Onward ~ and ~ Upward_Sigh, Sighing in Lung Disease, Pain, Anxiety/PTSD

Sighing (medical definition of a sigh): breaths with larger tidal volumes than surrounding breaths
Sighing (Merriam-Webster Dictionary): to take a deep audible breath (as in weariness or relief)

People rely on many forms of verbal and non-verbal communication, especially in judging the "mood" or emotional state of other persons. We look for cues of acceptance or rejection, or of satisfaction or dissatisfaction in the other person. This occurs so naturally and on a subconscious level that we don't even realize we have made judgments about the other person.

Ever fall into bed, so terribly exhausted, and let out a very long sigh? Did your bed-partner immediately turn to you and accuse you of being in a bad mood, irritable, or even angry?
Probably not (unless you happened to have an argument with your partner just before going to bed). Most often the exhausted sigher's noises are simply a sigh of complete contentment when their body meets the soft bed and pillow. How annoying would it be if someone at that point accused you of being impatient or angry-sounding?

Unfortunately, this is what many ill persons experience, when body noises come with pre-attached meanings. Nurses and even doctors, and other caregivers, read into noises a patient makes, often accusing patients of having emotions that are not accurate. Worse, medical staff may react based on their interpretation of patient "noises," without ever checking out the accuracy of the assumptions.

A good example of misinterpreting noises is in a patient with asthma. Children with asthma often develop a breathing pattern of a mixture of sighing and grunting, and adults with uncontrolled asthma or worsening COPD (Chronic Obstructive Pulmonary Disease) often sigh a lot. Sighing and grunting are not a conscious decision, but something the body requires; the grunt or sigh increases the pressure in the lungs more than the asthmatic can do with a normal breath. It literally feels to the person like they get more air than by normal breathing. And many asthmatics and persons with COPD are mouth-breathers (again, because it feels like they get more air). Sighing can sound very "angry" if the person is mouth-breathing or when they are doing or just finishing an activity, like walking. In no way is the person "angry" or even in a bad mood, but their sighs and grunts can be mis-read by others!

"I'm sick and tired of Mrs. Marshall's attitude," the assistant complains to Dr. Adams, a general practitioner with a busy office. "Every time she calls or comes in, I can hear her 'Ahhrrr,' the assistant tries to mimic the sound with exaggerated volume. "I won't talk to her anymore!"

Doc Adams is typically a patient man, but he's heard the complaint once too many times about Mrs. Marshall, and he's fed up. He has too busy of a practice, with too many ill people who need his help, to put up with a patient being nasty to his staff! At Mrs. Marshall's next visit, he confronts her about her "negative and rude attitude with the office staff." Mrs. Marshall is taken aback and feels attacked. She has never in her memory had a cross word with anyone at Dr. Adam's office, and she "just loves" the office girls. But, how can Mrs. Adams defend herself? Her doctor has been told she "has a bad attitude" and no one else heard the conversation except the two people on the telephone. Mrs. Marshall is so confused by Dr. Adams attacking comments, and feels so hurt, she resolves to never "call in" again.

Later that month, Mrs. Marshall's asthma acts up. She can hear herself wheezing and realizes she ran out of her inhaler. On top of that, she's caught a cold. Reluctantly she calls the doctor, but does it after-hours so she can avoid the office staff. The on-call answering service gives the message to Dr. Adams, who returns his patient's call. After each sentence, he hears her sigh, deeply, and realizes her sighs is a sign of her asthma. In severe cases, the lack of oxygen is referred to as "air hunger". In addition to calling the pharmacy to refill her inhaler, he instructs her to go to the emergency room if she worsens during the night, and to come to his office first thing in the morning.

Luckily, Dr. Adams is familiar with the symptom of deep sighing in asthmatics. He remembers his staff's complaints from the previous month and wonders if the staff heard the sighs of Mrs. Marshall during an asthmatic attack. Soon after the patient arrives at his office, he pulls the Assistant aside and asks if Mrs. Marshall is sighing today like she did on the telephone. "Yes, and she gives those short, abrupt answers to every question," the Assistant answers. Dr. Adams now understands why his Staff made those previous accusations and plans a later discussion with all his staff.

For now though, he owes a big apology to a very ill asthmatic.

There is also a strong connection between allergies and asthma; Allergies can actually cause asthma. Once allergies are treated, a person may actually experience fewer asthma attacks. Sighing may be present, but the person never associates their own sighing with their allergies or asthma!

