:

• 5% dissolved in plasma
• 30% combined with blood proteins
• 65% converted to bicarbonate ions for its transportation in the

blood

pH CO2 Link

blood

• CO2 + H2O = H2CO3 = H+ + HCO3-
• CO2 –24 times more soluble in the blood than O2. Similar

amounts in lungs and blood. aCO2 depends entirely on ACO2.

• CO2 disassociates into H+ and HCO3- constituting a

major alkaline buffer which resists changes in acidity. (reversibly bind H+)

pH CO2 Link

pH CO2 Link

• If you offload carbon dioxide, you are left with an excess
• f bicarbonate ion and a deficiency of hydrogen ion.
• During short term hyperventilation- breathing volume

subsequentially decreases to allow accumulation of subsequentially decreases to allow accumulation of carbon dioxide and normalisation of pH.

pH CO2 Link

• However, when over breathing continues for hours/days,

bicarbonate excess is compensated by renal excretion.

• Hypocapnia and pH shift are almost immediate;

adjustment of bicarbonate takes time. (Originally thought hours to days, but can occur within minutes)

Lum LC.. Hyperventilation: the tip and the iceberg. J Psychosom Res..1975 ;(19(5-6):375-83

pH CO2 Link

• Thus the chronic hyperventilator's pH regulation is finely

balanced: diminished acid (the consequence of hyperventilation) is balanced against the low level of blood bicarbonate maintained by renal excretion. blood bicarbonate maintained by renal excretion.

Jenny C King Hyperventilation-a therapist's point of view: discussion paper. Journal of the Royal Society of Medicine. 1988 Sep; 81(9): 532–536.

pH CO2 Link

• In this equilibrium small amounts of over breathing

induced by emotion can cause large falls of carbon dioxide and, consequently, more severe symptoms.

Jenny C King Hyperventilation-a therapist's point of view: discussion paper. Journal of the Royal Society of Medicine. 1988 Sep; 81(9): 532–536.

Bohr Effect

• In 1904, Christian Bohr, a

Danish biochemist discovered that “the lower the partial pressure of carbon dioxide (CO2) in arterial blood (paCO2), the greater the affinity

• f hemoglobin for the oxygen it

carries”

Bohr Effect

• That is, an increase in blood CO2 concentration, which

leads to a decrease in blood pH, will result in hemoglobin proteins releasing their load of oxygen.

• This discovery was named ‘The Bohr Effect’.

Bohr Effect

• In other words, the lower the partial pressure of CO2 in

arterial blood, the lower the amount of oxygen released by hemoglobin to cells for production of energy.

pH CO2 Link

• There is little difference between CO2 in alveoli and

arterial blood. The level of arterial blood depends entirely

• n alveolar CO2.
• n alveolar CO2.
• Alveolar CO2 depends on breathing volume.

Bohr Effect

• By nasal breathing, aCO2 is higher, the oxygen that is

inhaled is more efficiently distributed to fatigued tissues which should in theory improve health and athletic performance and recovery, with practice of the technique. performance and recovery, with practice of the technique.

OXYHEMOGLOBIN DISSOCIATION CURVE

• Horizontal axis; PO2
• Partial pressure of oxygen, which reflects the amount of
• xygen dissolved in the blood. Small amount of O2.
• Vertical axis: SpO2
• Percentage of oxygenated hemoglobin versus total

hemoglobin in arterial blood. (allows 70 times more O2 to be carried)

OXYHEMOGLOBIN DISSOCIATION CURVE

• An exercising muscle is hot and

generates carbon dioxide and it benefits from increased unloading benefits from increased unloading

• f O2 from its capillaries.

West J 1995 Respiratory Physiology: the essentials. Lippincott, Williams and Wilkins.

CONSTRICTION OF CAROTID ARTERIES

• A primary response to

hyperventilation can reduce the oxygen available to the the oxygen available to the brain by one half.

Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing

• Disorders. 1st ed. . Springer; 1994. page 7

CO2 Response to Hyperventilation

Arterial carbon dioxide tension and alveolar carbon dioxide are virtually identical and arterial CO2 is directly proportional to alveolar CO2. A decrease in PaCO2 (arterial) can result from hyperventilation. A decrease in PaCO2 without a change in the bicarbonate increases the blood pH producing respiratory alkalosis. Lung (1983) 161 : 257-273

CO2 Response to Hyperventilation

The changes in the arterial CO2 content and tension are greatest during the first 30 to 60 seconds of acute hyperventilation. PaCO2 can decrease to half the normal value after less PaCO2 can decrease to half the normal value after less than 30 seconds of hyperventilation. A single deep expiration and inspiration can reduce the PaC02 by 7- 16mmHg. Lung (1983) 161 : 257-273

CO2 Response to Hyperventilation

With a decrease in PaCO2 and respiratory alkalosis, there is a vasoconstriction of the cerebral arteries and reduced cerebral blood flow. There is a decrease in

• xygen delivery to the brain on the basis of both the Bohr

effect and the decreased cerebral blood flow. Lung (1983) 161 : 257-273

CO2 Response to Hyperventilation

Diminished cerebral blood flow may be responsible for the dizziness, faintness, visual disturbances, and impaired psychomotor behaviour that are commonly described during hyperventilation. Lung (1983) 161 : 257-273

Wim Hof Method

Voluntary activation of the sympathetic nervous system and attenuation of the innate system and attenuation of the innate immune response in humans

PNAS | May 20, 2014 | vol. 111 | no. 20 | 7379–7384 IMMUNOLOGY

WHM

• Excessive or persistent proinflammatory cytokine

production plays a central role in autoimmune diseases.

• Acute activation of the sympathetic nervous system

attenuates the innate immune response.

WHM

• Healthy volunteers were randomized to either the

intervention (n = 12) or control group (n = 12). The control group was not trained.

WHM

• Subjects in WHM group were trained for 10 d in

meditation (third eye meditation), breathing techniques (i.a., cyclic hyperventilation followed by breath retention), and exposure to cold (i.a., immersions in ice cold water).

WHM

Breathing techniques, consisting of two exercises.

• Hyperventilate for an average of 30 breaths.
• Then, exhale and hold breath for 2–3 min (“retention

phase”).

• Duration of breath hold entirely at the discretion of the

subject himself.

• Breath hold followed by a deep inhalation breath, that was

held for 10s. Subsequently a new cycle of hyper/hypoventilation began.

WHM

• Subsequently, all subjects underwent experimental

endotoxemia (i.v. administration of 2 ng/kg endotoxin).

WHM

• Flu-like symptoms were lower in the intervention group.
• Voluntary activation of the sympathetic nervous system

results in epinephrine release and subsequent suppression of the innate immune response in humans. suppression of the innate immune response in humans.

• These results could have important implications for the

treatment of conditions associated with excessive or persistent inflammation, such as autoimmune diseases.

WHM

• Biological therapies that antagonize proinflammatory

cytokines are very effective and have revolutionized the treatment of autoimmune diseases, such as rheumatoid arthritis and inflammatory bowel disease.

• However, these drugs are expensive and have serious

side effects.

WHM

• The present study demonstrates that, through practicing

techniques learned in a short-term training program, the sympathetic nervous system and immune system can sympathetic nervous system and immune system can indeed be voluntarily influenced.

WHM

• This study could have important implications for the

treatment of a variety of conditions associated with excessive or persistent inflammation, especially excessive or persistent inflammation, especially autoimmune diseases in which therapies that antagonize proinflammatory cytokines have shown great benefit.

