How Mouth Breathing is Destroying Your Health - Patrick McKeown [Podcast]

Jim talks with Patrick McKeown, President of Buteyko Professionals International and New York Times bestselling author of The Oxygen Advantage: The Simple, Scientifically Proven Breathing Techniques for a Healthier, Slimmer, Faster, and Fitter You. McKeown is widely regarded as one of the world's leading experts in breathing re-education. Topics include why everyone should stop breathing through their mouths for good, how air hunger can improve health, and much more.

 Transcript

Jim Donovan:

Hey there. This is Jim Donovan. Welcome to the show. I am so glad that you are here. Today we have a wonderful guest, Mr. Patrick McKeown. Patrick is the president of Buteyko Professionals International and a New York Times bestselling author of the book the Oxygen Advantage. He is a wonderful human being. He has got so much good information to share with you. This is a wonderful episode. It is packed with good information. Especially if you suffer from stress or congestion problems, breathing problems, sleep apnea, there's a lot of information that you need to know. So let's get started.

Jim Donovan:

Patrick, welcome to the show. I am so glad that you are here. I am really interested to hear how is it going over in Ireland today. I know that you are calling in from overseas.

Patrick McKeown:

Yeah, it's great. Thanks, Jim. All is good. I'm actually enjoying the little bit of stay at home here. It's quite busy anyway because everything is going over towards Zoom. I suppose the biggest impact is restricted travel. All the pubs are closed. As an Irish man, it doesn't do good for the Irish mentality when all of the pubs are closed. With that then, I suppose the best thing to do is to turn off the radio, turn off the TV, turn off social media, turn off pretty much everything, and just surround yourself in nature and you'll be absolutely fine.

Jim Donovan:

I've been finding a ton of solace just getting out into the woods, smelling the air, and leaving my phone in the car and just letting myself be. I think I maybe have taken that for granted over the years and this year, that's been a saving grace personally, so I am with you on that. I was looking. You have so many good resources about what you do. You have this website called oxygenadvantage.com. So as I was looking through it, I noticed... Right away, I got the impression that you've dedicated a lot of your live to breathing and reeducating people about how to do that. I'm interested, how did you land on this particular path?

Patrick McKeown:

Yeah, it was total accident. I was a mouth breathing child growing up. There are plenty of mouth breathing children growing up and nobody puts any attention to it. This has been written about since 1909, the negative impact of mouth breathing during childhood. But mouth breathing is probably the worst thing that any child can do persistently. It affected my concentration, my sports ability, my airways, my sleep.

Patrick McKeown:

When I was in high school, for me to get my grades, I really had to study hard and sometimes I lost interest in school because we know that kids who are mouth breathing and so adults as well, if you wake up with a dry mouth, you're more likely to be snoring, but you're also more likely to have obstructive sleep apnea. I had obstructive sleep apnea. It wasn't diagnosed. The only way I know I had it was that students used to tell me when I was staying in student dorms that they would hear me snore and then they would hear me stop breathing. But I was waking up feeling exhausted. So my asthma was getting progressively worse and you don't just have asthma, you don't just have a breathing problem. Because if your breathing is off, it can affect the mind and it can also affect your sleep.

Patrick McKeown:

So I graduated from a university in Dublin called Trinity College. It took me a lot of work because my concentration was not good. I remember studying. I always give this story. I was studying for an exam for three months and I was joined by a friend of mine. He hadn't opened the book and he asked me for my notes. I gave him my notes and he looked through my notes for 20 minutes. The two of us went off, did the exam, and he got the same results as I did. I couldn't help wonder how this guy has natural concentration and my concentration was absolutely shot. I would be looking at the page, but my attention wasn't on the page because I'm stuck in my head and I don't have the energy levels to take up that information. This is where sleep is coming in. Also if you have an agitated mind, it doesn't help.

Patrick McKeown:

So long story short, read a newspaper article. The vital importance of breathing through the nose and breathing less. Did a nose unblocking exercise, simply holding the breath to open up the nose. I changed to nasal breathing. That night, I taped up my mouth and wore nasal dilators, Breathe Right strips up my nose. I woke up the first morning, yeah, I was kind of getting used to it. Second morning, best night sleep I had in 20 years. I knew I was onto something. My asthma symptoms reduced by 50% in the first week.

Jim Donovan:

Whoa.

Patrick McKeown:

Now, I was trained for the corporate world. My background's economics and social science. So my background is completely so far removed from what I am doing. It was a couple of years later. I was driving from one part of Ireland to the other and I just got a feeling. I said, "I should be teaching or at least I should be more involved in this breathing because it's working and it worked for me." So I decided to change careers and I retrained in the field of breathing. I have to say I have never looked back. I have found an occupation that absolutely, if anybody was to say, "What's your ideal occupation that suits you?" I found it.

Patrick McKeown:

Now, Jim, it wasn't the easiest. It wasn't an occupation that you would go into in terms of nobody really cared about breathing 20 years ago. It was mainly in yoga. What we do is so far different from yoga breathing. It's going a lot deeper into it. It's looking at everyday breathing patterns. But I was lucky and I got plenty of breaks, I have to say. Journalists wrote stories about it, word of mouth spread, and it's been great. It's provided me with a lovely occupation.

