Do you want to increase your physical and mental performance and energy levels? Then, you might want to start by learning the right way to breathe.
I have a beautiful gift for you today. This is one of my personal favorite podcasts, and a topic that I believe is a huge missing key for so many people looking to overcome fatigue: BREATHING the right way.
We all know that breathing is important — we know that we’d die within minutes if we stopped breathing.
However, did you know that most people breathe in a WAY that causes anxiety, stress, and fatigue?
This week, I am talking to Patrick McKeown, author of The Oxygen Advantage, who will share his amazing expertise on the right breathing habits to start reducing stress and anxiety, raise your energy levels, and boost performance.
I have personally used the exercises from Patrick’s book, and I noticed VERY powerful effects within just two weeks — especially in my exercise performance, perceived exertion (how hard you feel you’re working at a given intensity), recovery times, and overall energy levels.
In this podcast, you’ll learn:
- The right and wrong ways to breathe
- How most people’s breathing set-point (in their brain) gets disturbed
- Why CO2 is definitely NOT just a waste product (but is vital for oxygen delivery to your cells)
- How to breathe properly while sleeping (this one is kind of crazy)
- What the symptoms of bad breathing habits are
- How you can measure your current breathing volume
- How to breathe from your diaphragm
- Why the “deep breathing” advice you’ve heard before is all wrong
This is a power-packed episode and I’m sure you’re going to love it. It’s honestly one of my favorite podcast episodes I’ve ever done, and I really love this guy’s work.
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The Right Way To Breathe For Increased Performance And Energy – Transcript
Ari Whitten: Hey, guys, this is Ari Whitten. Welcome back to The Energy Blueprint podcast. I have an amazing episode for you today it’s with a guy named Patrick McKeown, who is the author of The Oxygen Advantage, which I have with me right here.
It is an absolutely wonderful book that I highly recommend. Patrick is, like I said, the author of The Oxygen Advantage, and after the last 15 years he’s trained more than 7,000 people around the world in the right way to breathe to challenge their bodies to produce changes, changes in their energy levels, delaying fatigue during exercise. He’s worked a lot with elite and professional athletes. Increased lung capacity, decreased perceived effort during physical activity. Increased psychological preparedness and toughness.
There’s just a huge amount of benefits from these types of practices, especially for all of you listening, especially when it comes to improved energy levels. There’s some really key things that he gets into in this interview, that even just one or two of these things if you apply then could be really game-changers for you.
So it’s a wonderful interview. I just got done filming it, and I’m blown away with his knowledge. As I’ve said, I’ve actually been practicing this stuff in my own life for several months now, and I’m just blown away by how fast I started to notice changes and how profound those changes are. So, really power-packed interview for you guys today, and I know you’re going to love it. So without any further ado, let’s get into it and teach you more about the right way to breathe.
Welcome, Patrick. Thank you so much. It’s a pleasure to have you on the show.
Patrick McKeown: Great. No, thanks very much, Ari. It’s a delight to talk.
Why we should focus on the right breathing habits
Ari Whitten: Great. So first, I kind of want to start off with general context on the right way to breathe. Why should we be concerned at all with consciously breathing in a certain way or doing breathing practices, because, I guess on a fundamental level our breathing is supposed to unconsciously regulated by our brains. So I guess we can start there, why should we be concerned with breathing at all?
Patrick McKeown: Well, I think, you know, 500 years ago, even maybe 100 years ago, we were utilizing the right way to breathe, our breathing would have been pretty good. We were more akin to having good breathing patterns. We weren’t sitting down at desks, we weren’t stressed as much. The stressors that we had were different, they weren’t that longterm, kind of financial pressures that many people are exposed to. Our jobs were very industrial based or required physical movement. Nowadays are very sedentary, and add to that, then we’re talking a lot, all of these factors change breathing, posture, excessive talking, stuffy environments, stress levels, and lack of physical exercise.
So our breathing, even though it’s an involuntary activity, it’s also subject to change. When our breathing changes, many other functions of the human body can change. So it’s true, our breath, that we can influence positively or negatively, different functions of the body. So I think it’s important to recognize the effect that modern life has on breathing, and also what we can do to change breathing.
Why it is important to breathe the right way
Ari Whitten: Excellent, so we have a certain set point, I would imagine, as far as where our brain tends to regulate oxygen, carbon dioxide, and we’re going to get into more detail around that later. But just to kind of wrap up this initial idea, that the way that our brain tends to regulate breathing patterns in a certain way, can change as influenced by some of these factors that you’ve just mentioned.
Patrick McKeown: Yes, [inaudible] in the paper, Asthma and Hyperventilation, he said, “All it takes it 24 hours, 24 hours of excessive breathing will reset the breathing center towards more excessive breathing.” I’m not saying that your breathing will completely change in 24 hours, but 24 hours can all it can take to start the process.
Now, you can imagine, somebody who has been prone to three months of stress, or their job involves talking and they’re talking at a call center for six or eight hours per day, all of that is changing breathing, and that’s longterm changes to breath. So yeah, the theory behind it is that you habituate to a larger breathing volume, and that’s based on the low set point of carbon dioxide.
So basically, an event causes the body to breathe more and biochemical change takes place, carbon dioxide is initially lost as a result of over-breathing, but then the kidneys dump bicarbonate to maintain, to bring pH back to normal, and that’s when there’s a more permanent change. So now you’re left with low internal CO2 and reduced buffer.
Why breathing through your nose is the right way to breathe
Ari Whitten: Very interesting. So talk to me about the oxygen paradox. So why is it is a paradox? I know there’s a lot of misconceptions as far as common lay public beliefs around oxygen and carbon dioxide, so can you talk a bit about what those misconceptions are?
Patrick McKeown: Yeah, probably the biggest one is, take a deep breath, you know. The instruction to take a deep breath. And the next thing is you see this big breath or this fast breath, heavy breath often through the mouth.
The instruction to take a deep breath is correct, but the interpretation of taking a deep breath is incorrect. If you breathe through your nose you will activate the diaphragm. The word deep means far from the top.
