Valsalva Maneuver Helping With My Breathing And Chest Pain

[RichGotsPots]

As many of you know I have breathing problems that are scary. Only 3 things have helped so far.

1. drinking water (a gallon)

2. putting my legs up

3. wearing tight compression socks

Now I have have a 4th thing that helps.

4. Breathing in by restricting my my nostrils with my upper lip. This allows less air to go in and hurts my chest less than inhaling normally. Then I exhale with my with my mouth closed pushing the pressure back into my chest for 5-10 seconds. Then I blow the air out through pursed lips.

I relive this isn't exactly the Valsalva Maneuver but it's similar and I'm wondering why it works.

Anyone else try this and get positive results for their breathing issues?

I'm aware many people get this test for their autonomic testing but please don't post about the valsalva maneuver if it doesn't have to do with breathing problems.

I don't think this is related to hyperventilation because I don't breath fast at all, but this technique does slow down my breathing, which is what they recommend to correct that. But if I wanted to I couldn't slow breath the regular way because it hurts my chest..

I'm wondering if the autonomic changes this maneuver can cause are actually having a positive affect for me changing my blood flow..

[RichGotsPots]

Going to see my pulm in a few weeks to do pulm exercise test and get PFT results. I want to see if he finds end tidal co2 levels decreased, then maybe I'll believe I have hyperventilation....

[corina]

hope you'll get some answers rich!

[RichGotsPots]

I just read that "Pulmonary vascular resistance would also increase during a Valsalva maneuver"

wondering if this resistance is what is helping me... I may try PAP- positive air pressure devices if my pulm doc approves

[RichGotsPots]

also, "Valsalva maneuver: An attempt to forcibly exhale with the glottis, nose, and mouth closed.

This maneuver causes increased intrathoracic pressure, decreased heart rate, decreased return

of blood to the heart, and increased venous pressure. Intraabdominal pressure is also increased

(facilitates bowel movements). If the Eustachian tubes are not obstructed, the pressure on the

tympanic membranes also will be increased (used to clear ears with altitude change"

[abnel]

Thanks for posting this Rich. I don't understand why "pursed lip" breathing works either for some patients, but I do know it is recommended by some physicians for patients who have Chronic Pulmonory Obstructive Disorder and Emphysema. I actually intended to do this to see if it improved my breathing but never persisted.

how many times a day do you practise it Rich? Some say COPD patients should practise 10 times lying down, then progress to sitting, then to standing.

In what way has it helped your breathing? Do you feel you can take a deeper breath throughout the day and the obstruction in your breathing is going away, or, do you feel your breathing is becoming more automatic?

Thanks so much for posting. This is really interesting and positive.

[RichGotsPots]

It's been a big help in controlling the chest pressure I feel, that makes my breathing worse. I don't feel cured at all yet. But maybe if we have some kind of hyperventilation it's working on that level. They recommend to do slow breathing for 5 minutes twice each day. They say to slowly breath in 7 seconds then out 11 seconds. Eventually the inhalations can be reduced to 4 seconds.

I personally feel its the pressure that is having the impact and not the slowness of the breathing. When I breath out like I described I'm causing a pressure in my chest, then slowly releasing it. I either want to buy a Positive Air Pressure machine like they use for sleep apnea or a respiratory trainer they use to do Buteyko breathing. Plus I may take a Buteyko class to see the techniques.

I still need to find out if I have orthostatic hypocapnia as Dr Stewart describes. If I do then I'll start looking into why and how it can be corrected quickly.. I'm encouraged by some positive experiences people had with there CPAP devices for sleep apnea. Possibly those devices are helping to retrain their breathing or curbing their hyocapnia (low CO2 levels).

[bellgirl]

Rich, I think you are on to something here. Could you be having blood pooling in your lungs, which makes it hard to breath? I have had the chest pain you are talking about, and I notice it more in the evening when my blood pressure is lower, hence blood pooling, which makes it harder to breathe. When I coughed up a lot of blood that time after running with my dog a short distance, in 2004, it was in the evening, and I wasn't paying attention to how I was breathing (before my diagnosis, before a lot of other symptoms). It could have been blood pooling then, that I was unaware of at the time, which made it harder to breathe, together with a bronchospasm due to my asthma. The doctors never had an explanation that made any sense, bronchitis?!...I don't think so...My chest pain doesn't seem to be as bad with my Cpap for my apnea...maybe it is because I'm increasing my tidal volume, causing better perfusion and oxygenation to my lungs!! I tend to hold my breath without thinking sometimes, too. Wonder whether it could be compensatory. Thanks for the idea

[abnel]

I just realised that the kind of pursed lip breathing you are doing Rich is somewhat different to what I've seen recommended for COPD and Emphysema patients. What I've seen recommended is pursed lip breathing by creating resistance on the inhalation and then unrestricted exhalation. I believe that is what some of the impedance devices also do. Gaiam sells one online.