SIGHING IN PANIC DISORDER (PD), IN POST TRAUMATIC STRESS DISORDER (PTSD), AND IN GENERALIZED ANXIETY DISORDER (GA)

Sighing is also common in PTSD and Anxiety conditions and can lead to all kinds of judgments from others. An article written by Wilhelm, F. H., W. Trabert & W. T. Roth (2001). Biological Psychiatry 49(7): 606-614 reported that "Sixteen patients with panic disorder (PD), 15 with generalized anxiety disorder (GAD), and 19 normal controls were asked to sit quietly for 30 min. Respiratory volumes and timing were recorded with inductive plethysmography and expired pCO2, from nasal prongs. Results: PD patients sighed more and had tonically lower end-tidal pCO2s than controls, while GAD patients were intermediate. Sighs defined as >2.0 times the subject mean discriminated groups best. Sigh frequency was more predictive of individual pCO2 levels than was minute volume. Ensemble averaging of respiratory variables for sequences of breaths surrounding sighs showed no evidence that sighs were triggered by increased pCO2 or reduced tidal volume in any group. Sigh breaths were larger in PD patients than controls. After sighs, pCO2 and tidal volume did not return to baseline levels as quickly in PD patients as in controls. Conclusions: Hypocapnia in PD patients is related to sigh frequency. In none of the groups was sighing a homeostatic response. PD patients show less peripheral chemoreflex gain than controls, which would maintain low pCO2 levels after sighing."

The fact is many conditions can interfere with the amount of oxygen a person takes in, or which the body processes (example: In emphysema, the lungs do not transfer oxygen easily into the bloodstream because of less surface of the aveloi (the membrane device by which oxygen is transferred to the bloodstream in each intake of air ) Reduced oxygen levels in disease conditions can cause or can contribute to anxiety levels since patients often feel like they are suffocating or as though they are breathing through heavy towels. Whether the Generalized Anxiety (GA) group had concurrent medical conditions was not stated in the summary of the above article.

Pain can cause many changes in breathing patterns, including increased respiration rate (and increased blood pressure and heart rate). The breathing pattern can include sighing, or even a rapid expiration of breath that can sound like a hard, deep sigh (such as when a patient holds their breath to fight pain, then lets out their breath after painful movement). Family and friends may misread sighing as anger or irritation, when in fact, the person is in pain. But the simple act of sighing can and has caused rifts in relationships of the person in pain. It's sad that there is little information given to patients and families on the causes of sighing, including that of pain.

Persons on pain medication may even sigh more than someone who does not take narcotics for pain, because of the narcotic effect on respiration. Narcotics can depress respiration considerably. This is why patients are monitored so closely while receiving injections of narcotics after surgery. When a hospitalized patient receives narcotics, nurses have other medications available to reverse the effects of narcotics in patients whose respirations become too low or impaired. But for patients who take daily narcotics at home, the doctor must find an adequate balance between pain relief and possible impairment to respirations.

One woman who was taking morphine by mouth everyday complained she awoke in panic attacks every night, and her husband complained that his wife "sighs all day long." The doctor ordered a sleep study which showed that the woman was having drops in her blood oxygenation. (O2 saturation levels: the amount of oxygen available in the bloodstream to sustain life.) Because of the intensity of the woman's pain, she was continued on the same dosage of morphine and could not have the dosage increased, and she was instructed to watch for further signs of impaired respiration. Her husband was also instructed on the relationship between pain and sighing, and between impaired respiration and sighing, which helped husband and wife communicate better about her pain and about her pain medications. Instead of immediately feeling defensive because he thought his wife was angry, the husband became more supportive because he knew the sighing was connected to her pain.

Society has come to associate sighing with irritation, anger, impatience, and dissatisfaction, usually in interpersonal relationships. But the fact is sighing can be related to states of normal relaxation or satisfaction or dissatisfaction, as well as occurr in relation to pain, anxiety or lung diseases. If your loved one or patient is SIGHING frequently, ASK the person what they feel rather than assume that they are angry or dissatisfied. If you find yourself frequently accused of "sighing like you're mad," discuss it with your doctor; you may learn there is more to your sighing than you know!

If you already know there is a relationship to your sighs and a medical condition, be pro-active in educating others in your life about the possible causes of your sighing. It can get demeaning and degrading to always feel belittled and attacked over a bodily function like sighing; Keep explaining and talking about it until others begin to understand!

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SIGHING in ILLNESS and PAIN STATES