Claudia von Boeselager: welcome to another episode of the Longevity & Lifestyle Podcast. I'm your host, Claudia von Boeselager, here to uncover the groundbreaking strategies, tools, and practices from the world's pioneering experts to help you live at your best and reach your highest potential. If you haven't done so already, do go to LLInsider.com to grab your weekly newsletter on how to optimize your health, your longevity, and life.

Today's guest I'm very excited about is Mr. Patrick McKeown, and Patrick is the creator, CEO, and Director of Education and Training at Oxygen Advantage. He's also director of Education and training at the Buteyko Clinic, International President of Buteyko Professionals International. He is a leading international expert on breathing and sleep, an author of bestselling books, including The Oxygen Advantage. His focus is to empower more people every day to breathe better, feel better, and achieve their potential.

Patrick designed Myotape from 20 years experience in breathing for better, and we'll dig into that shortly. But first, I'd like to welcome you onto the podcast, Patrick. A pleasure to have you on today. 

Patrick McKeown: Thanks very much, Claudia, that bio. I need to alter it. It gets embarrassing the more I listen to it, so Yeah.

Claudia von Boeselager: Well, I'm sure you have new things to add to it in the meantime. Uh, right. So as you continue, you were just sharing there that you're in beautiful Connemara Galway, and for those who haven't been there yet, a definite, must see, stunning nature and not so far away from big cities like Dublin and London.
Patrick, I'd love to start with you sharing your journey. Where did this passion for breathing and understanding improving breath come from? 

Patrick McKeown: I suppose it's gonna be, I'm gonna have a similar story to many of your listeners. Any of us who go into a left of field industry normally fall into it because of her own issues.

At least that was my situation. So I had asthma, I had a stuffy nose. I was a chronic mouth breather. And typically when you have asthma, you have a problem with your nose, which is normal. Inflammation travels from the lungs up to the nose. And then when you have a problem at your nose and you're breathing through your mouth, your sleep is affected.

So I was tired and I knew there was always, of course, I was on medication for many years. I had a couple of hospitalizations. I got through high school, got through university, could have been a lot easier. My concentration was not good. Then I read a newspaper article in 1998 and it talked about the importance of breathing through your nose.

And it talked about breathing light. And I used a technique just to gently open up my nose by holding the breath and it worked. So then I was thinking, okay, there's something in this. And then I started actually slowing down my breathing to breathe less air and the temperature of my hands improved, because often I always had cold hands and cold feet.

So then I knew straight away there was a connection there. And I started putting it into practice and it made a dramatic reduction to my asthma symptoms, but it also improved my sleep and I started taping my clothes back in 1998. So now I did use a nasal dilator cuz my nose wasn't good.

And it takes a while, you're doing the exercise, you'll open it up, but you have to switch to nose breathing, especially if you're a chronic mouth breather like I was. It takes a few days and a week or two to get that transition to becoming from a mouth breather towards a nose breather, but I would say Claudia, on the second day waking up, I woke up at the best night's sleep I had in about 15 years and it was dramatic.

So that's how I fell into it. I was in the corporate world at the time. I did that course Business, Economic and Social Studies in Trinity College in Dublin, which coincidentally you did as well. So I wasn't expecting that and I was in the corporate world. But you know what, I felt very stressed in the corporate world and I used to hate going in every Monday morning.

And so sometimes I had resentment for the company. But then when I really looked back and it took me a few years delving back into it, my physiology was all over the place. So I was that youngster in my early twenties while I was a mid twenties then. I was chest breathing. I was a faster breathing pattern.

My sleep was off. I was in the constant sympathetic drive, that fight or flight response. You can't send a youngster into a corporate situation where resilience is required, energy is required, focus is required, concentration is required. My physiology wasn't there. And that's the one thing I'd say. And I had an interview with entrepreneurs on Monday, and sitting in, it was an assistant professor of one of the business schools and I attended business school and I said, we come out of it, we had no capacity to deal with stress. There is nothing in B E S S that deals with stress and there is nothing in B E S S that deals with improving your concentration. So why are we sending these kids out there without the resilience to be able to self-regulate?

So I was looking, I came across all of this information. Now, back then, nobody really wants to know about it, I have to say. So it was an interesting journey. I was working mainly with people who would ask my, as of fact, what happened then was I changed careers. I went over to Russia. I trained under Dr. Konstantin Buteyko. He was alive at the time. He developed his technique back in the 1950s. He was working as part of the Soviet the space race. And also when he was working with patients as an MD, he noticed that as people got sick, their breathing got faster and harder. Now he asked a question, he said, is it their sickness, which is causing them to be breathing faster and harder and upper chest?

But he said, is it their faster and harder upper chest breathing, which is feeding into their sickness? So we said, let's teach this group of patients, let's teach them how to breathe in natural through the nose, light breathing, slow breathing, low breathing, normalize their minute volume. And he was finding that he was able to help them recover in different conditions, but more specifically, he was with asthma, especially back then, but he actually worked with a hundred different conditions. Now, I'm not gonna say this is a cure all now. It'll probably come up at some point because he put all of his standing on his carbon dioxide, but that was back in 1952.

That was the available science back at the time. Roll on to now, what can we say breathing techniques are doing? They're helping to bring balance to the autonomic nervous system. They're helping to strengthen the barrel reflex. They're helping to stimulate the vagus nerve. They're helping to improve sleep quality.

And this is very, very important for people with various chronic conditions, especially inflammation, because stress and inflammation go together. And if we can stimulate the vagus nerve as discovered back in 1998 by a New York scientist called Kevin Tracey, and he was working with a rash and his colleagues thought he was bonkers.

They were outside in the corridor and they were placing bets that it wasn't going to work. He stimulated the vagus nerve in the rash and he was able to block pro-inflammatory cytokines, the chemical messengers that trigger inflammation. Now that's back 24 years ago. So, inflammation and stress and do we have some way of having to control that?

Claudia von Boeselager: And this really then is across the board. And I think, for people listening they think, okay, oh, I'm not an asthmatic or I have just minor symptoms. But you know, it's so powerful for the spectrum of people suffering from different issues to actually just people looking to optimize performance.

And I think one thing also you were mentioning is concentration, right? And I think this is super interesting and focus , one area I'm passionate about getting better at is the flow state, right? Optimizing for that. And how many of us are in this highly distracted monkey mind place? So I think helping people to understand that what you can do with your breath and can you talk a little bit about the physiology like what is actually going on that helps people to actually from an immune perspective, but also then from a focus perspective improve things like focus, but also solve things like asthma. Like what is really happening there, Patrick? 

Patrick McKeown: So I suppose there's different mechanisms. The breath is something that we can influence, and by influencing breathing, then it can impact other functions of the body.

So from an asthma point of view, very often people would, asthma, they have a stuffy nose. And because of their stuffy nose, they mouth breathe. Mouth breathing is gonna cause breathing to be more up upper chest. And I would always say to my students, look down at your chest, take the breath for the mouth, and you'll see that mouth breathing engages more of the upper chest.

