Disordered Breathing in ME/CFS & Fibromyalgia – Symptoms and Recovery

The efficiency of mitochondrial energy production is highly dependent on adequate cellular oxygen concentration – a key issue for those with chronic fatigue syndrome and fibromyalgia. In this recently updated article, fatigue consultant Blake Graham describes simple breathing exercises to help break the dysfunctional cycle that’s involved.


I have heard about the supposed importance of breathing in chronic fatigue syndrome (and fibromyalgia) for many years, and never took it very seriously.

Then I read an article in Alternative and Complementary Therapies journal titled “Clinical Roundup: How Do You Treat Chronic Fatigue Syndrome in Your Practice?” In the article, eight integrative/alternative medicine experts described how they treat ME/CFS.

While they come from a variety of different backgrounds, four of the eight mentioned the importance of breathing. This inspired me to look into the role of breathing in more detail. After studying this topic, I have become completely convinced that this is a very important issue.

The issues discussed here are all heavily interrelated. These relate to:
– The rate and depth of breathing,
– Dysfunction of the autonomic nervous system (ANS), and
– Stress/tension.

These issues collectively constitute a very important [cycle] which contributes to, and perpetuates, ME/CFS. And the treatment I’ll discuss is designed to break the cycle of these three issues. Some people have a bias against 'low tech', mind-body or free treatments, assuming they are not as potent as other treatments, so please keep an open mind as you read through this.

One of the sources I read was the book Bursting With Energy, by Dr. Frank Shallenberger. In it, he describes “Breathing Right” as one of the “Eight Secrets for Improving Energy.” A brief summary of this chapter, explaining the difference between chest and diaphragmatic breathing, is found online HERE.

Improper Breathing Retards Metabolic Energy Production

While people with ME/CFS have normal blood oxygen, cellular oxygen levels are often inadequate. Optimal breathing improves cellular oxygen concentration, including to the brain. Mitochondrial function, a key issue for those with ME/CFS/FM, is highly dependent on oxygen levels for energy production. Shallenberger cites a case study in his book in which a person increased his metabolic energy production 20% after just half an hour of breathing instruction.

Drs. Sarah Myhill and Charles Lapp are two CFS & Fibromyalgia experts who discuss the importance of breathing.

Dr. Myhill, a co-author of “Chronic Fatigue Syndrome and Mitochondrial Dysfunction,” discusses the topic in “Hyperventilation – Makes you feel as if you can’t get your breath.” She writes:

"Hyperventilation – the idea here is that for whatever reason, the patient over-breathes. One cannot increase the oxygen carrying capacity of the blood this way, so oxygen levels are not increased, but carbon dioxide is washed out. This changes the acidity of the blood in such a way that oxygen sticks more avidly to hemoglobin.

“So oxygen is not released to the mitochondria where it is required, and so mitochondria go slow – so cells go slow, and this results in fatigue."

And Dr. Lapp in his "Stepwise" treatment approach notes that in both CFS and fibromyalgia, most patients breathe shallowly, using the muscles in the upper part of the chest. He recommends deep breathing, through the lower part of the diaphragm, because "This type of breathing tends to relieve things like chest tightness, shortness of breath, as well as spasms in the postural muscles."

Stress and Breathing

The link between stress and breathing goes both directions.

• Higher stress levels cause faster/deeper breathing,

• And faster breathing causes higher stress levels.

Read "Breathing Matters – Stress" by ear/nose/throat specialist Dr. Jim Bartley for an excellent article on the relationship between stress and breathing.

The Autonomic Nervous System and Breathing to Restore Balance

The autonomic nervous system (ANS) is the part of the nervous system which controls involuntary functions. It is composed of two sections, the parasympathetic nervous system (PNS) and the sympathetic nervous system (SNS).

• The SNS activates our stress response (the ‘fight or flight' response) and is associated with higher energy utilization,

• While the PNS counteracts the stress response and is associated with relaxation, energy conservation, digestion, etc.

In many chronic illnesses, including anxiety disorders, this autonomic balance is impaired, with an over-active SNS response and under-active PNS response. Research on those with ME/CFS suggests that both the PNS relaxation response and the SNS SNS 'fight or flight' response are under-active, associated with exhaustion of the autonomic nervous system. As the autonomic nervous system is one of the major regulatory systems in the body, this is a huge problem.