Jim Donovan:

What a blessing to get to do something that rings your bell. Just lights you up.

Patrick McKeown:

Totally. Just know, and again, this is not touched on in schools. Why force subjects down children's throats and why not try and find out what exactly these kids are suited for? Because you know what? It makes life a little bit easier.

Jim Donovan:

We could use more of that. Right?

Patrick McKeown:

For sure.

Jim Donovan:

Just a little bit of relief from the intensity. I heard you say something a second ago, that you taped your mouth shut. Tell me more about that. I think a listener hearing that would go, "Why would he do that?"

Patrick McKeown:

Well, if you wake up with a dry mouth every morning, you're not likely to have a refreshing sleep. Also, we have to think about mouth breathing and snoring through the mouth. For example, mouth snoring goes something like this... There's a lot of turbulence in the throat and the soft palate is vibrating. Now, you can still snore through your nose; however, if you take your mouth closed, you stop mouth snoring. But it's really about getting the tongue into the roof of the mouth with the lips together, the jaw's relaxed, to help open up the airway so that you've got less resistance to breathing. This in turn then.

Patrick McKeown:

If we look at severity of sleep apnea, and one paper published in the Laryngoscope just a couple of months ago, they look at the AHI index, which is a measurement of apnea severity. Individuals with mouth breathing had 52 events per hour. Now, individuals with nose breathing still fairly strong, but it was 27. There's still a big difference between 27 events per hour with nasal breathing versus 52 with mouth breathing. So the tape that I used, I used simple, just medical tape at the time. We've since developed our own tape. I can show you a demonstration. How can you, for example, get the mouth closed that's more appealing, that's easier for people.

Patrick McKeown:

So the tape here, we have our own taped. We developed it actually for children initially because it's so important. So it's called Myotape. It's developed for the dental industry and it's developed for myofunctional therapy. But it goes like this. You've got a strip of tape and you stretch it. So you stretch it about 30 to 40%. It covers the mouth and hey, presto. It's elasticated so it's stimulating the muscle fibers here, the obicularis oris muscle, which is surrounding the mouth, to bring the lips together but without risk.

Patrick McKeown:

So say for example if a child hoping to restore nasal breathing. We use it as a training aid for children during the day. 25 to 50% of studied children persistently mouth breathe. They're sitting watching television with their mouth open. It alters the shape of their face and all mouth breathing children develop crooked teeth. Now, can you imagine the extent, the incidence of crooked teeth in western society? It's not natural for human beings to have crooked teeth. This is not primarily a genetic issue. This is not an issue that the child has inherited the big teeth from dad and the small jaws from mom. The problem is that the human face is changing in size. The issue with this is that the airway is getting smaller.

Patrick McKeown:

So for me, taping my mouth that night, we have to think of what function does the mouth do in terms of breathing? The answer is zero. None. Zilch. The mouth does absolutely nothing for breathing. No animal mouth breathes with the exception of the dog. A dog will mouth breathe to regulate body temperature. If we were to look at any nature, if you were to go onto National Geographic or watch any program about animals in the wild, you will see every single one them are nasal breathing. Our ancestors were nasal breathing. Our distant ancestors were nasal breathing. We only started mouth breathing relatively recently. Probably 400 years and probably even less.

Jim Donovan:

What? Why is that? Why do you think it was never that way before and it all of a sudden started?

Patrick McKeown:

I think it's linked with diet. When they looked at middle class graves in Europe who had access... Sugar has been around since the 11th century.

Jim Donovan:

Sugar? Yeah.

Patrick McKeown:

So sugar in Europe has been around for a long time. It has to be something to do with the diets because when they looked at the graves of upper middle class people who had access to sugar, for example, at the time, they had access to foods that peasants, and I would have been the peasant, we didn't have access to them. But when they looked at the graves, they noticed that the skulls, the shape of the skulls, the jaws were set back, there was overcrowding of teeth. That's from Dr. John Mew. He's an orthodontist in the U.K., but he also studied anthropology.

Patrick McKeown:

If you look at the work then of Marianna Evans from California, Dr. Kevin Boyd, there are many dentists and orthodontists that really notice and they know about the impact of mouth breathing on the shape of the skulls. And what's more, they also will tell you that if you correct and straighten children's teeth and if that child continues to mouth breathe, there's going to be a high chance of relapse. It's estimated to be about 75% of children. Their teeth will relapse unless nasal breathing is restored or they wear a permanent retainer.

Patrick McKeown:

So I think there's been a number of things. Number one, breast feeding is very important for the development of the muscles of the face, not just for nutrition. Number two, lack of awareness around tongue tie. So if the string that's holding the tongue to the floor of the mouth is too tight, difficult for the child to breast feed. The child then is introduced to the bottle. Number three, processed foods. But number four, the hardness of our food. We are eating food now that's pre-chewed. Our ancestors would be eating hard, hard food. They would have been exercising their jaws, developing muscle tone. They weren't eating McDonald's to put it that way.

Jim Donovan:

So all these different parts of the diet from highly processed food to the sugar itself play a part in the musculature of the face and really the tone of the muscles there. All those things play into the shape of the head and how the airways are open or not. Am I understanding that right?

