The symptoms of over-breathing are summarised on the outline of the human body on the left (remembering that all these symptoms can result from other causes, but they can ALL be caused or made worse by how we breathe)

The sequence of events that lead to or take part in overbreathing are shown on the flow-chart (above)….starting upper left-hand side.

The cartoon is for amusement – although it’s far from funny when fear, anxiety, panic happens

For those who have not recently visited my website please note that the content has just been been updated, with new downloadable pdf articles, as well as details of upcoming conferences, new book pages (Palpation Skills; Fibromyalgia Syndrome, and a coauthored book with Sandy Fritz on management of headache and neck pain, for massage therapists.) There are also a batch of new photographs on the ‘snaps’ page.

This blog post is adapted from the the column I contributed to the current issue of “Massage Today” February, 2010, Vol. 10, Issue 02

A few years back, I co-authored a book on breathing: Multidisciplinary Approaches to Breathing Pattern Disorders (Elsevier 2002) My co-authors (a physical therapist and a psychologist specializing in pain management) and I gathered together a great deal of information in order to describe how clinical management of a vast range of conditions – from anxiety, to irritable bowel, head and neck ache, low back pain, pelvic floor dysfunction, fatigue and lowered pain thresholds, to name just a few – could be assisted by recognition and rehabilitation of breathing pattern disorders.

Naively, I had imagined that the excitement I felt for the topic would translate into manual and movement therapists, of all schools, rapidly acquiring the information and then using this for the benefit of their patients/clients. Sadly, however, the annual sales of the breathing pattern book have remained modest, if steady. However, my excitement over the topic remains as heightened as ever and this week a new piece of research has got me going again.

A recently published paper by Zieman and colleagues (2009) entitled The Amygdala Is a Chemosensor that Detects Carbon Dioxide and Acidosis to Elicit Fear Behavior offers glimpses of some of the gaps in our knowledge on this fascinating topic.

This research group, from the University of Iowa, has explained the mechanism whereby the brain is sensitive to increasing acidity, triggering a fear/panic response.

They explain that they have identified that the amygdala is: “an important chemosensor that detects hypercarbia and acidosis and initiates behavioral

They have offered a molecular explanation for how rising CO2 concentrations trigger intense fear and provides a foundation for understanding one
cause of anxiety and panic disorders.

The word Hypercarbia refers to the physical condition of having an abnormally high level of carbon dioxide in the circulating blood. This can occur as a result of poor breathing patterns – literally hypoventilation (the exact opposite of over-breathing – hyperventilation).

Hypoventilation leads to higher levels of
CO2 than is normal in the blood, thus resulting in respiratory acidosis.

To clarify my excitement over these findings, I need to start somewhere else altogether – with respiratory alkalosis.

When someone over-breathes – an upper
chest pattern for example, with the extreme being hyperventilation – levels of CO2 drop below what is normal and alkalosis results.

And when this happens, one
of the first symptoms is for the individual to experience apprehension, anxiety and fear, just as they do with under-breathing and retention of CO2, as described above.

It seems that high pH (respiratory alkalosis) follows on from a period of over-breathing, which can be triggered by the acidosis influence on the amygdala, as described in this article.

The over-breathing can therefore be seen as a homeostatic response to excess CO2/acidosis.

Whether acidosis is due to pathology (liver or kidney disease for example) or due to pregnancy, or physical exertion, or dietary imbalances, there is clearly an attempt on the part of the body to lower carbonic acid levels via CO2 elimination in rapid breathing. If, however this pattern of breathing becomes excessive — as in someone who is a chronic upper-chest breather due to habit — we get to alkalosis and a chain of symptoms including increased apprehension and anxiety.

So the fear/anxiety outcome appears with both alkalosis and acidosis.

My understanding has always been that the effects of alkalosis are triggered by the respiratory centre, in the posterior aspect of the medulla, below the fourth ventricle. The really beautiful aspect of all this knowledge is the sense of balance. When we have a lack of balance – in this case of the pH of the blood, not only are there physiological consequences, but emotional ones, too.

When anxiety comes first

And, of course, all this works the other way around: fear and anxiety might result from a variety of life events/circumstances. This will automatically trigger either rapid breathing or a shut-down/under-breathing response.

Apprehension, anxiety, affecting balance, muscle tone and motor control all improve with breathing retraining. (Rhudy & Meager 2008)

Other studies have confirmed this (McLaughlin 2009) with functional improvements as well as reduced anxiety and fewer breathing difficulties resulting.

The Mensendieck technique, as practiced mostly in Europe and Scandinavia, uses a comprehensive approach involving movement, gait, posture, self-awareness of body sensations, variables related to breathing, and emotional status – including depression and anxiety.

This technique – which has better breathing as a key element – proceeds through three stages:

  • A “cognitive” phase: attending more closely to body sensations — visual, tactile, kinesthetic, and others – in essence providing a richer basis for change by maximizing attention to the feedback signaling system while focusing on more ideal sensation patterns,

  • An “associative” phase: developing awareness of new or enhanced body sensations in comparison with the ideal patterns;

  • An “automatized” phase – where the person uses more efficient or functional motor patterns with less or no conscious intention, and new motor and behavioral patterns are integrated into activities of daily life.

So we have overbreathing leading to anxiety, which leads to overbreathing……. a real chicken-and-egg situation that demands attention to the causes of anxiety, as well as the mechanics and causes of overbreathing, to achieve ultimate restoration of health.

How might a therapist – or an individual – recognize the possibility of either over- or under- breathing?

The symptoms would give clues, as would behaviour

  • Rapid breathing, perhaps?
  • Air-hunger or attempts to inhale like a fish out of water?
  • Speaking quickly, with irregular stops to grab a breath of air?
  • And a list of symptoms as outlined earlier in this article

These characteristics describe aspects of the hyperventilation end of the spectrum.

At the other end, you might have the virtually frozen
breathing pattern – very superficial, with breath-holding a feature.

Diagnosis demands far more than these clues – calling for both physical assessment of the breathing pattern (palpation, observation etc), as well as functional (breath holding times for example), and more sophisticated methods, ideally including capnography

Whether anxiety is the initiator of the process, or poor breathing habits are triggering anxiety, breathing rehabilitation is called for, and this involves both manual work to free-up the thoracic cage, diaphragm, etc., as well as gentle, repetitive exercises for home use, because without regular home application of retraining, there is no real chance of recovery.


1. Chaitow L, Bradley D, Gilbert C. Multidisciplinary Approaches to Breathing Pattern Disorders. 1. Edinburgh: Elsevier, 2002..

2. Haugstad G Haugstad T Kirste U 2006 Posture, movement patterns, and body awareness in women with chronic pelvic pain. Journal of Psychosomatic Research 61:637– 644

3. McLaughlin L 2009 Breathing evaluation and retraining in body work. Journal of Bodywork & Movement Therapies 13(3):276-282

4. Rhudy J Meagher M 2000 Fear and anxiety: divergent effects on human pain thresholds. Pain 84:65–75

5. Ziemann A, et al. The amygdala Is a chemosensor that detects carbon dioxide and acidosis to elicit fear behavior. Cell 2009;139:1012-21