Mouth breathing is faster, breathing harder, breathing, dry, cold air, that's unfiltered, unconditioned coming into the lungs, which is going to feed into asthma. So asthma is a vicious circle to some degree as somewhat of conditions. So you can imagine the person with asthma, their airways are narrowing, they're feeling that they're not getting enough air, they're feeling a chest tightness.

In response to the airway narrowing, they will typically breathe faster and harder to alleviate that feeling of suffocation, but that in turn is feeding into their symptoms. Now, it's been well recognized. Doctors used to recommend, I don't know if they still do it, if a child was diagnosed with asthma they would often say to that child, probably the best sport you could take up is swimming. Now we have to then think about swimming and what does it do to your breathing. So the child is getting into the pool, the tro, their diving stick to the bottom of the pool. They're doing a breath hold that's happening to open up their airways. They're also swimming on the water. The water's pressing against them. They're breathing against resistance, and it's happen to approve the respiratory muscle strength. So what do we do? Well, we recognize that people with asthma breathe faster, often harder, upper chest breathing, irregular breathing, mouth breathing.

It's feeding into conditions, but it's also activating a stress response. People with asthma don't just have asthma. As asthma severity increases, so does tiredness. They're more likely to have disrupted sleep. They're more likely to be waking up during the middle of the night, especially if they have uncontrolled asthma and oftentimes that's overlooked. And taking medication, of course, that's all very well. And of course it will help to control their asthma, but it's not getting to the underlying issue of a poor breathing pattern and it's not happening their sleep. So with asthma, we would always start off with breathing in and out through the nose.
 The mouth does nothing in terms of breathing. If I was to look inside a mouth, do you look inside your own mouth and you ask, what does the mouth do? It does nothing. It's a hole, you know, to be cruel about it. Air comes straight down your throat into your lungs and other than that, so we have to think about mouth breathing that our ancestors would've used, only the mouth in terms of an emergency.

We have to still equate that today and discovered back in 1991 as a gas called nitric oxide. So nitric oxide was discovered on the exhale breath of the human being just in 1991 and nitric oxide is antiviral ,it's antibacterial, it's a bronchodilator. So if you breathe through your nose, and especially if you hum, so say for instance, taking a breath in through your nose and then humming and you're vibrating the nasal passages, that's dumping nitric oxide into the nasal airway, and then you're carrying that nitric oxide into your lungs. And as bronchodilate, COVID, nobody was talking about nose breathing. They should have been, as antiviral, there are tests. Of course, if you look in clinical trial in the United States that factories are pharmaceutical companies were researching the effects of nitric oxide inhaled into the body as a treatment for COVID. Now granted, the doses are higher, but at the same time, we should have been giving our own body a chance. Breathing through your nose, you've got our own immune defense in terms of the respiratory system that's designed in comparison to the amount, the mouth just doesn't offer us a defense.

So that's, so for example, asthma. In terms of focus and concentration, I don't think we will ever have focus and concentration unless we get a good night's sleep and it's very normal when individuals have dysfunctional breathing and they're breathing harder and faster, there's an increased turbulence in the airway.

So for example, they are snoring. So I'll often say to my students, make the sound of a snore through your mouth and it goes like this *SOUND*. So then I say, close your mouth and try and snore. Watch your mouth closed through your mouth and it's not possible. So mouth snoring stops when you breathe in and out through your nose during sleep.

And then there's nasal snoring. So this is when there's turbulence in the nasal pharynx, in the nasal airway in where the nose is meeting the back of the throat and nasal snoring goes a little bit like this *SOUND*. Now, if we learn to breathe lighter during the day, we in turn will breathe lighter during sleep. So there's less negative pressure, less turbulence, and there's less snoring during sleep.

Our breathing during wakefulness influences our breathing during sleep. Now think of another condition, obstructive sleep apnea. So 90% of people are undiagnosed. It affects between 25 to 50% of men. With women, it's about 10% until postmenopause, because it's taught that progesterone helps to protect the female against collapse of the upper airway during sleep.

But postmenopause, it increases by 300 %. The problem with obstructive sleep apnea puts a lot of stress in the human body, it also causes sleep fragmentation. It's linked with many different issues, chronic fatigue, fibromyalgia, depression, PTSD. I'm looking at papers with PTSD, Post Traumatic Stress Disorder, up to 50 and 60% of this population have obstructive sleep apnea now.

And then we have to ask, what's the bidirectional relationship here? Is it the OSA, which is feeding into the PTSD? Is it the PTSD, which is feeding into the OSA? It's not clear cut, but at the same time, let's look at sleep. So coming back once more, then to flow states, what do we need for flow states? We need to have concentration.

You're not going to have concentration. That ability to hold our attention on one thing unless we have good sleep body, we need to be waking up feeling refreshed in the morning. Nose breathing is absolutely key to that. Now, there are other things, of course, sleep hygiene, but I would always start off at get breathing in and extra the nose, but also improve your breathing pattern from a biochemical dimension, from a biomechanical dimension. And if one is susceptible to sleep disorder breathing, it is putting us into that increased stress response, increased sympathetic drive. It's reducing heart rate variability, which would be an objective measurement of vagal tone, which is giving us information on the functioning of the autonomic nervous system. So poor sleep for me is really, it's problematic and it's problematic towards productivity, but reaching our full potential. I had poor sleep in university. You're sitting in school and you're graded based on your academic achievement, but nobody's taking into consideration your breathing pattern, your sleep levels. You're not thought how to concentrate. For flow states, we need to have, one is good sleep, but also we need to have balance of the autonomic nervous system. So for example, if we talk about flow states, say for example, police officers and this has been studied.

Urban police officers going to a situation, a study of 57 of them. When police officers were too stressed attending that situation, they were more likely to use little force. When they were too relaxed, they were more likely to miss cues, threatening cues that put their colleagues lives in danger.

So there's one example where it's very important to have balance of the autonomic nervous system, but of course it applies to any of us, because oftentimes I'll say to people is -if we have good concentration that we can hold our attention to one thing and we have a good attention span that we can sustain that over a period of time.

It means that we have some degree of control over our thinking processes. We can bring a space between thoughts. On one hand it's very positive, but also it gives us the tools to be able to deal with difficult situations. And I feel tremendously, lucky to have come across this because all going well, I won't have mental health problems ever because I have that capacity to self-regulate. Now if we start talking about attention and since the invention of mobile phones 2007, 8, and 9. Mm. I had 25 years without a mobile phone. Like I had 25 years that I could be stuck out in nature. 

Claudia von Boeselager: So for people listening, he's just turned the Patrick's, turned the camera around to beautiful fields and pretty much no building.
I don't see any building in the... . 