So nose breathing, which is the right way to breathe, automatically activates the diaphragm. So nose breathing does bring the air deeper into the lungs. If you look at the shape of the lungs, they’re triangular, and the greatest concentration of blood is in the lower lobes. Whereas, if you’re breathing through the mouth, you’ll tend to use the upper parts of the lungs. All you have to do is look down at your chest, take a breath through the mouth, and see what part of the body moves, it’s the chest.
Now, back to the lungs. The greatest amount of blood is in the lower lobes, and the greatest amount of air is coming into the upper if you mouth breathe. So just a ventilation perfusion mismatch here. So basically, what we need to do is, we breathe through the nose to bring the air from the top part of the lung down into the lower.
By breathing through your nose, you pick up a gas called nitric oxide, and nitric oxide redistributes the blood from the lower lobes of the lungs up to the upper. So that’s why a better gas exchange takes place.
Nose breathing improves arterial oxygen uptake by about 10-20%. So nose breathing improves oxygenation of the blood. Mouth breathing of course, is going to reduce it. Now, you’re talking about the oxygen paradox, the harder you breathe, the less oxygen that’s delivered to the cells. In order for oxygen to be delivered to the cells, you need carbon dioxide. If you breathe too hard, you offload CO2, you lose it from the lungs, you reduce it in the blood through the lungs.
The loss of carbon dioxide in the blood will cause blood vessels to constrict. The harder you breathe, the more the blood vessels constrict and the greater the bond between oxygen and the red blood cells. In other words, the hemoglobin, the red blood cells will hold on to oxygen when there’s a reduced pressure of carbon dioxide.
So ultimately, it’s your breathing which determines the pressure of carbon dioxide in the blood, you need optimum amount of CO2, and you need optimum amount of CO2 to allow the oxygen to be released from the red blood cells to the cells.
What the common beliefs about oxygen and carbon dioxide are
Ari Whitten: Yeah, let’s stop there, because I think it’s worth digging into that point more, because it’s so counter to what most people are operating in. You know, most people think of carbon dioxide, of CO2 as just a waste product.
We breathe in oxygen, we exhale carbon dioxide, it’s just the waste product. So what you’re saying there, for people who are not already familiar with this, you’re saying that CO2 is way more than just a waste product, but actually seriously, a very, very vital and important function, which is …
Patrick McKeown: Yes, yes, a number of functions. One is, carbon dioxide helps open up the blood vessels. It’s a vasodilator. Carbon dioxide also plays a role in opening the airways, both the upper and the lower.
You can open up your nose by increasing CO2. You also help open up your lungs, it’s a bronchodilator, by increasing CO2. Also, you assist with the release of oxygen from the red blood cells by increasing CO2.
Another factor is, they looked at the brain of rats, if you depress carbon dioxide, brain cells become more hyper-excitability. If you increase carbon dioxide, brain cell, is calming effect. In other words, that the brain can regulate its own excitability through the breaths.
We can’t just say that, yes, oxygen is good and carbon dioxide is bad. In order to properly really harness oxygen and to utilize oxygen, we need carbon dioxide. It is true that the body breathes to get rid of excess CO2.
The real problem with oxygen delivery
There’s such a surplus of oxygen in the human body. During rest, we exhale up to 75% of our intake of oxygen. During physical exercise, we exhale up to 25% of our intake of oxygen. The body has plenty of oxygen. The problem is not that the body does not have enough oxygen in the blood, the problem is getting the oxygen from the blood to where it’s needed, to the cells.
How to detect what your oxygen levels are
Ari Whitten: So these problems that you’re talking about, are these things that can be picked up with a pulse oximeter? If somebody just says, “Do I actually have oxygenation problems? I’m going to put on this pulse oximeter.” Will that detect the kind of problem that you’re referring to?
Patrick McKeown: Most people, when they use a pulse oximetry, which is measuring the peripheral oxygenation of the blood, most people will have normal, okay?
You will have people with COPD or with severe asthma, they’ve got a poor gas exchange taking place in the lungs, because of damaged airways, the oxygen can’t get from the lungs to the blood, so they’ll show lower SPO2.
We see many, many people with stress, many people with fatigue, panic attacks, brain fog, all of these can be changed and improved by their breathing, by changing their breathing, but their SPO2 is normal.
They’ve plenty of oxygen in the blood, but the oxygen isn’t getting from the blood to the cells. We need to get the oxygen from the blood to the cells, and we get the oxygen from the blood to the cells in the presence of carbon dioxide. Don’t breathe too hard to get rid of too much CO2, because the blood isn’t going to release the oxygen to the cells so readily.
What the right way to breathe is
Ari Whitten: Okay. So CO2 is vital for oxygen delivery to the cells, not necessarily oxygen saturation in the blood, but the ability of those red blood cells to drop off oxygen to the cells. So what you’re saying is, when people are over-breathing, they’re altering the CO2 levels in their blood in a way that leads to less efficient oxygen delivery.
So let’s dig into that over-breathing concept a little bit more. So what is this all about? I guess you’re saying that all those factors you mentioned initially, stress and sitting, sedentary jobs, and so on, alters breathing dynamics in a way that changes carbon dioxide levels in the blood and oxygen delivery. So what exactly does over-breathing look like, and what is the right way to breathe?
Patrick McKeown: Sure. The right way to breathe is in and out through the nose, driven by the diaphragm. It’s light, it’s quiet, and it’s gently paused in the exhale. It’s regular and it’s effortless. So that’s what healthy breathing looks like. Unhealthy breathing is the same breathing as we do when we get stressed. It’s slightly faster, it’s irregular, we sigh, the amplitude of each breath is a little bit bigger, there’s no natural pauses between breaths, it’s upper chest, it’s through the mouth, and it requires effort.
