Transcript

Claudia von Boeselager [00:00:48]:
How are you today?

Patrick McKeown [00:00:50]:
Good. How are you, Claudia?

Claudia von Boeselager [00:00:52]:
I'm doing really well. So excited to have you back again by popular demand.

Patrick McKeown [00:00:57]:
That's always good.

Claudia von Boeselager [00:00:59]:
It's always good, right? So much interest and such an important topic about something that would apparently be simple, but yet we all get so wrong and are not doing properly. So such an honor and pleasure to have you back on. Patrick, how are you today?

Patrick McKeown [00:01:13]:
Yeah, all is good. I'm here for a few days and I head off to Poland tomorrow. So we have a training there. But Anna Rycheck, so, yeah, so it's all good. And then I've got one more trip before Christmas and then the holidays, which is nice.

Claudia von Boeselager [00:01:29]:
And then decompressing.

Patrick McKeown [00:01:30]:
Right? Decompress, yeah, totally breathing really well.

Claudia von Boeselager [00:01:34]:
Super exciting. So thank you, everyone who's joining us here live. Again, you're welcome to put questions down below, but let's kick off here. So we had beautiful conversation before. I don't know how many of you who are joining in live or watching the recordings, our previous conversation, but I'd love to just recap for people when it comes to breathing, what are we getting wrong, Patrick, and why is nasal breathing so important versus mouth breathing? Let's just start as a baseline from there. Have I lost you, Patrick? Are you request. Hang on a second. I think I lost Patrick, so let's just get him back in.

Claudia von Boeselager [00:02:23]:
Okay, hang on a second. Thank you, everyone, for your patience. Okay, perfect. I lost you there for a moment, Patrick, but you're back, I think, now you're moving again.

Patrick McKeown [00:02:33]:
No idea what happened. I didn't touch things. So, yeah, this is Instagram I'm going to put down to you.

Claudia von Boeselager [00:02:40]:
No worries at all. Okay, so I don't know what you heard, what you didn't hear, but I think just for people who maybe this is the first time listening to this, et cetera, maybe just to have that baseline, like, why is nasal breathing so important? And what is it that we're getting wrong with breathing? So that we all have the same baseline understanding ahead of our conversation here.

Patrick McKeown [00:03:03]:
Yeah, I suppose the mouth has no function when it comes to breathing. It doesn't do anything. If you were to ask any medical doctor, is there any part of the mouth that's devoted to helping the breath? And the answer is no. So there's no part of the structure of the mouth that's there for breathing. The nose does everything now as well, slowly, as some people will say, well, I don't actually breathe through my mouth. So this is what some of the listeners are going to be thinking. But do they have their mouth open if they go for a walk? Do they have their mouth open if they do even kind of more moderate physical exercise, light jog, for example, do they have their mouth open during sleep? And a lot of people can be mouth breathing, and they're not even aware of it. So it starts with nasal breathing, and nasal breathing should be.

Patrick McKeown [00:03:50]:
How many instructors, in terms of breathing, will often say, breathe in through your nose and out through your mouth? That does not make sense either. I still can't get my head around that one.

Claudia von Boeselager [00:04:01]:
Can you explain that? Because we just had a comment from somebody, Theresa Murphy Moore, who said mouth exhale is vital. So many people do think in through the nose, out through the mouth. So what is wrong about that, or why do we need to think about that differently?

Patrick McKeown [00:04:16]:
Well, I can't think of the reasons why you would breathe out through them. Out. When we breathe in, the nose is moistening and warming up that air. We're harnessing nasal nitric oxide, and when we breathe, breathe in, there's a slight acceleration in our heart rate. So our heart rate is faster when the lungs are richer with oxygen. And when we breathe out, the whole key during exhalation is that we have a slow, relaxed exhalation, because it's the slow, relaxed exhalation that's helping to induce relaxation. But if we're breathing out through the mouth, we're not going to have that slow, relaxed exhalation. We're going to have a faster exhalation, which is more conducive to stress.

Patrick McKeown [00:04:57]:
But the other thing about it is with the exhalation, the nose recovers the moisture and heat from the exhale breath. So you think of the body expending this energy in terms of warming and moistening that incoming air. So then as the air is leaving the body, the nose will recover that heat and moisture. And by doing that, it helps to keep the nose open. Whereas if we breathe in through the nose, and if we breathe out through the mouth, the nose is more likely to get stuffy. So there's a 42% greater water loss breathing out through the mouth and through the nose, and no animal in the field is out breathing. We're in the countryside here. Luckily now there won't be too many animals around, but they're not breathing in through the nose and out through the mouth.

Patrick McKeown [00:05:40]:
The newborn baby isn't breathing in through the nose and out through the mouth. So why is the human being doing. I don't know, is there a circumstance?

Claudia von Boeselager [00:05:47]:
I'm just thinking, like, if you're a sprinter, right, or olympic medal is going for thing, and just the exhale to get out through the mouth, would you say that the point is to train to inhale through the nose and always just practice exhaling through the nose as well?

Patrick McKeown [00:06:02]:
Yeah.

Claudia von Boeselager [00:06:02]:
Is that the point?

Patrick McKeown [00:06:03]:
During physical exercise, the intensity of exercise gets too much, that it's not possible to sustain nasal breathing. The air hunger is just too much. So to get rid of carbon dioxide, which is generating that increased air hunger, one can breathe in through the nose and out through the mouth. So it's almost that you're starting off, say, with light to moderate exercise. You're breathing in through your nose, you're breathing out through your nose. When the air hunger gets a little bit stronger, then breathe in through your nose and out through the mouth. When the air hunger gets too strong, you're going to be breathing in through the mouth and out through the mouth. Now, another thing is, though, there could be an argument to say that we should be only exercising at an intensity whereby we can sustain nasal breathing.

Patrick McKeown [00:06:48]:
That's another point, especially for recreational athletes, because if we're breathing in through the nose and out through the mouth, or breathing mouth, mouth, it could lead to hyperventilation with athletes. And I'm not just talking about athletes, I'm talking about anybody who does physical exercise. So, yeah, I would say any recreational athlete only go as fast as you can, that you maintain nose breathing. And the more you continue with nose breathing during physical exercise, the air hunger diminishes and then it's easier to sustain that physical exercise.