Patrick McKeown: No, there's no buildings at all. And actual fact, there's a film called the The Banshees of Inisherin that's doing the rounds at the moment. And that was films not too far away from here. So we have the stone. We have The Stone Walls. The only reason we have the Stone Walls is because the land is so poor is probably a few banshees around as well.

There's a few howers too around here. But , but come on back to, so we were looking enough, okay, I'm nearly 50 years of age, so I had 25 years of my life that I didn't have that exposure to information technology and now we're thinking about youngsters coming up through the ranks and they have, literally, the mobile phone is an extension of their hand.

It's a distraction device, and we can't be surrendering all of our attention to this device. What is it doing to the mind? So on one hand, yes, it affects your productivity because the mind is all over the place and emails, all of those things that are screaming for our attention.

And we know of course if we're doing something and we have our attention there, if we get into that flow state. Flow state it's when there's no division between the worker and the task at hand. The athlete and the race becomes one, the musician and the song becomes one. The racing car driver becomes one with a car.

It's a state of effortless ease. The right action happens by itself. Time flies. It's a lovely state to be, it's a state of bliss , but it takes time to get into that flow state. But it can access, it can be accessed as well. I often find when I go to do a public presentation , I'll have my own little routine in terms of preparing.

So what I do normally is I down-regulate first. So for to down-regulate, I close my eyes. Well first I'm a little bit of an introvert. Even though I talk for a living, I hide somewhere cuz I don't want to talk to anybody because if I talk to people before the event, it drains me of energy. I don't want to watch other speakers because what happens then is I'm thinking, well, I'm not going to do as well as them guys, so I don't even wanna watch you now.

So while I'll turn up, I'll turn up just about an hour before the event, but I have my own preparation, hide somewhere in the corner. I sit down, I close my eyes, I bring my attention inwards, and I really start slowing down everything. Slowing down the breathing, especially slowing down the exhalation, because whenever we slow down the exhalation, the body is telling the brain that everything is okay, that the body is safe, and that's all the brain wants. The brain wants to know that our body is safe. And when the brain thinks that our body is safe, the brain is going to sing, send signals, and calm back to the body.

I slow down, my breathing stimulates the vegus nerve. I breathe low nose lights, low deep N L S D. I do that in a down regulation. It's bringing my attention into present moment. It's putting the critical mind aside. And then I do a few breath holes, it's an up regulator. I increase blood flow to the brain.

I open up my airways and then before going on, I flood the tension trap my body and I want to walk out on that stage, not with my attention stuck in my head because the critical mind is too slow and also times, I don't want any kind of talks coming in or going to sabotage my performance saying, oh my God, there's 500 people all looking up at you.

You're gonna make a mess of it. No, no, no. Put the critical mind aside. So we need to get that critical mind aside. And I do that by simply dispersing my attention throughout the body, walking out on stage with my attention throughout my body, and speaking with every cell of my body. And I dunno, but I think they're tremendous tools.

You know, Claudia, we all use them. Things go wrong, little things. And at least we have something to be able to regulate. 

Claudia von Boeselager: I love that and I wanna dig into tools. I just wanna circle back to one thing around concentration and one thing I'm digging into more at the moment, because my daughter's a diagnosis and I probably have it as well, is A D H D, right?

Or some form of ADD and attention deficit. I was just reading something yesterday. They were, reporting all the cases that have gone up and is it just, more people are being diagnosed and, or you know, where is it just undiagnosed in the past? What's the dynamic? Why is there so many cases coming through?

What is the correlation, would you think? Or is there a correlation between ADHD diagnosis, potentially breathing, and is there a way to potentially, or I would think so right through breathing and breathwork strategies done on a daily basis to assist particularly children, but even adults in with ADD mind. What would you say? 

Patrick McKeown: It was a very interesting study published in pediatrics in 2012. I'll send it on to you. Yeah. The researcher was Karen Bonuck, B O N U C K . She looked at 11,000 children in a town called Stratford-upon-Avon in the United Kingdom, the home of Shakespeare. Yeah. And she looked at their sleep patterns from age six months to 57 months.

So a large population over a long period of time. She concluded that children who had sleep issues by age five if untreated, they had a 40% increased risk of special education needs by age eight. Wow. Now, that paper was published in pediatrics, which is a, it's a pretty good authority in terms of a journal .She talks about during the formative years, during the early development of the child, the brain actuary develops during deep sleep.

So we need slow wave sleep because that's when the brain is developing. But children who are snoring or if they have their mouth open, or if they're stopping breathing during sleep, and all a child has to do is to stop breathing for two breaths during sleep. And that's one apnea. And even if they have one apnea per hour, it's clinically significant.

It's different for an adult. If an adult stops breathing for 10 seconds and if they have more than five events per hour, then it's clinically significant. But for a child, it's only one and it's only two breaths. These children, she says, is that they have abnormal brain development and she speaks also in that.

And she cites a few other studies as well, support of her findings. She says there are 3 million children in the United States age between six and 21 years. Okay. They're not children at 21 years, but 3 million individuals. Yeah. And they have special education needs and different issues including A D D, A D H D, autism, et cetera, that is related to sleep problems.

So we need to be getting back to the basics here. Yeah. You know? So now we have to ask the question, well, why would it be so prevalent now that children are having problems? And I have problems in sleep. You know, my parents had really well developed facial structures, broad faces, they didn't have overcrowding of teeth.

Their jaws weren't set back. I have a very high nerve patch as you can see it. Oh wow. So the arch is vaulted into my nasal airway, which is infringed my nasal airway. And when that happens in a child, automatically their sleep is going to be impacted. So from an anatomical perspective, now, why might I have those cranial facial abnormalities?

It can happen as a result of the diets that we're eating now, I know it was written back in 1930s, Dr. Weston Price. He wrote a book called Nutrition and Physical Degeneration and he looked at different civilizations. What happened when they were eating their traditional diet? So for example, Maori, Eskimos, aboriginal people, et cetera.

So they had their traditional diet that they were eating for tens of thousands of years, and then they switched over to our diet, chocolate and marmelade and sugar and all of that stuff. First generation children became mouth breathers. First ball it took was one generation. So then there's another aspect of it as well, from a societal point of view, that breastfeeding, of course is very important for child development. And it's not just about the nutrition, but it's also about when the infant is feeding from the breast, it's causing manipulation of the muscles of the face necessary for c craniofacial growth. So in other words, the child's face and muscle tone is going to be influenced by the feeding from the mother.

Nowadays, society has put so much pressure on parents that both parents have to be working. That's the way it is here. That's the way it is in Western society. So the mom doesn't have a chance to be able to give six months or 12 months of breastfeeding to their infant because there's a big mortgage to pay, which is another story and I won't even go there cuz sometimes I think society is driving us so hard.

And it's no wonder that there's a stress response. And probably, I know Covid was a difficult time for many people, but it gave us a great reset and we needed that. There's something positive that we were able to withdraw and stand back and just reflect how much we were caught up in all of this.