Patrick McKeown:

Yeah, it has to be that... I don't think anybody really knows. It's just one of those thing. It's difficult to absolutely quantify. There's probably a number of factors which has contributed to it, but it's the impact that food and breathing together. Because mouth breathing, of course, then you're talking about nasal allergies. You know what? It's easy to decongest a nose. 30% of the western society has a stuffy nose. If you hold your breath, you open up your nose. The thing about the human nose is that the more you breathe through it, the better it works.

Patrick McKeown:

If I was to say in one minute what are the functions, what are the benefits of the nose versus the mouth, number one, nose breathing increases the pressure of oxygen in the blood by 10%. That's known since 1988. Number two, your nose is directly connected with the diaphragm breathing muscle. Our diaphragm breathing muscle is not just about respiration. It's also there to provide stabilization for the spine. Also our diaphragm is connected with the emotions whereas mouth breathing, we're activating the upper chest and we're breathing fast and hard and it's putting us more into a sympathetic tone, or a fight or flight. The nose is protecting the airways. It's protecting both the upper airways and the lower airways. For example, people with asthma, people with exercise-induced bronchoconstriction.

Patrick McKeown:

Another aspect is nitric oxide. We think of COVID. Well, our nose produces its own... The first line of defense is nasal breathing and it produces a gas called nitric oxide. When you breath through your nose, we carry that nitric oxide to our lungs. I've had a long day of talking, by the way. Now it's nearly 7:00 PM and I've been talking since 9:00 AM.

Jim Donovan:

Oh, my.

Patrick McKeown:

Hence my voice is giving out. I've been doing it a few days in a row. So here's the impact of breathing is about. But nitric oxide, it's antiviral and it's also antibacterial. So whether it's posture, that's influenced by nasal breathing. The emotions are influenced by nasal breathing. Our sleep is influenced. Our oxygen uptake. But also our oxygen delivery because the one thing, Jim, is how often have we been told, "Take a deep breath," and how often have people taken this big, big breath? All I have to say is if you want to calm down, the worst thing that we could do is take a big, full breath because the harder you breathe, the more your blood vessels constrict and the less oxygen that gets delivered throughout the body, including the brain.

Patrick McKeown:

So there's many misinformation. There's a lot of misinformation out there about breathing. That's where my role just come into play. As one guy said to me, he says, "Patrick," he said, "They couldn't have all gotten it wrong." Back then, I says, "I actually think they did." I'm not saying that I know it all right or anything like that, but we have to look at breathing to detect... When we look at the application of breathing, just what we can get through the breath is amazing.

Jim Donovan:

So something I heard you say about nitric oxide. So we know that it's antiviral. Just one thing that I wanted to throw in there is that when the original SARS virus hit back in 2004, nitric oxide was actually one of the therapies that was used to help people deal with that original... what was a different coronavirus. I've seen research this year that talks about how they're doing that same intervention. They've been studying it and starting to see some good results with that. So I think it's relevant to what's happening.

Patrick McKeown:

They're looking at it in laboratories. They showed back in 2003 that nitric oxide in laboratory setting, that it prevented the replication of the virus. I wrote back in March of this year, I spoke about the importance of nasal breathing. In a way, I really wonder why have our healthcare authorities not just emphasized washing hands, wearing masks, but why not breathe through the nose? Two reasons. Number one is if you breathe through the nose, you take in less air. Number two, you help harness nasal nitric oxide. I'm not saying that this is going to prevent COVID, but at least it's going to offer some defense.

Patrick McKeown:

But for people who are infected, it's a respiratory condition. Breathing gets faster. The respiratory rate is one of the first thing that increases when we're infected with COVID. So we know that professional golfers, there were a couple of them that were diagnosed very recently, and they recognized that they were in trouble when their WHOOP, so it's a band or their watch, when it registered that their respiratory rate had increased by two breaths, they knew that they were in trouble. So the respiratory rate increases with it.

Patrick McKeown:

So people who were infected will feel suffocation breathing through the nose, so they switch to mouth breathing. Mouth breathing, there's a 42% greater water loss breathing out through the mouth. So you can imagine you have somebody infected in a household. The individual is having faster breathing. They're breathing through the mouth and they're emitting so much water vapor into the atmosphere and it's going to increase the risk of transmission. So for people who are not infected and for people who were infected, I think nasal breathing...

Patrick McKeown:

Like I was giving the example, I was on the Tube. I have been traveling. Once I've traveled to Denmark just about three weeks ago. I'm so conscious if I'm in a busy place. I will breathe through my nose, but I will also breathe hardly any air because if this virus is being transmitted airborne via aerosols, why not reduce the amount of air we are taking into our body? Or even hold your breath if you are around people and keep some distance.

Jim Donovan:

I've been doing something similar. Just like if I hug, even my kids, which we're all pretty safe but they still are out other places. If I hug them, just I hold my breath. Or if I'm near somebody, just like you said. Or a big one is even though I have a mask on, if I go into a public restroom, to limit the amount of air that I take in. Yeah. Just understanding that we do know it's aerosol transmitted, so just minimizing that as much as possible. What I'm hearing you say is that doing the nose breathing is definitely superior to that in the way that it can help maybe not fully protect us, but protect us way more than mouth breathing.

Patrick McKeown:

Yeah. There was a paper I can send on to you afterwards.

Jim Donovan:

Please.