Claudia von Boeselager [00:07:22]:
And I assume also that the more you do that, the more you train that and practice, that the pulmonary muscles as well become stronger. So you're able to breathe better through the nose as. Yeah, yeah. So we have a question from Manish here. How should we keep the tongue while breathing, while running and nasal breathing, is it on the upper wall or the more relaxed, or just having it normal? Is there any recommendations for that?

Patrick McKeown [00:07:49]:
Yeah, that's a good question. When you breathe in and out through your nose, your tongue is able to rest in the roof of the mouth. And when your tongue rests in the roof of the mouth, it helps to open up the airway. So you think of the individual who is doing physical exercise. It's imperative that they kind of open their airway as best they can, because then there's easier airflow. And the other thing about the tongue is that we often don't equate it with, but it provides a sense of balance as well. So they did one interesting study. They got a group of individuals, they put blindfolds on them, they put them on uneven surfaces, and they checked their balance when their tongue was resting in the roof of the mouth versus when it wasn't.

Patrick McKeown [00:08:32]:
Wow. The individuals with the tongue resting in the roof of the mouth had better balance. Wow. So there could be something in that as well.

Claudia von Boeselager [00:08:40]:
Yeah, I'm trying to think what the correlation is, but is it because then the neck is at a different angle or you're activating other muscles so that you have a better balance with the middle ear? Do you have any idea why there's better balance with.

Patrick McKeown [00:08:56]:
Don't know. I don't know. And I'm assuming, of course, there's going to be an answer there. Yeah, I have no idea.

Claudia von Boeselager [00:09:03]:
I'm just trying to figure out. Yeah, we have a question from Harbach. If I'm pronouncing the name properly, what is the best high altitude breath training? Patrick.

Patrick McKeown [00:09:16]:
Ok, so if you're at sea level, there's a number of things in terms of preparing for altitude. One is to prepare your body to be able to cope with lower blood oxygen saturation. So at sea level you could do exercises that involve intermittent hypoxic training. And basically that involves now only do this if you're relatively healthy. You're pretty young as well. If people are over 60 years of age, I don't feel comfortable if they're doing long breath holes. So there are exercise whereby you can simulate altitude training at sea level to prepare your body to make adaptations that you're better able to cope with lower oxygen at altitude. And those exercises are typically breath holes after an exhalation.

Patrick McKeown [00:10:02]:
So we would use them, say, with athletes. And an example would be as follows. You take a normal breath in and out through your nose, you pinch your nose with hold and you go for a jog with your breath held. It's very simple. With athletes, we do 40 meters sprints with the breath held, and then they have a recovery for 30 seconds and they have to do it again. And a recovery of 30 seconds and they do it again. So we deliberately lower their blood oxygen saturation down into the low 80s, which is severe hypoxia. But by doing that, then we're forcing their body to make adaptations.

Patrick McKeown [00:10:41]:
And in terms of that, then they're better able to delay lactic acid and fatigue. Now, another part of this then at altitude, the air is thinner, so atmospheric pressure at sea level is 760 mercury. But as we go up, as we climb higher atmospheric pressure reduces, and that in turn then puts an extra strain on our breathing muscles that they have to work harder to maintain breathing so they're more prone to fatigue. So another aspect then is to make sure that your breathing muscles are good and strong and well able functioning with good, optimal breathing patterns before you ascend. You could do this very simple way, would be there are devices, there's the likes of the power breed. We have our own sports mask, there's buteko belt, there's different devices which add a load to your breathing to help strengthen the respiratory muscle. Or you could go for a jog with your mouth closed, because if you breathe through your nose again, this is coming back to nose breathing. You breathe in and out through your nose.

Patrick McKeown [00:11:46]:
Your nose will naturally impose a resistance to your breathing that's two to three times that of the mouth. And when you're breathing against resistance, it's like a workload for the main breathing muscle, which is the diaphragm. So that's number two. So long answer to this question, Claudia. The third one then is, when you're ascending altitude, how should you breathe during the ascent? So say, for example, you're at 4000 meters, your blood oxygen saturation then at that point could be down to 83%. In other words, of all your hemoglobin, that's the main carrier of oxygen, only 83% of your hemoglobin is occupied by oxygen. So that would be severe hypoxia. Now, is there a way to breathe, to improve gas exchange, so that when you are breathing in that air, that you're helping to optimize oxygen transfer from the lungs to the blood? And yes, there is.

Patrick McKeown [00:12:44]:
Okay, the key there is to breathe slow and to breathe low, because when you slow down the respiratory rate, you don't waste as much air to what's called dead space. And as a result, then you're able to optimize alveolar ventilation and you can improve gas exchange. And I know there were a couple of studies of individuals climbing one was at a height of 5400 meters, which is pretty high. Yeah, I think Mount Everest is about 88 meters. So with 5400 meters, their blood oxygen saturation was 80%. And when they slowed down their breathing rate to six breaths per minute, their blood oxygen saturation increased from 80% to 89%.

Claudia von Boeselager [00:13:28]:
Wow.

Patrick McKeown [00:13:29]:
Which is huge. And this then has parallels in terms of people with asthma, people with COPD, people with different health conditions, whereby there is a risk of lowering blood oxygen saturation. And even this comes back to our athlete, an individual going for a run with their mouth open, as you see all the time. You won't have to go too far. I'm in the middle of nowhere. I'm actually going to show you where I'm based because it's very seldom is the sun shining here, especially coming into December.

Claudia von Boeselager [00:14:00]:
Is it shining today?

Patrick McKeown [00:14:01]:
Beautiful. I know it's one of those rare days that it's absolutely shining.

Claudia von Boeselager [00:14:08]:
Gorgeous, lovely part of the world. How often do you go running there with your mouth closed, Patrick?

Patrick McKeown [00:14:14]:
Well, this is where I run every morning and I'll show you there. So this is our training center. And you can just see the machines right down at the end. So that's my morning routine. Every morning.

Claudia von Boeselager [00:14:30]:
Fantastic. You have to practice what you preach, right? Exactly.

Patrick McKeown [00:14:33]:
Oh, no, totally. And I have to confess, for many, many months workload, you tend to put everything off. You get into your work and the next thing is the day is gone and you're too tired to exercise. So there's also, in terms of anything that we bring into our way of life, we have to think of ourselves first and absolutely bring it into our way of life. And then you feel so much more comfortable then working because you've already helped yourself. So, yeah, it's important.