Many people know how we breathe when we get stressed. But how about if you were breathing like that all of the time? Many people breathe like that all of the time. That is going to keep the body in that state of stress. It’s not just that stress changes your breathing. It’s that your breathing will also change your stress. So in order to bring the body into relaxation, we need to do the exact opposite to the stress response. Instead of breathing faster, we really need to slow down the breath, to quieten the breath, to calm the breath. Instead of breathing through the mouth, we need to breathe the nose. Instead of having irregular breathing, we want to achieve regular breathing. Instead of breathing using the chest, we want to breathe using the diaphragm. Instead of having effort for breathing, we want to have effortless breathing. So with breathing, less is more, and breathing can be changed.
How not all athletes know what the right way to breathe is
Ari Whitten: Beautiful. Okay. So do we have a reference for comparison as far as either athletes or really, really healthy people, that we can clearly see these people are breathing in a different pattern than maybe unhealthier people?
Patrick McKeown: Yes.
Ari Whitten: What does that look like? What are those differences?
Patrick McKeown: On a very simple level, if you were walking down the street, and you see somebody who’s more obese, you’ll often notice that they have labored breathing. Of course, now, their breathing’s going to be a bit heavier because they’ve got greater metabolic need and they’re carrying more weight and they have to carry that.
By anytime you see heavier breathing, it’s not a good sign of health. If you look at an athlete, an athlete would have light breathing.
Not all athletes, some athletes don’t know the right way to breathe, and they have the determination and the willpower to push themselves through. However, it can be very counterproductive for that athlete. So even though we often expect … Like what I say to people is, physical exercise isn’t a gateway to good breathing, but good breathing is the gateway to good physical exercise. Because if you’re breathing optimal during the day, you’re going to breathe optimal during physical exercise. You can’t expect your breathing to be off during the day. For it to suddenly fix itself during physical exercise, that’s not going to happen.
What the BOLT score is and how that determines whether you breathe the right way
So we use a measurement, there’s a few things I look at when I’m looking at somebody. I look at the amplitude of the breaths. Now, I don’t stare at it. I just get an idea of it. You get a feel for a person coming in. I look at the amplitude, I look at the respiratory rate. I look at the regularity. I look at the natural pause between breaths. I also measure their BOLT score.
The BOLT score is basically how long the individual can hold their breath comfortably following an exhalation. In other words, if a normal breath in through your nose, a normal breath out, and you pinch your nose, at some point during that breath hold, the brain is going to send a message to breathe. That’s the BOLT score, it’s the first reaction of the body to take a breath, it’s the first distinct desire to take a breath.
The lower the BOLT score, the greater the onset, and the degree of breathlessness during physical exercise. So that’s kind of the endurance of breathlessness during physical exercise.
Then I’ve got a measurement of the upper limit of tolerance of physical exercise. So that’s the steps score, or in the book we use, it’s the nose unblocking exercise. So we have the individual breathe in through the nose, breathe out through their nose, and pinch their nose. We count how many paces they can hold their breath for.
The objective is to be able to walk 80-100 paces holding the breath after an exhalation. Now, I know a lot of people will feel that sounds too much. But you build yourself up to it. Generally though, a really good athlete, if I have a top class MMA fighter, generally off the bat, their BOLT score is about 25-30 seconds, and the upper tolerance of their breathlessness is about 60-70 steps, so that’s a good starting point. What we want to do is, we want to bring all athletes to that point, but we want to get them beyond it. Because you can improve both your aerobic capacity, and also you can improve your anaerobic capacity, by doing a series of exercises designed to reset the breathing center in the brain.
Ari, in a way it makes sense, athletes will train every part of the body. They train their minds, they go to a nutritionist, they have all of these different disciplines to help them. But yet, often their breathing is the limiting factor. It’s their breathing that’s holding them back. But nobody is looking at how the athletes are breathing. It’s their everyday breathing that’s setting the limits during their physical exercise. You have to train your everyday breathing. Breathing isn’t just that thing that’s an involuntary activity, we have voluntary control over it, and we need to know what constitutes good breathing.
Ari Whitten: Yeah, I have to say that after practicing the steps exercise, the pacing exercise with breath holds, that literally within … It’s by far the most powerful breathing exercise that I’ve ever done. Within two or three weeks I actually noticed huge improvements in the gym when I was working out lifting weights, as far as my work capacity, as far as at what point in the workout did I really feel like I started to get run down, and as far as the rest between exercise.
All of a sudden, I was able to take much less rest. I was recovering much quicker after each bout of exercise. And I could do much more work in a workout before actually feeling like I was tired. I mean, really noticeable, big noticeable improvements within two or three weeks of practicing this, so this stuff is powerful for sure.
Why it is important to breathe with the diaphragm
Patrick McKeown: Yeah. No, it’s a very interesting exercise. That exercise alone, you can open up the nose, it makes you feel more alert, it adds an extra load onto the breathing muscles, it strengthens the diaphragm. Which is the right way to breathe.
You know, 50% of athletes can be prone to diaphragmatic fatigue. If the diaphragm gets tired, blood is stolen from the legs. So if you see somebody with jelly legs, and some of your listeners would have been watching the Mayweather, Conor McGregor fight there a few weeks back, you see it on the seventh round, the commentator makes a point, “McGregor is sucking air through his mouth.” Towards the end of the seventh round. The commentator is noticing that his breathing is getting that bit heavier. Then in the 10th round, the legs go jelly.
The legs go jelly, it could have been due to two things: a buildup of hydrogen ions and increased anaerobic activity, that the muscles of the legs weren’t getting enough oxygen and hydrogen ion wasn’t getting oxidized so fatigue set in the legs. That could be one aspect. But the second aspect could have been diaphragmatic fatigue. That the diaphragm was getting tired, and as a result, blood now is diverted from the legs to feed the diaphragm. So it could have been a combination. But both of those things can be improved. From the exercise that you were talking about, the nose unblocking exercise, that also works to help with that too.
Ari Whitten: Yeah, McGregor should have been working with you.
Patrick McKeown: Yeah. Well, you know what, a lot of athletes, they need to hear of this from a few different modalities. But we’ve worked with some brilliant athletes. We’ve worked with some really good MMA fighters. So the word is getting out there, you know, slowly but surely. I think breathing is one of those things that was kind of, hippies that would mainly do it, and guys with open sandal brigades, and tree huggers. But now, when you start looking at, you know, when you break down what you can do with the breaths, there’s an advantage in it.
