Relief
Koen de Jong
Bram Bakker
Relief
Breathing well for relaxation,
sleep better, have more energy, lose weight faster
Publisher Carrera, Amsterdam 2011
First Printing 2009
Sixth Printing 2011
© Koen2011 de Jong and Bram Bakker
Publisher 2011Carrera, Amsterdam Cover design:
Riesenkind
Photo authors: Bernet Elzinga
Typesetting: Perfect Service
isbn
9789048809936
nur
860www.uitgeverijcarrera.nl
Carrera is an imprint of Dutch Media Uitgevers bv.
978904881103 8
Contents
Preface
7
Introduction
11
Sixteen times a minute and what can you do
about it?
Causes of high breathing frequency
51
High respiratory rate and nutrition Respiratory
63rate and psychological functioning
77Respiration and
sport
89
Breathing and heart rate coherence 105
Respiration in children and during pregnancy
21
119
High respiratory rate and severe stress-related
conditions137
Breathing exercises and
exercise
regimens
161 and consulted literature and
websites
175Useful
addresses
179
Preface
In this book we will try to make the connection between
breathing and various psychological and physical
complaints clear. This connection is often not immediately
perceptible and little attention is paid to it. We are
convinced that the connection is indeed there and that it
plays a much bigger role than most people realize. What
kind of complaints are actually related to breathing?
First of all, there are psychological complaints, such as
anxiety attacks, traumatic memories and depressive
moods. But in addition to that you must also think of
various physical complaints that at first don't seem to be
explained properly, such as fatigue or pain. These kinds of
"vague" physical complaints are called
often referred to as "psychosomatic" symptoms.
In addition to insight into the central role that breathing
plays in the development and persistence of a variety of
complaints, you will find in this book many breathing
exercises that you can do to combat certain complaints.
It also features medical scientists who have been
working on breathing for a long time. People
8
Relief
who have successfully used breathing exercises to get
rid of physical complaints tell of their experiences.
These are often people who, probably like the interested
reader of this book, have full schedules and were initially
skeptical of breathing exercises. Surely it can't just be my
breathing,' we hear frequently.
The breathing exercises are easy to try and therefore
approachable, which is why many people have
discovered how much these exercises can benefit them.
Most people who get serious about their breathing are
soon pleasantly surprised at the re- sults. So give
breathing exercises a serious chance. In separate boxes
you will find more in-depth material, for profes- sional
practitioners or above-average interested readers.
Relief is a book for anyone who does a lot and sometimes
feels like it might be a little too much. When is your head
too full? When does 'nice and busy' shift to a confusing
amount of tasks on a 'to do list'? Which complaints can you
prevent or make disappear without having to resort to pills?
To find out, you can take a closer look at something simple
but powerful. Own, close by and changeable: your breath.
Sitting "quietly" in a chair, millions of Dutch people act
as if they are in danger. In the event of danger, the body
is in a state of extreme readiness with a high heart rate, a
lot of
Preface
9
adrenaline - and most importantly for this book - a high
breathing rate. When you breathe fast you use up a lot of
energy and constantly breathing fast leads to many
physical complaints. How do you recognize (too) fast
breathing? Why do you breathe (too) fast? What
complaints do you get from it? What can you do about it
yourself? That is what this book is about.
Koen de Jong and Bram Bakker
Introduction
When you breathe fast there is tension in your body.
This tension is not only felt in your muscles, but is also
terribly tiring, because both physically and mentally you
consume large amounts of energy with rapid breathing.
A (too) fast breathing often creeps in unnoticed. Few
people notice that their breathing is speeding up; after
all, life goes on faster and faster. Yet it is good to
regularly turn your back on this hectic world and pay
attention to slowing down. Sometimes slowness pays
off. For your health it is good to regularly clear your
head and spare your body. Slowing down thoughts may
be a difficult task, but breathing less fast is easy to learn
with simple exercises and also beneficial for an
overcrowded head. Your thoughts are not separate from
your breathing pattern. Quiet breathing and peace in
your mind go hand in hand: breathe quietly and your
brain will also come to rest.
Per minute, you breathe between four and sixty times
depending on your circumstances. One breath runs from
the beginning of your inhalation to the end of your
exhalation, flat
12
Relief
before the beginning of a new inhalation. The number of
times you breathe per minute depends on your physical
exertion, but also on your state of mind. If you are relaxed
on a chair, about six breaths per minute is normally
enough. You do not breathe deeply and without thinking.
With physical exertion, you breathe deeper and faster.
When you're walking, you're breathing ten to six-ten
times a minute; when you're running, you're breathing
forty to sixty times a minute. Also, when you think hard
you breathe faster, even when sitting in a chair or lying
in bed. Thinking or brooding can cause you to breathe
five times faster than your physical needs require. If your
head is flooded with thoughts and you don't remember
what it's like to have an "empty" head, you get used to it. In
the long run you don't mind that you think a lot and
breathe restlessly, because an active brain with many
thoughts has become 'normal'. You usually don't even
notice that your thoughts have an influence on your
breathing. For example, sitting in a chair, you may
continuously breathe twenty times a minute. Many people
do that. Milan Kundera has aptly described in his book
Slowness (1995) that your thoughts and your physical
actions directly influence each other, but without you
being aware of it:
There is a secret connection between slowness and memory, between
speed and oblivion. Let's take an extremely banal situation: a man is
walking down the street. Suddenly he tries to remember something,
but the memory escapes him. At that moment the memory-
Introduction
13
he automatically slows his pace. Someone, on the other hand,
who is trying to forget a painful incident he has just experienced,
unconsciously begins to walk faster, as if he wants to move quickly
away from whatever is still too close to him in time.
what is breathing?
Before you take a closer look at your breathing, here's a
brief explanation of exactly what breathing is. You
breathe in oxygen and breathe out carbon dioxide. The
oxygen comes through your nose or mouth via your
windpipe into your lungs. From the lungs, the oxygen
enters your bloodstream and travels from there
throughout your body. As you exhale, you exhale a
surplus of carbon dioxide; a good ratio of oxygen to
carbon dioxide is 3:2. The oxygen you breathe in is
needed everywhere in your body, from your brain to your
toes. Oxygen plays a role in all complex processes; think
of fabric change, thinking and walking, but also the
functio- nation of your liver and thyroid gland. In this
book we always emphasize the importance of good
breathing, because it affects your whole body.
determine if you are breathing properly
By doing the exercise below, you can find out if, at the
moment you are reading this, you are breathing faster than
14
Relief
is needed. If you find that breathing well does something
to you, you can ha- len meaningful tips and useful
information from this book. Because if you do breathe
well through the exercise, you know for sure that your
breathing was not good before. If you notice no
difference between your own breathing and the breathing
described below, then you are probably breathing
correctly at this moment, without thinking about it.
However, this does not mean that this makes you immune
to breathing too fast in stressful situations.
Do the exercise below sitting on a chair with both legs on
the ground. Repeat the instruction eight times.
Breathe in, not too deeply;
Now prolong your exhalation with force.
If the exercise is difficult and you feel you are not
getting enough oxygen, let out a little less air at the
beginning of your exhale. This can be done simply by
pretending to blow up a balloon. Or by opening your
mouth and exhaling with more force, so that less air
escapes at the beginning of the exhalation. Remember
well that it is important to breathe out longer than you
breathe in. This applies to everyone, always.
Repeat this instruction eight times as well.
Breathe in, not too deeply;
Make a spout of your mouth and extend your
exhalation.
Introduction
15
Are you starting to yawn? Do you get an itch on your
nose? Do you get dizzy? Do you start to sigh? Does this
relax you? Or do you actually get stuffy? Do you get
sleepy? Do you get tingling in your arm? Do you feel a
headache coming on?
Then before the exercise you were breathing faster than
necessary. This may be a snapshot, but either way it
indicates an ingrained pattern that has existed for much
longer. The more you respond to the above exercise,
the more likely it is that you are breathing too fast much
more often.
Make sure you don't breathe in too deeply, but breathe
all the way to your abdomen. Not too deep means that
you don't take in an excessive amount of air. Sitting on
a chair, you don't need a lot of oxygen, as long as you
use the oxygen efficiently. So inhale slowly, but make
sure you feel that you are breathing through to your
abdomen. You can check this by resting one hand
gently on your belly and placing your other hand on your
chest. You are breathing correctly when the hand on your
belly moves the same way as the hand on your chest.
rapid breathing
People who breathe continuously at least ten and
sometimes even more than twenty times a minute will
recognize many of the complaints described in this book.
Whether accelerated breathing is the cause or the result of
a particular complaint is of secondary importance as far as
we are concerned. We consider this to be a chicken-andegg issue and we are not interested in it.
16
Relief
will therefore not go into too much detail about it.
We assume that in most cases, accelerated breathing is
a result of too many and non-functional thoughts or
excessive brain activity. And prolonged rapid breathing
leads to the physical complaints we will describe. It is
difficult to predict to what extent complaints will diminish
or disappear with the use of breathing exercises, but there
are plenty of examples of people who have successfully
dealt with their complaints. In any case, it is undisputed
that good breathing has a much greater influence on wellbeing than most people think. It is also certain that very
many people unconsciously breathe too fast. Doing
something about it can provide a lot of insight and energy,
and - not unimportantly - all that without side effects.
Affecting your breathing can be difficult, but it is
always easier than changing behavioral patterns or
thoughts. If you learn to pay attention to your breathing,
you will know whether something is costing you energy
or bringing you benefits. Your breathing tells how you
respond to external stimuli. Just before a meeting with
your manager, in a crowded train, when you hurry your
child to school or when you are stuck in ten kilometers of
traffic, how do you react?
By observing your breathing 'objectively' you find out
when healthy tension turns into unhealthy stress. And
once you can feel when you're outrunning yourself, you
can use breathing exercises to correct it. By breathing
more concentrated and calmly
Introduction
17
relaxation occurs. You don't need medication for that. Nor
do you have to immediately look for another, less hectic
job, because often the exercises in this book are enough.
In any case it is a promising first step, which does not
entail any risks. You can always take pills or go to a
psychotherapist, if it turns out that better breathing does
not help sufficiently.
breathing too slow
Besides breathing too fast, you can also breathe too slow.
People can hold their breath in times of stress or 'forget' to
breathe while talking. This so-called under-breathing is
not discussed in detail in this book, because it is much
less common than over-breathing. Nevertheless, people
who under-breathe can also benefit from the breathing
exercises or recognize themselves in the examples
given. Only in the chapter onbreathing in children and
during pregnancy is slow breathing discussed in more
detail. We certainly do not underestimate the complaints
resulting from this breathing. The exercises you can do to
improve your breathing are no different than the exercises
for over-breathing. So if you know that you are not
breathing too fast, but that you often hold your breath
when you talk or tense up, then you should do it.
18
Relief
If you are not sure, you can try out the same exercises.
Then you will find out soon enough which exercise will
benefit you the most.
breathing too deep
In addition to breathing too fast or too slow, you can
also breathe too deeply. If you have a good breathing
frequency and just breathe six or seven times, but breathe
in with very deep breaths you can also have symptoms.
You can check if you do this by checking if your
exhale is a little longer than your inhale. If you notice
that your inhalations are long and deep and your
exhalations are short, then the exercises in this book will
be very helpful.
six times a minute, a relief
In addition to breathing exercises, we also recommend
exercise for the complaints and diagnoses discussed,
unless stated otherwise. A whole chapter is devoted to
exercise, not only because breathing changes during
exercise, but also because in many cases exercise can
make an essential contribution to recovery.
We do not pretend to offer a solution for all
complaints, syndromes and diseases in which breathing
plays a role. However, we would like to emphasize that
proper breathing
Introduction
19
and sufficient exercise are better for you than continuing
to take large amounts of medication, which is still very
often and easily prescribed. A combination of sport and
relaxation helps prevent new complaints from arising and
can considerably reduce existing complaints or even make
them disappear completely.
Much of what is covered in this book has been
scientifically proven in diver- se studies. In order to keep
the book readable, we do not constantly refer to articles
or books that go into more depth about the subject matter.
For practitioners and interested laymen who want to
know more, we have included a list of consulted and
recommended literature and websites at the end of this
book. In practice, you really don't need a scientific basis;
you can easily try all exercises yourself and in this way
determine what the exercises can or cannot do for you.
Feeling which exercise works best for you is worth more
than being able to quote the exact scientific
argumentation. On top of that, the lack of scientific
evidence does not mean that something "therefore" does not
work: most studies examine groups of people and
individuals can very clearly differ from group averages.
Once you have experienced what good breathing can do
for you, the amount of scientific evidence no longer
matters. In this regard, we like to refer to the Greek
philosopher Plato: "Those who know do not need to do
research, because they know, but those who
20
Relief
not knowing either, because to do research you have to
know what you are looking for.' On respiration, this
certainly applies as well.
Simple, powerful, with no side effects. Six times a minuut, a relief.
Sixteen times a minute and what can you
do about it?
complaints
First we will look at all the symptoms that can be directly
or indirectly related to an irregular breath. People with
dysregulated breathing usually tick at least five symptoms
on the list of complaints on the following pages. How many
complaints do you have?
do it yourself
Go through the complaint list completely and fill in
whether you have a complaint often, sometimes
or not. A complaint you feel daily is often. A
complaint you feel weekly is sometimes.
Relief
22
complaint list
ofte
n
some
times
not
1. Pressure on the chest
O
O
O
2. Chest pain
O
O
O
3. Palpitations
O
O
O
4. Pain in the shoulder or neck
O
O
O
5. Headache
O
O
O
6. Feeling of band around the head
O
O
O
7. Light feeling in the head
O
O
O
8. Feeling of fainting
O
O
O
9. Actual fainting
O
O
O
10. Dizziness, standing or walking
O
O
O
11. Dizziness, sitting or lying down
O
O
O
12. Bloated stomach
O
O
O
13. Frequent burping
O
O
O
14. Nausea
O
O
O
15. Braken
O
O
O
16. Frequent urination
O
O
O
17. Diarrhea/obstipation
O
O
O
18. Trembling hands
O
O
O
19. Tingling sensation in the hands
O
O
O
20. Tingling sensation in the feet
O
O
O
21. Tingling sensation around the
mouth
22. Stiff feeling in the hands
O
O
O
O
O
O
23. Cold or pale hands
O
O
O
24. 'Swab legs'
O
O
O
25. Agitation
O
O
O
Sixteen times a minute and what can you do
about it?
23
often some
times
not
26. Nervousness
O
O
O
27. Uncertain feeling
O
O
O
28. Fear
O
O
O
29. Vibrations all over the body
O
O
O
30. Irritable
O
O
O
31. Unreal feeling
O
O
O
32. Absent feeling
O
O
O
33. Unhappy feeling
O
O
O
34. Crying fast
O
O
O
35. Gag in the throat
O
O
O
36. Tingling tongue
O
O
O
37. Dry mouth
O
O
O
38. Difficulty speaking
O
O
O
39. Difficulty thinking clearly
O
O
O
40. Blurred vision
O
O
O
41. Double vision
O
O
O
42. Tinnitus
O
O
O
43. Frequent sighing or yawning
O
O
O
44. Shortness of breath during the day
O
O
O
45. Breathlessness at night
O
O
O
46. Shortness of breath
O
O
O
47. Feeling of breathing too much
O
O
O
48. Sleep problems
O
O
O
49. Tired quickly
O
O
O
50. Excessive sweating
O
O
O
Source: Reventacare
24
Relief
From this list of complaints, there is a top five list of
complaints that are most common in people who breathe
too fast:
1. Pain in the shoulders or neck
2. Agitation
3. Frequent sighing or yawning
4. Tired quickly
5. Palpitations
All of the above complaints relate to breathing in a
different way. Nevertheless, you can possibly remedy all
complaints by doing breathing exercises.
how the above complaints arise from
incorrect breathing
1. The auxiliary breathing muscles are attached to your
neck and these muscles are meant to allow you to
breathe faster for a short period of time, if desired. If
you run too fast these muscles become overloaded
and you get pain in your neck, shoulder or back.
This pain can be compared to the muscle pain in your
legs after running a long distance, if you don't do that
regularly. By resting, the muscle pain in the legs will
disappear and by breathing more quietly you will
relax the auxiliary breathing muscles and after a few
weeks the pain in the shoulders or neck will
disappear.
Sixteen times a minute and what can you do
about it?
25
2. The feeling of being agitated is because the accelerated
breathing disturbs the hormonal balance. You produce too much adrenaline and this gives you a
restless, agitated feeling, which does not go away by
itself.
3. Frequent sighing or yawning is actually a kind of
oxygen depletion. If you always breathe fast, your body
thinks that there will be a lack of oxygen if you breathe
less fast. As soon as you relax a little, you begin to
yawn or sigh, an attempt by the body to get a large
amount of oxygen in with fewer breaths per minute.
4. Fatigue comes from the fact that with a high respiratory
rate, you are continually using up your energy-rich
glucose stores. Your body has two fuels: fats and
glucose. With rapid breathing, your li- cham doesn't use
the energy-rich fats as fuel, or at all, but only the
energy-rich glucose is consumed.
5. The large emission of carbon dioxide causes your
vessels to constrict. Your heart tries to compensate for
this vasoconstriction by pumping blood into your body
at lightning speed. This is a smart response by the
body, but it makes many people anxious or stuffy and
causes heart palpitations.
Now that you know what symptoms you have, we'll take a
closer look at the relationship between symptoms and
respiratory rate.
26
Relief
an example from the practice of koen
de jong
Tim, a man with a busy job, pays a visit to my practice,
where he has his breathing measured.
'Sitting on a chair you breathe sixteen times a minute.
You do the same when you're cycling against the wind at
eighteen kilometers per hour,' I say, after measuring Tim's
breathing for ten minutes.
"So what, is that bad? Tim responds indifferently. 'That takes
an enormous amount of energy,' I reply. 'If you're always
breathing like that you get a lot of symptoms, like fatigue.'
'So why am I doing that?" asks Tim, who has already had
some newshas become more stingy.
'Presumably you were thinking about an annoying
phone call this morning or work that needs to be finished
by tomorrow, when you're already running out of time,' I
reply, 'or it's simply an ingrained pattern.'
'So what symptoms can I get from that?" wants to know
Tim. He's getting really curious now.
'This varies: it often involves fatigue and concentration problems, but heart palpitations and other
unpleasant physical symptoms are also common,' I say,
adding that he is not the only one, but that hundreds of
thousands of people in our country have this.
Tim is in his early forties. In a short time he has made a
career at the magazine where he works. He is a journalist
and works
Sixteen times a minute and what can you do
about it?
27
irregularly. At work, he is a valued colle- gian. Besides
working hard he goes to the gym once a week and in the
weekend he tries to go running. But he doesn't always
succeed, because he is also the father of two young
children with whom he likes to play soccer in the park on
Sundays.
After work, Tim regularly has a beer with a colleague
or with friends. Since he started his current job four years
ago, he has gradually gained five kilos. According to him
this is mainly due to irregular but not unhealthy eating.
Five kilos is not that much for him, he knows people who
have gained three times as much in less time. The
journalist finds himself always a bit restless. Enthusiastic'
he likes to call it, and 'the nature of the beast'. For no
apparent reason he has been troubled recently by
occasional palpitations, without any really worrying
symptoms. He did notice, however, that his ability to
concentrate had somewhat diminished. When a good
friend of his suffered a small heart attack, he was
suddenly quite frightened. To reassure himself he started
looking for an explanation of his heart beat. A visit to the
cardiologist didn't help, but an acquaintance pointed him
to my physiotherapy practice in the Jordaan district of
Amsterdam. There they suggested Tim take a closer look
at his breathing.
In this practice Tim then measured his breathing.
Wearing a chest band, he sat reading a magazine for ten
minutes, without consciously noticing his breathing.
28
Relief
It is important to pay attention. Using the chest strap, the
heart beat (the number of beats per minute that your
heart beats), breathing pattern (how does the inhalation
compare to the exhalation) and breathing frequency
(how often do you breathe per minute) are measured. His
breathing frequency was high, without his being aware of
it. It was the first time he heard about the connection
between his high breathing frequency and consuming too
much energy. The fact that his accelerated breathing could
be the cause of his concentration problems therefore
seems strange to him at first. After the rest measurement
it is clearly explained to him: because of the disordered
breathing there is low carbon dioxide in the blood. As a
result, less oxygen reaches the right place. The body goes
into fight/flight mode and the concentration goes down.
Tim had his breathing measured with specially developed
equipment. There are a number of practices in the
Netherlands where you can have your breath measured.
At the end of this book you will find a list of addresses
where you can go for this. There you will be told what
your breathing pattern is and what your exact frequency
is. But you can also count your own breathing
frequency. Before you continue reading, you could do
this now. Take a watch or stopwatch and count your
breathing frequency right now.
Sixteen times a minute and what can you do
about it?
29
what is your breathing frequency?
One breath begins at the beginning of the inhalation
and ends when you have exhaled completely, until
just before you inhale again. Count how many times you
breathe in sixty seconds and you will know your
breathing frequency at this time.
Counting your breath will make you breathe more
consciously and it may then be difficult to determine how
you breathe if you do not pay special attention to it. You
can also ask a friend or roommate to count your breathing
frequency at a time when you are not aware of it.
