Podcast Episode 098: Functional Breathing with Patrick McKeown

In this podcast, Dr. John interviews Patrick McKeown, author of The Oxygen Advantage and founder of the Buteyko Clinic. Learn about the benefits of nasal breathing!

April 7, 2020 | 94 minutes, 00 seconds
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Podcast Show Notes

Irish international breathing expert and author Patrick McKeown completed his clinical training in Russia in 2002. Patrick is breathing adviser to Laird Hamilton’s XPT, Fellow of The Royal Society of Biology, and published by international medical journals and leading book publishers. 

Are You Breathing Wrong?

You enter the world with a gasp of air, and take an estimated 500 million breaths in your lifetime.1 Breathing is the first and most fundamental motor pattern,2 a primary autonomic function, and absolutely vital to life. You don’t even really think about your breathing—it just carries on day and night, without conscious effort.

You might be surprised to know, then, that you’re probably doing it wrong!

Benefits of Breathing Exercises for Improving Biochemistry + Biomechanics of Breathing

  • Improve circulation
  • Increase oxygenation of the cells, muscles, and brain
  • Help balanced functioning of the nervous system
  • Relieve chronic stress, anxiety, depression, panic disorder, burnout, and fatigue
  • Alleviate respiratory illnesses, including asthma and hay fever
  • Eradicate sleep apnea
  • Improve concentration, focus, and working memory
  • Boost athletic performance and stamina
  • Support correct development of facial muscles and airways in children

But this is no flash-in-the-pan miracle cure-all. Scientists have demonstrated the clinical relevance of respiratory rate and volume for a huge number of physical and psychological conditions. The simple truth is many of us breathe too fast and take in too much air: we habitually hyperventilate.

When we think of hyperventilation, the common image is one of trying to stem a panic attack by blowing into a paper bag. But the term, as it was first coined in 1938,3 just means breathing more air than your body needs, causing blood carbon dioxide to drop. Too little CO2 means less blood reaches your brain.

Even wellbeing professionals often mistake a ‘big’ breath for a deep one. When you’re told to take a deep breath, the reaction is often an oversized gulp into the upper chest. Ironically, the bigger the breath, the less oxygen reaches tissues and organs. When you breathe too hard, excess CO2 leaves the body through the lungs, causing blood vessels to constrict and the bond between hemoglobin and oxygen to tighten. Blood pH rises and oxygenation of tissues is impaired.14

Chronic hyperventilation is a really common modern habit, and it’s often caused by mouth breathing.

Why Nose Breathing Matters

The nasal airway forms the foundation of healthy breathing. In fact, breathing through your mouth is the functional equivalent to stuffing food up your nose. Despite this, most of us mouth-breathe at least some of the time.

The nose performs around thirty functions on behalf of the body.4 Because the nostrils are smaller than the mouth, nasal breathing creates about 50% more air resistance,5 allowing the blood to absorb around 20% more oxygen from inspired air. Nose breathing warms and filters the air before it gets to your lungs. It also harnesses nitric oxide (NO), an amazing gas produced in the paranasal sinuses, which helps dilate blood vessels all the way down in the lungs so that oxygen can get into your bloodstream.6

Correct breathing addresses your blood biochemistry, making the most of carbon dioxide and oxygen. It activates your diaphragm, helping with postural support and functional movement.2 And it slows down your breathing, reducing hyperventilation, activating the parasympathetic nervous system, and calming the mind.7 Mouth breathing is often the result of nasal congestion, but if you breathe nasally, your nose will never become completely blocked.

If a blocked nose is frustrating your efforts to restore nasal breathing, try this simple exercise. (Don’t practice if you are pregnant or have a serious medical condition.)

