What is a diaphragm?

The diaphragm is a muscle between the lungs and heart that moves air in and out when you breathe.

When you inhale, your lungs expand and fill with air. Your diaphragm pushes downwards to decrease pressure in the chest cavity and allow the lungs to expand. In paradoxical breathing, the diaphragm moves upwards when you inhale, and the lungs can’t expand as much. This prevents you from inhaling enough oxygen, which is important for many bodily functions. It also makes it difficult to exhale carbon dioxide, which is a waste product of the respiratory system.

Depending on the severity of your condition, you may experience health problems because you aren’t receiving enough oxygen or getting rid of enough carbon dioxide each time you breathe.

What are the symptoms of paradoxical breathing?

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
  • poorer 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.

What causes this type of breathing?

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. However, 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 a neurodegenerative disease, such as multiple sclerosis, muscular dystrophy, and Guillain-Barre 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 that respiratory pathways become weak, which disrupts breathing patterns. This can happen in neuromuscular conditions such as multiple sclerosis and ALS.

How is paradoxical breathing diagnosed?

First, your doctor will ask you about the symptoms you’re experiencing and your medical history. They will 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 by 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.

How is paradoxical breathing treated?

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 have 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.

What’s the outlook for paradoxical breathing?

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 to 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. However, 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