Sitting down with a book, a breathing frequency of six
times per minute is sufficient. If you breathe more than
six times in such a situation, your physical state of
readiness is higher than necessary. Breathing faster than
necessary can be compared to endlessly winding up a toy
doll with a turning mechanism. By winding up the puppet
with a screw you increase the resistance. If you then let
go of the puppet, it will jump or dance until the spring is
relaxed again. If you tighten the screw longer than
necessary, the puppet will still not move for long or you
may even destroy the turning mechanism. However, the
longer you wind it up, the more energy it will take. It's
the same with breathing. If you breathe much more than
necessary, it doesn't produce more energy, but you
actually use energy. If you read this book with a breathing
frequency of above
30
Relief
the ten, then that takes energy, which is at the expense of
your concentration, for example. Again: sitting on a chair
has a breathing frequency of six per minute, and then
reading doesn't take up any unnecessary energy. You are
concentrated until it makes sense to get tired. Just as you
let go of the puppet and let it dance until it has fizzled
out, you can now breathe quietly and read this book. The
restlessness that is still in your body will then disappear,
until you can no longer read but fall asleep 'rested'.
difference between men and women
That there will be many people who do not read this book
with relaxed, calm breathing is certain. Is there any
difference between men and women in this regard? Do
men have more often dysregulated breathing or do
women? The difference between men and women is
especially noticeable during talking. Women tend to
breathe faster when they are talking. And then...
breathe... and then... breath... and then... breathe...;
women who talk enthusiastically talk fast and
sometimes breathe four times within a sentence. Men
usually do it differently. They breathe in and then lock
their breath, talk the whole sentence and only breathe in
again after one sentence. In both cases a shortage of
oxygen quickly occurs. For women, because the air is
already exhaled before it can be absorbed, and for men,
because they lock their breath and forget to breathe in.
Sixteen times a minute and what can you do
about it?
31
What exactly is proper breathing? and
what is dysregulated breathing?
Breathing too fast doesn't last a person years unpunished.
Breathing sixteen times a minute is, as we said, someone
who is cycling against the wind at eighteen kilometers an
hour. No body is strong enough to cycle 24 hours a day
for 18 kilometers per hour against the wind. If you 'cycle
eighteen kilometers per hour' all day long, sitting in the
car, sitting on the couch and sitting behind your desk,
there comes a time when the body protests. Even
professional cyclists only cycle six hours a day and the
rest of the day they mainly lie in bed to recuperate. Overtired people often look with great admiration and
amazement at cyclists who cycle the Tour de France. You
should know that a cyclist has a resting heart rate of
around thirty. Walking down the street, a cyclist feels
tired and sluggish. Only when he starts cycling with his
trained body and his heart rate increases from thirty to
one hundred and sixty to two hundred beats per minute,
the cyclist comes to life. Only then does he tap into his
energy reserves. This is exactly the opposite of what an
overtired, agitated person does. A cyclist does not work
hard on a bicycle for six hours a day, but does so all day.
In doing so, he actually makes a much heavier effort: his
body never gets any rest, even though it never delivers the
peak performance of a professional cyclist. The body goes
32
Relief
avenge itself when it does little physically but gets a
signal that it is active. This is the case with Tim and he is
no exception. As mentioned, many thousands of Dutch
people breathe deeper and faster than is physically
necessary and, as a result, their bodies are constantly in an
energy-draining state of readiness.
0102030405060
seconds
An example of good breathing, seven times a minute, sitting- tend on
a chair.
The black line is the respiration; this runs upward on inhalation and
downward on exhalation. It is especially important that the
exhalation is longer than the inhalation.
0102030405060
seconds
An example of breathing too fast, sitting on a chair.
In this example you see a breathing of twenty-two times per mi- nuut.
The exhalation is as long as the inhalation. This breathing takes an
incredible amount of energy.
Sixteen times a minute and what can you do
about it?
33
The rapid breathing in the graph is Tim's breathing from
our practical example.
'Actually quite logical, I think I've been breathing like this
since childhood. This explains a lot,' says Tim.
state of alert
From time immemorial, a certain state of readiness in the
face of stress has been necessary for survival. The
nervous system of today's humans has not changed much
over the past tens of thousands of years. However, the
number of impressions we have to process has
multiplied. In a dangerous situation, the body has
reacted the same way for many thousands of years. If
your house is on fire, your breathing frequency
increases from fright. This causes you to produce
adrenaline, you don't feel any pain or fatigue for a while
and you can quickly run out of your house. Once
outside, when the immediate danger has passed and
everyone is in safety, you relax and also feel your
physical needs again. In a burning house you don't think
about eating, going to the bathroom or having sex. And
you don't pay attention to your breathing or a pain in your
knee either. In an emergency, these feelings are of
secondary importance. Run away first, then eat quietly,
pee at the convenience and spare your knee. This applies
not only to panic during a fire, but in any threatening situation
that generates tension.
Nowadays, we rarely get into life-
34
Relief
dangerous situations and yet our bodies are very often in a
state of high alert. Demanding work, ambitious goals,
overfull agendas and busy working days and weekends
are common causes. The fact that many people no longer
feel this agitation is because they have become
accustomed to it. If you drive out of town in your car at
fifty kilometers an hour, that's a lot of speed. If you drive
on the freeway at 100 kilometers an hour for a while and
then go back into the built-up area, that same 50
kilometers an hour suddenly isn't fast at all anymore.
After a street where you're only allowed to drive thirty
kilometers, fifty kilometers is still fast for you. The same
applies to breathing. If you take twenty breaths a minute
while working and then plop down on a terrace where you
are still breathing "only" sixteen times a minute, this feels
relaxed. But even sixteen is far too restless and too fast.
Without being aware of your high breathing frequency
you can therefore develop complaints.
When you consciously breathe six times a minute for
two minutes, you experience how much more relaxed this
is. But if you stop to think about it, a breathing frequency
of ten is probably quite normal again.
Just for fun, sit on a bench in front of a su- per
market at 5:30 in the evening. Look people going in and
coming out in the eyes and try to see their breathing.
Guaranteed that in the majority of people you can clearly
see their breathing and that they look scared and agitated
rather than relaxed
Sixteen times a minute and what can you do
about it?
35
and cheerful. And yet they have finished their work. The
fact that people are less aware of their surroundings, do
not help another person reach for something or do not
greet the cashier, has a physical cause. When your body is
in a state of emergency, you think first of your own skin.
In a supermarket, this behavior is trivially selfish, but on
the run from a dangerous animal, it is vital. Sitting on a
bench in front of an Albert Heijn this observation is easy,
but how do you walk in there yourself?
breath and energy
Breathing is done first and foremost to take in oxygen and
get rid of waste products. Oxygen is needed to release
energy. When you breathe in, oxygen enters your lungs
and automatically goes to the energy-rich sugar reserves
in your body. When the two come together, energy is
released. Paradoxically, by breathing deeply and quickly,
you take in much less usable oxygen than you need. The
oxygen is already out of the body before it has been
absorbed. In other words: by breathing too fast you don't
use your energy effectively. Energy that usually lasts for
days is now sometimes used within a few hours.
Imagine that as a heater you have a burning hearth fire
and you have a nice supply of firewood. What you do
with breathing too fast is all your wood
36
Relief
Soak the wood in methylated spirits and throw it in a
burning fireplace. This does provide light and warmth, but
the wood disappears at lightning speed and you won't be able
to enjoy it for long. Once the fire is out, it's not easy to start
it up again. After all, you don't have any wood left and
you're sitting in the cold. The similarity between this fire and
the popular diagnosis of burnout soon becomes apparent.
So when you breathe too fast, you use a lot of energy in
a short period of time. Then you run out of energy and
have to live on your reserves. Day in, day out, you can
draw on your energy reserves more than is actually
necessary without noticing it. This can even continue at
night. If you hear from your partner that you are breathing
fast, restlessly or heavily at night, you know for sure that
your body is not recovering enough during sleep.
Therefore, in the morning you get up tired because your
body is not rested. This tiredness can feel even heavier
than the tiredness of the previous evening: not only have
you not recovered, but the adrenaline that can numb the
tiredness is still missing. An hour and two cups of coffee
later, you can somewhat ignore the tiredness and you get
some energy. At nine o'clock you throw logs into the
burning fire again and you have some energy, until it is
gone again. Usually this happens somewhere between
twelve and three o'clock in the afternoon: you are then
overwhelmed by sleepiness. Because lying down at this
time is usually not practical, you consciously come up
with an alternative: chocolate or other sweets. This is in
fact a cry for energy from your body.
Sixteen times a minute and what can you do
about it?
37
The chocolate bar that you swallow has the same effect
as the log of spirit that is thrown on the fire. It gives you
quick energy, but you won't enjoy it for long. When this
energy shot wears off, it's about five o'clock and you can
switch to alcoholic drinks or new sweets. Once you get
over this dip you just get through the evening, but in the
evening you fall asleep restlessly.
'Yes but, I've been living like this for twenty years, so why
am I only suffering now?" says Tim, who is still not
convinced of the connection between his rapid breathing
and his fatigue.
'Presumably you have already ignored a subtler signal at
least twenty times,' I reply.
Extreme fatigue, tension headaches and heart
palpitations don't come on suddenly and all at once. You
probably ignored earlier signals because you had to keep
going, or wanted to.
More subtle signs of rapid breathing are lots of
sighing and yawning. But also: waking up tired, more
craving for sweets, preferring wine to a book for
relaxation, little urination during the day but a lot in the
evening and less desire for sex.
Tim nods. Now that he thinks back, he realizes that
he often didn't feel like going to work because he was
tired. Even outings that he used to enjoy have become
more and more of a burden. And about his short-term
mind-
38
Relief
memory and ability to concentrate, he has been
dissatisfied for years. Yet it seems a bit too simplistic for
him to blame all that on accelerated breathing.
'Does calmer breathing then solve everything?' he asks
doubtfully. Whether it solves everything is impossible to say,'
I reply, 'but your breathing is much faster than necessary and
therefore you are using much more energy than necessary. It
is certain that more rest in your body will bring many
positive effects. In more areas than you can imagine now.
moeden.
combat symptoms by controlling your
breathing frequency
Bringing peace to your body is as difficult as it is simple:
by breathing less and moving more.
Tim was there early on and was fortunate enough to
have his breathing measured fairly quickly. Often
people have already had a whole series of therapists and
examinations and no one has been able to find the exact
cause of their complaints. Although people often feel
that there is a fundamental problem underlying their
complaint, they are often treated with a narrow mind, by
themselves and by professionals. Most people do not
protest against the professional approach to their
complaints, well-mannered or overwhelmed as they
usually are.
Sixteen times a minute and what can you do
about it?
39
Palpitations are still often controlled with me- dicines
called beta-blockers. Beta-blockers are pills that literally
limit the heart. High blood pressure is treated as an isolated
problem and depressive moods are "solved" with a
prescription for an antidepressant. With complaints of
fatigue and con- centration problems you often only get the
advice to take it a little easier and that is not very concrete.
Many complaints can be easily and effectively combated at
an early stage by reducing the frequency of breathing and
improving the breathing pattern. Roughly speaking you can
divide rapid breathing into three stages:
1. You breathe too fast, but you are not bothered by it. At
this stage, rapid breathing is just an unnoticed
phenomenon. This can start at a very young age.
Unrecognized dyslexia, quarrelsome parents or
mistreatment are three random examples of common
traumatic experiences that can cause breathing to
become disordered. Later in life, common causes for
rapid breathing are: a change of job, having children, a
divorce or a serious illness or the death of a loved one.
The breathing disorder at this stage is a seemingly
unimportant consequence of a substantial problem.
2. You have complaints, but think they are temporary and
you put the cause of the complaints down to a ge-
40
Relief
event outside of yourself. Fatigue, back pain and
heart palpitations are attributed in this phase to, for
example, the hectic time at work, the chaotic move or
a death in the family. The disordered breathing causes
complaints, but the complaints are still related to a
possible cause of the agitation and not to the agitation
itself.
3. You have symptoms and you go to doctors and
specialists to find and fight the cause of those
symptoms. You have high blood pressure,
palpitations and are too tired to work. Doctors tell
you to take it easy and that most complaints seem to
be related to stress. After a short effort (climbing
stairs) you feel your breath high and your heart racing.
Half-hearted attempts to eat without and take more
exercise do not work quickly enough. Perhaps you even
take a yoga class for a change, but you quickly
conclude that yoga is not for you. The disordered
breathing has at this stage disrupted your body and
the original symptom has become an isolated cause of
many other problems.
Sixteen times a minute and what can you do
about it?
41
an example from the practice of koen
de jong
Simone is an acquaintance of Tim's and also in her
early forties. On his recommendation, she had her
breathing measured. Simone's breathing was measured
a few months ago and in the meantime she has
improved considerably with breathing exercises and an
exercise program. She recognizes herself in the stages
mentioned above and has meanwhile got rid of many
complaints.
She sighs and wonders aloud if what she has just seen
could really be the solution. She has seen her heart beat
drop from to 82only64, by a simple breathing exercise.
Reducing her breathing from 22 to 6 gave a feeling of
enormous relaxation. And that while before she didn't feel
restless at all. Always busy with anything and
everything, that's for sure. Sitting still did not suit her,
that had been the case from an early age. That was just
part of her, she thought. Now she's tapped out, often
feeling anxious for no reason and almost constantly
agitated. Where did it go wrong?
After a busy college days with lots of contacts with
friends, sports and going out, but also good grades,
Simone became a lawyer. In her third year of study she
overslept herself once. By temporarily focusing all her
attention on her studies, she got over it without giving it
much thought.
42
Relief
She was able to handle her work just fine after that and
kept enough time to exercise and see her friends. When a
colleague of Simone's became ill and she was given more
and more work, Simone became chronically tired. She
was reluctant to go to work and increasingly made up
excuses to avoid going out with friends.
She hoped a week of winter sports would do her
good. Up on the slopes, however, Simone thought mainly
of her work and the mail that was piling up there.
When she arrived in the valley, she wanted to read her
e-mails quickly. She was unable to enjoy the beautiful
view and being physically active outside suddenly
seemed trivial. On the second evening of her winter sports
holiday she had her first heart palpitations in bed.
At home, she went to the family doctor, who referred
her to the cardiologist. However, the cardiologist found
nothing abnormal; her heart was in perfect health. Still,
she was given a beta blocker, in a low dose, just in case.
The beta blocker did indeed make the palpitations almost
disappear, but she was panting like a horse at the top of
every flight of stairs. She now slept nine hours a day
and still woke up exhausted. She could just about manage
everything at work, but all the energy she had went into
that. She talked about it with a friend (Tim), who pointed
her to someone in the neighborhood who does 'something
with breathing and heartbeat'. It turned out that at rest
Simone was breathing 22 times a minute. In addition, an
exercise test showed that her heart was already limited at
beats125 per minute by the medi- cation.
Sixteen times a minute and what can you do
about it?
43
cines. Her heart rate simply didn't get any higher, whereas
a healthy woman of her age normally has a maximum
heart rate close to the180. She also sometimes had the
feeling that she was carrying an invisible block of forty
kilograms with her during heavy exertion. That this
might be caused by the beta-blocker had not occurred to
her.
Simone was advised to go back to the car- diologist
to discuss with him whether she could try for three
months without her medication. He had no problem with
this and since then Simone has been running three times a
week, but not too intensively. She also does 15 minutes
of breathing exercises three times a day. Sleeping
improved immediately in the first week and in the
following weeks she got more energy. She still has
palpitations every now and then, but she can control
them perfectly with her breathing exercises.
In retrospect, I think I started breathing the wrong way from my
student days. After high school I went crazy in Amsterdam. It
was all wonderful of course, I thought the world was at my
feet. But I never realised that it was giving my body a serious
knock. Who thinks of such a thing now?
Simone is happy that the cause of her complaints was
discovered in time and that the exercises and sports are
working so well. Yet something also gnaws at her. After
all, she is four years old.
44
Relief
She had already gone to the family doctor with similar
complaints. He did tell her to take it easy, but never
looked at her breathing. Let alone that he measured her
breathing pattern. If it is so simple to make breathing
clear and if this can help prevent so many complaints and
even make them disappear, why didn't the doctor do this?
physicians and respiration
People with a wide variety of complaints, such as heart
palpitations, elevated blood pressure, or complete
exhaustion, are rarely made aware of their structurally
excessive breathing.
Is that ignorance? Lack of belief in the power of proper
breathing? Or do patients want to hear a different
solution to their problem? Presumably it is a
combination of factors. The general practitioner who,
when asked about headaches, intestinal problems, heart
problems, high blood pressure and fatigue, invariably
answers that it's probably because of breathing, does
have some explaining to do to his patients and colleagues.
A general practitioner often sees ten patients per hour,
and sometimes even more, with a wide variety of
complaints. Often these complaints are treated with
medications, such as tranquilizers, sleeping pills,
antidepressants or beta blockers. If these do not work,
the general practitioner refers to a cardiologist
Sixteen times a minute and what can you do
about it?
45
or other medical specialist. If no treatment provider can
find a cause for the complaint the patient came in with, a
referral to a respiratory specialist is worth considering.
Hippocrates (460-370 B.C.), the founder of modern
medicine, already said that as long as the cause of a
disease is not known, it cannot be treated properly. This
principle seems to have lost its validity, partly due to the
influence of the pharmaceutical industry. For the
pharmaceutical industry, breathing as a medicine is a
disaster. Serving as much from breathing as from
expensive brand-name drugs is impossible, so who is
going to pro- mote the cheap breathing? More and more
people are being prescribed medications without knowing
the cause of their symptoms. If the drug has unpleasant
side effects, the dose is adjusted or the drug is changed,
but in the first place it is mainly a question of seeing if it
does anything. A repeat prescription for depression, high
blood pressure and heart palpitations is often written for
months or even years without knowing where the
complaint comes from or whether the use of the
medication is still functional. It would also be a godsend
for the doctor if people could cure their complaints, or
part of them, with their own breathing. Fighting an
unhealthy lifestyle with heavy medication is mainly done
out of ignorance and lack of time, combined with
compassion for the patient. Would a doctor combat a
headache caused by too much alcoholic beverage with
morphine? No, the
46
Relief
doctor says you should wait until it passes and
recommends drinking a little less next time. So why does
a doctor combat palpitations caused by a busy job or
heartbreak with a beta blocker? Medications often have
unpleasant side effects. Of beta-blockers and
antidepressants, people find panting, weight gain and
decreased desire for sex (including the absence of
orgasms) the most unpleasant side effects. There is
little to lose: if a doctor advises firstly to gain insight into
the breathing and to start exercising more, you can always
switch to medication afterwards if the effect is
insufficient.
Yet it is anything but new to use breathing to combat
symptoms. Actually, it has been known for many decades
what breathing can do for diseases. There are doctors
who have used breathing to combat complaints for a long
time. Konstantin Buteyko is a well-known Russian
doctor from the last century, who worked a lot with
breathing. Buteyko discovered in what1952 rus- tic,
shallow breathing could do for people with asthma. He
did research and helped thousands of people in centers
across Russia. During his studies, Buteyko did experiments in which he asked healthy people to breathe
deeper and deeper. He discovered that by doing so they
evoked a number of medical complaints. They felt dizzy,
their heartbeat went up, some got an asthma attack and
a few even fainted. Then he began to realize that the
opposite might also be true.
Sixteen times a minute and what can you do
about it?
47
could be possible. That, if one were able to make
breathing calmer, one could positively influence health.
Meanwhile, books have been published in all languages
about Buteyko and his revolutionary approach to wellness
diseases. He taught people to breathe less deeply and less
quickly, with an emphasis on "less deeply. With patience
and discipline, he got people to breathe properly for two
hours a day, and so asthma and panic often disappeared.
Asthma is recognized and obviously has al- les to do with
breathing. However, it is less well known that there are
millions of people who breathe faster than they should
and who do not get any serious complaints from this, but
who do suffer from it. A Dutch doctor who is much
involved with breathing is the doctoral student Jan van
Dixhoorn, who has many publications to his name and
who also teaches about breathing to physicians.
Nevertheless, physicians who pay explicit attention to
breathing unfortunately remain an exception, even though
this could yield many health benefits.
breathing exercises as medicine
Incorrect breathing is health problem number one," says
Stans van der Poel, director of Decon Medical Systems.
Van der Poel is a former lung function lab technician and
now a leader in combating complaints by means of
breathing exercises at rest and during sports.
Relief
48
'Diabetes, chronic fatigue, obesity, burn- out, high blood
pressure, fibromyalgia, all are related to improper
breathing,' says Van der Poel. 'And also supportive in
cancer, respiratory exercises are of great importance.' That
is why Van der Poel has developed a device that can
provide insight into breathing. She had previously
developed equipment for therapists and has now
developed a watch that allows people to see their own
breathing frequency. Just as you can measure your own
heart rate with a heart rate monitor, you can measure your
heart rate and your breathing frequency with her ecwatch. The new watch will draw even more attention to
breathing.
ecm network
It is her dream that everywhere in the Netherlands
there will be centers where people can have their
breathing measured. That's why Van der Poel started a
2002network under the banner Energy Control Method
(ecm), named after the device she developed. She has
seen that many people who were skeptical nevertheless
started to work with breathing exercises because she
could show with the equipment that it really did
something. It is her firm belief that millions of Dutch
people would benefit from this. Through the ecmnetwork she hopes to actually reach all these people.