WHM

WHM

Kilopascal to Millimeter mercury CO2

4.49 33.67 2.11 15.82 4.01 30.07 2.03 15.22 3.76 28.20 1.69 12.67 3.48 26.10

Kilopascal to Millimeter mercury O2

PO2 (partial pressure of oxygen) reflects the amount of oxygen gas dissolved in the blood. 16.5 123.76 22 165 5.6 42 5.6 42 22.9 171.76 4.8 36 22.6 169.51 3.4 25.50

ASTHMA, SNORING, SLEEP SNORING, SLEEP APNEA,RHINITIS

EXERCISE INDUCED ASTHMA

• Exercise-induced asthma affects an estimated 4 to 20

percent of the general population and 11 to 50 percent

• f certain athlete populations.
• Rundell KW, Im J, Mayers LB, Wilber RL, Szmedra L, Schmitz HR. Self-reported symptoms and

exercise-induced asthma in the elite athlete. Med Sci Sports Exerc.2001 Feb;33(2):208-13

EXERCISE INDUCED ASTHMA

• Routine screening of UK Olympic team before Athens

Olympics, the recorded prevalence of asthma was 21%. (double the prevalence rate of the UK population)

• The two sports with highest prevalence was swimming

and cycling. (both over 40%)

• McConnell Breathe Strong, Perform Better

EXERCISE INDUCED ASTHMA

• Why should asthma be so high in athletes?
• Exercise is believed to trigger bronchoconstriction due

to dehydration of the airways. The moisture is ‘sucked

• ut’ of the airway cells causing them to dehydrate.
• ut’ of the airway cells causing them to dehydrate.
• Dehydration induces inflammation of the airways.
• McConnell Breathe Strong, Perform Better

EXERCISE INDUCED ASTHMA

• 55 percent of football athletes and 50 percent of

basketball athletes displayed airway narrowing conducive to asthma, athletes from the sport of water polo showed significantly fewer asthma symptoms. polo showed significantly fewer asthma symptoms.

• J Strength Cond Res.2012 Jun;(26(6)):1644-50

EXERCISE INDUCED ASTHMA

• We speculate that asthmatics may have an increased

tendency to switch to oral breathing, a factor that may contribute to the pathogenesis of their asthma.

• Kairaitis K, Garlick SR, Wheatley JR, Amis TC. Route of breathing in patients with asthma.
• Chest. 1999 Dec;116(6):1646-52.

EXERCISE INDUCED ASTHMA

• Nasal breathing provides a protective influence against

exercise-induced asthma. We hypothesized that enforced

• ral breathing in resting mild asthmatic subjects may lead

to a reduction in lung function. to a reduction in lung function.

• Hallani M, Wheatley JR, Amis TC. Enforced mouth breathing decreases lung function in mild
• asthmatics. Respirology. 2008 Jun;13(4):553-8.

EXERCISE INDUCED ASTHMA

• CONCLUSIONS: Enforced oral breathing causes a

decrease in lung function in mild asthmatic subjects at rest, initiating asthma symptoms in some. Oral breathing may play a role in the pathogenesis of acute asthma may play a role in the pathogenesis of acute asthma exacerbations.

• Hallani M, Wheatley JR, Amis TC. Enforced mouth breathing decreases lung function in mild
• asthmatics. Respirology. 2008 Jun;13(4):553-8.

EXERCISE INDUCED ASTHMA

Laffey, J. & Kavanagh, B. Hypocapnia, New England Journal of Medicine. 4 July 2002.

EXERCISE INDUCED ASTHMA

• The major cause of exercise induced

asthma (EIA) is thought to be the drying and cooling of the airways during the 'conditioning' of the during the 'conditioning' of the inspired air.

• Morton, King, Papalia 1995 Australian Journal of Science and

Medicine in Sport. 27, 51-55

EXERCISE INDUCED ASTHMA

• Nasal breathing increases the

respiratory system's ability to warm and humidity the inspired air compared to oral breathing and compared to oral breathing and reduces the drying and cooling effects of the increased ventilation during exercise.

• Morton, King, Papalia 1995 Australian Journal of Science and

Medicine in Sport. 27, 51-55

EXERCISE INDUCED ASTHMA

• This will reduce the severity of EIA provoked by a given

intensity and duration of exercise.

.

• Morton, King, Papalia 1995 Australian Journal of Science and Medicine in Sport. 27, 51-55

EXERCISE INDUCED ASTHMA

• Breathed with their mouths open when instructed

to breathe "naturally."

• Breathe only through the nose during the exercise, an almost

complete inhibition of the post exercise bronchoconstrictive airway response was demonstrated.

.

airway response was demonstrated.

