Researchers concluded that this could reduce the negative
impact of exercise for patients with high blood pressure, supporting the
health of the heart.15 In this experiment, the loaded breathing group was
compared against a control group who practiced slow, deep breathing
without the load. Blood pressure and heart rate were also lower in the
control group after the trial, but as with the previous study , the differences
were much less marked. One noteworthy  aspect of both of those studies is that the loaded
breathing device required the patient to mouth breathe. A 2019 review
published in Frontiers in Physiology  studied the effect of adding inspiratory
loads using both nasal and oral breathing.17 Loaded breathing resulted in
increased tidal volume. Nasal breathing promoted greater lung volume and
inspiratory muscle activation compared with oral breathing. Resistancefrom nasal breat hing is higher because the nostrils are so much smaller than
the mouth, so much greater energy and muscle recruitment is necessary to
generate the inhalation. The authors considered the effects of nasal
breathing better for the respiratory system17. But what is really interesting is
the sugg estion that nasal breathing effectively adds a natural load to
breathing. This means that slow  breathing exercises carried out through the
nose will have a positive impact on resting blood pressure without the need
for special load-adding equipment. In regard to the spikes in blood pressure experienced during intense
exercise, the results of a 1990 study are relevant.18 Scientists examined the
effect of nasal breathing on systolic blood pressure in 10 healthy men
during exercise. In this experiment, the participants wore nasal dilators,
which increased  nasal airflow by around 29%. With these dilators, all 10
men could cycle at maximum load without mouth breathing and with a
much smaller increase in systolic blood pressure than normal. The reason
for this modera tion in blood pressure is not known, but researchers put
forward the theory that facilitated nose breathing decreased respiratory
work, relieving the load on the heart, which, in turn, lowered the systolic
blood pressure during exercise.18
DENISE’S ST ORY: A PROGRAM FOR CHANGE
Denise is in her fifties and lives in California. When I first met her, she had
already spent 12 years suf fering from constant fatigue, muscle pain, anxiety ,
brain fog, and high blood pressure. She experienced a range of symptoms
including dizzin ess, constriction around the chest, and the feeling of never
getting enough air . Denise was worn down by her ill health and had little zest for life. In
her search for help, she had spent thousands of dollars visiting many
doctors, special ists, and other healthcare professionals. Recently , her
chiropractor had suggested that she may have chronic hyperventilation. Shortly into my first Skype session with Denise, it was evident just how
noticeable her breathing was. While sitting comfortably for 15 minutes,
Denise displayed a fast breathing rate with each larger-than-normal breath. She was breathi ng from the upper chest, and I could hear each sharp intakeof air as she spoke. Denise didn’ t suffer from asthma or any respiratory
condition, yet her breathing during rest was as noticeable as that of any
person with uncontrolled asthma  I have seen. When she mentioned that this
all starte d 12 years earlier , I suggested that she must have suffered from
significant stress at that time. She replied, “Yes, I had a huge amount of
stress.”
Undoubtedly , the stress Denise experienced 12 years earlier had
activated her sympathetic nervo us system, resulting in a large increase in
the volume of air she was taking  into her body . Over weeks and months, her
brain became accustomed to this larger volume of breathing and it became
habitual. This contributed to the negative effects that were  impacting
Denise’ s quality of life, including chronic stress, high blood pressure,
fatigue, and general ill health. Denise’ s starting BOL T score was only 5 seconds. Given such a low
measurement, I started her off with the Breathing Recovery  while sitting
exercise (see Chapter T wo). This involved her holding her breath for up to 5
seconds after exhaling, breathing normally for 10 seconds, and then
repeating. She was to continue this pattern for about 5 minutes before
taking a rest. The reason I asked Denise to practice this exercise first is that when the
BOL T score is less than 10 seconds it can be challenging to maintain a
tolerable air hunger during the reduced breathing exercise. This can add
tension and stress to the experience, which is not necessary and can be
avoided by beginning the practice very gently . For the first week, Denise’ s program was as follows:
• Practice Breathing Recovery  for 5 minutes every hour . • Practice Breathing Recovery  for 10 minutes before sleep. • Breathe only through the nose at all times. • If Denise sighed, she was to hold her breath for 5 to 10 seconds following the sigh. • Tape her mouth at night using MyoT ape or 3M Micropore tape. • Avoid taking large breaths before speaking. One week later, Denise’ s BOL T score had increased to 10 seconds, and
she was already feeling much more in control of her breathing. She no
longer felt that she was not getting enough air while at rest.In weeks  two and three, Denise began gentle, light, slow, deep breathing
and relaxation. She downloaded some recorded relaxation exercises and
played them twice daily , once before bed and again when she woke in the
morning. By practicing relaxatio n to gently lower breathing volume toward
normal, it is possible to begin the process of reversing years of stress. Denise also practiced gentle, light, slow, deep breathing for 10 minutes
every hour to continue her progress throughout the day . If you have high blood pressure, it’s important to go slowly and gently
when practicing reduced breathi ng exercises so as not to put added pressure
on your body . Practicing light, slow, deep breathing stimulates the
baroreceptors and activates the parasympathetic nervous system, bringing
you into a relaxed state. Your BOL T score will increase each week as you
continue to practice. This will help lower your blood pressure, making you
less reliant on medication. If you are currently taking medicatio n to control
high blood pressure, it’s import ant to consult a medical profes sional when
your BOL T score reaches 20 seconds so that your medication can be
adjusted to suit your current condition. Over several months, Denise’ s high blood pressure and cholesterol both
normalized, and she reported much higher energy levels. She also felt
calmer than she had for many years. Her BOL T score increased to 28
seconds, which,  considering it was only 5 seconds when she began, is
remarkable. Denise’ s health improved, and her doctor altered her
medication based on her progress. Denise’ s ongoing routine is as follows:
• She practices 10 minutes of light, slow , and deep breathing exercises four times
each day , with one session just before bed and one just after waking. • She tapes her mouth closed during sleep to ensure nasal breathing at night. • She practices Breathing Recovery  whenever she feels anxious or stressed. • She walks, with her mouth closed, for half an hour daily . • She observes her breathing periodically throughout the day and avoids taking big
breaths through her mouth. The benefits of slow breathing and relaxation are twofold: the
baroreceptors become more responsive to changes in blood pressure, and
the BOL T score increases. The reason Denise’ s BOL T score improved so
noticeably was that her sensitivi ty to blood CO2 had decreased. There is aninverse relationship between sensitivity to CO2 and the sensiti vity of the
baroreceptors19—those movem ent-sensitive nerve endings that work to
regulate blood pressure. When the sensitivity to CO2 is lower , which  is the
case in healthy breathing, the baroreceptors are stronger and more able to
maintain blood pressure at healthy levels. As we discussed in Chapter Four , there’ s a link between HRV and the
baroreceptors. This means that better HRV leads to better -regulated blood
pressure. Low HRV is a feature in adults20 and children21 with
hypertension. Autonomic dysregulation is present in the early stages of
hypertension20. Scientists suggest that because HRV provides an important
window into the responses of the autonomic nervous system, HRV
biofeedback may be valuable in treating hypertension.22 A 2013 study into
evidence-based applications for HRV biofeedback suggests that
biofeedback could be helpful in strengthening the baroreflex.23
OceanofPDF .comNCHAPTER TEN
FREEDOM FROM RESPIRATORY
DISCOMFORT
WHA T IS ASTHMA? o book on breath ing would be complete without a discussion about
asthma. But just what is asthma? The word asthma  is borrowed
from the ancient Greek ἆσθμα, âsthma, meaning “laborious
breathing,1 shortness of breath,2 or panting.”3 Reference to the condition
can be found in ancient Hebrew , Egyptian, and Indian medical writings, and
clear observations of patients experiencing asthma attacks exist as early as
the second century CE. The categorizat ion of asthma was refined in the second half of the
nineteenth century2 when English physician Henry  Hyde Salter published
his book, On Asthma and Its Treatment , a volume that one 1985 article
describes as “the best book on asthma to appear during the nineteenth
century .”4 In this work, Salter , who was himself asthmatic, describ es
paroxysmal breathlessness of a “peculiar character” with periods of healthy
breathing between attacks. This description perfectly captures a disorder in
which the airways narrow due to inflammation and contraction of the
smooth muscle. By the late nineteenth century , the medical community had
accepted the view that asthma was a distinct condition with a clear set of
causes and treatment requirements. The Canadian physician, Sir William Osler , who is sometimes credited
as the father of modern medicine, wrote about asthma in his 1892
textbook.5 He described the symptoms of the disease as:• Spasming of the bronchial muscles
• Swelling and inflammation in the airways
• Having distinctive, gelatinous mucus secretions
• Resembling hay fever , and being sensitive to atmosphere, climate, and allergens
• Running in families, often beginning in childhood and lasting a lifetime
• Sometimes triggered by fright, strong emotion, overeating, or particular foods
Asthma was treated predominantly by managing exacerbations with the
use of bronchodilators taken in the form of oral inhalers. Over -reliance on
this medication  was believed to be a contributing factor in various
epidemics of asthma death in the United States, United Kingdom, and
Australia in the 1960s, and in New Zealand in the mid 1980s.2 These deaths
drew attention to shortfalls in asthma treatment and emphasize d the extent
to which asthma was still not clearly understood. By the 1980s, doctors had more knowledge about the role of allergen
exposure as an asthma trigger . However , although the primary characteristic
of asthma—bloc ked or narrow airways—was well recognized and easy to
diagnose, the causal mechanisms were still not fully understood. While current thought questions  whether inflammation is the root cause
of asthma, it is certainly a factor in the disease. In eosinophilic asthma ,
inflammation occurs as part of an allergic or immune system reaction,
which causes specific white blood cells called eosinophils to be released. An increase in white blood cells typically leads to an inflammatory
response, causing the airways to thicken. The resulting fluid and mucus
may result in bronchospasm and asthma symptoms.6
THE CONGESTION CONNECTION
The nose and lungs form a single, unified airway . This means that where
inflammation is present, it can travel from the nose to the lungs and from
the lungs to the nose.7 This is one reason people with asthma experience
high levels of nasal congestion. The normal response to a stuffy nose is to
begin breathing through the mouth. This, however , increases breathing
volume, draws cold, unfiltered, dry air into the airways, and makes the
symptoms of asthma worse. Habitual mouth breathing also affects sleep and
causes or contributes to stress.People with asthma often don’t realize how much the condi tion can
impact their overall health, but asthma can lead to fatigue, poor
concentration, and anxiety . As you’ll read in the next chapter , it can also
have an enormous effect on things we would otherwise take for granted,
such as the ability to enjoy a healthy sex life. As with other  respiratory
conditions and underlying breathing pattern disorders, when breathing is
affected, so is the body and the mind. For any child or adult with asthm a, the switch to nose breathing and the
practice of breathing exercises to normalize breathing volume can be life
changing. When I work with a client, I expect their asthma symptoms to
decrease by 50% in just two weeks. There will also be notable
improvements in their sleep patterns, ability to focus, concentration, and
levels of stress. The airways of people with asthma are particularly prone to narrowing. This is due to a combination of factors including inflammatio n, increased
mucus secretion, and constriction of the smooth muscle surrounding the
airways. When the airways narrow , a feeling of breathlessness occurs. As
the body tries to compensate for the lack of air, breathing becomes faster ,
and the volume  of inhaled air increases. The sensation of air hunger may
encourage the switch from nasal to oral breathing. Normal breathing volume for a healthy adult is now between five and
eight liters per minute.8 This volume has actually increased. Twenty years
ago, normal minute ventilation was between four and six liters, with six
liters considered the upper limit. A minute volume of eight liters per minute
implies a breathing rate of 16 breaths per minute, which is too fast. In my
opinion, eight liters is an unhealthy minute volume, and it makes me
wonder , has modern living changed our breathing patterns so much that it is
now normal to overbreathe? In contrast, in people with asthma, resting ventilation is typically
between 10 and 15 liters per minute.9–11 While it is common for the
narrowing of the airways to cause breathing volume to rise, breathing too
much air will itself cause the airways to narrow . Thus, overbr eathing can
easily become a vicious cycle. The negative impact of overbreathing on compromised lungs is
underlined in a paper published in the Annals of the American ThoracicSociety  in 2020. According to it, a body of research demonstrates  the
importance of low tidal volumes when ventilating patients whose lungs
have been damaged by the COVID-19 virus. Scientist have found that,
when lungs have been injured by infection and the patient has suffered
acute respiratory distress syndrome (ARDS) and respiratory failure, the
injury can be compounded “if the size of the breath provided by the
ventilator is too large or the pressure used to inflate the lung is too
great.”12,13 These patients  must be treate d with smaller breath sizes to
prevent additional damage. How ever, this makes the sensation of air hunger
much worse. Prolonged air hunger can cause feelings of anxiety and fear,
and the paper points out that acute air hunger has been used as a very
effective form of torture. In this extreme case, to avoid both damage to the
lungs and psychological distress , researchers urge the use of opiates to treat
the resulting breathlessness and sedatives to moderate feelings of anxiety . More generally , a substantial 2016 study in Aller gy demonstrated that
mouth breathing was associated with the worsening of asthma. Even
participants who did not have asthma experienced poorer lower lung
function and more sensitivity  to house dust mites when they mouth
breathed. Researchers examined questionnaires completed by 9,804 people
from Nagahama  City in Japan and found that mouth breath ing causes
asthma to become more sever e, possibly by increasing vulnerability to
inhaled allergens. Scientists concluded, “The risk of mouth breathing
should be well recognized in subjects with allergic rhinitis and in the
general population.”14 A separate study found that habitual mouth breathing
reduced lung function in people with mild asthma and exacerbated the
symptoms of acute asthma.15
A diagnosis of poor lung function should be cause for concern,
prompting better self-care, and positive action. In a trial lastin g 30 years,
scientists from the University at Buffalo found that men with the poorest
lung function at the start of the study were over twice as likely to have died
by the follow-up than men with good lung function. Women with the worst
lung function were one-and-a-half times more likely to have died than their
healthy counterparts.16 In an interview for Science News , Holger
Schünemann, lead author on the study said, “This observation suggests thatthose with lower lung function levels may need to pay particu lar attention
to avoid negative ef fects, such as smoking, on their lungs.”17
The term dysfunctional breathing  describes abnormalities in breathing
patterns that span a range of extremes from fast, superficial breathing to
slow, overly deep breathing. A person with hyperventilation syndrome may
breathe into the upper chest 18 to 40 times a minute. While the term
hyperventilation  is often used interchangeably with dysfunctional br eathing ,
a slow breathin g rate of 5 to 8 breaths with breathing that engages the
diaphragm and the whole chest is also unhealthy . Both patterns result in an
excessive volume of air entering the lungs each minute and may cause
frequent sighing as the body tries to compensate for overinflate d lungs and
high tidal volume. While disordere d breathing is widely recognized, it is ill-defined and
often coexists with asthma. One 2017 study , which used the Nijmegen
Questionnair e (NQ), the preferred tool to screen for hyperventilation
syndrome, estim ated that 25% of studied patients with severe asthma also
displayed dysfunctional breathing.18 Given what we know about the
accuracy of dysfunctional breathing screening, it is likely that the actual
figure is higher . Standard asthma  drugs target bronchoconstriction, airway inflammation,
and possible comorbidities (conditions that exist alongside asthma but are