She has now been working for more than fifteen years
Sixteen times a minute and what can you do
about it?
49
respiration and in recent years the demand for her
equipment has skyrocketed. By now, her approach has
settled in all provinces. At the moment, Van der Poel is
mainly training physiotherapists and other practitioners.
In her training she insists on the destructive
consequences of a continuously running mo- tor, as she
describes a high breathing frequency. In addition to
breathing exercises, people being trained as ecmtherapists are also taught exercise physiology.
Practitioners learn to administer and properly interpret
exercise tests.
She refuses to label chronic fatigue, me or fibromyalgy as chronic diseases. In her view, that's not doing
people justice. You shouldn't tell patients that they have
to learn to live with it, you should give them a remedy
with which they can get to work: breathing properly,
both at rest and during physical exertion. Thousands of
people have already found their way to her knowledge
and, after many patients thanked her, she is now also
receiving recognition from the scientific world. The Coronel Institute, affiliated with the Academic Medical
Center (amc) in Amsterdam, was commissioned by the
Ministry of Public Health to investigate her approach.
The results speak for themselves: the method of
breathing exercises in rest and in exertion works
extremely well in burn-out. In the back of the book you
will find a reference to the website for the entire study.
Relief
50
do it yourself
Using a stopwatch or watch, sit for ten minutes.
Breathe in for two seconds and out for four seconds.
After exhaling wait two seconds before breathing in
again. Ten minutes seems little, but keep in mind that
you really do the exercise ten minutes at a time. If
you start paying attention to the seconds, which gives
you the idea that you cannot relax, you should not pay
attention to the time. During the exercise you must
experience the feeling of relaxation, otherwise it is
better not to do the exercise.
summary
1. Sitting in a chair, a breathing rate of less than ten
times per minute is sufficient.
2. Restlessness, fatigue, and difficulty concentrating are
maintained or even find their cause in an excessive
breathing frequency.
3. Millions of people unknowingly breathe faster than
necessary. Many complaints are related to breathing too
fast. Also, many people unknowingly breathe too
deeply.
4. The exhalation should be longer than the inhalation.
5. Breathing properly for fifteen minutes three times a day
already has a major positive effect on your health.
6. Physicians' attention to respiration is still ge- ring, but
is likely to grow.
Causes of high respiratory rate
By far the most important cause of rapid breathing is
persistent mental pressure. You can also call this
tension or stress. But it's not only tension that disrupts
breathing. Eating a large plate of spare ribs or a box of
chocolates, for example, will also disrupt your breathing.
And what happens when you drink a glass of wine? Or
a bottle? Not only food and drink affect breathing, but
smoking, or quitting smoking, and the use of drugs also
have a directly perceptible impact on breathing patterns.
Or pain, both chronic pain and short-lived, fierce pain.
Your posture when sitting or standing affects it. Chronic
respiratory diseases, such as asthma and bronchitis,
cause the breathing frequency to increase. All of these
causes are the subject of this chapter. You will see that
breathing is sometimes surprising, but all the time
logically related to actions you do throughout the day.
52
Relief
persistent mental pressure
Burnout is a term commonly used for people who are
persistently tired, feel empty and listless, and not
infrequently are gloomy. The symptoms are much like
depression. The cause? High work pressure is usually
identified as the main culprit, combined with private
circumstances, such as a sick mother or a fight with the
partner. People who are diagnosed with burnout are often
demanding and perfectionist. They have difficulty saying
no and, partly because of this, often work much more
than is good for them. However, fatigue can also be a
striking phenomenon in very different diagnoses.
Depression, sleep disorders, CVS (Chronic Fatigue
Syndrome, also known as me), fibromyalgia or a slowworking thyroid gland are well-known examples. The
biggest common denominator in all these diagnoses is
that everyone suffering from them is suffering from
stress, which has often been present for a long time. Yet
people often feel short-changed when their physical
complaint is called stress-related. What we want to show
in this book is that there is actually no difference between
a complaint caused by a vague concept like stress and a
complaint with a directly identifiable physical
(physiological) cause. If you work under stress for a long
time, your breathing pattern will be disturbed. And a
disturbed breathing pattern is a purely physical
explanation for complaints as described above.
Causes of high respiratory rate
53
Suppose you have been working for two years with a
boss who belittles and barks at you. This annoys you
enormously and you'd rather start looking for another job
than put up with this any longer. But you don't really
know what you want. You take your work home with
you, where you often have fights with your partner, partly
because you have a much shorter fuse than before. When,
after two years, your mother has to be admitted to a
nursing home, and you spend all weekend arranging
everything around it, such as the move, things suddenly
stop. Exhausted, you sit at home, you really can't work
anymore. At a first visit to a doctor you are told that it has
become too much for you. You just can't take it anymore.
This explanation does not satisfy you, because you have
the feeling that there is indeed something physically
wrong. During a visit to another doctor you are told that
your breathing frequency is24 at rest, while it is normally
six. The doctor says that you are incredibly strong,
because you have held on for so long with such a high
respiratory rate. But it makes sense that you are exhausted
now, because anyone in a similar situation would be. Both
doctors say pre- cies the same thing: take it easy for a
while. But your reaction will be very different in both
cases. After the visit to the second doctor you can start
very specifically with breathing exercises and really do
something about your tiredness.
Relief
54
smoking
Actually, smoking is the ideal breathing exercise.
Enjoying a cigarette means inhaling and then forcefully
blowing out the smoke. When the smoke clears, wait a
moment and then inhale again. This looks a lot like a
breathing exercise, the exhalation is always longer than
the inhalation and the short term effects of smoking
can therefore be partly explained by this unconscious
relaxation exercise. But what happens when someone who
has smoked for many years stops?
Long-term smoking damages the lungs. A person
will have to breathe faster to get the same amount of
oxygen. Smokers will therefore generally have a higher
respiratory rate than non-smokers. Only when the
smoker smokes is his breathing relaxed. Inhale deeply,
blow out the smoke slowly and wait a while. This is why
a smoker finds it very relaxing to light up a cigarette. So
with twenty cigarettes a day, a smoker is actually doing
a breathing exercise twenty times a day. If the smoker
stops doing this, he thereby misses out on twenty
breathing exercises. This gives an enormous agitation
and the damaged lungs add to it by screaming for even
more oxygen with every very slight effort: you start
panting like a horse. Don't confuse the relaxation you felt
when you were smoking with dependence on a cigaret, but remember that a breathing exercise is just as good
as a smoking one.
Causes of high respiratory rate
55
works. Instead of smoking again, you can also do
breathing exercises three times a day for fifteen
minutes. Or you can pretend to light a cigarette twenty
times a day: you will find that this is just as relaxing as
lighting up yet another real cigarette.
A woman who had smoked for a number of years and
had now stopped for ten years once told me that when she
was in the car, walking in the woods or sitting on the
toilet she would often put a filler in her mouth and
pretend to smoke a cigarette. She always made sure that
no one was looking, but then she secretly had a moment
of relaxation.
do it yourself
If you have just quit smoking, or if you are still
smoking, pretend to light a cigarette without lighting
it. Observe that this feels almost the same as inhaling
a lit cigarette.
cocaine and other drugs
Every hard drug causes unrest. It wreaks havoc on your
body both mentally and physically. Whether the drug is
still working or you're in the period after the euphoria,
your breathing frequency will skyrocket or you'll be
tempted to hold your breath. Almost every drug has a
tendency to cause all the
Relief
56
supplies (not only energy, but also, for example, feelings of
happiness) in a short period of time. This requires oxygen
and your body, when using drugs, actually always continues
to breathe with a frequency of more than fifteen times per
minute. After a line of coke you can remain stuck in a high
breathing frequency for days without noticing it. If you are
relaxed, using drugs for the same reason will do much less
harm than using drugs to get rid of suffering and tension.
When relaxed, you will return to a "normal" state fairly
quickly, whereas when tense, you can continue to expend
energy unnecessarily for days.
copd
The abbreviation copd stands for Chronic Obstructive
Pulmo- nary Disease, or chronic obstructive pulmonary
disease. It is a collective name for all kinds of known
ailments such as chronic bronchitis and emphysema. In
most cases, copd is caused by long-term smoking. With
copd, the stretch in the lungs goes out and the lungs
become larger but weaker. These people have a
ventilation problem if they breathe shallowly and quickly.
In the Netherlands, more than 300,000 people have copd
(source: CBS) and in more than eighty percent of the
cases it is the result of smoking.
Causes of high respiratory rate
57
With copd, you don't just have a high respiratory rate;
there are other symptoms as well. You can recognize
copd by such things as rising phlegm, coughing and
wheezing. Emerging phlegm, in particular, is an equally
annoying and clear indication of copd. The decreased
lung capacity automatically causes you to breathe faster.
The fact that your breathing frequency goes up in part
because the lungs really let less acid through does not
mean that breathing exercises are of no use to you with
copd or that you cannot exercise with copd. With
breathing exercises and li- cham exercise, you can slow
down or even reverse a further decline in lung capacity.
However, this should be done under the guidance of a
doctor or specia- lized physiotherapist. In every region
of our country you have a hospital or a physiotherapy
practice that has special copd- groups where you can
exercise. Make sure that the exercise is always
combined with breathing exercises. If you used to be
very sporty and strong, you shouldn't be too careful. Just
walking very quietly or sitting on a bike with a low
weather position won't help. Even if you are over sixty
and have copd, your muscles can still take a lot. By
lengthening your exhalation you will experience to what
intensity you can still exercise well.
Relief
58
posture
There is a picture of the evolution from ape to man that
you do see on t-shirts and posters. You see an ape lping on four legs, which slowly becomes upright as a
human being. Then man again assumes the same pose
as the ape, but now sitting behind a computer. The
message of this illustration is clear: human progress has
passed its peak and we are on the way back, obsessed
with computer screens. This cartoon puts its finger exactly
on the sensitive spot, when we look at possible causes of
a dysregulated breathing pattern, na- mately posture.
Your posture is very important for proper breathing. Just as
the 'devolution' sets in for the man in the cartoon, his
breathing will also be bad in the final position. It is
impossible to breathe properly and relaxed in front of a
computer.
If you find that you can do a breathing exercise lying
down well, but quickly get into trouble sitting down, most
likely your posture is not good. You can lean back a little,
but you have to be careful not to get too huddled up. In
any case, you should not lean too far forward, as if you
were looking tensely at a screen. Your chest should have
room to breathe in the air. When you sit, your shoulders
should not extend in front of your sternum and your upper
vertebrae should not
Causes of high respiratory rate
59
come forward more than your lower vertebrae. Also,
during a breathing exercise, always put both feet flat on
the ground and keep your crown as high as possible
toward the ceiling. Pay attention to this even when
working while seated, especially at a computer, and in the
car.
If these directions don't work well for you, it's best to
keep as a maxim that you're good when you're
comfortable. In any case, you should be careful to sit
comfortably while doing the breathing exercise. This is
most likely a different posture than sitting comfortably
with your attention focused elsewhere, such as while
watching a movie on television.
do it yourself
Interrupt workdays where you sit at the computer
for long periods of time by sitting up straight
every twenty minutes and taking four slow
breaths in and extending your exhale.
pain
There is a strong link between pain and breathing. An
instinctive reaction to pain is to "lock" the breath. After this
temporary locking you will automatically speed up your
breathing. With severe, incidental pain there is nothing
you can do about it. In such a case it is not at all necessary
to try to influence the pain.
60
Relief
your breathing pattern. With chronic pain, however, it is
extremely useful to try to get your breathing under
control, because accelerated breathing will really not ease
the pain. On the contrary, accelerated breathing makes it
more difficult to recover from physical tension and makes
the pain worse. Controlling your breathing may be
difficult, but it is certainly not impossible. Try to analyze
your pain in a contemplative way, from some distance,
and do the breathing exercise. Especially with chronic
pain that changes in location, it pays to use breathing
exercises to control the pain. In many people with
chronic fatigue syndrome (cvs, also known by the
abbreviation me) or fibromyalgia, breathing exercises
have already proven themselves. It seems that the
exercise works especially for people in whom the pain
"runs" through the body. Acidosis or stabbing pain that
resides in the upper left arm for days and then suddenly
and inexplicably appears in the upper right leg indicates
that the pain is chronic, but has nothing to do with a
specific muscle or joint. Acidification is pre-eminently
combated with oxygen, or a good breathing pattern.
In Weesp there is even a center where you can exercise
with extra oxygen. At Energy Control, as the practice is
called, there is an oxygen machine next to every bike,
so that people with dysregulated breathing can take in
more oxygen during exercise. Stans van der Poel is the
owner of this center and she thinks that names like me,
fibromyalgia and
Causes of high respiratory rate
61
The term "soft tissue rheumatism" is misleading. She
recognizes that these patients have serious complaints, but
she firmly believes that a disturbed oxygen/carbon
dioxide ratio in the blood is the main cause of all these
disorders. The solution to the pain is, in her opinion, in
the first place breathing out longer than breathing in,
very simple but very tangible.
summary
1. Stress, smoking and drugs negatively affect breathing.
2. Smoking is a good breathing exercise, but with many
negative side effects. 'Smoke' without a cigarette for a
change.
3. Doing breathing exercises with copd and chronic
pain is good, but frequent and long practice is
required for lasting effects.
4. Good posture improves breathing patterns.
High respiratory rate and nutrition
In addition to persistent mental pressure (stress), obesity
is one of the most important so-called welfare diseases of
our time. According to the Central Bureau of Statistics,
45.5% of all people over the age of twenty in the
Netherlands were2007 overweight. The magnitude of this
problem is the reason that we devote a separate chapter
here to obesity. There is a clear link between obesity and
disordered breathing. You could even say that losing
weight is doomed to failure if you forget to take a close
look at your breathing. Even if you're not overweight, it's
still advisable to take a critical look at your diet from time
to time, because cola, for example, can make your
breathing go faster.
food and drink
From too much food you start breathing too fast. Especially
from meat, dairy and sweet, your breathing frequency goes
"into the red. To experience this, shortly after a large meal
you only need to
64
Relief
but to pay attention to your breathing. Everyone knows
the bloated feeling after an evening of gourmet food,
cheese fondue or a sumptuous dessert. If this bloated
feeling is accompanied by a lot of burping or you feel you
can't take a deep breath, then you know that your
breathing has been disturbed by the meal. Extensive
dinners with a lot of meat and three courses (or more) will
probably not be a daily routine for most people, but even
with a normal daily meal, eating in a hurry can undermine
good breathing.
Are you someone who quickly prepares a meal after work
and then reads the newspaper or watches television while
eating? Then you are probably chewing too little and
breathing too fast. Besides eating too much, eating too
fast is also disastrous for your breathing. By eating too
fast and not chewing properly you swallow a lot of air.
For people who do this often, it sometimes seems as if
they have swallowed a balloon. A protruding belly that
also feels hard
- so no fat - can often be halved with a simple breathing
exercise. With such a hard belly you will have great
difficulty in the beginning to get your inhalation to your
belly. Try not to pay attention to that and only pay
attention to your exhalation. Extend your out-breath as
long as possible and let the in-breath come naturally.
Imagine that you have actually swallowed a balloon filled
with air; how do you get rid of the air from the balloon?
By letting the oxygen escape and not blowing it up again.
High respiratory rate and nutrition
65
do it yourself
If your belly has a large size but you feel that this is
not just fat because your belly feels hard, you can
investigate this further. Take a tape measure and
measure the circumference of your abdomen.
Then, for five minutes, extend your exhalation in
such a way
long as possible. It is important that you make a
spout of your mouth and exhale little air at a time.
After five minutes, measure the circumference of
your abdomen again. Some
you lost was therefore not fat, but air. Do this
exercise daily shortly before eating.
In addition to the breathing exercise, it is good to chew a
lot; this prevents useless air in your intestines. Several
books on nutrition recommend chewing thirty times
before swallowing. Although this may seem a bit
excessive, it works well to eat more consciously and more
slowly.
Shortly after eating a large meal, it is difficult to do a
breathing exercise: people often become nauseous if they
try to bring their breathing frequency back immediately
after the meal. This can be due to eating in a hurry,
without chewing properly, but it can also be the result
of an intolerance to certain food substances.
It is helpful to find out what foods or fuels are
disrupting your breathing. Some possible "breath triggers"
are:
Relief
66
•
•
•
•
•
•
•
•
•
Meat
Chocolate, candy
Sugar
Sweets
Coffee, tea
Cheese, yogurt, milk, whipped cream
Colorants and preservatives ('E-num- mers')
Cola and other carbonated soft drinks
Pasta, bread, or gluten
By doing a breathing exercise shortly before eating and
immediately after, you can find out what type of food you
react strongly to. People with gluten intolerance will be
able to see this reflected in their breathing frequency.
Similarly, people with an allergy to dairy (whether
diagnosed or not) will see a reaction to cheese, milk and
yogurt reflected in their breathing. A food intolerance to
any of the bo- ven products is very common, even without
your knowledge. If you discover that you react strongly to
certain foods, it is advisable to consult a nutritionist.
You can then see whether it is worthwhile changing
your diet. An alternative diet is usually easy to put
together.
High respiratory rate and nutrition
67
do it yourself
Shortly before eating, sit for five minutes and
breathe in through your nose. Make sure your
belly is "coming up" and
Extend your exhalation. Do this thirty times, taking
about five minutes. Then eat quietly, take your time
and chew well. After the main course, do the
breathing exercise again and write down whether
the exercise went easily or if you felt nauseous.
Write down what you ate and do this for a week. Do
you recognize a pattern?
Carbonated drinks such as cola should always be avoided, as
well as other drinks with a lot of added sugar, such as certain
drinking yoghurts and chocolate milk. The body has to work
very hard to get rid of these kinds of 'sugar bombs'. Actually,
this also applies to all E numbers and they are found in an
alarmingly large number of products. You also have to be
careful with so-called "light" products: It is likely that the
body recognizes light cola as a sweet poison and then starts
burning sugars to compensate. However, because no real
sugars have been ingested, the body will draw on the energyrich reserves. Thus, by drinking a lot of Diet Coke, you
become exhausted. How so healthy?
If you want to lose weight, the above exercise is good to
do da- equally before and after eating. Apart from being
good for your metabolism, you will also find it easier to
work with less weight.
Relief
68
food. You leave desserts out, for example. Of course,
eating less is most important when trying to lose
weight, but the above exercise, especially in
combination with exercise, can certainly contribute to
successful weight loss.
overweight
People who are overweight breathe too fast almost
without exception. At rest the breathing pattern is often
not good, let alone during (light) physical exertion. When
you're overweight, every effort is hard, even breathing.
And, ironically, if you're constantly breathing too fast,
losing weight becomes difficult. This is partly due to slow
metabolism, which in turn is the result of a high breathing
frequency. For example, we described earlier that the
physical state of pa- ratty traditionally fits in with
threatening situations and that then eating, defecating
and urinating are not desirable, causing the metabolism to
slow down. You already feel that you will quickly gain
weight if you constantly stop your metabolism and
continue to eat in the meantime. Do this for a number
of years and only a diet or more exercise will have
little effect. After all, relaxation is also necessary to get
rid of the fat deposits. The vicious circle in which an
overweight person can end up is as follows:
High respiratory rate and nutrition
69
arli
l
ov
ve
The fact that overweight people breathe too quickly
during seemingly light physical exertion is logical. If you
weigh a kilo75 and walk up a flight of stairs with two
bags of potatoes weighing five kilo each, you will be out
of breath at the top of that flight of stairs as well.
Carrying ten kilos of excess weight is the same as
taking forty packs of butter with you everywhere you go.
Whether the body assumes rapid breathing as a norm
and whether it is mainly because of this high breathing
frequency during light exertion that overweight people
breathe too fast when sitting down is not entirely certain.
It may also be the case that your breathing muscles are
simply not strong enough to hold an abdomen with
70
Relief
This is the amount of weight you have to lift in a
relaxed way thousands of times a day (after all, this has
to happen with every breath). Instead of relaxed
abdominal breathing, you then get superficial flank
breathing.
You cannot lose weight with a breathing exercise of ten
minutes a day. If you want to use breathing to lose ki- lo,
then you need to do a program of breathing exercises five
times a day for half an hour. That's a lot, but give it a try
for two weeks. Gaining thirty kilos takes a long time, so
in order to lose that weight you also have to take your
time. Because doing breathing exercises five times a day
for half an hour requires a lot of motivation, it's a good
idea not to try this on your own, but to ask for help from
a professional. In this case, the pro- fessional is not a
dietician, but an inspiring figure who will go through the
breathing exercises with you and also train you.
Without wanting to disqualify dieticians: obesity is first
and foremost a psychological problem and not a calorie
problem. That is why many dieticians already work
together with psychologists and psychiatrists. We would
like to see a respiratory expert added to a multidisciplinary team in which obesity is treated. A dietician for
the concrete nutritional advice if that is desirable, a
psychologist to analyze and help break through
unhealthy behavior patterns and a respiratory therapist
for relaxation or to improve the metabolism.
High respiratory rate and nutrition
71
an example from the practice of
koen de jong
'I've been cutting back on beer for a month, I watch my
food and I go to the gym once a week for spinning, and
still I don't lose an ounce of weight,' Wouter complains.
