With good breathing, the air traveling through the trachea reaches a wider area in the lungs (top and bottom) where it is distributed to the alveolis. Shallow breathing, by contrast, draws minimal breath to the chest area, which means that the air will mainly reach the upper part (apex) of both lungs.

When we take shallow breaths, we have shorter inhalations and exhalations, albeit at an equal cadence (shortness of breath by contrast indicates shorter inhalations than exhalations), and as a result the air is concentrated at the top of the lungs.

Ventilation (gas exchange: O2 in, Co2 out) is greater at the base of the lungs than at the apex for two main reasons. First, alveolis are less expanded (smaller volume) which makes them more distensible and therefore capable of more oxygen exchange. Second, gravity facilitates increased blood flow at the base because it is pulling blood down towards the base.

So, for efficient ventilation the air should end up in the lower parts of the lungs. If you take shallow breaths, you are forced to compensate by taking more breaths per minute, because you are using the wrong muscles.

Chest muscles were not designed for breathing, your diaphragm is the only breathing muscle and the most effective one at that.

If the diaphragm is under-used, it will become tense and weakened, the effects of which will be obvious during exercise as you get frequent side stitches or get tired quickly.


Powers KA, Dhamoon AS. Physiology, Pulmonary Ventilation and Perfusion. [Updated 2021 Aug 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:

Singh UP (2018) Chronic Hyperventilation: Hypocapnia and Psychophysiological Dysregulation . Psych Clin Ther J 1: 104





The goal is to extend the exhale and squeeze the air out.

1-Sit comfortably with relaxed neck and shoulder muscles

2- Breathe in slowly through your nose

3- Purse your lips and exhale slowly through your mouth


Press your lips together making an “sss” sound

4- Repeat as often as possible and practice as frequently as possible until you notice a change in your breathing pattern



Research shows that at rest breathing patterns are influenced by auditory and visual stimuli as well as emotional affects. Termed “ventilation personality”, those breathing patterns vary from one person to the next and they are repeated over long periods of time.

Notably, breathing patterns in anxiety present irregularities, especially when it concerns respiratory rates (i.e., how many breaths per minutes). For example, this study reports significant changes in the respiratory rates of individuals with anxiety that differ according to the type of anxiety and the type of action performed.

More specifically during physical exercise, the respiratory rates are greatly influenced by state anxiety (i.e., temporary anxiety) but not trait anxiety (i.e., chronic anxiety). Indeed, trait anxiety causes changes in breathing rates during a mental task.

Incidentally, the latter results align with some of the symptoms of testing anxiety, namely shortness of breath.

Furthermore, another distinct breathing pattern associated with anxiety involves expiratory time (i.e., length of expiration). The time it takes to expel one’s breath is in fact influenced by individual anxiety levels, and for example expirations are typically shorter when there is an increase in anxiety.


Masaoka, Y., & Homma, I. (1999). Expiratory time determined by individual anxiety levels in humans. Journal of applied physiology, 86 4, 1329-36 .



It is a mode of breathing that occurs at rest and does not require the cognitive thought of the individual. During eupnea, also referred to as quiet breathing, the diaphragm and external intercostals must contract

It is a mode of breathing that occurs during exercise or actions that require the active manipulation of breathing, such as singing. During hyperpnea, also known as forced breathing, inspiration and expiration both occur due to muscle contractions.

In addition to the contraction of the diaphragm and intercostal muscles, other accessory muscles must also contract: During forced inspiration, muscles of the neck, including the scalenes, contract and lift the thoracic wall, increasing lung volume. During forced expiration, accessory muscles of the abdomen, including the obliques, contract, forcing abdominal organs upward against the diaphragm. This helps to push the diaphragm further into the thorax, pushing more air out. In addition, accessory muscles (primarily the internal intercostals) help to compress the rib cage, which also reduces the volume of the thoracic cavity

It is a mode of breathing that requires the diaphragm to contract. As the diaphragm relaxes, air passively leaves the lungs. This type of breathing is also known as deep breathing. It is also known as natural breathing as when babies are born, they display that type of breathing (you can see their belly go up and down).

It is a mode of breathing that requires contraction of the intercostal muscles. As the intercostal muscles relax, air passively leaves the lungs. This type of breathing is also known as shallow breathing and it is the breathing style of anxiety.



Previous investigations have suggested that hyperventilation is not a precursor to panic attacks but rather a characteristic feature of them. This led researchers to consider the idea that individuals with panic disorders might have a biological hypersensitivity to carbon dioxide (CO2). This notion is further supported by their tendency to sigh, attempting to maintain CO2 blood levels below the threshold that triggers panic attacks. To delve deeper into the connection between hyperventilation and panic attacks, a recent study looked into the respiratory patterns of individuals with panic disorders during sleep, comparing them to those of healthy subjects.

