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When my parents first took me to the circus at 13-years-old, with all the dancing elephants and prancing horses, I knew there was something wrong with me. I had trouble breathing and almost went into anaphylactic shock.

It was two years later that I was diagnosed with asthma with animal dander rated at the top of the list. I was prescribed breathing medications for asthma and didn’t have another attack.

Good thing because now I have a stroke, and breathing is absolutely critical for people with brain injuries. The brain is extremely sensitive to oxygen levels, and proper breathing directly affects recovery.

The injured brain has increased demands and reduced ability to withstand oxygen shortage. Even brief periods of not enough oxygen can worsen brain injury and lead to secondary damage:

  • Less oxygen can create seizures, which adds to the brain’s oxygen requirements while simultaneously making breathing more strenuous.
  • Poor breathing leads to carbon dioxide increase (the carbon we exhale is the same carbon that was “inhaled” from the atmosphere by the plants we consume), which causes blood vessels in the brain to expand. This increases blood inside the cranium, raising pressure to dangerous levels that can crumble brain tissue.
  • Brainstem compression occurs when increasing pressure can push the brain downward, moving the brainstem where breathing and heart rate lie. This process creates an evil cycle where breathing becomes even more difficult.
  • When oxygen levels drop (hypoxia) to dangerous levels or oxygen is cut off completely (anoxia), brain cells begin dying minutes later. Even short episodes can inflict additional neuron death, expanding the injured area and worsening cognitive and physical shortcomings.
  • Serious oxygen shortages trigger a deluge of cell impairment causing cells to release toxic material, inflammation spreads to previously healthy brain tissue, and membrane breakdown. 

Preventing these secondary complications can mean the difference between recovery and permanent disability.

Breathing, notably controlled and mindful breathing techniques, can play a important role in supporting brain-injured individuals by improving oxygen to the brain, mildly adding whatever soothes–like music–to the nervous system, and learning how to reduce symptoms like depression and stress. Cortisol, the primary stress hormone, can even calm the brain.

Studies show breathing with the diaphragm lowers stress in 70-80% of ABI (TBI and non-TBI) patients, improving mood and focus. Brain injuries can impair the body’s natural breathing flow, especially with brainstem issues. This problem can lead to uneven breathing patterns, airway obstruction, or even respiratory failure.

Sufficient oxygen is most important for cell repair, reducing inflammation, and maintaining the energy needed for brain healing and management. Constant respiratory  scheduling are among the first priorities in brain injury recovery. This might include continuous oxygen monitoring, breathing exercises as part of rehab, or mechanical ventilation. 

For individuals recovering from brain injury, breathing exercises and techniques can also be valuable parts of therapy, helping with both physical recovery and managing symptoms like anxiety or cognitive fatigue that commonly occur during the healing process.

Also, timing matters critically. The brain’s vulnerability window is highest in the first 24 to 48 hours after injury. Breathing problems during this period can be especially disastrous, sometimes causing more damage than the original event. 

Breathing exercises improve alertness by increasing prefrontal cortex activity, which is often flawed in stroke and TBI, for example. They’re simple, study-based, and designed to fit your recovery needs. Don’t do both. They are:

  • Box breathing: Inhale through your nose for 4 seconds. Hold breath for 4 seconds. Exhale through your mouth for 4 seconds. 5 cycles for morning and night. You can expand the seconds held for each cycle.

OR

  • 4, 7, 8 method: Inhale through your nose for 4 seconds. Hold breath for 7 seconds. Exhale through your mouth for 8 seconds. 5 cycles for morning and night.

A caregiver might guide breathing sessions and can clarify instructions, like “Breathe in, breathe out.” Caregivers can practice breathing with you, both aiding mutual support to you and the caregiver. They should watch for signs of dizziness or discomfort, stopping if needed. Breathing techniques can complement, but not replace, other therapies.

Share breathing techniques with stroke/ABI survivors. Your strength in managing convoluted symptoms like breathing might enable you to integrate “breathe in, breathe out” on a daily basis until you recover, and it can strengthen your mutual support with other stroke and ABI survivors.

Oprah Winfrey once said, “Breathe. Let go. And remind yourself that this very moment is the only one you know you have for sure.”

Joyce Hoffman

Joyce Hoffman

Joyce Hoffman is one of the world's top 10 stroke bloggers according to the Medical News Today. You can find the original post and other blogs Joyce wrote in Tales of a Stroke Survivor. (https://talesofastrokesurvivor.blog)
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