Laugh To Breathe Better?

If you only have 5 seconds:

In addition to many other wellness benefits, laughing trains the muscles of the respiratory chain. However, in people with respiratory diseases, the benefits of laughter are still uncertain.

Otherwise, read on…

Folk wisdom has highlighted laughter in the form of multiple proverbs, in all cultures around the world. In the context of a blog on wellness, this Irish proverb seems particularly apt:

“A good laugh and a long sleep are the two best cures for anything.”

This proverb resonates with what Patrick McKeown, founder of Oxygen Advantage, offers. Indeed, he bases his approach to wellness on quality sleep and breathing. Without these two foundational elements, attempts to improve will be at best incomplete, at worst impossible.

But what do the two lower levels of this pyramid have to do with this proverb? Certainly, the proverb and Patrick are both Irish. But that’s not the point. Sleep, that’s obvious. But what does laughter have to do with the pyramid? And no, we are not going to talk about laughter in a pub over a stout beer. In fact, there is a connection between laughter and breathing.

Definitions of laughter vary in the way they approach it. They often focus on the emotional component of laughter. I admit to having a preference for the one in the English version of Wikipedia because it focuses on anatomy:

“Laughter is a physical reaction usually consisting of rhythmic, often audible, contractions of the diaphragm and other parts of the respiratory system. It is a response to certain external or internal stimuli.” [2]

As you may have gathered, its places laughter as a process that is primarily manifested through the respiratory system. So laughter is a serious topic for this blog.

When the body laughs, the respiratory muscles work

The respiratory aspect of laughter has been the subject of some scientific studies, involving theater actors as well as volunteers watching humorous sequences with Roberto Benigni [3, 4]. But then, what happens when we laugh? The stimulus can come from outside or inside, can be cultural (joke, humor) or reflexive (tickle). Once the nervous system has processed this stimulus and triggered the laughter process accordingly, laughter is characterized by a long, abrupt exhalation, followed by several short, jerky exhalations of varying duration [4]. During laughter, the expiratory saccades last on average 3.7 ± 2.2 s, at a frequency of 4.6 ± 1.1 Hz. They increase the pressure in the trachea and are coordinated with the activity of the laryngeal muscles that allow the sound release of laughter [5]. The expiratory movements result in a decrease in Residual Functional Volume of 1.55 ± 0.40 liters [4]. This decrease in volume is uniform throughout the thoracic cage. This highlights the action of the internal intercostal muscles which act in concert with the abdominal expiratory muscles. The external oblique abdominal muscles are used as much as during crunches (spinal curls), and even more in the case of the internal obliques [6]. These abdominal jerks are all events that compress the abdominal viscera towards the diaphragm. The diaphragm then protects the intrathoracic structures from too much compression by counteracting the abdominal pressure [4]. This indicates an eccentric contraction of the diaphragm. It is interesting to note, however, that the decrease in Functional Residual Volume is less than during forced expiration and never reaches Residual Volume. It should be noted that the expiratory saccades are followed by a deep inspiration, and it is therefore a priori the diaphragm’s turn to be engaged concentrically [5]. In addition to the work of the expiratory muscles, this process allows the renewal of stagnant air in the lungs. Moreover, since laughter is essentially an expiratory process, the exhalation is typically longer than the inspiration. This inspiration/expiration ratio in favor of expiration is in fact a specific characteristic of the manifestation of joy, compared to other basic emotions [3].

Finally, since the primary function of the respiratory system is to ensure gas exchange between the internal and external environments, it should be noted that the supply of O₂ is not impacted during laughter, despite the sudden increase in energy demand due to the effort and possible apnea phases [7].

In the end, these studies show that laughter is a way to mobilize the respiratory system. When we laugh, the respiratory chain works. Could this work be beneficial in treating certain respiratory problems?

