Paradoxical breathing is a sign that you aren’t breathing properly. It occurs when your diaphragm moves in the opposite direction than it should when you’re inhaling and exhaling.

Typically, when you breathe, your diaphragm (a muscle between the lungs and heart) pushes up or down to help control your airflow. During inspiration (or inhaling), your lungs expand, and the diaphragm pushes down to decrease pressure in the chest cavity and make room for your lungs to expand with air.

During expiration (or exhaling), the diaphragm compresses or moves up, which helps move air out of your lungs.

Here, we’ll look a why paradoxical breathing occurs, what can cause it, and how it’s treated.

Symptoms of paradoxical breathing are caused by poor oxygen intake. They include:

  • shortness of breath, or dyspnea
  • excessive sleepiness, also known as hypersomnia
  • fatigue, or exhaustion not relieved by sleeping
  • frequently waking up at night
  • decreased exercise performance
  • abnormally fast breathing (tachypnea)

You should see a doctor if you experience any of these symptoms. They can also be caused by other serious conditions.

Paradoxical breathing is a result of a condition doctors call diaphragmatic dysfunction. This condition can be hard to diagnose. Scientists aren’t entirely sure what causes paradoxical breathing or its underlying condition. But the following conditions can make people more likely to develop paradoxical breathing:

Obstructive sleep apnea

This condition disrupts the inflow of oxygen and exhalation of carbon dioxide. Eventually, the chest wall can turn inwards instead of outwards, which can cause paradoxical breathing.

Trauma or injury to the chest wall

Injury or trauma can separate your ribs from your chest wall. This separated section will no longer expand when you inhale. Sometimes this section can start to push in, causing paradoxical breathing.

Disruption of nerves

Phrenic nerves control the movement of your diaphragm and other key muscles in your torso. Nerve damage may disrupt the normal movement of muscles in your torso and cause changes in your breathing.

This can be caused by neurodegenerative diseases like multiple sclerosis, muscular dystrophy, and Guillain-Barré syndrome. It can also be caused by lung cancer and injuries to the chest wall.

Mineral deficiency

Deficiencies in certain minerals, including potassium, magnesium, and calcium, can impact breathing. For example, a low amount of calcium may disrupt the nervous system and impair breathing.

Weak respiratory muscles

In some cases, the muscles that support the respiratory pathways become weak, which disrupts breathing patterns. This can happen in neuromuscular conditions like multiple sclerosis and amyotrophic lateral sclerosis (ALS).

First, your doctor will ask you about the symptoms you’re experiencing and your medical history. They’ll often run a variety of tests to assess the oxygen and carbon dioxide levels in your blood. They can measure oxygen by taking a blood sample or using an oximeter, a small device that attaches to the finger.

Your doctor may order other tests, including:

  • fluoroscopy, a special type of X-ray
  • pulmonary function test
  • maximal static inspiratory pressure (MIP)
  • sniff nasal inspiratory pressure (“sniff test”)

A radiologist and pulmonologist may also ask for a variety of imaging tests of the torso to get a better understanding of what’s going on.

Most cases of paradoxical breathing can be resolved by treating the underlying condition. For instance, if the cause is a nutrient deficiency, you can take supplements or modify your diet.

Doctors can also prescribe treatments that can alleviate your symptoms. Nocturnal invasive ventilation can help people with high carbon dioxide or low oxygen capacity. If you have problems while you’re sleeping, your doctor might use continuous positive airway pressure (CPAP) to manage your symptoms.

If your symptoms persist or you have an extreme case, you might need surgery. People who’ve experienced trauma to their ribs or lungs usually require surgery for successful treatment.

If the diaphragm is paralyzed, a surgeon might use a technique called surgical plication to improve lung function. This involves flattening the diaphragm to give the lungs more space to expand.

People who are dependent on ventilators may find phrenic pacing helpful. This involves a machine that sends signals to the phrenic nerves in your torso, making your diaphragm muscles contract.

Paradoxical breathing is always concerning in adults, but that’s not the case with infants and young children. In fact, paradoxical breathing can be normal in infants.

An infant’s lungs and chest aren’t fully developed. The chest moves more easily during breathing, and sometimes the diaphragm moves in opposite directions.

That makes their regular breathing look irregular, but as long as the stomach expands when they inhale (a sign they’re bringing air into their lungs), this breathing pattern is normal.

But if you notice paradoxical breathing in your child, it’s good to be alert to other signs of respiratory distress. These include:

  • coughing
  • shortness of breath or difficulty breathing
  • very rapid breathing
  • grunting or wheezing
  • turning blue

If you notice any of these signs and symptoms in addition to paradoxical breathing, contact your child’s doctor.

If you notice their chest’s skin sinks into the ribs when the infant or child breathes, or they’re struggling to get enough air, seek emergency medical care.

After age 2 1/2, paradoxical breathing isn’t seen typically, and it’s very rare in older children. If your child shows signs of this breathing issue after that age, they should be seen by their doctor.

Paradoxical breathing is typically a symptom of diaphragmatic dysfunction. It has many different potential underlying causes, including nerve disorders, trauma, and infection. The condition can usually be treated when the underlying cause goes away.

If you experience any problems breathing, you should talk with your doctor. They can run tests and rule out life threatening conditions.

Many of the conditions that cause paradoxical breathing can’t be fixed through lifestyle changes. But you can reduce your risk of paradoxical breathing slightly by:

  • keeping a good diet with balanced nutrition
  • maintaining a healthy weight
  • reducing drinking and smoking
  • strengthening core muscles

Breathing is a carefully regulated process your body undertakes naturally. You don’t even need to give it much conscious thought.

But there are better ways to breathe, and they can help you get more oxygen into your body and keep your lungs healthy and flexible. These better breathing techniques include:

  • Breathing through your nose. Compared to mouth-breathing, nose-breathing helps you better regulate air flow. It also works your lungs more efficiently. Plus, your nose and nose hairs act as natural filters for allergens and toxins, and the mucus lining your nose moisturizes and warms the outside air, which helps prevent irritation in your airways.
  • Practicing deeper breathing sometimes. When you’re not focused on your breaths, your air is unlikely to fill your full chest cavity. But from time to time, you should take large breaths in and pull the air into your belly (you’ll know you’re doing this properly when your belly expands as you inhale). This deeper breathing helps exercise your lungs and stimulates the diaphragm.
  • Don’t overthink breathing. Breathing is an unconscious process. Your body can handle it fairly well on its own. But if you try to interrupt your own natural cycle, you may actually increase anxiety and cause irregular breathing. This could make breathing more uncomfortable and result in greater fatigue. Work within your natural rhythm — don’t try to change it.

In infants and children, paradoxical breathing can be common, but you should still watch for signs of breathing distress. Talk with your child’s doctor if you notice the breathing condition, as they’ll want to monitor your child’s breathing to see it corrects itself.

Paradoxical breathing isn’t common in adults. It’s a sign of an underlying breathing issue, and these issues can be serious if left untreated. If you experience paradoxical breathing and any other difficulties breathing, you should seek emergency medical attention.

With a correct diagnosis and appropriate treatment, it’s possible to stop paradoxical breathing or at least prevent it from worsening and causing further complications.