Wouter is and52 weighs kilo96, with a height of
meter1,84. He would like to lose sixteen kilos, because he
knows from the past that he feels best at eighty kilos. The
overweight came on gradually from when he was forty.
At that age he stopped playing soccer because of a knee
injury. Because he could no longer relax on the soccer
field, he increasingly took a whisky in the evening to
relax. When he was 50, he resolved to return to sports and
lose weight. After a few unsuccessful attempts, he has
now been seriously working out for a month. It is demotivating that he has not lost any weight to date.
'What day do you do that spinning?' I ask.
'Every Tuesday night, why?" he replies.
'Then you must be very tired every Thursday morning and
find it hard to keep your attention on your work,' I continue.
Wouter nods affirmatively.
Wouter is no exception. People often try to lose weight by
exercising, but when exercising they cross all kinds of
limits, so that they become exhausted but don't lose any
weight. During the hour of spinning, hard cycling with
exciting music, in a very short time
72
Relief
The whole energy supply is drained. At the moment
itself you do not feel this, because the blood circulation is
well underway and you get a satisfied feeling. After
exercise you are often a bit hyper, making it difficult to
fall asleep, but still the satisfied feeling prevails. The next
day you think that exercising has done you good, but two
days later you are tired and have noticeable difficulty
concentrating. However, because this happens over an
hour 36later, you no longer associate the fatigue with
exercise. This fatigue is however a direct consequence of
too heavy exercise and incorrect breathing during and
after the effort. What happens to Wouter is that he stops
his metabolism by a raging breath. During the spinning
session he is out of breath and sweats profusely, after the
spinning session his breathing "runs" long into his sleep.
The only weight he loses in this way is fluid and that
doesn't help him. All this time, the body is not able to
tap into the low-energy fat reserves in a healthy way.
The activity of his body is much too high. Because
Wouter has to recover from this heavy effort for a week,
he cannot exercise in the meantime. To make up for this,
he'll go all the way in the next spinning class and the
cycle will start all over again. It's much better to exercise
less intensively two or three times a week and to do a
breathing exercise immediately after exercise. This way
you'll build up your condition much faster and you'll lose
weight as well.
High respiratory rate and nutrition
73
alcohol
As a rule, you can say that alcohol has a negative impact
on breathing, but there are exceptions. The effect of
alcohol on breathing has different stages. One or two
glasses of alcohol has a positive effect on breathing
frequency in the short term. Little red wine has a relaxing
effect, also on your heart and breathing. However,
whether one glass of red wine a day still has a
beneficial effect on your breathing is already
questionable. It is likely that when your body is used to
one glass of red wine a day, you will no longer
experience any positive effect on your breathing. It is
even possible that in the long term more negative effects
occur: the liver has to work harder to break down
alcohol, while through habituation you no longer
experience the beneficial effect of relaxation.
A lot of alcohol, by which we mean three glasses or
more, immediately increases the heart rate and your
breathing rate goes with it (or vice versa: your breathing
rate goes up, which accelerates your heart rate). You can
easily observe this in other people who have drunk too
much. In a pub after midnight you can easily count the
breathing frequency of most people present. The chest
moves up and down so quickly and visibly that you can
count the respiration of such a pub-goer through the
clothes, even from a fairly large distance. And when
breathing is so visible, you know for sure that there is no
good
74
Relief
is breathed. Alcohol also amplifies the difference
between men who hold their breath and women who
actually talk and breathe faster. A woman who always
talks fast will talk and breathe completely fast, reinforced
by the alcohol.
Drinking lots of alcohol to clear your full head after a
long day of work so you can sleep is pointless for this
reason. You may be sleeping, but you are not resting.
Consider again the comparison of someone sitting quietly
in a chair pretending to cycle against the wind at eighteen
kilometers per hour. After drinking (a lot of) alcohol your
body will proverbially be cycling all night, due to the high
breathing frequency. And that takes a lot of energy.
Drinking every day for relaxation will soon turn against
you. Because your liver needs a lot of oxygen to break
down the alcohol, you will experience a (relative) lack of
oxygen in your brain. This is one of the causes of the
pounding headache after an evening of heavy drinking.
This oxygen shortage in your brain also causes rapid
breathing, which makes the headache even worse. In
addition to the influence of alcohol on oxygen deficiency
in the brain, drinking a lot also causes you to gain weight.
And being overweight is a threat to even- handed
breathing, as explained above.
High respiratory rate and nutrition
75
do it yourself
Want to drink whiskey, wine or beer just to relax?
Then first do ten minutes of the
breathing exercise. You may well not feel the need
for an alcoholic beverage after the exercise.
summary
1. Food affects your breathing rate, especially sugars and
E numbers are bad.
2. Overweight people breathe too fast almost without
exception. This slows down their metabolism, which
makes it easy for them to gain even more weight,
creating a vicious cycle.
3. Alcohol undermines proper breathing patterns. Even
the daily use of a few units can have obvious negative
effects.
Breathing frequency and psychological
functioning
Persistent mental pressure is, in our opinion, the most
important cause of the large scale of the "breathing
problem. To properly understand the relationship of
breathing and mental functioning, it is important to have
some basic knowledge of the anatomy of the brain and the
location and function of some important brain structures.
In the 1970s, "neurologists" were replaced by two
different specialists: neurologists and psychiatrists. The
common argument was that the neurologist should be
concerned with disorders of the nervous system
throughout the body and the psychiatrist "only" with the
brain and its possible malfunctioning. To this day,
biological psychiatrists maintain with great conviction
that mental disorders are synonymous with brain diseases.
Although from a historical perspective this split is
understandable, at the beginning of the 21st century it
cannot be concluded otherwise than that psychiatry has
become the interac-
78
Relief
of the brain with the rest of the body. A well-known
neurologist once called attention to the fact that every
disease also brought effects in the brain with the slogan
"There's always a brain attached.
Psychiatrists should be reminded repeatedly that with any
psychiatric malady, there are also observable effects in the
body. 'There's always a body attached.'
relationship between brain and
other organs
There are many and very different examples of the
complex interaction between brain and other organs.
Some random ones include:
Antidepressants such as Prozac and Seroxat are
supposed to correct the disturbed serotonin levels in
certain parts of the her- sine. But the whole body is full
of se- rotonin receptors, which are also affected by
taking such drugs. For example, the gastrointestinal
system, so side effects such as nausea, increased
appetite and altered bowel movements are only natural.
A thyroid that works too slowly, hypothyroidism, can
cause all sorts of vague symptoms that are also frequent
in depression: fatigue, sluggishness, and apathy are
High respiratory rate and nutrition
79
the most notable. If the thyroid gland produces too little
thyroid hormone, the production of thyroid-stimulating
hormone is increased from the brain (in a structure called
the pituitary gland). With a thyroid that works too fast,
hyperthyroidism, the opposite happens: the pituitary
gland stops secreting thyroid-stimulating hormone. It's
interesting to know that in the treatment of depression,
which does not respond to antidepressants, or responds
very slowly, thyroid hormone is sometimes prescribed to
combat the depression.
What is true for the thyroid gland is also true for most
other hormone systems in our bodies: the production of
hormones is regulated in the brain. There, a signal is
given as to whether there are too many or too few
hormones and whether the circumstances call for more
or less of a particular hormone. In recent years, it has
become rapidly apparent that the stress hormone
cortisol, which is produced in the adrenal glands, plays a
major role in most stress-related disorders. And the vast
majority of psychiatric syndromes are stress-related.
What has not yet been clarified is the classic chicken-andegg question: does a disturbance in the brain explain the
abnormal cortisol values found in many people with
mental illness, or does an increased amount of cortisol
adversely affect the functioning of the brain? It is now
undisputed that the functioning of the hip- pocampus, an
important part of the emotional
80
Relief
brain, under the influence of cortisol is adversely affected.
The hippocampus plays a crucial role in the functioning
of our memory; and problems with memory are a
notable feature of people who have been severely
traumatized.
the structure of the brain
The human brain can be roughly divided into three types
of brain: the reptilian brain, the mammalian brain and
the cerebral cortex.
From an evolutionary perspective, the reptilian brain is the
oldest. It lies directly above the spinal cord and consists of
the brainstem and cerebellum. The reptilian brain is
responsible for "primitive" functions such as heat and cold
regulation, the "fight or flight" response and hunger and
thirst. But breathing and the heart beat are also controlled
from the reptile brain. Our balance is lost without an
adequately functioning reptilian brain and moving around
becomes quickly impossible when this part of the brain is
damaged. It is therefore not surprising that a hemorrhage in
the brain stem often has a fatal outcome. The designation
reptilian brain and terms like 'primitive' functions do little
justice to the important place this part of the brain occupies
in human functioning. If the reptilian brain is not
functioning, your cerebral cortex is of little use, more on this
later.
High respiratory rate and nutrition
81
The part of the human brain that is largely similar to
that of other mammals such as monkeys, rats, mice, cats,
dogs and horses is referred to as the mammalian brain,
known in medical circles as the limbic system. Most
emotions are located here: fear, anger, sadness and
pleasure, for example. But blood sugar levels and blood
pressure are also regulated from the limbic system. The
best known part of the mammalian brain is the
hypothalamus, a small structure which acts as a
connection station between the central nervous system
and the various hormone systems. The pituitary gland,
which was discussed earlier, is located in the brain just
below the hypothalamus and is also directed by it.
Another structure that is also part of the limbic system
and is relevant in the context of this book is the amygdala.
The amygdala (the word is both singular and plural)
are literally translated the almond nuclei. We have two
of them, which are hidden deep in the brain. The
amygdala make the connections between the
information that is relayed to the brain from the senses
and link emotions to it. Thus, different situations result in
different emotions, with the ideal situation always
following the most appropriate emotion that fits a given
situation. The amygdala are very sensitive and also
respond to facial expressions, for example. In the case
of anxiety-provoking situations, the amygdala react with
lightning speed and fully automatically (the so-called
fear-
82
Relief
reflex). Although fear is the most well-known emotion in
which the amygdala is involved, it is certainly not the only
one: aggression, sexual behavior, and conditioning processes
also run through the amygdala. For each new situation the
individual decides which emotional reaction is the most
meaningful. The amygdala also reacts, for example, to the
facial expression of others. Because an emotional value is
assigned to a certain situation, which is stored in the
memory, it will be possible to react more quickly to similar
future situations. Think for example of the "fight or flight"
reaction in situations that are recognized as frightening.
Thus, the amygdala play an important role in
memory processes, but are not the only one. For
example, much information is also processed and stored
by the hippocampus, a structure that is also part of the
limbic system. Within the framework of this book it
would be going too far to elaborate on this.
The (neo)cortex or cerebral cortex is evolutionarily the
youngest part of the human brain. Neocortex literally means
"new cortex. This part of the brain is where humans are most
different from other mammals. Our ability to think is based
there and our "civilized" behavior (speaking with two words,
using a knife and fork and wiping our butts) would be absent
if it weren't for our cerebral cortex. Knowing this, you also
understand why the most notorious disorder of the cerebral
cortex, de-
High respiratory rate and nutrition
83
mentie, is accompanied by so-called loss of decorum: the
more the cerebral cortex is affected, the more primitive
the functioning of those who suffer from it.
When people talk about a left hemisphere and a right
hemisphere, this also refers to the cerebral cortex. You
can see the different functions of the cerebral hemispheres
in the diagram below.
Left hemisphere
Right Brain
Analytical
Comprehensive
Logical
Intuitive
Deliberate
Feeling
Rational
Inner Conscious
Methodical
Creative
Written language
Insight
Numerical skills
Spatial understanding
Reasoned
Via the imagination
Science
Music, art
Pro-active
Reactive, passive
Verbal intelligence
Practical intelligence
Intellectual
Sensory
To function optimally, it is very important that there is
adequate communication between the two hemispheres of
the brain.
84
Relief
This can be done through the so-called corpus
callosum, a bundle of millions of nerve fibers that
connects both hemispheres of the brain.
The cerebral cortex and stress-related
disorders
An increasingly common view of stress-related disorders
is that overactivity of the cerebral cortex is responsible for
many of the symptoms experienced by people with
depression, anxiety attacks or burnout. We are constantly
running our heads at full speed, taking in more and more
information at an ever-increasing rate for an everincreasing part of the et- time. Our cerebral cortex is
running at too high a speed and for far too long at a time.
It is difficult to measure this precisely, but there are
serious scientific claims that people in the Middle Ages
had to process as many stimuli during their entire lives as
we do in a single day. Ultimately, therefore, it is almost
inevitable that problems will arise. The communication
between the neocortex and the limbic system, the
cerebellum and the brain stem, suffers from the
dominance of the cerebral cortex. Thinking too much
makes you feel and perceive less well, simply put. So it
can happen that all kinds of parts in the mammalian brain
and in the reptile brain no longer function properly.
High respiratory rate and nutrition
85
A striking, but also somewhat wry example of the fact
that more and more emphasis is placed on the processes
of the cerebral cortex is the "reception" of train drivers who
have seen someone jump in front of their train. Many
train drivers unfortunately experience this several times
during their working lives and it takes little imagination to
realize that this is a very drastic event, which can give rise
to serious psychological complaints. Because the ns
recognizes that aftercare for its own staff is desirable in
such cases, a contract has been concluded with an
institution that provides care via the internet. The train
driver in question receives a log-in code for a computer
program and can immediately set to work behind the PC
to process what has happened. In this way it is 'prevented'
that the drastic event must be discussed in a personal
contact with a psychiatrist or psycho-therapist. In this
approach the focus is very much on rational thought
processes and it is assumed that the underlying emotions
will also be served by this. Of course, this is very
questionable...
The fact that the reptile brain no longer regulates
breathing properly under the influence of stress as a
result of an excess of stimuli is a telling example of a
completely disrupted balance between the reptile brain
and the mammalian brain (together also referred to as
the emotional brain) on the one hand and the cerebral
cortex on the other. For people who want to know
more about this, important information can be found in
the popular science section.
86
Relief
book The Emotional Brain by the American scientist
Joseph LeDoux. Much more accessible, but also more
criticized by we- t scientists, is Your Brain as Medicine by
French psychia- ter David Servan-Schreiber. A key premise
in this worldwide bestseller is that treatment with medicines or psychotherapy is primarily aimed at the
neocortex. Thus, cognitive therapy has for several years
been the most pro- moted and applied form of
psychotherapy, as well as a treatment that targets rational
thought processes by challenging impulsive, frightening
but formally incorrect thoughts and replacing them with
considered alternative explanations for unpleasant
perceptions. Servan-Schreiber lists in his book a series of
random "interventions" (attempts to bring about beneficial
change), which do not so much have to replace pills or
therapy as they can supplement them. He therefore speaks
of complementary rather than alternative treatments.
Methods he mentions in the book include training the
heart rate coherence, use of fish oil and running therapy.
As far as we are concerned, the breathing approach,
which is the subject of this book, also deserved a chapter
because the same applies to it. There could be a difference
of opinion only about the exact positioning of attention to
breathing in the treatment: we think that breathing
exercises are better used as a treatment first, before
deciding on antidepressants.
High respiratory rate and nutrition
prescribe or recommend
psychothera- pie.
do it yourself
an
intensive
87
form
of
Think of a drastic situation. Whether this situation
evokes a feeling of fear, annoyance, or aggression
does not matter for this moment. Think about this
situation for about half a minute. After half a
minute, begin to consciously pay attention to your
breathing. Without directing your breathing or
consciously doing an exercise, try to be with your
attention only on your breathing. What happens
now? It is very likely that you were breathing very
high and fast after the negative thoughts and that
you felt your breathing become calmer on its own
when you started paying attention to it.
For example, we know that breathing exercises are a
rational intervention that does directly affect the
reptilian brain. The size of the amygdala, for example,
is related to the degree of cooperation between the
emotional brain and the cerebral cortex: the amygdala
are larger the better this cooperation is. The special
thing about breathing exercises is that they have an
effect on all levels of the brain, and so every person has
a special control mechanism. It is incomparably more
difficult to radically change heart rate, blood pressure or
metabolism by rational means.
Relief
88
summary
1. The human brain consists of three parts: the reptilian
brain, the mammalian brain and the cerebral cortex.
2. Many stress-related symptoms are caused by an
overactive cerebral cortex.
3. Breathing exercises have effects on all parts of the
brain.
Breathing and sport
fun and usefulness of sport
Ask someone why they exercise and you will increasingly
get the answer that it is mainly for health reasons. I don't
really like it, but I have to. And it does work, I must
admit...'
In contrast to a few decades ago, fun in sports is no
longer the main thing, no, you do sports to lose weight,
to fight your burn-out or to get your blood pressure back
in order. And to prevent misery, because the preventive
value of sport is also becoming increasingly known. Yet
it would be desirable for sport to become a fun pastime
again in the first place.
That it has become a part of many people's busy
schedules is telling. Sport should be a form of
relaxation, not just afterwards, but something you look
forward to and which already makes you feel good while
exercising. If you exercise on doctor's orders, then the
outcome is central. Exercising is useful and it should
make you feel better.
90
Relief
From this perspective, we take a closer look at sports
here. What sports are healthy and what is recommended
or not recommended? What is a sensible frequency of
exercise? Should it always be heavy or should you start
slowly? Is muscle pain a sign that you've been doing well
or does it indicate that you've crossed a boundary? In this
chapter we try to answer these questions.
For anyone who sees sport as a necessary evil but still
drags himself to the gym twice a week, this is hopefully an
instructive chapter. Because many people who exercise in
such a way often do it just wrong, causing (physical and
mental) fatigue not to decrease, the excess pounds remain
and the blood pressure increases rather than decreases.
People who come home from sports and say, "The
sweat gushed from my head and if I have big muscle pain
tomorrow, then I've done well," have usually not trained
smartly. For example, you must always be able to control
your breathing and only if you still feel energetic and
sharp 36 hours later, then you have done a good job.
Sports schools are immensely popular if you look at
the number of members. However, the percentage of
members who actually come to exercise twice a week
is alarmingly low. Many people try to get rid of their
guilt about not exercising enough by buying an
expensive gym subscription. At birthday parties they
can then say
Breathing and sport
91
They are often told that they are members, but they don't
really exercise. Often-heard excuses not to exercise, such
as "it's too busy at work", "I'm too tired", "the weather is not
cooperating" and "I have no time", fall away when you have
agreed with someone to go running or play tennis. If you
go to the gym on your own, the above excuses might
justify not going, but they won't do you any good. If you
have an appointment, you won't get away with it at all.
But even with the gym members who do exercise two
or three times a week, the result often leaves much to be
desired. It could be that the present televisions, loud
music, magazines and other sports people distract the
attention so much that you don't technically perform the
exercises properly anymore, or train too lightly or too
intensively. The added value of keeping your attention on
the exercises was aptly described by Joris van den Bergh a
long time ago in Mysterieuze krachten in de sport (1941!).
Exercising in the open air and paying full attention to the
movement is therefore our preference.
which sports are better not to do and why?
Spinning
If you are exercising mainly for your health, it is better
not to do spinning or squash, both of which are precisely
very
92
Relief
are popular. Spinning involves cycling on a sort of
exercise bike for an hour to the beat of music, under the
supervision of a teacher. Squash is a mixture of tennis and
badminton in a glass cage, which also demands a lot from
the body. These kinds of sports mean exhausting hours in
which most of the energy reserves are emptied in a short
time, without giving you any benefit in the constructive
sense. After an hour of spinning or squash you will
probably feel better than before, but this is only
temporary. An hour after that you still feel satisfied and
your head is clear, but about forty hours later fatigue sets
in.
You probably don't associate this fatigue on Thursday
with exercising on Tuesday night, but it is a direct result
of it. What you do when you exercise like this for an hour
is the same as what you do when you breathe too fast.
You are drawing on energy reserves without taking
sufficient time afterwards to recover, i.e. to replenish the
energy reserves properly. Sports should be done in a
relaxed way in the first place. It may be that you have to
overcome something before it becomes fun, but once
engaged, relaxation is an absolute prerequisite for a
beneficial effect of sport.
Swimming
Swimming to build fitness or lose weight is almost always
futile. Only for the few swim-
Breathing and sport
93
For people with very good technique, swimming will
make them stronger. Swimming with a moderate
technique - which the vast majority of people have increases the breathing frequency, but does not lead to
an increase of muscle strength. Swimming is also
nonsensical for losing weight: everyone knows someone
who goes swimming twice a week, but never loses a
kilo. The only good reason to go swimming is
relaxation.
Ball Sports
Soccer, tennis and field hockey are generally sports that
people do not primarily because they are healthy, but
more because they are fun. For this reason, a ball sport is
healthier than the aforementioned sports such as
swimming, squash and spinning. However, people with
depressive symptoms, overweight and fatigue will benefit
less from soccer than from, for example, cycling. This is
because in soccer short sprints that are too intensive
(running with your man) are alternated with strolls that
are too quiet (a corner from the opponent where you as
the attacker do not have to defend for example). Ball
sports are also very injury-sensitive. Especially if you are
performance-oriented and tired at the same time, muscle
tears and sprained or bruised joints are common injuries,
which can be very long-term. In short: ball sports are fine
to do, but with a lack of energy or being overweight it is
better to
94
Relief
First start with a so-called cardio sport. Only when you
have regained strength and energy can you play tennis or
soccer.
A good example of someone who has experienced the
benefits of a cardio sport first hand is Klaas Bottelier.