not necessarily the result of it). Nonpharmacological asthma treatments
focus on diet, physical fitness , weight reduction in obese patients, and
avoiding triggers. When asthmatics show overt signs of dysfunctional
breathing, a program of breathing reeducation may be implemented with a
trained physiotherapist. Physiotherapists use methods including pursed lip, abdomi nal and
cadence breathi ng. However , even more benefit can be gained when the
breathing bioch emistry is addressed with the practice of light, nasal
breathing. One of the simplest ways to understand the BOL T score is in
terms of breathl essness. A lower breath-hold time corresponds  with more
breathlessness during rest and more airway obstruction. Each five-second
increase of the BOL T score reduces asthma symptoms such as exercise-
induced asthma, coughing, wheezing, breathlessness, and chest tightness. The BOLT works the same way as a breath-hold measurement called theControl Pause, which is practic ed in the Buteyko method—the breathing
technique I learned from Dr . Konstantin Buteyko. Scientists have studied the Buteyko method and its effect on asthma. The first trial of the Buteyko method for asthma in the western  world was
conducted at the Mater Hospital in Brisbane in 1994.19 Nineteen people
were assigned to learn the Buteyko method, while a 20-person control
group followed the hospital’ s in-house program for asthma. After 12 weeks
of pract ice in nasal and reduc ed volume breathing, the Buteyko group
showed a 70% reduction in symptoms, a 90% drop in their need for rescue
medication, and a 49% decrease in their need for inhaled steroid
medication. The control group, who were taught physiotherapy exercises,
experienced no improvement. The reason for this is likely to be that nasal
breathing and reduced volume breathing are not taught during
physiotherapy . At the start of the trial, all of the study particiopants
breathed 14 liters of air per minute. At the end of the 12 weeks, the Buteyko
group had reduced their minute ventilation to 9.6 liters, while  the control
group had minimal reduction. Interestingly , end-tidal carbon dioxide (CO 2) remained low in both
groups. At the beginning of the study , the Buteyko group showed an
average of 33 mmHg and the control group 32 mmHg. After 12 weeks, the
Buteyko group had slightly increased CO2 to 35 mmHg and the control
group to 33 mmHg. Although  Dr. Buteyko’ s original theory regarding
asthma revolved around CO2, the science has moved on since his work in
the 1950s. While the precise mechanism explaining the benefici al effects in
the Buteyko group is not clear, the fact is that over the past 20 years,
research into the impact of the Buteyko method on asthma has
demonstrated positive results. Now , the British Medical Journal  states in its
physiotherapy guidelines for adults, “The Buteyko breathing technique may
be considered to help patients to control the symptoms of asthma.”20
EXERCISING WITH ASTHMA
Many elite athletes who suffer from asthma favor swimming above other
forms of exercise. This is no coincidence. During swimming, the face is
immersed in water , and the weight of the body in the water exerts gentlepressure on the chest and abdomen. Both of these factors naturally restrict
breathing volum e. Even though the swimmer draws the breath in through
the mouth, the amount of air that reaches the lungs per minute is still less
than in other sports such as running or cycling. According to a 2018 paper ,
swimming causes much less post-exercise bronchospasm than running or
cycling at the same intensity .21 This is partly because the air is moist and
warm. In an indoor swimming pool, the average air humidity is around 60%
and the air temp erature around 27° Celsius (80.6° Fahrenheit). Both factors
can relieve asthma symptoms. The pressure of water on the chest wall helps
with exhalation , and the accum ulation of CO2 caused by the controlled
breathing necessary during swimming helps relax the airways.21
There is, however , a downside to swimming. Too much time spent in
chlorinated pools can damage lung tissue,22–25 a factor particularly
problematic for people with asthma. This is important for very young
children, especially if they are predisposed to asthma. One longitudinal
study of 337 children with asthma and 633 controls (age-matched children
without asthma) demonstrated that swimming pool exposure in early life is
associated with a significantly higher risk of preschool asthma onset by the
age of one year.26 The 2018 paper found that 21.7% of the asthmatic
children reporte d eye irritation in indoor swimming pools compared with
only 9% of the control group, and that 5.5% of children, all of whom were
sensitized to at least one inhalant allergen, experienced worse asthma
symptoms in indoor pools. A 2018 Canadian Respiratory Journal  article found that asthma is
highly prevalen t among elite endurance athletes.27 The study aimed to
determine how common asthma and the use of asthma medicat ion were in
competitive recreational endurance athletes and the association of these
factors with training. Researchers examined web survey responses from
38,603 adults who were participating in three Swedish endurance
competitions that involved cross -country running, cross-country skiing, and
swimming. They found that 12% reported asthma and 23% of those with
asthma used inhaled corticosteroids and long-acting beta-agonists daily . Participants who were more likely to suffer from asthma were female, those
with allergic rhinitis, a history of eczema, a family history of asthma, and
those who cycled or trained for more than 5 hours 50 minutes per week.The study found that the incidence of asthma among competitive
recreational endurance athletes was higher than in the general population. A
significant number of the athletes used asthma medications. The study
describes a distinct phenotype of asthma specific to elite athletes. “Sports
asthma” is defined by “exercise-induced respiratory symptoms and airway
hyper -responsiveness without allergic features.” This kind of asthma is
more common in athletes taking part in water and winter sports.27
Researchers also found that around 70% of swimmers and skiers suffered
with aller gic rhinitis. The athletes in the Swedish study included those at international and
high national competitive levels as well as professional and
semiprofessional sportspeople who trained for a significant number of hours
per week. A high training volume was found to impact asthma more than
the age of the athlete, suggesting that training may prevent remission of
asthma in adults . Cycling was found to be the sport most closely associated
with asthma, regardless of fitness. In fact, a high prevalence of asthma has
previously been reported among  Olympic cyclists.28 This may be because
cycling requires long training sessions with high-volume breathing. Also,
training often takes place outdoo rs, frequently on roads where the cyclist is
exposed to vehicle exhaust fumes, tire particles, and pollen, all of which
may contribute to asthma symptoms. Fortunately , by practicing the breathing exercises described in this book,
it becom es possible to continue nasal breathing at a higher intensity of
exercise. This reduces mouth breathing, which is one of the primary triggers
for exercise-induced asthma. SLEEPING WITH ASTHMA
Sleep is often very difficult for asthma sufferers. Asthma symptoms
commonly worsen overnight,29 particularly in the early hours of the
morning, and nighttime exacerbations are extremely common. The
detrimental effect of poorly controlled asthma on sleep has long been
recognized,30 but in recent years there has been a growing interest in the
way asthma interacts with sleep and sleep disorders. People with asthma
frequently suffer with sleep disturbance and poor-quality sleep, particularlywhen asthma is severe. Lack of sleep or impaired sleep quali ty is linked
with worse asthm a control. Poor sleep impacts quality of life and can affect
physical and mental resilience. As someone who suffered notic eable asthma symptoms and poor sleep
for over 20 years, I am intrig ued why such a strong conne ction exists
between asthma  severity and sleep-disordered breathing. I believe that if
researchers were to investigate uncontrolled asthma during sleep, they
might uncover clues for the treatment of sleep apnea. It is my experien ce from working with thousands of children and adults
with asthma, that people with asthma have a low breath-ho ld time. In
adults, the typic al BOL T score is between 10 and 15 seconds, and children
with asthma can normally hold their breath for around 20 to 40 paces. This
low breath-hold time, which is indicative of high chemosensitivity to CO2,
corresponds to a phenotype of sleep apnea called high loop gain. High loop
gain results in unstable breathing during sleep, from total stopping of the
breath to an exaggerated gasping for air when breathing resumes. The
exercises in this book are ideall y suited to people with high loop gain and
can be used to develop stable breathing patterns. When asthma is uncontrolled, breathing generally becomes faster and
harder . When we breathe faster , we are more likely to wake during the
night, resulting in poor sleep quality. This ties in with the arousal threshold
phenotype in sleep apnea. In addition, inflammation of the lungs during
uncontrolled asthma can migrate to the nose, resulting in nasal stuffiness. The feeling of air hunger when breathing through the nose inevitably results
in mouth breathing. This, in turn, narrows and increases turbulence in the
airways, causing sleep disruption. Finally , faster and harder breath ing through an open mouth is generally
from the upper chest. Breathin g fast from the upper chest is inefficient,
uneconomical, and the worst way to breathe as it inhibits oxygen transfer
from the lungs to the blood, reduces lung volume, and results in easier
collapse of the upper airway , causing the breath to stop during sleep. Scientists believe that sleep disturbances in asthmatic patients may
relate to sleep disorders including obstructive sleep apnea30. A substantial
body of research also indicates that nocturnal symptoms, including
coughing and breathlessness are accompanied by variations in airwayinflammation and anatomical changes that may be impacted by circadian
rhythms.29
Persistent cough ing is another factor likely to disrupt sleep. Coughing
wakes the sleeper out of deep sleep, causing poor quality of sleep and
fatigue the following day. Symp toms of asthma frequently worsen at around
four o’clock in the morning, when the incidence of asthma-related sudden
death is also most common.29 In one survey of 7,729 asthma patients, 74%
awoke at least once per week with asthma symptoms, 64% suffered
nocturnal asthm a exacerbations at least three times a week, and around 40%
experienced symptoms every night.31
Circadian rhythm s are the autonomous, self-sustained natural processes
that regulate the sleep-wake cycle.29 They make it possible for the body to
anticipate environmental changes and optimize survival. For example, the
sleep-wake cycle enables us to rest at night and be active during the day. Lung function fluctuates in any 24-hour period in healthy people, but in
people with nighttime asthma symptoms, these changes are much more
profound, with the difference in breathing volumes between wakefulness
and sleep exceeding 15%.29
One reason asthma symptoms  are worse at night and in the early
morning is that mouth breathing during sleep can add to breathing volume. If breathing during the day is poor, breathing during sleep will also be
uncontrolled. Even without the circadian fluctuations in lung function and
inflammation, poor breathing patterns and sleep-disordered breathing can
lead to nighttime breathing difficulties. For this reason, it is not advisable to
sleep for more than eight hours. While nocturnal asthma symptoms
frequently cause sleeplessness and daytime fatigue,32 correct practice of
breathing exercises during the day will help reduce overbreathing at night. Uncontrolled asthma results in hard, fast, upper chest breathi ng. The
solution to improve asthma control and quality of sleep lies in light, slow
and deep breathing. There are several techniques you can try that can
greatly improve asthma control and sleep quality:
1. Pay attention to your asthma symptoms before you go to bed. If you are wheezy or
have noticeable symptoms as you head of f to the land of nod, it’ s likely you will wake
up during the night with an attack. If you are experiencing symptoms before sleep,
it’s best to remain awake until they are under control or sleep sitting upright. If youhave been prescribed a steroid medication, make sure to take it before you go to
sleep, and always practice your breathing exercises to reduce symptoms
before going to bed . 2. Practice light, slow , and deep breathing to achieve a tolerable air hunger for 15
minutes before sleep. 3. Avoid sleeping on your back. This is the worst position for overbreathing. As there is
very little restriction to breathing, you are likely to breathe more deeply during the
night. The lower jaw is also more prone to drop down, causing mouth breathing. Sleep on your side or abdomen instead. 4. Wear the Buteyko belt over your nightshirt during sleep. The Buteyko belt is a
specially designed tool that imposes a resistance to the breathing muscles, lowering
the risk of hyperventilation during sleep. I often wear the belt during sleep and find
that it improves my quality of rest. T ighten or loosen the belt to create a tolerable air
hunger . You can purchase a Buteyko belt online. 5. Make sure your bedroom has a good circulation of fresh air . 6. Only breathe through the nose while asleep. W earing MyoT ape will help bring the
lips together to ensure nasal breathing. If the nose is very stuf fy, wear a nasal dilator
such as Mute Snoring. MyoT ape can be ordered from MyoT ape.com. 7. Work to improve your everyday breathing patterns by addressing breathing from all
three dimensions—light, slow , and deep. 8. Achieve a higher BOL T score. Every 5-second improvement to your BOL T score will
result in more light, slow , and deep breathing. Ideally , to improve asthma control and
sleep quality , the BOL T score needs to stay above 25 seconds. Once you have begun to norma lize your breathing volume, addressed
underlying breathing pattern disorders, and increased your BOL T score, you
will find you enjoy better sleep, and this will have a positive impact on your
energy levels and quality of life. PREVENTING AN ASTHMA A TTACK
Generally , an asthma attack does not come out of the blue. You will usually
experience warning signs such as increased tightness of the airways, a
blocked nose, and wheezing or coughing. When you feel the first symptoms
of an attack, it can be very helpful to perform the following exercises to
help control your breathing. Use these exercises to prevent or lessen
symptoms at the onset of the attack. Once an asthma attack is underway , it
is very dif ficult to maintain control of breathing using exercises. Medication
or medical attention may be necessary . EXERCISESPerforming Breathing Recovery (sitting or walking)  when you first observe
the onset of asthma symptoms can help reduce the severity of an attack or
even head it off completely . However , it is important not to create too
strong an air hunger during this exercise as it will cause a pronounced
increase in your breathing after the exercise. Breathing Recovery , Sitting
• Take a normal quiet breath in and let it out. • Following an exhalation, hold the breath for between 3 and 5 seconds. • Do not try to hold your breath for longer than this. It will only increase your breathing
and exacerbate the asthma attack. • Maximum breath-hold time should be no greater than half your BOL T score at the
time of practicing. • Leave 10 seconds between each breath hold, and don’t try to interfere with your
breathing during this time. • Repeat the small breath hold, followed by a rest of 10 seconds, during which you
should breathe normally through your nose. • Continue until the attack has passed. Breathing Recovery , Walking
Instruction:
• Exhale through your nose. • Pinch your nose with your fingers to hold your breath, and walk for 5 to 10 paces,
holding your breath. • Stop walking. • Breathe in through your nose, and rest for about 30 seconds while standing still. • Repeat up to 10 times.If you are practicing at home, you can repeat this exercise 6 times, five
times per day. Holding the breath for up to 10 paces is very suitable for
anyone with severe asthma, COPD or panic disorder . It is also ideal if you
have disproportionate breathlessness, anxiety , a racing mind, or a low
BOL T score. During an asthma attack, incomplete exhalations can cause air trapping
or breath stacking. It is often harder to breathe out than to breathe in. If you
experience this feeling of overinflated lungs, it is helpful to practice
breathing out slowly and comp letely . This is not easy to do when your
breathing is fast and labored, but it can be practiced between the exercises
to help stop your symptoms. Follow these steps to ease the feeling of
overinflated lungs:
EXHALA TION BY RELAXA TION
• Breathe in gently and hold your breath for half a second. • Concentrate on relaxing the chest, shoulders, and abdomen. • Slowly exhale through your nose. Do not force your breath out in any way . Gently
breathe out, slowly and completely . The natural elasticity of your diaphragm, lungs,
and ribs will return the breathing muscles to their resting positions, resulting in a full,
passive exhalation. • Breathe in as normal. • Repeat the exercise several times over the course of 10 minutes or until the attack
has passed. This exercise can be used at any time, whether you are suffering from
breathing difficulties or not. It will help to normalize breathing through
relaxation. Many people with asthma find that they truly begin to
understand the benefits of reduced volume breathing the first time they
successfully use the exercises to overcome an asthma attack. EXERCISE T O ST OP A COUGHING A TTACK
Coughing is one of the most common symptoms of asthma. Although some
people are more prone to bouts of coughing than others, a 2018 study states,
“Cough alone may sometimes be the sole presenting symptom of asthma.”
