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Coffee, running or breathing exercises- what’s best for asthma?

Looking at the most recent Australian Asthma Council Guidelines on complementary medicine I noticed that coffee is given a 2 star rating, that means its top of the list for all complementary medicines for asthma. The only other therapy with a 2 star rating is aerobic exercise. Breathing retraining gets just one star which might give the impression (to those who don’t understand the whole story) that coffee is better for asthmatics than learning to breathe properly. 

In the UK, the 2016 guidelines of the British Thoracic Society put breathing exercises, specifically the Buteyko and Papworth Methods, at the top of their list of effective complementary therapies, with an A rating . Breathing exercises were also ranked highest for complementary medicine treatments in Australian Asthma Council Guidelines in 2006 but this most recent publication (2014) has seen coffee rated higher, with breathing exercises dropping.  

These guidelines are meant to inform doctors about how to best advise patients about managing their asthma but if taken at face value and interpreted simplistically they could lead to some doctors giving their patients misleading advice.

The research tells us that it takes 3 cups of coffee a day to have a positive impact on asthma. I do love my coffee but even for me, 3 cups is over my comfort limit. My stomach and nerves don’t feel so good on that much coffee. Also coffee does tend to deplete the body’s stores of nutrients like magnesium that are known to improve asthma. So to my way of thinking coffee might show good results in research trials and help some asthmatics breathe more easily at times but it’s not a long term solution with deep curing and restorative properties. 

Increased aerobic fitness on the other hand makes most people feel good and fundamentally improves health so  it’s great to hear that research evidence shows that it specifically helps to improve asthma. So on in general, encouraging people with asthma to get more exercise is a really good thing. However many asthmatics have experienced exercise induced asthma. They know that hard breathing, especially of cold dry air can make the lungs irritated and inflamed. Some research suggests that up to 25% of elite athletes develop exercise related bronchoconstriction. In my experience asthmatics who want to get fitter have to learn to breathe properly first. They need to learn to exercise with mostly nasal and diaphragmatic breathing and to control tendencies to hyperventilate.  

And now to the topic of breathing retraining exercises, are they really less beneficial then coffee?  Well, it depends… on which breathing exercises we are talking about and how they are taught. The recent British Thoracic society guidelines give quite extensive recommendations around breathing retraining for asthma.  They say that they should involve at least 5 hours of training, be provided by a trained therapist and that they should be part of integrated medical care.  Similar recommendations are made by a report published by the by US Govt. Agency for Healthcare Research and Quality.  They say that breathing retraining for asthma is most likely to work if it is targeted and sufficiently intensive to achieve necessary changes.

Australia was once at the forefront of research into breathing therapy for asthma. However, we have dropped the ball. Most doctors do not recommend breathing exercises for asthma and there are few trained breathing therapists.

Over the last few years Ive been working hard on developing an integrative breathing therapy program that is in line with research findings about what works best. It includes techniques from Buteyko, respiratory therapy and breathing biofeedback.   I’ve been mostly working with patients individually but am now starting to run group programs. These involve one weekly class for 5 weeks.

I have a couple of group workshops for children and one for adults coming up this November.

Here are some links for info and bookings.

Adults Integrative Breathing Therapy Workshop in Mona Vale


Healthy Breathing Healthy Child Workshops in Mona Vale and Neutral Bay



What’s the Difference between Osteopaths, Chiropractors and Physiotherapists? 


Im often asked what’s the difference between an osteopath, chiropractor and physiotherapist? The short answer is that it depends on the practitioner and because of evidence based medicine and the fact that we all tend to read the same research literature and learn from each other we are tending to become more alike in how we practice. However there definitely are differences. Some of these are historical and philosophical and some are practical.  

I think most people are probably most interested in the practical differences. Here are some of the main ones:-

What happens in a treatment—The bulk of most osteopathic hands-on sessions include massage  and various types of tissue and joint manipulation. When compared to chiropractors, osteopaths do a lot more massage and less of the high velocity (joint cracking) manipulation.  They also use a lot more gentle manipulation, specific positioning techniques, active resistance, and slow release of ligaments and fascia. Osteopaths traditionally have not prescribed as much exercise rehabilitation as physios but this is changing rapidly and most osteopaths like their patients to do exercise to assist in the management of chronic and recurring problems.