The right way to breathe for a better BOLT score
Ari Whitten: Yeah. So let’s go a little deeper into this BOLT score and just make it really practical for people to do this for themselves. Because it can be done in, you know, what, less than a minute. You can get a BOLT score and just kind of tell people what that means and maybe what a good or not so good starting point is and where they want to get to. So, what is the right way to breathe for a better BOLT score?
Patrick McKeown: Sure. If an individual has got respiratory complaints, if they’ve got asthma, if they’re very panicky or anxiety, they tend to have a BOLT score between 5 and 15 seconds. If an individual is a recreational athlete and they’re pushing themselves a little bit, but they have poor breathing habits, I often see a BOLT score of between 15 and 25 seconds.
If the individual is a very good athlete and their breathing can be prone to improvements, they will be 25 seconds plus. The goal is 40 seconds. There was a book, it’s published in North America, it’s Nutrition and Physical Performance. It’s by an author called William McArdle. He said, “If an athlete exhales, they should be able to hold their breath for 40 seconds before the urge to initiate inspiration resumes.”
In other words, they can breathe in, a normal breath in, normal breath out, hold their breath for a period of 40 seconds, and when they resume breathing at 40 seconds, their breath is fairly normal. That’s good breathing.
I’ve only seen, out of 7,500 people, I’ve only seen two individuals with a 40 second BOLT time. One was a free diver, and the second was, she is world champion in Chi Gong, basically she’s a master of martial arts. She’s got eight black belts. She had a 40 second controlled pause off the bat.
I was talking to her about the breathing exercise. I wrote about her in the book. Her name is Meisterin Jennifer Lee. We were discussing, you know, how did she get her control pause, because of course, she’s living in Germany and she’s exposed to the same stress as everybody else is. She was saying that the discipline was passed down from generation to generation. But obviously, as it was passed down, it wasn’t getting distorted. Sorry, her discipline is Tai Chi.
But oftentimes we see in various disciplines that the information on the right way to breathe as it gets passed down through the ranks or through the generations, the information gets lost. I think that’s what’s after happening in yoga, and that’s what’s after happening in a lot of the eastern modalities.
But if you go back to the core of these traditions, the two things that they emphasize is that your breathing should be subtle and that it shouldn’t be hard. If your breathing is subtle, you will have a high BOLT time. If your breathing is hard during rest, you have a low BOLT time and you’re more likely to get breathless during exercise.
Ari Whitten: Great. So as far as where people want to get to, we’re looking upwards of at least 25 seconds, 30 seconds?
Patrick McKeown: Yes.
Ari Whitten: Okay.
Patrick McKeown: It’s ideal. People will feel better if every time the BOLT score increases by 5 seconds. Now, just measuring your BOLT score isn’t going to increase it. In order to increase your BOLT score, you need to breathe through your nose day and night. I would say to do most of your physical exercise with your mouth closed.
If you’re a really competitive athlete, do 50% of your exercise with your mouth closed and 50% with your mouth open. The mouth closed will add an extra load onto the breathing muscles, and the mouth open will allow you to maintain 100% of your workload, so for muscle conditioning. So that’s only for competitive athletes.
The other thing is to practice various exercise to reset the breathing center in the brain. Also, we need to breathe through the nose during sleep. If you wake up with a dry mouth in the morning, you’re breathing through your mouth during sleep, you’re more likely to be fatigued. But you’ve spent 6-8 hours breathing hard. That’s going to reset the respiratory center in the wrong direction.
The right way to breathe for increased energy
Ari Whitten: Excellent. So you know, there’s a few things I want to talk about that are wrapped up in what you just said. One, you talked about fatigue just now. My audience, you know, is really all about energy and fatigue. I’m wondering if you have any experience working with people who have chronic fatigue syndrome or who are burned out, and what your experience has been after implementing some of these breathing methods.
Patrick McKeown: Yes. When we work with people with chronic fatigue, it depends on the severity of the fatigue. If they are very, very severely fatigued, I have found that the exercises can add too much of a load onto them. So it’s difficult for me then to get them to that point whereby we can make progress. It can be difficult to show them the right way to breathe without them getting exhausted.
However, if they’re able to do exercise, I start anybody with chronic fatigue, I start them off with breath hold exercise, breathing recovery, that’s in the book. Breathing recovery is simply, hold your breath for 5, breathe for 10. So breathe in through your nose, breathe out through your nose, pinch your nose, hold it for a count of 5, 1, 2, 3, 4, 5, let go, and resume breathing for about 10 seconds, and hold for 5, and resume breathing.
I want the person with chronic fatigue to build their control pause up to a certain foundation. Once I get their breathing under more control with a higher BOLT time or control pause, once I get their breathing up to a better level, then we start doing the stronger exercises.
We do the nose unblocking the exercise. I actually believe it’s the nose unblocking exercise that’s getting a far better root or chronic fatigue. My theory is this, it’s driving the body into a sympathetic activation. By stressing the body out slightly, the body is making adaptations, and the body then is fighting the fatigue on the back of it.
So the best results that I have seen were, the reduced breathing is a brilliant exercise, the breathe light exercise is brilliant exercise, but the one thing that I noticed with chronic fatigue is, we have to push the people, but I don’t want to push them too soon at the start because it pushes them back. So that’s why we go very easy for a few weeks to get them adjusted to nose breathing, to get some progress with their breathing. Then when they make some progress with their breathing, then I start pushing them, because their body is better. The more strength they get, the better they’re able to do the exercise, which feeds back into it.
The right way to breathe during sleep – why it is important for your energy levels
Sleep is very important. They cannot have the mouth open during sleep. If you have your mouth open during sleep, it’s exhausting to the system.
Ari Whitten: I’m glad you brought this up, because that was my next question wrapped up in what you were saying. So how does one control that? Obviously, when you’re sleeping, you’re not sitting there being conscious of how you’re breathing, you’re asleep. So how do you get around that?
