• Breathe out for three seconds. • Repeat until panic symptoms have subsided. Daily Practice
If the feeling of air hunger brings on a strong fear response, regular practice
of the following short exercises will help desensitize your body’ s reaction to
the feeling of air hunger:
Breathing Recovery , Sitting  (exercise #12) for 10 minutes, six times
daily . OR
Breathe Light  (exercise #1) to create air hunger for 15 to 30 seconds,
followed by rest for 1 minute. Repeat for 5 to 10 minutes, six times a day . OR
Breathing Recovery , Walking  (exercise #13) Walk for 5 to 10 paces
while holding the breath. Practice five repetitions, six times a day . If you ar e comfortable with the feeling of air hunger:
• Breathe Light  (exercise #1) for 10 minutes, three times daily . • Breathe Slow  (exercise #3) for 10 minutes, two times daily . If your BOL T score is
less than 15 seconds, practice a 3-second inhale and a 3-second exhale. If your
BOLT score is greater than 15 seconds, practice a 5-second inhale and a 5-second
exhale. • Breathe Deep  (exercise #2) for 10 minutes, once per day .POST -COVID-19 CARE
I had an email from a colleague recently asking me for some advice about
COVID-19. She wrote:
I have a patient who was diagnosed with COVID-19 in April 2020. When I first met her, she couldn’ t say one sentence without
becoming breathless. When we started working together in October
2020, her BOL T score was just 3 seconds. Now , two months later,
her BOL T score  is around 10 or 11. She can’t do much exercise,
because it is difficult enough to breathe through her mouth. She
wears MyoT ape throughout the day and she can do small breath
holds and Breathe Light , but the other exercises are too difficult. We
did the exercise to decongest the nose and she immediately got a
severe headache. She is also experiencing headaches during the
other exercises. Her BOL T score after the breathing exercises goes
up to around 20 seconds, but her morning BOL T score stays around
10. What else can I do? What causes the severe headache  she
experiences during the exercise? Many people with COVID-19  are experiencing severe breathlessness. BOL T scores as low as three seconds have been reported. Whe n the BOL T
score is this low, it will be difficult to say a complete sentence without
becoming breathless. To improve the breathing, the objective is to increase the BOL T score
gently and consistently . With such a low BOL T score, the risk with any
breathing exercise is that it could contribute to unstable breathing. Exercise Protocol
1. Breathing Recovery , Sitting  (#12) for 10 minutes every hour . Also practice this
exercise if the nose feels congested. It is important to hold your breath for no longer
than half your BOL T score at that time—so if your BOL T score is just 3 seconds, you
will hold your breath for a maximum of 1.5 seconds. 2. Practice slow breathing with lateral expansion and contraction of the lower ribs to
improve alveolar ventilation. • Inhale slowly through your nose for 3 seconds. • Exhale slowly through your nose for 3 seconds.• If you are comfortable with this, inhale slowly through your nose for 5 seconds. • Exhale slowly through your nose for 5 seconds. • As you breathe in, feel your lower ribs gently moving outward. • As you breathe out, feel your lower ribs gently moving inward. • Practice for 5 minutes, 5 times a day . 3. Breathe only through your nose, day and night. W ear MyoT ape to keep your mouth
closed during sleep. MyoT ape is particularly suitable in this instance as it does not
cover the lips. It is unusual to suffer severe headaches when practicing the exercises. If
you practice intensive breath holds, headaches can occur due to increased
CO2 in the blood. Generally , the headache will subside fairly quicky . If you do exper ience a headache, reduce the intensity of the exercises. Go even more gently as you practice Breathe Light  and Breathing Recovery ,
Sitting . OTHER CONDITIONS
For people with:
Schizophrenia
Uncontrolled hyperthyroidism
Chest pains
Heart problems within the past six months
Sickle cell anemia
Cancer
Arterial aneurysm
Kidney disease
Make sure you breathe only through your nose during the day, during
exercise and at night. You can practice the Breathe Slow  exercis e (#3) or
walking with nasal breathing and listen to the free MP3 download available
from OxygenAdvantage.com/breathe-light. For older people and people with:
Second and third trimester pregnancy
High blood pressure
Diabetes
Epilepsy
Panic disorder and anxietySleep apnea
Cardiovascular issues
Serious medical conditions
Only practice breathing recovery exercises and breathing light, slow,
and deep through the nose during rest and physical exercise. Refrain from
practicing any breathing exercise that involves holding of the breath to
generate a strong air hunger . A WORD ABOUT DET OXIFICA TION
As your BOL T score increases, you may experience the effects of
detoxification. The exercises in this chapter are designed to help normalize
metabolic activi ty, improving the body’ s ability to get rid of waste and
clearing the system of toxins. During the detoxification period , it is very important to continue with
your breathing exercises. If you stop, detoxification might not be
completed. It is also beneficial to drink a glass of warm water with a quarter
teaspoon of good-quality sea salt dissolved in it each day . You may find that the symptoms experienced during a cleansing involve
a brief aggravation of your condition. For example, if you have asthma, you
may experience excess mucus production in the nose and airways,
especially during physical activity with nasal breathing. You may also
experience other mild side-ef fects such as a slight headache, diarrhea,
increased yawni ng, a head cold, insomnia, a bad taste in the mouth, and
reduced appetite. These are all just signs that your body is readjusting to a
healthier way of life. In gener al, symptoms should not be disruptive to
normal life and will pass in one or two days. Like any detoxification
process, there is always a short adjustment phase. If the idea of a “breathing detox” is new to you, you may be interested
to know  that toxins, including alcohol, leave the body via the lungs.7 To
illustrate this, there was a woman in my hometown of Galway , Ireland, who
had some knowledge about breathing. She was arrested on suspicion of
drunk driving. The woman failed the Breathalyzer test and was taken to the
police station for blood tests. While in the back of the police car, shedeliberately hyperventilated for several minutes. I can only imagine what
the of ficers must have thought. Despite the Breathalyzer results , blood results at the station showed low
alcohol levels and she was allowed to go. I am in no way encouraging or
condoning drunk  driving. I do, however , find it fascinating that it is possible
to get rid of alcohol from the blood through the breath. Recent research in
Canada even suggests that hyperventilation could provide a lifesaving
therapeutic intervention in cases of alcohol poisoning.8
OceanofPDF .comSECTION FOUR: EXERCISES T O IMPROVE FOCUS
AND CONCENTRA TION
One question I’m often asked by my students is “What is the difference
between breathing techniques designed as ‘stressors’ and breathing
techniques that are meant as ‘relaxers’?”