Some asthmatics  have normal lung function33 and experience coughing and
bronchial hyper reactivity (sensi tivity to airway-narrowing stimuli) withoutany shortness of breath or wheezing.34 Scienti sts have found that, on
average, 25% of patients with chronic cough have a type of asthma called
cough variant asthma. These people tend to respond to traditional asthma
therapy . A prolonged episode of coughi ng can be particularly difficult to stop. Much like other asthma symp toms, coughing attacks tend to be more
frequent at night or in the early morning. Persistent coughing is very
disruptive to breathing, so it is important to reduce its effects and prevent an
attack taking hold. Coughing is a reflex action caused by irritated airways. It’s the body’ s
way of clearing the airways of mucus and other irritants. Overbr eathing can
make the airway s dry and inflamed, triggering a cough, and this, in turn,
can lead to further overbreathi ng. When you cough, you take in a deep
breath followed by a forced expiration of air. This action causes cooling and
drying of the airways and a loss of CO2, which inevitably leads to another
cough and another forced expiration. If you don’t stop the cycle, you will
soon find yourself having a coughing fit. The following approach can help you stop an attack of coughing:
• Try to suppress the cough if possible. Y ou will experience a ticklish feeling in your
throat, but after a while, the urge to cough should decline. Swallowing will help curb
the need to cough. • Don’t try to force out mucus. Instead, reduce your breathing, and allow the mucus to
come up naturally . It can then be swallowed to dissolve harmlessly in the acid of the
stomach or be spat out if the circumstances are appropriate. • Try to cough only through your nose. • Perform Breathing Recovery , Sitting  of between 3 and 5 seconds until your cough
has passed. The main point to remember is that the deep breathing and forced
exhalations that occur during coughing will only perpetuate the cycle. Being conscious of this will help reduce the attack. It is important to note that breat hing exercises will only help alleviate a
coughing fit when applied during the early stages of an attack. If symptoms
have been occurring for more than five minutes, they will be a lot more
difficult to control using breathing exercises, especially if your BOL T score
is less than 20 seconds. If breathing difficulties continue for as long as five
minutes, take your medication. If you are having a severe attac k, take yourmedication immediately . If your symptoms do not respond to your
medication within a few minutes, seek medical attention. BLOWING YOUR NOSE
Another commo n symptom of asthma is a blocked nose. If you are prone to
nasal stuf finess, you will continue to experience symptoms until your BOL T
score is at least 25 seconds. The normal reaction to nasal congestion is to
repeatedly blow  your nose, in an effort to get rid of mucus and clear your
sinuses. But blowing your nose too much can actually aggravate the
problem, inflaming the airways  and increasing production of mucus. This
makes feelings of congestion worse, and so you find yourself caught in a
self-perpetuating and distressing cycle of excess mucus and nose blowing. To help decongest your nose without increasing your breathing volume,
follow these guidelines:
• Only blow your nose when it feels absolutely necessary . • If you must blow your nose, do so gently . • Spend five minutes reducing your breathing or practicing the nose unblocking
exercise (see Chapters T wo and Three ). OVERCOMING RHINITIS AND HA Y FEVER
Severe asthma is associated with a number of conditions that can make
disease management more difficult and affect treatment outcomes35. These
“comorbidities”—illnesses that exist independently of but along side asthma
—often mimic asthma symptoms and contribute to poor disease control. Asthma and rhinitis are closel y connected, and the risk of allergic
rhinitis (AR) is higher in those who have had allergic asthma in
childhood.36 The global prevalence of allergic disease has increased
considerably in recent decades,36 with a significant cost both economically
and in terms of well-being. One 2020 paper reported that 17.8% of 8,000
participants, aged between 20 and 69 years, had allergic rhinitis,37
otherwise know n as hay fever . The same article states that incidence of AR
is highes t during  childhood and steadily decreases with age. A 2018 review
of adults in T ehran found that 28.3% of those studied had AR.38 And a 2013paper from the World Aller gy Organization reported that allergic rhinitis is
the most common form of noninfectious rhinitis, affecting between 10%
and 30% of adults and up to 40% of children.39
Aller gic rhinitis is defined as an inflammatory and antibody-mediated
disease.40 Symptoms occur when airborne allergens are inhaled, but
diagnosis depends on how often symptoms are triggered. If rhinitis occurs
due to pollens, it will be classifi ed as seasonal; if dust mites are the cause, it
is perennial, and, if it is brought on by a specific allergic enviro nment, it is
intermittent.40 This differentiation helps doctors to find the most
appropriate treatment strategies. AR is also considered to be intermittent or
persistent, according to the duration of symptoms. People with persistent
rhinitis may suffer significantly impaired quality of life, loss of productivity
and workdays, missed school time, and reduced ability to learn. One of the most obvious and problematic symptoms of rhinitis and
allergic rhinitis is nasal congestion.41 It can be triggered by allergens such
as dust mites, pollen, and spores, by an oversensitive immune reaction, or
by nonaller gic reactions such as the common cold, and it can interfere badly
with sleep. People who have difficulty breathing through the nose are
almost twice as likely to suffer sleep problems,42 meanin g that persistent
nasal congestion can leave them feeling tired much of the time. A 2020 study summarizes the main underlying mechanisms that link
allergic rhinitis and altered sleep patterns as follows:
• Inflammatory cytokines related to allergic rhinitis cause feelings of fatigue. • The symptoms and underlying physiological changes that occur in AR indirectly
affect sleep. • Sleep can be negatively impacted by dysfunction of the autonomic nervous
system.43
Nasal congestion is known to affect sleep and contribute to sleep
disorders, including snoring and OSA. By decongesting the nose using the
exercise from Chapter Two and normalizing breathing patterns, you are
likely to experience better sleep, less daytime tiredness and improved
quality of life. RHINITIS AND THE AUT ONOMIC NER VOUS SYSTEMScientists believe that an imbalance of the autonomic nervous system
(ANS) plays a role in the poor quality of sleep experienced by people with
allergic rhinitis. One pathway by which the ANS impacts rhinitis is a
powerful autonomic reflex called the trigemino-car diac reflex  (TCR). The
trigeminal nerve  is the fifth and most complex of the cranial nerves. It
innervates the face and takes care of actions including chewing and biting.44
TCR helps reduc e the heart rate in challenging situations. It is known to
cause apneas. An exaggerated form of the reflex may contribut e to sudden
death and sudden infant death syndrome.46 One 2017 review explains:
The amount of influence that the autonomic system exerts on the
heart, manifest ing either as arrhythmias or as OSA-ind uced
bradycardia and hypertension, does suggest the possibility of the
TCR playing a role in sudden death.45
Another paper , also from 2017,  concludes that TCR could link rhinitis
and sleep disorders.46 TCR triggers parasympathetic overactivity and
sympathetic inhibition, leading to the sudden onset of bradyc ardia (slow
heart rate) hypo tension (low blood pressure), apnea, and gastric motility
(contractions of the smooth muscle of the stomach). Autonomic imbalance
also contributes to the onset and development of rhinitis. While the extent of autonomic dysfunction in allergic rhinitis and sleep
still needs further research, it is certain that constant nasal congestion,
uncomfortable breathing, and poor quality of life can influence autonomic
imbalance in the form of chron ic stress. This has a direct effect on sleep. AR is associated with symptoms, including congestion, nasal dischar ge,
sneezing, palata l itching, fatigue, and mood changes. Its most common
behavioral complications are tiredness and sleep disturbance caused by an
inability to breathe properly . Studies have also acknowledged compromised
mental health, including anxiety and changes in emotional reactivity . A highe r incidence of anxiety , and, in some cases, depression, has been
observed in people suffering from respiratory allergies. Anxiety itself can
produce an exaggerated inflammatory response due to an overa ctive fight-
or-flight mechanism. It has been suggested that high levels of anxiety can
develop as a direct result of chronic illness, creating a self-perpetuating
negative feedback loop. In a 2009 study , scientists demonstrated anxietyand reduced social interaction in rodents with experimentally induced
rhinitis. They concluded that allergic rhinitis could influence behavioral
responses.47
During allergic rhinitis, inflammatory mediators, including histamine,
are released. These have a direct influence on the central nervous system
and contribute to disturbed sleep and daytime tiredness. Histamine can
affect the regulation of the sleep-wake cycle, and this may lead to a sleep
condition called arousal disorder . Aller gic rhinitis also causes reduced
levels of certain cytokines called interleukins that are vital in activating
immune respon ses, such as inflammation, and may be important in
stimulating restorative sleep and improving circadian rhythms.43
While it may not be news to anyone who suffers with the condition,
scientists have proven that rhinitis can have a negative impact on feelings of
well-being. One 2020 study reported that the quality of life in children with
allergic rhinitis was directly related to the severity of their symptoms.48
Researchers noted that parents often overestimated the quality of life
experienced by their children in this situation, and therefore, that it is of
great importance to ask children how they feel rather than rely on parental
perception. CAN NASAL BREA THING RELIEVE RHINITIS? Healthy nasal breathing can minimize symptoms of rhinitis and moderate a
range of conditio ns that lead to nasal congestion. The high conc entration of
nitric oxide in the sinuses is instrumental in keeping the nose and lungs free
of disease and inflammation. It is likely that the reduction in inhaled NO
caused by mouth breathing during sleep contributes to the nega tive effects
of noctu rnal mouth breathing49. When we breathe nasally , NO is released
into the nasal cavity50 and carried down to the lungs in concentrations that
are betw een 5 and 20 times higher than during mouth breathi ng.51 When
nasal breathing is combined with slow breathing, this allows an even
greater concentr ation of NO to be carried into the lungs. As the BOL T score
increases, breathing becomes slower , and so it is likely that a higher BOL T
score leads to improved uptake and use of NO.Numerous studi es demonstrate that nasal nitric oxide is found in much
greater amounts in people with untreated symptomatic seasonal rhinitis, and
that when AR is treated with nasal steroids, NO levels return to normal.52
This strongly suggests that quantities of NO are released as part of the
body’ s immune response, which  fits with what we know about the role of
NO as a first line of defense against infection. The increased level of NO in
rhinitis patients is so marked that nasal NO measurement has become a
more-or -less standard way to assess nasal inflammation and the response to
anti-inflammatory medications. This function of nasal NO is noted in various studies, including  a 2019
paper that examines the clinical uses of exhaled NO measurement in the
management of asthma and allergic airway inflammation. Researchers in
that trial concluded that when  stimulated as part of the inflammatory
response,53 special enzymes called nitric oxide synthase produce NO at a
slow rate but in large quantities. This causes the concentratio n of NO to
increase many times, and it is why NO is viewed as an important
inflammation biomarker in the respiratory tract. What’ s interestin g in terms of breathing exercises is that nasal NO has
been found to increase sharply during 30 seconds of breath holding.54 This
may be one mechanism by which techniques including the BOL T, yogic
breathing, and the exercises in this book significantly relieve the symptoms
of various respiratory complaints. THE ROLE OF CO 2
Another reason breath-holding and reduced breathing may be helpful in
rhinitis is the role of CO2. One 2008 study , which examin ed the application
of intranasal CO2 (CO 2 administered directly into the nose) in seasonal
allergic rhinitis,  found that the gas produced a statistically significant
improvement in nasal symptoms. The trial involved 89 participants, 60 of
whom received treatment with CO2. The other 29 were given a placebo. Two 60-second intranasal CO2 treatments resulted in relief of allergic
rhinitis symptoms within 10 minutes and which lasted for 24 hours.55
Intranasal CO 2 was also shown to reduce symptoms of seasonal allergic
rhinitis in a 2011 trial designed to evaluate the effect of CO2 on symptomscaused by nasal allergens.56 In a small study with only 12 participants,
subjects were exposed to 20 seconds of CO2 before breathing a filter paper
“sham” allergen followed by two increasing doses of either grass or
ragweed allergens. Researchers collected secretions from both nostrils and
tested for histamine and eosinophils to evaluate the nasal reflex. In this
study , both nose and eye sympto ms were recorded. After the CO2 treatment,
participants experienced a significant reduction in symptoms including
sneezing and runny nose. When the subjects received a placebo treatment,
their histamine levels increased  significantly on exposure to the allergens,
but in those participants who had been treated with CO2, no increase in