Patrick McKeown:

It was published by Elsevier. It's an article written by medical doctors. They spoke about getting the mouth closed during sleep and they did actually recommend taping because they said it may help to reduce viral load and give the immune system enough of a chance to fight this.

Jim Donovan:

Well, that's good information. I would love to see that if you wouldn't mind sending it to me.

Patrick McKeown:

Of course.

Jim Donovan:

That would be very helpful. Now, when we're nose breathing... First of all, I just want to back up a little bit. I heard you say the common wisdom is when you're stressed out, let's take a deep breath and how if we do that through the mouth, that actually helps to turn more of the sympathetic nervous system on. It makes us more stressed?

Patrick McKeown:

What happens is if we take a big breath, and the reason I say a big breath because that's the way most people interpret a deep breath, we don't bring it in any more oxygen. We don't increase the blood oxygen saturation because our blood is already almost fully saturated at about 97, 98%. Breathing more air doesn't increase that, but breathing more air gets rid of carbon dioxide. Carbon dioxide is not just a waste gas. All it takes is one single big breath and that can get rid of between 7 and 16 millimeters of mercury of CO2. It's a significant amount.

Patrick McKeown:

The point here is that if we breathe too hard and we get rid of too much carbon dioxide, our blood vessels constrict. We have 70,000 miles of blood vessels throughout the body. Not only do our blood vessels constrict, but the bond between the red blood cells which are carrying oxygen and oxygen increase. So in other words, the red blood cells hold onto oxygen and don't deliver it so readily to the tissue and organs when we lose carbon dioxide. That last point, that was discovered back in 1904 by a Danish physiologist called Christian Bohr, that carbon dioxide is a catalyst.

Patrick McKeown:

So you can imagine the red blood cells carrying oxygen and the vast majority of oxygen in the blood is carried by hemoglobin. Hemoglobin releases oxygen in the presence of carbon dioxide. Now, on a very simple note, many people with dysfunctional breathing are faulty breathing or poor breathing. They've got cold hands and cold feet. That indicates that they have peripheral vasal constriction. We can help to improve the blood circulation within about two to three minutes by not breathing more air, but by breathing less. Like I often say, the other thing is I'm going to talk about snoring and then I'm going to talk about slowing down the breath and how people can experience... Can they bring an increased temperature to their fingers? Can they activate the body's relaxation response with increased watery saliva in the mouth?

Patrick McKeown:

So first of all, mouth snoring I spoke about. We said that that stops when you tape your mouth because if your mouth is closed, you can't snore through the mouth. Nose snoring, it goes something like this. The reason I talk about snoring is because it's so common. Nose snoring goes like this... Okay? Now if you were to really breathe slowly and to really breathe very soft and slow gentle breath in and very relaxed and slow breath out, and now a very soft and slow gentle breath in and a very relaxed and slow breath out, and as you breathe slow, can you snore through your nose? So try it there, Jim. Really breathe slowly and as you're breathing slowly, can you snore? You will find that as you breathe slowly, that it is more difficult to snore.

Patrick McKeown:

It's not just about the size of the airway. Any engineer who is looking at a pipe, they're not going to consider the diameter of the pipe in isolation. They are also going to ask the question what is the flow? But in sleep medicine, the whole emphasis is on the airway and the diameter of the airway without considering flow. Now, if you have somebody who's got poor breathing patterns, if they're unfit, if they're anxious, if they have respiratory issues, their breathing is faster and harder. How we breathe during the day influences how we breathe during sleep. They have faster and harder breathing through sleep, often through an open mouth, and that's going to contribute to snoring and obstructive sleep apnea.

Patrick McKeown:

Now, if any of your viewers want to try and improve their blood circulation, it's very simple. You could be just sitting up straight and the whole objective is to focus on the airflow coming in and out of your nose. So you're focusing on the slightly cold air coming into the nose and then you're having a really relaxed and slow, gentle breath out. Then when you need to breathe in, you're focusing on the cold air coming in, but gently soften the speed of the air coming into the nose. So on the breath in, the objective is really slow down the speed of air coming into the nose almost that you feel hardly any breath. At the top of the breath, bring a total feeling of relaxation to the body that you have a relaxed and slow, gentle breath out. Then when you need to breathe in again, take a really soft and slow breath in. Almost that the fine airs within the nostrils do not move.

Patrick McKeown:

So your breathing now should be less than what it was before you started. The objective is that you feel air hunger. Air hunger tells you that carbon dioxide has increased in the blood. If you continue slowing down your breathing with a feeling of air hunger for about three to four minutes, you will notice that you feel a little bit drowsy, that the saliva in the mouth is increasing, and typically the temperature of the fingers are increasing. So what I would say is for the viewers, try that. In the comfort of your own home, try deliberately under-breathing. For a few minutes, don't take so much air into your body. Really reduce the volume of air that you are breathing. Try and hide your breathing. How do you do it? Simply slow down the speed of the air coming into the nose and you're really slowing it down almost to the point where you feel hardly any air coming into nose and at the top of the breath, a total feeling of relaxation to the body. Maintain that feeling of air hunger for three or four minutes and see what happens, the body physiology.