The answer is that breathing exercises that focus on increasing the speed
or duration of the inhalation are “stressors.” So are breath holds involving
strong air hunger . These inclu de Oxygen Advantage exercis es that use
breath holding to create a strong air hunger , and they include some of the
techniques used by W im Hof. Breathing exercises designed to slow the speed and/or lengthen the
duration of the exhalation are “relaxers.” Breath holds involving light air
hunger are relaxers. Breathe Light  (exercise #1), with its emphasis on
relaxation and light air hunger , is a relaxer . So is slow breathi ng, because
the vagus nerve, which drives the parasympathetic nervous system (the
“rest and digest” branch of the autonomic nervous system), is only activated
on exhalation. This means that spending longer in the exhalati on phase is
beneficial to relaxation. Y ou can read about this in detail in Chapter Four . Important:  Hyperventilation and breath holding are very powerful
exercises designed to tempora rily disrupt the body’ s balance to trigger
adaptations. They are not suitable during pregnancy or for anyone with
serious health conditions, including diabetes, sleep apnea, epilepsy , anxiety ,
panic disorder , or cardiovascular issues. #19. Box Breathing
This exercise can be used as an alternative to Breathing Recovery , Sitting
(exercise #12). Box Breathing  is traditionally practiced by military
personnel to balance the autonom ic nervous system (ANS). It is designed to
create a state of relaxed alertness, getting you “in the zone.” There are
different versions of the exercise depending on your BOL T score. If your BOL T scor e is less than 15 seconds:• Breathe in for 2 seconds. • Hold for 2 seconds. • Exhale for 2 seconds. • Hold for 2 seconds. • Breathe in for 2 seconds. • And so on . . . • Practice for 5 minutes. If your BOL T scor e is 15 seconds or mor e:
• Breathe in for 4 seconds. • Hold for 4 seconds. • Exhale for 4 seconds. • Hold for 4 seconds. • Breathe in for 4 seconds. • And so on . . . • Practice for 5 minutes. #20. Preparation for Public Speaking or Performance
You can use breathing exercise s to achieve a state of flow in which your
mind is relaxed and alert at the same time. I personally use the following
sequence for public speaking, to enter a flow state, focus attention, and stay
present. The same exercises can be used for interviews, presentations,
performance, and sport events. Good quality sleep is imperativ e. Your ability to focus the mind under
pressure very much begins the night before.To prepar e the night befor e:
• Breathe Light  (exercise #1) to create air hunger for 15 minutes before sleep. • Nasal breathe only during sleep (use MyoT ape to close the lips). In the 30 minutes pr e-speech/performance:
1. Relax your mind
• Sit down and place your hands either side of your lower ribs. • Close your eyes and bring your attention inward. This will also helps reenergize. • Breathe Light, Slow , and Deep  (exercise #4) for 5 to 10 minutes. Ideally , practice for
10 minutes. 2. Incr ease alertness
• Exhale through your nose. • Pinch your nose with your fingers to hold your breath and walk for 10 to 50 paces
while holding your breath to generate a moderate to strong air hunger . • Stop walking. • Breathe in through your nose and rest for 30 seconds or so while standing still. • Repeat five times. This practice will allow you to move your attention out of your mind
and away fr om racing thoughts.As you walk into the room to make your presentation, dispe rse your
attention throug hout your body . Take your attention out of your head. Walk
into the room with every cell of your body . During the presentation, direct  some of your attention to your body ,
instead of having all your attention stuck inside your head. Be aware that the feelings of breathlessness, depersonalization, and
being “out of your body” that sometimes accompany performance anxiety
are all just symptoms of chronic hyperventilation, not a sign that you are
not up to the job! Perform with every cell of your body . #21. W arm-Up for Physical Exercise
This warm-up exercise is not restricted to walking or jogging. It can be used
for any sport and can be applied during continuous movement. Breath
holding on the exhalation until a moderate air hunger is achieved can be
incorporated into most warm-up routines. Perform five breath holds during
the warm-up, with a minute or two rest in between each. It makes sense to
open the airway s and blood vessels, harness nasal nitric oxide, and increase
oxygen delivery to the cells prior to physical exercise. Directions:
• Move at a moderate pace for 10 to 15 minutes. • Nose breathe only for the duration of the warm-up. • During the warm-up, breathe light, slow , and deep. • Take fuller breaths but fewer of them, with lateral expansion and contraction of the
lower ribs. • Exhale through your nose and pinch your nose with your fingers to hold your breath. • Continue moving during the breath hold. • When the feeling of air hunger is moderate, let go of your nose, and breathe through
it. • Minimize your breathing taking half of a normal breath in and out through your nose
for six breaths. • Resume normal breathing for a minute or two. • Repeat the breath hold five times during your warm-up. OceanofPDF .comSECTION FIVE: STRESS AND RELAX BODY AND MIND
IS BREA THING T O STRESS THE BODY A GOOD IDEA? Some of what you read in this book might seem to contradict information
you may have heard in relation to other popular breathing methods. There is
currently an explosion in breathwork, and several techniques have received
significant coverage. This global “breath revolution” is a positive thing. The
breath is a vital tool for health, performance, and self-mastery . The interest in various kinds of breathwork is also a good thing because
there is a widespread lack of knowledge about the basic principles of
breathing. This is reflected in the fact 60% to 80% of adults have
dysfunctional breathing patterns.9 It is therefore worth looking at the ideas
behind several types of breathin g exercises to understand how they affect
the body and why they may be ideal for some people but not for others. My main purpose in addressing this subject is not to raise arguments
about which breathing method is best. I am interested in discussing the
importance of balance and helping you understand your options. Some
breathing techniques use deliberate hyperventilation, and since the focus of
this book is on reversing the harmful effects of chronic hyperventilation, I
want to offer some explanation as to why these exercises can be helpful. It
is my opinion that when conscious hyperventilation is practiced, it is
important to balance its effect with reduced volume breathing exercises. In
other words, if you up-regulat e the body , it is also necessary to down-
regulate. This produces the best long-term results in terms of breathing
biochemistry and the function of the autonomic nervous system. #22. Prepare for Simulation of Altitude T raining
This exercise is to be performed to a comfortable air hunger only . The objectives are to experience a light to medium hunger  for air
(depending on your BOL T score) and to prepare for stronger breath holds. Directions:• Take a normal breath in and out through your nose. • Pinch your nose to hold your breath, and walk for 10 to 15 paces. • Stop walking and release your nose. Breathe in through your nose and resume
gentle breathing in and out of your nose. • Wait for 30 to 60 seconds and repeat. • And again, take a normal breath in and out through your nose. Pinch your nose with
your fingers and walk 10 to 15 paces while holding your breath. • Stop walking and release your nose. Breathe in through your nose and resume
gentle breathing in and out of your nose. • Wait for 30 to 60 seconds and repeat. • Repeat the exercise five times.#23. Simulation of Altitude T raining
When you hold your breath to create a strong air hunger following a passive
exhalation, several things happen. 1. The breath hold causes a disturbance to the blood’ s acid-base
balance. As the breath is held, the cells continue to extract oxygen from your blood. Meanwhile, excess CO 2 cannot leave the blood through your lungs. Regular
practice of breath holding exposes the body to increased acidosis. This
causes the body to adapt. The result is less acidity of the blood during
intense exercise and a delay in the onset of fatigue. 2. The br eath hold str engthens the br eathing muscles. This combination of high CO2 (hypercapnia) and low blood  oxygen
saturation (hypoxia), along with the sensation of discomfort in the
diaphragm, causes the respiratory center in the brain to send impulses to the
breathing muscl es to resume breathing to restore blood gases to normal. As
the breath hold continues, these impulses increase in intensity , causing the
diaphragm to contract repeatedly . In essence, the diaphragm  receives a
workout as it continues to contract throughout the breath hold. 3. The body experiences “good” str ess. When you hold your breath until a strong air hunger is experienced, you
expose your body to short-term  stress. This is beneficial because it causesthe body  to make adaptations that improve the functioning of the immune
system. Breath holding also boosts mental preparedness and willpower . For
athletes, it can help develop tolerance for strong feelings of breathlessness
and can significantly reduce exercise-induced asthma. When practicing this exercise, it can be motivating to wear a hand-held
pulse oximeter to observe your blood oxygen saturation as it lowers to
between 80% and 87%. This low blood oxygen level simulates training at
an altitu de of 4,000 to 5,000 meters (13,000 to 16,400 feet) above sea level
where the pressure of atmospheric oxygen is much less. In my experience, most studen ts can achieve simulation of altitude
training within three to four days of practice. Progress will depend on your
BOL T score, your level of fitness, and your genetic predisposition. Many
students manage to simulate altitude training on their first day of practice. The exercise causes the following ef fects:
• Creates a medium to strong hunger for air
• Activates the diaphragm
• Improves respiratory muscle strength
• Improves immune function
