12 Feb Why it’s Hard to Breathe with a Mask on?
Facemasks have become part of our everyday life – do you ever find yourself feeling breathless? If you do, then you are not alone. I have personally felt the discomfort whilst treating my patients with a mask on, and even after several weeks I’ve yet to adjust to this suffocating feeling. This is what prompted me to write this blog. So, if you are interested in this topic, please read on as I will be covering the following questions:
- Does a mask actually affect the gas exchange we require for activities of daily living?
- Why do we FEEL breathlessness?
- What are some strategies to combat these feelings of breathlessness?
Do masks impact gas exchange?
To clarify, our first question is addressing whether we are actually getting an altered amount of oxygen/carbon dioxide transfer as a result of covering our face with a mask. This is concerned with the physiological aspect of mask-wearing, while our second question is addressing the feeling or sensation of breathlessness or claustrophobia, which concerns the psychological aspect of mask-wearing.
So does mask-wearing affect our ability to get enough air into our lungs? In a nutshell, no. Research suggests that wearing masks during physical activity and even during heavy exercise did not a) increase work of breathing, b) alter pulmonary gas exchange or c) increase dyspnea (shortness of breath)1. This was demonstrated in both sexes and across multiple age groups. There were decreased gas exchange levels in participants with Chronic obstructive pulmonary disease (COPD) but this was the case across for all face coverings (they tested it with cloth masks vs surgical masks and other face coverings such as neck gaiters). Another study showed while there was a decrease in gas exchange with people with COPD, it was not sufficient in any harmful way2. So if you’re healthy/don’t have a chornic respiratory disorder; mask wearing does not impact how much oxygen you are breathing.
Why do we feel breathless with a mask on?
So if physiologically masks do not affect our gas exchange in any significant way, why do we FEEL breathlessness, dyspnea or a general sense of claustrophobia? There are two main reasons. Firstly, the increased sensory input our brain has to process because of the mask touching our mouth and nose area plays a part. Secondly, we are generally not used to breathing in hot air. For example, if you’ve ever tried bikram or hot-room yoga, you would be familiar with the sense of difficulty breathing.
Furthermore, there are levels of work of breathing that people ‘accept as normal’, so when this is increased, such as warding off a pandemic, there is a period of adjustment. Mask wearing is personally still a very new way of life; something I have yet adapted to. However, for nurses and surgeons, this is nothing new and so they are therefore less likely to suffer through such discomfort.
Strategies to combat mask associated breathlessness:
This threshold of perceived breathlessness is real and should not be discounted. An effective way to dial down such sensation is by using deep breathing techniques whereby we are reducing our typical breathing rate from 12-20 times per minute to 8 times per minute3.
We do this by: Inhale for 3 seconds, pause for 1 second, exhale for 4 seconds, and pause for 1 second. This represents 1 cycle and we repeat this over and over.
These long, slow breaths will steady you, as will the knowledge that despite how you’re feeling, your lungs are getting enough oxygen as needed.
You may also want to try wearing your mask around the house to see how it feels. Just as a snorkeler gets used to the strange sensation of breathing under water, you too can adapt to breathing with a mask covering your mouth and nose. 
In closing, yes, masks can be uncomfortable, but no, they don’t affect gas exchange in any meaningful way. We acknowledge it is a hassle but it is still the most simple and effective way in preventing the spread of COVID. Thankfully there are some strategies to help make mask wearing for some of us more tolerable.
Post by: Dr Marcus Ng (Osteopath)
- Efficacy of face masks, neck gaiters and face shields for reducing the expulsion of simulated cough-generated aerosols by William G. Lindsley, Francoise M. Blachere, Brandon F. Law, Donald H. Beezhold, and John D. Noti
- Effect of Face Masks on Gas Exchange in Healthy Persons and Patients with COPD by Rajesh Samannan, M.D., Gregory Holt, M.D., Ph.D., Rafael Calderon-Candelario M.D., Mehdi Mirsaeidi M.D. and Michael Campos, M.D.
- Study on Reducing the Stress of Wearing a Mask through Deep Breathing by Zhixing Tian, Bong-Young Kim and Myung-Jin Bae