The findings of this study align with an earlier hypothesis put forth by Klein D.F., predicting that individuals with panic disorders would display irregular breathing not only during wakefulness but also during sleep. Indeed, the study reveals that a significant number of participants experiencing panic attacks exhibited more frequent brief micro-apneas, which are short pauses in breathing during sleep. Intriguingly, these episodes occurred at a time when anxiety is presumed to be at its lowest—during sleep.

To simplify, let’s break down the key points:

  • Hyperventilation and Panic Attacks: Some people believed that hyperventilation might cause panic attacks, but evidence suggests it’s actually a feature of panic attacks.

  • Biological Hypersensitivity to CO2: Individuals with panic disorders may have a heightened sensitivity to carbon dioxide. They often sigh to keep CO2 levels in their blood below the threshold that triggers panic attacks.

  • Micro-apneas During Sleep: The research found that many panic participants experienced brief pauses in breathing (micro-apneas) during sleep. Interestingly, these episodes occurred when anxiety levels are assumed to be lowest—during sleep.

In essence, this study delves into the breathing patterns of individuals with panic disorders, shedding light on how their respiration behaves during sleep. This information contributes to our understanding of the complex relationship between breathing irregularities and panic attacks.


Stein, M. B., Millar, T. W., Larsen, D. K., & Kryger, M. H. (




      • Anterior placement (back) of the tongue indicates fear

      • Pushing the tongue against the roof of the mouth helps silence the verbal mind chatter

      • Proper positioning of the tongue is where the tongue rests at the top of the mouth sitting ½ inch behind the front teeth. Entire tongue should be pressing against the roof of the mouth (including the back of the tongue), lips should be sealed and teeth rest slightly apart.

      • Your tongue should be resting entirely on the palate, your lips together, and your breathing should be through the nose 95-100% of the time



    During respiration, the hyoid bone moves in a craniocaudal direction, due to the action of the extrinsic muscles of the tongue, causing the pharyngeal space to dilate. In general, the anterior part of tongue is considered important for non-respiratory activities, while the posterior part is important for respiration.

    Al l the tongue muscles, extrinsic and intrinsic muscle groups, always work synergistically and not separately. The tonus of those muscles must be well-balanced; otherwise dysfunction can occur, resulting in an alteration in the position of the hyoid bone and the functionality of the tongue.

    The tongue position influences the body. If the tongue is positioned against the palate, the parasympathetic system will reduce it systemic activity (for ex., heartbeats and respiratory rhythm increase), but if positioned against the soft palate, the sympathetic system will reduce its activity.

    Tongue movement, generally postero-lateral activate the anterior Cingulate Cortex (ACC), which plays an important role in the sensory, cognitive, and emotional information and pain processing. ACC is often concerned with visceral sensations.

    The tongue has control on the posture, thanks to its greater tactile sensitivity than the finger.

    The tongue position and its voluntary and involuntary strength might vary with lung volume. Changes in the tracheal traction at different lung volumes may alter the mechanics of the tongue muscles and their ability to produce protrusion force, and these changes in the lung volume alter tension transferred through the trachea to the hyoid arch.

    Tonic tongue muscle activity and movements related to spontaneous respiration increase significantly in the supine position with respect to the upright position.



    The upper airway can collapse at one or multiple sites: the pharyngeal structures that can contribute to airway crowding and collapse include the genioglossus, soft palate, lateral pharyngeal walls, and epiglottis.

    The human pharynx is vulnerable to collapse during sleep. There are 20 muscles in the upper airway that are involved in respiratory and non respiratory tasks. A subset of these muscles play a predominant role in airway stability during breathing.

    Activation of the upper airway dilator muscles is effective in opposing the collapsing pressures generated during inspiration. However, during sleep, state-dependent reduction in muscle activity combined with anatomical susceptibility can induce airway collapse.

    The genioglossus, the largest pharyngeal dilator muscle, receives up to 6 different patterns of drive, the summation of which typically results in activation of the muscle. But its activity is reduced during sleep, unlike the tensor palatine muscle (palatal muscle) that is active throughout the breathing cycle.

    Activation alone of the genioglossus is not sufficient to re-open the airway, which goes to show that the involvement of all the upper airway muscles is required for breathing.




    Practice for 5 minutes at the minimum, but for better results 15-20 min. You may practice several times in a day, in the morning, at midday and before bed.

    • First withdraw the tongue a little and the relax so it stays naturally inside the mouth cavity, and is not pointing towards the roof of the mouth.

    • When we curl the tongue up towards the roof of the mouth, we need to exert an intention to do so, the effort results in activating the sympathetic nervous system.