Claudia von Boeselager [00:15:03]:
I love the expression, like they say on the plane, you have to put your oxygen mask on first before helping anyone else. Right. You have to give from the overflow of the cup and not from an empty cup. And also what I really love for me and anyone with focus or attention things is the BDNF effect, the brain derived nootropic factor you get of doing exercise in the morning. Then you have that benefit for the day, ideally topped with some cold water therapy, right. So that you have that dopamine of up to 500% increase over a prolonged period of time.

Patrick McKeown [00:15:33]:
I have to confess, okay. I put in infrared sauna and we put in a bath. I use the infrared sauna every day. I haven't used the bath once.

Claudia von Boeselager [00:15:43]:
Okay.

Patrick McKeown [00:15:43]:
So I'm going to have to make a confession there.

Claudia von Boeselager [00:15:46]:
Dare you to try it tomorrow morning. Patrick, tell me how you feel, honestly. Because in biohacking circles, all about like, oh, yeah, the cold and then the thing. And I'm like my german grandmother over a century ago was doing the heat, the sauna, followed by the bats, the cold bats, as just. It's so invigorating. It's so rejuvenating. There was a recent study out of Finland of these centurions there, how often they use sauna and things, too. So at least you've got the sauna part down, Patrick.

Claudia von Boeselager [00:16:15]:
But let me know how the.

Patrick McKeown [00:16:17]:
I like the. It's my comfort, trust me.

Claudia von Boeselager [00:16:21]:
Me too. And I've learned that it has to be. Yeah. So we have some more questions here. So how to train holding your breath. This is from love, my kids. How to train holding your breath for free diving.

Patrick McKeown [00:16:35]:
Wow.

Claudia von Boeselager [00:16:35]:
So free diving is obviously quite a challenge. What would you say?

Patrick McKeown [00:16:42]:
Free divers, they understand about breath holding. They have specific tables, the co2 tables, in terms of the whole aspect about free diving is being able to sustain a significant drop in oxygen and a significant increase in carbon dioxide. Now, I would say to the free diver, though, is you should also be thinking about how are you breathing outside of your free diving? Because your breathing during an event doesn't just automatically change during that event. It's how you breathe in your everyday life that will influence your breathing when you come to an event. It's like an athlete saying, how should I breathe during competition? Well, if you have poor breathing outside of competition, your poor breathing isn't automatically going to correct itself just as soon as you do competition. So we need to be thinking about the bigger picture here for the free diver to be breathing in and out through the nose during sleep, for the free diver to be doing physical exercise with the mouth closed and also doing breath holding on land, because you can simulate the same diving response. I know, I understand. But water, it can be having a slightly different effect.

Patrick McKeown [00:17:53]:
But by doing an exhalation, an exhale hold on land, you can lower your blood oxygen saturation, you can increase carbon dioxide, you can cause spleen contraction, you can cause Brady cardia. There's aspects you do increase a retropoiete. And so there is part of the diving response that kicks in. Now, it's slightly different if you're doing a static apnea versus what we would do as dynamic apneas. We do apnea as we do breath holes during physical movement. And you have an even greater response if you do a breath hold during more intense physical movement. So there's kind of a conflict there, because if you do intense physical movement, your body is really demanding oxygen. There's an increase of carbon dioxide.

Patrick McKeown [00:18:39]:
But of course, if you're doing a breath hold during that intense physical movement, you're depriving your body during that time. But that's where the benefits can take place. So, yes, we're coming back to free diving. Think about your everyday breathing.

Claudia von Boeselager [00:18:54]:
I think that's really important. And, Patrick, what would you say is for optimal everyday breathing? What are some strategies that are applicable not just to high performance athletes, but to everyone, really? What should things be that people could train or be practicing on a day to day basis in order to ensure their optimal breathing capabilities?

Patrick McKeown [00:19:17]:
I think, Claudia, the best exercise are the ones that you can actually bring into your wave life. So it's going to, first of all, what does the individual do? Do they like to have time out themselves that they focus inwards? You could be practicing light breathing there. I actually love the exercise, light breathing. This is when you're deliberately under breathing, so you're really softening and slowing down the speed of the breath in, and you're having a very, very relaxed and a slow and a gentle breath out. And the objective is to breathe less air that in turn, you say like.

Claudia von Boeselager [00:19:50]:
10 seconds in, like ten in, ten out, or ten in, 15 out, something like that.

Patrick McKeown [00:19:54]:
We never time it. Because the thing about timing is if we have, say, somebody coming in with poor breathing and their normal respiratory rate is 20 breaths per minute, and if I was to ask them to slow down their breathing one cycle in for ten and out for ten, that's three breaths per minute, they would never do it. So I always start off with breathing relative to where the person is at, because I suppose the people who really need breathing the exercises the most are the ones that will find breathing the most challenging. They'll often feel that they're not getting enough air. Sometimes they'll even get anxious when they put their attention on their breath. Because every time that they've had an issue in the past, if they had, say, panic disorder or if they've had asthma or high stress or hyperventilation, it was always associated with a problem with their breathing. So now their body has a memory that when they then hone their attention on their breath, it can bring up those memories of past trauma. And how common is trauma in terms of human life? So with some people, I don't even have them practice.

Patrick McKeown [00:21:00]:
I don't even have them observe their breath. I will ask them, go for a walk with your mud closed. I will genuinely say it's one of the best breathing exercises. It's without a doubt. I know Julia Bradbury, she wrote a book, walk yourself happy, and she included a chapter in that book as well. Nose breathing during exercise. Now, can you imagine devoting a chapter on nose breathing during exercise? Again, it's what you said at the very start. It is so simple, but yet it is so simple, it has been completely overlooked.

Patrick McKeown [00:21:32]:
The benefits of that nose breathing during physical exercise, you've got increased carbon dioxide in the blood, you've got increased blood flow to the brain, you've got increased oxygen delivery to the brain, you've got better recruitment of the diaphragm. This, in turn, we have the connection between the diaphragm of the mind via the phrenic nerve. And then we think of mental health issues, schizophrenia, schizophrenic. We also have the individual do physical exercise with their mouth closed that they experience a sensation of breathlessness. Now, they might call it suffocation, but it's breathlessness. It's training their body to desensitize them to be able to cope more with suffocation, because very often they're terrified of suffocation. So I'm talking about people who would be prone to panic, disorders, et cetera. So it's coming back to your question.