• When instructed to breathe only through the mouth

during exercise, an increased bronchoconstrictive airway response occurred.

Shturman-Ellstein R, Zeballos RJ, Buckley JM, Souhrada JF. The beneficial effect of nasal breathing on exercise-induced

• bronchoconstriction. Am Rev Respir Dis. 1978 Jul;118(1):65-73.

OTHER CONSIDERATIONS- ASTHMA

• More normal breathing volume leads to less cooling and

dehydration of the airways.

• Changing breathing volume towards normal, with a
• Changing breathing volume towards normal, with a

higher BOLT is especially effective at helping to prevent exercise induced asthma and cyclists cough.

SLEEP DISORDERED BREATHING BREATHING

SLEEP DISORDERED BREATHING

• Snoring is a sound created from turbulent airflow. It is

noisy breathing during sleep caused by the exchange of a large volume of air through a narrowed space, which in turn causes the tissues of the nose and throat to vibrate. turn causes the tissues of the nose and throat to vibrate.

SLEEP DISORDERED BREATHING

• Simple snoring - vibration of the soft palate. (mouth

snoring)

• High upper airway resistance (HUAR) - turbulent airflow

in the nasopharynx and oropharynx causing inspiratory in the nasopharynx and oropharynx causing inspiratory flow limitation (IFL)

THE NEXT PROGRESSION FROM SNORING IS FROM SNORING IS SLEEP APNEA

RHINITIS & SLEEP APNEA

• Apnea is a Greek word meaning “without breath.”
• Three types: central, obstructive and mixed.
• Obstructive sleep apnoea is the most common type of

apnoea and is characterised by holding the breath from apnoea and is characterised by holding the breath from collapse of the upper airways during sleep.

RHINITIS & SLEEP APNEA

• Can occur five to fifty times per hour.
• Each breath hold can range from a few seconds to over
• ne minute, causing one’s blood oxygen saturation to

decline to as low as 50%. decline to as low as 50%.

RHINITIS & SLEEP APNEA

• "There are athletes everywhere who have sleep apnea".
• "Not only does the apnea affect their athletic

performance, but it is extremely hard on their cardiovascular systems as well." cardiovascular systems as well."

• W. Christopher Winter, M.D., medical director of the Martha Jefferson Hospital sleep medicine

center in Charlottesville, Virginia

RHINITIS & SLEEP APNEA

• Though heart-related deaths from untreated sleep apnea

usually occur during sleep, chronic stress on the heart can leave victims vulnerable during strenuous athletic events. events.

RHINITIS & SLEEP APNEA

• "Athletes' hearts are pushed by their sport during the day

and by their apnea at night," says Dr. Winter. "A time for rest and recovery now becomes a time that puts their health in peril.” health in peril.”

RHINITIS & SLEEP APNEA

• The prevalence of sleep-disordered breathing among all

professional football players to be 14 percent overall and 34 percent within the high-risk group. (Offensive and defensive linemen) defensive linemen)

• N Engl J Med 2003; 348:367-368

ASTHMA & SLEEP APNEA

• Approximately 74% of asthmatics experience nocturnal

symptoms of airflow obstruction secondary to reactive airways disease.

• Bonekat HW, Hardin KA, Severe upperway airway obstruction during sleep. Clin Rev Allergy
• Immunol. 2003 Oct;25(2):191-210

ASTHMA & SLEEP APNEA

• 88% of patients in the severe asthma group, 58% of

patients in the moderate asthma group, and 31% of patients in the controls without asthma group had more than 15 apnoeic events per hour.

• Julien JY, Martin JG, Ernst P, Olivenstein R, Hamid Q, Lemi?re C, Pepe C, Naor N, Olha

A, Kimoff RJ.Prevalence of obstructive sleep apnea-hypopnea in severe versus moderate asthma. J Allergy Clin Immunol. 2009 Aug;124(2):371-6. Epub 2009 Jun 26.

than 15 apnoeic events per hour.