    • We withdraw the tip of the tongue a little and relax it. In so doing, the tongue rests naturally inside the mouth cavity without touching anything, neither the teeth nor the bottom of the mouth.

    • Sit with back straight (2 ears above the shoulders), head straight (tip of the nose aligned with navel), eyes half closed looking down at a spot about 2 to 3 hand spans in front of us) – eyes closed could lead to sleepiness and eyes wide open could lead to straining the eyes  – and body relaxed. Lips are naturally closed and teeth are slightly open, not clenched.

    • If practicing correctly, saliva is secreted as a result f the parasympathetic system being activated. If incorrectly practiced, or if angry or tense, the sympathetic system will be activated and inhibit saliva secretion, resulting in dry mouth.

    • Tongue root tension will crowd and constrict your throat. The tongue via the hyoid bone is connected directly to the larynx.

    • Tongue stretcher: stick tongue out, grab it with tissue and gently draw it down to the chin. Relax your mouth, jaw and tongue. Repeat three times. This exercise is best for resting or chronic tension (as in anxiety).





    True: Under normal conditions, the air we breathe is 21% oxygen (O2), 78% nitrogen (N), 0.04 % carbon dioxide (C02) and other gazes such as hydrogen.

    False: Under normal circumstances, the oxygen supply is always ample in nature, and therefore the body’s need for it is slight. Carbon dioxide is what significantly drives respiration.

    False: The process of muscular contraction in vertebrates (includes humans and animals with backbones) is actually anaerobic, which means it does not require oxygen.

    False: Co2 is in fact more fundamental to life than oxygen. It helps maintain blood acidity, controls respiration, and influences the heart and blood circulation.

    True: O2 is carried by hemoglobin and Co2 is combined with alkali in the plasma. As a result a blood sample can have as much O2 as Co2 or as little Co2 as O2.

    True: Co2 improves the oxygenation of the blood and tissues. O2 is necessary for the conversion of lactic acid into carbon dioxide.

    True (partially): If there is enough or too much Co2 in the blood, we automatically cease to breathe (or breathe slowly) if at the same time the amount of Co2 available is deficient.

    True: According to the “Hering and Breuer” reflex, each expiratory deflation of the lungs stimulates the diaphragm and other respiratory muscles to induce inspiration. Inspiration and expiration are reflexes controlled exclusively by the nervous system (we cannot control that). A good illustration of this reflex is our inability to stop ourselves from inhaling and exhaling after holding our breath.

    True: Whenever blood acidity is to high or too low (normal blood acidity or pH is between 7.35 and 7.45), respiratory adjustments take place. If it is too low, there is an increase in respiration; if it is too high, there is a decrease in respiration

    False: The volume of breathing necessary during respiratory adjustments(increased breathing or decreased breathing) depends on the depth of breathing not the rate.

    False: Breathing is regulated by the carbon dioxide (or carbonic acid) produced in the muscles and organs and carried by the blood to the respiratory center in the brain. Co2 is what stimulates this center.

    False: Excessive breathing is induced by O2 deficiency in the blood exerting an abnormal and excessive action on the respiratory center. Excessive breathing is then triggered which in turn depletes the body’s store of Co2

    False: A healthy person with anxiety experiences a panic attack because of low levels of carbon dioxide in the blood.

    True: When anxious, we tend to have irregular breathing patterns, the degree of which depends on the level of anxiety. Typically, we tend to overbreathe or hyperventilate, which means that we may take between 18 to 20 breaths per minute (normal breathing rate is 12 to 18 breaths/min), sometimes rising to 30 breaths per minute, which may results in a panic attack.

    True: When hyperventilating, we use the chest muscles, often putting a strain on it, which may lead to chest pain. Chest breathing is erratic, shallow, and uncomfortable, because you only get partial ventilation in the lungs. Exhaling in this case is often forced and noisy, and sighing and yawning are frequent.

    True: Ventilation refers to the gas exchange that takes place in the lungs where oxygen is added to the blood by bonding to hemoglobin and transported to other organs in the body. However, in order for the oxygen to be released from the hemoglobin, carbon dioxide must be present. During hyperventilation, more oxygen is taken in than the body needs and too much carbon dioxide is being removed from the body, as a result not enough oxygen is actually delivered to the organs and the low levels of carbon dioxide further trigger increased respiration.

    True: Diaphragmatic breathing is how babies breathe, which means it is the natural way of breathing.

    True: If you are having a panic attack, get a large paper bag (don’t use plastic), scrunch the top of it, and breathe fully into it. Re-breathe the air in the bag in and out several times until you feel better. This will bring the carbon dioxide levels back up. Then, try to lean forward over a table with your elbows on your knees.