Parents are caught up in it. What else? What other factors that the food and the children are eating, you know? Yeah. They're eating the pureed food. They're not developing their jaws. They're not developing their airway. So then you have a child that their airway is smaller than what it should be.

Their sleep is impacted. It's impacting the brain development, it's affecting the IQ. These kids who are sleepy, they have 10 times the risk of learning difficulties. I'll give you a little bit of story about myself because probably I only started talking about, I wrote a book called Atomic Focus last year. Okay. And I left school originally at 14 years of age, never to go back to school. Never. I left school in 1988. And I left school out of a total sense of frustration. I just could not hack it. I wasn't disruptive. I couldn't understand why I had to sit in a classroom for six hours a day when I didn't have the capacity to pay attention to what the teacher was saying.

I couldn't remember the information. Now, I went back to school one year later and I studied for 10 and 12 hours per day to get my results. It could have been easier, you know? And that's why I would love to see in the educational system how many children are falling between the cracks, not because these kids aren't bright, they can be highly intelligent children, but if they have a sleep issue , if they have a breathing pattern issue, it's going to hold the back. And there's a social cost in this as well. So if we think then of children who are in this high stress environment, that's a toll and it's a toll on their peers, these kids may be becoming bullies because they're in that situation.

So there's a knock on effect as well. And other things that could happen as a result of going back to the basics. 

Claudia von Boeselager: This is so fascinating and phenomenal. And I feel like you should be in every school Patrick, explaining, I'm sure you're working on this and I'd love to get into that. It's a reeducation, I guess, and awareness of the importance of breath and being aware not only of children but us as adults.

So I've had to really the last year's refocus on breathing because when I started learning about it, I realized I'm a total upper, the typical female, everything core tight and upper chest breathing, not breathing properly. I had medical issues going back now a few years, which led me on this journey with chronic sinusitis.

So nasal breathing, feeling groggy, chronic fatigue as a result, right? So I'm getting the list of the things from the doctor. Meanwhile, I'd always been the super fit, never sick person. I'm like, what is, where's all these things coming from? And it's unfortunate that sort of knock on effect if you don't address it, fast forward I do breath training.

I don't know. You familiar with Airofit? phenomenal. I did a few sessions and I went for a run again and something that I would've found challenging. I didn't find challenging at all. So absolutely brilliant to know what's out there and that's why I'm so passionate about sharing.

So I appreciate you coming on today . But what I'd love to also just understand the point you mentioned there about the food that children are being fed can impact their physiology. Is that correct? 

Patrick McKeown: Yes. Because if you think about our ancestors before maybe the advent of agriculture, maybe about 10,000 years ago or so.

And even up to more recent times, infants, once they were weaned off the mother's breast, they were typically gave the food that adults were eating. So there wasn't this transition from going from breastfeeding to eating pureed food. You're getting into nutrition, but you're not exercising anything.

But even if you think of the older kids, then you know, the treat is going to McDonald's or the treat is going to Burger King or any of these fast foods. They're eating mince meat, it's already chewed up for them. So again, it's not giving them a chance. They're eating soft by bread.

Everything is soft. So it's eating something hard because that's the chewing muscles and that's developing, helping to develop the shape. Now if we ask, then, okay, how common is this? Well, between 25 to 50% of study children, persistently mouth breathe, now some of these kids are tongue-tied. Tongue tie is an issue because of course if the frenulum, which is the string that holds the tongue, if it's too tight, the tongue isn't able to get from the floor of the mount up towards the roof of the mount. But also if the young infant is tongue tied, they're not able to feel off the mother. And what happens is that the baby then is chomping on the mother, the mother is becoming very sore. The baby isn't thriving. A bottle is introduced, but your a bottle is just milk flowing into the baby, no effort involved, so yeah. There's a book called Baby-led Weaning book that was written by a nurse called Gill Rapley.

Now it's easier said and good done as well and I've gotta confess because I remember with our infant that I was saying, okay, let's go with the, the Baby-led Weaning and let's give, a piece of carrot. And the next thing is of course, the gag reflex of the child is very forward. And everybody's saying, especially the mother-in-law, oh my God, the baby's choking.

The baby is choking . So I will say, just bare different things in mind. You know, that the concept is like many of these things I think one would need to delve into it, but just to be aware of those facts, but especially older kids, why not give them a piece of tough meat and let them work on that to help develop that. But I think it's really important for people to be aware of. Number one is the anatomical factors with the child as they're growing up. There's a paper and there's other papers showing that there's an a risk between abnormal anatomical development such as my high pallete, narrow jaws, jaws that are set back in sudden infant death syndrome in infants. Wow. The children have poor breathing. They can die of hypoxy during sleep because this could be identified, you know, on day dash when the baby is born because there's genetic influences here. And the thing about this is it could be identified that the child then is able to develop the way they should be developing without a risk of having sleep apnea for the rest of their life.

And now I know some people may say that's a bit farfetched, but it's not that all people would sleep apnea. It's not that the anatomy is always to blame, but the anatomy is the single biggest factor. If we look at obstructive sleep apnea and the phenotypes and characteristics of sleep apnea, I wrote a paper on this with two ear, nose, and throat doctors.

It was peer reviewed, we had it published. We support it with 160 different references. We have no science, all I could do was really pulling, showing where the connection was, joining the dots together. But we haven't had a group of people with sleep apnea, teach them how to breathe in and out to the nose during the day, but also during sleep, had their tongue resting in the roof them out, which helps to take it out of the airway. Improve their breathing from a biomechanical biochemical point of view so that their breathing is lighter during sleep with lighter breathing, there's less negative pressure in the airway.

Improve their breathing from a biomechanical point of view because your diaphragm breathing muscle is mechanically linked with the upper airway later muscles in the troche, which is often going unrecognized. And also then give people strategies to help bring balance to the autonomic nervous system, especially people with insomnia, hyper arousal, they're over stimulated and when insomnia and obstructed go sleep apnea go together, depression is higher. So this is stemming back then. How are we going to get to the bottom of sleep problems? When people get to 50 years of age like me, it's when they're young kids, are their children mouth breathing, are they tongue-tied? What foods are they eating? The shape of the human face is changing, but it's not changing for the better. And one can ask, is there any direct evidence of that? Yeah. Go into any young children's classroom, 11 years of age and ask, how many of you here have to get orthodontic treatment, because when you have overcrowding of the teeth it's not that the teeth are too big, that's not the problem, the problem is that the jaws are too small. So the maxilla, which is the top jaw is not wide enough to house all of the teets. Now with a smaller jaw, there's not enough room for the tongue.

When there's not enough room for the tongue, it's going to encroach the airway. So why is there such a high instance of crooked teeth? We don't see it in the animal world, but yet probably 75% of children now have orthodontic treatment. Our ancestors didn't have to do it. 