Patrick McKeown: Yes, of course, the muscles relax. We should be looking at position as well. Don’t sleep on the back. If you sleep on the back, the tongue is more likely to go into the airway, it can increase the risk of obstructive sleep apnea, that’s when we stop breathing during sleep.
So I want people sleeping on their side or on their front. It would be ideal for them to wear some form of, it’s a paper tape that we use, you know, the paper tape, I know it sounds a bit kind of shocking when people hear of it first. But wear it for about 15-20 minutes during the day, get used to it. The normal mode of breathing is, breathe through the nose.
Ari Whitten: Sorry to interrupt. Just to clarify what you’re saying, because it might not be clear to people, you’re saying, tape the mouth shut.
Patrick McKeown: Yes. Now, it’s not by using duct tape or insulation tape or construction grade tape. We would use a medically based tape. There’s even a new tape now that’s come out of United States, which is brilliant. It was developed by a dentist in Colorado, called Dr. Frank Seaman. He noticed that his patients coming in, a lot of them had bruxism or grinding of the teeth. So he’d fit crowns, he would do lovely dental work, and the next thing is they’d be coming back in a few months later and the dental work has been destructed as a result of clenching of the jaws and grinding of the teeth.
So he found it was specifically mouth breathing that was contributing to this, because mouth breathing was affecting the activation of breathing during sleep, and it was changing the positioning of the jaws, and it was increasing the likelihood of bruxism, so he started taping. So he developed a tape called LipSeal tape. It’s a great little tape. It’s nice and easy to wear.
So if, for instance, you know, probably the biggest scare that people have is, I can’t tape up my mouth because my nose gets blocked. But your nose only gets blocked if you breathe through your mouth, it only gets blocked fully if you breathe through your mouth. If you continue breathing through the nose, the nose opens up. It’s just as important to breathe out through the nose as it is to breathe in. Because if you breathe out through your nose, your nose captures the moisture and hit and the exhaled breath and it’s the capturing of the moisture and heat that actually opens up the nose.
So the difference between sleep, we looked at studies, and they’ve a number of studies whereby they had individuals breathe through their nose one night and breathe through their mouth another night. The night that they breathed through the nose, the subjects had deeper sleep, they woke up more rested, they had less obstructive sleep apneas, etc. Subjectively and objectively they felt better. Then they had those same individuals breathe through an open mouth during sleep. One individual developed obstructive sleep apnea, merely just on the basis of open mouth breathing, they felt worse when they woke up, and also objectively, when they looked at, they spent more time in light sleep.
Deep sleep is very important for repair of the human body. We’re all aware of the lymphatic system in terms of the body’s natural sewage waste disposal system to get rid of waste from the body. But in the brain there’s what’s called the glymphatic system, and that’s when the waste is mopped up, that the brain kind of, if I use the word, repairs itself or cleanses itself or restores itself. But it only happens during very deep sleep.
Why slowing down your breathing before bedtime ensures a better quality sleep
So deep sleep is vitally important. And by utilizing the right way to breathe, you ensure a better quality sleep.
I think, for chronic fatigue, I think it’s really important to get sleep right. It’s not just the quantity of sleep. We have to be thinking of the quality. Now, insomnia, which can affect quite a number of people, which will lead to fatigue during the day, that can be helped significantly by really slowing down your breaths, and slowing down your breathing to the point that you get a slight air hunger, and maintaining that slow breathing for 15-20 minutes before you go to sleep. We need to switch off. You can’t just be go, go, go, go, go all day.
The next thing is, you know, you can’t go from a state of constantly going, going, going and then expect to go into deep sleep, it’s not going to happen. What’s worse, what do people do to relax? They look at their iPads, they stare into their mobile phones, they scroll through Facebook. All of the modern technology is sending a blue light that’s reducing melatonin of the brain and that’s keeping the brain in that awake state, so they don’t even get down to a good night’s sleep.
No blue light technology, very dark room, good circulation of air, don’t sleep on the back, don’t drink alcohol or eat food late at night, and breathe through your nose. But more importantly, if you reduce your breathing for 15-20 minutes before you go to sleep, by really slowing down your breath, you’ll activate that parasympathetic response, that relaxation response, and you’ll have a deeper sleep.
Ari Whitten: So what does that look like, as far as slowing down the breath? Can you kind of demonstrate or make this very practical for people maybe who don’t really understand what that means?
Patrick McKeown: Sure. So basically, people follow their breathing, they follow their breath and air flow as it comes into their nose and out through the nose. They follow maybe the slightly colder air as it comes in, the slightly warmer air as it leaves, and they pay attention to their breathing. They could put one hand on their chest and one hand just above their diaphragm, and they could apply gentle pressure. The whole objective is to really slow down your breathing, to the point that you feel a need for air.
So you need to slow down your breath by about 30%. In other words, instead of taking, say, the breath in like that and the breath out, that you completely slow it down. But by slowing it down you don’t make the amplitude bigger. You slow it down. You don’t hold your breath. You don’t freeze your breathing. You don’t tense up your breathing muscles. You focus on the airflow coming in and out of the nose, and you intentionally slow down the speed of the air as it enters and leaves your nostrils.
By slowing down the speed of the air as it enters and leaves your nostrils, carbon dioxide builds up in the blood. As carbon dioxide builds up, the blood vessels dilate, more oxygen gets released from the blood to the cells. You experience increased watery saliva in the mouth, and you get drowsy. You activate the relaxation response, you improve your blood circulation, and you open up your airways by slowing down your breath.
How most yoga, pilates, and stress counselors are not teaching you the right way to breathe
What’s more, it’s the absolute opposite that is commonly taught in Pilates, western yoga, and by stress counselors.
Ari Whitten: Explain what you mean by that. What do they commonly teach?
Patrick McKeown: They’re commonly teaching, and any time when I’ve sat in, you know, I’ve sat in, and this is not a criticism, this is just an awareness, if you go to a yoga studio, you should never hear people breathing during rest. You should never hear people increasing their breathing or taking more air in. Because to get true benefits from the breath, we should be doing the opposite.