Length of treatment sessions- most osteopaths do 30-60 minutes treatment sessions.  This tends to be longer than most chiropractors, (who may do 5-15 minute session) and similar (although probably slightly longer) to muscular-skeletal physiotherapists. 

Whole body focus- Osteopaths tend to treat more than one part of the body because they are trained to always consider the ways that all parts of the body are connected.  For example, a person with a shoulder problem may also have restrictions and imbalances in the ribcage and pelvis that contribute to abnormal function of their shoulder.

Healing the whole person- Historically osteopathy was concerned with healing a range of ailments, not just muscular-skeletal pain and injury.  Today we can still say that the body’s self-regulating (or homeostatic) ability is enhanced when structure and physiology are balanced and efficient. Relaxation of the body and the nervous system is an important aim of osteopathic treatment because of the way this supports the healing response.

Frequency of treatments- Osteopaths tend to treat less often than chiros and physios. I believe that the combination of long treatment times, whole body focus, and variety of treatment techniques that focus on the whole body and work on different types of tissue  mean that people  tend to get better with less number of treatments.

Skill and Training

Osteopaths, chiropractors and physiotherapists all  undertake 4- 5 years of university education (usually to the level of master’s degree).  I would argue (and some might disagree) that osteopaths probably get the best training in massage and soft tissue skills.  They are extensively trained in specific osteopathic techniques that require high levels of sensitivity, focus and interpretative touch.

Many people say they love the feeling of wellbeing and relaxation they experience with osteopathic treatment. Perhaps it’s because they can feel that the osteopath is thinking with their hands, interpreting and responding to what’s under their hands; adjusting technique, pressure and position as the tissues change during the treatment.

Results- Treatment results depend on the skill of the practitioner, whether osteo, chiro or physio and the fit they and the techniques they use have with the patient and/or their condition. 

If you want to read a bit more about the philosophy of osteopathy. Here is are a couple of links.


 More about Osteopathic treatment.  






Asthma and Chronic Lung Diseases- Getting Healthy Naturally


Rosalba Courtney ND, DO, PhD

Natural Health Strategies for Asthma and Chronic Lungs Disease

Medical treatments for asthma and chronic respiratory diseases, such as COPD and Emphysema have improved over the years and many people can live full lives with minimal symptoms. However as many as 50% people with chronic asthma (1)  do not have good control of their breathing or their health either because they don’t regularly take their prescribed medications or because prescription medications are not enough to fully control their symptoms.  COPD is a chronic and progressive condition that needs a comprehensive strategy to ensure ideal health outcomes.  Many people with these conditions want to do as much as they can be live well,  often  seeking out complementary medicines and natural therapies such as breathing training, diet, herbs, massage and other therapies. 

Complementary natural medicine treatments for asthma and COPD include herbal medicines, nutritional supplements, breathing therapy, relaxation, mindfulness, hands-on therapy, strength and fitness training, Yoga and Tai Chi.  There is research evidence for effectiveness of many of these therapies, some stronger than others.  Making sense of what to use and when can be very confusing for the consumer and the guidance of a trusted experienced integrative health practitioner who is up to date on the research is very helpful for navigating these waters.  

Focus on the basics-

For people with asthma and chronic respiratory disease its important to start by optimizing basics such as diet, exercise and stress reduction. These lifestyle factors all work together to reduce inflammation, improve immune function, enhance energy metabolism, reduce breathlessness and prevent deteriorating health. 


Making sure your diet is high in fruits, vegetables, good fats, unprocessed grains and legumes and good quality protein while being low in processed foods, sugars and chemical additives is essential. 


Exercise that promotes general strength and fitness is also essential. Many people with chronic respiratory illness avoid exercise, yet improved fitness and muscles strength are proven strategies for reducing breathlessness, maintaining energy and reducing inflammation.

Relaxation, Meditation, Stress Reduction

Regular practice of relaxation, meditation, mindfulness and stress reduction techniques also have a huge influence on inflammation, health and the impact that the respiratory diseases have on your quality of life.  People with respiratory illness have about 4x higher incidence of anxiety and panic disorder so having a toolkit of self-regulation strategies to calm the brain and balance the nervous system is particularly important. 

Breathing therapy

Breathing exercises can also be very helpful in the management of asthma.