Exercise for Breathing with a Blocked Nose

  • Breathe in and out normally through your nose
  • Use your fingers to pinch your nostrils together and hold your breath
  • Gently nod your head while you hold your breath
  • Hold the breath until you feel a strong air shortage
  • When it becomes too difficult to keep the breath hold, let go of your nose and breathe in through your nostrils, bringing your breathing volume down towards normal
  • Wait about a minute, then repeat the exercise
  • Repeat this exercise six times

Breathing Too Much Makes You Sick

Mouth breathing activates the upper chest, causing shallow, fast breaths. This produces many undesirable effects, including activation of your fight-or-flight response, resulting in chronic stress. It dries out the mouth, creating gum disease, halitosis,8 and dental cavities. It promotes sleep-disordered breathing, linked to issues as wide-ranging as high blood pressure,9 sudden cardiac death,10 and road traffic accidents,11 not to mention the fact that sleep has a massive impact on quality of life.

In children, mouth breathing has been proven to cause poor academic performance, craniofacial deformities, dental problems,12 and behavioral issues—it fundamentally stunts your child’s development both mentally and physically13.

During the day, unhealthy breathing shows up in ways that may seem totally innocuous—frequent breath-holding, sighing, upper chest breathing, irregular breathing, and breathlessness. If your breathing during rest is audible, it’s time to make some changes!

These exercises help reduce ventilation and balance your blood biochemistry.

Breathing + Sleep

If you breathe through the nose during sleep, you’ll experience refreshing rest, less snoring, and significantly reduced sleep apnea. Nose breathing helps maintain an open airway at night, as nasal nitric oxide works to stiffen the dilator muscles of the throat, making the airways less likely to collapse.

  • If you wake up with a dry mouth in the morning, you are unlikely to feel refreshed. But did you know that this is because you were mouth breathing during sleep?
  • More than 50% of children breathe through open mouth.5 Sleep apnea in early childhood has been linked with sudden infant death syndrome.15
  • People over 40 are six times more likely to spend at least 50% of their sleep breathing through an open mouth.16

The science of sleep medicine has taken huge strides in recent years. Obstructive sleep apnea (OSA), which used to be viewed purely as an anatomical issue, is now considered to have four contributing factors,17 or phenotypes. While only one of these is anatomical, 69% of OSA patients are understood to demonstrate one or more of these physiological traits:18

  1. PCrit (pharyngeal critical closing pressure) is the main cause of OSA.19 It’s a measure of the mechanical impairments that cause the airway to collapse during sleep. It’s closely linked with mouth breathing, which encourages upper chest breathing and can allow the tongue to fall into the airway.20
  2. High loop gain is an exaggerated response to minimal changes in blood CO2. Because breathing temporarily stops during an apnea, CO2 is unable to leave the lungs and accumulates in the blood. This creates an exaggerated inhalation when breathing resumes, causing a sudden drop in blood CO2 (hypocapnia). Because CO2 provides the primary stimulus to inhale, insufficient CO2 can prompt another apnea, and so the pattern repeats.21 Aside from the anatomical factors, elevated loop gain is the biggest trigger for OSA, affecting around a third of all OSA patients.
  3. Arousal threshold is the propensity to awaken from sleep. Frequent waking contributes to poor ventilatory control.22
  4. Upper airway recruitment refers to the effort required to engage the upper airway dilator muscles. Around 30% of OSA patients have poor muscle responsiveness to the airway collapsing during sleep.17

What Causes Sleep Apnea

Fundamentals of Breathing Re-education Using Oxygen Advantage

  • Restoring full-time nasal breathing during day and night. Anyone four years and up can use MYOTAPE to ensure nose breathing at night.
  • Making sure your tongue rests in the correct position.
  • Slowing the speed of breathing. Six breaths a minute stimulates the vagus nerve, exercises baroreceptors, and increases heart-rate variability, all indicators of a balanced autonomic nervous system (ANS). Chronic stress, anxiety, depression, fatigue, asthma, and IBS all impact ANS function.
  • Learning to breathe from the diaphragm. The diaphragm is important for core support7 and its functioning can affect emotions.23
  • Achieving normal minute ventilation.
  • Determining your sensitivity to blood CO2 by measuring your breath-hold time. BOLT is a measure of how long you can hold your breath after an exhalation before the muscles begin to contract, creating an impulse to inhale. Breathing is considered functional when your BOLT is 25 seconds or more. Below 25 seconds, you will suffer from snoring, nasal congestion, coughing, wheezing, and breathlessness. In scientific terms, BOLT is a measure of sensitivity to blood CO2.