Meditation has been used for 2,500 years to activate that relaxation response. Stress makes people sick, and on the basis that stress makes people sick, relaxation helps to make them better. When we go into that relaxation response, our breath diminishes, and diminishes, and diminishes. We’re not taking harder breathing. The whole purpose of meditation is to diminish the breath. That’s where you get the benefits. What I’m saying is, just go straight into it. Deliberately start diminishing your breath. You’ll naturally activate the relaxation response, and you naturally will open up your blood vessels and airways.
When we get stressed, the mouth goes dry. A dry mouth is activation of the sympathetic response. Increased water saliva in the mouth happens as a result of meditation, but it also happens when you do reduced breathing.
A lot of people find that it can be frustrating to meditate because their mind is scattering all over the place. It’s a lot easier to reduce your breath, and by reducing your breath you’re focusing on the breath, and when you’re focusing on the breath to get air hunger, the mind is more anchored on the breath. So you’re getting a meditation but you’re also activating the physiological aspect of relaxation.
We know that when you do controlled slow breathing it dampens the sympathetic response and it promotes the parasympathetic response. Systems which are disturbed by stress can be repaired through slow, quiet, gentle, soft breathing.
There’s a saying from yoga, and I’m talking about yoga from maybe hundreds of years ago, that your breathing should be so light that the fine hairs within the nostrils do not move. Breathing should be subtle, that’s what the original Sutras of yoga said, not hard, how it’s commonly described today. So if you’re in your yoga and you’re doing your postures, the main thing is, don’t hear your breathing.
The 3 ways to breathe properly
As Chris Pei said, Beginner’s Guide To Chi Gong, he said, “There’s three levels of breathing. The first level is to breathe softly so that the person next to you does not hear your breathing. The second level is to breathe softly so you do not hear your breathing. And the third level is to breathe softly so you do not feel your breathing.” He is not telling people to breathe more. Because intuitively he knows that breathing more is harmful, breathing more is the stress response.
Well, if breathing more is the stress response, why are we doing it as part of western yoga traditions? It’s because the people who are teaching breathing exercises, and again, this could be controversial when I’m saying that, and the people who are teaching it haven’t been trained in the basic physiology of breathing, the importance of breathing through the nose, and the importance of breathing light.
Ari Whitten: Beautiful, yeah. What you’re saying is fascinating because you’re saying that things can work in both directions. In other words, if you think of how you breathe in a stress response, like for example, let’s say, in the context of intense exercise, you’re going to be breathing very, very hard. So what you’re saying is, if you intentionally just at rest breathe very hard, you will send your body into that state of sympathetic dominance, fight or flight, more stress, physiology stress breathing patterns.
Vice versa, if you look at meditation, how you breathe in a deeply relaxed, calm state, it’s very, very light breathing. You’re saying, if you just consciously breathe that way you will shift your physiology more in that direction.
Patrick McKeown: Yes. Recently scientists at Stanford Medical School, they discovered that there’s a pacemaker in the brain. We all know about the pacemaker in the heart, it’s, you know, as an electrical conduit. But the pacemaker in the brain is activated through our breathing.
If we breathe faster, we agitate the brain. If we breathe slowly, we bring a sense of calm and tranquility. So if we breathe faster we bring on that stress response. So we need to do the opposite. For people, just Google it, ‘slow breathing Stanford Medical School’. It was published in March of 2017.
Patrick’s take on resistance breathing devices
Ari Whitten: So a couple of things I want to ask you in this context. What do you think of resistance breathing devices? You know, for example, I’ll show you one of my little tools here. This thing goes in your mouth. And I’m sure you’re seen these before.
Patrick McKeown: Yes.
Ari Whitten: What do you think of those? One of the challenges with them is obviously that they’re mouth breathing. But I’m wondering if you perceive them as having benefits or not being a good idea.
Patrick McKeown: Yes, I think they’re good. The diaphragm is prone to fatigue, and physical training doesn’t increase or improve muscle of the diaphragm or intercostal muscles. So physical training doesn’t increase or improve your breathing muscles. The only sport that may increase and improve respiratory muscle strength is swimming. All other sports, not going to do it. You know, if you really wanted to kind of increase respiratory muscle strength, you’d have to increase at such a high intensity, but you wouldn’t be able to sustain it for a long time.
Now, the only thing that I would say negatively about that device is, it’s a mouthpiece. Whereas, I want to target the diaphragm. You’ll actually target the diaphragm when you breathe through your nose. You don’t target the diaphragm when you’re breathing through your mouth. So what that’s doing is bringing the air mainly up into the upper parts of the lungs, whereas, actual fact, the main breathing muscle is in the lower lobes, the diaphragm. So in order then to activate the diaphragm, you have to breathe more. By breathing more, then you can be disturbing blood gases.
Breath holding will also target, and the main muscles to target in improving respiratory muscle strength is the inspiratory muscles. Because when you look at the breath, the inspiration is the active breathing, and the expiration is the passive part.
So the main muscles that get tired are inspiratory muscles. Now, during intense physical exercise, yes, it is both active, the inspiration and the expiration is active. But generally, the main muscles to target are going to be inspiration. The purpose of a device like that is to breathe against resistance so you add an extra load onto the breathing muscles and the theory is then to strengthen them. You could also do breath holding.
You could breathe in, breathe out, hold your nose, walk around your kitchen. As you hold your breath, the breathing center in the brain will notice that there’s a change in blood gases. It will continually send the message to the breathing muscles to breathe. The breathing muscles will continue to contract, but you’ve stopped breathing, so in other words, you’re contracting the muscles while not resuming breathing, and that will also improve respiratory muscle strength. But yeah, they’re good, they’re good.
How short bursts of rapid breathing is not going to harm your overall breathing habits
Ari Whitten: Okay, interesting. So a couple of other things I want to ask you about actually. One is, in certain traditions of yoga, in Kundalini yoga in particular, there’s something that they do called, fire-breathing. Actually, it can be done through the nose, but it’s very fast, very forceful, in, out, in, out, in, out sort of breathing.