• Reduces the perception of breathlessness
• Greatly disturbs blood gases (hypoxic/hypercapnic response) to improve aerobic
and anaerobic capacity
• Generates anaerobic glycolysis without the need to perform intense physical
exercise
• Reduces chemosensitivity to CO 2
• Quietens the mind (the mind stops thinking during a stronger breath hold)
• Acts as a measure of the upper limit of breathlessness
This exercise is ONL Y SUIT ABLE for those in good health.Directions:
• Take a normal breath in and out through your nose. • Pinch your nose with your fingers to hold your breath. • Start walking with your breath held. • Walk faster . • Jog. • Jog faster . • Relax into the muscle contractions. • When the air hunger is moderate to strong, let go of your nose, and breathe in
through the nose. • Walk a few paces and stop. • Practice minimal breathing for six breaths. T ake very short breaths in and out of the
nose. Just breathe in enough air to fill the nostrils and no more. T ake hardly any air
into your lungs for six breaths or so. • And now breathe normally for 12 to 18 breaths. Allow your breathing to recover . • Following 18 normal breaths, repeat the exercise. • Repeat five times. #24. Get out of Y our Head
This exercise activates the sympathetic and parasympathetic nervous
system—the body’s stress-balancing relaxation response. It also exercises
the breat hing muscles. It is to be practiced while sitting or lying down. Each
set consists of three steps. This exercise is ONL Y SUIT ABLE for those not
pregnant and in good health.Directions:
Step 1:
• Breathe a fast, full breath in and a fast, full breath out through your nose. Fill your
lungs with air and exhale fast. • Repeat 20 full breaths in and out. Step 2:
• Exhale and hold the breath until you experience a medium to strong air hunger . You
may want to pinch your nose with your fingers to hold the breath. Step 3:
• Breathe light with air hunger for three minutes. Slow down the speed of your
breathing. During the inhalation, feel hardly any air entering your nose. Allow the
exhalation to be slow , prolonged, and relaxed. • Repeat the exercise two to three times from Step 1. #25. Rapid Fire Breaths
This morning, while working on this chapter , I had a telephone call with
Yasin Seiwasser . Yasin has been practicing martial arts and meditation for
over 35 years and is a former German MMA Champion. He holds the world
record for the fastest knockout of three seconds in an MMA title fight, has
trained US special forces and marines, and has worked as a bodyguard for
the King of Saudi Arabia. Needless to say, he knows a thing or two about
self-control. We discussed an exercise that can disrupt homeostasis (the body’ s state
of healthy equilibrium) to “shake” the autonomic nervous system. This
exercise changes the acidity of the blood by altering the concentration of
blood CO2. CO2 fluctuates from normal to low to high
(normocapnic/hypocapnic/hypercapnic). The exercise activates the twobranches of the autonomic nervous system alternately and repeatedly ,
stimulating sympathetic, parasympathetic, sympathetic, parasympathetic
(stress, relax, stress, relax), and so on. It also brings attention to the
breathing and gives the respiratory muscles a workout. This exercise is
ONL Y SUIT ABLE for those not pregnant and in good health. Directions:
• Place your hand on your belly . Begin slowly by taking a short breath in and out
through the nose. As you take each short breath in, push your belly outward. As you
take each short breath out, pull your belly inward. Do this for 15 seconds. THEN
• Increase the speed to a respiratory rate of up to three breaths per second. Continue
breathing using the belly . Breathe as fast as you comfortably can. Do this for 45
seconds. THEN
• Practice Breathe Light  (exercise #1) with prolonged exhalations, developing the
feeling of air hunger . Do this for 1 minute. Practice three rounds of the fast breathing for one minute followed by
light breathing for one minute. Then sit still for three minutes and let the energy flow. Observe your
breath and thoughts without interference. This will help activate your
parasympathetic nervous system. Recap: One minute fast breath ing, one minute light breathing, one
minute fast breathing, one minute light breathing, one minute fast breathing,
one minute light breathing. Sit still for three minutes.THE HEAL TH BENEFITS OF HORMETIC STRESS
In much of this book you will find practices to reduce stress, reduce stress
hormones, and relax the body and mind. You will also find many
descriptions of the potential negative effects stress can have on the body in
terms of health, inflammation, cardiovascular disease, and even how long
you live. However , some breathing exerc ises are designed to activate the body’ s
stress response for the purposes of good health. To understand this, it is
necessary to examine the benefits of these methods and the difference
between “types” of stress. First, let’s clarify what stress is. Stress is the disruption of equilibrium
(homeostasis) in the body . It is something that puts your systems off-
balance. The type of stress involved in these breathing techniques is called
hormetic stress, or hormesis . Hormesis is a way of using stress to your
advantage because stress trigge rs adaptations in the body , and this can be
harnessed for positive effect. For instance, when you work out, you need to
“damage” your muscles so that your body will rebuild them. Over time, this
causes your muscles to become stronger . Hormetic stress can be introduced using breathing techniques. Although
breathing techni ques using this concept have recently become popular , this
is not a new idea. Ancient breathing practices have a lot to teach us when it
comes to stimulating adaptati ons in the body via the disruption of
homeostasis. The Balance of Opposites
One concept universally found in traditional yoga breathing (Pranayama
and T ibetan yoga breathing) is the balance of opposites. This ancient principle is relevant today . These are breathing techniques
that:
• Use large, slow , full breaths. • Involve very fast mouth breathing. • Focus on keeping the breath to a minimum. • Involve not breathing at all for periods of time.As with differen t strands of yoga, these methods can attract followers who
are almo st evang elical in their approach. This can make it hard to work out
which method is “right.” The answer is, used correctly , they all are. This book is not about yoga breathing, but it is relevant. Traditional
Pranayama, which is the yogic practice of breath control, teaches that to
master our breathing, we must develop great flexibility and adaptability . This means being able to switch from small to large breaths, very fast or
very slow, using the mouth or the nose. For example, some breathing
techniques limit  us to a very small amount of air, reducing the normal
volume of air inhaled by as much as 10 times. Others require that we
breathe a volume of air almost 20 times greater than normal. To illustrate these differences, let’s take a look at two ancient breathing
techniques. One is from traditional Pranayama and the other from Tibet. These exercises  use hyperventilation balanced with breath holds and slow
breathing. This moderates the impact on the levels of CO2 in the blood and
maximizes the oxygenation of cells and or gans. 1. Bhastrika (Indian Y ogic Breathing)
Bhastrika  is a classic Pranayama technique also known as the Bellows
Breath and sometimes  called the Breath of Fire. It uses complete, full
breaths in rapid succession (as many as 60 breaths per minute for a total of
100 breaths),10 which means it is a hyperventilation technique. After one
minute of hyper ventilation, the student holds the breath on a full inhale for
as long as possi ble to balance the dischar ge of CO2 that occurs during the
fast breathing. This extended breath hold is followed by a long, slow
exhalation, which is repeated several times before returning to the start of
the exercise with the fast breath ing. The whole practice is completed using
only nasal breathing. The hyperventilation phase of this breathing practice works on
biochemistry , reducing CO2 and alkalizing the body . It also works on
biomechanics, massaging the internal organs in the abdomen with the
diaphragm. Perhaps more important, it affects the autonomic nervous
system, activating both the sympathetic and parasympathetic branches,
stress balanced by relaxation. In this way, the practice triggers adaptationsin the body that allow the body  to better maintain balance in its systems
under stress.11
2. Tum-mo Breathing (T ibetan Pranayama)
Tum-mo breathi ng is based on slow breathing and breath holds. Reduced
slow breathing following hyperventilation is also used. The practice is
characterized by a technique called “vase breathing,” which is accompanied
by static  contra ction of the muscles in the abdomen and pelvis during a
breath hold after inhalation. Today a variation of this practic e has been
made popular by the work of the Iceman, Wim Hof, and his Wim Hof
Method. There are at least two types of Tum-mo practice, Forceful Breath and
Gentle Breath. These two types differ in terms of the breathing technique
involved and in their goals. Although both are based on vase breathing, one
is forceful and vigorous while the other is gentle and without strain. Scientists have proven that Tum-mo breathing produces heat in the
body12-14 (a proce ss calle d thermogenesis), a side effect of the practice that
is useful in colder climates like that of Tibet. The goal of Forceful Br eath is
to raise “psychic  heat” while Gentle Breath is desig ned to maintain it. It is
physically difficult to use the complex Forceful Breath technique for
extended periods or while walking around. In Tibetan monasteries, Gentle
Breath is used during a ceremony that involves drying wet sheets. The
sheets are drape d around the bodies of the monks who practice  Tum-mo to
raise their body temperature, sometimes by as much as 17° Fahrenheit,
causing the sheets to dry.15,16 Like Bhastrika , Tum-m o breathing is
practiced using only nasal breathing. HORMETIC BREA THING PRACTICE FOR MODERN LIFE
Leonardo Pelagotti is an Oxygen Advantage instructor based in Paris,
France. He was a national-level gymnast for 15 years and achieved a black