Jim Donovan:

Well, that is really good. Even just doing it a couple times along with your demonstration, I could already start to feel that. So what I'm hearing you say is that I'm going breathe in very slowly through the nose, barely even feeling it come in, and then exhaling very slowly. What I was wondering is when I get down to the part where I'm empty of air, do I sit there and wait empty for a while?

Patrick McKeown:

Well, just wait until you feel the need to breathe in again. However, if you've really softened and slowed down the speed of the breath in and if you've had a very relaxed and slow breath out, then you will probably need to breathe in again because you want to have air hunger both on the inhalation and on the exhalation.

Jim Donovan:

Air hunger. Yeah.

Patrick McKeown:

Air hunger is what we're looking for or a slight feeling of breathlessness or a feeling that you would like to take in more air. The air hunger is not that the blood oxygen saturation has dropped. So it's not due to a deprivation of oxygen. It's actually due to an increase in carbon dioxide. So we're purposely breathing less air to increase carbon dioxide in the blood and as carbon dioxide increases in the blood, it improves our blood circulation.

Patrick McKeown:

But also, the whole point about this is I look at somebody breathing. Say they have anxiety. Typically I look at their breathing. Generally it's faster and it's upper chest. This is feeding into their anxiety. It's not just an anxiety is going to cause fast and upper chest breathing. It does. But fast and upper chest breathing is feeding back into anxiety. So I teach the person to really slow down their breath, to soften their breathing for periods of time throughout the day. With practice, this becomes their more normal way to breathe and they don't have air hunger. So it's almost that we are deliberately slowing down breathing so that that becomes the new way to breathe.

Patrick McKeown:

But just before I go on, it's not just about the air hunger. We also need to teach people how to breathe low and we teach them how to breathe slow. For example, low breathing is about improving the biomechanics of breathing. Then slow breathing is about slowing down the breath to a respiratory rate of between 4.5 and 6.5 breaths per minute to stimulate the vagus nerve, to exercise bio-receptors, to improve heart rate variability because here we can help bodily systems disturbed by system. Heart rate variability is an amazing concept. It's an amazing concept because it's a marker of resilience in the human being. People who are not well either emotionally or physically have reduced heart rate variability.

Patrick McKeown:

There's a number of ways of improving heart rate variability. One is nose breathing during sleep. Number two is that last exercise that we did. Hypercapnia increases heart rate variability. Number three, breath holding and number four, slow breathing to a cadence of between 4.5 and 6.5 breaths per minute. So when we look at the application of cadence breathing or resonant frequency breathing with nasal breathing and diaphragmatic breathing, it can really help a lot of people.

Jim Donovan:

It's built into your body.

Patrick McKeown:

For sure. That's it.

Jim Donovan:

That's the mind blowing part of all these practices is that you're born with them.

Patrick McKeown:

Yes. Yeah.

Jim Donovan:

I was taking a look through your materials and I saw something about how these kinds of breathing exercises can help people with weight issues. Can you tell us about that?

Patrick McKeown:

Yeah. We can't always reproduce it. It's something that we've seen over 20 years that when people soften their breathing and reduce their breathing, that their appetite can reduce. Now, there's probably a number of reasons to it. I certainly thing sleep is one. If we can experience deeper and restorative sleep, it has less of an impact on hormone levels.

Patrick McKeown:

For example, individuals with obstructive sleep apnea, they've got increased hormone called Ghrelin. Ghrelin is a food promoter, or Ghrelin switches on appetite. Leptin will switch off appetite or at least reduce appetite. But people with obstructive sleep apnea, if they are stopping breathing during sleep, they have a much greater appetite during the day. They eat more food, they put on more weight. As they put on more weight, it increases their risk of sleep apnea. So what we do with breathing exercises is that we change their breathing patterns to low, to slow, to light, to nasal breathing. This in turn will then reduce the risk and the severity of sleep apnea. As a result, it's going to reduce the negative impacts that that may have on hormone changes.

Patrick McKeown:

The second aspect is that we can help to get a balance between the parasympathetic and sympathetic nervous system. This is improving sympatho-vagal tone, stimulating the vagus nerve. If we can bring the body into relaxation, we are less likely to be craving food because of stress. It's very often that people are stressed and they use food as a comfort. So there's those two aspects. Now, you could say there's a third aspect to it. We improve breathing patterns so that it's easier for people to do physical exercise. They don't feel as breathless. The breathlessness during physical exercise, that's influenced by everyday breathing patterns.

Patrick McKeown:

Now, I work with elite athletes right up to Olympians to the very normal. Even a five year old kid for example. We teach this to five year olds. So we have our little book here, Always Breathe Correctly, for example. The point, anybody can do it. But it's our everyday breathing that influences our breathing during physical exercise and a lot of people can be put off doing physical exercise because they feel too breathless. So instead, what I will have them do is change their breathing during the day, breathe through the nose, slow down their breathing and their breath hold time improves. Breath hold time is a measurement of breathlessness. They find it easier than to do physical exercise. They find it more enjoyable. It's like this, if you do physical exercise, if it's more enjoyable, you're more likely to stick with it.

Patrick McKeown:

But we do encourage only nasal breathing, Jim. Especially for recreational athletes. Their recovery is much better. There's less trauma to the airways. The benefits are just much more superior with nasal breathing than with mouth breathing.