Patrick McKeown [00:22:21]:
Some of the best breathing exercises are the ones that we can just integrate seamlessly into our way of life. I don't think people have time. I have to think of my own. I don't have time. I was on this for 30 minutes this morning. Nose, breathe light, breed slow, breed with my physical exercise. And I try and exercise with every cell of my body that I'm not just exercising with my attention stuck in my head, so I actually make it a meditation. Then I went into the dry sauna.

Patrick McKeown [00:22:49]:
But if I was then to jump into it, not spat, forget about it. Even for me, the preparation of having to put water in the badge, generate eyes, do everything, that would be too much for me. I have 30 minutes to 1 hour and that's it. Full stop. And I think most people are lucky even if they have that. So where can we get then? There's so much we can do with breathing. Because when people talk about mindfulness and they talk about breathing, it's in your everyday life, it's when you go for your walk, it's when you go to the gym, it's when you do your yoga practice. If every yoga instructor, if they only give two instructions, breathe through your nose in and out and breathe with silent breathing.

Patrick McKeown [00:23:32]:
That would change the breathing patterns of their students. But that hasn't come to pass because many students are breathing in through their nose and they are breathing out through the mouth, and they're also breathing with noisy breathing. As long as they breathe in through the nose and out through the mouth and breathe with noisy breathing, they are not getting the benefits, the real benefits that they would do, from a biochemical point of view, reducing the chemosensitivity to carbon dioxide, it would improve their everyday breathing patterns, because our blood flow is influenced by carbon dioxide. And if those individuals, all yoga students, were breathing in through their nose and out through their nose with silent breathing, they would have higher co2 in the blood. It would improve their blood circulation, 50,000 miles of blood vessels, it would reduce their chemosensitivity to carbon dioxide and so much more. This is where the simple tweak happens.

Claudia von Boeselager [00:24:27]:
Wow, that's interesting, because I know, I've been to yoga Castle, like, breathe out strongly through your mouth, making noise. My understanding is with the. We'll forget that, with the vagus nerve activation, right, to help with triggering the parasympathetic, but essentially with breath, you can just as well trigger the parasympathetic nervous system as well, and move from the sympathetic state. Right? So from the fight or flight to the rest and digest through the slow breathing. Right.

Patrick McKeown [00:24:55]:
Carbon dioxide is vagotropic. And also in terms of improving. If you're doing your yoga practice with silent breathing and nose breathing, you reduce your chemosensitivity to carbon dioxide so that your respiratory rate is naturally slower, that you have a soft inhalation and a relaxed, slow, gentle exhalation. That, in turn, will have to improve vagal tone. There's a very strong connection between the sensitivity of the body to carbon dioxide. So we have, this gas that we produce internally is the primary driver of our breathing. But some of us are more sensitive to this gas than others. And if we are overly sensitive, our breathing then is faster and harder.

Patrick McKeown [00:25:33]:
There is a connection between the sensitivity of our body to carbon dioxide and the sensitivity of what is called the barrow reflex. These are pressure receptors inside the major blood vessels, which are continuously monitoring changes in our blood pressure, and they work to keep our blood pressure normal. But it's the sensitivity of the barrel reflex, which in turn is influencing the autonomic nervous system in terms of balance. So both vagal tone and barrel reflex sensitivity is feeding into balance of the autonomic nervous system. If we bring in nose light and slow breathing and low breathing into our everyday practice. Then it becomes an unconscious. We don't even have to think about it. We, in turn, will help to reduce the chemosensitivity to carbon dioxide, which in turn is helping to increase the sensitivity of the barrel reflex, which is helping to guard us against developing cardiovascular issues over time.

Patrick McKeown [00:26:32]:
But it's also helping to bring balance to the autonomic nervous system. It's really amazing. That's simple. Like, for me, I would have to ask the question, why come carbon dioxide was forgotten about? Because it's not just this waste gas.

Claudia von Boeselager [00:26:50]:
Wow, that's really powerful as well. We have a question from Jackson Hillm here for pro boxing. What would you say to not hyperventilate? Or what would you say to not hyperventilate? Yeah. So I guess as a pro boxer, hyperventilation comes into play. How do you avoid that? How do you prevent that?

Patrick McKeown [00:27:12]:
Watch Michael Conlon when he's fighting in early December. You'll see him on Instagram, and he will show you how to breed in his preparation. So with any individual, any athlete who is preparing for a fight say, we want to improve everyday breathing. We want to improve the bolt score, because literally what we want to do is we want to optimize breathing patterns so that the individual can do physical exercise with less ventilation. So you can imagine that a boxer is training, they're training their arms, they're training their legs, they're training their skills, they're training their mind, but they don't necessarily train their breathing patterns. But yet, come the six, seven day round, the breathing respiratory, the breathing muscle, the breathing system can be prone to fatigue. And if the diaphragm gets tired, what happens is that blood is stolen from the legs to feed the diaphragm, and then the legs are going to give out. And the other thing about that sensation of breathlessness during physical exercise, when there's physical fatigue setting in, there's also mental fatigue setting in.

Patrick McKeown [00:28:21]:
So it's about training breathing and training in the brain. It's really about getting the body to do more with less. So I would say to a pro boxer, don't do all of your physical exercise with your mouth closed, but absolutely do 50% of your physical training with your mouth closed, and do 50% of the high intensity stuff. Then switch to mouth breathing as you need. But also during your training, bring in some breath holes when you're doing high intensity stuff. So if you're on the pads, if you're sparring, can you spar and hold your breath until you feel a fairly strong air hunger. In other words, simulate what you're doing in the ring and superimpose breath holding to the same intensity of exercise, because that's very important to make the adaptations. There's also other things for boxers in terms of how do you have to get that state of mind? You don't want a boxer going into a ring and they're going in, in body, but their attention is stuck in their head because the thinking mind is too slow.