Breathing retaining, relaxation and manual therapy can improve dysfunctional breathing.   Research has shown that after breathing training asthmatics often have less symptoms, less medication and better quality of life (2-4).

Dysfunctional Breathing  

Dysfunctional breathing  increases symptoms and reduces quality of life in many people with chronic respiratory illnesses.

When a person has dysfunctional breathing the following  things can occur-

  • ·        Breathing muscles become tense, weak and poorly co-ordinated
  • ·        The rib cage becomes tight and does not expand well
  • ·        The diaphragm becomes tense, short and weak
  • ·        The  upper rib cage and shoulder muscles become the dominant breathing muscles
  • ·        Chemical regulation of  breathing becomes  abnormal leading to chronic  hyperventilation and pH abnormalities.
  • ·        The lungs become hyperinflated
  • ·        Also there is often  a mismatch between how much air a person thinks they need and the actual amount they actually require.  Dysfunctional breathing leads to    It lead to disproportionate breathlessness and other symptoms that do not respond to asthma medication.

 Hyperventilation, which is one type of dysfunctional breathing can make the airways more inflamed and susceptible to spasm in response to triggers.

 Integrative Breathing Therapy –

Integrative breathing therapy is comprehensive breathing retraining that works on several levels to correct dysfunctional breathing. It trains breathing by resetting the motor control of breathing muscles,  normalising CO2 setpoints and  set-points of breathing and  breathing of the brain, nervous system and breathing control system to restore functional brething.  These can be combined with relaxation, strength and fitness training and manual therapy such as osteopathy, massage and physiotherapy.

Treatment begins with a thorough assessment for presence of acute or chronic hyperventilation, breathing pattern disorders, poor breathing habits and stress related breathing issues.

After breathing assessment patients are taught a range of breathing techniques that are modified as necessary to ensure that all key aspects of breathing functionality are optimized.  

Integrative Breathing Therapy is available in individual sessions and after initial assessment you can also complete the IBT program in a small group class.


1.            Demoley P, Gueron B, Annunziata K, al e. Update of asthma control in 5 European countries. European Respiratory Review. 2010;19:150-7.

2.            Grammatopoulou EP, Skordilis EK, Stavrou N, Myrianthefs P, Karteroliotis K, Baltopoulos G, et al. The Effect of Physiotherapy-Based Breathing Retraining on Asthma Control. Journal of Asthma. 2011;48(6):593-601.

3.            Thomas M, McKinley, R.K., Freeman, E., Foy, C., Prodger, P., Price, D.,. Breathing retraining for dysfunctional breathing in asthma; a randomised controlled trial. Thorax. 2003;58:110-5.

4.            Cowie R, Underwood MF, Reader PG. A randomised controlled trial of the Buteyko technique as an adjunct to conventional management of asthma. Respiratory Medicine. 2008;102(5):726-32.



Living Well with Asthma –What’s Functional and Dysfunctional Breathing Got to Do With It 

The Impact of Asthma

Asthma affects 1 in 10 people in Australia, that’s about 2 million people and about 655 million dollars is spent on asthma every year according to the Australian Bureau of Statistics .  What these figures don’t show is that asthma has very different effects on people’s lives. Some asthmatics live well with their asthma, stick to their written asthma plan and manage to have a good quality of life despite having asthma.    However many people with asthma   do not have good control of their asthma either because they don’t regularly take their asthma medications or because they don’t respond well enough to their medication to live without the suffering of unwelcomed breathlessness, stress, fatigue and reduced physical capacity.  A survey conducted in 2008 of 5 European countries showed that this was the case for over 50% of asthmatics [1] and the figures are likely to be similar for Australia.

Why severity of asthma does not equate to symptoms

One of the interesting facts about asthma is that breathlessness and other symptoms  do not necessarily correlate with how well people score on lung function tests[2]. Some people with mild asthma suffer more than people with more severe asthma.  The reasons for this are complex but presence of dysfunctional breathing  is one important factor known to  increase symptoms and reduce quality of life in asthmatics.

Symptoms that arise from dysfunctional breathing do not respond to asthma medication because they are not part of asthma, they are due to dysfunctional breathing.   Other symptoms,  including certain types of breathlessness are produced by asthma but aggravated by dysfunctional breathing.

Some aspects of dysfunctional breathing can also aggravate the pathological lung tissue changes that characterize the disease asthma, making the airways more inflamed and susceptible to spasm in response to triggers.