belt in Kung-fu Shaolin after just five years of practice. Since 2017, he has
been an instructor of the Wim Hof method, a practice that combines
meditation, breathing exercises, and exposure to cold to regulate stress
levels. He works closely with the method’ s founder , Wim Hof, and hastrained hundreds of people to overcome their fears and mental limitations. Leonardo is also an Oxygen Advantage Master Instructor . He has a
scientific backg round that enables him to understand and teach the
processes behind  these hormetic breathing techniques and to apply them to
modern living. One of the fundamental principles in this book is the reduction of
sensitivity to CO2 in the blood. This is achieved by means of exercises that
down-regulate breathing to counteract hyperventilation. If you use
techniques that involve delibera te hyperventilation, the secret is to balance
your breathing practice. Leo explains:
Exercises to elevate carbon dioxide and balance breathing are
especially important for anyone who practices deliberate
hyperventilation techniques. If this is not done, you will experience
an increase in sensitivity to CO2, which is the opposite of what we
want to achieve. In exercises involving hard and fast breathing, such as Wim Hof
breathing, for instance, if you don’t practice any exercises to raise
levels of carbon dioxide (reduced breathing and breath holds),
sensitivity to CO2 increases and the result is a faster breathing rate
and an increased responsiven ess to CO2, which  manife sts as
breathlessness. To create and maintain physiological balance, dif ferent breathing
techniques must be used to move within the full spectrum of
breathing. This means that you become able to manipulate levels of
oxygen and CO 2 in your blood so that they are high, low , or normal. In Pranayama, many exercises exist and these all have different
purposes and benefits.10 In the same way, the reduced breathing
techniques in the Oxygen Advantage can be integrated with well-
known hypercapnic/hyperventilation techniques like Sudarshan
Kriya, Holotropic Breathwork®, Tum-mo breathing, and the Wim
Hof method. The Oxygen Advantage provides a way to “dose” the activation
of the stress and relaxation responses correctly to benefit from both
without potentially causing tolerance to CO2 to suffer. This allowsfor the perfect balance in your breathing practice, in which you can
up-regulate and down-regulate your autonomic nervous system  and
breathing biochemistry at will. THE PRACTICE
What Leo suggests is a concep t linked to hormetic stress using breathing
exercises that work along the three dimensions of breathing patterns:17
1. The biochemical dimension—alters CO 2 levels in the blood from normal to low to
high (normocapnic to hypocapnic to hypercapnic). 2. The psychological dimension—activates both the sympathetic and parasympathetic
nervous systems. 3. The biomechanical dimension—practices both deep and shallow breathing. #26. Hormetic Exercise 1: CA TANA Breathing
This breathing exercise takes  its name from its dual action on the
metabolism—catabolic (CAT) and anabolic (ANA). It isn’t necessary to
understand what these terms mean, only that the practice is a form of
hormetic breath ing. Its objective is to disrupt homeostasis to promote
adaptations in the body that, in turn, will lead to a stronger physiological
balance. CATANA is a breathwork training based on a
hypo/hyperventilation equilibrium—a balancing of underbreathing and
overbreathing. This technique fosters physical regeneration and mental
calmness. Directions:• First, perform six full breaths, inhaling slow and deep from the diaphragm, up
through the ribs, and finally to the chest. Inhale only through the nose, without
friction or force. After each inhalation, exhale through your nose. Begin each
exhalation by simply relaxing your belly , then your chest. • After these six breaths, inhale and hold your breath for five seconds with full lungs. Release on the exhalation, naturally letting the exhaled breath out. • Hold your breath after the exhale. At the first diaphragmatic contractions, resume
breathing as follows . . . • Take a deep and slow inhale, and, at the top, hold your breath again for as long as
possible. During this phase, contract your pelvic floor muscles and bring your navel
in toward your spine. • When you can’t hold your breath any longer , exhale as slowly as possible and
resume breathing as slowly as you can for about one minute. • Repeat the entire exercise up to five times. • When you are comfortable with the exercise, you can add a final element to finish. This element integrates the exercise on a psycho-physiological level. As you breathe
in and out in a natural and uncontrolled way , imagine energy entering and recharging
your body on each inhalation and imagine debris leaving your body for each
exhalation. FINDING YOUR P ACE
There are breathing exercises for everyone. Some people feel a lot better
when they practice Wim Hof’s method. Some find a program of
hyperventilation, breath holding, and recovery exercises extrem ely helpful. Others feel benefit from slow breathing exercises or practicing many small
breath holds while sitting or walking. Ultimately , the foundation of breathwork is restoring functional
breathing patterns with normal  biochemistry and biomechani cs. Without
this, a crucial piece is missing from the puzzle. Regardless of the breathing
method you prefer , always remember that healthy breathing for humans,
whatever your age or state of health, is in and out through the nose, Light,
Slow , and Deep. This story from a fellow Irishman Niall Donnelly , who lives in
California, illustrates the point that sometimes the people who are most
driven to succeed and achieve are the very same people who find the
greatest relief from slowing down and reducing the breath. Niall has a full, demanding life. He’s the CEO of a tech comp any and
has child ren to keep him busy. He began meditating four or five years ago
to stave off stress, but found his mental chatter made it difficult. Instead, hedoubled up his daily physical exercise and, with a little meditation thrown
in, that kept him feeling good for a couple of years. But, as life happened
and stress levels grew , he found  his anxiety ramping up to the point where
he began experiencing panic attacks. He was determined not to go down the
route of medicating and decide d to study and test as many methods as he
could to see what did and did not work for him. He tried many breathing
techniques, from Pranayama to Wim Hof, Kundalini, Tum-mo, and more
besides. He says:
I for one was more enamored with the more “glamorous” techni ques
in my early days. It’s like the whole yoga community worldwide
following their guru’ s and not questioning whether the breathing
techniques are good for them or not, it doesn’ t make sense. I found
them all very interesting and they all brought pretty deep
experiential and emotional release experiences. Especially the more
mouth-driven hyperventilation ones, which I initially spent most of
the time doing. But something deep inside me kept saying,
“Something’ s not right here.” I started to feel like the techniques
couldn’ t be good for my heart or my brain, and the fact my fingers
and toes were getting cold indicated that the practice was doing  the
reverse of everything I thought I knew about taking deep breaths to
oxygenate my body . At this stage, I began to experience more panic
again. So one day I just stoppe d the harder breathing. I listene d to
my heart and my gut and then just lay in my meditation room  and
did six breaths a minute for 40 minutes. Then I came out and said to
my wife: “This feels good. Something is telling me to slow my life
down and slow my breath down and I need to listen to this.” I then
started bringing six breaths a minute into my day as much as I could
and within days, I could feel a change. I’m a very ener getic guy with
a lot of dema nds, but everything started to slow down. I’m
convinced that light breathing and CO2 tolerance training have the
power to shift humanity becau se overbreathing is making us all
physically and mentally ill. The lesson in this story is simple. You may find that hyperve ntilation
breathing techni ques work for you, especially if you balance them withlight breathing. But, if they don’t, don’t push yourself to practice them. Focus instead on exercises that make you feel well, even if they seem less
glamorous and exciting. Listen to your body and it will thank you. Niall and I talked again recently as I was preparing the final manuscript
for this book. He told me he had been practicing a humming technique and
noticed positive changes to his sleep and his heart rate variability . I’ve been testing  all sorts of things sleep related for a few months,
but the best thing I’ve found is breathing light mixed with humming
before sleep. In bed, before sleep, I take a small breath in through
my nose (around 60% or 70% of my normal breathing volume) and
then hum the exhale out. I repeat this cycle for 10 minutes. On every
third or fourth breath, I hold my breath for 3 seconds at the end of
the exhalation. I wear an Oura Ring at night (see Chapter Four ), and
this past week it’s showing very clear signs of increased HRV, lower
resting heart rate and reduced respiratory rate overnight. I am also
getting more deep sleep, better REM cycles, and around 15% more
sleep. I’m falling asleep faster and staying asleep throughout the
night in a better way . Humming has been part of my meditations for a few years, but I
only tried it before sleep about a week ago. I’m pretty blown away
by how helpful it is. I even have fewer crazy , vivid dreams when I
hum, where normally I’m a jumpy , nightmarish person. The other great thing I find with humming is it helps me extend
my nasal exhalation. Otherwise , I kind of struggle with this after
doing a small inhalation. Maybe the extra nitric oxide from
humming has something to do with a better sleep? Interesting to
think about. Niall is quite right. It is now widely understood that nitric oxide facilitates
sleep, particularly non-rapid eye movement sleep, and is intimately
connected to sleep homeostasis. OceanofPDF .comSECTION SIX: EXERCISES FOR CHILDREN