Patrick McKeown [00:29:25]:
We want to get them out of their head, but we can use breathing as a tool to get them out of their head and into their body so that they're going to fight every cell of the body. Whether it's a boxer, whether it's any individual, a person going out to do a public presentation, a person going to do a job interview, it doesn't matter. Regardless of whatever we need to do in our way of life, we don't want to go in there with our attention stuck in our head. It's too slow and it will sabotage our performance. So in terms of using breathing, we want to use it to regulate states to determine that perfect state of mind or flow state whereby the right action is happening by itself. It's almost that everything is slowed down and that our attention is moving simultaneously with time, that we're not looking through this veil of thought. We have to get the thinking mind out of the mind. The thinking mind is not what we want at that point.

Claudia von Boeselager [00:30:21]:
Yeah, because that's what the training is for.

Patrick McKeown [00:30:23]:
Right.

Claudia von Boeselager [00:30:24]:
And then when it's showtime, you just want it to so beautifully.

Patrick McKeown [00:30:27]:
Right? Totally.

Claudia von Boeselager [00:30:28]:
We have a great question here from tam Gray. She says, my mother has recently stopped smoking after 40 plus years. She has short breaths. Are there exercises that can be done to get her breaths or breathing back to a normal rate?

Patrick McKeown [00:30:44]:
Yeah, what I would do is, in terms of very simple exercises that you can do that are really gentle to help open up the airways. Because it's kind of ironic, when people give up cigarettes, they often find that their breathing deteriorates. Now, I'm not saying go back on cigarettes. Definitely not. But what I am saying is that now you can do breathing exercises and get your breathing back on track and even better than what it was before. So start with small breath holds. We call them breathing recovery. You'll find them on YouTube.

Patrick McKeown [00:31:17]:
The exercise is take a normal breath in and out through your nose. Hold your nose and hold your breath for about 5 seconds, then let go, but breathe in. So what you're doing is you're looking to pull nitric oxide inside the nose, because nitric oxide is coming from the paranasal sinuses, and also it's produced locally in the nose. When you do that breath hold, nitric oxide pools in your nose. Then you let go, you breathe in, you carry that nitric oxide into your lungs, and it redistributes the blood throughout the lungs. It helps to open up the blood vessels in the lungs. It helps to open up the airways. So it can do a lot in terms of our breathing, just to open up the airways.

Patrick McKeown [00:31:55]:
So, yeah, I would be practicing that. I would be practicing nose breathing all the time. So even if she said, okay, I don't want to do that, go for. Do all of your physical exercise with your mouth closed. Start with that. Breathe through your nose during your sleep. Vitally important. Never wake up with a dry mouth in the morning.

Patrick McKeown [00:32:12]:
Nobody should be doing that anyway. And there's breathe light, breathe slow. But, yeah, just even start off with small breath holes. Nasal breathing during exercise. Nasal breathing during sleep. Nasal breathing during rest.

Claudia von Boeselager [00:32:26]:
And just to make a point with the nasal breathing through sleep, I was like, oh, I'm always breathing through my nose for sure. Like, I don't breathe through my mouth, and I wouldn't even wake up with a dry mouth. But then when I tried your myotape. So for those, it's this beautiful tape that goes around the mouth versus some of these mouth tapes that actually completely covers your mouth, but it encourages the mouth to stay closed. I honestly noticed a difference in cognition the next morning, which just goes to show that even though I was convinced I was a nasal breather all night, that obviously there is some, if you move around or whatever, that you do breathe a bit through the mouth. So having that tape is just not sexy, but it's very effective, and so highly recommend it for no one has tried it yet. The myo tape. Myo tape that Patrick has invented is really phenomenal.

Claudia von Boeselager [00:33:14]:
And even just try it for a few nights and see how you feel. I feel like that's always the best way before you have to commit to something for longer term. Do you wear yours every night, Patrick, your mouthpiece?

Patrick McKeown [00:33:25]:
I do. Now, I know it's not that people need to be wearing it every night. I do, because what happened was I kept on using it and using it well. Back in the day, though, I've been using mouth tape since 1998, so it's been for many, many years. I was using paper tape. I didn't have a beard, of course. It was easier, but then when I was testing myotape, I kept on testing different strengths and different fabrics and things like that, because even in the world of kinesio tape, you've got cotton tape, you've got nylon tape, you've got different synthetics, you've also got different glues for the face. So I was testing and going through, but I was doing it on myself first to find out which one worked.

Patrick McKeown [00:34:06]:
Now, for beards, of course, we have one for beards. So that's the one I use. Yeah, I just like it. It's almost like it's a trigger. I put on a tape, and it's almost a trigger to tell me that it's time for sleep and bump, I.

Claudia von Boeselager [00:34:22]:
Guess it's almost like. I remember a dentist mentioned to me once that some people who wear retainers at night, let's say they grind their teeth or whatever, they get so used to it that they actually can't sleep now without it. So I guess it's the same thing. Same as well for you, right?

Patrick McKeown [00:34:34]:
Yes.

Claudia von Boeselager [00:34:35]:
We have a question from melt the ice, and we talked about this a little bit before, but what are the benefits of breathing through the nose? Yeah. So can you maybe just expand on that again for people who maybe just joined us now?

Patrick McKeown [00:34:49]:
Yeah. There's the obvious ones that people will know about filtration, the air that's coming in. You've got the body's own immune system there that's able to defend against bacteria, germs, also airborne particles. They get trapped inside the nasal airway. You've got a mucous blanket there, and any particles that are trapped inside the nose, the nose is able to get rid of these particles pretty quickly, whereas if they go into the mouth, there's pretty much no defense. They go down the troj into the small air sacs in the lungs. And I remember one quote. I wrote a book 20 years ago called close your mouth, and I was only reminded of it.

Patrick McKeown [00:35:27]:
There was a client at a workshop, and she had the old version of the book. And I said, God almighty, because I knew well by the COVID Where did that come out of? She says, I remember one quote. She says, when particles come into the mouth and end in the small air, end up in the small little alveoli in the lungs, it takes 60 to 120 days for them to be removed from the body versus 15 minutes from your nose. Now, I'll have to go back and dig up that reference, but that was from the book that I wrote, but I would have checked it back then, so it's something you never experience you breathe in these particles, you're walking London streets, you're walking around any street and having them out open. Of course there's going to be particles in the air. If we're in a house, for example, we're going to have dust mites regardless, irrespective of what's going to be going. How clean your house is. So your nose is that defense.