Dysfunctional breathing in asthma-its common and multidimensional.

Research has shown that about 30% of asthmatics[3] and over 65% of asthmatics with problem or poorly controlled asthma[4] have dysfunctional breathing.    

Dysfunctional breathing is multidimensional with 3 key dimensions [5, 6]-

  1. biochemical (hyperventilation),
  2. biomechanical (breathing pattern disorders)
  3. psychophysiological (stress related breathing issues)

These dimensions are linked but do not necessarily always co-exist.  Each dimension on its own can contribute to asthma symptoms, reduce asthma control and affect health and quality of life [6].

 How Hyperventilation Affects Asthma

Hyperventilation, (which means breathing in excess of your metabolic requirements so that you get depleted in carbon dioxide) is much more common in asthma sufferers than in the healthy population. In asthma hyperventilation can become conditioned so that asthmatics hyperventilate more readily in response to physical exercise, emotional stress or lung constriction.  Over time hyperventilation can become chronic, throwing the whole chemical control of breathing out of balance. The effect of chronic (or even frequent short term) hyperventilation is very destabilsing for the health and wellbeing of asthmatics for a number of reasons. Here are a few major reasons-

  1. Hyperventilation makes bronchi more likely to constrict, nerves become more twitchy and the bronchi themselves are more likely to  become  reactive to asthma triggers[7].
  2. Hyperventilation leads to symptoms like numbness, tingling, dizziness and mental confusion and even anxiety and panic that are not directly related to asthma and so do not respond to asthma medication[8]. 
  3. People with chronic hyperventilation develop a lower set point to CO2 and while most people want to slow down or stop their breathing when CO2 levels are critically low, chronic hyperventilators will be induced to hyperventilate even more creating viscious cycles that keep breathing out of control [9]. 


How Breathing Pattern Disorders and Poor Breathing Habits Affect Asthma

Breathing pattern disorders include high thoracic or chest breathing, paradoxical breathing where the rib cage and abdomen narrow during inhalation instead of widening and excessively erratic and irregular breathing with lots of sighing.  

The presence of these types of breathing pattern disorders in asthma sufferers is often associated with both tension/hypertonicity and weakness of key respiratory muscles such as the diaphragm.  Tension and weakness can sometimes co-exist because muscles that are shortened due to tension are also weak.

 In any case tense, weak and poorly co-ordinated breathing muscles do not respond well to voluntary and involuntary breathing efforts.  This contributes to breathlessness and respiratory discomfort [10].  Very often people with neuromuscular dysfunctions of respiratory muscles will complain that they cant take a satisfying breathing or that their rib cage is tight and cant expand.  When symptoms of respiratory discomfort  are coming from the chest wall and the respiratory muscles rather than the bronchi, they are not responsive to asthma medication. This fact and the feeling that breathing muscles are not responding as expected to breathing efforts can a person feel that their asthma is out of their control. 

How Stress Related Breathing Issues Affect Asthma

Stress anxiety and conditions such as panic disorder are about 4x higher in people with asthma[11, 12]. Also people with asthma are highly susceptible to the effects of stress on their breathing and on their perception of breathlessness.  Asthma suffers who are anxious and tense can become conditioned to have unusual breathing patterns and they also  experience more breathlessness. 

Many decades of research has shown that one’s sense of being in control is very important for health[13]. Low sense of control increases fear and anxiety which can, amongst other things lead to more asthma symptoms. Presence of hyperventilation and breathing pattern dysfunctions both reduce sense of control in asthma because they produce symptoms that don’t respond well to medication and also because they disrupt the mechanisms and pathways that regulate breathing.

Learning to take control of symptoms by correctly modifying your breathing is an important step for increasing your sense of control.  

 What can be done to correct dysfunctional breathing in asthma.

Breathing retaining, relaxation and manual therapy can improve dysfunctional breathing.   Research has shown that after breathing training asthmatics often have less symptoms, less medication and better quality of life [14-16].

