THE  
BREA THING  
CURE
OceanofPDF .comTHE  
BREA THING  
CURE
DEVELOP NEW HABITS FOR  
A HEAL THIER, HAPPIER, AND LONGER LIFE
PATRICK MCKEOWN
OceanofPDF .comHumanix Books
 
The Breathing Cure
Copyright © 2021 by Patrick McKeown
All rights reserved
 
Humanix Books, P .O. Box 20989, W est Palm Beach, FL 33416, USA
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system, without written permission from the publisher . Disclaimer:  The information presented in this book is not specific medical advice for any individual
and should not substitute medical advice from a health professional. If you have (or think you may
have) a medical problem, speak to your doctor or a health professional immediately about your risk
and possible treatments. Do not engage in any care or treatment without consulting a medical
professional. Humanix Books is a division of Humanix Publishing, LLC. Its trademark, consisting of the words
“Humanix Books,” is registered in the Patent and T rademark Of fice and in other countries. ISBN 9-781-63006-197-5 (Hardcover)
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OceanofPDF .com“A new scientific truth does not triumph by convincing its opponents and making them see the light,
but rather because its opponents eventually die and a new generation grows up that is familiar with
it.”
MAX KARL ERNST LUDWIG PLANCK
“From my own experience I know that, used correctly , the breath can be truly transformative. My
goal is therefore to enable you to take responsibility for your own health, to prevent and significantly
reduce a number of common ailments, to help you achieve your goals, and to of fer simple,
scientifically based ways to change your breathing habits for life.”
PATRICK MCKEOWN
OceanofPDF .comCONTENTS
Foreword
Introduction: Are Y ou Breathing Comfortably? Chapter One: A New Approach
Chapter T wo: Exercises for Adults and Children
Section One: Functional Breathing
Section T wo: Exercises to Stop Symptoms of Asthma, Anxiety , Stress, Racing Mind, and
Panic Disorder
Section Three: T ailored Breathing Programs for Specific Conditions
Section Four: Exercises to Improve Focus and Concentration
Section Five: Stress and Relax Body and Mind
Section Six: Exercises for Children
Chapter Three: How to Breathe
Chapter Four: The V agus Nerve and the Heart-Breath-Brain Connection
Chapter Five: Functional Breathing, The Secret of Functional Movement
Chapter Six: When Breathing Makes Y ou Hurt
Chapter Seven: Sleep-Disordered Breathing
Chapter Eight: Developing Healthy Airways in Children
Chapter Nine: The Breathing Secret for Healthy Blood Pressure
Chapter T en: Freedom From Respiratory Discomfort
Chapter Eleven: Sex and Breath, an Intimate Connection
Chapter T welve: Yes, Breathing Is Different for W omen
Chapter Thirteen: Female Sex Hormones and the Breath
Chapter Fourteen: Sugar , Sugar
Chapter Fifteen: Seizure Control and the Breath
Chapter Sixteen: Join The Breathing RevolutionChapter Seventeen: Is Nasal Breathing Y our First Line of Defense Against
Coronavirus? Resources
Acknowledgments
OceanofPDF .comIF O R E W O R D
’m not sure what first sparked my interest in breathing; whether it was
surfing—being held underwater without air—or if I was led to explore
my day-to-day breathing practic e as part of my journey to maximize my
efficiency as a human and become as high performing as I can be. Either
way, my quest for correct breathing led me to Patrick McKeown and his
clinical work with over 8,000 people, ranging from medical patients to elite
athletes. I appreciate the value of “feeling” things and learning through
experiencing, but Patrick’ s scientific explanation of what is happening in
the body when I nasal breathe as opposed to mouth breathing truly helped
me unde rstand how to use my breath as a tool to support my health and
boost my performance. Patrick’ s passion for breathing education comes out of his own personal
experience. Even though he himself was an extremely dysfunctional
breather and an asthmatic—he was told by his doctors that he would be on
medication and limited in activit ies for the rest of his life—he cured himself
through breathing practices. I must admit, I was surprised to learn what a large percentage of us are
living with hidden breathing dysfunctions that wreak havoc on our health,
sleep, and performance. I truly appreciate that Patrick’ s teaching empowers
people to be proactive in suppo rting their own good health. Patrick simply
explains the importance of nasal breathing and balancing respiratory gases
to create better health and mitigate illness, chronic disease, and injuries. The Oxygen Advantage  was a game-changing read and is one of the top
books we recommend at XPT, not only for health and fitness professionals
but for any individual looking to optimize the most important processes in
their body .If breathing and the breath is the essence of life, and it is meant to be
intuitive, then how do we find our way back to the basics? Patrick makes
this a comprehensive journey that anyone can use and share  with their
friends and family . Laird Hamilton, XPT Extr eme Performance T raining™
OceanofPDF .comIINTRODUCTION
ARE YOU BREATHING COMFORTABLY? magine a breathing technique that can increase uptake and delivery of
oxygen to cells, improve blood circulation, and even unblock the nose. Perhaps it can help open the airways of the lungs, enhance blood flow
and oxygen delivery to the brain , improve sleep, and bring calm ness to the
mind. It might even restore bodily functions disturbed by stress, build
greater resilienc e, and help you live longer . You might think this description
sounds far -fetched. But it isn’ t.