Measure Your BOLT

Let’s take a look at how these ideas work with those four aspects of sleep apnea…

  1. PCrit: Nasal breathing engages the diaphragm24 and increases lung volume, supporting the throat and preventing airway collapse.21
  2. High loop gain: Slow breathing reduces sensitivity to blood CO2. By applying the Buteyko breathing exercises and increasing your BOLT, you will lower your ventilatory response to CO2, reducing loop gain.
  3. Arousal threshold: People who breathe through the nose sleep more deeply and are less likely to wake so frequently.25
  4. Upper airway recruitment: The nitric oxide you harness when you breathe in through the nose is important in helping maintain muscle tone and regulating the neural pathways of the upper airways20.

Breathing + Anxiety

Respiratory physiology plays an important role in anxiety. This is why cognitive behavioral therapy, while excellent for managing negative thoughts, may not entirely resolve symptoms like panic attacks.

Anxiety and other mental health conditions interact negatively with breathing, causing habitually fast, shallow breaths. Unfortunately, when stress or anxiety is removed, poor breathing patterns often remain, feeding back to the brain to create feelings of worry, panic, and depression. Correct breathing addresses the physiological considerations that contribute to common mental health disorders.

  • Slow breathing calms the mind and improves sleep quality
  • Improved sleep calms the mind
  • Diaphragm breathing calms the mind
  • Light or quiet breathing increases blood flow and oxygen delivery to the brain, calming the central nervous system
  • Decreased sensitivity to blood CO2 prevents the onset of panic attacks
breathing emotions sleep

Nasal Breathing for Exercise

During exercise, particularly when things get intense, air hunger can become strong, prompting the switch to mouth breathing. Initially, this may seem like a great idea. After all, it’s much easier to mouth breathe. However, mouth breathing dries airways and contributes to exercise-induced bronchoconstriction. Breathing becomes fast and shallow, and oxygen uptake is reduced.

Professor of Exercise Science Dr. George Dallam has published in-depth research on nasal breathing in sport. It’s fair to say Dallam knows a thing or two about training—he competes as a triathlete himself, and his coaching portfolio includes Hunter Kemper, the top ranked male triathlete in the world in 2005-2006. Dallam’s research showed recreational athletes who trained with only nasal breathing for six months developed reduced respiratory rates, lower levels of expired oxygen (meaning the body was using oxygen more efficiently), higher CO2 levels, and a 22% reduction in ventilation,27 reflecting more economical breathing.

See also Brahmari Pranayama: Enjoy 15x More Nitric Oxide Benefits with Humming

Benefits of Nasal Breathing while Exercising

  • Diaphragm strength is maintained
  • More oxygen enters the bloodstream
  • Working muscles are better oxygenated
  • Airways are protected against dryness and inflammation

Practice this continuously, and within 8 to 10 weeks, feelings of air hunger will start to diminish. Dr. John Douillard first wrote about this almost thirty years ago in Body, Mind, and Sport. Sustained nasal breathing during physical exercise causes the body to make adaptations conducive to improved physical performance and recovery.

Restoring Functional Breathing to Reach Your Potential

Whether you want to sleep better, run faster, or just enjoy a healthier life, your breath holds the key to so many aspects of wellbeing. The Oxygen Advantage focuses on breathing from a three-dimensional standpoint, addressing optimal mechanics, biochemistry, and respiratory rate. There is no easier and more all-encompassing way to reach your full potential than by working to restore your breathing to its functional best.

Additional Resources for Functional Breathing

Ayurveda Meets Modern Science is hosted by Dr. John Douillard, DC, CAP, founder of LifeSpa and author of seven health books (including bestselling Eat Wheat and The 3-Season Diet), seven online courses (including Yoga Journal courses Ayurveda 101 and 201), and numerous free eBooks.

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