At present the British Thoracic  Society  gives a Level A rating for the evidence on breathing therapy and recommends that it be used in addition to standard medical care.  The Australian Asthma Council which gave a Level 2+ rating for effectiveness of breathing therapy  in 2006, has been less encouraging in recent years. In their 2014 handbook they report that the results of research are inconclusive but that breathing therapy is probably effective.   What were the reasons for the decrease in ratings between 2006 and 2014, what changed?  Between 2006 and 2014 there was a significant increase in the number of research studies on breathing training and asthma, investigating approaches such as the Buteyko method, physiotherapist led breathing retraining, biofeedback, inspiratory muscle training and pranayama.  Most of these showed positive results in some aspect of a whole range of variables including  medication needs, asthma symptoms, quality of life, anxiety and depression, airway resistance, lung function measures such as FEV1, PEF, FEV1/FVC and  MVV.  However, the systematic review reference by the Australian Asthma Council in their report stated that while breathing training had benefits that should not be dismissed, the increased number of   the large number of differences in breathing techniques, treatment rationales, intensity and duration of treatment and patient selection made the data difficult to interpret.

One of the key conclusions of a large study by the American Agency for Healthcare Research and Quality [17]investigating comparative effectiveness of breathing exercises and/or retraining techniques in the treatment of asthma was that to be effective treatment has to be targeted to the patient and of sufficient intensity and duration.

Integrative Breathing Therapy – A comprehensive approach to breathing training

Integrative breathing therapy is a comprehensive approach to breathing retraining that considers the 3 key dimensions of dysfunctional breathing, the biochemical, biomechanical and psychophysiological.  Treatment begins with a thorough assessment for presence of acute or chronic hyperventilation, breathing pattern disorders, poor breathing habits and stress related breathing issues.

After breathing assessment patients are taught a range of breathing techniques that are modified as necessary to ensure that all key aspects of breathing functionality are optimized.  

Integrative Breathing Therapy is available in individual sessions and after initial assessment you can also complete the IBT program in a small group class.

For more info see





1.            Demoley, P., et al., Update of asthma control in 5 European countries. European Respiratory Review, 2010. 19: p. 150-157.

2.            Teeter, J.G. and E.R. Bleeker, Relationship between ariway obstruction and respiratory symptoms in adult asthmatics. Chest, 1998. 113: p. 272-277.

3.            Thomas, M., et al., Prevalence of dysfunctional breathing in patients treated for asthma in primary care: cross sectional survey. BMJ, 2001. 322: p. 1098-1100.

4.            Stanton, A.E., et al., An observational investigation of dysfunctional breathing and breathing control therapy in a problem asthma clinic. J Asthma, 2008. 45(9): p. 758-65.

5.            Courtney, R., Dysfunctional Breathing: Its Parameters, Measurement and Clinical Relevance, in School Health Sciences. 2011, RMIT: Melbourne. p. 317.

6.            Courtney, R., K. Greenwood, and M. Cohen, Relationships between measures of dysfunctional breathing in a population with concerns about their breathing. Journal of Bodywork and Movement Therapies, 2011. 15(1): p. 24-34.

7.            Sterling, G.M., The mechanism of bronchoconstriction due to hypocapnia in man. Clin. Sci., 1968. 34: p. 277-285.

8.            Ritz, T., et al., Hyperventilation symptoms are linked to a lower perceived health in asthma patients. Ann Behav Med, 2008. 35(1): p. 97-104.

9.            Folgering, H. and P. Colla, Some anomalies in the control of PACO2 in patients with a hyperventilation syndrome. Bull. Europ. Physiopath. Resp., 1978. 14: p. 503-512.

10.          Lougheed, M.D., Variability in asthma: symptom perception, care and outcomes. Can  J Physiol Pharmacol., 2007. 85(1): p. 149-54.

11.          Ritz, T., A.E. Meuret, and A.F. Trueba, Psychosocial factors and behavioral medicine interventions in asthma. Journal of Consulting and Clinical Psychology, 2013. 81(2): p. 231-250.

12.          Lehrer, P., et al., Psychological aspects of asthma. Journal of Consulting and Clinical Psychology, 2002. 70(3): p. 691-711.

13.          Seeman, M. and T.E. Seeman, Health behavior and personal autonomy: A longitudinal study of the sense of control in illness. Journal of Health and Social Behavior, 1983: p. 144-160.

14.          Grammatopoulou, E.P., et al., The Effect of Physiotherapy-Based Breathing Retraining on Asthma Control. Journal of Asthma, 2011. 48(6): p. 593-601.