What does this have to do with breathing?

Well, it turns out that our breathing rate is a key modulator of the balance between SNS and PNS activation, and certain breathing practices can be used therapeutically to restore balance in the autonomic nervous system.

• Even if you feel mentally calm, if your breathing rate is overly fast, as it is for many people, this causes SNS activation.

• Slow breathing (also called 'paced respiration') tones and normalizes activity of both the SNS and PNS.

Read the fascinating article “The Science of Coherent Breathing” by Stephen Elliott, author of The New Science of Breath, for an in depth discussion of the link between breathing and autonomic nervous system balance.

Breathing more deeply and expanding the diaphragm also stimulates the peripheral nervous system and influences autonomic status. It's also interesting to note that energy medicine practices such as qigong (which literally means ‘breathing exercise’) believe that slow abdominal breathing is critical for the balance and flow of energy in our system.

For more information on the profound influence the diaphragm has on our body, see "Diaphragm Mediates Action of Autonomic and Enteric Nervous Systems," Jan 8, 2010, Psychophysiology, by Stephen Elliot.

Using Coherent or Resonant Breathing – Daily Breath Training

While breathing experts don’t agree on everything, they all agree that we generally breathe too fast and too shallow – and that predominantly breathing through our nose is ideal.

While a typical person might have 15 to 20 breath cycles per minute, an ideal number is 5 to10 cycles per minute at rest. For example, five breath cycles per minute = one breath cycle per 12 seconds, or inhaling for 6 seconds and exhaling for 6 seconds.

While we can’t quickly take up these new habits permanently, what we can do is daily breath training. A person can listen to an audio track which has a sound cue every six seconds. You simply inhale or exhale at each interval using the track like a metronome. Breathing at this rate is referred to as coherent or resonant breathing.

What are the benefits of doing this?

• On an immediate basis, this is deeply relaxing for most people.

• Cumulative over several weeks, daily breath training has numerous benefits. It improves the function and balance of the autonomic nervous system, which carries with it a host of benefits. Our natural breathing rhythm gradually shifts in the direction of that during the training so we don’t just benefit during the breathing exercises.

Coherent breath training is one of the best ways to reduce levels of stress. You can order a ‘breathing pacemaker’ CD called 'Respire I' or download the audio tracks as MP3s (free audio samples are available). I enjoy track 2, which has Tibetan bells as the breath cue.

I recommend that people with ME/CFS/FM do this breath exercise, combined with the practices described below, for 25 minutes twice daily.

Commit to two months of daily practice and then evaluate your response.

1. Breathe through your nose and you should be able to feel your abdominal region expand with each inhalation. Breaths should be gentle and relaxed, not forceful or high volume. This exercise is also preferably done with eyes close, as having one's eyes open favors sympathetic nervous system activation.

2. While performing the breathing exercise, mentally scan your body and release any obvious areas of tension, e.g., in your jaw, shoulders and chest.

Throughout the day, periodically observe your breathing, slow your breathing rate and make sure you are breathing through your nose and abdominally. Also use this breathing technique, combined with Ujjayi (pronounced "oo-jai") breathing described below, in times of acute stress.

Ten minutes of Ujjayi breathing at five breaths per minute is an excellent stress buster! When done in bed the combination of coherent breathing, Ujjayi breathing and progressive muscle relaxation described below is very beneficial for many people with insomnia.

Ujjayi ("oo-jai") Breathing for Calming Anxiety

In the excellent book How to Use Herbs, Nutrients, and Yoga in Mental Health Care, written by three psychiatrists affiliated with universities in New York, the authors recommend 'Respire I' from www.coherence.com, cited above. They also recommend combining this with a simple breathing technique called Ujjayi breathing (literally, 'loud breathing'), a yogic breathing technique. They write:

"Those who are able to learn Ujjayi breathing can be instructed to use the Respire I CD with Ujjayi for even greater effects. Ujjayi breathing creates a sound using contraction of laryngeal muscles with partial closure of the glottis, permitting fine regulation of the respiratory rate while increasing airway resistance, intrathoracic pressure, baroreceptor stimulation, HRV, RSA (Calabrese, Perrault, Dinh, Eberhard, & Benchetrit, 2000), and stimulation of somatosensory afferents in the pharynx, lungs, chest wall, and diaphragm. When done at a slow rate (2 to 6 breaths per minute) … Ujjayi is physically and mentally calming.