Jim Donovan:

Well, that's fascinating. Just that one tweak of doing... You're talking nasal breathing is in through the nose and out through the nose, correct?

Patrick McKeown:

Yes. Yeah, because if you breathe in, the body is expending energy, heat and moisture on the breath as it comes into the body. Then on the exhalation, the nose recovers that heat and moisture. I know in India, say, which you'll give, for example, if it's a really hot environment, it may make sense to have some breaths in through the nose and out through the mouth because you can get rid of heat from the body. But it doesn't make sense in every environment. Again, no animal breathes in through the nose and out through the mouth. A newborn baby doesn't breathe in through the nose and out through the mouth. The mouth doesn't do anything in terms of breathing. So the nose is there to recover the heat and moisture on the exhaled breath and this is what helps to keep the nose open.

Patrick McKeown:

So it has been studied. If you've got individuals to breathe in through their nose and out through the mouth, their nose is more likely to get congested. But also, the breath itself, the inhalation, is driven more by the sympathetic nervous system, the vagus nerve, which is the wandering nerve throughout the body, and it's sending a lot of communication from the body back to the brain. The vagus nerve steps back when we breathe in. If we have a prolonged and slow and relaxed exhalation, we stimulate the body's relaxation response. So the main driver of the exhalation is the parasympathetic nervous system. Now, if we breathe in through the nose and if we breathe out through the mouth, mouth breathing tends to be faster and faster breathing and the exhalation activates the stress response.

Patrick McKeown:

So say for example if you think of the Wim Hof Method, it's fast breathing in and out. It's the exhalation, it's the speed of the exhalation which influences whether you activate a stress response or a relaxation response. So if we think of it this way, if for example we are feeling stressed and if we want to bring the body into relaxation, a very simple way to do it is breathe in and out through the nose, but take a very soft breath into the nose and then have a really prolonged and relaxed breath out through the nose. As we have a prolonged breath out through the nose, this information is communicated from the body back to the brain that everything is okay. Then the brain is going to work with that information and communicate back to the body.

Patrick McKeown:

So we can almost tap into... It's a very primitive way because I think throughout our evolution, anytime we were stressed as human beings, we never had a slow exhalation. We always were in that fight or flight and that fast respiratory rate. Now we can use it to our benefit, that we deliberately slow down the breath to activate that relaxation response.

Jim Donovan:

That is so helpful and I love the idea that I can deliberately and consciously tell my brain that everything is okay just by deliberately slowing the breath down. Even if crazy stuff is happening, right?

Patrick McKeown:

Yeah, of course. I know it's not easy. Like if people are stressed and the last thing you probably want to do is focus on your breathing. However, the time to focus on breathing is not when the situation happens, the time to focus on breathing is now. I can say this 20 years on. I experienced life situations. We all will experience life situations. But the breath has been a tremendous companion and life is a lot softer. Our reaction to situations is a lot less and the mind activity is a lot less. There's more space between thoughts. We're more in present moment awareness.

Patrick McKeown:

Sometimes people think that breathing is for tree huggers and hippies and all of this. Listen. We have SWATs, Special Weapons and Tactics, doing this. We have Navy SEALs doing it. We have elite professional MMA fighters doing this. So we have the top of the top doing this and why do they do it? For resilience and to handle stress. Because as one guy says, a measure of a leader is not how well that person goes when things are going well. Anybody can run a company pretty much when things are going well. The company runs itself. The measure of a leader is how well does that leader perform when things are going badly. That's what a leader. The losing football team, the leader is the guy that can turn it around, that can change the moods, that they can stay focused, that they can get behind the players, that they can win the match. That's the measure of a leader.

Patrick McKeown:

So my thing here is it's back to the breath and the mind. For focus and for concentration, our breath is a companion there. It's not just about focusing on the breath. It's also changing breathing patterns to activate different states, but also increase blood flow to the brain. If we're breathing hard and fast... By the way, 75% of the anxiety population have dysfunctional breathing patterns. They are going to psychotherapy, they're going to psychology, they go to psychiatrists who is looking at their breathing. It's not just about taking the deep breaths, it's about going into a debt to improve their breathing across a biochemical point of view, biomechanical point of view, and also resonant frequency.

Jim Donovan:

Super helpful. It seems like that anyone who's getting trained to be a therapist needs to have this in their toolbox.

Patrick McKeown:

There's no question. Like cognitive training is great. But cognitive training does not change respiratory physiology. The other thing is, and we had this conversation today earlier on, people who are depressed, when you talk to them, how do they feel when they wake up in the morning, they often feel that they're absolutely exhausted. Now, then we have to ask the question what's causing what? Is it that the depression is causing the exhaustion or is it they have sleep disorder breathing, which is causing exhaustion, they cannot function, they are more anxious, and prolonged anxiety is contributing to depression? We know that when insomnia and obstructive sleep apnea go together, the risk of depression is higher. We cannot treat. We cannot just look at mental health, but without looking at breathing and without looking at sleep.

Jim Donovan:

What I'm hearing you say too is that it is the consistent practice that helps us to re-pattern or reeducate our brain and our body into that different, just regular state of breathing in terms-

Patrick McKeown:

Correct.

Jim Donovan:

So is it the fact that I just have to basically force myself to breathe slowly every time I think about it? Is that how you did it?