Klaas is depressed and played soccer because he noticed
that the exercise and contact with people did him good
even in bad periods. When the soccer season ended and
he didn't do anything physical during the summer months,
he always felt gloomier and had no energy at all. The nice
summer weather didn't seem to have a positive effect on
his voice, but the lack of exercise did have a negative
influence. In 2009 Klaas did his "peak tour". This is a tour
he has devised himself, in which he does 100 famous
climbs from the world of cycling on a racing bike. A
hundred peaks to combat the valleys. This endurance
sport does him much more good than soccer. You can
read his findings on his website www. dalenenpieken.nl.
what sports are healthy though?
Cycling and running
So when is exercise really constructive? A good rule of
thumb for the novice athlete is that it's okay as long as
you're still able to exhale during exercise.
Breathing and sport
95
You have to be able to watch your breathing and then
move faster or slower to control it. So you must be able
to pay attention to your breathing and then move faster or
slower to control it. This means that one person may be
walking through the woods in a constructive manner and
another may have to run along the beach at a punishing
pace to stimulate his body properly. Cycling, rowing,
running or walking (the so-called cardio sports) are
particularly suitable for this. In the gym (if it has to be
done indoors anyway), scooters and cross-country skiing
are added.
The great advantage of these cardio sports is that you
can do the same effort over a longer period of time,
getting into a certain rhythm that is both exciting and
makes the muscles stronger, but is also relaxing. It is
important that you do not exercise too slowly, but above
all not too intensively.
People who exercise, almost without exception,
experience the relaxation that results from exercise.
This feeling of relaxation during running and cycling has
a strong correlation with breathing. There are many
people who, sitting on a chair, have a breathing
frequency of sixteen times per minute and who,
running in the park, have the same breathing frequency
per minute. The fact that you experience relaxation while
running is then the logical consequence of the fact that
the breathing frequency corresponds to the actual
physical effort you are making.
96
Relief
sport and stress
The main result when you have been exercising properly
for half an hour is that your stress (partly) disappears.
What you are actually doing is giving a physical answer
to the mental stress, which has put your body in a state of
readiness, without there being any actual physical effort in
return. Stress also makes you physically agitated, and by
exercising you are putting a physical effort into that. If
you stop exercising, your body recognizes this signal
unequivocally: 'Just now I was exerting myself, now I'm
sitting on the couch.' That de-stresses.
The great value of exercise for people with over-active
brains and sedentary jobs is perhaps most easily
understood by considering the opposite. There are
people who don't need sports or other forms of exercise
at all to feel good. Buddhist monks who meditate for
hours a day do not need to run to clear their heads or
regain energy. These monni- nes use their energy smartly
and recover as needed. The balance between energy
consumption and the amount of energy present is never
disturbed in them, so exercising to restore this balance is
unnecessary.
Breathing and sport
97
lengthening your exhalation
There are two criteria for determining the right intensity
of exercise: you should be able to extend your exhalation
without difficulty, and the daily sores should disappear
from your mind without getting completely out of breath.
self-exercise with a he a rt r at e
mo nito r The exercise of prolonging your
exhalation as long as possible during exercise is
very suitable to
with a heart rate monitor. With it, you can do a lot of
saving energy. A heart rate monitor is an ideal tool
for checking whether the exercises you do while
exercising are actually having an effect. They used to
be expensive devices only used by professional
athletes, but nowadays they can be bought on the
internet and in almost every sports store for a few
bucks.
Walk or bike at a pace you are used to and know
you can sustain for some time. Hold this pace for
five minutes. Now watch your heart rate. After five
minutes you can start to lengthen your exhalation.
Make sure you don't get stuffy and do this for two
minutes. Make sure you keep the same speed. Look
at your heart rate again: most likely your heart rate
will be five to fifteen beats lower. Is your heart rate
indeed lower,
98
Relief
If you do not have a lot of energy, this exercise is very
good to do regularly during sports. You acidify less
quickly and you save energy. If your heart rate
doesn't change, you know that your breathing is
good during exercise anyway. It is then worthwhile to
try the same exercise at a higher speed.
Extending your exhale is always good to do. Track cyclist
Tim Veldt competes in the kilometer sprint and has been
Dutch champion in that discipline. This is a very short
and explosive effort and a breath-holding exercise
during the minute of this race is impossible. However,
Veldt does breathing exercises up to a second before the
start to keep calm for as long as possible and thus save
his energy reserves for the moment suprême.
There are also countless examples of the opposite:
many of the medalists who were supposed to win didn't
achieve their goal because they hyperventilated nervously
in the hours before the grand finale. They had already
used up their energy before the start.
sport and fat and glucose stores
Roughly speaking, you have two energy reserves in your
body: fats and sugars. With very light exercise, you
mainly use fats. The more strenuous the exercise, the
more you use pro-
Breathing and sport
99
from your energy-rich sugar reserves. It must be noted,
however, that although energy can be obtained more
effectively from sugars, this energy is also used more
quickly. A well-trained body has two hours of energy-rich
sugar reserves and more than six hours of fat reserves. If
you get one hundred percent from your energy-rich sugar
stores, you will start to acidify. This is the burning feeling
that everyone knows, for example after a long sprint to
catch a train.
By exercising a lot you learn to use the lower energy
fat supplies better and you will increase the amount of
energy fast sugars. This is already advantageous if you
walk up a few stairs, for example. You will then maintain
a lower heart rate while climbing stairs, you will use
relatively more fats and you will be able to climb more
stairs due to the larger reserves of energy fast sugars.
Thus, you will not only notice your progress during
exercise, but you will also notice in numerous daily
activities that they require less energy.
sport and lose weight
The main gain for people who start exercising to lose
weight is not the (relatively small) amount of calo- ries
they consume during their hour of exercise, but the
changed metabolism, whereby burning of body fats is
more effective. If you exercise for an hour
100
Relief
have this is about kcal400. That is equivalent to a chocola bar with a glass of coke or half a pizza. Don't let this
relatively small number discourage you, because much
more important is the fact that your metabolism has
been kick-started. You'll still benefit from that two
hours after exercising, sitting on the couch.
sportfasting
If you want to lose weight, sportfasting is a good way.
It's very hard, but in ten days you teach your body to use
its energy-saving fat reserves as fuel again. Medical
biologist Remco Verkaik has developed this method and
it is a combination of exercising and not eating. The sport
fasting cure takes days10, you build up three days with
little food, then you eat three days absolutely nothing
and then you build up again four days. The biggest
difference with other fasting cures is that Verkaik's course
is combined with exercise. You have to exercise every
day for half an hour, also on the fasting days. The results
are very good, people lose weight and feel remarkably
fitter.
how often should you exercise?
Beginning athletes wonder how often they should
exercise. It is advisable for everyone to begin-
Breathing and sport
101
ning with about three times a week, preferably every other
day. In the graph below you can see why that works better
than once or five times a week. What you see in the graph
is called the super compensation curve. It applies to
everyone, both top athletes and novice athletes.
Day 0, 2 and 4 are training days: energy level
drops. Day 1 and 3 are rest days: energy level
recovers and the body makes some 'extra', this
is the training effect or super compensation.
En
er
gy
Re
so
ur
ce
s
Impact
2
Training Effect 1
Glucose supply initial situation
01234
(days)
Day is 0the day you start exercising. On that day your
energy supply decreases, because you consume energy
during exercise. After exercise you recover, with your
body producing slightly more energy than before. This is
the training effect, making you faster and stronger from
exercise. Only on the day you see2 that the amount of
energy is greater than that before the training. If you start
exercising again on the second day, you go through the
same cycle again: your energy level is higher than before.
102
Relief
stock drops, you recover and you make some extra. This
is how you slowly gain energy.
If on day 2 you decide not to exercise and you wait a
week before you start exercising again, you won't build
anything up: the body notices that the energy gained is
not used anyway and falls back to the initial situation.
If you exercise extremely intensively on day 0, you will
use up all your energy reserves and your body will need a
week to recover. You won't be able to build up your
strength at all. As mentioned earlier, this happens
regularly to people with burnout. Of course, initially you
do gain strength and at the moment itself it may feel
good, but unnoticed the underlying fatigue increases and
sooner or later it comes out. In practice, we often see this
problem with people who do spinning once a week or
have a weekly appointment to play squash.
For people who dislike sports, it is good to realize that
the regained energy not only benefits the body, but is
also used for mental processes such as creative thinking,
business analysis and concentrated work. The body has an
ingenious internal transport system, with which the
recovered energy from the legs is transported to the
brain. If at least it is signaled that the energy is not
needed in the legs to cycle, but in the head to think
properly.
As any endurance athlete knows, it is important to be in
Breathing and sport
103
the half hour after exercise to quickly replenish
carbohydrates and proteins, it is also good to take in extra
amounts of usable oxygen after a workout by consciously
prolonging your exhale.
Both novice athletes and elite athletes do well to get
used to doing the breathing exercises after exercise as a
regular part of a workout.
summary
1. Sports have a calming effect, which is related to
breathing.
2. Your body can draw on two types of energy sources:
the relatively slow fats and the fast sugars.
3. Sugars are the fuel for your brain; by exercising in a
dosed fashion, you can increase this supply.
4. The supercompensation curve makes it clear when and
why you should exercise again.
5. In the build-up phase, it is wise to choose a so-called
cardio sport: running, cycling, rowing, rollerblading,
walking, cross-country skiing or scooting.
Breathing and heart rate coherence
what is heart rate coherence?
The concept of heart rate coherence or heart rate
variability is appearing more and more frequently in
popular scientific articles about tension and relaxation.
In this chapter we explain what heart rate coherence is
and we show that the heart and breathing are
inextricably linked. Many athletes measure their resting
heart rate regularly and heart rate monitors are
purchased by hundreds of thousands of people each
year. We take it for granted that an increased resting
heart rate indicates that the body has not yet recovered
from sport or stress. Here we go a little further than just
the heart rate, by discussing heart rate variability (hrv)
or heart rate coherence. The hrv or heart rate coherence
is the variation in time between two consecutive
heartbeats. A person with a resting heart rate of sixty
beats per minute may have a pause of about one second
each time between two heartbeats. With a resting heart
rate of sixty, you can also have a pause of half a second
or one and a half seconds between two consecutive
heartbeats.
106
Relief
sen have two heartbeats. The latter is considerably better
than the former. Why is this so and can you influence it
yourself?
Contrary to what many people think, it is necessary for
your heart not to beat regularly and for the time
between two heartbeats to vary. You can compare a
healthy heart with a good dancer. Sometimes he speeds
up his movement to the beat of the music, only to slow
down again a little later, without you, the spectator, being
aware of the exact moment of deceleration. This is
because it happens in beautiful, flowing movements.
The heart is constantly speeding up and slowing down in
response to all kinds of stimuli. For example, your heart
responds to temperature, food, drink, thoughts,
breathing, blood pressure, sound and many more
external stimuli. A heart that barely varies and beats with
the regularity of a marching platoon of soldiers is very
unhealthy. The regularity of your heart thus betrays the
tension in your body. Boom. boom... boom... Your
body marches on in hunted regularity. As a result, the
body will no longer adjust in time if the blood pressure
rises a little or the breathing speeds up a little. You can
easily influence the variation between your heartbeats
yourself.
Breathing and heart rate coherence
107
the importance of good heart rate
coherence
In his bestseller Your Brain as Medicine, which we wrote
about earlier, French psychiatrist David Servan- Schreiber
writes extensively about the importance of good heartbeat
coherence. According to Servan-Schreiber, a good
heartbeat coherence is proof that someone is healthy, both
physically and mentally. People with depression, stress,
cancer or an approaching end of life have, without
exception, low heart rate coherence. These bold
statements are supported by a series of exercises to
improve heart rate coherence in order to make patients
partly responsible for their own recovery or at least to
give them a tool which they can use themselves. ServanSchreiber discusses heart rate coherence in relation to the
auto- nome nervous system in his book. Your autonomic
nervous system consists of two parts, the sympathetic and
parasympathetic nervous systems. Heart rate coherence
says something about how these two relate to each other.
Heart rate coherence, the nervous
system and respiration
The sympathizer represents everything that has to do with
ac- tie. When it dominates in your body, it is in
108
Relief
the so-called fight-flight mode, in which your breathing
speeds up, your digestion stops for a moment and blood
drains from your skin to your muscles, internal organs and
brain. The sympathizer is often compared to the gas pedal
of a car. Research has shown that people under stress
have markedly increased activity in their sympathetic
system.
The parasympathetic represents everything about
recovery: a quiet heartbeat, slow breathing to the abdomen,
blood flow to the skin, and active digestion. The
parasympathetic is also called the brake pedal. In the book
De Parasympathicus, in relatie met stress, geestelijke en
lichamelijke ziekte (Parasympathetic, in relation to stress,
mental and physical illnesses) by Pieter Langedijk and Agnes
van Enkhuizen (1989) the influence of the parasympathicus
on health is discussed in detail. This book also contains
concise research data which were collected by Prof. Gaillard
on behalf of tno. The gist of all the results is that there is a
di- rectal link between reduced activity of the parasympathicus and physical complaints. In addition, it is
undeniable that breathing exercises can 'activate' the
parasympathetic nervous system.
The charts below show how breathing affects heart
rate coherence.
Breathing and heart rate coherence
he
ar 80
tb 60
ea 40
t
109
0102030405060
seconds
Breathing too fast
The up and down line is breathing; the line goes up on
inhalation and down on exhalation. If the line has been up
and down once, that is one breath. The pluses indicate the
heart rate. The vertical axis shows the heartbeats per
minute. The horizon- tale axis is the time in seconds. In
this minute, the breath-fre- quency, in this case of a
woman sitting on a chair, Her22. heart rate was average
over this minute Her 61.average heart rate per minute
is fine, however, her breath-fre- quency is very high. Yet
you can also infer the restlessness in her body, which you
clearly see in her breathing, from her heart rate. To
demonstrate this, we have this woman do a breathing
exercise.
After a brief explanation, she does a breathing exercise
and you can see the results of this breathing exercise in
the chart below.
110
he
ar 80
tb 60
ea 40
t
Relief
0102030405060
seconds
Proper breathing
Obviously, the breathing rate is much lower because she
is doing it consciously. In this minute she is not breathing
22 times but only seven times per minute. Not only
does her breathing frequency drop sharply, but her heart
also responds particularly well to this exercise. In this
minute her average heart rate is somewhat higher, 63, but
the variation in her heart rate is considerably better.
As you can clearly see in the graphs above, when the
breathing pattern is good, the heart rate runs with the
breathing pattern.
In Your Brain as Medicine, Servan-Schreiber describes how
he no longer just helps people with anxiety disorders and
depression with medication, but also with exercises to
improve heart rate coherence. This is called a
"complementary treatment. He writes:
The direct result of the traffic between the emotional brain and the
heart is the normal variability of our heartbeat.
Breathing and heart rate coherence
111
Because the two systems of our autonomic nervous system are
always in balance, they are constantly speeding up or slowing down
the heart. Therefore, the pause between two consecutive heartbeats
is never the same. This variability is in itself very healthy, because it
indicates that the brake and the gas pedal are functioning properly,
and with them our physiology.
If the brake or gas pedal is not functioning properly for
any reason, it is useful to objectify that with a
measurement. The exercises Servan-Schrei- ber uses to
restore the imbalance in the autonomic nervous system
focus directly on the heart. When breathing in, he
recommends trying to breathe "through" your heart, going
back in your mind to happy moments in your life.
Because this can work well, we name this exercise here.
Withdraw from the outside world and try to put
aside all worries for a few minutes. Inhale deeply
twice and lengthen your exhale. Now shift your
attention to your heart area. Imagine that you are
breathing through your heart, continuing to breathe
slowly without forcing it. Imagine that as you
breathe in, the oxygen you need is coming in, and
that
As you exhale, the waste products are discharged.
Feel how each breath passes through this
important part of your body. After this, get in touch
with the feeling of warmth or space that rises in
your chest.
112
Relief
The feeling is often weak at first, but it quickly
becomes stronger. A good way to encourage this
feeling is to think of a child you love dearly or a
beloved pet. You may find that as you do this
exercise, you feel a smile rise up, as if it were rising
from your chest to unfold on your face. This is a sign
that heart coherence has been established.
breathing exercises improve your
heart rate coherence
As you can see from the above graphs in this chapter,
focused breathing exercises are also a very suitable way
to improve heart rate coherence. With your heart rate
coherence in view, you can objectify which exercise
relaxes you the most. There are different types of
equipment to visualize breathing and heart rate. This
equipment is too expensive for many individuals, but
more and more health centers and sports schools now
have it available for their clients.
If the sympathizer dominates for a long time it is called
with a fancy term "sympathicotonia" and you can get the
symptoms described in this book. Don't think, however,
that this is something that has simply happened to you.
Breathing and heart rate coherence
113
You do it, consciously or, much more often,
unconsciously namely yourself. The autonomic nervous
system is often described as an unconscious system
that regulates many bodily functions, without you being
able to consciously influence it. This is incorrect. Of
course your heart beats even when you are not aware of it,
and you breathe happily under almost all
circumstances. Just like digestion never stops completely
or the blood flow to the organs. However, this does not
take away the fact that you yourself can have a great deal
of influence on the autonomic nervous system by being
explicitly aware of it. Unconscious breathing is what
you do until you breathe consciously. Reducing your
excessive breathing frequency is easy. And if you do
that well, then the heart, digestion and circulation will
join in automatically. If you improve your heart rate
coherence with other relaxation exercises, your
breathing pattern will naturally change as well. How so
unconscious?
do it yourself
• Put on a heart rate monitor and see how many
beats are different between the highest and
lowest reading.
• Slowly inhale to your abdomen, lengthen your
exhale and pause for a moment. Repeat eight
times.
• Notice how your heart rate gets higher on
inhalation and lower on exhalation? By doing this
exercise you are improving your heart rate
coherence.
114
Relief
Don't have a heart rate monitor (yet), but want to monitorren whether your heart rate coherence is improving?
• Then with your left index and/or middle finger, feel
your heartbeat near the palm side of your right
wrist. This is best felt on the side of your thumb.
Once you feel the heartbeat, first stay seated for
a minute and observe the heartbeat.
• Slowly inhale to your abdomen, lengthen your
exhale and pause for a moment. Repeat eight
times.
• Do you feel your heartbeat speeding up when
you breathe in and slowing down when you
breathe out? Then you have activated the
parasympathetic and thus brought it into
balance with the sympathetic which was still
dominant a moment ago.
an example from the practice of koen
de jong
Bart (36) works as a PE teacher at a secondary school. He
is also a youth coach at HFC Haarlem soccer club. Until
he needs all his energy to cycle three hundred meters to
the doctor...
'The signals? I ignored those.'
I was happy when the traffic light turned red, then I
could close my eyes for six seconds while sitting behind
the wheel.
Breathing and heart rate coherence
115
do," Bart explains. Now he can laugh about his ability to
ignore alarm signals. In hindsight he realizes that his reserves
were already exhausted at that point. But he went on and did
even more damage to his body. After the lessons at school he
went straight to soccer club Haarlem for the youth training of
fifteen and sixteen year old boys. Yes, you're running from 7:30
in the morning to 7:30 in the evening and you also want to
relax," Bart continues. But at a certain point the only way to
relax was with whiskey, because without it
kept his head spinning at full speed.
I just couldn't imagine leading a different life than I
did. And there were plenty of people around me who had
just as hard a life," Bart describes his tunnel vision.
'Mock relaxation,' Bart now calls it. 'Always busy, all the
time laughing. People liked having me around, I did
provide sociability.'
Until it really wasn't possible anymore. Exhausted, Bart
went to see his family doctor. Even cycling to the doctor's
practice, a few hundred meters, was hard for him.
Many tests follow. His blood values are in order, his
heart is very strong. The doctor advises him to take it easy
for a while. Via via, Bart arrives at a practice where his
heart rate coherence is measured. But there is no
coherence at all: his heart is strong, but there is hardly
any variation in time between heartbeats. He understood
that things could and should be better; with simple
breathing, he could get a better result.
116
Relief
haling exercises is also proven: Bart discovers that he
is able to bring peace to his body himself with these
exercises. By doing many targeted relaxation exercises,
but also by picking up his old tai chi exercises from the
sports academy again and by doing very dosed sports
himself, Bart regains his energy.
In the beginning it is very difficult, because Bart uses
up the energy he recovers just as quickly. After a
refreshing evening of sports, it is tempting to drop in on
an old friend he hasn't seen in a long time and have a few
beers with him. This usually makes the next day tough
again. Two steps forward and one step back,' as Bart
describes it. But Bart gradually feels an improvement and
the knowledge he gains about his own body is reassuring.
Especially the objective values of his HRV give him
something to hold on to. Because he has ignored all the
alarm signals for years, it is at first difficult to trust his
feelings. When he crosses a boundary, he hardly feels it at
first. With the help of regular measurements of his hrv,
Bart learns to find out which efforts are good for him and
which are not. Bart also asks himself and others the
question of how he was able to get this far.
The fatigue is not something that came on suddenly, he
soon realizes. It is a very logical consequence of his own
actions. With this knowledge he can get through the bad
days a little calmer, which also helps.
Breathing and heart rate coherence
117
To recover faster. Bart has learned to feel his own heart
rate variability. Now he only has a hrv determination done
during busy periods.
