How a Mindful Buteyko Breathing Course can help your sleep apnoea

Do you wake feeling refreshed after a night’s sleep?

If not; it is very likely you are the victim of poor sleep.

If you or someone else suspects that your poor sleep may be due to sleep apnoea you should first see your doctor to arrange a polysomnography (sleep study).

A sleep study maps the architecture of your sleep giving you and your doctor a reasonably accurate picture of the quality and quantity of your sleep. Importantly the study records your breathing pattern, or any apnoea or hypopnea you experienced and their duration.

An apnoea occurs when you cease breathing for 10 seconds or more. A hypopnea occurs when there is a reduction in airflow or shallow breathing which is abnormal.

But even before undergoing a sleep study, you can assess if you are sleeping poorly if any of the following symptoms occur regularly:

1. You are waking with a headache, feeling unrefreshed or experiencing brain fog
2. You wake several times to urinate during the night
3. You are snoring
4. Your limbs are moving excessively, known as “restless leg syndrome”
5. You experience fatigue during the day and you have difficulty concentrating
6. You easily fall asleep either during a meeting, at the desk, in front of the TV or while driving
7. You experience breathlessness during exercise

Of course, some of your symptoms need to be observed by someone else. However, if you sleep alone and often wake with a dry mouth and you experience some of the daytime symptoms a sleep study is highly recommended.

What changes occur to the oxygen and carbon dioxide (CO₂) levels during an apnoea?

During the onset of an apnoea, the CO₂ level in the tiny air sacs within our lungs (alveoli) has decreased due to the sleeper having exhaled an excess amount of CO₂. The CO₂ deficit in the alveoli, in turn, results in a CO₂ deficit in the arterial blood level.

Consequently, the oxygen in the blood (which has bound itself to the haemoglobin to form oxyhaemoglobin) is not released to the tissues and cells. When the baseline level of CO₂ is too low, the oxygen is not fully unloaded resulting in an oxygen deficiency in the tissue.

The apnoea occurs to prevent further loss of CO₂. Once an adequate amount of CO₂ has accumulated in the lungs and in the blood, it triggers the medulla region of our brain to activate an inhalation.

Mindful Buteyko Breathing as a remedy

By taking a Mindful Buteyko Breathing Course you are taught how to become aware of your breathing before you learn how to normalize your breathing.

The symptoms of sleep apnoea are a manifestation of dysfunctional breathing. Regularly breathing large amounts of air when not exercising, especially through your mouth, and relying on your upper chest muscles to move large volumes of air in and out of your lungs is dysfunctional breathing.

Many of us breathe in this way simply because that is the way we have always breathed. You have breathed in this way without giving a second thought to it. It has become a mindless activity simply because you are unaware of how you are breathing. Consequently, you are unlikely to appreciate why you should try to change how you breathe.

By breathing in this manner, you perpetuate an entrenched habit of over-breathing or hyperventilating. If you regularly hold your breath, sigh and yawn these are also hallmarks of dysfunctional breathing.

A consequence of dysfunctional breathing is that you exhale too much CO₂. This has a detrimental effect on the balance of your blood gases and the pH of your bodily fluids.

Breathing and the pH of your blood are reliant on each other. Breathing assists in regulating the pH of your blood and the pH of the blood regulates your breathing. It is vital to maintain a balanced pH of 7.35 – 7.45 otherwise it will become too alkaline or too acidic.

The importance of CO₂ cannot be overstated. Apart from regulating your breathing and maintaining pH, it is involved with the:

1. control of blood flow to your brain and to your body’s extremities
2. relationship with haemoglobin and oxygen
3. regulation of pH inside your nerve cells
4. facilitation of message-sending by nerves
5. control of the balance between the sympathetic and parasympathetic nervous systems

As CO₂ comprises only .04% of the air outside your lungs it is a timely reminder that CO₂ is metabolically produced within your lungs. The optimum partial pressure of CO₂ within the alveoli is 40 mmHg (or millimetres of mercury). It comprises about 5.5% of the alveolar air whereas oxygen comprises about 14%. This amount of oxygen contrasts with oxygen comprising 21% of the air outside your lungs.

Therefore, any loss or retention of CO₂ within your lungs depends upon how you breathe. Put simply, if you hold your breath or reduce your inhale CO₂ pressure increases, and when more CO₂ is exhaled than is being produced, the pressure decreases.

A Mindful Buteyko breathing course recommends exclusive nasal breathing except where strenuous exercise warrants large amounts of air being quickly inhaled through the mouth into the lungs. Nasal breathing will ensure that a smaller amount of air is inhaled and at a slower speed so that it is humidified and cleaned before it enters your lungs.

The antibacterial properties found in the nose do not exist in the mouth and throat. Consequently, mouth breathers inhale large amounts of dry unfiltered and cold air into their lungs. By way of a response, excess mucus will form as a protective measure against inflammation. Significantly nasal breathing creates a pressure difference between the lungs and the atmosphere.

This difference results in improved airflow and greater uptake of 10-20% oxygen into your bloodstream.

Nasal breathing engages your diaphragm enabling an automatic rhythm or breathing pattern to be established. It also ensures a greater circulation of oxygenated blood to your vital organs and not merely to your upper chest area.

Nitric oxide (NO) is produced within your paranasal cavity and not in your mouth or throat. NO has numerous benefits including its

relaxant effect in dilating blood vessels which, in turn, results in:

• an increased flow of blood and oxygen to your brain
• a decrease in your blood pressure

NO has been scientifically found to assist in releasing oxygen to your tissues.

CPAP as a remedy

If the Sleep Technologist finds that your sleep study results show that you have either moderate or severe sleep apnoea you will be recommended to be treated with the assistance of a respiratory aid that provides Continuous Positive Air Pressure (CPAP).

There are two types of sleep apnoea, namely, obstructive sleep apnoea and central sleep apnoea.

Obstructive sleep apnoea occurs when the walls of the throat (pharynx) narrow and collapse thereby preventing you from taking the next breath.

Central sleep apnoea occurs when the brain temporarily ceases to send signals to the respiratory muscles thereby preventing you from taking the next breath.

CPAP forces air (which may be humidified) into your mouth or your nostrils at a regulated rate and rhythm.

Many people do not tolerate CPAP (as many as 50% of users) and it can be restrictive and claustrophobic. However, it can provide urgent relief. Many users are clearly content to use it as a form of sleep treatment.

But it is only treating the symptoms of sleep apnoea in that it is forcing the airways open so that an apnoea does not occur. Unfortunately, CPAP does not resolve the problem of breathing-disordered sleep or over-breathing. In fact, this condition is perpetuated during the night and the person’s dysfunctional breathing will continue during the day.

So the continual use of CPAP is effectively masking (no pun intended) the problem of your breathing-disordered sleep without addressing the underlying cause of this type of breathing disorder.