"In clinical practice, the authors find that basic Ujjayi breathing is the single most rapidly effective breath intervention for anxiety symptoms in patients diagnosed with anxiety disorders… The patient who is taught Ujjayi breathing will usually experience a profound sense of physical and mental calmness within five to 10 minutes of doing this technique."

Type in “Ujjayi breath” at http://www.youtube.com to watch videos on this breathing technique. Incorporate Ujjayi breathing along with the coherent breathing for the duration that suits your body and complete the duration of the breathing time by simply breathing along to the sound cues.

You may need to start with just 5 minutes of Ujjayi breathing and build up over time as is comfortable. Make sure you keep your neck, throat, shoulders and chest relaxed as you breathe. It shouldn't feel strained or forceful, just relaxed and slow with a partial contraction of your throat muscles.

Complementary Practices – More Options for Banishing Stress

Start with the combination of coherent/resonant and Ujjayi breathing until it feels natural and easy. At this point, you can add aspects of other mind-body practices such as meditation or qigong for further benefit. A few options are as follows:

Progressive muscle relaxation. Created by Stephen Elliot of www.coherence.com and Stephen Hawley, the Six Bridges is a form of progressive muscle relaxation, focused on autonomic balance, which complements the basic Coherent balance exercises. ("Muscles throughout the body gradually relax, including those of the spine and the vascular system. Blood flow throughout the body increases, knots in the muscles gradually disappear…") Also see the June 2009 Coherence Newsletter for more information. The Six Bridges audio is available as an MP3 download or as a CD.

Mantra based or breathing meditation. For example, focus attention on the flow of your breath.

Qigong meditation. Qigong traditions believe the abdominal region between your navel and pelvic bone, called the lower dantian, is a key energy reservoir. Qigong practices often involve focusing attention, or meditating, on this area.

Happy Breathing!

Blake Graham, BSc (Honours), AACNEM

* Clinical Nutritionist Blake Graham, practicing in Perth, Western Australia, specializes in nutritional and environmental medicine therapies for those with chronic medical conditions, such as ME/CFS, fibromyalgia, and environmental illness. His website – www.nutritional-healing.com.au . This article, last updated Jan 4, 2011, is reproduced with kind permission from Blake Graham’s Nutritional Healing e-newsletter. To sign up for the free newsletter, click here.

Note: This information has not been evaluated by the FDA. It is not intended to prevent, diagnose, treat or cure any condition, illness, or disease and is not a substitute for personal medical care. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.

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9 thoughts on “Disordered Breathing in ME/CFS & Fibromyalgia – Symptoms and Recovery”

  1. NTXFMS says:

    I read this article and was greatly inspired by it. My acupuncturist & fibromyalgia doctors both agree that my mitochondrial is not working properly and that breathing exercises can help. I also use a product that adds oxygen to water, and I use it daily.

    I do not breathe deep enough and at times feel at a loss of breath, even when I am sleeping, will wake up quickly — no it isnt apnea– but I seem to not breathe well! Who knew?

    Thank you for explaining different styles of breathing so I may try some new things to increase my breathing to a deeper level which in turn will energize my wearied body! I highly recommend these exercises to my support group members! Bravo! Great article!

    Shelley Echtle, Director
    North Texas Fibromyalgia Support Group

  2. TrudyBird says:

    This was a facinating article. My massage therapist had to remind me to breath when I first started getting massage from her. It makes a huge difference in how I feel after the massage. I also tend to breath shallow and even hold my breath when concentrating at work or during stressful situations. I didn’t notice my breathing pattern until a couple of years ago. Now I try to be more aware of it so that I catch myself holding my breath and start doing some slow, long, deliberate breaths to “feed” my body that I seem to be starving from oxygen. The slow, deep breathing with yoga, combined with slow,easy stretching makes an encredible energy boosting session. It really makes a difference.

  3. lvjesus says:

    I have had days where I would be very fatigued when I left home but on the way to work I would be singing with the radio or a CD and I would feel better when I got there and I knew it was from the breathing deeper to sing.