Bart is happy with his new insights: 'Providing insight into
heart rate variability has helped me enormously. Seeing for
myself that you're continually stepping on the gas pedal is
confrontational and it really gets you going. Otherwise I
would probably have kept saying that it wasn't that bad.
summary
1. Your autonomic nervous system consists of the
sympathizer and the parasympathetic.
2. A dysregulated breathing pattern means that the
sympathi- cus is unhealthily dominant.
3. Heart rate coherence says something about the variation
in time between two consecutive heartbeats.
4. The greater the variation in time between two
heartbeats, the more relaxed you are.
5. Exercises to increase the variation between heartbeats
can be focused on both the heart and the breathing.
6. There is equipment that allows you to understand
breathing and heart rate variability.
Respiration in children and during
pregnancy
In this chapter we try to give you insight into when and
why your breathing may have become disordered. We
also give advice on what you can do with your children.
How do they breathe and how can you teach them early
on to breathe calmly?
causes of improper breathing in your youth
People often wonder if their dysregulated breathing is
sometimes hereditary. If you realize that you have been
breathing (too) fast since childhood or if you have had
symptoms from an early age that are probably related to
rapid breathing, it is understandable to suspect an
inherited predisposition. Yet, fast breathing is most likely
not hereditary. Parents do, of course, have an influence on
their child's breathing, but that doesn't mean that they
themselves are genetically predisposed to breathing too
quickly and therefore "burdening" their child.
120
Relief
It is a physically determined rapid breathing, which is
entirely independent of itself and not dependent on
circumstances. So what is it that sometimes causes you to
have so much restlessness within you at a very young age
that incorrect breathing is an inevitable result?
A child can have wrong breathing in two ways: it
breathes much too little or it breathes too fast. If you
were already breathing incorrectly as a child, it is also
fairly easy to reconstruct in adulthood whether you were
breathing too little or too much at the time.
Breathing rate too low
A child who feels unwanted will hold its breath in an
attempt to become invisible or inaudible. It does not
breathe enough to eliminate itself. Even at a young age,
this behavior for the sake of sweet peace can take
extreme forms. For example, if as a child you had an
alcoholic mother who often took out her aggressive
drinking on the family when she came home, chances are
you were already holding your breath when you heard the
front door open. At a young age, breathing naturally
returns to a healthy pattern the moment your mother
appeared not to be drunk. Whether the holding of breath
in this example also leads to complaints certainly
depends on the duration and frequency of the stress
situations. You can imagine that, if the atmosphere at
home was so tense that you were always holding your
breath, the physical consequences would be significantly
greater than if you were 'only'
Respiration in children and during pregnancy 121
had to deal with a drunken mother once a week. Of course,
it is not only the children of alcoholic parents who often
tend to hold their breath for long periods of time. Children
who are sexually abused or physically abused also do this.
These are often very quiet, almost timorous children,
who in their thoughts often flee
to another place.
do it yourself
Go back in your mind to a memory from before. You
don't have to look for a particularly pleasant or
unpleasant memory, but try to imagine vividly what
you were like. Go back in your mind to your
childhood. After two minutes let go of the memory
and pay attention to your breathing. Extend your
exhalation as long as you like and breathe in gently,
relaxing into your belly. Do you notice any difference
between your breathing during your memory and
your breathing during the exercise? The greater the
difference, the more plausible it is that you used to
have dysregulated breathing. This is because your
memory will not only recall the images from back
then, but also your breathing pattern from back then.
Excessive breathing frequency
Breathing too fast is also already common in children.
Busy children, who have difficulty concentrating and
conforming to authority, for example, breathe
122
Relief
often too quickly. These are, of course, not the children
who quietly try to make themselves invisible in a corner,
but the ones who draw attention with a lot of noise and
busy gestures. These children usually have nothing to
do with physical violence or similar misery in the home
situation, but with insecurity and doubt.
Many adults retrospectively explain their own turmoil
during childhood often as a result of major events such as
divorce, a move, or a death. Dyslexia is also a popular
retrospective explanation for difficulties during the
school career. In practice, children who breathe too fast
have very diverse backgrounds. Almost always there is a
lot of emotion in the domestic sphere. In the past,
psychiatrists liked to talk about "a high ee" (Expressed
Emo- tions). If all emotions are communicated, and often
with a certain ferocity, this meant, according to the then
prevailing views, a clear risk factor for psychological
problems in later life.
motivation for breathing exercises
As an adult, if you look back on a hectic childhood and
things fall into place because of the above, you may be
able to draw from that the motivation to really get started
with the breathing exercises. Keep in mind that the
longer you have a disordered breathing
Respiration in children and during pregnancy 123
The more time you have, the more patience you will need
to master the breathing exercises and benefit from them.
Also realize that there is much more to be gained if you
have been breathing incorrectly for much longer and that
it is therefore important to give practicing a serious
chance.
influence of the mother's breathing on
her child
Young children always have higher breathing rates than
adults, so forget about a breathing rate of around six per
minute. Babies of a few months old not only breathe
much faster, but also a lot noisier. This is quite normal,
and from birth to about six years of age, you can usually
ignore rapid breathing. However, this does not mean that
babies or young children do not perceive a restless
environment. It may be that a disordered breathing at a
later age has its origins in the first years of life. But to
be able to actively do something about it, the child must
be older than six. Of course, it is better for your child if
you yourself are calm and alert. Jolant van den Haspel
from the University of Groningen did research on mothers
of restless children. Fourteen long-term stressed
mothers of children with adhd, pdd-nos, an autistic
disorder or other anxiety problems participated in the
study.
124
Relief
The mothers received training to use heart rate coherence,
evoked with breathing a rhythm of ten seconds, for
stress reduction. This ten-second rhythm corresponds to a
breathing frequency of six times per minute. The study
aimed to investigate the effect of this form of stress
reduction in terms of physiological rhythms, the
autonomic nervous system, brain activity and the lichal, emotional and cognitive aspects of stress. The study
shows that a two-week period of relatively little training,
four half-hour sessions and a small amount of homework
of five half-minute sessions per day, is sufficient for
significant improvement. The question 'can stress be
reduced by applying heartbeat coherence in the mothers of
restless children' can be answered with 'yes'. The children of
the mothers who had followed the course had fewer
tantrums than before.
breathing exercises for children
From about the age of six it makes sense to pay
attention to your child's breathing and to do relaxation
exercises if necessary. Fatigue, difficulty concentrating
and headaches are three common complaints in children
with a high breathing frequency. Ask explicitly if your
child suffers from the above symptoms, because before
you know it, it's time to ask.
Respiration in children and during pregnancy 125
child, they may be so common that he or she has never
bothered to complain about them. If your child has none
of these symptoms, you can easily count the number of
breaths when the child is sleeping. Children often breathe
very audibly, so then it is not difficult to measure
respiratory frequency. Count sixty seconds of inhalations
and you will know what his or her respiratory rate is per
minute. If a child of six or older has a breathing frequency
of more than twelve during sleep, it is advisable to do a
relaxation exercise the next evening before going to bed.
A frequency of twelve or more during the night is higher
than necessary for a child. The child will also rest less
well during sleep as a result. The breathing exercises
described in this book for adults do not work well for
young children. Therefore try the following exercises from
The yoga5 club by Suzanne Raaijmakers:
The first exercise is the lotus. It is best to do this exercise
in the morning or as soon as you get out of school. Not
only does it relax you, but it also gives you energy.
126
Relief
The lotus
Explanation
• Sit up straight, in the tailor's seat (the lotus
pose) or just on a chair.
• When you sit in the lotus position, rest your hands
on your knees, with your palms facing up. When
sitting on a chair, keep your arms bent in front of
you at the height of your chest.
• Keep your hands loosely closed.
• Breathe out gently through your mouth and in
through your nose.
• On a quiet exhale, open your hands and let go of
everything you don't want to think about
anymore.
• Try to take as long to do this as you exhale.
• On the inhale, close your fingers and think of
fine things.
• Proceed at your own leisurely pace.
• Don't change your breathing, let it come and go
as it feels comfortable for you.
Information
The lotus is a breathing exercise and an exercise for
your hands. If you breathe out quietly, you will
automatically breathe in quietly again, just try it.
Breathing literally means 'life energy'. When you
breathe in, you breathe in oxygen. If you also breathe
in a fine
Respiration in children and during pregnancy 127
Your body will be energized and feel good. If you
want to feel secure and powerful, try to breathe
calmly.
Shortly before you go to sleep you can do the exercise
below. This exercise is wonderfully relaxing and it will
help you sleep well.
The boat
Explanation
• Fold a boat out of paper.
• Lie relaxed on your back.
• Spread your legs slightly apart and let your toes
fall out. When you turn your feet back inside, your
big toes just barely touch. Let your feet fall out
again.
• Put your arms straight and relaxed next to your
body. Your hands and arms do not touch your
body.
• Your palms point upward.
• You may close your eyes; if you prefer to keep
them open, that's okay too.
• Put the little boat you folded on your stomach.
• Relax your face, letting your tongue lie loose
in your mouth.
• Close your mouth so that your lips are just touching.
• Exhale gently through your mouth and inhale
gently through your nose.
128
Relief
• Your lips now move a little bit apart.
• Close your lips again and breathe in gently
through your nose.
• If you exhale calmly, you will then naturally
breathe in calmly again.
• Imagine that your belly is the waves of the sea.
• When you breathe in, a wave comes, your belly
bulges.
• On an exhale, your belly thins again and the
boat goes down again.
• Just feel how your boat moves on the waves of your
breath. Do not change it, your breath is good as it is.
Information
When you exhale, you breathe waste products out of
your body. When you breathe in, you breathe in
oxygen. Your body needs oxygen to function
properly. When you are angry or tense you often
breathe much faster and less deeply than when you
are relaxed. A breathing exercise can help you
become calm.
If you have done any of these exercises with your child, it
is a good idea to count the number of breaths again in the
evening when your child is asleep. Do this at about the
same time as the first evening, when you started
counting without doing any relaxation exercises. Is the
breathlessness
Respiration in children and during pregnancy 129
quence lower, or the breathing is less loud, then your
child is indeed calmer than the first evening you
counted. This calmness obtained may be due to the destressing exercise you did with your child, but it doesn't
have to be. If you want to be completely sure that the
exercise is working or that there is another cause for the
fact that your child has become calmer, then you can
count the breathing frequency during sleep at the same
time point for a week. To know what makes your child
sleep restless, you can keep an eye on three things:
1. Has your child been playing or exercising until late?
2. Were you in a hurry yourself and panting from work
to cook, feed your child and put them to bed soon
after?
3. What did your child eat and what time?
Keeping an eye on all this and linking it to the breathing
frequency is quite a hassle. But with this knowledge it is
often easier to be patient with your child and through the
exercises you can calm your child down in time. But even
without all this diligence you will find out if the exercises
are good or not, a child will feel unerringly if an exercise
has a pleasant effect. It will even start asking for it.
130
Relief
breathing exercises at school
Because relaxation exercises work so well with young
children, you may wonder whether this could not be
included as a permanent component in elementary
school. Meanwhile there have been several studies at
schools and the results are very positive. In 2006-2007 a
study was done at elementary school "De Schepelweyen"
in Dommelen on the effect of yoga on children. The
preliminary results were presented by Ellen Pie- ters and
Diane Valkenburg, both students at the Faculty of
Movement Sciences of the Free University in Amsterdam.
In addition to an hour of yoga at school, the children were
also given exercises to do at home. The exercise that the
children learned to do shortly before going to bed was
particularly appreciated. One of the children told:
Yes, when I can't sleep well, I sometimes do the sun salutation.
And then the scary dreams go away and I can sleep better. That
helps. And mom and dad really like that, because then I don't get
out of bed as often.
The exercises that these children did are also from the book
The Club of 5 does yoga by Suzanne Raaijmakers.
Respiration in children and during pregnancy 131
breathing exercises for children with
adhd
Restless or busy children often respond well to
exercises that lower their breathing frequency. It has long
been proven that these exercises, if done seriously and
regularly, can have a significant impact. However, the
use of medications among young children is increasing at
an alarming rate and more and more children are being
labelled as having adhd, with the accompanying drug
treatment, while the breathing exercises mentioned above
are hardly ever prescribed.
In the Netherlands, the number of prescriptions for
adhd (Attention Deficit Hyperactivity Disorder, or: lack
of attention and too much activity) tripled in the period
between 2002 and 2007 to 600,000 (source: Trouw).
Adhd pills are being prescribed to increasingly younger
children. Medications such as Ritalin and Concerta have
methylphenidate as the active ingredient. This is a
stimulant that acts on the brain in the same way as
amphetamines and cocaine. In her book The Depression
Epidemic (2008), Trudy Dehue writes about the "misuse" of the
term adhd. According to Dehue, the term adhd is an
abbreviation that was originally intended primarily for
healthcare professionals to categorize certain behaviors.
Nowadays, however, the term adhd is mainly used to
indicate an illness. More and more children are wrongly
diagnosed with adhd. But adhd is a description of
behavior, not a disease.
132
Relief
Because doctors and other care providers act as if
adhd is a disease that a child (and increasingly,
according to the experts, an adult) can get, parents will be
less encouraged to work on their child's behavior
themselves. You don't do anything yourself with an
illness, a doctor does something about that. Prescribing a
pill, for example. However, the possible side effects of
drugs with methylphenidate as the active ingredient are
not childish. It's frightening," says Bruno Toussaint, editorin-chief of the French medicine bulletin Prescrire. 'Users of
these drugs can suddenly experience psychosis, become
manic or suffer from hallucinations and agres- siveness.
These are common, serious side effects. We also see
growth retardation and neurological dependence.
Children with congenital heart conditions are at an
increased risk of sudden death and acute heart problems if
they take adhd pills.'
Reason enough to try the relaxation exercises
separately and to be alert to behavioral changes that may
be influenced by quiet breathing. Give these exercises a
chance for a few months and try out different relaxation
exercises. As a parent, you can always fall back on the
breathing frequency for objective control. If this doesn't
work, you can always start with Ri- talin or a similar
drug. With the possible side effects of these medications
in mind, it is very worthwhile to invest a lot of time and
energy in exercises without side effects.
Respiration in children and during pregnancy 133
breathing and pregnancy
That young children can already have dysregulated
breathing, partly under the influence of their mothers, has
been made clear above. By extension, we can go back a
step further and see if a pregnant woman can influence
the degree of relaxation of her unborn child.
Whether a woman's breathing during her pregnancy
affects the health of a newborn baby is not known. There are
those who make a direct connection between pregnant
women's breathing and adhd in children. The theory is that
a woman who breathes too fast will have too low a carbon
dioxide level in her blood. This low carbon dioxide level
would also reach the newborn child, through the mother. The
low carbon dioxide levels could cause oxygen deprivation in
the brain, causing a child to become restless and unfocused,
and to "over-breathe. To our knowledge, there is no research
on this yet, but that doesn't mean it wouldn't be worthwhile.
Nor do you have to wait for this research to find out if you
can use breathing exercises to calm down your unborn child.
Many women notice during their pregnancy that the fetus
responds to their behavior. He or she responds to music,
movement, stress or voice- men. A common reaction is that
the baby becomes very mobile when the expectant mother
relaxes. If the pregnant person lies down, then the baby goes
into action. This often
134
Relief
reported perception of pregnant women could mean that
during the day there is nevertheless too much hustle
and bustle, giving the unborn child insufficient
opportunity to develop properly. Therefore, as a pregnant
woman, it is good to take enough time for relaxation.
exercise for pregnant wom en
As just mentioned, many pregnant women notice
that when they relax their child actually becomes
very mobile. This is a clear indication that the child is
responding to the mother. Therefore, take the time
to really relax. Do the following exercise for fifteen
minutes, lying on your bed.
Lie quietly and consciously breathe into your
abdomen. While breathing, alternately rub your
left
and your right hand over your bare belly. Start with your
little finger
about three inches above your navel and rub your hand
until your entire hand is past your navel.
Feel that your breathing is coming up to your belly,
but not "lifting" your belly.
If you notice the child in your belly starting to turn,
kick or poke, you know the still unborn girl or boy has
noticed your peace of mind.
Respiration in children and during pregnancy 135
and become more active yourself. In addition, of
course, you yourself will notice the relaxation if it is
good.
An additional advantage of the above exercise is
that it will also lower your blood pressure if you
have high blood pressure, something that is quite
common, especially in the last trimester of
pregnancy. If your blood pressure is low, it will not
drop any further.
If you do this exercise ten minutes before and ten
minutes after a busy period, for example before
and after work, it will be very beneficial for both
you and your child. And in addition, of course, it is
simply nice to feel that your child is so close.
Again: we do not pretend that the above exercise is the
cure for adhd or hysterical children. But we do want to
emphasize once again that as a parent you should not
simply be satisfied with a diagnosis and certainly not
with a medicine as the 'solution' for a certain behavior.
Tension and stress cause many more diseases than we can
now imagine. Anything you can do yourself to get more
rest is well worth trying.
136
Relief
summary
1. High respiratory rate is not hereditary.
2. High respiratory rate is not irreversible.
3. Children up to six years of age have irregular, noisy
breathing.
4. From the age of six, it makes sense to consider
relaxation exercises in children.
5. Pills prescribed for adhd are very- least without side
effects, first try to relax without me- dications.
6. During pregnancy, breathing exercises take on an added
dimension.
High respiratory rate and severe stressrelated disorders
Rapid breathing has many degrees. In this chapter we
will discuss diagnoses which include serious
complaints. The more severe your symptoms are, the
more difficult it is to assume that breathing exercises
can be a solution to the symptoms, even if only partially.
Nevertheless, even with serious psychiatric disorders, it is
useful to consider breathing exercises rather than just
taking medication.
Breathing too fast is an expression of stress. This
means nothing more and nothing less than that every
psychological disorder that is stress-related can result in
an excessively high breathing frequency. Although stress
plays a role in most psychological problems, in practice
stress-related disorders are primarily thought of as anxiety
disorders and depression. However, you must
immediately remember that these are psychiatric terms:
there are many diagnoses by lay people or people from
the 'alternative circuit', which have a lot in common with the
formulations used by psychiatrists, psychologists and
psychotherapists.
138
Relief
anxiety disorders
In the psychiatric classification system dsm-iv (Diagnostic and Statistical Manual of Psychiatric Disorders, fourth edition) the term "stress" appears in the designation of two anxiety
disorders. These are acute stress disorder (Ass) and posttraumatic stress disorder (PTSD). In both cases the
diagnosis may only be made when someone has
undergone a traumatic experience. By definition this
involves unexpected and far-reaching events which could
have led to serious injury or even death. Well-known
examples are rape, an armed robbery or a serious traffic
accident. A major but by definition non-traumatic event is
the death of a beloved family member or of a pet. Such
events can cause stress and psychological problems, but
they are more likely to be complicated grief reactions or
depression.
In addition to the two stress disorders, there are other
anxiety disorders that involve stress and agitated
breathing. The best-known anxiety disorder in which
breathing plays an important role is panic disorder, a
condition historically referred to as hyperventilation
syndrome. People with panic disorder initially suffer from
unexpected panic attacks; over time, the panic attacks
often occur in specific situations, such as in a crowded
win- kel or in a traffic jam. In the dsm-iv, on the basis of
which the
Breathing rate and stress-related disorders 139
Most psychologists and psychiatrists in the Netherlands
make their dia- gnoses, the following definition of a panic
attack is given: a limited period of intense fear, in which
at least four of the following phenomena occur suddenly
and reach their peak within ten minutes:
1. palpitations, pounding heart, or accelerated
heart action
2. sweat
3. trembling or shaking
4. feeling of breathlessness or suffocation
5. gulp
6. chest pain or discomfort
7. Nausea or abdominal discomfort
8. feeling of dizziness, unsteadiness,
lightheadedness or faintness
9. derealization (feeling of unreality) or
depersonalization (feeling detached from
oneself)
10. Fear of losing self-control or going crazy
11. fear of dying
12. paresthesia ("tingling" not caused by
external stimuli)
13. hot flashes or chills
The above list includes a few phenomena directly
related to breathing, but
140
Relief
It is good to realize that many of the other symptoms can
also be caused by an excessive frequency of breathing
("hyperventilation"). The best way to investigate this is to
put it to the test. If you stand up straight and consciously
take deep, fast breaths for a minute or two, you'll notice
nausea or dizziness or both. Other people start to sweat,
experience palpitations or a tightness in the chest. The list
of physical symptoms that may be associated with
accelerated breathing is very long.
The fact that the diagnosis of "hyperventilation syndrome"
is no longer used has nothing to do with the fact that
hyperventilation would not occur during panic attacks or
that hyperventilation could not cause a panic attack.
However, there is no so-called causal relationship, i.e.
hyperventilation does not always lead to anxiety attacks
and hyperventilation does not always occur during a panic
attack. According to the scientists who investigated this,
there are people who suffer from panic attacks without
hyperventilating and there are people who hyperventilate
without being anxious. What does remain an important
point of discussion here is the definition of
hyperventilation: in the very pronounced cases it
doesn't matter, but what is the significance of a slightly
increased respiratory rate, for example in a situation
where someone is sitting at home on the couch and
breathing twice as fast as strictly necessary? It is
Breathing rate and stress-related disorders 141
to our knowledge not well researched, but we suspect that
almost everyone suffering from an anxiety disorder has
an excessive respiratory rate already at rest to a greater or
lesser extent.
