All together now: Breathe in, breathe out. Breathing is life’s greatest autopilot. Thankfully, it just happens and we don’t have to think about it. However, when we are stressed or upset, our breathing changes, and many times we are not even aware of it. Our cortisol level shoots up and causes our muscles to tense and constrict, leading to shallower breaths. Those short and shallow breaths do not come from the diaphragm, which is the most beneficial form of breathing for overall wellness. Practicing slow, deep breaths can help lower a racing heart and melt inflammation-promoting stress into calm.
There are two complaints I hear from dental hygienists.. One is that they are sweating their tushes off, which I have no help for, and the other is that they are not able to breathe properly. The term for shortness of breath, labored breathing, or “air hunger” is called dyspnea. One of the signs of dyspnea is feeling like you cannot take in enough air, which is clearly happening with the many masks RDHs are wearing.
But there may be a solution for getting better quality breathing. It is interesting that one of the main tricks to help reduce air hunger is to reduce stress and improve your surrounding air quality and flow. Whether you are in the operatory, break room, driving home, or getting ready to sleep, here are some breathing techniques that may help with the stress component of air hunger.
One simple way to help with stress and perhaps help with dyspnea is pursed lip breathing.
There may be a benefit to those “fish lips” that selfie girls like to post on their Insta feeds, if you are breathing during it. Pursed lips allow you to control your oxygenation and ventilation. Breathe in through your nose and breathe out through your mouth in a controlled slow flow. Taking longer exhalations stimulates the autonomic nervous system and promotes relaxation.1 Take a normal breath for two counts; then pucker and exhale for four. Try a few rounds and see if you feel that you are getting more air and taking the edge off of stress.
Diaphragmatic breathing, or belly breathing, is the master of breathing exercises. You breathe through your nose and focus on how your belly fills up with air. When I started this technique, it was counterintuitive because I have always tried to suck in my gut. You can do this sitting up or lying down and feel the air expand your tummy. Then breathe out slowly through your pursed lips. The goal is to feel like you are pushing an object with your abdomen while inhaling deeply with the diaphragm. Some of the benefits include:
- Relieves stress: Stimulates the parasympathetic nervous system while increasing feelings of relaxation
- Supplies more oxygen: Encourages full oxygen exchange—the beneficial trade of incoming oxygen for outgoing carbon dioxide
- Lowers blood pressure: During diaphragmatic breathing, the amount of oxygen carried by the air may be doubled. The oxygen supply to the blood increases, allowing improved blood circulation, which affects blood pressure
- Improves concentration: Taking in lots of oxygen to be circulated in the brain improves focus and also increases blood flow to the prefrontal cortex of the brain. The prefrontal cortex is the part of the brain attributed to complex behaviors such as planning and thinking
- Increases lung capacity: Consciously exercising the diaphragm can stretch it further down toward the belly, which gives the lungs more space to expand. Actors, singers, and athletes practice this type of breathing regularly in order for it to become habitual and improve performance
- Detoxes our bodies: By supplying more oxygen to our cells and stimulating blood flow, we gently cleanse our bodies
Dr. Andrew Weil developed a popular breathing technique based on a yoga practice called pranayama that helps you gain control over your breathing. This is a practice for relaxation that can be done during the day and can also be used to help you fall asleep. It is designed to bring a state of relaxation, allowing the body to replenish its oxygen. Put your tongue on the incisive papilla. Breathe in four counts, hold for seven, and breathe out for eight. Keep your lips closed on the inhale and hold; then, on the exhale, open the lips a tad or purse them and make a whooshing sound as you exhale. The most important part is the hold for seven counts.
It is recommended that when you start the practice, do four rounds only for a month and work up to a maximum of eight cycles a day. Dr. Weil recommends doing this twice a day and increase the number of cycles after a month, limiting the number of cycles to eight. Results can be noticed in about six weeks. He finds that patients have improved digestion and lowered heart rate and blood pressure. He sees this as the first line of defense for anxiety. This YouTube video explains it in detail: https://youtu.be/p8fjYPC-k2k
Alternate nostril breathing
When you try to refocus in a hectic situation, a yogic breath control practice called nadi shodhana pranayama (alternate nostril breathing) may be a way to solve stress.6 I laugh when I hear this because a great friend of mine went through a tough divorce and had a coach recommend this when she was about to throttle her ex. You use your finger and thumb and alternately inhale on one side while the other is blocked. It works like this: You inhale with one nostril for four beats, hold for four, and exhale for four. To help with counting, you can use a mantra such as “sa ta na ma.”
Jaw release—modified lion’s breath
I think this could be one of the best stress releases yet! It can be performed in any comfortable position, whether seated or standing. Take a deep breath through the nose, filling up the diaphragm. At the peak of inhalation, forcefully exhale from the back of the throat while extending the tongue from the mouth and rolling eyes upwards. You will be stretching your jaw with a long “ha” sound. Think about it—a fierce lionlike expression along with a roaring sound of breath in the middle of your office! (Maybe do this one in the break room.) This technique stretches muscles and stimulates the nerves in the face, relieving tension and improving circulation. Repeat for several breaths.
There is no doubt that forms of face protection including masks and shields are confining, claustrophobic, and can cause undue stress for the clinician. Headaches, dizziness, and shortness of breath are a few of the many symptoms reported when using respirators and N95 masks. The moments when masks can come off between patients, at lunch, or after work can be used to great advantage by using simple breathing techniques, which may make the day a little less stressful.
- Bergland C. Longer exhalations are an easy way to hack your vagus nerve. Psychology Today. May 9, 2019, https://www.psychologytoday.com/us/blog/the-athletes-way/201905/longer-exhalations-are-easy-way-hack-your-vagus-nerve
- Steffen PR, Austin T, DeBarros A, Brown T. The impact of resonance frequency breathing on measures of heart rate variability, blood pressure, and mood. Front Public Health. 2017;5:222. doi:10.3389/fpubh.2017.0022
- Nidich SI, Rainforth MV, Haaga DA, et al. A randomized controlled trial on effects of the Transcendental Meditation program on blood pressure, psychological distress, and coping in young adults. Am J Hypertens. 2009;22(12):1326-1331. doi:10.1038/ajh.2009.184
- Yong MS, Lee HY, Lee YS. Effects of diaphragm breathing exercise and feedback breathing exercise on pulmonary function in healthy adults. J Phys Ther Sci. 2017;29(1):85-87. doi:10.1589/jpts.29.85
- Chen YF, Huang XY, Chien CH, Cheng JF. The effectiveness of diaphragmatic breathing relaxation training for reducing anxiety. Perspect Psychiatr Care. 2017;53(4):329-336. doi:10.1111/ppc.12184
- Cronkelton E. What are the benefits and risks of alternate nostril breathing? Healthline. Updated July 9, 2018. https://www.healthline.com/health/alternate-nostril-breathing
Anne O. Rice, BS, RDH, CDP, FAAOSH, graduated from Wichita State University, and then continued her studies and earned a bachelor’s degree in oral health promotion. She is a graduate of the BaleDoneen Preceptorship course for cardiovascular disease prevention for health-care practitioners. After almost 30 years of clinical care, she founded Oral Systemic Seminars and is passionate about educating the community on modifiable risk factors for dementia and its relationship to dentistry. In 2020, Anne became a Fellow with the American Academy of Oral Systemic Health and a Certified Dementia Practitioner. Please reach out to Anne at www.anneorice.com.