These children’ s exercises provide excellent tools with which to restore
healthy breathin g patterns in even quite small children. Information about
identifying dysfunctional breathing in your child and ideas to motivate
young people to engage with the practice can be found in Chapter Eight  on
children’ s breathing. 1. MOUSE BREA THING
Children sometimes find it difficult to understand the concept of reduced
breathing exerci ses, so breathing reeducation in children requires a creative,
playful approach. The last thing you want is for breathing practice to
become a stressful chore. Teaching through stories is generally an excellent
way to ensure that children engage with and remember the techniques. I
find the following story about a cat and mouse works well, especially when
it’s necessary to remind your child to reduce their breathing throughout the
day. Sit quietly with your child, somewhere you won’ t be disturbed. Ask the
child to relax and to drop their shoulders. Next, ask the child to pretend to
be a little mouse. You get to play at being a big, hungry cat. This hungry cat
has very good hearing and is listening carefully for the mouse’ s breathing. Your child (the mouse) must see how quietly they can breathe so the cat
doesn’ t hear them. This is not a breath-holding exercise. The little mouse
must be clever and continue to breathe. If the cat cannot hear the mouse’ s
breathing, the mouse will be left alone, but if the cat hears so much as a
sniff, it will chase the mouse. Using the cat and mouse story , follow these instructions with your child:
• Ask your child to sit down with good posture. • Now, it’s time to relax and become as soft and wobbly as jelly . • Place a finger under your child’ s nose to monitor airflow . • Next, the child should try to breathe so gently that the breathing is silent, with no
movement from the chest or tummy .• This reduction in breathing will create a feeling of air hunger . Your child will
experience an urge to take big breaths. Encourage them to keep their breathing soft
(so the cat does not hear them), maintaining the air shortage for the duration of the
exercise. • Perform the exercise several times, for one to two minutes each time. 2. STEPS EXERCISE FOR CHILDREN
Children and teenagers can get a lot from the Steps Exercise. It can also be
used to measure progress. The Steps Exercise is simp le and requires the
child to hold the breath during walking, jogging, or running. Precautions:  If the child, teen, or adult has pulmonary hypertension,
epilepsy , or any serious medical  condition, you must not practice the Steps
Exercise. People with pulmonary hypertension should not practice this
exercise because  holding the breath to reach a strong air hunger will cause a
temporary increase in blood pressure. If you or your child has diabet es, be aware that breath-hold exercises
can lower blood sugar levels. Take a snack before practicing the exercise
and monitor blood sugar levels frequently during the Steps . If your child is wheezy or coughing, limit the Steps Exer cise to between
10 and 20 paces . The Steps Exercise will help impro ve asthma and reduce
the child ’s symptoms, but it is important that breathing at the end of the
exercise remains controlled. Heavy breathing after a breat h hold can
exacerbate symptoms. BEGINNERS’ STEPS
Small children (four to six years ) can be introduced to the Steps Exer cise by
walking a short distance of only five paces or so with the breath held. It can
be useful to ask another adult or an older sibling to help. You can then stand
at either end of the walking distance so that the child can walk back and
forth from one helper to the other . Adult one   →   Distance of five paces   →   Adult twoBefore your child begins the exercise, place a piece of paper tape across
his or her lips. This will ensure that the child breathes nasally . Alternatively ,
I have designed  a special tape called MyoT ape which is a great tool for
teaching nasal breathing. It is suitable and specifically sized for children
and is available from MyoT ape.com. The tape does not cover the lips. Instead, it safely surrounds the mouth, eliminating any anxiety that may
come from taping the mouth and allowing the child to talk and take a sip of
water whenever they need to. Here’s how to do the Steps:
• To begin the exercise, breathe in and out gently through your nose. • After an exhalation, pinch your nostrils closed with your fingers to hold the breath. • With the breath held, walk the five-pace distance between your two helpers. • Let go of the nose and resume gentle nasal breathing. • Wait for between 30 and 60 seconds and repeat the exercise. ADVANCED STEPS
When you have established that the child is able to hold his or her breath
over a short distance, gradually  increase the number of paces. You can do
this by lengthen ing the distance between the two helpers. Or you can keep
the five-pace distance and have the child walk back and forth several times
before releasing  the breath, like swimming laps underwater . It is important
to find out how many steps the child can achieve. This is determined by
asking the child to gradually take more steps with the breath held until a
strong air hunger is felt. After the breath hold, the breath must be taken in through the nose. The
breathing must also be calme d immediately . The first breath after the
exercise will usually be bigger than normal. Make sure that your child
reduces or suppresses the second and third breaths to keep the breathing
gentle. You can combine this exercise with the cat and mouse story ,
reminding the child to breathe like a little mouse so that the big cat cannot
hear them when they release the breath hold. The Steps Exer cise should be perfo rmed six times per set, with about 30
seconds or a minute’ s rest betw een each repetition. Sets of Steps  are to be
practiced two to three times per day. Count the Steps  out loud and recordyour child’ s score so that progress can be monitored from week to week. Compare each week’ s Steps  with the previous scores to evaluate
improvement, and encourage your child to increase the number of Steps
they take. You could work this into a star chart and motivate your child with
rewards. The Steps Exercise can also be incorporated into other activities
such as skipping or running. IMPOR TANT INFORMA TION
Young children have a relativel y strong response to the buildup of CO2 in
the blood, althou gh this will lessen as they get older . With this in mind, the
Steps Exercise should be adapted according to the child’ s age. Children
aged between five and seven should aim to achieve 50 to 60 paces during
Steps . For children aged between eight and nine years, the goal is to reach
60 to 70 paces. And for children aged ten and over , 80 paces is optimal. Be mindful of your child’ s breathing throughout the day. If at any time
you can hear your child breathing, or see them breathing with their mouth
open, remind them to breathe gently through the nose with their tongue in
the roof of the mouth. Ensure that your child does not let any air sneak in
through the mouth. This too can be made into a game, reinforcing the
importance of keeping the mout h closed by telling off the “sneaky” air for
trying to get in. Children have short attention spans, so games can really help. If your
child becomes bored with practicing the exercises, you can replace the
Steps  with breath holding while playing, jogging, running, hopscotch,
performing jumping jacks, or jumping on a trampoline. Breath-hold exercises such as the Steps  can be very effective for
decongesting the nose. However , if your child continues to feel an air
hunger after six repetitions of the Steps Exercise, there may be an
obstruction at the back of the nose due to enlar ged adenoids. There is much
detailed information about this in Chapter Eight  on children’ s breathing. USING MOUTH T APE T O REST ORE NASAL BREA THING
It may be useful to place tape across the child’ s lips durin g the Steps
Exercise. This will help you ascertain how comfortable nasal breathing isfor the child after doing the exercise. Holding the breath to achieve a strong
air hunger has no reported risks for healthy children, and, as I discovered in
the course of my teaching, taping to bring the lips together is an invaluable
tool in breathing reeducation. During my work with children and parents, I occasionally encountered a
child who persistently breathed  through an open mouth, no matter how
many times we emphasized the importance of nose breathing. In most
cases, these children were able to unblock their noses by practicing the
Steps , so it became apparent that their habit of mouth breathing was not due
to a nasal obstruction. The parents would feel as if they were constantly
nagging to no avail, the child would become frustrated and upset by the
constant pressur e to breathe through the nose, and I couldn’ t figure out why
this mouth breathing habit continued despite all our combined ef forts. Then I began working much more with lip tape, ensuring that the children
wore paper tape across their lips for periods during the day. This simple but
profoundly effective technique was a game changer , resulting in an
immediate improvement in nasal breathing habits for those children. If the idea of taping your child’ s mouth seems profoundly alien to you,
it’s worth looking at the research. A new study published in 2020 explored
the effectiveness  of lip tape as an objective tool to assess nasal breathing.19
The study was to find out if tolerance to lip taping could be used to identify
people at risk of mouth breath ing. The test involved having participants
breathe nasally for three minutes  with the mouth taped. Researc hers wanted
to find out whether mouth tapin g could be used to discover if the cause of
mouth breathing was anatomic al or habitual. This is not possible with
traditional methods, especially when the patient is unaware of problems
with nasal breathing. It is particularly challenging in children who may not
be able to articulate that they are struggling to breathe through the nose. As the study’ s authors state, the establishment of full-time nasal
breathing is now appreciated as “the single most important objective in
securing adequate craniofacial and airway development in children.”
