Long Covid can induce a wide range of symptoms, from chronic fatigue to tinnitus. We speak to two experts to find out more about breathlessness and how singing can help.
Shortness of breath is a common issue for Long Covid sufferers – it’s one of the more frustrating symptoms I have encountered. I remember when I was first struck with Long Covid, I was trying to carry a few groceries back from the shop (a two-minute walk from my home) and I had to stop every few steps, unable to catch my breath. It was like I couldn’t breathe deeply enough, no matter how hard I tried.
Thankfully, there are lots of ways to help improve this oftentimes debilitating symptom. In 2020, the English National Opera (ENO) joined forces with the Imperial College Healthcare team to create ENO Breathe, a pioneering breathwork programme designed to help those recovering from Covid.
The first step towards improving my symptoms and day-to-day capacity, this pioneering programme was also the most crucial. Sitting at my laptop for the first Zoom session was nerve-wracking, but I’ve always loved singing. And as soon as I heard my classmates humming, singing, moving, laughing and sharing their experiences, I felt bolder and less isolated.
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What do we know about breathlessness and Long Covid?
Alongside fatigue and brain fog, shortness of breath is one of the most common symptoms — it’s experienced by just over half of those living with Long Covid (ONS data, February 2023).
“Tests and investigations, especially for those not hospitalised with Covid-19, don’t find any structural lung damage,” says Cassie Lee, a Clinical Research Fellow at Imperial College Healthcare NHS Trust. “There may be multiple reasons why someone with Long Covid has breathing difficulties… It’s often in a cluster with other symptoms, particularly fatigue, anxiety, depression and PTSD (Evand et al, 2022), suggesting that there is a systemic mechanism at play.”
Breathlessness can be prompted — and compounded — by psychological factors, such as anxiety. It can range in severity, causing some to struggle with gentle exercise or even walking or talking for extended periods.
What is the link between singing and recovery?
Singing, especially as part of a group, can bring joy, and opportunities to connect with others. That’s a fundamental element of the ENO Breathe programme: connecting with people experiencing the same — often invisible — symptoms, and with experts who can provide tools to use in your own time.
“Singing releases endorphins, the feel-good hormones, and oxytocin, the love hormone,” explains ENO Breathe’s creative director and session leader Suzi Zumpe. “Singing with others can be even more beneficial. To sing — or vocalise at all — is to exhale: our vocal folds make sound when air moves through them. Breathing out via singing can be a way to explore doing less; a means of getting out of your own way and making space for an easier inhale.”
Breathwork techniques have long been used to help those with enduring respiratory difficulties. This programme’s underlying principles are the same, but singing adds new techniques and benefits. “Singing demands competent breathing control and coordination,” says Cassie, “which vocal coaches have expertise in training.”
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What are some breathwork techniques that people can practice at home?
Suzi highlights that before delving into any specific techniques with participants, it’s important to cover simple ways to help them allow their bodies to experience ‘doing’ less. Here are a couple of ideas that are used on the programme:
Breathing out to breathe in
“There’s lots written about how to breathe,” notes Suzi. “But it’s easy to get in a muddle with what part of your anatomy should move where, and how it should feel — especially when you can’t see what you’re working with.”
Try these steps to remind yourself what ease feels like, to ground yourself and to calm anxious breathing:
- Step one: Breathe out with a ‘whoosh’, blowing air through pursed lips
- Step two: When you feel comfortably ’empty’, hold on to that empty feeling. Resist the urge to breathe in straight away, and hold for a count of three
- Step Three: Stop holding and resisting, and allow air to fall into your lungs
This is a good way to remind your body that in-breaths should be easy, rather than sucking in air. An easy in-breath is reflexive, not active.
Stabilising accessory muscles
“Stress or habit can lead our breathing to be shallower and faster,” explains Suzi. “Breathing in this way for an extended period is tiring for muscles at the side of our neck and the top of our back. When those areas become tight, it’s challenging to take a lower, more engaged breath.”
When the accessory muscles are stabilised and can’t ‘help’ with breathing, the body defaults to lower slower breathing where the diaphragm is more actively involved. Remind your body how calm breathing feels with these steps:
- Step one: Notice how you’re sitting, and lengthen your spine
- Step two: Lace your fingers together, palms facing you
- Step three: Put your hands behind your head, cradling the base of your skull in your interlaced fingers, with elbows out to either side
- Step four: Breathe softly through your nose, feeling the air fall into your lower respiratory system
- Step five: When you’ve had enough, bring your arms down and rest your hands in your lap, but hold on to the sensation of ease and space.
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What’s special about ENO Breathe?
Many Long Covid symptoms such as fatigue, brain fog and breathlessness can be invisible to others. Sufferers often find themselves misunderstood and with no clarity about their recovery. That accentuates their anxiety and isolation, which affects their sense of self and wellbeing.
“Joining a programme where you meet others who understand what you’ve been through and can share similar experiences is hugely beneficial,” explains Cassie. “The individuals on the programme are participants, not patients. This allows them to exist fully and be seen not through the lens of their symptoms but as fully rounded individuals.”
ENO Breathe is a holistic programme that welcomes and nourishes creativity. Crucially, in my opinion, the exercises are approached with positivity and fun, with session leaders who can lift the mood while being considerate and caring. I found that this positivity helped to make the techniques more memorable.
I still experience breathlessness, but it’s for short periods and usually when I’ve pushed myself too hard with physical exertion or poor stress management. And now, when that happens, I have a toolbelt of exercises to find my way back to something akin to normalcy.