Claudia von Boeselager: This is a super interesting point.
I had an orthodontist years ago now I've had braces, but I had two canine teeth that were, the roof of the mouth had to be pulled forward. So don't know if I would qualify a hundred percent or not, but he said that it depends more on physiology and genetics. So that was what he said. Now, this is going back a fair few years now, but are you saying that if caught on time in children, small children, the physiology can be put in the right way that's needed so that the orthodontics would never be required at all?

Patrick McKeown: Wow. Yes. And that is not just me. 
Yeah. I've been in this field for 20 years. I've talked at many conferences throughout the world. There is a group of orthodontists that recognize this. I think there's a tremendous role for dentists and orthodontists to be involved in sleep medicine. They are the gatekeepers after all to the mountain airway. They would identify all the risk factors, is not solely genetics. Genetics of course, is some influence. Thumb sucking, tongue trusting, the environment. But it very much, we have this, and regardless of its genetics or not, like none of this is new.

There's a journal that, that was around back in 1909 called Dental Cosmos. And in that is an article about mouth breathing and the writers talks about the child being inattentive in school and the face looks dull and expressionist because of course the cheekbones didn't form the way they should do.

The child hasn't get this lovely forward growth because the mouth breathing face, the nose is typically bent like mine because the maxilla isn't far forward enough, and because the maxilla isn't forward enough, the mandible isn't forward enough, and then the airways compromised. I have a compromised airway.

It could have been avoided. There's many orthodontists that are wonderful worldwide that they know us and they get it, but there are two schools of thought. So what I would say to anybody embark an orthodontic treatment, first of all, never do extractions because if you, we as adults, , we have 32 teeth.

We need to keep those teeth because if you have extraction, what's it gonna do? It's gonna make the jaws smaller. And if the jaws get smaller, where's the tongue going to go? Always ask that question. So if you are embarking on orthodontic treatment for a young child and if the orthodontist is insisting on extraction, do some research and get a second opinion.

And especially look for a dentist who is not just about straightening the teeth , but about developing the face because ultimately that's what it should be. 

Claudia von Boeselager: Phenomenal. As a parent of two children, my antenna's completely up on this. So for children and though for adults, if someone's listening and thinking, oh, but how do I know if I might have a breathing issue or not?

Say like the non-obvious ones. Right. So, and obviously as you said yourself, was it 90% of people with sleep apnea are not even aware that they have sleep apnea? Right. But for people who think, maybe I have breathing issues. How can I tell? What would you say are some things to observe and to look out for in order to assess the relevance of really digging into this?

Patrick McKeown: A very simple tool is using breath to time and breath to time will be measuring the length of your comfortable breath tool time after an exhalation. So simply the person is sitting down. Have them take a breath in through the nose or breath out through the nose. They pinch their nose with their fingers.

They stop breathing and they time it in seconds. How long does it take until they feel the first step, desire to breathe. And when they resume breathing, their breathing should be relatively comfortable. So if you have a low breath of time, meaning that if it's under 25 seconds, but especially if it's under 20 and definitely under 15 seconds, it indicates the breathing is faster. Breathing is more likely to be upper chest breathing can be irregular. There's no natural pause after exhalation. And this will also put that person into an increased stress response because we have to think about how do we stimulate the vagus nerve via the breath.
                    
It's all about the having that slow and relaxed exhalation. So during the inhalation, the vagus nerve steps back and that's why our heart rate is a little bit faster during inhalation. But during exhalation, the exhalation is primarily under the control of the body's rest and digest response, the parasympathetic nervous system.   

And when we have that really slow and relaxed exhalation during rest, the exhalation should be one and a half times the length of the inhalation. So with the ratio is one to 1.5. And when you're having that slow and relaxed gentle exhalation, your body is telling the brain that the body is safe, but how about the person who is in the habit of mouth breathing? They're going to be faster breathing, upper chest breathing, faster and harder breathing and a fast exhalation, their body is continuously sending input to the brain. So via the vagus nerve, we've got 80 to 90% of the communication is from the body up to the brain.

So it's not just this top down communication. What's more importantly is this a bottom up communication. We can tap into that. So Kyle Keel did a paper on this, then he published it and he asked the question exactly what you asked. Is there a simple screening tool to assess for dysfunctional breathing and all, and it's the breath to time and his conclusion was he looked at 51 individuals. His conclusion was that if the breath full time is above 25 seconds, there is an 89% chance that dysfunctional breathing is not present. 25 seconds is what he was looking for. Breathing is a little bit more complex, Claudia. It's not just about going down to your local yoga studio.

And there's another conversation we're having by the way. It's not just about the biomechanics. The biomechanics is only one aspect. It's only one factor dimension of breathing. There's also the biochemical dimension. So whenever researchers look at breathing, they look at breathing in terms of the biochemistry, which is carbon dioxide in the blood, carbon dioxide, chemo sensitivity.

They look at the biomechanics, whether the person is breathing high or whether they're breathing low. And they also look at the psychophysiological dimension, the connection between the psychology and the physiology and vice versa. So breathing is just that little bit more complex, but a simple way just to narrow it down is use the breath of time for adults now for children.

I use what's called the maximum breathlessness test. I have them walking for me working with kids, and I've been working with kids the same as with adults. Children won't do slow breathing, unless they're an absolute angel. I know my angel wouldn't be doing slow breathing. It's hard enough to get them to do the walking exercises, but they'll do movement, they'll do movement, you know?

 And whatever the parents do, their children will follow, like if the parents are going around with the mouth open, the children are going to do the same and getting them out closed during sleep, practicing restoring nasal breathing, sh showing the child how to de congested nose. And for children, we've put, all of the resources are out there for free and, towards the end I suppose we can touch, how can people get access to the resources because everything that I teach, I put free out on the internet.
It's all out there. 

Claudia von Boeselager: Amazing. With the exercises. Well, I was just thinking of a point there. So that testing and just awareness and I think, would you say, obviously bodies are complex, but waking up sort of groggy, obviously depends on the time you went to beds, what you ate before bed, et cetera.

But would you say that is a good sort of wake up call if someone is consistently waking up after what should be a good night's sleep? Groggy, that could be a mouth breathing issue to look into? Dry mouth. 

Patrick McKeown:Dry mouth. Yeah. And for a man, and I know you, but a man should wake up in an erection.
If a man in a sleep disorder breathing, It doesn't happen. And then there's an issue with the cardio with the blood circulation. So we should all be waking up with a moist mount in the morning. It's a kind of a pretty good indicator, but 50% of the adults very understudied, really understudied.

But about 50% of the adults population will be mouth breathing during sleep and it's something that happens as we get older as well. So we should always check, do we have the mouth closed? Are we waking up in a moist mount in the morning? And anybody who tracks their sleep via Whoop or via Oura rings or anything like that.
They will typically notice that when they have their mouth closed during sleep, that their sleep quality is deeper. Now there's a couple of other things as well. It's not just about getting the mouth closed during sleep, it's also about getting the mouth closed during wakefulness. 