When I do that, I definitely feel a burning in what I think is my diaphragm muscle, I feel like it’s really exercising the diaphragm strongly. Even though that’s very fast, forceful breathing, I’m wondering if as something done for just a few minutes, as an exercise to maybe work those muscles, it might be beneficial.
Patrick McKeown: Yes, you know, if you’re just doing it for a few minutes, in terms of hyperventilation, it’s not going to do any longterm damage. The fire breath will activate the respiratory muscles including, of course, the diaphragm. But could you do the fire breath with breathing so subtle breaths? Very fast breathing targeting the diaphragm, but without the risk of over-breathing. So you could still get the benefits of it, and minimize the risk. But short-term over-breathing, it doesn’t do any harm.
What I’m interested is, how are you breathing 24/7? How are you breathing walking down the street? How are you breathing at rest? How are you breathing during your sleep? How are you breathing working on a computer? How are you breathing driving your car? That’s more important than what you’re doing during the couple of minutes when you’re taking the fire breath or whatever.
What studies say about the Buteyko breathing exercises
Ari Whitten: Right, okay. Next question is, there was an article on science-based medicine, a blog that the guy who runs that blog wrote, that was a critique of Buteyko breathing. He was trying to debunk Buteyko breathing. I have to say that I read the blog and I actually became skeptical of Buteyko and some of the claims around it.
But after that, I was already skeptical of it, I decided to pick up your book and read your book, and I just started practicing the exercises, and I have to say that, for me, it was just proven, regardless of any theories or any type of ideas around these different breathing practices and what they do, I experienced the results firsthand.
Also, you know, we were going against the placebo effect because I already came into it skeptical. So the benefits for me were just overwhelming, that I’ve become a big advocate of this. I’ve also since discovered a lot of research, especially out of Russia, around intermittent hypoxic training. There’s a whole body of evidence around that, that really impressed me. So anyway, I would just love your thoughts on sort of some of the critiques of Buteyko.
Patrick McKeown: Yes. You know, in terms of the science out there, carbon dioxide can be controversial. We see people who are, you know, they’re showing symptoms of hyperventilation, but yet they can show end tidal CO2 which is normal. You’ve got other people with excessive breathlessness and they seem to show end tidal CO2 as normal. Carbon dioxide is just one of those gases. Doctors don’t like the whole premise of carbon dioxide. Now, when Buteyko put his theory together, it was put together in the 1960s, and the available science at the time was primarily CO2.
Now, in saying that, carbon dioxide still serves the same functions as a vasodilator as, you know, it’s based on the Bohr effect, which was discovered in 1904, in that the release of oxygen from the hemoglobin is dependent on CO2, etc. We can develop dysfunctional breathing patterns. The science is often difficult to connect the science with the experience. It could be that the human body is so complex that we don’t know for sure what’s going on.
You know, in terms of asthma, the Buteyko method has had 17 clinical trials. One of the clinical trials said, and this was published in a medical journal, and it said, “If this was a drug it would be widely available.” But they also said in the papers that the precise mechanism is unknown.
Because even if we were to just isolate it for asthma, the theories that are commonly used for asthma is that over-breathing will cause cooling and drying out of the airway walls, and basically, moisture is sucked from the airways because of over-breathing, or during physical exercise you can breathe harder, you’re taking more air into your lungs, moisture gets sucked out of the airways, and the airways constrict in response to that.
Now, that theory is more plausible. Whereas, the carbon dioxide theory, which Buteyko would say, is that the individual was breathing too much, they were losing carbon dioxide, and carbon dioxide relaxes the smooth muscle embedded in the airways, and the loss of CO2 was causing the airways to constrict. It’s the same thing that’s happening, but looking at it from a different scientific perspective. Is it the carbon dioxide causing the airways to constrict? Or is it cooling and dehydration of the airways that is causing the airways to constrict? It doesn’t matter. The thing is that over-breathing is causing the airways to constrict. What’s exactly happening from a scientific point of view needs to be found out. The main thing, it works.
Yeah, and I think in some ways, the debate around science, people have hotly debated the theory, but they haven’t put it into practice. It’s like this, if I was told, “Here’s a PhD on how an apple tastes.” Well, I would sooner taste the apple than read the PhD, because there’s more experiencing from the tasting of it. You know, the first principle of medicine, first do no harm. What harm is there in terms of switching to nose breathing and slowing and softening the breaths? No harm, and huge potential.
You know, this was debated since 1871. American physician called Da Costa, he came back, he was an American physician during the American civil war, and I hope that I have my date correct there, but he noticed that soldiers returning from war, they had fatigue, they had breathlessness, and they took such a long time to recover. It was called the Costa syndrome. Whereas, in actual fact, it wasn’t until 1937, that it was called hyperventilation syndrome. Claude Lum then, in the 1960s, he wrote more about hyperventilation.
So this thing has been around, hyperventilation and excessive breathing, chronic over-breathing, it has been documented for over 100 years. And yet, even though it’s estimated that it affects up to 10% of patients who are visiting general practitioners in the United States, 10%, a lot of people, yet it’s not getting any attention. It just makes sense. You know, what could be more normal than breathing through the nose and breathing lightly. Until we start getting a greater awareness out there, there’s not going to be research.
I’ll give you a story. We have done researched on the nose with a university here in Ireland. The great professor there, who is very open-minded, and he had seen the results over a period of seven years. His patients he’s seen making progress. I remember him telling the junior doctor, he said, “You know, your colleagues are going to poo-poo you for getting involved in this research because it’s too simple and it’s not sexy enough.”
That’s why scientifically as well we haven’t evolved, because doctors, you know, there’s a lot of peer pressure for doctors to remain within that certain circumference and not to go outside it, and breathing is outside it. Well, I think it’s time to bring breathing into conventional management and not to have it out on the extremes.
The difference between breath holds with air exhaled versus holding the breath in
Ari Whitten: Beautiful, yeah, well said. One thing I just remembered that I wanted to ask you about, that I spaced out, is breath holds with air exhaled versus holding the breath in.