I actually tried this and is seemed to help me a little, but both my respiratory physician and POTS specialist told me not to bother, so I felt quite discouraged afterwards. I've also noticed that if I'm having a hard time walking up stairs, if I suck in the air by creating resistance, whether through pursed lips or any other way, it helps with my dizziness and shortness of breath. I just do it automatically and only noticed I was doing it after the event.

I don't believe POTS patients are the author of their own misfortune in having shortness of breath by unconsciously breathing incorrectly (which is I think what Buteyko would have us believe). I think the reason our breathing is too shallow, too deep, too fast, etc, is for reasons that have yet to be fully understood. That said, if you decide to try Buteyko, please keep us posted on how you go.

I only noticed really bad breathing issues 18 months into POTS after drinking litres of V8 on a daily basis. All of a sudden I had what felt like obstructed breathing which I'd never had before and couldn't take a deep breath. No asthma was diagnosed but my shortness of breath just got progressively worse after a long, humid summer. The mast cell meds I am on have helped so far. Was SOB one of your first POTS symptoms Rich?

[RichGotsPots]

I just realised that the kind of pursed lip breathing you are doing Rich is somewhat different to what I've seen recommended for COPD and Emphysema patients. What I've seen recommended is pursed lip breathing by creating resistance on the inhalation and then unrestricted exhalation. I believe that is what some of the impedance devices also do. Gaiam sells one online.

That makes sense because Hypocapnia is the opposite of the COPD and Emphysema which presents as Hypercapnia. Hypocapnia usually happens because of hyperventilation. The respiratory rate in Dr. Stewart's testing stayed the same during tilt for none hypocapnia POTS patients, the control group and hypocapnia POTS patients so Dr. Stewart says it's hyperpnea.

"Hyperpnea is increased depth of breathing when required to meet metabolic demand of body tissues, such as during or following exercise, or when the body lacks oxygen (hypoxia), for instance in high altitude or as a result of anemia." (wikipedia)

So if it's not hyperventilation that is rapid breathing but more of a deep breathing, I'm not sure why my breathing technique unless it just helps with the pressure and with changing the hypocapnia increasing the CO2...

More studying needs to be done on our breathing..

[Lemons2lemonade]

Rich, have you ever had a chest ct scan?

[RichGotsPots]

Rich, I think you are on to something here. Could you be having blood pooling in your lungs, which makes it hard to breath? I have had the chest pain you are talking about, and I notice it more in the evening when my blood pressure is lower, hence blood pooling, which makes it harder to breathe. When I coughed up a lot of blood that time after running with my dog a short distance, in 2004, it was in the evening, and I wasn't paying attention to how I was breathing (before my diagnosis, before a lot of other symptoms). It could have been blood pooling then, that I was unaware of at the time, which made it harder to breathe, together with a bronchospasm due to my asthma. The doctors never had an explanation that made any sense, bronchitis?!...I don't think so...My chest pain doesn't seem to be as bad with my Cpap for my apnea...maybe it is because I'm increasing my tidal volume, causing better perfusion and oxygenation to my lungs!! I tend to hold my breath without thinking sometimes, too. Wonder whether it could be compensatory. Thanks for the idea

You're welcome :-) You are just one of many people who have mentioned Cpap helping their daytime breathing and do think it helping with perfusion. I don't know the mechanism exactly yet. It might be the pressure, the retraining, oxygenation, the increase in CO2.... it may be the hypocapnia (Low CO2) causes an increase in vasodilation of pulmonary vascular blood vessels leading to hypervolemia in the lungs rather than hypovolemia (pooling) int he lungs. Possibly the increase in CO2 and O2 leads to better pulmonary vascular resistance.

If we had pooling I think there might be an edema in lungs from it that would show up on scans or xrays.. But my leg pooling experience is that I don't get edema's in my legs even when pooling. I can only guess it is because my whole body has less volume to pooling just fills my legs from their reduced volume to a normal volume. And when I pool my feet ache, so maybe I get that same ache in my chest. Just wish there was somewhere I could go to figure this out, it's frustrating..

[RichGotsPots]

Rich, have you ever had a chest ct scan?

Yes, both a CT scan without contrast and VQ/perfusion lung scan both came back normal.. I'm really surprised by the normal perfusion scan, but I was laying down for it and I think I should have also taken it standing up...

[RichGotsPots]

I just tested my HR and O2 level with my pulseOX (which I haven't used in a few weeks) and while I do the above mentioned breathing exercise my O2 level stays constant but my HR drops for 3-5 seconds while I exhale. It drops from 93 to 77 bpm.... Maybe that's normal just thought I'd mention it..

[anna]

Rich have you looked at Dr.Diana Driscoll's theory yet?! While at the moment I do not agree with this being the cause of my ANS dysfunction, many have found her protocol very helpful.

[bellgirl]

Rich, I also think my singing in the choir helps with this, too! Even though after singing on Sunday, my Mondays, I'm totally wiped out!! But in the long run it helps. Yesterday's "Unto the Lamb" was very taxing to sing, (I was shaking like a leaf), but it was Awesome, and a privilege to be a part of this worship!! There are several choirs that sing it on you tube...listen and you will be blessed:o). I'll look into Dr. Diana Driscoll's theory, thanks Anna