The study involved 633 participants, including 315 children aged
between 3 and 11 years. Researchers discovered something interesting. Most participants with self-reported mouth breathing or moderate to severe
difficulty nasal breathing were still able to comfortably breathe through thenose for at least three minutes. More than 80% of participants who mouth
breathed almost all of the time while awake were able to pass the lip-taping
test.19 This is consist ent with earlier studies, which indicate that mouth
breathing can persist after a nasal obstruction has been removed. That
underlines the importance of breathing reeducation in reestablishing nasal
breathing. An easy way to ensure consisten t and ongoing nasal breathing is to ask
your child to wear medical grade paper tape or MyoT ape around their lips
for at least half an hour each day. It is helpful to combine this with an
activity that distracts the child, such as reading, watching TV, or playing on
a tablet or phone. You may also have to engage in some good old-fashioned
bargaining. For example, you may find it helpful to allow screen time on
the condition that your child wears the MyoT ape. If you still have  reservations, you can see for yourself how MyoTape
works, still allowing the child to speak. Simply search for my free
children’ s breathing program on YouTube where you will find my daughter ,
Lauren, modeling the lip tape. The best approach when helping children to improve their breathing
habits is to be consistent and patient. The idea that it takes 21 days to form
or change a habit is unrealistic and outdated. Scientists have found that, on
average, a new habit takes 66 days to build, and it can even take as long as
254 days20. This time is necessary for new neural connections to establis h
and for breathin g behavior to change. If you are trying to change your own
breathing habits, you will need to be equally patient. If you would like to explore further ways to explain the concept of
breathing light and the Steps Exercise to your child, many people have
found my book Buteyko Meets Dr. Mew  to be a useful  aid in teaching
children and teenagers about breathing through full-color comic book
storytelling. • Ask your child to wear MyoT ape across the lips for at least half an hour each day . It
is best to do this when the child is distracted. • Use games to introduce the techniques to small children. Be as creative as you like! • Start by practicing the Steps Exercise  for beginners. • Practice the Steps  while walking, jogging, or running. Do this for six repetitions, two
to three times a day .As you will discover in Chapter Eight  on children’ s breathing, children
can benefit enormously from breathing exercises that promote nasal
breathing and help prevent sleep-disordered breathing. I believe
passionately that this is absolut ely vital for each child to reach their full
potential. This is why my childr en’s breathing program will always be free
of charge. You can find a wealth of free tutorial videos on YouTube by
searching for “ Patrick McKeown Childr en.”
OceanofPDF .comICHAPTER THREE
HOW TO BREATHE
n texts about the anatomy and physiology of breathing, the respiratory
tract is described as the path14 for air to trave l from the nose to the
lungs. The mouth doesn’ t get a mention for one simple reason:  despite
common habits and preconceptions, our bodies are designed for nasal
breathing. It has been said that breathing through the mouth is like eating
through the nose. I was a habitual  mouth-breather  throughout my childhood and into my
early twenties. For all that time,  I completely bypassed my nose. Little did I
know that the development of the lower half of the face and jaw is largely
influenced by whether the mouth is open or closed during the formative
years of childhood. Prolonged mouth breathing even altered the structure of
my face, resulting in a smaller nasal airway , high upper palate,
underdeveloped jaw , and crooked teeth. Although mouth breathing is a distortion of an intrinsic bodily function,
it is incredibly common. A 2008 study of 370 randomly selec ted children
between three and nine years old, all from Abaeté, Brazil, found that 55%
were mouth breathers.1 In 2010, a Portuguese study examined the incidence
of mouth breathing in children aged between six and nine. The results of
496 parental questionnaires revealed that nearly 57% of the children
breathed through  their mouths.2 The frequency of mouth breathing among
adults receives less attention, but one 2016 paper of more than 9,000 people
from a town in Japan reported that 17% breathed through their mouths.3
As we’ll see, mouth breathing doesn’ t just disrupt the growth of the face
and teeth. It is also a significant factor in a variety of proble ms, rangingfrom obstructive sleep apnea to high blood pressure, a reduce d quality of
life and fatigue.4–9
WHA T’S SO GREA T ABOUT BREA THING THROUGH
THE NOSE? Nasal breathing performs at least 30 functions on behalf of the body .10 One
of the most important of these is oxygenating the blood, organs, and cells. Because the nostrils are significantly smaller than the mouth, nose breathing
while awake creates about 50% more resistance to airflow than mouth
breathing. This results in a 10% to 20% greater oxygen uptake in the
blood.11,12 Breathing through the nose filters and warms the air before it
enters the lungs, and the resistance created by nasal breathing makes the
breathing slower and deeper , engaging the diaphragm and calming the
mind.13
Contrary to the advice of many  sports coaches, it is not a good  idea to
breathe in through the nose and out through the mouth. In one study where
subjects were instructed to breathe that way, nasal stuffiness increased by
200%. What’ s more, congestion  persisted for 10 minutes after the challenge
ended.14 Even during only exhaling, mouth breathing causes the loss of heat
and wate r. To be precise, 42% more water is lost when exhaling through the
mouth than through the nose.15 This loss of moisture and warmth causes
inflammation, stuffiness, and dehydration—which makes breathing more
difficult. Once your nose is blocked, you can find yourself needing to
breathe through your mouth, and so mouth breathing can become a habit. It is best to breathe both in and out through the nose. This not only
facilitates oxyge nation, it also helps prevent nasal congestion. When your
nose is clear , breathing is easier during both rest and exercise. It may sound
contradictory that nasal breathi ng helps clear your nose. After all, most
people breathe through their mouth because their nose is blocked. However ,
when your nose is blocked, the counterintuitive act of breathing through the
nostrils helps keep the airways  clear , prevents dehydration, and improves
breathing volume. When you inhal e or exhale through the nose, breathing is slowe r due to
the extra resistance created by the smaller airway . This resistance toexhaling in nasal breathing helps maintain lung volume.16 Even after
maximum exhal ation, there is always some air left in the lungs. This air is
called residual volume. When the nose is blocked, forcing mout h breathing,
total lung capacity and residual volume both decrease significantly . To understand why this residual volume is important, think about
inflating a balloon.17 The most difficult part is blowin g the initial volume of
air to get the balloon going. However , if you allow an inflated  balloon to
deflate just partway , it is much easier to reinflate it than when you let all of
the air escape. In the same way, if your lungs were completely emptied of air after
every exhalation , breathing would require more effort, the lungs would
collapse, and strenuous activity would be impossible. Ever y time you
exhale through your mouth, you may breathe out more air than necessary . That means that every inhalation takes extra effort. Breathing becomes
much harder work than it needs to be. During nasal breathing, several  things happen differently than they do
during mouth breathing:
• When breathing through the nose, the lungs can extract oxygen from the air during
both exhalation and inhalation.18 Although the oxygen supply to the air sacs in the
lungs is renewed during the inhalation, oxygen dif fuses continuously into the
blood,18 because the small size of the nostrils helps create a flow of air back into the
