"Remember to breathe. It is after all, the secret of life." - Gregory Maguire, A Lion Among Men
At birth, we take our first breath. In death, we take our last breath. During the years between birth and death, we may take countless breaths and never think about the 'act of breathing'. That is, until the 'power of a breath' is drawn to our attention.
In my case, the impact of a single breath caught me by surprise my senior year of nursing school. Given all the delivery rooms were full, a classmate and myself had been left to monitor a young, single mother, who was not as far along in her labor as the other mothers. The doctor had been called and, once contractions increased in frequency, we had been instructed to push the emergency bell and alert a registered nurse for assistance. We had also been told, since the baby was going to be given up for adoption, the young mother was not to see her newborn.
Contractions increased. The bell was pushed. No one came to our rescue. Panic! I was at the foot of the bed and could see the baby's head. Breathless and heart pounding, I grabbed the gloves laid out for the doctor and tried to remember, shoulders down or shoulders up? Guide the baby out. "Oh, God," I still remember my terrified prayer, "Please do not let me drop the baby in the kick bucket."
Meanwhile, my classmate, much calmer than myself, had plopped herself on a stool at the head of the bed, turned on the bit of gas we were allowed to administer, and holding a mask over the young mother's mouth and nose was gently saying, "Breathe in, Breathe out, everything's fine". Amazingly, the rhythm of those words subdued the turmoil inside me. I took a breath, guided the baby out, and, as the doctor and registered nurse entered the room, put the wailing little body on the mother's tummy. The umbilical cord was cut and the newborn was safely transported to the nursery. Sighs of relief. My classmate had created "calm in the midst of chaos."
Throughout my career in critical care nursing, I used those words to create "calm in the midst of chaos" with patients, families, registered nurses, and student nurses. Depending on the situation, "Breathe in, Breathe out" was followed by "you've got this, everything is under control, I'm here for you", or whatever seemed to be appropriate at the time. Oddly enough, I never applied them to myself and my journey with migraine until my first visit to the migraine clinic. So, now that I have your attention, let's take a closer look at the 'act of breathing" and how, for those of us with migraine, it can help create "calm in the midst of chaos " and, with practice, contribute to a decrease in duration and severity of our migraine attacks.
At this point, we need to be aware that one of the areas in the brain implicated in the pathogenesis of migraine disease is the hypothalamus. The main function of the hypothalamus is to regulate homeostasis, or balance between our internal and external environments. An example of how the hypothalamus maintains homeostasis, and one that is critical to our survival, is the stress response. The stress response is an adaptive physiological response to a real or perceived threat. When a perceived threat (stressor) is recognized, the hypothalamus tells the adrenal gland to release a flood of hormones, including but not limited to, epinephrine, norepinephrine, and cortisol. For those of us with migraine disease, fluctuations in these hormones may trigger a migraine attack (i.e. "let-down" stress), make us susceptible to other triggers like poor sleep, dehydration, and skipped meals, and given the headache phase of an attack itself may be perceived as a stressor, amplify attack duration and severity.
Thus, we arrive at the 'power of a breath' and how to create "calm in the midst of chaos". During an attack, along with increased heart rate and blood pressure, our breaths may become rapid and shallow. Only the upper portion of our chest (thorax) may expand, limiting the amount of oxygen that gets to the lower portion of our lungs. Low oxygen levels may make us feel dizzy and lightheaded. Pain and anxiety may make us panic and breathe faster, creating a vicious cycle (chaos). As well, other symptoms we have may be magnified, including cold nose, hands and feet (vasoconstriction); chills; nausea and vomiting; confusion; and, insomnia. In addition, gastric emptying may be delayed (gastric stasis) and the oral medications we take may be prevented from entering the small intestine and being absorbed.
At the migraine clinic, I was told breathing effectively during an attack could help slow my respirations down, increase my oxygen intake, promote relaxation, increase absorption of my medications, and hopefully, decrease the severity and duration of my attack. Made sense to me. In other words, taking my own advice, "Breathe in, Breathe out", I could create "calm in the midst of chaos".
So, let's take a look at a technique, rhythmic breathing, I find particularly helpful (Murray, 2013, p. 153). Most of us are unaware of our breathing pattern, therefore, to begin with, you need to identify your normal pattern of breathing. Place one hand on your chest and the other on your abdomen. Take a breath in and notice which hand moves outward with the breath. If the hand on your chest moved, you are a thoracic (chest) breather. If the hand on your abdomen moved, you are an abdominal breather. You should know thoracic breathing is the usual finding in healthy adult females, and abdominal breathing is predominate in infants, children, adult males (more common with rapid rates) and in the elderly because the chest stiffens with age. (Murray & White, 1999, p.p. 25, 76, 78). The reason females (and perhaps some males) tend to be chest breathers rather than abdominal breathers is not well defined but, in graduate school, I was told it was thought to be related to "vanity" (push the chest out and suck the tummy in).
Rhythmic breathing involves inhaling and exhaling at a fixed pace while you pay attention to the flow of air going in and out of your body. The breath is not forced , and the chest and abdomen move as one unit. On inhalation, this allows the diaphragm to drop down into the tummy and more air to reach the bottom of the lungs. On exhalation, the diaphragm moves back into position, the lungs and respiratory tissue recoil, and air escapes into the atmosphere. Some sources have you count to 3, 4, or 5 as you inhale and exhale. I have stuck with the words I learned long ago in nursing school, "Breathe in", and "Breathe out".
So, get comfortable. You can sit or lie down:
- Place one hand on your lower chest and the other on your abdomen.
- As you inhale slowly through your nose, say the words, "breathe in".
- As you exhale slowly through your nose or mouth, say the words, "breathe out".
- Concentrate on relaxing your muscles.
Slow and easy...in and out... a hand on the lower chest and a hand on the belly, everything moving together, expand on inhalation, contract on exhalation. After you repeat the pattern a few times, you should start to feel calm. If you practice this technique throughout the day (standing, sitting, or lying down) between attacks, you will find it easier to draw upon when you have an attack. As well, you may find during any stressful situation or event, you automatically revert to the technique.
"You've got this!" Warm wishes for great success.
Murray, S., MS., RN. Migraine: Identify Your Triggers, Break Your Dependence On Medication, Take Back Your Life. San Francisco:Conari Press, 2013.
Murray, S. E., MS, RN, & White, B. S., DrPH, RN-Cs, ANP. GNP. Critical Care Assessment Handbook. Philadelphia: W.B. Saunders Company, 1999.
Copyright May, 2016, Sharron E. Murray.
This article is not intended as a substitute for medical advice. If you have specific concerns about your health or nutrition, please consult a qualified health care professional.