Breathing Disorders and Parkinson’s Disease — Out-Thinking Parkinson’s

Some of the common “symptoms” of Parkinson’s Disease could be reframed as behavioural patterns contributing to overall symptomology, but which can be ameliorated through appropriate retraining to help with progressive symptom reduction. Examples of such retrainable “habits” include issues with posture, mindset and breathing. These patterns tend to impact each other, for example habitual mouth breathing can result in the forward head position common in PD. People with PD will often see in hindsight that, once identified, these problematic habits were apparent years before diagnosis. In this article, we specifically consider how unhealthy, but fixable, breathing patterns could be an exacerbating factor in PD. We will cover how poor breathing interacts with, and may even be causal of, many other symptoms, and explore what we can do to improve our quality of life by taking action to retrain our breath.

In her book, “Music as Medicine: Particularly in Parkinson’s”, Daphne Bryan reviewed the scientific literature of breathing problems in PD:

“One study… found that 35.8% reported shortness of breath on exertion (dyspnea), 17.9% reported a cough and 13% reported phlegm production… a higher proportion of Parkinson’s patients die of pneumonia than in the general population. There is also a chance of increased respiratory infections… “;

“…the most common manifestation of which is soft speech which affects as many as 70% of people with the disease… people with Parkinson’s produce more variable and less efficient movements of the chest wall when preparing to speak, taking in less breath before speaking and continuing to speak when breath reserves were finished… identified inspiratory muscle weakness, even in early-stage patients. Rigidity, a common symptom of Parkinson’s, can affect the muscles of the chest wall and the diaphragm, which will restrict the movement needed to breathe fully… stooped posture, affecting many, can reduce lung volume… the reduction in dopamine of the condition itself may cause shortness of breath or the perception of shortness of breath… the loss of dopaminergic input to the brainstem and carotid bodies can cause altered regulation of the carbon dioxide and oxygen and consequently an altered perception of breathing. “

Also, people with PD tend to breathe fast and shallow, through the mouth not through the nose, and from the chest or the neck not from the diaphragm. Taking myself as an example, at the time of writing this, I breathe unconsciously once every two to three seconds, or 20 to 30 breaths per minute, and the more symptomatic I am, the faster, but the shallower, I breathe. Although the breath is shallow, the rapidity of it means I am moving much more gas in and out of my lungs than normal. I have observed similar patterns of breathing in other people with PD. We will see that the very same features of dysregulated breathing are associated with generalized breathing disorders, outwith PD, and, moreover, that the symptoms associated with these general disorders overlap strongly with those of Parkinson’s Disease. Consequently, breath retraining methods which have been developed to ameliorate these disorders are likely to significantly benefit people with PD.

A good introduction to this field is the book “Recognizing and Treating Breathing Disorders: A Multidisciplinary Approach,“ by Leon Chaitow and co-workers, and his blog post “Remembering the Connection: Respiratory Alkalosis and your Patient’s Symptom Catalogue”. These provide very clear explanations of how unhealthy hyperventilation or overbreathing, corresponding to shallow, but fast breathing with many more inhales and exhales per minute than normal for the resting state. can become habitualized, how this is associated with anxiety or chronic stress, and also the list of symptoms these breathing disorders cause.

The major mechanisms at play here are to do with the role of carbon dioxide (CO2) in the blood. CO2 arises as “waste” products from the normal metabolic activity of cells, and is partially expelled out of the body during the exhalation part of breathing. For example, during sustained active exertion, the faster energy conversion in the cells results in increased levels of CO2 being produced, and hence to maintain safe levels, chemical sensors in the body and brain, which constantly assess CO2 levels, tell the body to involuntarily breathe more rapidly in order to expel the excess CO2 from the system, and to restore balance.

However, if one is persistently overbreathing or hyperventilating even when the body is passive or at rest, as in common in people with PD, then the CO2 in the body is constantly being expelled faster than it can it build up, resulting in chronically low levels in the blood. This has huge implications for health, not only because then the blood becomes too alkaline, but also because CO2 levels in the blood have an absolutely vital role in the delivery of oxygen to the tissues of the body and brain.

In the normal course of events, oxygen taken in from the air via the lungs during inhalation is circulated around the body by becoming bound to the haemoglobin of red blood cells. Some of this bound oxygen can dislodge from the blood cells and pass into the tissues to oxygenate the muscles, organs, brain, etc. However, the degree of stickiness of oxygen to haemoglobin, and hence the ease with which it can dislodge and enter the tissues, depends sensitively on the amount of CO2 present in the blood. The less CO2 there is, the more sticky the oxygen and haemoglobin become, and the less easy it is for the oxygen to detach. Thus, far from just being a “waste” product, the CO2 has a crucial role in regulating oxygen delivery.

We now see why chronically low levels of CO2 in the blood caused by overbreathing has enormous implications for health, because when the blood is low on CO2, the oxygen and haemoglobin become tightly bound together: the oxygen becomes very stuck to the red blood cells and does not readily detach in order to diffuse into the tissues. This means that although the blood may be completely saturated with oxygen, the brain and body are in fact getting very little of the oxygen which the tissues need to survive and thrive.

Moreover, when overbreathing becomes habitual, a vicious circle occurs, because the body gets used to the low CO2 levels, and settles into a new equilibrium. Once this occurs, the body becomes intolerant to more CO2, such that any increase sets off alarm bells in the system, causing even more hyperventilation through panic attack like symptoms in order to quickly bring the CO2 levels back down to the habitualized low level. Overcoming low CO2 tolerance, and hence returning CO2 levels to normal is therefore not easy or straightforward and requires a programme of graduated breathing exercises performed daily over the long term in order to gradually reacclimatize the system to tolerate normal levels of CO2.

Chronic overbreathing, and the resulting low levels of blood CO2 and increased alkalinity of the blood, creates a wide variety of symptoms and health issues. Since these arise in part due to a lack of oxygen to the muscles and brain, it is pertinent to compare the symptoms of these types of breathing disorders with those of PD, and indeed to consider if overbreathing is compounding or may even be causing other symptoms of PD. According to the article by Leon Chaitow cited above:

“The ramifications of altered blood pH, towards the alkaline end of the spectrum, may also relate to more general features such as muscle tone, balance and motor control.”

These are the primary features of PD. Furthermore,

“symptoms associated with alkalosis emerge – fatigue, brain fog, increased pain sensitivity, anxiety”

which are also primary symptoms of PD. Leon also lists tremor, one of the most obvious signs of PD, as a possible symptom of overbreathing. The figure below, taken from the article, summarizes the principle symptoms of breathing disorders, and people with PD will recognize many of these.

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