Laughter and respiratory diseases: mixed results, missing data

Chronic obstructive pulmonary disease (COPD) is a disease characterized by airway obstruction resulting in difficulty for the body to perform this basic function. This results in a decreased quality of life, a medical euphemism for “life-ruining”. In some cases, COPD can cause death. It is the third leading cause of death worldwide according to the WHO, causing the death of more than 3 million people per year [8]. Ninety percent of the victims are in low-income countries. The main known causes are smoking (active or passive), air pollution, asthma and genetic predisposition [8]. A characteristic feature of COPD is an overinflation of the lungs, trapping air, preventing it from being renewed and causing gas exchange problems [9]. This is followed by a flattening of the diaphragm; all of which causes difficulty in breathing [10]. A team tested whether the repetition of expiratory efforts brought about by laughter could reduce the volume of the lungs in patients. This small study (19 patients, 10 healthy controls) consisted of measuring the lung capacity of the subjects before and in the hours following a clown show, dispatched for the occasion. It appeared that, on the whole, and in spite of a great variability in the cohort, laughter allows to decrease the lung volume during the two hours following the intervention. Moreover, it is interesting to note that the observed decrease in lung volume results from a decrease in residual volume. This corresponds to a turnover of trapped air in the sick individuals [10]. The decrease in residual volume followed by its recovery allows for a more efficient renewal of air in the lungs. In contrast, another study concluded that laughter worsened lung overinflation in patients, but could not conclude whether this effect was deleterious in the long term or merely transient [11]. Finally, Fukuoka et al did not find any improvement in the respiratory functions of COPD patients by laughter yoga but their study lasted only 2 weeks [12]. Finally, it seems important to take precautions with laughter as a support for COPD. Indeed, the studies are rather in the preliminary stage and contradict each other too much to conclude with certainty about the benefits of laughter on COPD. It is possible that the effects depend on both the severity of COPD and the intensity of the intervention, from smiling to moderate laughter, to explosive laughter and mirth.

Laughter beyond breathing

This article is only concerned with the breathing aspect of laughter, as it is one of the major focuses of this blog. But I can’t help but point out that laughter has many other benefits and interests. In fact, while the studies mentioned above are not very conclusive on lung health for people with COPD, but they are unanimous on the improvement of the quality of life through laughter [10, 11, 12]. This is not surprising. Indeed, there is something intuitively obvious in the statement “laughter improves quality of life”. This resonates with the popular saying “laughter is the best medicine” around the world. In this case, research has shown the benefits of laughter on the vascular system and pain perception [13]. Beyond pure physiology, laughter has a social component, and it is now known that it is not even peculiar to Homo sapiens! [14]

In conclusion, it appears that laughter can be an ally of respiratory health by mobilizing the respiratory muscle chain. We can only regret that it is not taken more seriously. Those who follow me through the Wim Hof Method have probably already heard that my 4th pillar of practice is “to practice seriously, but not to take yourself too seriously”. But then, if laughter is an objective ally of wellness, there are serious reasons not to take yourself too seriously. On that note, I have a pile of jokes to work on for my next workshops.

🔥❄️🧠✌️

Sébastien.

References

1. https://oxygenadvantage.com/atomic-focus/
2. https://en.wikipedia.org/wiki/Laughter
3. Bloch S, Lemeignan M, Aguilera N. Specific respiratory patterns distinguish among human basic emotions. Int J Psychophysiol (1991)11(2):141-54
4. Filippelli M, Pellegrino R, Iandelli I, Misuri G, Rodarte JR, Duranti R, Brusasco V, Scano G. Respiratory dynamics during laughter. J Appl Physiol (2001)90(4):1441-6
5. Luschei ES, Ramig LO, Finnegan EM, Baker KK, Smith ME. Patterns of laryngeal electromyography and the activity of the respiratory system during spontaneous laughter. J Neurophysiol (2006)96(1):442-50
6. Wagner H, Rehmes U, Kohle D, Puta C. Laughing: a demanding exercise for trunk muscles. J Mot Behav (2014)46(1):33-7
7. Fry WF, Stoft PE. Mirth and Oxygen Saturation Levels of Peripheral Blood. Psychother Psychosom (1971)19(1-2):76–84
8. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
9. O’Donnell DE. Ventilatory limitations in chronic obstructive pulmonary disease. Med Sci Sports Exerc (2001)33(7 Suppl):S647-55
10. Brutsche MH, Grossman P, Müller RE, Wiegand J, Pello, Baty F, Ruch W. Impact of laughter on air trapping in severe chronic obstructive lung disease. Int J Chron Obstruct Pulmon Dis (2008)3(1):185-92
11. Lebowitz KR, Suh S, Diaz PT, Emery CF. Effects of humor and laughter on psychological functioning, quality of life, health status, and pulmonary functioning among patients with chronic obstructive pulmonary disease: a preliminary investigation. Heart Lung (2011)40(4):310-9
12. Fukuoka A, Ueda M, Ariyama Y, Iwai K, Kunimatsu M, Yoshikawa M, Uyama H, Tomoda K, Kimura H. Effect of laughter yoga on pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. J of Nara Med Assoc (2016)67(1,2,3):11-20
13. https://www.health.harvard.edu/blog/laugh-and-be-thankful-its-good-for-the-heart-20101124839
14. https://www.franceculture.fr/emissions/la-methode-scientifique/rire-c-est-du-serieux