histamine was found.56
Researchers concluded that CO2 not only resulted in a reduced reaction
to allergens, it suppressed reflex responses, indicating that it had some
positive effect on the way the brain processed its reaction to allergens. These findings have been reiterated more recently in a 2018 review ,
published in The Journal of Aller gy and Clinical Immunology , which
described the ef ficacy of CO 2 in treating aller gic rhinitis.55
The most common treatments for rhinitis and hay fever include  trigger
avoidance, decongestants, corticosteroids, allergy shots, and surgery. While
these may offer therapeutic benefits, they are often effective only for as
long as treatment continues. Breathing reeducation, however , harnesses the
power of gases intrinsic to respiration in a natural, noninvasive way that has
been proven to reduce symptoms. It’s important to understand the extent to which mouth breathing
contributes to nasal congestion , and the prevalence of habitual mouth
breathing. This can be illustrated by the fact that patients who under go nasal
surgery to correct mouth breathing often retain unhealthy breathing habits
and therefore continue to experience symptoms. This point is easily
illustrated by “empty nose synd rome” (described in Chapter Three ). It was
also my own experience before I learned about the therapeutic benefits of
functional breathing training. NASAL BREA THING AND RESPIRA TORY INFECTIONWe already looked at the connection between nitric oxide and respiratory
illness in Chapter Three . However , I’d like to add that over the years, I have
observed many students experi ence a significant reduction in head colds
and chest infections after they changed to light nasal breathing. Unfortunately , it is often those people who are most vulnerab le to chest
infections, those with asthma, bronchiectasis, bronchitis, and cystic fibrosis,
who mouth breathe because they feel that they cannot get enough air
through their nose. Nasal breathing serves to filter the air before it enters the body , but as
we discussed, nasal NO also has intrinsic qualities that form a first line of
defense for the immune system . Optimal protection of the lungs takes the
coordinated action of multiple cell types, and the tissue cells of the airway
secrete a variety of antimicrobial substances as well as NO.57
Respiratory infections, such as cold, flu, and more recently SARS and
COVID-19, commonly travel from person to person in droplets of mucus or
saliva. The virus disperses when an infected person sneezes or coughs and
droplets are expelled into the air and onto surfaces. Droplets from these
airborne illnesse s can travel several feet in a cough or sneeze and stay
suspended in the air for up to 10 minutes making it easy for infection to
spread.58 Health guidelines for preventing the transmission of these
infectious illnes ses center on hand washing, catching sneezes in a tissue or
elbow , and staying home from work if you are unwell. Pandemic responses
have also seen people using protective facemasks to shield them from
viruses or to protect those around them if they have symptoms. Concerns about the impact of influenza-type viruses on the elderly and
those with compromised respiratory systems have been particularly
pressing during the COVID-19 outbreak. Ageing often involves a
progressive decline in immune responses, rendering vaccines less effective
and increasing susceptibility to infection.59 Lower respiratory tract
infections are thought to contrib ute to the development of asthma and are
known to exacerbate asthma symptoms. One 2019 study suggests that
asthma in the elderly is a distinct, more severe variant that may be linked
with the deterioration of immune function in the airways.59
The respiratory tract can be colonized with bacterial, fungal, and viral
microor ganisms. These are collectively known as the airway“microbiome”60 and may play a significant role in the development,
persistence, and outcome of chronic inflammatory diseases, including
asthma and COPD.59 The presence of respiratory viruses during childhood
has been recognized as a major risk factor for asthma in adolescents and
adults. Viruses like rhinoviru s, parainfluenza viruses, and respiratory
syncytial virus represent the most common causes of asthma exacerbation. While the spread of any infection is alarming, it has been consistently
demonstrated that nasal breathing leads to better overall health. It also
makes logical sense, given that nasal NO offers an initial defense to
airborne viruses, that breathing  through the nose can support the body’ s
natural resistance to infection, pathogens, and allergens. While nasal
breathing does not guarantee that you will never experience another cold,
bout of flu, or asthma exacerbation, it becomes ever clearer that this small
change in daily habits can make a genuine difference to quality of life and
health. OceanofPDF .comTCHAPTER ELEVEN
SEX AND BREATH, AN INTIMATE
CONNECTION
he term peak performance  used in the context of breathing
techniques doesn’ t generally refer to your prowess between the
sheets. Yet sex is one of our most fundamental physical activities. It
may not use as many muscles  as a gym workout, but it still requires
exertion. Sexual  function relies on a healthy body . It can be dramatically
affected by poor breathing patterns, like every other area of health, with
sometimes devastating impacts on quality of life, self-esteem, and
relationships. You may be slightly taken aback  to find this boldly titled chapter in the
middle of a book about breathing and health. Until relatively recently , sex
was taboo. Just like money , it’s something we all have in varying amounts,
but nobody talks about it. It may, in all honesty , never be a topic you
casually bring up over dinner . Even if it isn’t still viewed as “dirty ,” our
perceptions of other people’ s sex lives can certainly cause us to wonder if
we’ve been getting it wrong for years. Fortunately , I see from my coaching
that attitudes to sex are changing, and people are more open than ever to
educating themselves about the body in a holistic way . In writing this chapter , I am approaching the subject of sex in response
to many questions from readers and clients over the years. The information
is not based on my personal experience but is included to show the wide
application of functional breathing and other breathing techniques for
healthy sex. If you want to read more detailed personal accounts, there are
several books mentioned that are perfect for further exploration.For sure, I am no expert on sex or the topic of breathing during sex. My
wife will be the first to tell you that! But on a more serious note, the science
shows that sexua l function can be an important indicator of heart health and
that respiratory illness, which I work with a lot, can create a distressing
impediment to a healthy sex life. You may still feel uncomfortable
broaching this subject with your healthcare professionals, but I hope this
chapter can help you open up that often-dif ficult conversation around sex
and chronic conditions and perhaps give you some useful insights and
vocabulary to ask the right questions for your own health. Ancient practice s, such as Taoism and Tantra, actively use the breath to
harness what they consider to be the spiritual power of sex. In these
traditions, the breath is seen as a connecting life force. As Jolan Chang
points out in The Tao of Love and Sex, diaphr agm breathing is basic to
almost all forms of meditation.1 Kundal ini Tantra yoga focuses on raising
the sexual power to nourish the vital centers known as the chak ras, and its
breathing exerci ses are designed to heighten and channel sexual energy.2 In
Tantra and Taoism, sex is perce ived as something more than a stimulating
erotic act. It is used to achieve and experience differen t states of
consciousness and to promote a healthy body and a long life. In contrast,
restricted breathing is seen as creating a sort of internal “contraction” that
blocks feelings and emotions and makes it dif ficult to control the mind. Healthy breathing helps provide the energy for sex. In the same way
that it supports  overall health, improves sleep, and reduces stress and
anxiety , the breath can directly and indirectly affect sexual function and
sexual pleasure. When breathing patterns are unhealthy or respiratory
illness is present, it is comm on to experience breathlessne ss, fear of
breathlessness, or worsening respiratory symptoms during sex. This can
cause particular problems for people with chronic conditions like asthma
and COP D. Sex is active. It uses the heart, lungs, and muscles,  and causes
the heart rate and blood pressure to rise. If you have strug gled with sex, you are not alone. The inability to enjoy
a “normal” sex life is a feature of many common health condit ions. If you
suffer with ongoing respiratory  symptoms, chronic stress, a bad back, or
sleep-disordered breathing, chances are that your sex life is below par. Snoring is not sexy, and stress can switch off your libido. However , don’tdespair . Not only can these issues be managed and improved by practicing
the exerc ises in this book, some schools of thought claim that the breath can
provide the gateway to the best sex you’ve ever had. (DON’T) T AKE MY BREA TH A WAY
We’ve talked a lot about the importance of nasal breathing and the problems
that mouth breat hing can cause, so it shouldn’ t be too much of a surprise to
find that nasal breathing during waking and sleeping is important for sexual
function too. The first reason for this relates to carbon dioxide (CO 2). When
we breathe through the mouth, we overbreathe, causing blood CO2 levels to
drop below normal. CO2 has vasodilator y properties, meaning it helps the
blood vessels dilate. This contri butes to the relaxing of the muscles around
the penis and erectile tissues. When the concentration of blood CO2 is low,
the smooth muscles responsible for blood flow to the penis, clitoris, and
vagina contract. Blood can’t flow as easily , and it becomes more difficult
for the erectile tissues to beco me, well . . . erect. This can mean, for
example, a dip in sex drive for women during the second part of the
menstrual cycle, when increased progesterone creates a drop in blood CO 2. Nitric oxide also plays an important role in sexual health. NO has
vasodilatory properties and enables the dilation of blood vessels  that lead to
the sexual organs, without whic h erection is impossible. It also plays a role
in delaying ejaculation.3 In 1998, the Nobel Prize in Physiology or
Medicine was jointly awarded to three US researchers who demonstrated
the role of NO as a “signaling molecule” in the cardiovascular system—the
gas is produced by one cell but can pass through cell membranes to regulate
the function of other cells. The researchers pinpointed the widening effect
of NO on blood vessels, an insight applied in the treatment of male
impotence. This research led to the development of drugs, including V iagra. Viagra (Pfizer ’s brand name for the drug sildenafil, a PDE5 inhibitor)
was first developed in 1989. It had been designed to compete with
nitroglycerin as a treatment for heart-related chest pain. However , Viagra
caused men to have erections,  so it became marketed as a solution for
erectile problem s, slated to enhance sexual prowess in men. This productseemed to solve a real problem for the 30 million men in the United States
with erectile dysfunction.4
Although the NO responsible for blood flow to the sexual organs is
produced in the cells rather than traveling down the airways, research has,
nevertheless, identified nasal breathing as directly important for sexual
wellbeing. A 2011 paper publis hed in the American Journ al of Rhinology
and Aller gy found that men who mouth-breathed as a result of nasal polyps
were more likely to experience erectile problems than men who breathed
through the nose.5 Before their mouth breathing was treated by surgically
removing the polyps, 34% of the men had reduced sexual function
compared to only 3% in the control group. After the polyps were removed
and nasal breathing was restored, only 10% of the men continued to have
problems. An earlier study repor ted that 67.5% of men who mouth-breathed
experienced sexual difficulties,  including erectile dysfunction , premature
ejaculation, and lower sex drive. Nasal breathing also helps engage the diaphragm, encouraging deep
belly breathing. This is important because of the role of the pelvic floor
muscles in sex. For men, the muscles of the pelvic floor , which are
connected to the diaphragm, help maintain an erection by exert ing internal
pressure on the veins of the penis so that enough blood remains in the penis
to make it fully rigid.6 Pelvic floor muscles, including  the pubococcygeus
muscle, also play a role in or gasm.7
Over the last 20 years, resea rchers have explored the relationship
between the pelvic floor muscle s and the diaphragm.8 They found that the
muscles of the pelvic floor contract and relax during inhaling and exhaling
at the same pace as the diaphragm. The pelvic floor becomes more active
during the sudden increase of intra-abdominal pressure (IAP) that happens
when we cough or sneeze. In fact, these muscles have been found to be
essential to the interaction of the diaphragm and abdominal muscles for
maintaining IAP. A recent study found that men who practice d breathing
exercises to improve diaphragm function after prostate surgery experienced
greater improvement to pelvic  floor muscle endurance than men who
practiced only pelvic floor strengthening exercises or abdominal muscle
exercises. The men who practi ced diaphragm exercises also had greater
improvement in urinary continence after six months.8Studies have demonstrated the effectiveness of pelvic floor muscle
exercises in treating men with erectile dysfunction, 9 even suggesting that
the exercises produce benefits comparable to PDE5 inhibitor drugs like
Viagra.6 Regarding women, Arnold Kegel made the connection between
pelvic floor muscle tone and “sexual feeling” in the vagina way back in
1952.10 Scientists have likewise found direct links between overactive
bladder and poor sexual arous al in women11.
