A Breath Spa? Quis-quis. What-E-ver. Attitude before platitudes.
Long ago, in a Latin class, by way of distracting us from the endless rote learning of verb conjugations, my teacher introduced us to an early TLA, the spa, or sanitas per aqua
. Said Latin teacher also had a cough that made the average classroom into a Sensurround
version of any disaster film that involves shaking, quaking, and the sudden appearance of vast fissures in the ground. That was the first time that I wondered if it was possible to have a breath spa: spiritus per anima or sanare per anima.
I remembered this experience the first time that I wondered whether breathing re-training could help children to correct disordered breathing and to improve their physical, mental and emotional wellbeing.
The way that children breathe can have a significant impact on their health. Conditions such as asthma are familiar to us: throughout the UK, an estimated 1 in 10 children has this condition. However, a lot of research reports that disordered breathing is also found in a number of other less obvious conditions. This raises the interesting question as to whether disordered breathing contributes to a number of physical, cognitive, emotional and behavioural disorders, or whether it is an epiphenomenon
and no more than an interesting feature that occurs independently but is of no clinical significance.
Children’s sleep can be disrupted by irregular breathing patterns causing a condition known as sleep-disordered breathing (SDB). One of the main signs is frequent snoring: around 10% of children snore habitually and would be classified as having SDB.
SDB can also involve hundreds of episodes during the night where the breathing stops for brief periods and the child jolts awake to start breathing again: the estimate for children affected by this is 1%.
Like many other habits, breathing patterns are often learned unconsciously. Simple breathing exercises and techniques can break these patterns and reduce the symptoms of disordered breathing in both adults and children. Practising the exercises restores healthy breathing habits. I am interested to learn whether for some children, restoring healthy breathing habits can reduce SDB sufficiently to help bring the benefits of refreshing sleep. Beyond that, I would hope to offer some findings that would contribute to a discussion about whether SDB is an epiphenomenon or sometimes, a clinically significant finding.
Research has linked SDB to:
Snoring is so common among children that it was thought to have no ill effects for them. Recently, however, research links SDB in children to how they perform at school and how they behave [1-3]. The same research links SDB to Attention Deficit Disorder. SDB has been shown to cause problems in later life such as raised blood pressure, obesity, diabetes and heart disease [4-6].
SDB & impaired thinking
Because of the disruption to the breathing, one of the features of SDB can be a significant drop in oxygen levels, known as hypoxia. Research indicates 71 ways in which hypoxia can adversely affect the well-being of children . These include impaired thinking and difficulty in performing tasks that involve planning or problem-solving .
SDB and educational performance
A study of primary school children  revealed a significant link between regular snoring and hyperactivity, a lack of attention, poor behaviour and difficulties with friends. It also found that the children who were snoring were more likely to feel tired and sleepy during the day and were more likely to under perform at school.
Lower oxygen levels in children have been shown to reduce their IQ scores by as much as 8-9 points [8-10]. One study found that IQ was 12 points lower in children who snored . This affect on IQ is attributed to a general impact on the body of lower oxygen levels and snoring. The most noticeable signs of this range from feeling tired during the day to physical changes that can subtly or dramatically affect a child’s health.
Inattentive behaviour is one of the most frequently reported features of SDB ; it affects both memory capacity and intelligence. Children can not work to their full potential when their concentration is reduced. The children can not be taught to their true level and thus they underperform: this effect is cumulative throughout their educational career.
SDB, Hyperactive Behaviour and Attention Deficit Hyperactivity Disorder (ADHD)
Research links snoring and symptoms of hyperactive behaviour (HB)  or Attention Deficit Hyperactivity Disorder (ADHD) [11-13]. The conditions are a combination of behaviours: inattention, impulsiveness, outbursts such as tantrums, over-activity, restlessness, poor co-ordination and social difficulties. Hyperactive-inattentive behaviour is common among children who snore frequently [1, 19]. Some researchers argue that it is possible that some children with SDB are mis-diagnosed with HB or ADHD because of a similarity in the symptoms (estimates range from 15% to 39% depending on the demographics of the group under consideration ). One study analysed children’s breathing during sleep, and assessed their educational performance and behaviour. In a follow-up one year later, those children who no longer snored frequently showed improved behaviour. The report concludes that:
Habitual snoring was common among these primary school children and was associated with hyperactive and inattentive behavior and daytime tiredness and sleepiness...Considering its high prevalence and assuming a causal link to disturbed behavior, habitual snoring seems to be a substantial public health problem in school-aged children. (my emphasis) 
SDB and health in later life
A recent review highlights the potential link between SDB and chronic health conditions in later life (e.g., diabetes and heart disease) .
The physical changes caused by SDB are thought to lead to raised levels of blood sugar and cholesterol. The disturbed sleep pattern and hypoxia associated with SDB may also be involved in a chain of physical reactions that contribute to later cardiovascular, cognitive and behavioural problems .
SDB & Sleep Apnoea
Obstructive sleep apnoea (OSA) is a serious form of SDB where the sleeper can stop breathing several hundred times a night. OSA is less common in children than adults but the statistics are increasing because of contributory lifestyle factors such as obesity and lack of exercise. At least a third of children with severe OSA show significant physical or behavioural disorders [16-18]. OSA has related secondary symptoms that include morning headaches, blood pressure fluctuations, weight gain, heartburn and insomnia.
SDB And Sleep Assessments
SDB in children is reportedly underdiagnosed in general practice . In a survey of children attending a general practice, 18% were frequent snorers, and 0.6 to 5% not only snored, but displayed at least one other symptom of OSA. Sometimes, parents don't know whether their children snore, particularly if a child doesn't share a room. Or, it may be that everyone in the family snores habitually, and snoring is considered a normal part of sleep. Parents who are aware that their children are habitual snorers or have frequently observed signs of daytime sleepiness etc. that do not correlate with the child's time asleep, should consult their family doctor.
The doctor can check for over-developed adenoids or tonsils that may be contributing to SDB, and make a referral, if appropriate. The family doctor would also be able to assess the child for other medical conditions or lifestyle factors that may be contributing to SDB. Sometimes, it may be necessary to refer a child for a more formal sleep assessment although access to this varies throughout the UK.
The Breath Spa Project
I run breathing retraining workshops for children who have SDB. I applied to UnLtd
for funding to cover the cost of the workshop materials and also some travel expenses. I was fortunate enough to be awarded a small grant and I am grateful to UnLtd for their support. I am happy to deliver presentations to interested groups of teachers, parents, community or health workers. I've worked with children in pre-school groups who were as young as two years old. I'm in the south of England, half-way between London and Cambridge. However, with the sometimes amazing travel deals that are available in the UK, please email me if you are interested in the project and might be interested in hosting a course.
Depending on the age of the child, I sometimes use capnometry as a biofeedback mechanism: older children enjoy the gadgetry and even young children have a surprising interest in it. I've demonstrated biofeedback and the impact of breathing techniques in both science and PSHE (personal, social and health education) classes for different ages in both school and community outreach settings.
The breathing techniques are based on accepted principles of respiration and physiology. The techniques are not something that are to be practised for only a few minutes a day. We are looking to re-train the breathing habits so that children breathe appropriately, all of the time. For example, we emphasise the importance of breathing in and out through the nose
most of the time. Children learn these techniques in simple exercises and activities to practise at school and at home with their parents. The techniques can also be easily integrated into many existing activities, such as walking, playing games, watching television and reading stories.
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Labels: biofeedback, obstructive sleep apnoea, sleep disordered breathing, snoring