If you are having an acute dyspnea attack it is important that you know how to position you body for maximal use of your respiratory muscles. This module will show you dyspnea positions while standing, sitting, and lying.
These positions utilize gravity effects, and positioning, to permit use of not only your regular muscles of breathing, but also your so-called "Accessory Muscles of Breathing." These muscles are generally not used in regular breathing, but can be emergency adjunct muscles to assist your breathing. In fact, if properly positioned and braced, most of the external muscles of the chest are accessory breathing muscles, and if properly used, the anterior abdominal muscles can also assist.
As a general rule, moderate forward bending, while keeping your spine relatively straight, will assist your breathing. However, excessive forward bending, and compressing your chest by forward curving your spine and neck, must be avoided. This will impair upper abdominal and diaphragm movement on inspiration. And with this forward bending there should generally be some moderate tensing of the shoulder muscles, to provide bracing for some accessory breathing muscles.
STANDING DYSPNEA POSITIONS
Unassisted Standing Positions
The simplest standing dyspnea position is to stand erect, leaning slightly forward, and let your shoulders and arms hang slightly forward. You can use this position in a public place where you do not want to appear conspicuous. During this time, relax and calm yourself, and concentrate on your breathing training skills, and/or do Pursed Lip Breathing.
This position will be assisted by leaning further forward and placing your hands on your upper thighs, and then using your arms and shoulders as a brace to further engage your accessory breathing muscles. Try sliding your hands down to about mid thigh and see if this improves your breathing, and if this works to advantage, then try placing your hands on you knees. You should not try placing your hands past your knees, as in fact knee placement may be too far for some, and particularly those with a protruding "pot belly."
Assisted Standing Positions
The simplest assisted position is to lean forward and place both hands on an object about three to four feet high, such as the back of a chair, or a low fence. Then moderately tense your upper arms and shoulders to use them as braces for your accessory muscles. Again, relax and calm yourself, and concentrate on your breathing training skills, and/or do Pursed Lip Breathing.
Further recruitment of your accessory muscles may be obtained by leaning further forward, and placing your elbows or forearms on an object four or five feet high.
The Rollator is an excellent four wheeled rolling device that has handles you grip for support while you walk about. Properly used, it essentially provides good forward leaning posture and shoulder bracing for more efficient use of the accessory muscles of breathing. Some models have a basket and a seat. If you are going shopping you don't have to carry things home, and if you are short of breath you can sit down and rest. Furthermore, if you are frail and in danger of falling, you have a constant means of support while walking, Indeed, a very clever piece of equipment for the elderly and COPD patients.
SITTING DYSPNEA POSITIONS
Unassisted Sitting Positions
The simplest sitting position is to just lean forward. This is an inconspicuous position. However, it is important that you keep your back straight, otherwise you might curl-up and cause your lower chest to impair upper abdominal inspiratory movement. Also, keep your knees moderately spread, so your abdomen can hang freely and not compress and inhibit abdominal motion. This is particularly important for those with a large and protuberant abdomen. These precautions about keeping your back straight and spreading your knees apply to all sitting dyspnea positions.
Assisted Sitting Positions
Assisted sitting may be initiated by simply placing your hands on thighs or knees, and then bracing the upper arms and shoulders.
Further assistance may be obtained by placing your elbows or forearms on your thighs. This requires more exaggerated forward leaning, and you must be particularly careful to keep your back straight to avoid curling-up and causing lower chest and upper abdominal restriction. Obese people, and those with a "pot belly" may find this position uncomfortable, and if so this position should not be done.
A good resting sitting position would be to place one or two pillows on a regular table (or on top of a high bed, if you have a hospital type bed), and then leaning forward while wrapping your arms about the pillows. This arm positioning now permits the powerful pectoralis major muscles of the anterior chest wall to act as accessory breathing muscles. In this manner you can rest, or take brief naps. If you are having unrelieved dyspnea at night you might try sleeping in this position. If so, you must realize there is some danger of falling while sleeping, and you take precautions such as supporting pillows or padding about the floor.
LYING DYSPNEA POSITIONS
The simplest lying position is just to be propped-up on two, three or four pillows. Again, if propped-up very high there is some danger of you falling out of bed and injuring yourself. If you feel you would like to try sitting up, it is best to do this in a comfortable easy chair, with your feet on a foot stool or similar object.
A precaution here. If you find over a fairly sudden time period, over perhaps three or four days, that you are feeling the need to be up high while sleeping, it may be a sign of cardiac weakness and water congestion in your lungs. If you think you may be having this problem it is important that you check with your physician and possibly get medications to clear water in your lungs.
High Side Lying
This is the preferred lying dyspnea position in COPD. Lie on your side, propped-up on three of four pillows. Or you might consider a large triangular shaped foam rubber cushion plus only one or two pillows. Place a single pillow in front of you, so you can hold on to it and minimize slipping off the high support. Cross your upper knee over in front of you. Then relax, and calm yourself, and concentrate on your breathing training.
Persons with severe COPD are working hard to breathe, even when they are sitting quietly and doing nothing to exert themselves. Rest is therefore an important part of a COPD program, and getting a reasonable night's rest is indeed important.
Recall from the Barrel Chest Deformity module that typically this common problem is associated with a humped upper back called Kyphosis, and additionally with forward leaning of the neck and chin. This places the chest in an unfavorable position of efficient chest breathing movement.
Much of this problem can be corrected by self-attention to a better upright posture, and neck straightening. Particularly when walking and standing, try to imagine yourself suspended upright from the top back of your head, and with your shoulders pulled back. And when sitting, continue to habitually keep this same upright / shoulders back posture.
Stubborn problems of more severe Kyphosis may benefit from Physical Therapy consultation and spinal mobilization and diathermy or other heat treatments. And Yoga exercises have an emphasis on spinal correction and good general posture. But in the end, it is up to you to habitually maintain a good posture. It is well worth the effort, for the sake of your breathing comfort.
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