_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:

        Researchers concluded that this could reduce the negative
impact of exercise for patients with high blood pressure, supporting the
health of the heart. 15 In this experiment, the loaded breathing group was
compared against a control group who practiced slow, deep breathing
without the load. Blood pressure and heart rate were also lower in the
control group after the trial, but as with the previous study, the differences
were much less marked. One noteworthy  aspect of both of those studies is that the loaded
breathing device required the patient to mouth breathe. A 2019 review
published in Frontiers in Physiology  studied the effect of adding inspiratory
loads using both nasal and oral breathing. 17 Loaded breathing resulted in
increased tidal volume. Nasal breathing promoted greater lung volume and
inspiratory muscle activation compared with oral breathing. Resistancefrom nasal breat hing is higher because the nostrils are so much smaller than
the mouth, so much greater energy and muscle recruitment is necessary to
generate the inhalation. The authors considered the effects of nasal
breathing better for the respiratory system17. But what is really interesting is
the sugg estion that nasal breathing effectively adds a natural load to
breathing. This means that slow  breathing exercises carried out through the
nose will have a positive impact on resting blood pressure without the need
for special load-adding equipment. In regard to the spikes in blood pressure experienced during intense
exercise, the results of a 1990 study are relevant. 18 Scientists examined the
effect of nasal breathing on systolic blood pressure in 10 healthy men
during exercise. In this experiment, the participants wore nasal dilators,
which increased  nasal airflow by around 29%. With these dilators, all 10
men could cycle at maximum load without mouth breathing and with a
much smaller increase in systolic blood pressure than normal. The reason
for this modera tion in blood pressure is not known, but researchers put
forward the theory that facilitated nose breathing decreased respiratory
work, relieving the load on the heart, which, in turn, lowered the systolic
blood pressure during exercise. 18
DENISE’S ST ORY: A PROGRAM FOR CHANGE
Denise is in her fifties and lives in California. When I first met her, she had
already spent 12 years suf fering from constant fatigue, muscle pain, anxiety,
brain fog, and high blood pressure. She experienced a range of symptoms
including dizzin ess, constriction around the chest, and the feeling of never
getting enough air. Denise was worn down by her ill health and had little zest for life. In
her search for help, she had spent thousands of dollars visiting many
doctors, special ists, and other healthcare professionals. Recently, her
chiropractor had suggested that she may have chronic hyperventilation. Shortly into my first Skype session with Denise, it was evident just how
noticeable her breathing was. While sitting comfortably for 15 minutes,
Denise displayed a fast breathing rate with each larger-than-normal breath. She was breathi ng from the upper chest, and I could hear each sharp intakeof air as she spoke. Denise didn’ t suffer from asthma or any respiratory
condition, yet her breathing during rest was as noticeable as that of any
person with uncontrolled asthma  I have seen. When she mentioned that this
all starte d 12 years earlier, I suggested that she must have suffered from
significant stress at that time. She replied, “Yes, I had a huge amount of
stress. ”
Undoubtedly, the stress Denise experienced 12 years earlier had
activated her sympathetic nervo us system, resulting in a large increase in
the volume of air she was taking  into her body. Over weeks and months, her
brain became accustomed to this larger volume of breathing and it became
habitual. This contributed to the negative effects that were  impacting
Denise’ s quality of life, including chronic stress, high blood pressure,
fatigue, and general ill health. Denise’ s starting BOL T score was only 5 seconds. Given such a low
measurement, I started her off with the Breathing Recovery  while sitting
exercise (see Chapter T wo). This involved her holding her breath for up to 5
seconds after exhaling, breathing normally for 10 seconds, and then
repeating. She was to continue this pattern for about 5 minutes before
taking a rest. The reason I asked Denise to practice this exercise first is that when the
BOL T score is less than 10 seconds it can be challenging to maintain a
tolerable air hunger during the reduced breathing exercise. This can add
tension and stress to the experience, which is not necessary and can be
avoided by beginning the practice very gently. For the first week, Denise’ s program was as follows:
• Practice Breathing Recovery  for 5 minutes every hour. • Practice Breathing Recovery  for 10 minutes before sleep. • Breathe only through the nose at all times. • If Denise sighed, she was to hold her breath for 5 to 10 seconds following the sigh. • Tape her mouth at night using MyoT ape or 3M Micropore tape. • Avoid taking large breaths before speaking. One week later, Denise’ s BOL T score had increased to 10 seconds, and
she was already feeling much more in control of her breathing. She no
longer felt that she was not getting enough air while at rest. In weeks  two and three, Denise began gentle, light, slow, deep breathing
and relaxation. She downloaded some recorded relaxation exercises and
played them twice daily, once before bed and again when she woke in the
morning. By practicing relaxatio n to gently lower breathing volume toward
normal, it is possible to begin the process of reversing years of stress. Denise also practiced gentle, light, slow, deep breathing for 10 minutes
every hour to continue her progress throughout the day. If you have high blood pressure, it’s important to go slowly and gently
when practicing reduced breathi ng exercises so as not to put added pressure
on your body. Practicing light, slow, deep breathing stimulates the
baroreceptors and activates the parasympathetic nervous system, bringing
you into a relaxed state. Your BOL T score will increase each week as you
continue to practice. This will help lower your blood pressure, making you
less reliant on medication. If you are currently taking medicatio n to control
high blood pressure, it’s import ant to consult a medical profes sional when
your BOL T score reaches 20 seconds so that your medication can be
adjusted to suit your current condition. Over several months, Denise’ s high blood pressure and cholesterol both
normalized, and she reported much higher energy levels. She also felt
calmer than she had for many years. Her BOL T score increased to 28
seconds, which,  considering it was only 5 seconds when she began, is
remarkable. Denise’ s health improved, and her doctor altered her
medication based on her progress. Denise’ s ongoing routine is as follows:
• She practices 10 minutes of light, slow, and deep breathing exercises four times
each day, with one session just before bed and one just after waking. • She tapes her mouth closed during sleep to ensure nasal breathing at night. • She practices Breathing Recovery  whenever she feels anxious or stressed. • She walks, with her mouth closed, for half an hour daily. • She observes her breathing periodically throughout the day and avoids taking big
breaths through her mouth. The benefits of slow breathing and relaxation are twofold: the
baroreceptors become more responsive to changes in blood pressure, and
the BOL T score increases. The reason Denise’ s BOL T score improved so
noticeably was that her sensitivi ty to blood CO2 had decreased. There is aninverse relationship between sensitivity to CO2 and the sensiti vity of the
baroreceptors19—those movem ent-sensitive nerve endings that work to
regulate blood pressure. When the sensitivity to CO2 is lower, which  is the
case in healthy breathing, the baroreceptors are stronger and more able to
maintain blood pressure at healthy levels. As we discussed in Chapter Four, there’ s a link between HRV and the
baroreceptors. This means that better HRV leads to better -regulated blood
pressure. Low HRV is a feature in adults20 and children21 with
hypertension. Autonomic dysregulation is present in the early stages of
hypertension20. Scientists suggest that because HRV provides an important
window into the responses of the autonomic nervous system, HRV
biofeedback may be valuable in treating hypertension. 22 A 2013 study into
evidence-based applications for HRV biofeedback suggests that
biofeedback could be helpful in strengthening the baroreflex. 23
OceanofPDF. comNCHAPTER TEN
FREEDOM FROM RESPIRATORY
DISCOMFORT
WHA T IS ASTHMA. o book on breath ing would be complete without a discussion about
asthma. But just what is asthma. The word asthma  is borrowed
from the ancient Greek ἆσθμα, âsthma, meaning “laborious
breathing,1 shortness of breath,2 or panting. ”3 Reference to the condition
can be found in ancient Hebrew, Egyptian, and Indian medical writings, and
clear observations of patients experiencing asthma attacks exist as early as
the second century CE. The categorizat ion of asthma was refined in the second half of the
nineteenth century2 when English physician Henry  Hyde Salter published
his book, On Asthma and Its Treatment, a volume that one 1985 article
describes as “the best book on asthma to appear during the nineteenth
century. ”4 In this work, Salter, who was himself asthmatic, describ es
paroxysmal breathlessness of a “peculiar character” with periods of healthy
breathing between attacks. This description perfectly captures a disorder in
which the airways narrow due to inflammation and contraction of the
smooth muscle. By the late nineteenth century, the medical community had
accepted the view that asthma was a distinct condition with a clear set of
causes and treatment requirements. The Canadian physician, Sir William Osler, who is sometimes credited
as the father of modern medicine, wrote about asthma in his 1892
textbook. 5 He described the symptoms of the disease as:• Spasming of the bronchial muscles
• Swelling and inflammation in the airways
• Having distinctive, gelatinous mucus secretions
• Resembling hay fever, and being sensitive to atmosphere, climate, and allergens
• Running in families, often beginning in childhood and lasting a lifetime
• Sometimes triggered by fright, strong emotion, overeating, or particular foods
Asthma was treated predominantly by managing exacerbations with the
use of bronchodilators taken in the form of oral inhalers. Over -reliance on
this medication  was believed to be a contributing factor in various
epidemics of asthma death in the United States, United Kingdom, and
Australia in the 1960s, and in New Zealand in the mid 1980s. 2 These deaths
drew attention to shortfalls in asthma treatment and emphasize d the extent
to which asthma was still not clearly understood. By the 1980s, doctors had more knowledge about the role of allergen
exposure as an asthma trigger. However, although the primary characteristic
of asthma—bloc ked or narrow airways—was well recognized and easy to
diagnose, the causal mechanisms were still not fully understood. While current thought questions  whether inflammation is the root cause
of asthma, it is certainly a factor in the disease. In eosinophilic asthma,
inflammation occurs as part of an allergic or immune system reaction,
which causes specific white blood cells called eosinophils to be released. An increase in white blood cells typically leads to an inflammatory
response, causing the airways to thicken. The resulting fluid and mucus
may result in bronchospasm and asthma symptoms. 6
THE CONGESTION CONNECTION
The nose and lungs form a single, unified airway. This means that where
inflammation is present, it can travel from the nose to the lungs and from
the lungs to the nose. 7 This is one reason people with asthma experience
high levels of nasal congestion. The normal response to a stuffy nose is to
begin breathing through the mouth. This, however, increases breathing
volume, draws cold, unfiltered, dry air into the airways, and makes the
symptoms of asthma worse. Habitual mouth breathing also affects sleep and
causes or contributes to stress. People with asthma often don’t realize how much the condi tion can
impact their overall health, but asthma can lead to fatigue, poor
concentration, and anxiety. As you’ll read in the next chapter, it can also
have an enormous effect on things we would otherwise take for granted,
such as the ability to enjoy a healthy sex life. As with other  respiratory
conditions and underlying breathing pattern disorders, when breathing is
affected, so is the body and the mind. For any child or adult with asthm a, the switch to nose breathing and the
practice of breathing exercises to normalize breathing volume can be life
changing. When I work with a client, I expect their asthma symptoms to
decrease by 50% in just two weeks. There will also be notable
improvements in their sleep patterns, ability to focus, concentration, and
levels of stress. The airways of people with asthma are particularly prone to narrowing. This is due to a combination of factors including inflammatio n, increased
mucus secretion, and constriction of the smooth muscle surrounding the
airways. When the airways narrow, a feeling of breathlessness occurs. As
the body tries to compensate for the lack of air, breathing becomes faster,
and the volume  of inhaled air increases. The sensation of air hunger may
encourage the switch from nasal to oral breathing. Normal breathing volume for a healthy adult is now between five and
eight liters per minute. 8 This volume has actually increased. Twenty years
ago, normal minute ventilation was between four and six liters, with six
liters considered the upper limit. A minute volume of eight liters per minute
implies a breathing rate of 16 breaths per minute, which is too fast. In my
opinion, eight liters is an unhealthy minute volume, and it makes me
wonder, has modern living changed our breathing patterns so much that it is
now normal to overbreathe. In contrast, in people with asthma, resting ventilation is typically
between 10 and 15 liters per minute. 9–11 While it is common for the
narrowing of the airways to cause breathing volume to rise, breathing too
much air will itself cause the airways to narrow. Thus, overbr eathing can
easily become a vicious cycle. The negative impact of overbreathing on compromised lungs is
underlined in a paper published in the Annals of the American ThoracicSociety  in 2020. According to it, a body of research demonstrates  the
importance of low tidal volumes when ventilating patients whose lungs
have been damaged by the COVID-19 virus. Scientist have found that,
when lungs have been injured by infection and the patient has suffered
acute respiratory distress syndrome (ARDS) and respiratory failure, the
injury can be compounded “if the size of the breath provided by the
ventilator is too large or the pressure used to inflate the lung is too
great. ”12,13 These patients  must be treate d with smaller breath sizes to
prevent additional damage. How ever, this makes the sensation of air hunger
much worse. Prolonged air hunger can cause feelings of anxiety and fear,
and the paper points out that acute air hunger has been used as a very
effective form of torture. In this extreme case, to avoid both damage to the
lungs and psychological distress, researchers urge the use of opiates to treat
the resulting breathlessness and sedatives to moderate feelings of anxiety. More generally, a substantial 2016 study in Aller gy demonstrated that
mouth breathing was associated with the worsening of asthma. Even
participants who did not have asthma experienced poorer lower lung
function and more sensitivity  to house dust mites when they mouth
breathed. Researchers examined questionnaires completed by 9,804 people
from Nagahama  City in Japan and found that mouth breath ing causes
asthma to become more sever e, possibly by increasing vulnerability to
inhaled allergens. Scientists concluded, “The risk of mouth breathing
should be well recognized in subjects with allergic rhinitis and in the
general population. ”14 A separate study found that habitual mouth breathing
reduced lung function in people with mild asthma and exacerbated the
symptoms of acute asthma. 15
A diagnosis of poor lung function should be cause for concern,
prompting better self-care, and positive action. In a trial lastin g 30 years,
scientists from the University at Buffalo found that men with the poorest
lung function at the start of the study were over twice as likely to have died
by the follow-up than men with good lung function. Women with the worst
lung function were one-and-a-half times more likely to have died than their