Patrick McKeown [00:36:26]:
Now there's other interesting ones, like, we select our partners based on the communication from the nose to the brain. So we like animals, we choose our mates based on that communication, that sense of smell. So we have a nerve called the olfactory nerve, which is from the nose to the brain. And they've done experiments with females. They've had males wear t shirts, and then they had a group of females to smell the scent off the t shirts. I know this is kind of a strange experiment. They found that females chose individuals who were very different genetically to themselves. And it probably comes back to survival of the species, that when we were in more collective environments, it wouldn't have been good if there was a mixing of the gene pool, so that we then select our partners who are genetically very different, and that communication is through the sense of smell.

Patrick McKeown [00:37:23]:
Now there's other ones. Then again, visual spatial awareness, for example, if we're out in a really wide open plane, throughout evolution, we might have been focusing on a target that was maybe two, 3 miles away, but at the same time we had to be scanning for predators. With nasal breathing, there's increased visual spatial awareness. With mouth breathing, it's produced.

Claudia von Boeselager [00:37:46]:
Why is that?

Patrick McKeown [00:37:48]:
That, I don't know. This is again, increased visual spatial awareness. It was a study that was done in Israel in 2020 and we looked at. I draw from it for the book, the breathing cure, because I was very kind of interested in terms of. You think about, we use this all the time. If we're driving a car and we're in one lane, but we're also looking, is there anybody coming either side of us? Or if you're out in a football field or rugby field or anything, you don't want to be bumping into things. So we need to be able to. I think back in the day, of course, it would have made sense because it was more about survival.

Patrick McKeown [00:38:25]:
It was a safety aspect of it. And another thing about the nose, the term sniffing out danger. We have the nose responsible for a lot of functions. Memory increases with nasal breathing, attention span increases with nasal breathing, the relaxation response, of course, it's protecting the airways. You've got better recruitment of the diaphragm. There's a lot. I have a list of 30 functions, but I know there's many, many more. And I have also a lot of functions in terms of what does breathing through the mouth to it is not good at all.

Claudia von Boeselager [00:39:02]:
Beautiful. Yeah. So everyone listening, and also to the replay, make sure to train breathing through your nose, right?

Patrick McKeown [00:39:09]:
For sure.

Claudia von Boeselager [00:39:10]:
We have one from Aish Pete who says nose breathing while swimming, what to do? Thoughts? Because obviously it's a bit trickier if you're underwater. Obviously doesn't work so well, I don't think. What do you recommend?

Patrick McKeown [00:39:25]:
But some people will tell me they can nose breathe during swimming. See, swimming is an interesting sport because when you're swimming, the water is pressed up against you. So you're swimming on the water, you're breathing against resistance. So the act of swimming is naturally going to impose a resistance to your breathing to help improve your breathing patterns. So from a biomechanical point of view, swimming is really important from a breathing point of view, but also from a biochemical point of view, your face is in the water, you breathe less air. So if you were to compare your breathing volume while swimming, in comparison to while jogging or similar intense exercise, you will breathe less air during swimming. Now, that is known. This may be one of the reasons why doctors used to recommend children with asthma to swim, because those same kids with asthma, you look at a child swimming, they don't just swim in the surface, they normally dive down to the bottom of the pool, which is breath holding.

Patrick McKeown [00:40:24]:
And that's why when we're working with people with asthma, breath holding is a fundamental function of that, because we want to change their body's tolerance of blood gases in terms of carbon dioxide. We want to open up their airways. We know when we hold the breath, we can open up the airways. This is known since 1923. If you were to breathe in through your nose and out through your nose and pinch your nose gently and just nod your head up and down for ten times, by doing that, ten times, your nose opens up. So you can imagine now a kid getting into a swimming pool, because if the child is inflammation of their lungs, that inflammation will travel up to their nose. They often have a stuffy nose. It's one airway.

Patrick McKeown [00:41:07]:
We know automatically we can open up the nose, but we also know we can open up the lungs. Here's the thing about asthma, Claudia, that I haven't got my head around. 20 clinical trials looking at breathing techniques for asthma, most specifically the buteca method. Breathe in and out through your nose. Breathe light. Breathe slow. Dot holding the first trial outside of Russia because he was a ukrainian doctor, and the first trial outside of Russia was in 1994. It was published in the Australian Medical Journal in 1998.

Patrick McKeown [00:41:40]:
They got 40 individuals with asthma. They divided them up into two groups. 20 did buteco, 20 did the in house hospital program. At the end of twelve weeks, the Buteco group had 70% less symptoms, 90% less need for rescue medication and 49% less need for inhaled corticosteroid. The in house hospital program had 0% change. And this was the program that they are teaching inside in the hospital. Wow. So then we have to beg the question.

Patrick McKeown [00:42:12]:
We often think that breathing is simple, but breathing absolutely is simple, but that doesn't mean that it should not get attention. Now, we have to think of the UK. I think there's about 5 million people with asthma in the UK. There's 400,000 people here in this country. And people with asthma, they don't just have asthma, they have stuffy noses, they are tired. So it's almost that breathing now is a hot topic, but it needs still that greater awareness. And that's where I'd love to bring it out of the field. At the realm of that, it should be done only if you're in the lotus position, or it should be done only if you're doing this.

Patrick McKeown [00:42:51]:
No, forget about that. Bring breathing into your way of life. Same as meditation. Meditation. If you go for a walk, you should be meditating. In other words, don't go for your walk with your attention stuck in your head. There's a whole conversation around, how come even 20 years later. And the BBC did a wonderful documentary on this through QED.

Patrick McKeown [00:43:15]:
It's kind of like a panorama. I don't know if you remember QED, but I think this was back in 1998, the BBC did a documentary. They interviewed a GP from Glasgow. You'll see in the documentary. Well, first of all, they got three very severe asthmatics. Now, I mean severe. One woman, Donna is her first name, she was in hospital every six weeks now. You can imagine the economic cost, but the social cost in her life.

Patrick McKeown [00:43:44]:
Campbell was not able to work because he was too debilitated, because asthma is a terrible condition. That feeling of suffocation, just going for a walk. And then they got in a youngster, she was about 14 or 15 years of age. They put the three of them through five days of breathing training. Five days, 2 hours per day for five days. They had the cameras on them. And it's worth watching the documentary to see the results. Now, one Glasgow GP who was interviewed on the program, Dr.

