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Reducing Insomnia with Buteyko Breathing

Patrick McKeown

  • Insomnia is a sleep disorder characterized by difficulty sleeping1. You may find it hard to fall asleep or struggle to stay asleep for as long as you want
  • Common features of insomnia include daytime sleepiness, irritability and poor concentration
  • Insomnia increases your risk of road traffic accidents. One 2017 study of truck drivers found that those with insomnia were almost twice as likely to have an accident, and three times more likely to be involved in a near miss compared to drivers without insomnia2
  • People with insomnia are 9.82 times more likely to develop depression and 17.35 times more likely to suffer significant anxiety3

Insomnia and stress

Sleep is the behavioral and neurological state in which your body rests. It’s essential for proper, healthy functioning of the body’s systems. The average adult needs at least seven hours sleep each night. Those who frequently get less are more likely to suffer from health problems including heart disease, asthma, obesity, depression and diabetes. Despite the undesirable effects, more than a third of adults in the US regularly get by on fewer than 7 hours sleep, and sleep deprivation is becoming a public health epidemic4. Worldwide, between 35% and 50% of adults show symptoms of insomnia5.

Poor sleep can be caused by many aspects of modern life – backlit computer screens, light bulbs, mobile technology and the blurring of boundaries between work and down-time all result in a chronic imbalance in the autonomic stress response. This “exaggerated and maladaptive neurobiological and cognitive–emotional reactivity to stress” 6 is a common marker of insomnia.

Insomnia has major implications for health and quality of life. Every year, around 109,000 road traffic accidents and 6,400 fatal crashes in the US happen as the result of a sleep-deprived driver7. Medical costs are high, with 4% of Americans relying on potentially habit-forming hypnotic drugs such as benzodiazepines8, which can disturb sleep patterns and produce side effects including withdrawal, suppressed respiration, increased risk of death, depression, and possibly cancer9. And sleep deprivation costs the economy billions of dollars in sick leave, low productivity and medical bills10.

Scientists have suggested that natural interventions such as breathing, relaxation and sleep hygiene techniques11, which all improve sleep quality and duration, may be more effective long-term than the use of hypnotic drugs in addressing the global issue of insomnia.


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Is insomnia a breathing pattern disorder?

In 2012, scientists in the US examined the relationship between treatment resistant chronic insomnia and sleep-disordered breathing. In order to gain a clear view of the relationship between breathing and insomnia, patients with obstructive sleep apnea, (OSA) were excluded from the review. Despite this, researchers found that around 90% of awakenings observed in participants were preceded by respiratory-related events12. They also reported that, although OSA patients had been excluded from the trial, 11 of the 20 participants actually met the clinical criteria for OSA. They either had a high AHI reading (apnea, hypopnea index) or displayed upper airway resistance syndrome – a sleep disorder characterized by the narrowing of the airway, the primary symptoms of which include excessive fatigue and chronic insomnia13. These observations suggest a high prevalence of sleep disordered breathing amongst those with insomnia12.

The studied sample discussed in the review was typical of insomnia sufferers, but it was noted that 55% of them snored, 75% were taking nightly sleep medications and 50% had trauma history14. The researchers observed that any one of these considerations could contribute to sleep-disordered breathing or awakenings.

Arousal from sleep can make people more vulnerable to ventilatory and upper airway instability too. While more research is needed to confirm the theory, the paper suggests that arousal of the brain and sympathetic nervous system could cause airway instability, prompting sleep-disordered breathing and resulting in awakening and difficulty getting back to sleep.

The review also describes a crossover trial involving patients with mild sleep-disordered breathing, in which those participants who received treatment for their breathing disorder followed by cognitive behavioral therapy displayed better results than those who received the treatments the other way round15. Researchers concluded that patients with chronic insomnia should be considered for polysomnography to determine sleep-disordered breathing.


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Buteyko Breathing as a treatment for insomnia

Common treatment suggestions for insomnia include:

  • Improving sleep hygiene
  • Using exercise to regulate homeostatic functions
  • Reducing light exposure to regulate circadian rhythms
  • Reducing stimulants including alcohol and caffeine
  • Using relaxation techniques to manage stress11

Some relaxation techniques are known to activate the parasympathetic nervous system’s rest-and-digest mode via the vagus nerve. Others use cognitive-behavioral elements and visualizations of tranquil scenes and places. All of these have been found to help calm the mind and relax the body, addressing certain aspects of insomnia.

One 2019 study looked in detail at the impact of self-regulated slow breathing practice and its benefits for insomniacs11. Although slow, diaphragmatic breathing is the most commonly used technique for insomnia, there has not been much direct research into why it works16. It has been suggested, however, that autonomic dysfunction plays a part in insomnia. Since slow breathing stimulates the vagus nerve, helping to balance out the activity between the two branches of the autonomic nervous system and increasing resilience against stress, it makes sense that it would improve sleep quality.