Do your physical exercise breathing in and extra the nose. It doesn't make sense to breathe in through the out, like you go into every gym, they're all in there slugging away with their mouth wide open, it's reducing oxygen uptake in the blood. It's reducing oxygen delivery to the tissues.

It's drying out and traumatizing the airways, it's causing reduced, recruitment of the diaphragm, and the diaphragm breathing muscle. When people talk about the core and they're thinking about, it's all about the, it's not the diaphragm is the roof. The roof. You've got the pelvic floor, you've got the abs to the front, and you've got the spinal muscles to the back.

The diaphragm plays an intrinsic link in terms of core strength. So we need to be thinking about going beyond the abs and if we bring functional breathing into physical exercise, it's a great way then for people to continue with it, because none of us have any time anymore. That's just the way it is, and there's a pressure on people to do physical exercise and then do your meditation, and now because it's becoming into vogue, do your breathing well, why not do all three together, you know?

I have my machines behind me, I make sure I get on in the morning and I do all three. I do my physical exercise, but I won't be looking into a screen when I'm doing it. I have my attention on my breath in my body. Make your exercise and meditation, and also make your exercise a breathing exercise, that you're conscious of improving your breathing from the three dimensions , throw in a few breath tools if, you know, once you're not pregnant and you don't have any serious, cuz the breath holes are good because it's a little bit of a stressor. It's good to stresses a little bit because this is the body then making adaptation.

So yeah. I think it's the best way to help develop a habit. 

Claudia von Boeselager: And so would you say that's like the optimal morning routine to get you going is combining it with the exercise, what you were just saying there as well? Yes. 

Patrick McKeown: There's times that the workload for me, we were building this clinic here.
We have, we've 12 staff, so it's not that many but it's still, there's a few people, the workload is high enough. And for a time I was like everybody else, I was being totally consumed by work. I wasn't able to give myself any attention and then I was becoming resentful for it.

And I was just thinking to myself, what's a all about? We have to think of ourselves because if we can give ourselves attention, then we're in a better position to be able to help other people. And we're in a better position than to be able to do whatever we need to do.

I set the time aside in the morning, so I get up, get onto the machines and then I go from there and say Sauna. And even if I'm a bit sleepy, I'll just completely just chill out the sauna , and then have my shower, and then I start my day. And once that's happening, it's a tremendous way to start, bringing everything in together.
And I think it's not just about a training for the body, but it's a training for breathing and it's a training for the mind as well. 

Claudia von Boeselager: And for the whole little system. I have a morning priming practice as well, and, my day is exponentially better which includes, exercise in the morning, which I recommend to my clients as well because of BDNF factor, et cetera.

But also do breathwork exercises and breath holding. And I can tell some days I can hold it much longer than others, and I know I'm like, okay, I didn't sleep well. There's something going on. Like you can just see straight away the difference in, and if I don't do it, my day is just a bit of a mess with like, everything happening in A D H D and being more reactive than proactive.

So yeah, just such a game changer. And, what I see time and again with all the pioneers, I luckily to have on the podcast like yourself this morning routine is just so critical and breath as a, as an essential part to it as well. So thank you for sharing that Patrick. And I'd love to dive into you just talking about your clinic there.

So tell us, what are you doing, Patrick, for people unfamiliar? What is the Oxygen Advantage? And you also founded Myotape, so can you share with us a little bit about your ventures and what you're working on? 

Patrick McKeown: So initially in 2002, I was working mainly with people with asthma, and I worked only with asthma for about five years or so.
That was children and a adults. And I felt that the established authorities in the field of asthma weren't interested. I had approached 'em and they would listen to me, but they wouldn't really do much about it. So I was thinking to myself, I'm not getting really that much of an interest from healthcare professionals.

Is there a way for me to get it out into the general population? So I wrote books, and I wrote a book in 2003 and four. One was called Asthma Free Naturally, it was published in Europe. It was published in the United States. I wrote a book called A B, C, all was briefed correctly for young kids. 

And then I wrote a book called Closure Mouth, which these books are still available, we're talking about almost 20 years later, is to get them the hands of the public. Then I started working with sleep, and Sleep was and Asthma, 2006, 7 8 9, and then post economic crash here. A lot of anxiety, a lot of panic and I started putting out these breathing and mindfulness courses because for me, mindfulness is wonderful, but it's not enough because it's not investigating sleep. We have to think about mindfulness. Where has it come from? It's come from Buddhism. And this was originated back in the day, maybe 2002 and a half thousand years ago.

Life was different then. People didn't have the chronic stresses that they are having now. And it was interesting because I worked with about 3000 people only with anxiety and impact disorder over 20 10, 11, 12 in around that time. I asked each of them. It was in small groups, I asked the small groups, have you ever done meditation?

Trying to get an insight into what they've already done and a small percent would've done it. And then I asked, how many of you stick with it? Very few. So it just made me reflect. And the other thing that I noticed was that 90% of the people who come in were female males weren't coming to attend the courses.

So that's why I brought up Boxed an Advantage. So the idea was how can I create a program that is going to deliver these same techniques in getting people out of their heads and into their body, and creating space between the mind and improving their focus and concentration, the resilience. An oxygen advantage was born because it was all about sports and mental and physical performance.

See, the first, the male came in , it was the male thing. The first 10 years was all about health. You had a health issue, you had anxiety. Go to that. Yeah. But men don't run. If you see anxiety in it, they're not going to go this way. They're going to go the other way. Yeah. But is the information was the same.

The science of course, is different. We're presenting with different papers here we're shown different things. How do you improve anaerobic threshold? Your aerobic threshold? Like I worked with a MMA fighter just before I'd come on with you. And we've worked with some of the top bands in the world.

People will see it on their Instagram feed. We've got one boxer who's fighting for a word title. I've worked with snipers, so I've been brought in how to teach them how to breed while pulling the trigger of a gun, because of course it's all about self-regulation ?

So I think there's a thing about breathing Claudia, that breathing has had a bad name for many years. It's too associated with left a field. It's too associated with the beads and the robes and the om and all of that. That has a place. But it's not for your normal everyday person. And what I want to do is breathing is something that we should all understand because it's a simple tool that we can self-regulate.

I was listening to a podcast by Dr. Rangan Chatterjee, and he's based in Manchester in the United Kingdom, and he was interviewing a brain surgeon called Dr. Rahul. So I can just imagine Monday morning you're going into work as a brain surgeon. You have to open up somebody's head and you're pretty much looking into it.

And he says, when I get into a tricky situation, the first thing I do is I prevent myself from hyperventilating. So here you have a brain surgeon is talking about when he gets into it, that's a tricky situation. He's preventing himself from hyperventilating. He knows that if he starts breathing a little bit faster, a little bit harder, a little bit irregular, the brain is thinking that the body's under trash and all the brain wants to do is getting outta there. He knows it. How many other people know it? Why doesn't the student going into the exams know it? There are studies shown that youngsters going into exams, their ability to perform well, and the exam is not necessarily down to their academic ability, but is because of the nerves that they experience going in.

