Short of breath when talking

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Carolynyg

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Joined
Jan 28, 2016
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16
Reason
PALS
Diagnosis
11/2015
Country
US
State
TX
City
Dallas
I have had lower limb onset ALS for three years. In the last several months I find myself getting short of breath while talking. I do not get short of breath when I'm lying down. This seems odd to me and I just wonder if anyone else has experienced that. As a former respiratory therapist, it doesn't particularly make sense to me! My oxygen levels are fine.
 
Normal breathing (tidal breathing) is an unconscious activity. In fact, if one is told to "breathe normally," one usually is unable to do so because breathing has moved to a more conscious level. When we breathe for life purposes, inhalation is active and exhalation is passive; in other words, we use muscles to get air into the lungs but air is forced out by the natural recoil of the respiratory system. The primary muscle of life breathing is the diaphragm, but it important to note that this muscle is active during inhalation, but not exhalation.

Speech breathing is a more conscious activity than life breathing and requires more muscular effort. While inhalation and exhalation are roughly of equal duration during tidal breathing (about 40% of a respiratory cycle is spent inhaling, 60% exhaling), we need to get air in quickly and exhale it gradually for speech, resulting in about a 10%-90% inspiratory-expiratory ratio per cycle.

The diaphragm and external intercostal muscles (located between the ribs) are typically active during speech inhalation and, initially, the external intercostals are active during the beginning of exhalation for speech as they "check" the nonmuscular forces from the lungs. After a certain point, the internal intercostal muscles activate and assist those passive forces and, depending on how much we have to say, other (accessory) muscles may come into play, particularly at lower lung volumes.

However, the diaphragm is not active as an exhalatory muscle for speech. The reason for this difference in muscle activity in speech breathing vs. life breathing is that our goal during speech is to maintain a constant pressure (subglottal pressure) to drive the speech mechanism and maintain a steady voice.

Although the diaphragm is said to contain two muscles or two portions - the crural and costal muscles (Pickering & Jones, 2002), it does not appear that these muscles or portions of the diaphragm can be activated or controlled independently (see quote from Pickering below). Readers can learn more about breathing and speech breathing from any basic speech science textbook (e.g., Hixon, Weismer, & Hoit, 2008; Raphael, Borden, & Harris, 2011).
 
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Hi Carolyn, my PALS has had respiritory failure from day one so he did not expierence what you are describing . I found this discussion on the differences between normal breathing and speech breathing and thought that as a respiritory therapist you may be able to determine if this may help explain what you are experiencing. Kate
 
As the excerpts Kate posted suggest, Carolyn, speech leverages somewhat different muscles to different extents than subsistence breathing. And as you know, O2 levels don't tell the whole story in ALS as CO2 can accumulate and not affect the O2 till late in the game, and/or as FVC/MIP/MEP decrease, the body can adapt to an extent with shallower breathing but with attendant losses in comfort/speech/nutrition.

And again, depending on musculature, supine position may not be where your volume takes the largest hit.

I would get PFTs done to see where you stand, and if speech volume is an issue when you breathe optimally, there are personal amplifiers. Depending on how the tests net out, it might be time for BiPAP.

Best,
Laurie
 
Wow, that was fascinating about the different muscles used in talking versus regular tidal breathing! THANKS
 
Thanks Kate this said it with such wonderfully plain language it makes immediate sense - it's quite a skill to explain medical stuff without using acronyms and a lot of terminology that confuses most people, or without sounding horribly clinical so the brain half shuts off. This hit the mark perfectly.
 
My post is from a paper written by Peter Reitzes and Dr Robert Quesal titled " The Anatomy and Physiology of Costal Breathing and How it Relates to Stuttering". I tried to post the link but don't know how to do it. I agree Tillie, I loved how they wrote it in such a understandable way.
 
Kate, this was so interesting, I emailed the quote to a respiratory therapist friend, who also founded extremely interesting. We admitted it covered a gap in our knowledge! thanks so much.
 
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