  4. Sandy10m says:

    Because I knew my body was oxygen-deprived, I tried hyperbaric oxygen therapy. This is where you go into a large tube, and they pressurize the tube so that it feels like the same pressure as scuba diving. You breathe 95% oxygen while you’re inside. I stay in there for an hour (but the time is variable depending upon your preference). I didn’t know what to expect from doing the therapy, but I found that my fibro was reduced by about 50% over a few weeks of Mon-Wed-Fri therapy. My feeling was that there was a lot of muscle/ligament/tendon damage (from not having enough oxygen for a long time), and that was aggravating the fibro. When I gave my body all that oxygen, it could finally repair some of this stuff properly, and thus the fibro wasn’t complicated by that. There is NO DANGER to doing hyperbaric therapy at the depths and times that I mentioned. The commentary you may find on the internet is completely uneducated (I am a physicist as well, so I understand what I’m talking about). And I’ve been doing this therapy for 1.5 years (I’m down to once per week now) with only positive effects. It’s worth a try at least, since I’ve found long-term benefit from doing the therapy.

  5. BobSmiley says:

    Many people underestimate the benefits of proper breathing. Deep breathing is achieved by inflating your stomach whenever you breath in. this increases the volume of air into your lungs as it stretches your diaphragm. An increased air flow improves oxygen intake. Treatment of stress can be as easy as taking periodic deep breaths.

  6. JohnWilson says:

    I have just read the comments on ‘Disordered Breathing’. I wish I had seen this years ago. I was diagnosed ME/CFS 10/11 years ago now, having had many problems that ME gives us. I blamed additional medication for Glaucoma (Travatan) that was affecting my breathing even though I was also diagnosed with Bronchiectasis which in itself gives me breathing problems. Having had a serious chest infection recently and 4 weeks of ant-biotics which has not cleared the problem totally. My medical advisors recommended ‘Salbutomol’ inhaler. I will try the breathing exercise also. This “ProHealth site is brilliant, only found it by accident. Looking for Clare Francis on Action for ME.

  7. adonnay says:

    per a study in the British Medical Journal,

    For adults, the optimal breathing rate
    is 6 b/m is optimal for heart lung function.

    This rate is
    known in medicine as the Mayer rhythm

    BMJ study found 6 b/min was induced within minute of
    startinbg to repeat rosary in prayer or “om mani pade om” mantra in meditation.

    both traditions are thousands of years old and
    and continue because they quickly and effectively reduce stress.

    They are alsto free with no need for any “tone tracks”

    note 6 b/m= 10secs per breath.
    most natural is 4second inhale and 6 second exhale or 3-7
    in and out via nose, with no breathholding.

    Better breathing methods alone however
    cannot cure cfs and fm cases
    caused by CO poisoning.

    for these cases–
    distinguished by multi-sensory sensitivity–
    Daily tx with supplemental oxygen is needed
    to normalize exhaled oxygen, CO2 and CO.

    an Rx is required from a physician but
    normobaric oxygen at home is sufficient
    (My protocol specifies 2 hrs / day for 4mo. @5l/m)

    hyperbaric oxygen is riskier (not well tolerated by all)
    much more expensive, and hard to do daily for several months as is
    still needed.

    for more see mcsrr.org

    Albert Donnay, MHS
    consulting toxicologist and env health engineer

  8. janevcameron says:

    Few days ago i read one article where they mentioned Fibromyalgia and Chronic Fatigue Syndrome? clearly have different symptoms, that the underlying cause of the illness is the same. Fibromyalgia symptoms often develop many years after people have suffered with Chronic Fatigue Syndrome.Dentist in Mississauga

  9. julianellis901 says:

    I was diagnosed of Chronic Obstructive Pulmonary Disease (COPD) in 2012 at the age of 63. I had been a heavy smoker, my symptoms started out with dry cough and shortness of breath, i ended up in the hospital, on a ventilator. I should have known it was coming, but like most smokers, thought it would never happen to me. My COPD got significantly worse and unbearable because of my difficulty catching breath. Last year, i started on a natural COPD Herbal therapy from NewLife Herbal Clinic, i read a lot of positive reviews from patients who used the treatment and i immediately started on it. I had great relief with this herbal treatment. I breath very much better now, no case of shortness of breath or chest tightness since treatment. Visit NewLife Herbal Clinic website ww w. newlifeherbalclinic. com. This COPD treatment is a miracle!!

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