Patrick McKeown [00:44:15]:
Gerald Spence, he talks during the interview about he taught his patients it and his budget was 15,000 pounds per annum with his asthma clientele. And after Buteco, it was down to 5000 pounds per annum. So can you imagine? Despite that, there was very little interest in terms of the want for clinical trials. And really that's what we want. Don't just ignore it. It really needs that awareness. And this is jodasma. Now, think about sleep issues which can be fundamentally affected by breathing.

Patrick McKeown [00:44:58]:
Think about anxiety. We're talking about now. There's such an awareness with mental health issues. How are those people breathing? How do we breathe? If we have anxiety or panic disorder or depression or chronic fatigue syndrome, we don't breathe well. And our breathing pattern is that one function that we have a direct influence to the autonomic nervous system. Because when we are in a state of anxiety or depression, we're very often in that increased stress response, debilitating that we don't have good balance of the autonomic nervous system. And we should be using breathing as a means of just helping to bring balance there, dampening the stress response, increasing relaxation.

Claudia von Boeselager [00:45:42]:
That's such an important point. I just want to highlight on this as well. So anxiety, chronic stress, chronic fatigue syndrome, chronic stress as well, right. This is applicable to so many people. So what would you say, Patrick? Is there a protocol to start your day, right, with certain modalities and then do hourly check ins, like, how is my breathing? How is my posture? Am I breathing through my nose? Am I breathing through my mouth? What would you recommend for people that maybe have more like office jobs and versus athletes to get out of that chronic cycle of the chronic fatigue syndrome, chronic stress anxiety, and how their breath can help them? What would be the protocol that you would say would work for many people?

Patrick McKeown [00:46:27]:
I think we need to have a default over something that we can fall back on. And my default is that if I go into a difficult situation, I don't know if I mentioned it last time in the instagram. I had an interview back in May of this year, and it was going into a group of about four or five individuals, pretty high powered individuals, seven cameras. And the interview was for an hour and a half. And I was left first in a small room from 12:00 p.m. That day till 05:00 p.m. So this was too unnatural for me. I'm pretty sure of it.

Patrick McKeown [00:47:05]:
And then when I'm brought into the room, I was left outside the door for seven minutes and I could feel my heart rate. My heart rate took off and I could feel it there. And I'm thinking to myself, I'm about to go into these individuals and I've been purposely leftist. Door for seven minutes and my heart rate is starting to kick off. I automatically kicked in with breathing. One of the associate producers, he said, take a deep breath. And I turned around and says, I'm not taking any deep breaths. And I just stood there and all I did was bring my attention inwards.

Patrick McKeown [00:47:36]:
I took a soft breath in from my nose and a really relaxed and slow gentle breath out. And a soft breath in through my nose and a really relaxed and slow gentle breath out. Because all I wanted to do then was I wanted my body to tell my brain that I was safe. I didn't want my body telling the brain that I'm under thresh because then a fight or flight response is going to kick in and I wouldn't have performed at all because even though I might have been walking in in body, my brain wanted to get me out of this situation. Now there's an example that the simplest of things. And if somebody does have debilitating conditions, we too need to be telling the body. The body needs to be telling the brain always, you're safe. You can communicate that via the breath.

Patrick McKeown [00:48:29]:
Now how do people ordinarily breathe if they have a chronic condition? It would be very normal. You're feeling anxious about it because you don't know when your symptoms may strike. Of course there can be an element that you're feeling sorry because you might be comparing yourself to other people of your age. And all of these things are natural, but they don't help because when we're getting anxious, of course that the body doesn't know the difference between a real event and an imagined event. And it's almost that the body is going into that stress response just from the worries and the anxiety that's going. I look at the breathing patterns of people who have chronic fatigue syndrome. They are breathing upper chest, they are breathing fast, they are breathing hard, same with anxiety, same as panic. And all that breathing pattern is doing is continuously telling the brain, under trash, under trash, under trash.

Patrick McKeown [00:49:21]:
And at some point the body is not able to cope with that constant message of arousal, constant trash for any of us, especially in the society that we're living. And that's probably a conversation that different story, but it's from the young child, the competitive pressures going through school, getting into university, getting into the corporate world. It's crazy. It's crazy. We need to have some tool that we can tell the brain we are continuously safe. So coming back to your question, I can only think of how would I do it myself? Because if I can do it myself, then I feel comfortable with requesting other people to do it. Whenever you feel that you're going into a difficult situation, bring some attention.

Claudia von Boeselager [00:50:12]:
Patrick, it's paused. Are you still there?

Patrick McKeown [00:50:23]:
I don't know what's going on.

Claudia von Boeselager [00:50:25]:
You're back. You're back.

Patrick McKeown [00:50:27]:
A message comes in. Maisie, I am absolutely, totally naive with Instagram and all social media, so coming back to that, we will always have little challenges in our way of life. And if we are fairly comfortable with our breathing patterns, breathing through our nose during sleep, breathing through our nose during exercise, breathing through our nose during the day, sitting down in the evening, just gently soften our breath. Soft breath in through the nose. Really relax. Slow, gentle breath out. Not living in our head as much as we normally would. Using this as a means of being able to get out of our head, but into our body and practicing just gentle breathing techniques for the body to tell the brain that we're safe.

Patrick McKeown [00:51:18]:
Now bring that into your everyday life. Then when you have a challenge, you can automatically go back to that. And there's a comfort knowing that you can go into a challenging situation and that you're going to be able to cope because you have something to fall back on. Just as my example, my heart rate is increasing now. If that was 25 years ago, I would have been a disaster. I would have been like, going into it, wouldn't have coped. Wouldn't have coped at all. And just standing outside the door for maybe 30 seconds, I'm not sure exactly how long it was, but that's all it can take.

Patrick McKeown [00:51:56]:
And all I did was just soft breath into the nose. Really relax. Slow, gentle breath out. My body is telling the brain that I'm safe. I'm putting the critical mind out of the way, and I'm walking into the situation and I was comfortable.