Excessively fast breathing not only affects people who suffer
from panic attacks as part of a pa- nism disorder, but also
people who have an abnormal fear of certain social situations
(participating in a meeting, signing an autograph at the post
office while a long line of waiting people looks on, giving a
speech, and so on). This is called social phobia, and people
with this anxiety disorder not infrequently have a pa- nish
attack in a situation they fear.
People with a pronounced fear of dirt or contamination
sometimes also have panic attacks in situations in which
they feel there is a very high chance of coming into
contact with dirt or contamination. In addition to
compulsive thoughts (obsessions), there are also
usually compulsions, such as washing one's hands
dozens of times or endlessly checking that the lights
are off and the doors are locked before one dares to
leave the house. The compulsions are usually aimed at
reducing the anxiety caused by the compulsive
thoughts. Because this is often not successful, a vicious
circle often develops, in which the amount of
compulsive actions increases more and more without
the fearful thoughts disappearing. This anxiety disorder is
called
142
Relief
called obsessive-compulsive disorder (ocd) or obsessivecompulsive disorder.
The most common anxiety disorder is undoubtedly the
specific phobia, which involves excessive fear of, for
example, heights, certain animals (mice, wasps, snakes),
getting an injection or seeing blood. The mere thought of
what is feared can trigger an anxiety attack in which
breathing becomes too rapid.
The last anxiety disorder that deserves separate mention
here is generalized anxiety disorder. This common anxiety
disorder is characterized by a vague, unrealistic and
unreasonable fear with no clear cause. Almost
continuously, sufferers are worried or anxious. A person
feels threatened, uncomfortable and restless, and fearful
pre-feelings of impending doom constantly appear,
without any subsequent action. ('Man often suffers most,
because of the suffering he fears, but which never
materializes...') Complaints such as being restless or
irritable, being tired excessively quickly, having difficulty
concentrating, suffering from increased muscle tension
and sleeping problems are also common in people with
generalized anxiety disorder.
Breathing rate and stress-related disorders 143
Drug treatment of anxiety disorders
The classic treatment of anxiety disorders consists of
prescribing medication, psychotherapy or a combination
of both. The medications used are tranquilizer tablets like
oxazepam (Seresta), di- azepam (Valium) or alprazolam
(Xanax), or antidepressants like paroxetine (Seroxat),
sertraline (Zoloft) or venlafaxine (Efexor). As a rule,
sedative tablets (also called anxiolytics) provide some
relief almost immediately. But in the majority of cases it
is no more than symptom control: the intense, acute
symptoms are somewhat lessened, but they rarely
disappear. There is also the problem of habituation:
benzodiazepines (almost all sedatives belong to this group
of drugs) are quickly habituated and because they have
hardly any side effects, the temptation to use more and
more of them arises. Oxazepam has been one of the top
prescribed drugs for many years. The main problem with
habituation is that at a certain point you get little benefit
from it, but also that you can't do without it: the
withdrawal symptoms that occur when someone who has
taken many of these drugs for a long time suddenly stops
taking them can be just as dramatic as the so-called "cold
turkey" withdrawal of a drug addict or alcoholic. The
guidelines of
144
Relief
general practitioners and medical specialists therefore also
indicate caution in prescribing benzo- diazepines and
avoiding long-term use altogether.
In let2008 the Ministry of Health know that there are
about chronic670.000 users in the Netherlands. There
are also sources that talk about more than a million
users. As of January 1, 2009, sleeping pills and sedatives
are no longer covered by insurance companies. However,
a prescription will still be required to obtain these types of
drugs from a pharmacy.
Antidepressants are used by about the same number of
people; there are estimates suggesting that nearly a
million compatriots also try to swallow away life's
problems with drugs such as Prozac and Seroxat. Antidepressants were heavily promoted in the 1980s as a
reasonable alternative to tranquilizer tablets: the user
would not become addicted to them and mental
symptoms would be addressed much more effectively. In
recent years, however, it has become unequivocally
clear that antidepressants are not harmless panaceas
either. As with the anxiolytics, there are many people
who cannot stop taking the drug without immediately
developing serious symptoms. Although it cannot be
formally called an addiction, many thousands of people
have become completely dependent on their
antidepressants. Also, it was not until years after its
introduction that it became clear that the use may not be
dangerous, but it was certainly a nuisance.
Breathing rate and stress-related disorders 145
weight gain, loss of libido and impotence were found to
be common side effects with very unpleasant
consequences. In addition, research has shown that about
half of the people who have used an antidepressant
relapse in the first six months after stopping. This is not
unrelated to the fact that most people do not change
significantly by taking an antidepressant. Someone who
suffers from palpitations and becomes so anxious that
they have a panic attack can get rid of the anxiety attacks
by taking an antidepressant. However, if he or she
experiences palpitations again after discontinuing the
drug, there is a good chance that a panic attack will
occur again and the person will eventually decide to go
back on the antidepressants.
Partly on the basis of all the disadvantages, a clear
trend toward less rapid and less frequent antidepressant
prescribing is to be expected. But it is not yet clear what
the chronic users will have to do. Even among the
potential users of the above-mentioned drugs, people
with anxiety symptoms, the willingness to fight the
symptoms with pills seems to be diminishing.
Fortunately, there is a growing awareness that an
approach in which regular exercise and responsible
eating receive a great deal of attention may be more
successful, especially in the somewhat longer term.
146
Relief
Treatment of anxiety disorders with
psychotherapy
Still many people think of psychotherapy as lengthy
sessions in which the patient lies on a couch talking a lot
and the therapist saying relatively little back. This form of
psychotherapy, which Freud christened psychoanalysis,
is still used, but not for anxiety disorders. Even Freud,
who also suffered from panic attacks, understood that
delving into childhood memories is of little use here,
and certainly not if someone is literally terrified. Insight
offers no prospects," a well-known psychiatrist once said.
In recent decades, psychotherapy has become much
more concrete and practical. Targeted work on
complaints, according to a clear plan and with a clear
goal in mind, has become the right starting point. The
most widely used and in the meantime also best known
form of psychotherapy according to this method is
cognitive behavioral therapy (cbt). At the heart of this
form of therapy is the effort to replace irrational,
frightening thoughts with more rational and less
frightening beliefs. For example, if you suddenly
experience very severe heart palpitations at eleven
o'clock in the morning at the office, this is not
automatically the first signal that a fatal heart attack is
imminent. A more rational explanation might be that
you haven't had much breakfast and that you've already
had five cups of strong coffee since arriving at work....
Breathing rate and stress-related disorders 147
It is also a topic of discussion with professional helpers
that unpleasant physical symptoms are almost always
intensified when they evoke fear. To illustrate this,
behavioral experiments are regularly used in which
people have to test their thoughts literally. For example,
many people who suffer from anxiety attacks think that
palpitations are harbingers of an impending heart attack.
By expressing this too clearly, a person can then arrive
at a hypothesis such as, "As soon as my heart rate exceeds
150 beats per minute, I will collapse and die shortly
thereafter from an acute heart attack. In a therapy, as a
gesture experiment, you can then ask the patient to put on
a heart rate monitor and run up and down the stairwell
until that supposedly fatal value is reached. If it turns out
that little else happens other than the patient becomes
fatigued, the hypothesis can be rejected.
That there is nothing wrong with the heart in people
who suffer from panic disorder is not certain: there are
studies that show that people with anxiety disorders die
sooner on average than people in similar circumstances
who do not have an anxiety disorder. Also, a disease of
the heart is more often the cause of death...
148
Relief
recurrence of symptoms
Both for the medication and for the therapy, the rule is
that there is usually an improvement when they are
applied, but that almost all symptoms never disappear. In
English-speaking countries there is a striking expression
on this subject: "Improvement is the rule, cure the
exception.
A problem already mentioned, which concerns
medications in particular, consists of the notinsignificant chance that all symptoms will gradually
return. This can happen after a person has stopped or
reduced the medication, but also while a person is still
on the initially successful dose. Eventually, almost
everyone who has suffered from an anxiety disorder
develops symptoms again at some point in his or her
life. Only a small percentage of people-about ten procents by estimate-have not developed problems again
twenty years after a period of symptoms.
Critics of pills and solution-focused forms of therapy
attribute the high numbers of people who develop new
complaints to the fact that the problems underlying the
complaints remain untreated. These would be problems
which often have their origin in childhood. Traumatic
childhood experiences in particular, which are
sometimes completely repressed, are said to be an
important cause of anxiety symptoms.
Research has also been published showing that
insightful therapy increases the likelihood of a new
Breathing rate and stress-related disorders 149
period with anxiety symptoms, but whether all people
who benefit from insight therapy had the same pro- blems
is highly questionable.
treatment of anxiety disorders with breathing
exercises
Breathing and relaxation exercises have been widely
studied as a treatment for anxiety disorders and have
also been found to be effective. However, they are used
relatively little by psychologists, psychotherapists and
psychiatrists, however unjustly. A technique such as
applied relaxation can even be found in the official
guidelines for the treatment of generalized anxiety
disorder, but only if cognitive therapy is not available or
there is a contraindication (reason not to use that
treatment). Using applied relaxation, a person can learn to
recognize early signs of panic and manage them through
relaxation exercises. First the patient learns to relax in
peace, then the relaxation can be connected to a certain
soothing word, which can help to prevent the worsening
of tension in case of signs of panic.
Breathing and relaxation exercises are often used in socalled alternative care. However, with the loaded term
"alternative" we do not mean that the help offered would
not be effective. Also regu-
150
Relief
lier caregivers who work outside of mental health care,
such as physical therapists, already often apply breathing
exercises.
depression, burnout and other stress-related
health problems
The fact that depression and burnout are classified under
the same category will immediately cause confusion or
even irritation in many people. It would be going too far
to repeat here the complete text which one of us published
earlier (Bram Bakker, Cowboy in psychiatry, pages 256276). In short, it comes down to the fact that the
similarities between depression and burnout are many
times greater than the differences. As for those
differences, one depression can make a very different
impression from another. In principle, the idea underlying
the making of different diagnoses is that different
treatments can be considered. In practice, it appears that
all complaints that are summarised under the diagnosis of
depression are treated with the same pills
(antidepressants), however different the complaints may
be. Even anxiety disorders are mainly treated with the
same antidepressants.
The argument here is that both abnormal anxiety and
abnormally impaired mood involve a dysregulation of
serotonin in the brain, which can
Breathing rate and stress-related disorders 151
be corrected with so-called "selective serotonin reuptake
inhibitors" or ssri's. The best-known antidepressants,
such as fluoxetine (Prozac), paroxetine (Seroxat) and
sertraline (Zo- loft), all belong to the group of ssri's.
Traditionally, depression has also been linked to the
dysregulation
of
another
neurotransmitter,
norepinephrine. The older antidepressants in particular,
which have even more side effects than the ssri's, are
thought to have an influence on this. In the case of severe
depression in particular, drugs such as amitriptyline
(Tryptizol) and nortriptyline (Nortrilen) are also still
prescribed.
The effect of antidepressants in the treatment of burnout
has not been well researched and they are also used by
themselves. This will certainly also have to do with the
impossibility for manufacturers to register their products as a
recognized treatment for this non-medical diagnosis.
Moreover, the term "burnout" is first and foremost a Dutch
invention. In psychotherapy, cognitive and behavioral
therapy are mainly recommended for the treatment of
depression and anxiety disorders as well as burnout
symptoms. This popular form of psychothera- pie focuses, as
mentioned earlier, on replacing unreal, gloomy or anxious
views with rational, alternative views that are less stressful.
There are also other forms of psychotherapy that have been
scientifically proven to remedy depression, but, as with pills,
a non
152
Relief
insignificant proportion of patients (think about half)
continue to suffer from symptoms to a greater or lesser
degree.
Also, the treatment of burnout through psy- chotherapy
is anything but a miracle method. It will therefore come
as no surprise that alternatives to medication and
psychotherapy are increasingly being sought. In particular,
"prescription exercise" is rapidly gaining po- pularity.
There has been little or no research into whether a
particular type of complaint responds better or less to a
speci- cific treatment. In the context of this book it is
particularly interesting to look at the physical complaints
which can be part of depression or burnout. For we now
know very well that there is often a connection with rapid
breathing.
According to the dsm-iv, depression requires the
presence of at least five of nine symptoms over a period
of at least two weeks. The five symptoms must include at
least a depressed mood (1) or loss of interest or pleasure
in (almost) all activities (2). The other symptoms are
weight change or altered appetite (3), sleeping poorly or
too much (4), irritable mood and accompanying
restlessness or just the opposite, apathy (5), fatigue or loss
of energy (6), feelings of inferiority or guilt (7), reduced
ability to think or concentrate or indecisiveness (8),
recurrent thoughts of death, thoughts of suicide and
suicide attempts (9).
Breathing rate and stress-related disorders 153
This is a fairly arbitrary list, as there are many
phenomena that are not included. For example, loss of
libido is a common symptom of depression that is not
mentioned. However, tense muscles, aching joints, and
headaches are also examples of symptoms suffered by
many people with depression that may be related to
rapid breathing. If we formally limit ourselves to the nine
symptoms mentioned, it is certain that breathing can play
a role in weight change, changed appetite, sleep problems,
restlessness, fatigue or loss of energy and a reduced
ability to think or concentrate. So perhaps breathing
exercises can reduce a good deal of depressive
symptoms.
On the website www.burnin.nl we read the following
about the physical and emotional consequences of
burnout: Burnout is accompanied by numerous physical
and psychological health problems, including
deteriorating mental conditions, a decrease in self-esteem
and self-confidence, depression, irritability, helplessness
and anxiety. Physical complaints include over-tiredness,
headaches, and gastrointestinal complaints.'
Immediately notable here is the overlap with
depression and anxiety disorders, and the possible
relationship between many of the symptoms and
improper breathing is, again, well worth considering.
The role of stress in the development of anxiety
disorder, depression or burnout is actually not
considered by anyone
154
Relief
contested. On the burnout website mentioned earlier, it is
stated that the difference between stress and burnout lies in
the fact that stress is the result of certain circumstances and
in principle disappears the moment the circumstances
improve. In burnout, the disappearance of the stressful
factors does not solve the problem. Interestingly,
www.burnin.nl mentions a large number of 'related
syndromes', of which the cause is usually not clarified either,
and in which rapid breathing could also be a cause or a
consequence. We will not discuss all the symptoms here in
detail, but we will give you the following list: anxiety, body
dysmorphic disorder (bdd), depression, chronic fatigue
syndrome (cvs or me), fibromyalgia, hyperventilation and
rsi (the 'mouse arm'). Even "bullying at work" and the "quarterlife crisis" are mentioned as "related syndromes.
The conclusion may be clear: there are an incredible
number of indications for phenomena which are very
similar, but in all cases the exact cause is unknown. That
there is stress, however, is without exception the case.
We are also convinced that for the enormous number of
people who suffer from physical complaints, it is possible
that they unconsciously maintain these complaints
through incorrect breathing. Think, for example, of
headaches or backaches.
Breathing rate and stress-related disorders 155
Doctors often apply the meaningless label of
"psychosomatic" to this. In psychiatric terms this leads to the
so-called somatoform disorders, of which hypochondria and
conversion are the best known. But it is not uncommon for
complaints that are difficult or impossible to objectify, such
as 'whiplash', to be classified under this heading.
exercise
In some patients, it can be counterproductive to
consciously pay attention to breathing. If it's your
if practitioner fails to get your patient to relax with
focused breathing exercises, you can do a simple
meditation exercise. Have someone carefully
observe what he or she feels in the triangular area
beginning between the eyes and then running down
to the tip of the corners of the mouth. Instruct
someone only to
feel what is happening there. Inside the nose, almost
everyone can feel a flow of breath. Do not direct
that, but allow objective observation. In addition to
the flow of breath, a person may feel itching on the
nose, or a drop of sweat just below the nostrils. Thus,
there are many sensations that someone may feel.
The advantage of this exercise is that no performance
is expected and someone can never get it wrong.
Because the task of just observing does encourage
someone to focus on the body, it is quite possible
that someone will naturally begin to breathe more
quietly.
Relief
156
exercise
For people with anxiety disorders, it is often difficult
to do a breathing exercise while sitting or lying
down. This is not to say that people with anxiety
disorders cannot do breathing exercises at all, but it
may work better to do an exercise walking or biking.
Walking
First, start walking slowly for a minute. Then you can
begin to lengthen your exhalation. Do not put your
hands in your pockets, but let them hang loosely
along your body. You can also count steps. Then
make sure your inhalation is four steps and your
exhalation ten steps.
Cycling
You can also do the breathing exercises while cycling.
In the beginning it is important to use a bike that
allows you to sit up straight, so no racing or
mountain bike. Cycle slowly and find a long straight
stretch, preferably in nature. Do not pay attention to
your speed, but sit up straight and lengthen your
exhalation as long as possible.
Finally, we point out that smoking and the use of alcohol and drugs may also interfere with normal, healthy
breathing. Even various medi-
Breathing rate and stress-related disorders 157
cines can have this effect without the package insert
explicitly mentioning it.
an example from the practice of
koen de jong
A 32-year-old young man who suffers from panic attacks
takes part in a scientific experiment at a university
hospital. In order to see whether he has an increased
sensitivity to the stress hormone adrenaline in the course
of these symptoms, he is given a small amount of the
substance as a result of which he is injected with an
inhaler. Beforehand, he is told in detail which physical
sensations adrenaline can cause and that he should not be
frightened by it. Prior to the experiment, it was explained
to him that the moment the infusion was stopped, all the
adrenaline would be out of his body within seconds
because he was in a safe environment. The experiment
has been going on for less than five minutes when the
young man starts breathing very quickly and deeply. He
makes a very tense impression, but at the same time it is
clear that he is hyperventilating on purpose.
Afterwards he was asked why he was breathing so
heavily during the examination. The man then gave a
startling explanation: "When I started suffering from
hyperventilation attacks, my family doctor took me to a
hospital.
158
Relief
I was referred to a physiotherapist for breathing
exercises. There I learned that I could gain control over
the attacks myself, for example by taking fast, deep
breaths. Now, if I feel a panic attack coming on, I
immediately start hyperventilating hard, because then I
know for sure that all the symptoms are caused by me.
This peculiar practical example shows well how complex
the interaction between the body and the brain is.
Whereas many anxious people only become more anxious
because of unpleasant feelings in their body, this man
thinks: if I cause them myself, I need not be afraid of
anything. The message here seems to be that you can
control your body with your mind. Normally this peculiar
paradoxical approach (breathing faster instead of calmer)
will not work for most people with anxiety symptoms. It
is much wiser to feel unpleasant bodily sensations
diminish as you relax through calm abdominal breathing.
Breathing rate and stress-related disorders
159
summary
1. Anxiety disorders, burnout, depression and many
other stress-related illnesses have in common a
relationship with dysregulated breathing.
2. Medications are often addictive and have unpleasant
side effects. If you stop taking them, the symptoms
often come back.
3. Although breathing exercises have already been
proven effective in anxiety disorders and depression,
they are still little taken for granted in treatment.
Breathing exercises and workout schedules
If, after reading this book, you are convinced of the
importance of breathing exercises and you want to start
doing them yourself, then the exercises below will give
you something to hold on to. There are people who, after
just one conversation about breathing, already feel that
there is a lot of energy to be gained from good breathing
or they suspect that with better breathing they will need
less medication. Yet in practice, it turns out to be
extremely difficult for most people to do the breathing
exercises so regularly that they have a lasting impact.
The exercises in this book also work well if you do
them without reading the text around them. If you pick
out one or two that are useful to you, that's fine too.
However, for a number of complaints, such as chronic
fatigue or obesity, you can only expect results if you do
the exercises often and keep them up daily for at least
two weeks. This chapter contains a number of training
schemes for the practical application of breathing
exercises. How often and for how long you do the
exercises
Relief
162
The most sensible exercises to do depend on your
current physical condition and what you expect from
them. First, below you will see three exercises
described earlier in the book. Below them you will see
which exercises you can do best and for how long.
exercise
1
Sit down with both feet on the ground.
Breathe in through your nose, not too
deeply.
Make a spout of your mouth and extend your
exhalation. Repeat this breathing eight times.
Make sure that you really don't breathe in too
deeply, but rather he- le to your abdomen. Not too
deep means that you shouldn't take in too much air.
Sitting on a chair, you don't need a lot of oxygen, as
long as you use the oxygen wisely. So breathe in
slowly, but make sure you feel that you are breathing
through to your abdomen. You can check this by
resting one hand on your belly and putting your
other hand on your chest. If the hand on your chest
barely moves, you are breathing correctly. In
addition, it is important that your exhale is longer
than your inhale.
Breathing exercises and workout schedules
exercise
163
2
Lie quietly on your back and consciously breathe
into your belly. While breathing, rub your left and
right hand alternately over your belly until your
entire hand is past your navel.
Feel that your breathing is coming up to your belly,
but not "lifting" your belly.
Repeat this breathing eight times.
exercise
3
Walk with your hands next to your body. Let your
arms naturally swing with your walking motion.
Breathe in through your nose and out through your mouth.
Walk slowly and notice that you become calm.
Do this exercise for ten minutes.
