Why do I feel so breathless when my tests are normal?

"My chest xray was normal . My oxyen levels are fine. My lung function is normal. So why do I still feel so breathless?"

This is a question I hear regularly from people experiencing persistent breathlessness.

The important thing to understand is that normal test results do not mean that your breathlessness isn't real. They can be reassuring in that they may show that there is no obvious lung or heart problem causing your symptoms, but they don't always explain how your breathing feels.

One possible reason is a breathing pattern disorder.

What is a breathing pattern disorder?

Breathing normally happens automatically, without us needing to think about it. However, illness, stress, anxiety, pain, persistent coughing, changes in fitness or other factors can sometimes alter the way we breathe.

You may start breathing a little faster, taking larger breaths, sighing frequently, breathing through your mouth or using the muscles around your upper chest and neck more than necessary.

Over time, this altered breathing pattern can become habitual.

You may then experience symptoms such as:

• Feeling that you cannot get a satisfying breath

• Frequent sighing or yawning

• A tight feeling in your chest

• Breathlessness, particularly when talking or exercising

• Feeling the need to take repeated deep breaths

• Dizziness or light-headedness

• Tingling in the hands or around the mouth

• A feeling that your breathing is difficult to control

  
  

These symptoms can be very uncomfortable — and understandably frightening.

Why can breathing feel difficult when your oxygen levels are normal?

Oxygen saturation tells us how much oxygen is being carried in your blood. It doesn't tell us exactly how efficiently or comfortably you are breathing.

Your breathing is influenced by much more than oxygen levels. The muscles you use to breathe, the size and speed of each breath, your breathing pattern and the way your brain responds to changes in breathing can all affect how breathlessness feels.

This is one reason someone can have a normal oxygen saturation and still experience significant breathlessness.

But isn't it just anxiety?

Not necessarily.

Anxiety and breathing pattern changes can influence each other, but breathlessness should not simply be dismissed as anxiety.

You may become anxious because you feel breathless. That anxiety can then change your breathing further, which can increase the sensation of breathlessness.

This can create a frustrating cycle:

Breathlessness → worry → altered breathing → increased breathlessness → more worry

Breaking that cycle can be an important part of treatment.

Why can taking deep breaths sometimes make things worse?

This is something that surprises many people.

When you feel you aren't getting enough air, your natural instinct may be to take a bigger breath.

But repeatedly taking large breaths isn't necessarily the answer.

For some people with a breathing pattern disorder, deliberately taking bigger breaths can actually increase uncomfortable symptoms such as dizziness, tingling, chest tightness or the feeling that you need to breathe even more.

This is why breathing retraining isn't simply about “taking deep breaths” or forcing yourself to breathe into your belly.

The aim is to understand your individual breathing pattern and gradually develop a more comfortable and efficient way of breathing.

What can help?

The first step is making sure that appropriate medical assessment has taken place and that other possible causes of breathlessness have been considered.

If your investigations are reassuring but you continue to experience breathlessness, a respiratory physiotherapy assessment may help determine whether your breathing pattern could be contributing to your symptoms.

Treatment is individualised. It may include education, awareness of your breathing pattern, strategies to reduce unnecessary over-breathing, relaxation of breathing muscles and techniques to help you manage breathlessness during movement, exercise or speaking.

When should I seek medical advice?

New, unexplained or worsening breathlessness should always be discussed with an appropriate healthcare professional rather than assuming it is a breathing pattern disorder.

Seek urgent medical attention if breathlessness is sudden or severe, particularly if it is accompanied by chest pain, fainting, blue/grey lips or significant difficulty speaking or breathing.

If you continue to feel breathless despite reassuring investigations, you don't have to simply put up with it.

At Oxfordshire Breathing Clinic, I provide respiratory physiotherapy assessment and treatment for breathing pattern disorder and persistent breathlessness, both online and in person. Please contact me.