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By: Amy Denney
It’s common for women transitioning into menopause to get winded more easily or start suffering from sleep apnea. This is because during menopause, the body decreases the production of hormones such as estrogen and progesterone, which are closely linked to lung function and breathing.
Both breathing conditions can also increase anxiety (which may cause additional hormone imbalances) and exacerbate or cause vasomotor symptoms, such as heart palpitations and hot flashes. However, these experiences don’t have to be a normal part of menopause.
Breathing exercises, though not the subject of abundant research, have been shown to improve sleep, lung function, anxiety, and vasomotor symptoms.
It’s a subject that Dr. Louise Oliver, a general practitioner, is so passionate about that she’s become certified as a functional breathing practitioner to help her patients better navigate menopause.
Disordered breathing can make it very hard for women to function efficiently, she told The Epoch Times. Learning to breathe better is especially helpful in managing uncomfortable symptoms associated with menopause—as a replacement or supplement to hormone replacement therapy (HRT).
“Just because we breathe and it’s generally automatic, we assume we automatically breathe efficiently, and in the modern-day world, that isn’t always true,” Oliver said. “As we transition from perimenopause to menopause, there’s a steep rise in sleep-disordered breathing. That impacts everything else.”
Lungs Gone Wrong
A 20-year examination of 1,438 European women noted lung function declined rapidly throughout their menopausal transitions, beyond the expected age-related decline. Researchers quantified the changes as comparable to smoking about a pack of cigarettes a day for at least two years and up to 10 years.
“The decline in lung function may cause an increase in shortness of breath, reduced work capacity, and fatigue,” co-author Kai Triebner from the University of Bergen in Norway said in a news release.
Published in the American Journal of Respiratory and Critical Care Medicine, the study examined breathing capabilities using spirometry, and compared these results to hormone tests and other collected data. Lung function seemed to decline even in women who did not have asthma, surgical menopause, or other gynecological disorders.
“Hormonal changes in menopause, linked to complex biologic events, might contribute to the demonstrated acceleration in lung function decline with menopause,” the study said.
The study mentioned possible reasons, including systemic inflammation associated with low estrogen levels. Estrogen is primarily related to reproductive health, but it also affects most of the body’s systems. It’s mostly made in a woman’s ovaries, but smaller amounts are made by the adrenal glands and fat cells.
Estradiol, the most dominant form of estrogen associated with childbearing years, has a modulatory effect on inflammation. In animal research, low levels of estradiol appear to amplify inflammation, whereas higher levels appear to calm inflammation.
Another possible reason menopause may drive poorer lung function is the change in bone density. “Hypoestrogenism plays a critical role in osteoporosis, which results in reduced height of the thoracic vertebrae, which may mechanically reduce the expansion of the thoracic cage during inspiration and place the diaphragm in a suboptimal position,” the study said.
Overlooked Sleep Apnea
Hormones such as estrogen and progesterone are believed to protect breathing, putting postmenopausal women at two to three times the risk of sleep apnea compared to premenopausal women, according to Johns Hopkins Medicine.
Exactly why is unclear, and the association may be overstated. A study in the journal Menopause noted that while menopause was associated with sleep-disordered breathing independent of age and weight, there hasn’t been a strong connection showing that HRT lowers the risk, confounding the hormonal argument.
“Many other mechanisms by which menopause could affect sleep-disordered breathing are possible, but they have not been rigorously tested,” the study said. “Some short-term experiments on small samples have suggested that levels of sex hormones can affect breathing during sleep.”
Another study in the American Journal of Respiratory and Critical Care Medicine said it’s worth noting that menopausal women’s sleep complaints are often brushed off as being caused by hot flashes and anxiety or are simply overlooked and undiagnosed.
Women who complain of snoring, unsatisfactory sleep, or daytime sleepiness should be evaluated, the study said, as women have a higher mortality rate for sleep-disordered breathing than men do.
“It’s well-documented there are various different reasons that it may happen. There’s not enough research on it,” Oliver said, adding that hormones are hardly the only thing affecting breathing.
Sleep-disordered breathing can happen because of weak throat muscles or because the tongue blocks the airway. It can also be the result of breathing with the mouth open, bringing in too much or too little oxygen, or breathing too quickly.
“Any one of those or a combination of all those things can be relevant for any particular person,” Oliver said.
Changing Breathing Habits
The good news is that most contributing factors to disordered breathing are modifiable, she said.
“We can change our own conscious breathing pattern while we’re awake to improve our unconscious breathing habits, but obviously it takes time,” Oliver said. “It can take three months to develop the muscle memory and the nerve connections to make it unconscious.”
She works with patients who want to improve their breathing before they undergo a sleep study. Often, that’s because patients want to improve nasal breathing so they can use a nasal CPAP (continuous positive airway pressure) mask. The nasal mask has been found to be more comfortable and effective in research, but can be difficult to adjust to.
Oliver said her patients often find the breathing exercises alone are enough to reverse sleep apnea and they don’t require a CPAP.
There are also exercises that train the tongue for correct positioning and strengthen the muscles of the throat. Even simple techniques can make profound changes, Oliver said. Breathing should be light, low, and slow, which recruits the diaphragm, the major muscle in respiration that’s often underused.
“I think the most important thing is to teach people to be more carbon dioxide tolerant because you breathe slower, and if you breathe slowly, you’re naturally going to breathe with the diaphragm,” she said.
Slow and gentle nasal breathing also strengthens the vagus nerve, Oliver said, which is the nerve that controls parasympathetic relaxation response and has a role in the baroreceptor reflex that keeps heart rate and blood pressure in homeostasis.
Oliver believes slow and gentle nasal breathing can have a spillover impact on hot flashes and night sweats, which have been associated with decreased vagal tone in medical studies.
Breathe Away Hot Flashes
Medical research on breathing techniques for menopause has focused primarily on paced respiration, a slow, deliberate nasal breathing often with a target rate of six breaths per minute.
A study in Menopause to assess paced respiration as a feasible option for hot flashes found evidence that practicing the six-breaths-a-minute technique twice daily is most helpful—though even once-a-day practice could have benefits.
Sixty-eight women completed the study, with nearly 80 percent finding it easy to do the exercises, and 65 percent reporting they could practice the technique on most days. The results were a 52 percent reduction in hot flashes among those who practiced paced breathing twice daily. Other groups also experienced a slightly lower reduction in hot flashes, including those who only practiced it once a day and a third control group whose breathing pace was around 14 breaths per minute.
