Tired All the Time? Your Breathing Could Be To Blame

Researchers have uncovered a hidden breathing issue that may be worsening symptoms in people with chronic fatigue syndrome.

Chronic fatigue syndrome often leaves people feeling profoundly tired and mentally foggy, and symptoms commonly intensify after mental or physical effort, a response known as post-exertional malaise. Researchers looking into shortness of breath in people with chronic fatigue have now found that many are prone to dysfunctional breathing. This abnormal breathing pattern may be linked to dysautonomia, a condition involving disrupted nerve signals that regulate blood vessels and muscles. Focusing treatment on these breathing disturbances could help ease some of the condition’s most difficult symptoms.

“Nearly half of our chronic fatigue subjects had some disorder of breathing — a totally unappreciated issue, probably involved in making symptoms worse,” said Dr. Benjamin Natelson of Icahn School of Medicine, senior author of the article in Frontiers in Medicine. “Identifying these abnormalities will lead researchers to new strategies to treat them, with the ultimate goal of reducing symptoms.”

Breathe easy

To explore this connection, researchers studied 57 people diagnosed with chronic fatigue syndrome along with 25 healthy volunteers of similar age and activity level. Participants completed cardiopulmonary exercise testing over two consecutive days. During these tests, the team monitored heart rate, blood pressure, oxygen uptake efficiency, blood oxygen levels, and the effort required to breathe. Breathing rate and breathing patterns were also recorded to identify signs of hyperventilation and dysfunctional breathing.

Although dysfunctional breathing is commonly linked to asthma, it can develop for many reasons. It may involve frequent deep sighs during normal breathing, breathing too quickly, forceful exhalation using the abdomen, chest-focused breathing that does not fully engage the diaphragm, or poor coordination between the chest and abdomen. When this coordination breaks down, the muscles involved in breathing no longer work together efficiently.

“While we know the symptoms generated by hyperventilation, we remain unsure what symptoms may be worse with dysfunctional breathing,” said Dr. Donna Mancini of the Icahn School of Medicine, first author of the article. “But we are sure patients can have dysfunctional breathing without being aware of it. Dysfunctional breathing can occur in a resting state.”

Catching your breath

The researchers found that people with chronic fatigue took in roughly the same amount of oxygen as the control group, meaning their peak VO₂ max values were similar. However, 71% of those with chronic fatigue showed signs of breathing abnormalities — including hyperventilation, dysfunctional breathing, or both.

Nearly half of the chronic fatigue participants displayed irregular breathing during testing, compared with only four people in the control group. About one-third of the chronic fatigue group hyperventilated, while just one control participant did. Nine people with chronic fatigue experienced both hyperventilation and dysfunctional breathing at the same time, a combination that was not seen in any of the controls.

Both dysfunctional breathing and hyperventilation can trigger symptoms that closely resemble chronic fatigue, such as dizziness, trouble concentrating, shortness of breath, and exhaustion. When these conditions occur together, they can also lead to heart palpitations, chest pain, fatigue, and (unsurprisingly) anxiety. According to the researchers, these breathing issues may worsen chronic fatigue symptoms or even play a direct role in post-exertional malaise.

“Possibly dysautonomia could trigger more rapid and irregular breathing,” said Mancini. “It is well known that chronic fatigue syndrome patients often have dysautonomia in the form of orthostatic intolerance, which means you feel worse when upright and not moving. This raises the heart rate and leads to hyperventilation.”

Pulmonary physiotherapy?

These findings suggest that improving breathing patterns could help reduce symptoms for some people with chronic fatigue syndrome. The research team plans to continue studying how dysfunctional breathing and hyperventilation interact. While additional studies are needed before treatments become widely available, the scientists have already identified several potential approaches to improve breathing.

“Breathing exercises via yoga could potentially help, or gentle physical conditioning where breath control is important, as with swimming,” suggested Natelson. “Or biofeedback, with assessment of breathing while encouraging gentle continuous breath use. If a patient is hyperventilating, this can be seen by a device that measures exhaled CO₂. If this value is low, then the patient can try to reduce the depth of breathing to raise it to more normal values.”

Reference: “Abnormal breathing patterns and hyperventilation are common in patients with chronic fatigue syndrome during exercise” by Donna M. Mancini, Danielle L. Brunjes, Dane Cook, Tiffany Soto, Michelle Blate, Patrick Quan, Tadahiro Yamazaki, Anna Norweg and Benjamin H. Natelson, 19 September 2025, Frontiers in Medicine.
DOI: 10.3389/fmed.2025.1669036

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