They should be taught how to self-regulation. The corporate worker, they're not taught how to deal with stress. They're not even trained how to concentrate. The kid in school isn't trained how to concentrate, you know? So I really feel that we need to take this. It's the, it's, I don't know, is it the package, but it's the language that we use.

It's really for people to understand that there's something in this, and start off, and I always say, people dip your toe gently in the water, you can up-regulate. You talked about doing the breath to exercises. Another way to up-regulate is hyperventilation controlled hyperventilation.

But I would say go careful with that. The thing is, if we up-regulate too much and if the stress is too much , it could bring on tinnitus, it could bring on shingles, it can bring on anxiety. But fortunately I have put people into panic. by doing upregulation. It gave me an experience to be able to then with certain people, I have to gear up.

I have to start off very gently, dip their toes into the water, just gently gear up. For me, the downregulation is really important. Being able to take attention out of the mind. Being able to change states, bringing attention onto the breath, into the body, into the present moment. It's a tremendous capacity because we even enjoy life.

We don't enjoy life. When we're stucking in our, stuck in our heads, we're all to some lesser, greater degree stuck in our mind, but even the capacity to be able to just to be able to take your attention out of your mind and into what's happening in life. Looking and saying, listening and hearing ,feeling, smelling, tasting, even to enjoy a nice meal. We need to be able to connect our senses to that meal if we have a beautiful meal in front of us, and if we're stuck in our head, we're not even going to see the meal in front of us. Yeah. It's the simple things. Yeah. 

Claudia von Boeselager: That presenting. Exactly. And I think the breath is such a powerful tool to get back into that present moment.

And the stress, the monkey mind. It just, yeah, it, especially what you were saying before, with all the distractions that we have, it's such a vital tool to be able to know how to self-regulate and using the breath is just it's free, right?

Patrick McKeown: Yes. That's the problem.

Claudia von Boeselager: If there was big money in it, everyone would be jumping. We talked briefly offline before we jumped in about funding and moving forward. What would be your big vision or what would be your ideal state and say five years time or 10 or 50, whatever that number is, Patrick, like what would you love to see in terms of breath awareness and use?
 
Patrick McKeown: It's interesting cuz we had a meeting here with about 30 of us, 30 of our master instructors who were in different countries throughout the world. For the first time we wrote our mission statement. Okay. It took 20 years, but we eventually got to it.

Better later than ever. And we included that basically we want people to understand and to apply and to bring into their everyday life breathing techniques to be able to self-regulate for sleep, for respiratory health, for mental health. 75% of people with anxiety and panic disorder have dysfunctional breathing.

75%. They're going to their therapist. How many therapists are actually improving their breathing from a biochemical and a biomechanical point of view, it's been overlooked. So part of the journey, my main journey now at the moment is really to, in some ways I'm stepping back cuz the workload has been pretty intensive for about 20 years and I just felt that I really want to bring a balance as well because there's a point that I'm starting to, just once that five oh mark is very interesting because it just gives you, you have some reflection on what you've done and where you're going. So for me, I love the work. So I'm tremendously grateful. I'm booked out for 2023. Wow. Completely. It's booked out, but it's putting in some time there. Now part of that is we developed an app, so I've spent about 12 months working on the app and I put in $150,000 into it and the app is to include all of the breathing exercise. So there's 130 videos. There's different daily plans. So for PTSD, for people with high blood pressure, people who have asthma, a sports performance in the office, women's breathing, by the way, is different to men's breathing. That's also worth considering as well.

But this mightn't be perfect coming from a B E S S head. But, I decided intuitively that to put the out app for free, that was no subscription model, because I didn't want to, I say it doesn't tie in what our mission statement, my mission statement is, try and get the information out there. Like I've written 10 books.

The purpose of the books is to put all of the information into the books to get them out there. Like one of the recent books is called The Breathing Cure. I don't have it here. But I have a new book coming out as well in February called Breathing for Yoga. Yoga breathing changed in around the 1880s, which is very interesting, but before that was about light breathing. So where's it all going, Claudia? I think the app is a means of helping to get it out into the population. What's her name, Patrick. It's going to be, it's going to be Oxygen Advantage. Oxygen Advantage, okay. Yeah. So just Oxygen Advantage and it will be available on iTunes and Android.

Now. It won't be out in probably until about the first week of February, 2023. So depending on when people are listening to this, I'm hoping that the app is very useful. We put a lot of work into it and as I said, I could have a nice Porche sitting out in my driveway with the money that I put into the app.

And here's the thing, this is when you sometimes have to go with your gush. Now, if maybe I might have made a mistake, I don't know. Every person who's involved in business are saying it's crazy to release it for free. But you know what it feels the right thing to do. So let's see what.

Claudia von Boeselager: Well look, Google started for free as well and then found a business model.  

Patrick McKeown: So that's, that's fine. Not even gonna comparison there, but, uh, we won't talk about that.

Claudia von Boeselager: I think it's phenomenal that it's for free, especially sometimes I speak with clients who are in other countries around the world, like we don't have the access to the testing or the price for us is 10,000 times what it is for buying, purchasing power that they have.

So that's really, your philanthropic sides Patrick, well done for putting that out there and I'm excited to check it out. So from today's date the 26th of January, it's next week. So very exciting. I think just getting it out there, it sounds like to me and really changing not only the mental health, but the physiology of people and children it sounds like with that as well, I'd love to touch on my own take just so people understand what it is.

When I first unpacked a previous guest from the podcast was Hanu Health, which is all around HRV, checking stress resiliency and I ordered one of the devices and it came, the Myotape came and I actually can't see right properly here, we'll include the link in the show notes of the podcast.

And I was looking at it and I hadn't come across, actually keeping their mouth shut overnight. That was actually the first time when I was laughing at the image, cuz it doesn't obviously look very romantic. The couple with tape over their mouths, but the science obviously backs the reason why it is very beneficial as well.
So can you talk about your vision and mission with Myotape as well? 

Patrick McKeown: Myotape it was brought out specifically for children, because for 20 years we have been taping their mouths and we were using three M one inch micropore tape, which is pretty good. But of course we were really stuck with say a child, it's five or six or seven or 8, 9, 10 years of age.

And part of the training with children is to establish nasal breathing during the day first. So whenever the child is distracted, that we have them wear a tape. Now, if you just seal the child's mouth, it's a little bit extreme, but at least with the Myotape, it was designed that if a child, you can imagine a child looking at television or they're looking into their mother's iPhone, over our father's iPhone.

And the child gets distracted. The might is open, the Myotape is elasticated. It'll pull their lips together again. So sending that connection to the brain. Breathe through your nose, breathe through your nose, breathe through your nose. And then for sleep. Once the child establishes nasal breathing during the day, then we use it for children during sleep and because it is safe, because if the child did say, for example, have to get vomit or anything like that, they can open their mouth.

