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COMMON FEATURES OF BPD AND FIBROMYALGIA Mainly affects females BPD is at least twice as common in females compared with adult males, possibly because of hormonal influences. For example, progesterone stimulates respiratory rate, so that in the luteal (post-ovulation/ premenstrual) phase of the menstrual cycle, CO2 levels drop, on average, 25 percent. Additional stress can then "increase ventilation at a time when CO2 levels are already low," resulting in a range of symptoms commonly labeled as premenstrual tension. 9 A team of researchers identified several participants in a fibromyalgia study who "changed" their diagnosis during the course of a menstrual cycle. 10 They fulfilled the diagnostic criteria for fibromyalgia after ovulation, when progesterone levels were high, hyperventilation patterns were more obvious, and pain thresholds at their lowest; but never during the follicular phase when pain thresholds were highest, and breathing more normal. 11 Anxiety Feelings of anxiety have been shown to trigger more rapid breathing. 12 However, the converse is also true—rapid breathing creates feelings of apprehension/anxiety and sometimes panic (a sympathetic arousal, fight-or-flight response). People with fibromyalgia justifiably resent any suggestion that their multiple symptoms are "all in the mind" (i.e., psychosomatic), and therefore often find it difficult to accept that anxiety (about their condition, as well as due to BPD) might be aggravating their pain and fatigue. An understanding of the automatic link between habitual rapid breathing and anxiety can lead to acceptance of the possibility that by improving the breathing pattern, their anxiety levels (and associated symptoms) are likely to be reduced. Once habitual BPD (possibly including hyperventilation) exists, a variety of triggers start a vicious cycle, leading to a range of pain, fatigue, and other symptoms, as well as even greater anxiety—all of which generates more rapid breathing, and yet more anxiety. Pain correlations The general under-oxygenation of the tissues during alkalosis also creates an environment in which myofascial trigger points are more likely to develop, and so begets the evolution of more pain. Because diaphragm function is closely linked to pelvic floor function, genitourinary symptoms (including stress incontinence) and pelvic pain—all too common in fibromyalgia—are increased in individuals with BPD. Interestingly, Scandinavian researchers have observed that women with chronic pelvic pain "typically display upper-chest breathing patterns, with almost no movement of the thorax or the abdominal area." 13 They also confirm that such women demonstrate "… a lack of coordination and irregular high costal respiration," and that "the highest density, and the highest degree of elastic stiffness [is] found in the iliopsoas muscles." In addition, anatomical studies show that the fascial envelope around the superior aspects of the psoas connects directly to the medial arcuate ligament of the diaphragm, explaining the structural link between the psoas and breathing function. 14 So, breathing too fast—for whatever reason—can result in an avalanche of symptoms, including anxiety, fatigue, increased pain levels, brain fog, as well as gut, 66 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 1 7