healthy counterparts. 16 In an interview for Science News, Holger
Schünemann, lead author on the study said, “This observation suggests thatthose with lower lung function levels may need to pay particu lar attention
to avoid negative ef fects, such as smoking, on their lungs. ”17
The term dysfunctional breathing  describes abnormalities in breathing
patterns that span a range of extremes from fast, superficial breathing to
slow, overly deep breathing. A person with hyperventilation syndrome may
breathe into the upper chest 18 to 40 times a minute. While the term
hyperventilation  is often used interchangeably with dysfunctional br eathing,
a slow breathin g rate of 5 to 8 breaths with breathing that engages the
diaphragm and the whole chest is also unhealthy. Both patterns result in an
excessive volume of air entering the lungs each minute and may cause
frequent sighing as the body tries to compensate for overinflate d lungs and
high tidal volume. While disordere d breathing is widely recognized, it is ill-defined and
often coexists with asthma. One 2017 study, which used the Nijmegen
Questionnair e (NQ), the preferred tool to screen for hyperventilation
syndrome, estim ated that 25% of studied patients with severe asthma also
displayed dysfunctional breathing. 18 Given what we know about the
accuracy of dysfunctional breathing screening, it is likely that the actual
figure is higher. Standard asthma  drugs target bronchoconstriction, airway inflammation,
and possible comorbidities (conditions that exist alongside asthma but are
not necessarily the result of it). Nonpharmacological asthma treatments
focus on diet, physical fitness, weight reduction in obese patients, and
avoiding triggers. When asthmatics show overt signs of dysfunctional
breathing, a program of breathing reeducation may be implemented with a
trained physiotherapist. Physiotherapists use methods including pursed lip, abdomi nal and
cadence breathi ng. However, even more benefit can be gained when the
breathing bioch emistry is addressed with the practice of light, nasal
breathing. One of the simplest ways to understand the BOL T score is in
terms of breathl essness. A lower breath-hold time corresponds  with more
breathlessness during rest and more airway obstruction. Each five-second
increase of the BOL T score reduces asthma symptoms such as exercise-
induced asthma, coughing, wheezing, breathlessness, and chest tightness. The BOLT works the same way as a breath-hold measurement called theControl Pause, which is practic ed in the Buteyko method—the breathing
technique I learned from Dr. Konstantin Buteyko. Scientists have studied the Buteyko method and its effect on asthma. The first trial of the Buteyko method for asthma in the western  world was
conducted at the Mater Hospital in Brisbane in 1994. 19 Nineteen people
were assigned to learn the Buteyko method, while a 20-person control
group followed the hospital’ s in-house program for asthma. After 12 weeks
of pract ice in nasal and reduc ed volume breathing, the Buteyko group
showed a 70% reduction in symptoms, a 90% drop in their need for rescue
medication, and a 49% decrease in their need for inhaled steroid
medication. The control group, who were taught physiotherapy exercises,
experienced no improvement. The reason for this is likely to be that nasal
breathing and reduced volume breathing are not taught during
physiotherapy. At the start of the trial, all of the study particiopants
breathed 14 liters of air per minute. At the end of the 12 weeks, the Buteyko
group had reduced their minute ventilation to 9. 6 liters, while  the control
group had minimal reduction. Interestingly, end-tidal carbon dioxide (CO 2) remained low in both
groups. At the beginning of the study, the Buteyko group showed an
average of 33 mmHg and the control group 32 mmHg. After 12 weeks, the
Buteyko group had slightly increased CO2 to 35 mmHg and the control
group to 33 mmHg. Although  Dr. Buteyko’ s original theory regarding
asthma revolved around CO2, the science has moved on since his work in
the 1950s. While the precise mechanism explaining the benefici al effects in
the Buteyko group is not clear, the fact is that over the past 20 years,
research into the impact of the Buteyko method on asthma has
demonstrated positive results. Now, the British Medical Journal  states in its
physiotherapy guidelines for adults, “The Buteyko breathing technique may
be considered to help patients to control the symptoms of asthma. ”20
EXERCISING WITH ASTHMA
Many elite athletes who suffer from asthma favor swimming above other
forms of exercise. This is no coincidence. During swimming, the face is
immersed in water, and the weight of the body in the water exerts gentlepressure on the chest and abdomen. Both of these factors naturally restrict
breathing volum e. Even though the swimmer draws the breath in through
the mouth, the amount of air that reaches the lungs per minute is still less
than in other sports such as running or cycling. According to a 2018 paper,
swimming causes much less post-exercise bronchospasm than running or
cycling at the same intensity. 21 This is partly because the air is moist and
warm. In an indoor swimming pool, the average air humidity is around 60%
and the air temp erature around 27° Celsius (80. 6° Fahrenheit). Both factors
can relieve asthma symptoms. The pressure of water on the chest wall helps
with exhalation, and the accum ulation of CO2 caused by the controlled
breathing necessary during swimming helps relax the airways. 21
There is, however, a downside to swimming. Too much time spent in
chlorinated pools can damage lung tissue,22–25 a factor particularly
problematic for people with asthma. This is important for very young
children, especially if they are predisposed to asthma. One longitudinal
study of 337 children with asthma and 633 controls (age-matched children
without asthma) demonstrated that swimming pool exposure in early life is
associated with a significantly higher risk of preschool asthma onset by the
age of one year. 26 The 2018 paper found that 21. 7% of the asthmatic
children reporte d eye irritation in indoor swimming pools compared with
only 9% of the control group, and that 5. 5% of children, all of whom were
sensitized to at least one inhalant allergen, experienced worse asthma
symptoms in indoor pools. A 2018 Canadian Respiratory Journal  article found that asthma is
highly prevalen t among elite endurance athletes. 27 The study aimed to
determine how common asthma and the use of asthma medicat ion were in
competitive recreational endurance athletes and the association of these
factors with training. Researchers examined web survey responses from
38,603 adults who were participating in three Swedish endurance
competitions that involved cross -country running, cross-country skiing, and
swimming. They found that 12% reported asthma and 23% of those with
asthma used inhaled corticosteroids and long-acting beta-agonists daily. Participants who were more likely to suffer from asthma were female, those
with allergic rhinitis, a history of eczema, a family history of asthma, and
those who cycled or trained for more than 5 hours 50 minutes per week. The study found that the incidence of asthma among competitive
recreational endurance athletes was higher than in the general population. A
significant number of the athletes used asthma medications. The study
describes a distinct phenotype of asthma specific to elite athletes. “Sports
asthma” is defined by “exercise-induced respiratory symptoms and airway
hyper -responsiveness without allergic features. ” This kind of asthma is
more common in athletes taking part in water and winter sports. 27
Researchers also found that around 70% of swimmers and skiers suffered
with aller gic rhinitis. The athletes in the Swedish study included those at international and
high national competitive levels as well as professional and
semiprofessional sportspeople who trained for a significant number of hours
per week. A high training volume was found to impact asthma more than
the age of the athlete, suggesting that training may prevent remission of
asthma in adults. Cycling was found to be the sport most closely associated
with asthma, regardless of fitness. In fact, a high prevalence of asthma has
previously been reported among  Olympic cyclists. 28 This may be because
cycling requires long training sessions with high-volume breathing. Also,
training often takes place outdoo rs, frequently on roads where the cyclist is
exposed to vehicle exhaust fumes, tire particles, and pollen, all of which
may contribute to asthma symptoms. Fortunately, by practicing the breathing exercises described in this book,
it becom es possible to continue nasal breathing at a higher intensity of
exercise. This reduces mouth breathing, which is one of the primary triggers
for exercise-induced asthma. SLEEPING WITH ASTHMA
Sleep is often very difficult for asthma sufferers. Asthma symptoms
commonly worsen overnight,29 particularly in the early hours of the
morning, and nighttime exacerbations are extremely common. The
detrimental effect of poorly controlled asthma on sleep has long been
recognized,30 but in recent years there has been a growing interest in the
way asthma interacts with sleep and sleep disorders. People with asthma
frequently suffer with sleep disturbance and poor-quality sleep, particularlywhen asthma is severe. Lack of sleep or impaired sleep quali ty is linked
with worse asthm a control. Poor sleep impacts quality of life and can affect
physical and mental resilience. As someone who suffered notic eable asthma symptoms and poor sleep
for over 20 years, I am intrig ued why such a strong conne ction exists
between asthma  severity and sleep-disordered breathing. I believe that if
researchers were to investigate uncontrolled asthma during sleep, they
might uncover clues for the treatment of sleep apnea. It is my experien ce from working with thousands of children and adults
with asthma, that people with asthma have a low breath-ho ld time. In
adults, the typic al BOL T score is between 10 and 15 seconds, and children
with asthma can normally hold their breath for around 20 to 40 paces. This
low breath-hold time, which is indicative of high chemosensitivity to CO2,
corresponds to a phenotype of sleep apnea called high loop gain. High loop
gain results in unstable breathing during sleep, from total stopping of the
breath to an exaggerated gasping for air when breathing resumes. The
exercises in this book are ideall y suited to people with high loop gain and
can be used to develop stable breathing patterns. When asthma is uncontrolled, breathing generally becomes faster and
harder. When we breathe faster, we are more likely to wake during the
night, resulting in poor sleep quality. This ties in with the arousal threshold
phenotype in sleep apnea. In addition, inflammation of the lungs during
uncontrolled asthma can migrate to the nose, resulting in nasal stuffiness. The feeling of air hunger when breathing through the nose inevitably results
in mouth breathing. This, in turn, narrows and increases turbulence in the
airways, causing sleep disruption. Finally, faster and harder breath ing through an open mouth is generally
from the upper chest. Breathin g fast from the upper chest is inefficient,
uneconomical, and the worst way to breathe as it inhibits oxygen transfer
from the lungs to the blood, reduces lung volume, and results in easier
collapse of the upper airway, causing the breath to stop during sleep. Scientists believe that sleep disturbances in asthmatic patients may
relate to sleep disorders including obstructive sleep apnea30. A substantial
body of research also indicates that nocturnal symptoms, including
coughing and breathlessness are accompanied by variations in airwayinflammation and anatomical changes that may be impacted by circadian
rhythms. 29
Persistent cough ing is another factor likely to disrupt sleep. Coughing
wakes the sleeper out of deep sleep, causing poor quality of sleep and
fatigue the following day. Symp toms of asthma frequently worsen at around
four o’clock in the morning, when the incidence of asthma-related sudden
death is also most common. 29 In one survey of 7,729 asthma patients, 74%
awoke at least once per week with asthma symptoms, 64% suffered
nocturnal asthm a exacerbations at least three times a week, and around 40%
experienced symptoms every night. 31
Circadian rhythm s are the autonomous, self-sustained natural processes
that regulate the sleep-wake cycle. 29 They make it possible for the body to
anticipate environmental changes and optimize survival. For example, the
sleep-wake cycle enables us to rest at night and be active during the day. Lung function fluctuates in any 24-hour period in healthy people, but in
people with nighttime asthma symptoms, these changes are much more
profound, with the difference in breathing volumes between wakefulness
and sleep exceeding 15%. 29
One reason asthma symptoms  are worse at night and in the early
morning is that mouth breathing during sleep can add to breathing volume. If breathing during the day is poor, breathing during sleep will also be
uncontrolled. Even without the circadian fluctuations in lung function and
inflammation, poor breathing patterns and sleep-disordered breathing can
lead to nighttime breathing difficulties. For this reason, it is not advisable to
sleep for more than eight hours. While nocturnal asthma symptoms
frequently cause sleeplessness and daytime fatigue,32 correct practice of
breathing exercises during the day will help reduce overbreathing at night. Uncontrolled asthma results in hard, fast, upper chest breathi ng. The
solution to improve asthma control and quality of sleep lies in light, slow
and deep breathing. There are several techniques you can try that can
greatly improve asthma control and sleep quality:
1. Pay attention to your asthma symptoms before you go to bed. If you are wheezy or
have noticeable symptoms as you head of f to the land of nod, it’ s likely you will wake
up during the night with an attack. If you are experiencing symptoms before sleep,
it’s best to remain awake until they are under control or sleep sitting upright. If youhave been prescribed a steroid medication, make sure to take it before you go to
sleep, and always practice your breathing exercises to reduce symptoms
before going to bed. 2. Practice light, slow, and deep breathing to achieve a tolerable air hunger for 15
minutes before sleep. 3. Avoid sleeping on your back. This is the worst position for overbreathing. As there is
very little restriction to breathing, you are likely to breathe more deeply during the
night. The lower jaw is also more prone to drop down, causing mouth breathing. Sleep on your side or abdomen instead. 4. Wear the Buteyko belt over your nightshirt during sleep. The Buteyko belt is a
specially designed tool that imposes a resistance to the breathing muscles, lowering
the risk of hyperventilation during sleep. I often wear the belt during sleep and find
that it improves my quality of rest. T ighten or loosen the belt to create a tolerable air
hunger. You can purchase a Buteyko belt online. 5. Make sure your bedroom has a good circulation of fresh air. 6. Only breathe through the nose while asleep. W earing MyoT ape will help bring the
lips together to ensure nasal breathing. If the nose is very stuf fy, wear a nasal dilator
such as Mute Snoring. MyoT ape can be ordered from MyoT ape. com. 7. Work to improve your everyday breathing patterns by addressing breathing from all
three dimensions—light, slow, and deep. 8. Achieve a higher BOL T score. Every 5-second improvement to your BOL T score will
result in more light, slow, and deep breathing. Ideally, to improve asthma control and
sleep quality, the BOL T score needs to stay above 25 seconds. Once you have begun to norma lize your breathing volume, addressed
underlying breathing pattern disorders, and increased your BOL T score, you
will find you enjoy better sleep, and this will have a positive impact on your
energy levels and quality of life. PREVENTING AN ASTHMA A TTACK
Generally, an asthma attack does not come out of the blue. You will usually
experience warning signs such as increased tightness of the airways, a
blocked nose, and wheezing or coughing. When you feel the first symptoms
of an attack, it can be very helpful to perform the following exercises to
help control your breathing. Use these exercises to prevent or lessen
symptoms at the onset of the attack. Once an asthma attack is underway, it
is very dif ficult to maintain control of breathing using exercises. Medication
or medical attention may be necessary. EXERCISESPerforming Breathing Recovery (sitting or walking)  when you first observe
the onset of asthma symptoms can help reduce the severity of an attack or
