Sighing and breathlessness: breathing pattern disorder explained

Dyspnoea is the medical word for breathlessness. Sighing dyspnoea describes the pattern in which a person feels unable to get a satisfying breath, sighs or yawns repeatedly in an attempt to relieve it, and may have little or nothing wrong with the lungs on testing. It is not a separate disease so much as a recognisable description of a breathing pattern disorder.

University Hospitals Plymouth explains that breathing pattern disorders occur when breathing loses its natural rhythm and becomes a less efficient pattern, with deeper or quicker breaths than the body needs. This ranges from upper-chest breathing, where the wrong muscles are used, to hyperventilation, where breathing is too fast. Bradford Teaching Hospitals describes it as an altered rhythm, rate or pace of breathing that has existed for some time and causes you to breathe beyond what your body requires.

The Plymouth leaflet lists a range of possible signs and symptoms, and notes there is not always an obvious trigger. Many are produced by over-breathing itself, which changes the balance of gases in the blood and can cause unexpected sensations throughout the body.

• Frequent sighing or yawning and a sensation of "air hunger", of not getting enough air into the lungs.

• Breathlessness after slight exertion, or when talking or eating.

• Palpitations, and pins and needles in the hands, arms or around the mouth.

• Light-headedness or dizziness.

• Feeling bloated, throat symptoms, a dry cough or throat clearing.

• Aching and tightness around the jaw, shoulders and neck, and chest discomfort.

• Feeling exhausted and unable to concentrate for no apparent reason.

The Plymouth leaflet lists common causes: anxiety or stress, acute illness such as a chest infection or pneumonia, long-term respiratory conditions such as COPD or asthma, traumatic events (physical or emotional), pain especially in the abdomen or lower back, and digestive issues such as reflux or hernias. It also says the pattern can build up over time or start suddenly.

Bradford adds that short-term changes such as a racing heart, tingling in the fingers and breathlessness usually disappear once a stressful period is over, but if breathing does not return to normal after the stressful event has passed, symptoms may continue, which can occur in people experiencing anxiety. Triggers can include physical exertion, strong smells, cold weather and stress.

Because breathlessness has many causes, it is important not to assume a breathing pattern disorder without assessment. The NHS lists common causes of shortness of breath as asthma, a chest infection, being overweight, smoking and a panic attack, and more serious causes including COPD, idiopathic pulmonary fibrosis, heart failure and lung cancer. It says not to try to self-diagnose the cause and to always see a GP.

A GP will usually consider heart and lung causes first, which may involve examination, blood tests, a chest X-ray, lung function tests or heart tracings depending on the picture. Once these have been considered, a breathing pattern disorder becomes a positive diagnosis rather than only a diagnosis of exclusion, and it can sit alongside asthma or another respiratory condition.

The NHS says to call 999 or go to A&E immediately if you have severe difficulty breathing (gasping, choking or not able to get words out), your chest feels tight or heavy, you have pain that spreads to your arms, back, neck and jaw, your lips or skin are turning very pale, blue or grey, or you feel suddenly confused.

It says to contact NHS 111 if you have difficulty breathing or are more short of breath than usual, feel or are sick, cough up blood, have pain or swelling in one leg or have heart palpitations. It advises seeing a GP if breathlessness gets worse with normal activities or when lying down, if you are short of breath with swollen ankles, or if you have been coughing for 3 weeks or more. People who have been told they have a breathing pattern disorder still need to treat new red-flag symptoms as urgent.

The Plymouth leaflet says that once an inefficient breathing pattern becomes a habit it can be difficult to alter, but a physiotherapist can help, with treatment focusing on breathing pattern retraining, lifestyle changes and relaxation. It describes normal breathing as quiet, regular and in and out through the nose, with a normal rate of 8 to 12 breaths per minute, and says the diaphragm does about 70 to 80 per cent of the work.

A practice exercise in the leaflet involves lying comfortably, closing the mouth, loosening the jaw, breathing in gently through the nose so the tummy rises, resisting the urge to take a deep breath, breathing out lightly through the nose and pausing at the end of each breath. It suggests practising as often as possible, for example 2 to 3 minutes every hour, and then progressing to sitting, standing and walking under the guidance of the physiotherapist. Bradford lists breathing control, nose breathing, understanding triggers such as anxiety, reflux or pain, shoulder relaxation, postural correction, regular exercise and a healthy diet.

Staying active is encouraged, and the Plymouth leaflet notes that shortness of breath is a normal part of exertion. Referral to a specialist respiratory physiotherapist is the usual route, through a GP or hospital team.