Claudia von Boeselager [00:52:10]:
I think that's such a beautiful example, Patrick, and I think applicable for so many. Always. Challenges are always going to come up. So it's like you put in the training, you put in the work so that when they come up, you have that toolbox, you have that modality of the gentle breathing in and out, nice and slow. And you know what you're doing. Your body knows what it is. Well, and then just reminding yourself, like, I am safe, right. There's no saber toothed tiger lurking behind us.

Claudia von Boeselager [00:52:34]:
That we need the fight or flight. And then it just gets us back into the prefrontal cortex.

Patrick McKeown [00:52:40]:
Right.

Claudia von Boeselager [00:52:40]:
Our rational thinking, our planning, and away from the amygdala, which is this whole terror system. Right. So we really having that modality, it's free. You don't need to think about bringing something with you just in case, like, you have it with you the whole time. And the more you train it, the more you know that that is your fallback system, which really makes sense.

Patrick McKeown [00:52:58]:
Yeah. And you know another thing, Claudia, nobody even knows that you're doing anything because there's nothing to see. Now, in a way that's probably held it back because in the western world, we love this drama. We love this big know, there's no spectacle here. There's nothing to see. But there's such a power in that. So I will consider this to be the introverted breathing technique. There's a place for the introverts as well.

Patrick McKeown [00:53:25]:
So, yeah, we have our introverted breathing technique and we have our extroverted breathing technique.

Claudia von Boeselager [00:53:31]:
Exactly.

Patrick McKeown [00:53:31]:
There's also room for this one.

Claudia von Boeselager [00:53:32]:
Beautiful. We have a good question from sin g 15. How do we get a four year old to nose breathe? So I think this is a really important topic around helping children. Not as easy as adults who can maybe make the choice themselves. But how do we help children, particularly smaller children, to nose breathe?

Patrick McKeown [00:53:53]:
Yes. Whenever I'm working with children, sometimes it's not always easy working with your own child. That's the only thing that I would say. But at the same time, every little tidbit of information that you give to the child is going to be positive. Normally, when we're working with kids, we actually have them wear a little piece of paper tape when they come into the class. And the reason being is because I want to change their behavior as well in terms of mouth breathing. I have them wear the tape and I start them off with very small, little breathing exercises. And then I have them do physical exercise with their mouth closed.

Patrick McKeown [00:54:28]:
So I have them do walks, I have them do jogging. I've even had some of the kids ask, well, what do you do during physical education that are doing. We do this, we do that. The other, we have them replicate their PE class, but it's all with them out closed. So in other words, whatever these kids are doing in their normal, everyday life, that they are associated, that the next time that they do that, it's not with their mouth open, but it's with their mouth closed. Now, for children, we put all of the information out for free. Everything all of the exercises are available for free. I'm working with my own daughter now.

Patrick McKeown [00:55:03]:
It's going back a few years ago, but there's a number of different breathing exercise. How to start off, how to decongest the nose, how to do physical exercise. We call it race horse breathing. How to do breath holds, we call that dolphin breathing. How to do slow breathing, we call that tortoise breathing. And we've also spent the last four months putting together a suite of presentations with our instructors. Because this isn't in schools, unfortunately. And children who are mouth breathing in schools, they're not just mouth breathing during the day, but they're also likely to be mouth breathing during sleep.

Patrick McKeown [00:55:40]:
That in turn, then increases the risk of sleep disorders. And these children, then, if they are snoring or if they might have apnea or mouth breathing during sleep, they have a lighter sleep. And as a result, then they're waking up feeling not as refreshed, but they don't have the same degree of cognitive ability. And their academic performance then is impacted, but so is speech. They have developmental delay, but it can also influence development of the brain. This is based on a paper by Karen Boddock. She looked at 11,000 british kids and she had it published in the Journal of Pediatrics in 2012. She looked at them from age six months to 57 months.

Patrick McKeown [00:56:22]:
Pretty amazing study. 11,049 children. Her research found. Her findings were that children who had sleep disorders at age five, if untreated, they had a 40% increased risk of special education used by age eight. I wrote a book on two books on breathing for kids back, but now they're outdated. So I wasn't the right person to write the books this time. So we've enlisted some of our instructors who were school teachers. So who better than a school teacher to bring breathing presentations, a whole suite, different books, et cetera? They will be made available because we're hoping then to be able to get this into the school system.

Patrick McKeown [00:57:09]:
25% of study children are persistently map breathing and those kids are going to be held back. I was one of those children. Like, I left school initially at 14 years of age because I couldn't fathom sitting in class whereby we're supposed to be able to remain. Now, I wasn't hyperactive, but I will consider that I was attention deficit. It's not all children who have, and it wasn't that I was stupid. It was because I had poor sleep quality that was going on for weeks and months and years culminated in low energy living in my head all the time as so many kids have. And as a result, I felt, why was I in school? I wanted to get out. I wanted to own my own shops.

Patrick McKeown [00:57:58]:
I wanted to be an entrepreneur. That's what I wanted to do back at 14 years of age, I left school, my parents, I'm pretty stubborn. Claudia. It has helped me in some ways. In some ways it's not good, but some ways it's good. But it comes back to these kids. These kids then they're supposed to be model children. Succeeding academically.

Patrick McKeown [00:58:19]:
If you don't succeed academically, you're not going to get this job. And it's almost as if their career paths are laid out based on what they're able to do in exams. Nobody's talking about how these kids are functioning.

Claudia von Boeselager [00:58:31]:
They're forgetting that main component part as well. So important. I love that myotape also has the mouth tape for kids as well, which I think is really great. My little one, when she was trying to get over sucking her thumb, she's like, can I use that? Which I thought was a great idea to make it a bit more awkward to suck your thumb at night, which they can't always control as well. So an added benefit to it, too. Katie, we're at the top of the hour. Thank you so much for all your wisdom and information. Thank you everyone who's joining us live and catching the replay as well.

Claudia von Boeselager [00:59:02]:
Any further questions? I know there's a bunch of other questions we didn't get to, but clearly back by popular demand, we'll have to find a new time in the new year as well. But love what you're doing. Patrick, thank you so much for your amazing work.

Patrick McKeown [00:59:14]:
Thank you so much, Claudia, a pleasure.

Claudia von Boeselager [00:59:16]:
Great to see you. Okay, bye, everyone. Thank you for joining us live and catching the replay. Bye.