Patrick McKeown:

Well, perhaps. When I was doing it, I didn't have the instructions that I had now and I made some mistakes in the process as well. But normally when I'm working with a student, we have them, say for example, practice slowing down their breathing to the point of air hunger. Then I asked them to do it for at least 10 minutes four times daily. I asked them to do their physical exercise with the mouth closed. If their nose gets stuffy, I asked them to do this exercise. Don't do it if you're pregnant or if you've any serious medical conditions. But anytime you have a stuffy nose, if you want to open it, even if you've got a head cold, take a normal breath in and out through your nose, pinch your nose with your fingers, and walk around while you hold your breath. Continue walking while holding the breath until you feel a relatively strong air hunger and then let go, but breathe in through your nose. Breathe normally for about a half a minute and do it again, and repeat it six times.

Patrick McKeown:

So the next time that you feel that your nose is stuffy, you want to open up your nose, you have a head cold, and also people with COVID were doing this as well, it's slightly different, take a normal breath in through the nose, a normal breath out through the nose. Pinch the nose, hold the nose, and simply walk holding the breath. Keep holding your breath until you have a strong air hunger. Then let go and breathe in through your nose. Do that five or six times and the nose will open up.

Jim Donovan:

Well, I can't wait to try that. That's exciting. I'm getting excited about this.

Patrick McKeown:

It's been known since 1923. We use it with kids as well. So none of this information is new.

Jim Donovan:

It's not new and yet not known.

Patrick McKeown:

Well, [crosstalk 00:45:24]-

Jim Donovan:

I can only postulate why.

Patrick McKeown:

Well, I think it's because of commercial reasons to be honest with you.

Jim Donovan:

Yes. So how does this play into... I saw you have something in your information about chronic hyperventilation system.

Patrick McKeown:

Yeah, so-

Jim Donovan:

Chronic hyperventilation syndrome.

Patrick McKeown:

Chronic hyperventilation syndrome is just... It's a more common trait of dysfunctional breathing patterns. Chronic hyperventilation syndrome means that the person is breathing a little bit faster or a little bit harder, that they are breathing too much air. This is causing lower carbon dioxide levels, or it causes more fluctuations in carbon dioxide. It may be the fluctuations in carbon dioxide that's bringing on symptoms as well as... Jim, it's like this. If I said to you, "Take five or 10 big breaths in and out of your mouth," how does your head feel? We often feel lightheaded. We feel dizzy. So that's a more an exaggerated example. But how about the person who is breathing just a little bit faster and a little bit harder chronically? Their sleep is impacted. This can affect many organs systems to different degrees. It can affect the respiratory system. It could affect the mind. It can affect the gastrointestinal tract. It can affect exhaustion for example.

Patrick McKeown:

Unfortunately breathing doesn't get a whole lot of research. The main research though is in heart rate variability and that's where we can bring in what we do as well because we know we can improve HRV. But one paper in Europe looked at 35 individuals with burn-out syndrome, exhaustion syndrome. All 35 of them had hyperventilation syndrome. The reason being is this. If we as human beings, we are not able to cope with long-term chronic stress, we have never had it throughout our evolution. We have never had constant stress day in, day out for months and months and months on end. If we are in that situation, our breathing naturally increases and then we habituate to that harder and faster breathing pattern. Even when the stress is removed, our breathing pattern continues. But that breathing pattern is feeding back into stress.

Patrick McKeown:

Along history, this was first identified during the American Civil War by an American physician called Da Costa. He spoke about soldiers returning from the front line. They had symptoms of fatigue, breathlessness. We would call it post traumatic stress disorder. I think there's no coincidence that slowing down the breathing rate to six breaths per minute has been shown to be effective in helping with PTSD.

Jim Donovan:

This is the thing with how intense things have been this year. It was already intense before this year and this, it just seems like it's ramped up exponentially, that we are taking on new patterns even in the breathing that just aren't doing us any favor and actually causing us more anxiety on top of the anxiety that we had because we've habituated, as you said, to this new anxiety breath.

Patrick McKeown:

Yeah. I think one of the best things that I ever introduced, just on a personal level, was focusing on the breathing. I understand that for people with anxiety, that if the mind is racing, it can get a little bit frustrating at the start because you're taking your attention out of the mind onto the breath. But there are different exercises. For example, I have some exercises up on YouTube that are free for people with panic disorder. Take a normal breath in and out through your nose, pinch your nose and hold your breath for five seconds, and then breathe normal for 10. Hold your breath for five, breath normal for 10. Because this helps to increase blood flow and also desensitizes the body to the feeling of suffocation. But also, if we can increase blood flow to the brain, it has a calming effect on the central nervous system. So the brain and the spinal cord, they become aroused as a result of hyperventilation syndrome.

Patrick McKeown:

But coming back to it, I think we have to be very selective about the information that we let into our minds. I for one, I don't listen to the news and if I do, I just listen to it by accident. I switch off media. I'm not somebody who's looking into my mobile home very often throughout the day. We do have social media and we use it for business for example. I just feel that so much in modern society is taking our attention. When we think of social media and technology companies, and we have to wonder, we have to consider their modus operandi here. The modus operandi is how do we get users to stay for as long as possible on this platform? People are surrendering their time. They are giving two hours a day of their time. Many of people. Many people are to these platforms.