Patrick McKeown: Huge difference.
Ari Whitten: This is something that I myself am confused about as far as what exactly the differences are. I haven’t been able to find anywhere where it’s clearly explained. But most of your practices seem to be about exhaling and then holding. So why is that?
Patrick McKeown: Yes, I explained it in the book, because I think it’s a very interesting thing. Breath holding has been used in sports since the 1980s, but actual fact, probably going back a lot longer than that. Counsilman was a very famous swimming coach, and he used to instruct his athletes, his swimmers, to breathe in and hold. He called it hypoxic training. Now, if you breathe in and hold, you won’t drop your SPO2, it’s not hypoxic.
Ari Whitten: Okay, and for people listening, that’s your blood oxygen level.
Patrick McKeown: Yeah, so you’re not going to lower your blood oxygen saturation to below, say, 91%. When you breathe in and hold you increase carbon dioxide, so it’s called a hypercapnic response, high CO2. But it would be normal oxygen. Now, the benefit’s threefold of doing a breath hold after an exhalation. One is, as you hold your nose, nitric oxide sharply pools inside the nasal cavity, when you release your nose you have to breathe in, and all the nitric oxide that’s been accumulated, you’re carrying that into your lungs, and it’s going to pass into the blood, it sterilizes the air, it assists with ventilation perfusion, it’s a bronchodilator, etc., etc.
So one of the benefits of the exhale hold technique is, you get increased accumulation of nitric oxide. The second effect is, you get a hypoxic effect. When you exhale hold, you’ll drop your SPO2, you will drop your oxygen saturation in the blood, this is intermittent hypoxic training. Without a shadow of a doubt, I’ve used this with hundreds of people using their pulse oximetry, it’s very easy to determine if you’re lowering your blood oxygen saturation.
Buy a good quality pulse oximeter, put it on your finger, there’s a little infrared light there that detects if hemoglobin is saturated with oxygen, and you will be able to lower your SPO2 to simulate a height of about 12-14,000 feet in about three to four days of practice. Easily done, takes a bit of work, but it’s doable.
You also get a hypercapnic response. So there’s more going on if you exhale hold. There’s less going on if you breathe in and hold. So in terms of the blood gases, it’s a far stronger effect by having a normal breath in, normal breath out and hold. It’s much stronger and it’s more beneficial than breathing in and holding.
Ari Whitten: Okay. Now, in terms of carbon dioxide levels, if you breathe in and hold, do carbon dioxide levels get higher than they would if you would …
Patrick McKeown: Yes.
Ari Whitten: Okay.
Patrick McKeown: No, no they wouldn’t. Sorry, they will increase, but I wouldn’t expect them, because you would expect a higher carbon dioxide from the exhale hold technique because the CO2 now that’s coming from the blood into the lungs is not going to be diluted because there’s only a residual volume of air left in the lungs.
Ari Whitten: Okay, so there’s literally no aspect of it that’s superior with holding in?
Patrick McKeown: No. You’re better off, just so much better, breathe in, breathe out, and hold.
Ari Whitten: Okay. Awesome. Well, this has been absolutely wonderful, so insightful, and it’s been a pleasure to have you on the show.
Patrick McKeown: You’re very welcome.
Ari Whitten: I’m a huge advocate of your work. On a personal note, you mentioned altitude just now, and intermittent hypoxic training, I have to say that I was practicing your methods for about six weeks prior to doing a recent trip where I was doing a lot of hiking at high altitude, and I was the only one who didn’t get altitude sick and was just hiking at high altitude without really feeling the ill effects from it. So yeah, for sure, I think that you can mimic altitude quite easily just with some of these breath hold practices.
As I mentioned before, I just want to recap, that I’ve also experienced increased energy, increased work capacity in the gym, lower perceived effort, less time recovery time in between sets. I mean, I’m just a huge advocate of this, and I’ve experienced the benefits in my life personally.
Patrick McKeown: Great.
Ari Whitten: I recommend your book frequently, and to everybody listening in, I highly recommend picking up a copy of The Oxygen Advantage. I’ll show it here, just so people know that I have it personally. Where can people get a copy of your book? And where can people find out more about your work?
Patrick McKeown: We’ve put up a lot of the science and some of the questions as well that you asked, we put the science up on our website, it’s OxygenAdvantage.com. The book, it’s available absolutely online, Amazon, but a lot of the bookstores as well, Barnes & Noble, etc., will stock the book. So I think it’s quite easily accessible.
Ari Whitten: Okay, wonderful. Well, thank you so much, Patrick. It’s been an absolute pleasure.
Patrick McKeown: Great, thank you, Ari.
Ari Whitten: All right, take care.
Patrick McKeown: Bye.
The Right Way To Breathe For Increased Performance And Energy – Show Notes
Why we should focus on the right breathing habits (1:51)
Why it is important to breathe the right way (3:20)
Why breathing through your nose is the right way to breathe (4:54)
What the common beliefs about oxygen and carbon dioxide are (7:32)
The real problem with oxygen delivery (9:02)
How to detect what your oxygen levels are (9:26)
What the right way to breathe is (10:38)
How not all athletes know what the right way to breathe is (12:56)
What the BOLT score is and how that determines whether you breathe the right way (14:14)
Why it is important to breathe with the diaphragm (17:50)
The right way to breathe for a better BOLT score (19:37)
The right way to breathe for increased energy (23:32)
The right way to breathe during sleep – why it is important for your energy levels (26:00)
Why slowing down your breathing before bedtime ensures a better quality sleep (29:50)
How most yoga, pilates, and stress counselors are not teaching you the right way to breathe (33:00)
The 3 ways to breathe properly (35:37)
Patrick’s take on resistance breathing devices (38:04)
How short bursts of rapid breathing is not going to harm your overall breathing habits (40:52)
What studies say about the Buteyko breathing exercises (42:30)
The difference between breath holds with air exhaled versus holding the breath in (49:01)
You can find out more about Patrick’s work at his page Oxygen Advantage here.