even head it off completely. However, it is important not to create too
strong an air hunger during this exercise as it will cause a pronounced
increase in your breathing after the exercise. Breathing Recovery, Sitting
• Take a normal quiet breath in and let it out. • Following an exhalation, hold the breath for between 3 and 5 seconds. • Do not try to hold your breath for longer than this. It will only increase your breathing
and exacerbate the asthma attack. • Maximum breath-hold time should be no greater than half your BOL T score at the
time of practicing. • Leave 10 seconds between each breath hold, and don’t try to interfere with your
breathing during this time. • Repeat the small breath hold, followed by a rest of 10 seconds, during which you
should breathe normally through your nose. • Continue until the attack has passed. Breathing Recovery, Walking
Instruction:
• Exhale through your nose. • Pinch your nose with your fingers to hold your breath, and walk for 5 to 10 paces,
holding your breath. • Stop walking. • Breathe in through your nose, and rest for about 30 seconds while standing still. • Repeat up to 10 times. If you are practicing at home, you can repeat this exercise 6 times, five
times per day. Holding the breath for up to 10 paces is very suitable for
anyone with severe asthma, COPD or panic disorder. It is also ideal if you
have disproportionate breathlessness, anxiety, a racing mind, or a low
BOL T score. During an asthma attack, incomplete exhalations can cause air trapping
or breath stacking. It is often harder to breathe out than to breathe in. If you
experience this feeling of overinflated lungs, it is helpful to practice
breathing out slowly and comp letely. This is not easy to do when your
breathing is fast and labored, but it can be practiced between the exercises
to help stop your symptoms. Follow these steps to ease the feeling of
overinflated lungs:
EXHALA TION BY RELAXA TION
• Breathe in gently and hold your breath for half a second. • Concentrate on relaxing the chest, shoulders, and abdomen. • Slowly exhale through your nose. Do not force your breath out in any way. Gently
breathe out, slowly and completely. The natural elasticity of your diaphragm, lungs,
and ribs will return the breathing muscles to their resting positions, resulting in a full,
passive exhalation. • Breathe in as normal. • Repeat the exercise several times over the course of 10 minutes or until the attack
has passed. This exercise can be used at any time, whether you are suffering from
breathing difficulties or not. It will help to normalize breathing through
relaxation. Many people with asthma find that they truly begin to
understand the benefits of reduced volume breathing the first time they
successfully use the exercises to overcome an asthma attack. EXERCISE T O ST OP A COUGHING A TTACK
Coughing is one of the most common symptoms of asthma. Although some
people are more prone to bouts of coughing than others, a 2018 study states,
“Cough alone may sometimes be the sole presenting symptom of asthma. ”
Some asthmatics  have normal lung function33 and experience coughing and
bronchial hyper reactivity (sensi tivity to airway-narrowing stimuli) withoutany shortness of breath or wheezing. 34 Scienti sts have found that, on
average, 25% of patients with chronic cough have a type of asthma called
cough variant asthma. These people tend to respond to traditional asthma
therapy. A prolonged episode of coughi ng can be particularly difficult to stop. Much like other asthma symp toms, coughing attacks tend to be more
frequent at night or in the early morning. Persistent coughing is very
disruptive to breathing, so it is important to reduce its effects and prevent an
attack taking hold. Coughing is a reflex action caused by irritated airways. It’s the body’ s
way of clearing the airways of mucus and other irritants. Overbr eathing can
make the airway s dry and inflamed, triggering a cough, and this, in turn,
can lead to further overbreathi ng. When you cough, you take in a deep
breath followed by a forced expiration of air. This action causes cooling and
drying of the airways and a loss of CO2, which inevitably leads to another
cough and another forced expiration. If you don’t stop the cycle, you will
soon find yourself having a coughing fit. The following approach can help you stop an attack of coughing:
• Try to suppress the cough if possible. Y ou will experience a ticklish feeling in your
throat, but after a while, the urge to cough should decline. Swallowing will help curb
the need to cough. • Don’t try to force out mucus. Instead, reduce your breathing, and allow the mucus to
come up naturally. It can then be swallowed to dissolve harmlessly in the acid of the
stomach or be spat out if the circumstances are appropriate. • Try to cough only through your nose. • Perform Breathing Recovery, Sitting  of between 3 and 5 seconds until your cough
has passed. The main point to remember is that the deep breathing and forced
exhalations that occur during coughing will only perpetuate the cycle. Being conscious of this will help reduce the attack. It is important to note that breat hing exercises will only help alleviate a
coughing fit when applied during the early stages of an attack. If symptoms
have been occurring for more than five minutes, they will be a lot more
difficult to control using breathing exercises, especially if your BOL T score
is less than 20 seconds. If breathing difficulties continue for as long as five
minutes, take your medication. If you are having a severe attac k, take yourmedication immediately. If your symptoms do not respond to your
medication within a few minutes, seek medical attention. BLOWING YOUR NOSE
Another commo n symptom of asthma is a blocked nose. If you are prone to
nasal stuf finess, you will continue to experience symptoms until your BOL T
score is at least 25 seconds. The normal reaction to nasal congestion is to
repeatedly blow  your nose, in an effort to get rid of mucus and clear your
sinuses. But blowing your nose too much can actually aggravate the
problem, inflaming the airways  and increasing production of mucus. This
makes feelings of congestion worse, and so you find yourself caught in a
self-perpetuating and distressing cycle of excess mucus and nose blowing. To help decongest your nose without increasing your breathing volume,
follow these guidelines:
• Only blow your nose when it feels absolutely necessary. • If you must blow your nose, do so gently. • Spend five minutes reducing your breathing or practicing the nose unblocking
exercise (see Chapters T wo and Three ). OVERCOMING RHINITIS AND HA Y FEVER
Severe asthma is associated with a number of conditions that can make
disease management more difficult and affect treatment outcomes35. These
“comorbidities”—illnesses that exist independently of but along side asthma
—often mimic asthma symptoms and contribute to poor disease control. Asthma and rhinitis are closel y connected, and the risk of allergic
rhinitis (AR) is higher in those who have had allergic asthma in
childhood. 36 The global prevalence of allergic disease has increased
considerably in recent decades,36 with a significant cost both economically
and in terms of well-being. One 2020 paper reported that 17. 8% of 8,000
participants, aged between 20 and 69 years, had allergic rhinitis,37
otherwise know n as hay fever. The same article states that incidence of AR
is highes t during  childhood and steadily decreases with age. A 2018 review
of adults in T ehran found that 28. 3% of those studied had AR. 38 And a 2013paper from the World Aller gy Organization reported that allergic rhinitis is
the most common form of noninfectious rhinitis, affecting between 10%
and 30% of adults and up to 40% of children. 39
Aller gic rhinitis is defined as an inflammatory and antibody-mediated
disease. 40 Symptoms occur when airborne allergens are inhaled, but
diagnosis depends on how often symptoms are triggered. If rhinitis occurs
due to pollens, it will be classifi ed as seasonal; if dust mites are the cause, it
is perennial, and, if it is brought on by a specific allergic enviro nment, it is
intermittent. 40 This differentiation helps doctors to find the most
appropriate treatment strategies. AR is also considered to be intermittent or
persistent, according to the duration of symptoms. People with persistent
rhinitis may suffer significantly impaired quality of life, loss of productivity
and workdays, missed school time, and reduced ability to learn. One of the most obvious and problematic symptoms of rhinitis and
allergic rhinitis is nasal congestion. 41 It can be triggered by allergens such
as dust mites, pollen, and spores, by an oversensitive immune reaction, or
by nonaller gic reactions such as the common cold, and it can interfere badly
with sleep. People who have difficulty breathing through the nose are
almost twice as likely to suffer sleep problems,42 meanin g that persistent
nasal congestion can leave them feeling tired much of the time. A 2020 study summarizes the main underlying mechanisms that link
allergic rhinitis and altered sleep patterns as follows:
• Inflammatory cytokines related to allergic rhinitis cause feelings of fatigue. • The symptoms and underlying physiological changes that occur in AR indirectly
affect sleep. • Sleep can be negatively impacted by dysfunction of the autonomic nervous
system. 43
Nasal congestion is known to affect sleep and contribute to sleep
disorders, including snoring and OSA. By decongesting the nose using the
exercise from Chapter Two and normalizing breathing patterns, you are
likely to experience better sleep, less daytime tiredness and improved
quality of life. RHINITIS AND THE AUT ONOMIC NER VOUS SYSTEMScientists believe that an imbalance of the autonomic nervous system
(ANS) plays a role in the poor quality of sleep experienced by people with
allergic rhinitis. One pathway by which the ANS impacts rhinitis is a
powerful autonomic reflex called the trigemino-car diac reflex  (TCR). The
trigeminal nerve  is the fifth and most complex of the cranial nerves. It
innervates the face and takes care of actions including chewing and biting. 44
TCR helps reduc e the heart rate in challenging situations. It is known to
cause apneas. An exaggerated form of the reflex may contribut e to sudden
death and sudden infant death syndrome. 46 One 2017 review explains:
The amount of influence that the autonomic system exerts on the
heart, manifest ing either as arrhythmias or as OSA-ind uced
bradycardia and hypertension, does suggest the possibility of the
TCR playing a role in sudden death. 45
Another paper, also from 2017,  concludes that TCR could link rhinitis
and sleep disorders. 46 TCR triggers parasympathetic overactivity and
sympathetic inhibition, leading to the sudden onset of bradyc ardia (slow
heart rate) hypo tension (low blood pressure), apnea, and gastric motility
(contractions of the smooth muscle of the stomach). Autonomic imbalance
also contributes to the onset and development of rhinitis. While the extent of autonomic dysfunction in allergic rhinitis and sleep
still needs further research, it is certain that constant nasal congestion,
uncomfortable breathing, and poor quality of life can influence autonomic
imbalance in the form of chron ic stress. This has a direct effect on sleep. AR is associated with symptoms, including congestion, nasal dischar ge,
sneezing, palata l itching, fatigue, and mood changes. Its most common
behavioral complications are tiredness and sleep disturbance caused by an
inability to breathe properly. Studies have also acknowledged compromised
mental health, including anxiety and changes in emotional reactivity. A highe r incidence of anxiety, and, in some cases, depression, has been
observed in people suffering from respiratory allergies. Anxiety itself can
produce an exaggerated inflammatory response due to an overa ctive fight-
or-flight mechanism. It has been suggested that high levels of anxiety can
develop as a direct result of chronic illness, creating a self-perpetuating
negative feedback loop. In a 2009 study, scientists demonstrated anxietyand reduced social interaction in rodents with experimentally induced
rhinitis. They concluded that allergic rhinitis could influence behavioral
responses. 47
During allergic rhinitis, inflammatory mediators, including histamine,
are released. These have a direct influence on the central nervous system
and contribute to disturbed sleep and daytime tiredness. Histamine can
affect the regulation of the sleep-wake cycle, and this may lead to a sleep
condition called arousal disorder. Aller gic rhinitis also causes reduced
levels of certain cytokines called interleukins that are vital in activating
immune respon ses, such as inflammation, and may be important in
stimulating restorative sleep and improving circadian rhythms. 43
While it may not be news to anyone who suffers with the condition,
scientists have proven that rhinitis can have a negative impact on feelings of
well-being. One 2020 study reported that the quality of life in children with
allergic rhinitis was directly related to the severity of their symptoms. 48
Researchers noted that parents often overestimated the quality of life
experienced by their children in this situation, and therefore, that it is of
great importance to ask children how they feel rather than rely on parental
perception. CAN NASAL BREA THING RELIEVE RHINITIS. Healthy nasal breathing can minimize symptoms of rhinitis and moderate a
range of conditio ns that lead to nasal congestion. The high conc entration of
nitric oxide in the sinuses is instrumental in keeping the nose and lungs free
of disease and inflammation. It is likely that the reduction in inhaled NO
caused by mouth breathing during sleep contributes to the nega tive effects
of noctu rnal mouth breathing49. When we breathe nasally, NO is released
into the nasal cavity50 and carried down to the lungs in concentrations that
are betw een 5 and 20 times higher than during mouth breathi ng. 51 When
nasal breathing is combined with slow breathing, this allows an even
greater concentr ation of NO to be carried into the lungs. As the BOL T score
increases, breathing becomes slower, and so it is likely that a higher BOL T
score leads to improved uptake and use of NO. Numerous studi es demonstrate that nasal nitric oxide is found in much
greater amounts in people with untreated symptomatic seasonal rhinitis, and
that when AR is treated with nasal steroids, NO levels return to normal. 52
This strongly suggests that quantities of NO are released as part of the
body’ s immune response, which  fits with what we know about the role of
NO as a first line of defense against infection. The increased level of NO in
rhinitis patients is so marked that nasal NO measurement has become a
more-or -less standard way to assess nasal inflammation and the response to
anti-inflammatory medications. This function of nasal NO is noted in various studies, including  a 2019
paper that examines the clinical uses of exhaled NO measurement in the
management of asthma and allergic airway inflammation. Researchers in
that trial concluded that when  stimulated as part of the inflammatory
response,53 special enzymes called nitric oxide synthase produce NO at a
slow rate but in large quantities. This causes the concentratio n of NO to
increase many times, and it is why NO is viewed as an important
inflammation biomarker in the respiratory tract. What’ s interestin g in terms of breathing exercises is that nasal NO has
been found to increase sharply during 30 seconds of breath holding. 54 This
may be one mechanism by which techniques including the BOL T, yogic
breathing, and the exercises in this book significantly relieve the symptoms
of various respiratory complaints. THE ROLE OF CO 2
Another reason breath-holding and reduced breathing may be helpful in
rhinitis is the role of CO2. One 2008 study, which examin ed the application
of intranasal CO2 (CO 2 administered directly into the nose) in seasonal
allergic rhinitis,  found that the gas produced a statistically significant
improvement in nasal symptoms. The trial involved 89 participants, 60 of
whom received treatment with CO2. The other 29 were given a placebo. Two 60-second intranasal CO2 treatments resulted in relief of allergic
rhinitis symptoms within 10 minutes and which lasted for 24 hours. 55
Intranasal CO 2 was also shown to reduce symptoms of seasonal allergic
rhinitis in a 2011 trial designed to evaluate the effect of CO2 on symptomscaused by nasal allergens. 56 In a small study with only 12 participants,
subjects were exposed to 20 seconds of CO2 before breathing a filter paper
“sham” allergen followed by two increasing doses of either grass or
ragweed allergens. Researchers collected secretions from both nostrils and