15.          Thomas, M., McKinley, R.K., Freeman, E., Foy, C., Prodger, P., Price, D.,, Breathing retraining for dysfunctional breathing in asthma; a randomised controlled trial. Thorax, 2003. 58: p. 110-115.

16.          Cowie, R., M.F. Underwood, and P.G. Reader, A randomised controlled trial of the Buteyko technique as an adjunct to conventional management of asthma. Respiratory Medicine, 2008. 102(5): p. 726-32.

17.          O'Connor, E., et al., Breathing exercises and/or retraining techniques in the treatment of asthma: comparitive effectiveness. 2012, Agency for Healthcare Research and Quality: Rockville, MD.




Mouth breathing in children- it’s just the tip of the ice-berg

One of the most important things we can do to improve a child’s present and future health and structural development is to stop them habitually breathing through their mouth. The mouth should only be used for breathing on special occasions like hard sporting activity (and even that can be minimized to the childs benefit).  

Its been well recorded that habitual, excessive mouth breathing does not occur in children living in non industrialized societies. Disturbingly many children in modern westernized societies have their mouth open most of the time. 

This is of concern for 2 reasons 1.  it reflects an underlying deterioration in our children’s health and 2.  it contributes to a whole lot of problems.

The problems caused by habitual mouth breathing include -

·        Increased numbers of colds and upper respiratory infections

·        More asthma and allergies

·        Abnormal swallowing patterns

·        Speech dysfunction

·        Poor posture

·        Dental crowding

·        Narrow face and jaws

·        Increased snoring, sleep apnea and sleep disordered breathing

You can really get a sense of how important it is to correct mouth breathing when you consider that this list of  consequences of mouth breathing themselves cause  even more problems.  For example snoring and sleep apnea in children are associated with a 4 fold increase in ADHD and a range of cognitive, emotional and behavioral difficulties.  The postural changes found in mouth breathers  cause headaches, chronic neck, jaw and back pain.  Uncontrolled asthma lead to increased incidence of emphysema in later adulthood. Its also associated with greater incidence of psychological distress including depression, anxiety and panic disorder.

Simplistic solutions don’t always work

Once a child is mouth breathing it can be difficult to correct. Treatment such as removal of adenoids and tonsils, medication for nasal congestion and dental treatment to expand the maxilla and increase size of the airway can lead to great improvements in many children but research shows that sometimes they are just not enough[1].

Effective solutions often depend on treating the whole child, removing the causes  and customizing the treatment to improve immune and gut health, correct dysfunctional breathing habits and behaviors, posture and muscle function.

Treating the causes of mouth breathing in children

These are some of the causes of mouth breathing that need to be addressed

  • Narrow airway- A narrow airway can be caused by enlarged adenoids, tonsils and other lymphoid tissue in the upper airway, allergy, narrow nasal passages and insufficient/incorrect development of the upper and lower jaws.
  • Allergy and immune problems-Nasal allergy, nasal sensitivity and too many colds can lead to a persistent mouth breathing habit.
  • Digestive problems and reflux- poor gut motility and food intolerances can lead to reflux of stomach acid which irritates the upper airway and leads to hypersensitivity, congestion and swelling.
  • Breathing control dysregulation- Children who have had lots of stress or some kind of airway obstruction or low oxygen in sensitive development periods can develop poor breathing control.       

Breathing, posture and muscle rehabilitation is often the missing link

In many children mouth breathing, dysfunctional breathing and associated conditions can not be  improved without rehabilitative exercises.  Removal of adenoids and tonsils and expansion of the maxilla with a dental appliance can make the size of the airway adequate but unless breathing, posture and muscle function are retrained these problems persists.  

How can parents help their children to improve breathing, posture and muscular function

You may be able to get help for your child with an appropriately trained speech pathologist, osteopath, physiotherapist, orofacial myologist or breathing therapist.

If you would like more information Im doing a brief seminar for parents  titled “How to really help your child’s breathing problem” on  Sat, July 2nd and Wed, July 6th.

You can book online by clicking the links on this website or call us at the Breath and Body Clinic on 02- 99183460


1.            Levrini, L., et al., Model of oronasal rehabilitation in children with obstructive sleep apnea syndrome undergoing rapid maxillary expansion: Research review. Sleep Sci, 2014. 7(4): p. 225-33.