Then we start using it with adults and it's actually became quite popular. So like I'm amazed. I think it's, we're really fortunate that we developed the product and we're waiting for patents as well to go through and things like that. And yeah, I think it's brilliant. It kind of solves that aspect of getting lip closure.

Yeah. Gwyneth Paltrow, by the way, did a post in it and we were so chuffed, this is when you walk in of a Monday morning and you're, you're seeing all these orders and saying, what's after happening here? so yeah, she did a post in it. She used it, so I said, wow 

Claudia von Boeselager: Recently a friend was asking, she said, oh, my husband, he is snoring so much, and what can I do?
And would you say that this is a good starting point for someone who snores? Or do they have a sort of larger assessment or can you just recommend Myotape for snorers? 

Patrick McKeown: That's the only way in terms of an assessment would be you could, for instance, download, there's an upward sleep scale that's free on the internet download that, that's often used with sleep studies.

And I think there's also another one called B A N G. There's also a nasal obstruction symptom evaluation. It's from Stanford Medical School for sleep. So you could do those that were questionnaires first. The only way to investigate sleep is to do an actual sleep study. Now, somebody coming in, snoring, I would say start for the man. You were talking about it's not very romantic, wearing the tape. It's a lot less romantic with somebody snoring and stopping breathing during their sleepers. That's not romantic, is to start breathing through the nose during the day. And, possibly if that individual has snoring, that it's nasal snoring, that they may have issues with their nose establish if you can actually breathe comfortably through your nose. If your nose gets stuffy, you can decongest it. You can decongest your nose holding your breath. Take a normal breath into the nose, out through the nose. Pinch the nose, hold.

Then you let go, you breathe in through your nose. So it's known since 1923. If your nose is stuffy and the blood vessels are inflamed, breathe in and out through your nose, pinch your nose gently nod your head up and down as you're holding your breath and continue holding your breath until you feel a relatively strong air hunger, then let go, but breathe in through your nose. Wait a minute, and do it about five times. And this way then it'll help to open up your nose. And there's a way also to assess a little bit if your nose is helping or if your nose is open or not. Use your mobile phone. You get the screen and just breathe with your nose onto the screen.
And then look at the halo. So you're looking at the moisture left on the screen. And you'll typically see that one side of the nose is a little bit congested than the other, which is normal. There's a nasal cycle. Okay. Do the nose and blocking your yours is looking pretty even there actually, which is pretty good.

You can see it , do the nose unblocking and then check if there's a change in the halo. And also whether you're feeling any different, start breathing through your nose during physical exercise. Really, really important. Change your intensity. Don't feel that you have to be really pushing it during physical exercise.

Allow your nose to determine how hard and faster you're going with physical exercise. It's initially the air hunger is stronger, but the more you do your physical exercise with the mouth closed, the air hunger diminishes over a period of time, over a few weeks and I would also measure the person's bold score as we measured earlier on.

Once the individual is fairly comfortable that he can breathe through his nose during the day, then get them out closed during sleep. Your nose will never fully block once you're breathing through it, because as long as you breathe through your nose, it might partially block, but then it opens up again.
 
Claudia von Boeselager: Those are phenomenal steps. For everyone listening who either knows someone who snores or snores themselves, I think everyone would agree. It's not the most pleasant thing. So these are great strategies and tools, so thank you for sharing that Patrick as well. Before we finish up today, Patrick, where can people find out more information?

You've mentioned some of your books, but where can people find out more about you, what you're up to, follow your new developments and what's coming out? What's the best way? . 

Patrick McKeown: Even though I don't like social media, we were laggards getting onto social media, but we're up there now. So we are on Instagram, on YouTube.
All of the children's videos are all free up on YouTube. By the way, if you put in Patrick McKeown, Children's Breathing you'll see all of the exercise are there. So our channels are Oxygen Advantage. That's kind of the body mind sport or Buteyko Clinic, which is based for asthma, for mental health and for sleep.

So the websites are by the same name and the app will be out as well. It's going through the testing phase at the moment, which is always a couple of bits. So we're hoping to get these out of the way and we're ready to go.

Claudia von Boeselager: Super exciting.
Congratulations. And we'll link everything in the show notes. Patrick, do you have any final ask or recommendation or any parting thoughts or message from my audience? 

Patrick McKeown: Oh. So I would say, listen, breathing is there, just you have to tap into it. Pay attention to, for example, if you are breathing a little bit faster, do you, does your breathing feel effortful?

Or does it feel effortless? Do you get overly breathless during physical exercise? Are you snoring? Are you tired waking up? Do you have respiratory issues? And start off with nose breathing. That's the foundation. Nose breathing during rest, having the tongue resting up on the roof of the mouth, nose breathing when you're doing your physical exercise, nose breathing during sleep.

If your nose gets stuffy, you can do the nose of blocking. Exercise if you're feeling any anxiety of the mind. Just small little breath hole exercises, because sometimes with anxiety, people get anxious by focusing on their breathing. So every time that they've had an anxiety or a panic disorder in the past, it was always associated with suffocation of the breath and difficulty breathing.

So we are placing that attention on breathing. It can then trigger a little bit of anxiety, you don't have to focus your attention on your breath to actually change your breathing if you go for a walk with your mouth closed. It is also a breathing exercise because by walking with your mouth closed, you improve your breathing from a biochemical and a biomechanical point of view, slow down your breathing. You know you're sitting at home in the evening. And a good way to test if you're activating the rest and digest responses to saliva in the mouth. So you're late in the evening, put something light on TV, don't be putting on the noose, something light. Put one hand on your chest, one hand just above your naval, and just gently soften then slow down the speed of your breathing. Take a very soft breath through your nose, and a really relaxed and a slow and a gentle out. Because when you're having that soft breath in and the really relaxed and slow, gentle out through the nose, your body is telling the brain that the body is safe, you're stimulating the vagus nerve. You're activating the sleep response because now you get sleepy, but also check in with the saliva in the mouth. You're activating the digest response because of course, when the body is ready for the digestion of food was increased watery saliva. So try that for 10, 15 minutes before you go to sleep, especially if you have over overstimulation of the mind. When you think about it, Claudia, we're in a society. We're in a society that it's go, go, go, go. And then we're expected to have a good night's sleep. And how do you switch off? You know? So that's why I would be careful. Don't overload ourselves with information.

Be very selective about what you allow in. And pay attention, of course to what you're spending mobile phones and things like that. Bring it into your way of life. I will genuinely say you will never waste attention with the breath, but dip your toe gently into the water first.

And there are breathing techniques which are all about hyperventilation and breath holding and all. They are not for everybody. Don't start off with those techniques. , that's a sprint. For many of us, including myself, we start walking, do the walk first and then gently gear upwards.

Claudia von Boeselager: Excellent advice. Thank you so much Patrick. Such a pleasure to come on today. Such an important topic. Such a pleasure to have you on. Thank you. 

Patrick McKeown: Pleasure. Thanks very much, Claudia.