tested for histamine and eosinophils to evaluate the nasal reflex. In this
study, both nose and eye sympto ms were recorded. After the CO2 treatment,
participants experienced a significant reduction in symptoms including
sneezing and runny nose. When the subjects received a placebo treatment,
their histamine levels increased  significantly on exposure to the allergens,
but in those participants who had been treated with CO2, no increase in
histamine was found. 56
Researchers concluded that CO2 not only resulted in a reduced reaction
to allergens, it suppressed reflex responses, indicating that it had some
positive effect on the way the brain processed its reaction to allergens. These findings have been reiterated more recently in a 2018 review,
published in The Journal of Aller gy and Clinical Immunology, which
described the ef ficacy of CO 2 in treating aller gic rhinitis. 55
The most common treatments for rhinitis and hay fever include  trigger
avoidance, decongestants, corticosteroids, allergy shots, and surgery. While
these may offer therapeutic benefits, they are often effective only for as
long as treatment continues. Breathing reeducation, however, harnesses the
power of gases intrinsic to respiration in a natural, noninvasive way that has
been proven to reduce symptoms. It’s important to understand the extent to which mouth breathing
contributes to nasal congestion, and the prevalence of habitual mouth
breathing. This can be illustrated by the fact that patients who under go nasal
surgery to correct mouth breathing often retain unhealthy breathing habits
and therefore continue to experience symptoms. This point is easily
illustrated by “empty nose synd rome” (described in Chapter Three ). It was
also my own experience before I learned about the therapeutic benefits of
functional breathing training. NASAL BREA THING AND RESPIRA TORY INFECTIONWe already looked at the connection between nitric oxide and respiratory
illness in Chapter Three. However, I’d like to add that over the years, I have
observed many students experi ence a significant reduction in head colds
and chest infections after they changed to light nasal breathing. Unfortunately, it is often those people who are most vulnerab le to chest
infections, those with asthma, bronchiectasis, bronchitis, and cystic fibrosis,
who mouth breathe because they feel that they cannot get enough air
through their nose. Nasal breathing serves to filter the air before it enters the body, but as
we discussed, nasal NO also has intrinsic qualities that form a first line of
defense for the immune system. Optimal protection of the lungs takes the
coordinated action of multiple cell types, and the tissue cells of the airway
secrete a variety of antimicrobial substances as well as NO. 57
Respiratory infections, such as cold, flu, and more recently SARS and
COVID-19, commonly travel from person to person in droplets of mucus or
saliva. The virus disperses when an infected person sneezes or coughs and
droplets are expelled into the air and onto surfaces. Droplets from these
airborne illnesse s can travel several feet in a cough or sneeze and stay
suspended in the air for up to 10 minutes making it easy for infection to
spread. 58 Health guidelines for preventing the transmission of these
infectious illnes ses center on hand washing, catching sneezes in a tissue or
elbow, and staying home from work if you are unwell. Pandemic responses
have also seen people using protective facemasks to shield them from
viruses or to protect those around them if they have symptoms. Concerns about the impact of influenza-type viruses on the elderly and
those with compromised respiratory systems have been particularly
pressing during the COVID-19 outbreak. Ageing often involves a
progressive decline in immune responses, rendering vaccines less effective
and increasing susceptibility to infection. 59 Lower respiratory tract
infections are thought to contrib ute to the development of asthma and are
known to exacerbate asthma symptoms. One 2019 study suggests that
asthma in the elderly is a distinct, more severe variant that may be linked
with the deterioration of immune function in the airways. 59
The respiratory tract can be colonized with bacterial, fungal, and viral
microor ganisms. These are collectively known as the airway“microbiome”60 and may play a significant role in the development,
persistence, and outcome of chronic inflammatory diseases, including
asthma and COPD. 59 The presence of respiratory viruses during childhood
has been recognized as a major risk factor for asthma in adolescents and
adults. Viruses like rhinoviru s, parainfluenza viruses, and respiratory
syncytial virus represent the most common causes of asthma exacerbation. While the spread of any infection is alarming, it has been consistently
demonstrated that nasal breathing leads to better overall health. It also
makes logical sense, given that nasal NO offers an initial defense to
airborne viruses, that breathing  through the nose can support the body’ s
natural resistance to infection, pathogens, and allergens. While nasal
breathing does not guarantee that you will never experience another cold,
bout of flu, or asthma exacerbation, it becomes ever clearer that this small
change in daily habits can make a genuine difference to quality of life and
health. OceanofPDF. comTCHAPTER ELEVEN
SEX AND BREATH, AN INTIMATE
CONNECTION
he term peak performance  used in the context of breathing
techniques doesn’ t generally refer to your prowess between the
sheets. Yet sex is one of our most fundamental physical activities. It
may not use as many muscles  as a gym workout, but it still requires
exertion. Sexual  function relies on a healthy body. It can be dramatically
affected by poor breathing patterns, like every other area of health, with
sometimes devastating impacts on quality of life, self-esteem, and
relationships. You may be slightly taken aback  to find this boldly titled chapter in the
middle of a book about breathing and health. Until relatively recently, sex
was taboo. Just like money, it’s something we all have in varying amounts,
but nobody talks about it. It may, in all honesty, never be a topic you
casually bring up over dinner. Even if it isn’t still viewed as “dirty,” our
perceptions of other people’ s sex lives can certainly cause us to wonder if
we’ve been getting it wrong for years. Fortunately, I see from my coaching
that attitudes to sex are changing, and people are more open than ever to
educating themselves about the body in a holistic way. In writing this chapter, I am approaching the subject of sex in response
to many questions from readers and clients over the years. The information
is not based on my personal experience but is included to show the wide
application of functional breathing and other breathing techniques for
healthy sex. If you want to read more detailed personal accounts, there are
several books mentioned that are perfect for further exploration. For sure, I am no expert on sex or the topic of breathing during sex. My
wife will be the first to tell you that. But on a more serious note, the science
shows that sexua l function can be an important indicator of heart health and
that respiratory illness, which I work with a lot, can create a distressing
impediment to a healthy sex life. You may still feel uncomfortable
broaching this subject with your healthcare professionals, but I hope this
chapter can help you open up that often-dif ficult conversation around sex
and chronic conditions and perhaps give you some useful insights and
vocabulary to ask the right questions for your own health. Ancient practice s, such as Taoism and Tantra, actively use the breath to
harness what they consider to be the spiritual power of sex. In these
traditions, the breath is seen as a connecting life force. As Jolan Chang
points out in The Tao of Love and Sex, diaphr agm breathing is basic to
almost all forms of meditation. 1 Kundal ini Tantra yoga focuses on raising
the sexual power to nourish the vital centers known as the chak ras, and its
breathing exerci ses are designed to heighten and channel sexual energy. 2 In
Tantra and Taoism, sex is perce ived as something more than a stimulating
erotic act. It is used to achieve and experience differen t states of
consciousness and to promote a healthy body and a long life. In contrast,
restricted breathing is seen as creating a sort of internal “contraction” that
blocks feelings and emotions and makes it dif ficult to control the mind. Healthy breathing helps provide the energy for sex. In the same way
that it supports  overall health, improves sleep, and reduces stress and
anxiety, the breath can directly and indirectly affect sexual function and
sexual pleasure. When breathing patterns are unhealthy or respiratory
illness is present, it is comm on to experience breathlessne ss, fear of
breathlessness, or worsening respiratory symptoms during sex. This can
cause particular problems for people with chronic conditions like asthma
and COP D. Sex is active. It uses the heart, lungs, and muscles,  and causes
the heart rate and blood pressure to rise. If you have strug gled with sex, you are not alone. The inability to enjoy
a “normal” sex life is a feature of many common health condit ions. If you
suffer with ongoing respiratory  symptoms, chronic stress, a bad back, or
sleep-disordered breathing, chances are that your sex life is below par. Snoring is not sexy, and stress can switch off your libido. However, don’tdespair. Not only can these issues be managed and improved by practicing
the exerc ises in this book, some schools of thought claim that the breath can
provide the gateway to the best sex you’ve ever had. (DON’T) T AKE MY BREA TH A WAY
We’ve talked a lot about the importance of nasal breathing and the problems
that mouth breat hing can cause, so it shouldn’ t be too much of a surprise to
find that nasal breathing during waking and sleeping is important for sexual
function too. The first reason for this relates to carbon dioxide (CO 2). When
we breathe through the mouth, we overbreathe, causing blood CO2 levels to
drop below normal. CO2 has vasodilator y properties, meaning it helps the
blood vessels dilate. This contri butes to the relaxing of the muscles around
the penis and erectile tissues. When the concentration of blood CO2 is low,
the smooth muscles responsible for blood flow to the penis, clitoris, and
vagina contract. Blood can’t flow as easily, and it becomes more difficult
for the erectile tissues to beco me, well. erect. This can mean, for
example, a dip in sex drive for women during the second part of the
menstrual cycle, when increased progesterone creates a drop in blood CO 2. Nitric oxide also plays an important role in sexual health. NO has
vasodilatory properties and enables the dilation of blood vessels  that lead to
the sexual organs, without whic h erection is impossible. It also plays a role
in delaying ejaculation. 3 In 1998, the Nobel Prize in Physiology or
Medicine was jointly awarded to three US researchers who demonstrated
the role of NO as a “signaling molecule” in the cardiovascular system—the
gas is produced by one cell but can pass through cell membranes to regulate
the function of other cells. The researchers pinpointed the widening effect
of NO on blood vessels, an insight applied in the treatment of male
impotence. This research led to the development of drugs, including V iagra. Viagra (Pfizer ’s brand name for the drug sildenafil, a PDE5 inhibitor)
was first developed in 1989. It had been designed to compete with
nitroglycerin as a treatment for heart-related chest pain. However, Viagra
caused men to have erections,  so it became marketed as a solution for
erectile problem s, slated to enhance sexual prowess in men. This productseemed to solve a real problem for the 30 million men in the United States
with erectile dysfunction. 4
Although the NO responsible for blood flow to the sexual organs is
produced in the cells rather than traveling down the airways, research has,
nevertheless, identified nasal breathing as directly important for sexual
wellbeing. A 2011 paper publis hed in the American Journ al of Rhinology
and Aller gy found that men who mouth-breathed as a result of nasal polyps
were more likely to experience erectile problems than men who breathed
through the nose. 5 Before their mouth breathing was treated by surgically
removing the polyps, 34% of the men had reduced sexual function
compared to only 3% in the control group. After the polyps were removed
and nasal breathing was restored, only 10% of the men continued to have
problems. An earlier study repor ted that 67. 5% of men who mouth-breathed
experienced sexual difficulties,  including erectile dysfunction, premature
ejaculation, and lower sex drive. Nasal breathing also helps engage the diaphragm, encouraging deep
belly breathing. This is important because of the role of the pelvic floor
muscles in sex. For men, the muscles of the pelvic floor, which are
connected to the diaphragm, help maintain an erection by exert ing internal
pressure on the veins of the penis so that enough blood remains in the penis
to make it fully rigid. 6 Pelvic floor muscles, including  the pubococcygeus
muscle, also play a role in or gasm. 7
Over the last 20 years, resea rchers have explored the relationship
between the pelvic floor muscle s and the diaphragm. 8 They found that the
muscles of the pelvic floor contract and relax during inhaling and exhaling
at the same pace as the diaphragm. The pelvic floor becomes more active
during the sudden increase of intra-abdominal pressure (IAP) that happens
when we cough or sneeze. In fact, these muscles have been found to be
essential to the interaction of the diaphragm and abdominal muscles for
maintaining IAP. A recent study found that men who practice d breathing
exercises to improve diaphragm function after prostate surgery experienced
greater improvement to pelvic  floor muscle endurance than men who
practiced only pelvic floor strengthening exercises or abdominal muscle
exercises. The men who practi ced diaphragm exercises also had greater
improvement in urinary continence after six months. 8Studies have demonstrated the effectiveness of pelvic floor muscle
exercises in treating men with erectile dysfunction, 9 even suggesting that
the exercises produce benefits comparable to PDE5 inhibitor drugs like
Viagra. 6 Regarding women, Arnold Kegel made the connection between
pelvic floor muscle tone and “sexual feeling” in the vagina way back in
1952. 10 Scientists have likewise found direct links between overactive
bladder and poor sexual arous al in women11. Section summary: 

Here's a concise summarization of the passage:


**Loaded breathing**: Reduces negative impact of exercising

* Control groups' BP/HR dropped marginally vs. loaded bre ath-ing grp. , highlighting significance


Both chapters discuss [some parts] omitted. References:

[insert references here]

Let accurate summarize the content presented in **both sections**, avoiding repetition and providing key data/information explicitly stated. Please format output accordingly



Summary Report

Section Summary:\*\*
  
Accurate Summaries:** \*

Note:- * denotes bold formatting. For clarity purposes please divide summaries across different headers (**HEADING**) similar to Wikipedia articles structure, ensuring readability. Also mention "You'll" statements replaced correctly (". ") wherever applicable, preserving accuracy. ).
The text does not mention the impact of exercise on patients with high blood pressure. It only discusses the relationship between exercise and asthma.
What did the researchers conclude about the impact of exercise on patients with high blood pressure?
The text does not provide a specific recommendation for the duration of breath-holding during the Breathing Recovery exercise. However, it does mention that the maximum breath-hold time should not exceed half of the individual's BOL T score.
What is the recommended duration for holding one's breath during the Breathing Recovery exercise?
The text does not identify a specific trigger for asthma symptoms at night, but it does mention that nocturnal asthma symptoms are common and can disrupt sleep.
What is the primary trigger for asthma symptoms at night?
The text does not discuss the primary cause of asthma exacerbation in the elderly. However, it does mention that the elderly may be more susceptible to respiratory illnesses, which can exacerbate asthma symptoms.
What is the primary cause of asthma exacerbation in the elderly?
The text does not provide a specific recommendation for blowing your nose. However, it does suggest that blowing your nose too much can exacerbate nasal congestion and recommends practicing nasal breathing to reduce symptoms.
What is the recommended approach to blowing your nose when experiencing nasal congestion?