lungs even during nasal exhalation. • The slower nasal exhalation gives the lungs more time to extract the oxygen. When
this optimal blood gas exchange occurs, carbon dioxide (CO 2) is processed properly ,
and blood pH remains balanced. • Air inhaled through the nose passes through the nasal mucosa. This stimulates
reflex nerves that control regular breathing.19,20 (One reason mouth breathing can
lead to snoring, sleep apnea, and irregular breathing patterns is that it bypasses this
nasal mucosa.) • The air passes through the nose, which houses the olfactory bulbs. Those are
connected to the hypothalamus, the part of the brain linked to many automatic
functions such as heartbeat, blood pressure, appetite, thirst, and homeostasis. • In nasal breathing, the sinuses produce nitric oxide (NO), which is necessary for
regulating inflammation in the airways and in the body’ s defense against airborne
pathogens, viruses, and bacteria. NASAL NITRIC OXIDE: THE WINNING ELEMENTWhile the link between CO2 and blood oxygenation was demonstrated as
far back as 1904 in the research of the Danish biochemist Chris tian Bohr , it
was not until much later that the role of nitric oxide was fully understood. In fact, NO was considered a toxic gas. This small and simple  molecule22
was associated, along with nitrogen dioxide, with environmental pollution,
acid rain, car exhaust fumes, and the smog found in overpopulated
industrial cities. The presence of NO in the exhaled breath of humans23 was
not shown until 1991. In 1992, nitric oxide was named “Molecule of the
Year” by Science  magazine,24 and in 1995, it was discovered that the gas is
produced in the nasal cavity and paranasal sinuses, a group of four air-filled
spaces surround ing the nose. The concentration of NO originating from the
nose is 100 times higher than in the lower airways.25
The paranasal sinuses have a variety of important functions. They
humidify and warm inhaled air and make our speech more resonant. They
also lighten the head and protect vital structures in the event of facial
trauma. These sinuses are positioned around the nose and release nitric
oxide26 into the nasal airways as we inhale through the nose.27 According to
Jon Lundber g, a professor of NO Pharmacologics at Sweden’ s Karolinska
Institute, large amounts of NO are constantly being released into the nasal
airways as we breathe. Every time a breath is taken in through the nose, NO
follows the airflow down into the lungs, where it opens the airways28 and
increases oxygen uptake by the blood. When we breathe, air travels into the lungs, reaching the alveoli—the
small air sacs where gas exchange occurs and oxygen is absorbed from the
air into the blood. The ratio of air-to-blood that reaches the alveoli every
minute is called the ventilation-perfusion ratio . Ventilation refers to the air
we breathe, perfusion to the flow of blood to the small air sacs in the lungs. Ideally , enough oxygen should reach the bloodstream to fully saturate the
blood. However , two factors can cause an imbalance where the upper parts
of the lungs receive more air while the lower parts receive more blood. These are mouth breathing and gravity . When this ventilation-perfusion
mismatch occur s, the body is less able to use the oxygen in the lungs,
resulting in poor oxygenation. NO facilitates a significantly more efficient balance of perfusion to
ventilation, as shown in the diagram.How does it do this? Nitric oxide has vasodilatory properties; that is, it
prompts the blood vessels in the lungs (and other places) to relax, opening
them up for stronger blood flow. When you inhale through the nose, NO is
carried down into the lungs where it helps redistribute the blood more
evenly . This counteracts the negative effect that gravity can have on blood
flow in the lungs.29 Mouth breathing not only causes the shallow , fast
breathing shown  in the first picture (below), it also bypasses nasal nitric
oxide altogether . A 2017 article concluded that nitric oxide is instrumental in many
additional aspects of respirato ry function, including bronch ial smooth
muscle tone, pulmonary blood flow, mucus output, and other processes,
such as antioxidant homeostasis, lung development,22 and local host
defense. In partic ular, NO is key to the production of a vital substance called
surfactant. Pulm onary surfactant, produced in the lungs, is a complex
mixture of specific lipids, proteins, and carbohydrates. It decreases surface
tension in the alveoli, facilitates the uptake of oxygen into the blood,
prevents lung collapse and edem a, and is vital to the elasticity of the lungs.This is often illustrated by a comparison with washing-up liquid between
two panes of glass. The soap allows the two panes to move freely over each
other . In the lungs, surfactant allows easier breathing with less friction and
is funda mental to our ability to breathe air.22,30 Nitric oxide controls the
production of surfactants and maintains surfactant function. That is why the
gas is often used in treating premature babies.31
A FIRST LINE OF DEFENSE
In 1999 , Lundber g and Weitzber g reported that nitric oxide inhibits the
growth of various pathogens, including bacteria and viruses. This suggests
that NO in the nasal airways could serve to help protect the body from
infection.27 As the world battles the unprecedented global pandemic caused
by the COVID-1 9 coronavirus, the relationship between NO and respiratory
infection takes on new relevance. Research in the wake of the first SARS
virus had found that NO acts to keep the sinuses sterile.32 It is also thought
that the very low levels of nasal nitric oxide in people with cystic fibrosis
and Kartagener ’s syndrome might play a part in their increased
vulnerability to respiratory infections. A 2013 paper , “Evidence for the Cure of Flu through Nose Breathing,”
reported that nasal breathing benefits patients with flu.33 This is consistent
with previous studies that showed NO has “opposing effects” in infections
including pneum onia and flu.34 A 2009 laboratory experiment found that
NO inhibited the replication of SARS in two ways. In fact, NO inhibits the
replication of a variety of viruses.35 While the 2009 study didn’ t
specifically use nasal nitric oxide, earlier research into the common cold
had found that we produce more NO in the nose and airways when the
human rhinoviru s is present, which suggested that NO may be the body’ s
way to help clear viruses.36
A wave of clinical trials durin g the 2020 pandemic has continued to
explore the antiviral properties of nitric oxide. Research teams all over the
world have studied inhaled NO for the treatment of COVID-19.37–39
Scientists theorized that high concentrations of inhaled NO, when
administered in the early stages of the infection, would have  a viricidal
effect and prevent progression  to a more severe form of the illness.Research also hypothesized that NO might reduce the severity of the illness
and patients’ recovery time. In June 2020, a company in Canada began phase II clinical trials of a
nitric oxide nasal spray in the fight against COVID-19.40 Speakin g to the
Globe and Mail  in April 2020, Dr. Chris Miller , chief science officer at
SaNOtize Resea rch and Development Corp. said the product is, “Much like
hand sanitizer for the nose.” Before the pandemic, Dr. Miller and his
colleagues had been developin g the spray as a treatment for chronic
sinusitis, but research indicating that NO prevents the novel coronavirus
from replicating caused them to redirect their efforts.41 The spray is
intended to limit the spread of the virus, especially among healthcare
workers treating patients with COVID-19. One scientific article suggests that therapies designed to increase the
levels of NO, such as gas inhalation, could improve oxygenation and boost
overall health in patients with COVID-19. Significantly , this article also
points to lifestyle factors that reduce NO in the airways, especially mouth
breathing and smoking. The researchers argue that combining nasal
breathing and good quality sleep with a healthy lifestyle could help
decrease viral load.39
The same article mentions anecdotal evidence that taping the mouth
during sleep reduces common colds. This may be due to the humidifying
and filtering effects of the nose. It is also thought that the increase in NO in
the airways may reduce viral load during sleep and give the immune system
a boost.