RHINITIS & SLEEP APNEA

• During sleep upper airway resistance was much higher

while breathing orally. In addition, obstructive (but not central) apnoeas and hypopnoeas were profoundly more frequent when breathing orally (apnoea-hypopnoea index frequent when breathing orally (apnoea-hypopnoea index 43+/-6) than nasally (1.5+/-0.5).

• Fitzpatrick MF1, McLean H, Urton AM, Tan A, O'Donnell D, Driver HS. Effect of nasal or oral

breathing route on upper airway resistance during sleep. Eur Respir J. 2003 Nov;22(5):827-32.

RHINITIS & SLEEP APNEA

• Study was to determine the effect of acute nasal
• bstruction on sleep and breathing in eight normal
• persons. The subjects were randomized into two groups.

One night the subject was studied with the nose open One night the subject was studied with the nose open and a second night with the nose obstructed.

• Olsen KD, Kern EB, Westbrook PR. Sleep and breathing disturbance secondary to nasal
• bstruction. Otolaryngol Head Neck Surg. 1981 Sep-Oct;89(5):804-10.

RHINITIS & SLEEP APNEA

• The subjects with the nose obstructed awoke more often,

had a greater number of changes in sleep stage, and spent a greater amount of time in stage I (light sleep).

• Olsen KD, Kern EB, Westbrook PR. Sleep and breathing disturbance secondary to nasal
• Olsen KD, Kern EB, Westbrook PR. Sleep and breathing disturbance secondary to nasal
• bstruction. Otolaryngol Head Neck Surg. 1981 Sep-Oct;89(5):804-10.

RHINITIS & SLEEP APNEA

• Acute nasal obstruction increased the number of partial

and total obstructive respiratory events (obstructive hypopnea and obstructive apnea). Sleep apnea developed in one subject during this study merely on the developed in one subject during this study merely on the basis of acute nasal obstruction.

• Olsen KD, Kern EB, Westbrook PR. Sleep and breathing disturbance secondary to

nasal obstruction. Otolaryngol Head Neck Surg. 1981 Sep-Oct;89(5):804-10.

STUDIES

• 30 Patients with ≥5 events hourly but <15 hourly on the

apnea-hypopnea index (AHI) were enrolled. All patients slept with their mouths closed by using the tape.

• Huang TW, Young TH Novel porous oral patches for patients with mild obstructive sleep apnea and

mouth breathing: a pilot study. Otolaryngol Head Neck Surg. 2015 Feb;152(2):369-73.

STUDIES

Before POP Using POP

• ESS 8.1 ± 1.5

5.2 ± 1.6

• VAS

7.5 ± 2.0 2.4 ± 1.4

• The median AHI score was significantly decreased by
• The median AHI score was significantly decreased by

using a POP from 12.0 per hour before treatment to 7.8 per hour during treatment (P < .01).

• (Median AHI reduced by 33% just by closing mouth!)
• Huang TW, Young TH Novel porous oral patches for patients with mild obstructive sleep apnea and

mouth breathing: a pilot study. Otolaryngol Head Neck Surg. 2015 Feb;152(2):369-73.

GETTING A BETTER NIGHT’S SLEEP

Low BOLT and mouth breathing contribute to the following:

• Snoring, Sleep apnoea
• Disrupted sleep
• Nightmares
• Asthma symptoms (3am-5am)
• Asthma symptoms (3am-5am)
• Needing to use the bathroom at about 6am
• Fatigue first thing in morning
• Dry mouth upon waking
• Symptoms upon waking- blocked nose, wheezing, coughing or

breathlessness

GETTING A BETTER NIGHT’S SLEEP

• Avoid blue light – smart phone and laptop
• Sleep in a cool and airy bedroom
• Don’t eat late at night or drink alcohol
• Switch to nasal breathing permanently
• Practise breathing softly for twenty minutes before sleep-

parasympathetic NS

• Sleep on side or tummy (not back)

GETTING A BETTER NIGHT’S SLEEP

• Nasal dilator MuteSnoring
• Tape mouth closed- LipSealTape.com
• Provide each student with tape
• Demonstrate how to apply it
• Wear tape for twenty minutes during the day to become

comfortable with it

• If mouth naturally moist in the morning, no need for tape