Patrick McKeown:

Well, how about giving ourselves some attention? How about just taking a quiet spot, closing our eyes, or even keeping the eyes open and taking our attention out of the mind onto the breath? And doing that at different times throughout the day. It creates gaps between thoughts and it gives us a lot more control over the mind. Most people, they don't have control over their mind. People might say to me, "Well, I have control over my mind." Well, the question then that I would ask, "Are you able to stop thinking?" And, "Can you switch off your mind? For how long can you bring a space into the mind without thought?" Most people will find it's maybe one or two seconds. We are living in our heads. As an educated society, we've been trained how to think. We haven't been trained how to stop thinking. We have been taught how to analyze, to decipher, to break information into tiny pieces. It's almost that we have been trained to sabotage ourselves.

Patrick McKeown:

I for one, I spent 20 plus years living in my head. I would walk down a beautiful street. I could be in a beautiful scenery. I wasn't there because I was stuck in my head. I've made a conscious effort since then of bringing my attention out of the mind into the every day, into the present moment. Even just bringing my attention out of my mind into my body, onto my breath. It all goes together because the breath is the connection between the mind and the body. But the benefits that it brings for our quality of life. If somebody said to me, "I'll give you a choice between a Master's degree, which you've had to work very hard for, or the ability to bring stillness into your mind," I would choose the ability to bring stillness into my mind. No question. Because it has done more for my life and my quality of life than any Master's degree could possibly do.

Jim Donovan:

That's what it's all about. How can we, with what we've been born with, improve quality of life in a way that doesn't make us pay for it later?

Patrick McKeown:

Yes. For sure. For sure. It's like to think that book, Atomic Habits. If we have a bad habit, we get self-gratification now, but we pay for it later on. A reward, yeah, we put in the effort now, but we get the reward later on. So I think you're correct.

Jim Donovan:

This has been a phenomenal conversation. I'm so grateful that we even get to do it. Before I let you go here, could you tell us about your book Oxygen Advantage?

Patrick McKeown:

Yeah. The Oxygen Advantage is... it's looking at breathing from a number of different perspectives, including performance, but sleep, asthma, childhood development, which I think for any readers, try and encourage your children to breathe through the nose. Our children's breathing program is completely free. All of the exercises are free up on YouTube for kids. Because I didn't want that situation of a child, if they weren't able to afford the exercises, I want every child to access this. No child should persistently breathe through their mouths. For the adults, start off. Make sure your mouth is closed during sleep. Wake up at a moist mouth in the morning. If nothing else, if you have your mouth dry, it impacts your dental health. You're more prone to bad breath. You're more prone to dental cavities. You're more prone to gum disease. You're even just more prone to chapped lips. So very simple things. Breathe through the nose, gently slow down your breathing, don't live in your head. Of course, it's a lot more than that, but it's a good place to start. So that's what the Oxygen Advantage is about.

Patrick McKeown:

We've got different videos on social media. We're on Instagram. All of those things that I don't like and social media, but we're there because I suppose we use it as a means of getting the message out there.

Jim Donovan:

And that's important, to share what you've got, help reduce suffering. I mean, that's a part of what we do here and I can see that you're really playing a great part in that. Tell us, what's the best place or the best way to get in touch with you, where all of your information is so we can send people there?

Patrick McKeown:

I suppose oxygenadvantage.com is for... Now, it seems to be more kind of a sports oriented website, which it is. The other website for health and for focus is butekyoclinic.com. I hope to have a new book. I've just finished writing 140,000 words.

Jim Donovan:

Wow. Congratulations.

Patrick McKeown:

Yeah. Well, you think you have it done and then you hear from your editor that, yeah, you have to change this, this, this, and this. So I'll know in time when it goes out there, but yeah. I'm looking forward to getting it out there because women's breathing is different than men and this has been known since 1905. How we can influence type I diabetes and epilepsy, functional movement, and those things that I haven't covered in the Oxygen Advantage, but that will be in the new book. So yeah, it's exciting. The application of breathing, it's quite vast.

Jim Donovan:

It's very exciting. I'll tell you what I'll be doing. I want to make sure I sign a big light on what you're doing over there. I think it's absolutely critical-

Patrick McKeown:

[crosstalk 00:56:58]-

Jim Donovan:

... and important for everyone to learn. We'll be putting all of the social media channels and these websites in our show notes as well as on the social media channels that we share this podcast on. So I tend to share things over and over again with these particular episodes, so we'll get a lot of eyes on this. Just really appreciate you, man. Thank you for taking this time to speak with my audience and I. I appreciate it.

Patrick McKeown:

My pleasure. Listen, thanks very much because anytime we can help drive awareness of a very simple thing... Breathing, it's so simple. It's so overlooked. But it's got tremendous potential. Thanks, Jim.

Jim Donovan:

That's great. Hang out for one second and I'm just going to sign off here. Everybody out there listening, thank you again for tuning in. I appreciate you. I appreciate you taking the time to listen in today. Take impeccable care of yourself. We'll see you soon.

Jim Donovan:

Well, that's it for today. I appreciate you tuning in. Remember to come see us on our social media channels on Facebook, Instagram, Twitter, and YouTube. Just search Jim Donovan, Sound Health.