Three training schedules are discussed below. The first
scheme is for people who (still) have few problems
with an irregular breathing pattern. The second scheme
is for people who have already had clear signals in the
form of complaints and who have already seen a doctor
once (usually to no avail) with these complaints. The
third, most intensive, scheme is for people whose
complaints are seriously limited and who have gone
through the whole medical examination process without
finding a solution.
164
Relief
digging explanation for the symptoms has been found.
What matters is that you yourself start feeling when
you benefit from a certain exercise and that you reach a
point that you start doing the breathing exercise 'because
it feels so good'. To get to that point requires some
perseverance.
Therefore, we provide here three written out training
schemes to learn a good breathing pattern. Don't be put
off by the length and frequency of the exercises. In
principle, you only need to follow this strict schedule
temporarily, until you start breathing properly again.
1. You feel good, but a little more relaxation never hurts
Are you not ill and do you generally have enough energy,
but do you sometimes notice that you are running after
yourself or are losing the overview of your own
schedule? Or have you recently started a new job, a child
or suffer from minor physical complaints and you don't
want to continue like this for years? Don't want to take
medication, but has your doctor already told you that you
might soon get a pill for high blood pressure? Then this
first schedule is particularly suitable to follow for the
next five weeks. If you have followed the schedule
below during this period, you will not need to
consciously do the breathing exercises after that. You
will notice that in a little over a month's time you learn
to notice when breathing is too fast.
Breathing exercises and workout schedules
165
Without really sitting down for it, you will find it quite
easy to control your breathing even at busy times. The
schedule below seems heavy and much-demanding, but
learning the effects of proper breathing should encourage
you to complete the program.
Week 1: Do exercise 1 every time after exercise for a
minimum of five minutes and at times when you notice
you're overdoing it at work. In addition, do exercise 2
every day for ten minutes before going to bed.
□ Exercises done
□ Exercises not done, because .....................................
......................................................................................
......................................................................................
Week 2: Do exercise 1 each time for five minutes before
and five minutes after exercising and do exercise 3 for ten
minutes every day during your lunch break.
□
Exercises done
□ Exercises not done, because .....................................
......................................................................................
......................................................................................
166
Relief
Week 3: Do exercise 1 each time for five minutes before
and five minutes after exercising and lengthen your
exhale as much as possible during exercise. Do exercise 2
not only before going to sleep but also during the day, for
example five minutes in the car on the way home.
□
Exercises done
□ Exercises not done, because .....................................
......................................................................................
......................................................................................
Week 4: Do exercise 1 every time ten minutes before and
ten minutes after exercising. While exercising lengthen
your exhalation as much as possible. In addition, do
exercise 10 minutes during your lunch break and3
prolong your exhale as much as possible while
commuting. Do exercise for twenty2 minutes, before
going to bed.
□
Exercises done
□ Exercises not done, because .....................................
......................................................................................
......................................................................................
Week 5: Do not do the breathing exercise consciously
this week, but do register when you think about your
breathing and, if it feels good, do the breathing exercise.
Breathing exercises and workout schedules
□
□
□
□
167
Not thinking about my breathing
Thought about my breathing once a day
Between two and five times a day I thought about my
breathing
More than five times a day to my breathingthought
If you notice that your body alerts you when you are
overextending yourself, then you have achieved what you
want with the schedule. With it, you will be able to
recognize an incipient burnout or an overly busy period in
a timely manner and thus be able to take rest in time.
2. Your body has put on the brakes and you know:
something has to change
Have you been to the doctor for the third time in the past
month with heart palpitations or are you already taking
medication for high blood pressure? Have you been home
sick for a week because you couldn't cope with the
pressure at work anymore or have you started exercising
again because you feel that being 20 kilos overweight
is really too much? If you are about to take more
medication, but still have doubts about it, it might be
better to work more intensively on your breathing.
Because breathing is a powerful tool but not a panacea,
you will need to practice a lot to get good results. In the
first week you will be consciously working on your
breathing for more than half an hour a day.
168
Relief
haul. That is a long time, but a good result depends on
doing the exercises a lot at the appropriate times. The
exercises are spread throughout the day so that you can
get the most out of them. Try to stick to the schedule
below for at least the next six weeks. It may be difficult
to get into the habit, especially in the beginning, but after
six weeks it will no longer be necessary. Then you can
leave the breathing exercise for what it is and be satisfied
with the result achieved.
Week 1: You start the day lying down, with ten minutes
of exercise 2. In addition, do exercise 1 every time after
sport, for at least ten minutes, and whenever you notice at
work that you are in danger of outdoing yourself. In
addition, do exercise 2 every day for ten minutes before
going to bed. If you have to wait during the day, for
example for the train or in a traffic jam, extend your
exhalation immediately to bring rest to your body.
□
Exercises done
□ Exercises not done, because .....................................
......................................................................................
......................................................................................
Week 2: You start the day lying down, with fifteen
minutes of exercise Do2. exercise every1 time before and
after exercising, for at least ten minutes and at times
when you notice at work that you are in danger of
outdoing yourself. In your lunch break
Breathing exercises and workout schedules
169
Do your exercise for 3fifteen minutes and in addition you
can do exercise 2 every day for fifteen minutes, before
going to sleep. When you have to wait, for example for
the train or in a traffic jam, extend your exhalation
immediately to bring rest to your body.
□
Exercises done
□ Exercises not done, because .....................................
......................................................................................
......................................................................................
Week 3: You start the day lying down, with fifteen
minutes of exercise Do2. exercise every1 time before and
after exercise, for at least fifteen minutes. On your lunch
break do 315 minutes and immediately after work do
another 15 minutes. Do exercise 2 every day for twenty
minutes, before going to bed. If you have to wait on a
day, for example for the train or in a traffic jam, extend
your exhalation immediately to bring rest to your body.
□
Exercises done
□ Exercises not done, because .....................................
......................................................................................
......................................................................................
Week 4 & 5: You start the day lying down, with twenty
minu- tions of exercise 2. Do exercise 1 every time before
and after exercise, for at least fifteen minutes. In your
lunch break do
170
Relief
your exercise for 3fifteen minutes and immediately after
work for another fifteen minutes. Do five minutes every
hour at work Do1. exercise 2 every day for thirty minutes,
before going to bed. If you have to wait on a day, for
example for the train or in a traffic jam, immediately
lengthen your exhalation to bring calmness to your body.
□
Exercises done
□ Exercises not done, because .....................................
......................................................................................
......................................................................................
Week 6: Do the breathing exercise this week no longer
consciously, but do register when you think about your
breathing. If it feels good, do the breathing exercises.
□
□
□
□
Not thinking about my breathing
Thought about my breathing once a day
Between two and five times a day I thought about my
breathing
More than five times a day to my breathingthought
Do you notice what the breathing exercise does and can
you feel when you really need the exercise? If you realize
that in times of restlessness and palpitations you can use
your breathing to bring your body back under control,
this training program has worked.
Breathing exercises and workout schedules
171
3. Your illness controls your life and you are aware of your
limitations almost every minute
Do you have an illness that controls your life? Do you
have hardly any energy and often unexplained muscle
pain? Are you unable to work or exercise due to your
symptoms? Then breathing exercises can still be
surprisingly powerful, provided you spend enough time
on them. It is literally making hours. You can't expect
much from two times ten minutes a day if you have
severe physical complaints which have existed for a long
time. Below is a weekly schedule that asks a lot of you.
Already in the first week you have to work more than two
hours a day on your breathing. That's tough, but in order
to combat serious complaints, intensive practice is
necessary. If you do not notice any positive change after
two weeks, it is necessary to ask a therapist for help. In
the first week you can start on your own, but it often
works better to have someone motivate you and correct
you if necessary. Changes can be discussed with a doctor
after six weeks: what exactly did you do and does any
medication need to be reviewed?
week &1 2: In the morning, do a half-hour exercise Do2.
twenty minutes of exercise at eleven o'clock Shortly3.
before lunch do ten minutes of exercise 1 and
immediately after lunch do ten minutes of exercise At
3.three o'clock do a half-hour of exercise-
172
Relief
ning Do2. ten minutes of exercise after dinner and3 half an
hour of exercise before bed 2.
□
Exercises done
□ Exercises not done, because .....................................
......................................................................................
......................................................................................
........................................................................
The following exercise feels most comfortable to me:
□ Exercise 1
□ Exercise 2
□ Exercise 3
Week 3 & 4: Do three quarters of an hour exercise 2 in
the morning. At eleven o'clock do thirty minutes of
exercise 3. Shortly before lunch do ten minutes of
exercise 1 and immediately after lunch do ten minutes of
exercise 3. At three o'clock do a half hour of oe- f
exercise Do2. ten minutes of exercise after dinner and3
before bed three quarters of an hour of exercise 2.
□
Exercises done
□ Exercises not done, because .....................................
......................................................................................
......................................................................................
Breathing exercises and workout schedules
173
The following exercise feels most comfortable to me:
□ Exercise 1
□ Exercise 2
□ Exercise 3
Week 5 & 6: In the morning do three quarters of an hour
exercise 2. At eleven o'clock do thirty minutes of exercise
3. Shortly before lunch do ten minutes of exercise 1 and
immediately after lunch do ten minutes of exercise Do3. a
half hour of exercise at three o'clock and2 at five o'clock
do thirty minutes of exercise Do3. ten minutes of exercise
3 after dinner and before bed three quarters of an hour of
exercise 2.
□
Exercises done
□ Exercises not done, because .....................................
......................................................................................
......................................................................................
The following exercise feels most comfortable to me:
□ Exercise 1
□ Exercise 2
□ Exercise 3
Did you notice that in the last week you found exercise 3
the most pleasant, while earlier you found exercise 2 the
most relaxing? Then that is a signal that you have learned
to find relaxation during movement as well. It is then
good to start exercising carefully after six weeks and to
continue the breathing exercises.
174
Relief
lings exercise when you feel restlessness in your body.
After six weeks you are obviously not suddenly fit as a
fiddle, but if you have noticed that paying attention to
your breathing can clearly improve your overall
wellbeing, that is already a big win.
summary
1. You can do the breathing exercises lying down,
sitting or standing.
2. You can do breathing exercises according to a targeted
training schedule.
3. For severe symptoms, it is good to do the exercises
more often and for longer periods of time.
Recommended and consulted literature
and websites
Want to know more? Some reading tips from the authors:
Bakker, Bram and Simon van Woerkom, Running
Therapy. The standard work for runners and professionals.
Publisher Sporthuis, 2008
Bakker, Bram, Cowboy in psychiatry. Publisher Maarten
Muntinga, 2008
Beek, Fred van, Taking a Breath. Andromeda Publishing, 2004
Bergh, Joris van den, Mysterious forces in sport. Published by
Thomas Rap, (2008reprint)
Dehue, Trudy, The depression epidemic. Augustus Publishing,
2008
Devriendt, Geert, Taking a breath. Publisher Lannoo,
Dixhoorn2003, Dr. J.J. van, Relaxation instruction. Publisher:
Reed Business, 2001
Haspel, J. van den, "Can stress be reduced by applying heart
coherence?", article in www.back. nlBreathing exercises
and training regimensgmw/ news/newsfaculty/
newsfacultygeneral/Kan_
176
Relief
stress_reduction_by_applying_heart_coherence_Jolant_van_den_Haspel.pdf (2009)
Janssen, Marleen, The Prozac Monologues. Scrip- tum
Publishing, 2007
Langedijk, Pieter and Agnes van Enkhuizen, The Parasympathicus. Ankh-Hermes Publishing, 1989
LeDoux, Joseph, The Emotional Brain. Phoenix House
Publishing, 1999
Lewis, Dennis, The Tao of natural breathing. Published- row
Bzztôh, 1997
Lum, L.C., 'Hyperventilation syndromes in medicine and
psychiatry' in Journal of the Royal Society of Medicine, Vol.
p80,. April 229.1987
Lum, L.C., "Hyperventilation: the tip and the iceberg," in
Journal of Psychosomatic Research, Vol. pp19,. to
375Pergamon383. Press, 1975
Raaijmakers, Suzanne, The club of 5 does yoga. Published by
Hub-Tonnaar, 2008
Servan-Schreiber, David, Your brain as medicine. Kosmos
Publishing, 2003
Snitselaar, Drs. B., "Hyperventilation Syndrome," article in
www.hyperventilation. info/downloads/hyperventilationsyndrome.doc
Takken, Dr. Tim, Exercise Test. Reed Business Publishing,
2007
Recommended and consulted literature and websites 177
Some favorite websites of the authors
www.ademtherapie-aos.org
www.altijdmoe.nl
www.airu.nl
www.brambakker.com
www.buteyko.nl
www.degoudenreael.nl
www.ecmnetwerk.nl
www.kiwinederland.nl
www.runningtherapie.nl
www.sportvasten.nl
Useful addresses
Below is a list of addresses where you can go to have
your breathing pattern scrutinized with a practitioner.
We advise everyone to do this. Even with one visit you
can gain insight into whether you are doing the exercise
properly. All mentioned practices have equipment to
measure heart rate coherence. This gives you a direct
insight in whether the exercise indeed gives you the
desired relaxation. Behind the name you will see the
abbreviations aot or vdp. aot are practitioners who
give breathing and relaxation therapy according to the
van Dixhoorn method. vdp stands for a practice where
longer out-breathing is practiced in combination with
sports advice. In both cases you can come once to test
exercises from this book with the equipment.
The list is changing rapidly as the number of
practitioners working with it grows rapidly. For a current
list, please visit www.kiwinederland.nl. Are you a
practitioner and do you want to measure breathing
patterns yourself? Please contact rq Health Sportconcept:
Stans van der Poel (stans- vanderpoel@gmail.com), 06 410
431 35, Blijklaan 32 1394 kb Nederhorst den Berg.
180
Relief
North Holland
Koen de Jong (vdp)
Kiwi Netherlands
www.kiwinederland.nl
06388997koen@kiwineder
land.nl 30
Radioweg ar 3,1394Nederhorst den Berg
Michiel van Alphen (vdp)
www.airu.nl
michiel@airu.nl
06430304 33
Radioweg ar 3,1394Nederhorst den Berg
samsterdam (vdp)
www.degoudenreael.nl
02062319info@degoudenr
eael.nl 49
Brouwersgracht hd214,1013 Amsterdam
ManualFysion (vdp)
w02067627ww.manualfyio
n.nl michael@manualfysion.nl
75
Burgerweeshuispad ep 54,1076Amsterdam
Useful addresses
mtc Huizen (vdp)
w03552413ww.mtchui
zen.com
info@mtchuizen.com 89
Hugo de Grootsingel cl 1,1277Huizen
Desiree Schoordijk (vdp)
Energy Control
www.altijdmoe.nl
info@altijdmoe.nl
02944832 84
Rijnkade gt155,1382 Weesp
SportWellnesscenter De Dars (vdp)
www.dedars.nl
info@dedars.nl
00
Europasingel 114-116, gv1693 Wervershoof
South Holland
Physio Fit Active
(vdp)
w07030971ww.fysiofit-actief.nl info@fysio-fitactief.nl 00
Wezelrade xe186,2544 The Hague
181
182
Relief
Center for People and Work
w07861426ww.centrummensenwer
k.nl info@centrummensenwerk.nl
22
Stationsplein jv17,3311 Dordrecht
Sport2Bfit (vdp)
www.sport2bfit.nu
06546406michiel@sport2b
fit.nu 78
Rijndijk b53, ac 2394Hazerswoude-Rijndijk
Eveline Kempenaar (aot)
Physiotherapy practice Kempenaar
www.evelinekempenaar.nl
info@evelinekempenaar.nl
0252534 887
Main Street and135,2182 Hillegom
Bike in Balance (vdp)
w07187950ww.bike-inbalance.nl info@bike-inbalance.nl 12
Veenderveld tv 18,2371Roelofarendsveen
Useful addresses
Personal fit 4you
w06516672ww.personal
fit4u.nl
info@personalfit4you.nl 22
Hagelwit ae18,2718 Zoetermeer
Utrecht
Practice De Borg (aot)
w03346204ww.praktijk
deborg.nl
monique56@gmail.com 12
Borgesiuslaan jv17,3818 Amersfoort
Miriam Helsper (aot) Speech
therapy practice OdijkBunnik
www.logopediepraktijkodijk.nl
03065673info@logopediepraktijkodijk.nl
80
Rhine Island ma5,3984 Odijk
Lex Drop
Body and
Vision
www.lijfenvisie.nl
i0356030nfo@lijfen
visie.nl 504
Nijverheidsweg 8-06, er3762 Soest
183
184
Relief
trias Test Training & Advice Center (vdp)
www.triastotaal.nl
info@triastotaal.nl
62
Mississippidreef ce 61,3565Utrecht
José de Sain
Physiotherapy
Werkhoven
www.fysiowerkhoven.nl
fysiowerkhoven@hccnet.nl
42
Beverweertseweg rd14,3985 Werkhoven
Brothers Sports & Health
w03075187ww.broertjessport
health.nl
kees@broertjessporthealth.nl 87
Huis ter Heideweg 52-54, lz3705 Zeist
Flevoland
Gregor Stam (vdp)
Personal/Mental coach & Running therapist
The Prevention Center
gregor.stam@kpnmail.nl
06107900 35
Randstad 22-01, bn1316 Almere
Useful addresses
Altius Physiotherapy Testing and Training Center (vdp)
www.altiuszeewolde.nl
info@altiuszeewolde.nl
26
Mast kg 28,3891Zeewolde
Groningen
Health Center Provitaal (vdp) www.provitaal.nl
info@provitaal.nl
72
Hawthorn Avenue 2, ax 9651Meeden
Friesland
Palestra
www.palestra05192220d
okkum.nl 24
Hogedijken 18-6, wv9101 Dokkum
Overijssel
Physiotherapy de Werfheegde
(vdp)
w05357275ww.fysiotherapiewerfhe
egde.nl info@fysiotherapiewerfheegde.nl
61
Spoelsterstraat kh90,7481 Haaksbergen
185
186
Relief
Gelderland
Gerie van de Vlekkert (aot) De
Heeze Health Center
www.ademkracht.nl
info@ademkracht.nl
05554293 98
Graanhof av 134,7335Apeldoorn
Eva Simonetti (aot)
Evadum
www.evadum.nl
02644277info@evadu
m.nl 22
Graaf Ottoplein ha8,6821 Arnhem
Simon van Woerkom (vdp)
Physiotherapy & Sport Van
Woerkom www.fysiotherapiemalden.nl
02435860 51
Schoolstraat bg8,6581 Malden
Physioteam
Renkum
(vdp)
w03173122ww.fysioteamr
enkum.nl
info@fysioteamrenkum.nl 47
Industrieweg ka 4,6871Renkum
Useful addresses
187
Erik Westein Sports Center De Plataan
www.sportcentrumdeplataan.nl
info@sportcentrumdeplataan.nl
03174141 14
Plataanlaan pt1,6708 Wageningen
North Brabant
MERAS Physical Therapy
(vdp)
w04975303ww.merasfysiot
herapie.nl
info@merasfysiotherapie.nl 83
Gebint 1-f, wd5521 Eersel
Stressmaster (vdp)
www.stressmaster.nl
06223306info@stressma
ster.nl 50
Locomotiefstraat tt52,5641 Eindhoven
Center for Movement and Therapy (vdp & aot) www.cbtfysio.nl
info@cbtfysio.nl
37
Jasonstraat jb3,5631 Eindhoven
Ergo Optima (vdp)
w07368907ww.ergo
optima.nl
info@ergooptima.nl 90
The Small Elst jk21,5246 Rosmalen
188
Relief
Emons Physiotherapy
(vdp)
emonsfysio@planet.nl
01346774 10
Hart van Brabantlaan lc301,5038 Tilburg
Limburg
PhysioQ (vdp)
www.fysioq.nl
04647708info@
fysioq.nl 55
Copenhagen Street ll5,6135 Sittard
Zeeland
Physant (vdp)
w01114504ww.
fysant.nl
info@fysant.nl
75
Miereweg sj 3,4301Zierikzee
Belgium
Wellness Center Fitopia
www.fitopia.be
info@fitopia.be
(0032)(0)3454 66
Mechelsesteenweg Edegem154,2650
Addiction is a phenomenon that is as profound as it is
elusive and takes many, sometimes bizarre, forms. In
addition to drugs and medication, legal or otherwise, you
can become addicted to food (or fasting), shopping, sex,
gaming, sports, internet, TV, you name it. Some
practitioners see the seeds of addiction in the cradle,
others in genes or culture. Either way, in our society of
abundance, there is virtually no person who does not
struggle with one or more seemingly harmless
addictions. But, as we see happen again and again, the
transition to serious forms of addiction happens
gradually and often unnoticed. Until it's too late.
192 pages π € 15,- π isbn
3
The advice to start moving more is not an empty phrase,
you have to do something with it. More exercise gives
energy and relaxes at the same time, it makes you feel
happy, improves sleep, concentration and you lose weight.
Exercise is good for your heart, your high blood pressure
and your metabolism. But what is meant by exercise and
what is good for you to do? Is climbing stairs and biking
to work enough, or is it better to join the gym for more
energy? Should you go dancing and gardening for
depression or is running better? In Moving for Beginners,
experts Bram Bakker and Koen de Jong combine theoretical
knowledge with practical training tips, fun facts and
examples.
192 pages π €16,90 π isbn
0