Numerous studies have shown that slow breathing at a rate of six breaths a minute optimizes the interaction between heart rate and breathing pattern. Interestingly, the synchronization of breath and heart rate, or cardiac synchronization17 that occurs during slow-wave sleep helps in the restorative function of sleep18. It’s also directly associated with an increase in parasympathetic or vagal tone, which in turn aligns the body and brain in a state of relaxation.

Slow, deep breathing techniques form the basis of some of the oldest therapeutic and contemplative practices in the world. There’s a growing weight of evidence showing benefits of slow breathing on stress, asthma, pain and other mental and physical conditions. But there’s very little literature on the effects of slow breathing on insomnia11. The 2019 study suggests that the impact of slow breathing on the nervous system may be a balancing one – the parasympathetic, rest-and-digest system is strengthened, and the overactive sympathetic fight, flight or freeze branch “largely brought about by the frenetic nature of modern life,” is attenuated11. There is empirical evidence that a breathing rate of six breaths a minute (a frequency of 0.1 Hz) is the most effective in combating insomnia19, because this is the respiratory rate that initiates cardiac synchronicity and enhances parasympathetic activity. Breathing at six breaths a minute improves sleep quality and ease of falling asleep, and enhances the ability to stay asleep19.

The study also looks at nasal breathing, explaining that breathing through the nose may help to organize brain activity, for example, by exerting control over cortical excitability20. This means that it may be possible to use breath training to alter brain waves (as seen in the increase in delta activity during slow breathing21) which has exciting implications for the potential use of breath training in the modulation of sleep.


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Buteyko Technique for reducing insomnia

The optimum breathing rate of six breaths a minute is important in addressing breathing pattern disorders. From a biochemical standpoint, it offers the best conditions for blood gas exchange, so as to best oxygenate the cells and muscles. Biomechanically, it engages the diaphragm and reduces the amount of air breathed, alleviating chronic hyperventilation.

The simple exercises that form the Buteyko Technique will teach you to breath slow, light, and deeply through your nose, improving your everyday breathing patterns, and your sleep quality.


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Tips to achieve better quality sleep

  • Slow breathing: Practice an exercise to reduce your breathing. Place one hand on your belly and the other on your chest. Softly slow your breathing to create a light air hunger. Practice this for around fifteen minutes before bed. This exercise is very helpful in sleep-disordered breathing and can help you to get to sleep more easily.
  • Restore full-time nasal breathing: Nasal breathing during sleep is really important. It prevents mouth snoring, sleep apnea and even protects against gum disease. If you frequently wake with a dry mouth in the morning, the chances are you mouth-breathe in your sleep. Try applying MYOTAPE before sleep to help you re-learn habitual nasal breathing. If your nose is congested, use the nose unblocking exercise before taping your mouth. You may also find a nasal dilator like the Mute™ snoring device helpful. Your nose will only ever fully block if you revert to mouth breathing. Once you have restored the habit of nasal breathing at night, you may find you no longer need the dilator.
    N.B. Any child wearing MYOTAPE at night must be able to remove the tape themselves if they need to. Do not use this method on children under five years old, or if your child has a tummy upset or may vomit. Adults should not wear the tape if they are feeling sick or have been drinking alcohol.
  • Avoid eating a large meal just before you go to bed. And remember, alcohol is a stimulant. While it may send you off to sleep easily, your sleep quality will be poor.
  • The best position to lie in to get a good night’s sleep is on your left side. This reduces ventilation, which makes it less likely that your breathing will be uncontrolled. Equally, lying on your tummy minimizes breathing because of weight of your body. Research has also shown that lying on your left side greatly reduces gastric reflux during sleep.
  • Try to keep your bedroom calm, and free from screens and backlit devices. You’re much more likely to get a good night’s sleep if your bedroom is a technology-free zone.
  • Check your control pause: By measuring your control pause before bed and again first thing in the morning, you can find out whether you are over-breathing during your sleep. If your control pause is lower in the morning, you have been mouth breathing or breathing too hard at night. If you regularly wake up with breathing difficulties during the night, try sleeping in an upright position. Set an alarm to wake you up every few hours. This will stop you from falling into a deep sleep where your breathing may become uncontrolled. each time the alarm sounds, measure your control pause and practice reduced breathing volume exercises. Once your breathing has calmed down, you can go back to sleep.
  • Avail of Patrick McKeown’s online clinic for insomnia, snoring and sleep apnea. Patrick teaches in small groups, explaining each exercise of the Buteyko Method and guiding all participants how to practice the Buteyko exercises. Click here to find out more.


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References:

1. Wikipedia contributors, “Insomnia,” Wikipedia, The Free Encyclopedia, https://en.wikipedia.org/w/index.php?title=Insomnia&oldid=940644398(accessed February 14, 2020).

