What are the different types of breathing pattern disorder?

Most people have heard of hyperventilation. Fewer know that it's just one of several breathing pattern disorders - and that the type of disorder you have matters when it comes to understanding your symptoms and getting the right help.

If you've been told your breathing is off, or you've suspected it yourself, this is worth reading.

What is a breathing pattern disorder?

A breathing pattern disorder (BPD) describes a change to the normal rhythm, rate or mechanics of breathing that produces symptoms - breathlessness, chest tightness, dizziness, fatigue or a feeling you can't get a full breath in - in the absence of, or beyond what's explained by, any underlying lung condition.

The research literature uses several terms interchangeably: dysfunctional breathing, functional breathing disorder, breathing pattern disorder. They broadly refer to the same thing.

What's less well understood - even clinically - is that BPD isn't one single presentation. Several distinct patterns have been described and they look and feel quite different from one another.

What does normal breathing actually look like?

Before covering what goes wrong, it helps to understand what optimal breathing involves.

Efficient breathing is:

• Nasal, slow and low - using the diaphragm rather than the upper chest

• Regular in volume, with breaths that are consistent in size

• Following an inspiratory to expiratory ratio of roughly 1:2 - your out-breath is twice as long as your in-breath

• Followed by a natural expiratory pause before the next breath begins

That pause matters. It's not a sign of not breathing enough - it's a sign that your breathing is calibrated correctly. When it disappears, it's often one of the first indicators that something has shifted.

The main types of breathing pattern disorder

Hyperventilation

This is the most researched and recognised form of BPD. The prevalence of hyperventilation syndrome in the general population is estimated at around 6-10%, rising considerably in people with asthma.

Hyperventilation doesn't always look dramatic. Chronic low-level over-breathing is common and often goes unnoticed. What's happening physiologically is that the breathing rate increases, the inspiratory to expiratory ratio shifts closer to 1:1 and the expiratory pause disappears. This causes excess carbon dioxide to be exhaled, which alters blood chemistry and produces a cascade of symptoms including:

• Breathlessness and chest tightness

• Tingling in the hands, feet or around the mouth

• Dizziness or light-headedness

• A sense of air hunger despite breathing frequently

It's closely linked to anxiety but the relationship goes both ways - hyperventilation can trigger anxiety and anxiety can trigger hyperventilation.

Periodic deep sighing

This pattern is characterised by irregular breathing with frequent, large sighs interspersed throughout. Sighing itself is normal - it happens in healthy breathing too - but in periodic deep sighing it becomes frequent and is associated with a sensation of air hunger or an inability to take a satisfying breath.

Volumes are inconsistent. Some breaths are large, some small. There's often visible upper chest movement. The person may feel as though they're constantly trying to "catch" a proper breath, which is a hallmark symptom many people with this pattern describe.

Thoracic dominant breathing

In thoracic dominant breathing, the upper chest does all the work. The diaphragm contributes very little and breaths extend up into the upper lung field - what's called the inspiratory reserve volume - rather than moving air into the lower ribcage where gas exchange is most efficient.

This is a tiring way to breathe. The neck and shoulder muscles become overloaded as they compensate for the underused diaphragm. People often report aching through the upper back, neck and chest, alongside breathlessness - particularly during activity.

It's not always obvious. Someone can appear to be breathing normally while their entire breathing mechanics are working from the wrong place.

Other patterns seen in clinic

Beyond the patterns described above, our clinicians at the Breathing MOT regularly identify additional presentations that don't fit neatly into existing categories:

Forced expiration - where the breathing out becomes active and effortful rather than the passive recoil it should be. This places unnecessary strain on the respiratory muscles and disrupts the natural breathing cycle.

Breath holding - where breathing is repeatedly interrupted or paused, often unconsciously. Many people do this during concentration, stress or screen use without realising.

Breath stacking - where the person takes a new breath before fully exhaling the previous one, gradually increasing the volume of air sitting in the lungs and creating a sense of tightness or restriction.

These patterns are real, they produce symptoms and they're identifiable on assessment.

Why does the type matter?

Because treatment - if and when it's needed - should be targeted at the specific pattern, not applied as a generic approach. Research supports this: the techniques used for hyperventilation are not necessarily appropriate for someone with thoracic dominant breathing or breath stacking - and applying the wrong approach can be unhelpful or even counterproductive.

Identifying the pattern is therefore the first step. That's what a Breathing MOT assessment is designed to do.

What a Breathing MOT looks at

During your assessment, a specialist respiratory physiotherapist will assess your breathing at rest and during activity, looking at:

• Your breathing rate and the ratio of in-breath to out-breath

• Whether the expiratory pause is present

• Whether you're using your diaphragm or relying on upper chest and accessory muscles

• The consistency and volume of your breaths

• Any patterns of forced expiration, breath holding or breath stacking

• Physical measurements including oxygen levels, heart rate and peak flow

You'll leave with a clear explanation of what's happening, why it's producing your symptoms, and what the appropriate next step looks like.

If you recognise any of these patterns in your own breathing, or you've been searching for an explanation for symptoms that haven't shown up on standard tests, a Breathing MOT assessment is a good place to start.

Book now at thebreathingmot.com, email info@thebreathingmot.com or call 020 7971 1464.