_OceanofPDF.com_The_Breathing_Cure_-_Patrick_McKeown.txt
Summarize the following text section accurately and concisely. Maintain specific details and numerical information, and use anti-repetition mechanisms:

        • Breathe out for three seconds. • Repeat until panic symptoms have subsided. Daily Practice
If the feeling of air hunger brings on a strong fear response, regular practice
of the following short exercises will help desensitize your body’ s reaction to
the feeling of air hunger:
Breathing Recovery, Sitting  (exercise #12) for 10 minutes, six times
daily. OR
Breathe Light  (exercise #1) to create air hunger for 15 to 30 seconds,
followed by rest for 1 minute. Repeat for 5 to 10 minutes, six times a day. OR
Breathing Recovery, Walking  (exercise #13) Walk for 5 to 10 paces
while holding the breath. Practice five repetitions, six times a day. If you ar e comfortable with the feeling of air hunger:
• Breathe Light  (exercise #1) for 10 minutes, three times daily. • Breathe Slow  (exercise #3) for 10 minutes, two times daily. If your BOL T score is
less than 15 seconds, practice a 3-second inhale and a 3-second exhale. If your
BOLT score is greater than 15 seconds, practice a 5-second inhale and a 5-second
exhale. • Breathe Deep  (exercise #2) for 10 minutes, once per day. POST -COVID-19 CARE
I had an email from a colleague recently asking me for some advice about
COVID-19. She wrote:
I have a patient who was diagnosed with COVID-19 in April 2020. When I first met her, she couldn’ t say one sentence without
becoming breathless. When we started working together in October
2020, her BOL T score was just 3 seconds. Now, two months later,
her BOL T score  is around 10 or 11. She can’t do much exercise,
because it is difficult enough to breathe through her mouth. She
wears MyoT ape throughout the day and she can do small breath
holds and Breathe Light, but the other exercises are too difficult. We
did the exercise to decongest the nose and she immediately got a
severe headache. She is also experiencing headaches during the
other exercises. Her BOL T score after the breathing exercises goes
up to around 20 seconds, but her morning BOL T score stays around
10. What else can I do. What causes the severe headache  she
experiences during the exercise. Many people with COVID-19  are experiencing severe breathlessness. BOL T scores as low as three seconds have been reported. Whe n the BOL T
score is this low, it will be difficult to say a complete sentence without
becoming breathless. To improve the breathing, the objective is to increase the BOL T score
gently and consistently. With such a low BOL T score, the risk with any
breathing exercise is that it could contribute to unstable breathing. Exercise Protocol
1. Breathing Recovery, Sitting  (#12) for 10 minutes every hour. Also practice this
exercise if the nose feels congested. It is important to hold your breath for no longer
than half your BOL T score at that time—so if your BOL T score is just 3 seconds, you
will hold your breath for a maximum of 1. 5 seconds. 2. Practice slow breathing with lateral expansion and contraction of the lower ribs to
improve alveolar ventilation. • Inhale slowly through your nose for 3 seconds. • Exhale slowly through your nose for 3 seconds. • If you are comfortable with this, inhale slowly through your nose for 5 seconds. • Exhale slowly through your nose for 5 seconds. • As you breathe in, feel your lower ribs gently moving outward. • As you breathe out, feel your lower ribs gently moving inward. • Practice for 5 minutes, 5 times a day. 3. Breathe only through your nose, day and night. W ear MyoT ape to keep your mouth
closed during sleep. MyoT ape is particularly suitable in this instance as it does not
cover the lips. It is unusual to suffer severe headaches when practicing the exercises. If
you practice intensive breath holds, headaches can occur due to increased
CO2 in the blood. Generally, the headache will subside fairly quicky. If you do exper ience a headache, reduce the intensity of the exercises. Go even more gently as you practice Breathe Light  and Breathing Recovery,
Sitting. OTHER CONDITIONS
For people with:
Schizophrenia
Uncontrolled hyperthyroidism
Chest pains
Heart problems within the past six months
Sickle cell anemia
Cancer
Arterial aneurysm
Kidney disease
Make sure you breathe only through your nose during the day, during
exercise and at night. You can practice the Breathe Slow  exercis e (#3) or
walking with nasal breathing and listen to the free MP3 download available
from OxygenAdvantage. com/breathe-light. For older people and people with:
Second and third trimester pregnancy
High blood pressure
Diabetes
Epilepsy
Panic disorder and anxietySleep apnea
Cardiovascular issues
Serious medical conditions
Only practice breathing recovery exercises and breathing light, slow,
and deep through the nose during rest and physical exercise. Refrain from
practicing any breathing exercise that involves holding of the breath to
generate a strong air hunger. A WORD ABOUT DET OXIFICA TION
As your BOL T score increases, you may experience the effects of
detoxification. The exercises in this chapter are designed to help normalize
metabolic activi ty, improving the body’ s ability to get rid of waste and
clearing the system of toxins. During the detoxification period, it is very important to continue with
your breathing exercises. If you stop, detoxification might not be
completed. It is also beneficial to drink a glass of warm water with a quarter
teaspoon of good-quality sea salt dissolved in it each day. You may find that the symptoms experienced during a cleansing involve
a brief aggravation of your condition. For example, if you have asthma, you
may experience excess mucus production in the nose and airways,
especially during physical activity with nasal breathing. You may also
experience other mild side-ef fects such as a slight headache, diarrhea,
increased yawni ng, a head cold, insomnia, a bad taste in the mouth, and
reduced appetite. These are all just signs that your body is readjusting to a
healthier way of life. In gener al, symptoms should not be disruptive to
normal life and will pass in one or two days. Like any detoxification
process, there is always a short adjustment phase. If the idea of a “breathing detox” is new to you, you may be interested
to know  that toxins, including alcohol, leave the body via the lungs. 7 To
illustrate this, there was a woman in my hometown of Galway, Ireland, who
had some knowledge about breathing. She was arrested on suspicion of
drunk driving. The woman failed the Breathalyzer test and was taken to the
police station for blood tests. While in the back of the police car, shedeliberately hyperventilated for several minutes. I can only imagine what
the of ficers must have thought. Despite the Breathalyzer results, blood results at the station showed low
alcohol levels and she was allowed to go. I am in no way encouraging or
condoning drunk  driving. I do, however, find it fascinating that it is possible
to get rid of alcohol from the blood through the breath. Recent research in
Canada even suggests that hyperventilation could provide a lifesaving
therapeutic intervention in cases of alcohol poisoning. 8
OceanofPDF. comSECTION FOUR: EXERCISES T O IMPROVE FOCUS
AND CONCENTRA TION
One question I’m often asked by my students is “What is the difference
between breathing techniques designed as ‘stressors’ and breathing
techniques that are meant as ‘relaxers’. ”
The answer is that breathing exercises that focus on increasing the speed
or duration of the inhalation are “stressors. ” So are breath holds involving
strong air hunger. These inclu de Oxygen Advantage exercis es that use
breath holding to create a strong air hunger, and they include some of the
techniques used by W im Hof. Breathing exercises designed to slow the speed and/or lengthen the
duration of the exhalation are “relaxers. ” Breath holds involving light air
hunger are relaxers. Breathe Light  (exercise #1), with its emphasis on
relaxation and light air hunger, is a relaxer. So is slow breathi ng, because
the vagus nerve, which drives the parasympathetic nervous system (the
“rest and digest” branch of the autonomic nervous system), is only activated
on exhalation. This means that spending longer in the exhalati on phase is
beneficial to relaxation. Y ou can read about this in detail in Chapter Four. Important:  Hyperventilation and breath holding are very powerful
exercises designed to tempora rily disrupt the body’ s balance to trigger
adaptations. They are not suitable during pregnancy or for anyone with
serious health conditions, including diabetes, sleep apnea, epilepsy, anxiety,
panic disorder, or cardiovascular issues. #19. Box Breathing
This exercise can be used as an alternative to Breathing Recovery, Sitting
(exercise #12). Box Breathing  is traditionally practiced by military
personnel to balance the autonom ic nervous system (ANS). It is designed to
create a state of relaxed alertness, getting you “in the zone. ” There are
different versions of the exercise depending on your BOL T score. If your BOL T scor e is less than 15 seconds:• Breathe in for 2 seconds. • Hold for 2 seconds. • Exhale for 2 seconds.
10 minutes, six times a day.
What is the recommended duration of the Breathing Recovery, Sitting exercise?
To increase the score gently and consistently, as it is difficult to say a complete sentence without becoming breathless.
What is the purpose of the BOL T score in the exercises?
To increase it gently and consistently, as it is difficult to say a complete sentence without becoming breathless.
What is the purpose of the BOL T score?
It is not specified in the provided text, but it is mentioned that it can be used as an alternative to Breathe Light (exercise #1) to create air hunger for 15 to 30 seconds, followed by rest for 1 minute. Repeat for 5 to 10 minutes, six times a day.
What is the recommended duration of the Tum-mo breathing exercise?
It is not specified in the provided text, but it is mentioned that the author practices it for 10 minutes before sleep, and then continues to breathe normally for a minute.
What is the recommended duration of the Humming exercise?