2. Garbarino, Sergio, Nicola Magnavita, Ottavia Guglielmi, Michelangelo Maestri, Guglielmo Dini, Francesca Maria Bersi, Alessandra Toletone, Carlo Chiorri, and Paolo Durando. “Insomnia is associated with road accidents. Further evidence from a study on truck drivers.” PLoS one 12, no. 10 (2017).

3. Taylor, Daniel J., Kenneth L. Lichstein, H. Heith Durrence, Brant W. Reidel, and Andrew J. Bush. “Epidemiology of insomnia, depression, and anxiety.” Sleep 28, no. 11 (2005): 1457-1464.

4. “1 in 3 Adults Don’t Get Enough Sleep.” CDC Newsroom, Published February 18, 2016. https://www.cdc.gov/media/releases/2016/p0215-enough-sleep.html(accessed February 14, 2020).

5. Walsh, James K., Catherine Coulouvrat, Goeran Hajak, Matthew D. Lakoma, Maria Petukhova, Thomas Roth, Nancy A. Sampson et al. “Nighttime insomnia symptoms and perceived health in the America Insomnia Survey (AIS).” Sleep 34, no. 8 (2011): 997-1011.

6. Kalmbach, David A., Andrea S. Cuamatzi-Castelan, Christine V. Tonnu, Kieulinh Michelle Tran, Jason R. Anderson, Thomas Roth, and Christopher L. Drake. “Hyperarousal and sleep reactivity in insomnia: current insights.” Nature and science of sleep 10 (2018): 193.

7. Tefft, Brian C. Prevalence of motor vehicle crashes involving drowsy drivers, United States, 2009-2013. Washington, DC: AAA Foundation for Traffic Safety, 2014.

8. Daugherty, J., L. Hendricks, and Chris Simpson. “Sleep aids: sedative-hypnotic drugs in america.” In Natl Forum J Counsel Addict, vol. 3. 2014.

9. Kripke, Daniel F. “Mortality risk of hypnotics: strengths and limits of evidence.” Drug Safety 39, no. 2 (2016): 93-107.

10. Hafner, Marco, Martin Stepanek, Jirka Taylor, Wendy M. Troxel, and Christian Van Stolk. “Why sleep matters—the economic costs of insufficient sleep: a cross-country comparative analysis.” Rand health quarterly 6, no. 4 (2017).

11. Jerath, Ravinder, Connor Beveridge, and Vernon A. Barnes. “Self-regulation of breathing as an adjunctive treatment of insomnia.” Frontiers in psychiatry 9 (2019): 780.

12. Pigeon, Wilfred R., and Michael J. Sateia. “Is insomnia a breathing disorder?.” (2012): 1589-1590.

13. Wikipedia contributors, “Upper airway resistance syndrome,” Wikipedia, The Free Encyclopedia, https://en.wikipedia.org/w/index.php?title=Upper_airway_resistance_syndrome&oldid=937395499 (accessed February 14, 2020).

14. Krakow, Barry, Edward Romero, Victor A. Ulibarri, and Shara Kikta. “Prospective assessment of nocturnal awakenings in a case series of treatment-seeking chronic insomnia patients: a pilot study of subjective and objective causes.” Sleep 35, no. 12 (2012): 1685-1692.

15. Guilleminault, Christian, Kala Davis, and Nelly T. Huynh. “Prospective randomized study of patients with insomnia and mild sleep disordered breathing.” Sleep 31, no. 11 (2008): 1527-1533.

16. Bertisch, Suzanne M., Rebecca Erwin Wells, Michael T. Smith, and Ellen P. McCarthy. “Use of relaxation techniques and complementary and alternative medicine by American adults with insomnia symptoms: results from a national survey.” Journal of Clinical Sleep Medicine 8, no. 06 (2012): 681-691.

17. Schäfer, Carsten, Michael G. Rosenblum, Jürgen Kurths, and Hans-Henning Abel. “Heartbeat synchronized with ventilation.” nature 392, no. 6673 (1998): 239-240.

18. Jerath, Ravinder, Kyler Harden, Molly Crawford, Vernon A. Barnes, and Mike Jensen. “Role of cardiorespiratory synchronization and sleep physiology: effects on membrane potential in the restorative functions of sleep.” Sleep medicine 15, no. 3 (2014): 279-288.

19. Tsai, H. J., Terry BJ Kuo, Guo‐She Lee, and Cheryl CH Yang. “Efficacy of paced breathing for insomnia: enhances vagal activity and improves sleep quality.” Psychophysiology 52, no. 3 (2015): 388-396.

20. Heck, Detlef H., Samuel S. McAfee, Yu Liu, Abbas Babajani-Feremi, Roozbeh Rezaie, Walter J. Freeman, James W. Wheless et al. “Breathing as a fundamental rhythm of brain function.” Frontiers in neural circuits10 (2017): 115.

21. Bušek, P., and D. Kemlink. “The influence of the respiratory cycle on the EEG.” Physiol Res 54 (2005): 327-33.