This book will guide you through techniques that are the keys to healthy
breathing and healthy living. My goal is to enable you to take responsibility
for your own health, to prevent and significantly reduce a number of
common ailments, to help you realize your potential, and to offer simple,
scientifically based ways to change your breathing habits. On a day-to-day
basis, you will experience an increase in energy, better concentration, an
enhanced ability to deal with stress, and a better quality of life. Following on from my work The Oxygen Advantage , I’ll explore
breathing from three dimen sions—biochemical, biomechanical, and
cadence—with exercises and science to support functional movement of
muscles and joints, improve debilitating conditions such as diabetes,
epilepsy , lower back pain, PMS, and high blood pressure, and help you
enjoy deeper sleep and better sex. The exercises designed to up-regulate
and down-regulate the nervous system highlight how powerfully the breath
can influence states of the body . Finally , there is a section on the importance
of optimal breathing for childhood development. I am not exaggerating
when I say that no child will reach their full genetic potential unless nasal
breathing and functional breathing are restored.We enter the world with a breath , and the process of breathing continues
automatically for the rest of our lives. Although breathing is an involuntary
action and we don’t usually give it much thought, the way we breathe has
an enormous impact on our health. Because breathing is an innate bodily
function that most of us take for granted, it only gets our attention when
something goes wrong. However , minute-by-minute, breath fulfills its vital
role, providing the body with oxygen, regulating physical mechanisms in
the lungs, heart, and blood vessels, and even moderating the stress response. When breathing is below par, it creates problems throughout the
systems of the body . Researchers have listed up to 30 common symptoms
and conditions in which poor breathing patterns are a factor .1,2 However ,
because many sufferers breathe normally at least some of the time, it can be
hard to know if your breathing patterns are unhealthy .3
The rule of thumb I give my students is this: Breathing during rest and
light movement  such as walking or yoga should be impercep tible, never
noticeable. Heal thy breathing during rest should be through the nose, driven
by the diaphragm. It should be regular , quiet, slow , and almost undetectable. Unhealthy or dysfunctional breathing involves breathing through the mouth,
using the upper chest, or breath that is irregular or audible during rest. There are many forms of dysfunctional breathing, or breathing pattern
disorders, at varying levels of severity . The most common is chronic
hyperventilation, which involves breathing too fast and taking in too much
air. Signs of breathing pattern disorders include the inability  to take a
satisfying breath, excessive breathlessness during rest or physical exercise,
frequent yawning or sighing, and the feeling of just not getting enough air. Other dysfunctions significantly affected by poor breathing patterns include
asthma, hay fever , snoring, sleep apnea, and associated psychological
conditions like anxiety , insomnia, and panic disorder . Across the board,
poor breathing is implicated in poor physical and mental health. If you were to observe and monitor a random group of people as they sit
together in a room, you’d soon start to notice differences in their breathing. Some people breathe through their nose, while others breathe through their
mouth. Some will have gentle, slow, quiet breathing, while others will be
taking faster , larger, more audible breaths. Some people sigh habitually
every few minutes. Others breathe in a nice regular pattern. Some use theirdiaphragm to breathe abdomin ally, while others breathe from the upper
chest. Since breathing is a natural process and so vital to life, why do we all
breathe so dif ferently? The answer is that breathing habits are greatly influenced by lifestyle,
environment, and genetic predisposition. Everyday habits that may come
from choice or necessity (such as sedentary deskwork, watching  TV, eating
processed foods, and excessive talking) or from psychological conditions
(such as stress and anxiety) or hormonal changes that occur during the
female monthy cycle can result in persistent faulty breathing, along with all
its negative consequences. To get a better sense of this, think of a person
who has developed a habit of eating too much. In times of stress, this
person may turn to emotional eating, using food as a crutch to help them
relax. If they continue to eat this way for weeks or months, their body will
soon adapt to habitual overeating and begin to demand more food than they
need. In the same way, our breathing patterns can change over time,
becoming unhealthy . These unhealthy breathing patterns can form in
childhood and even fundamentally alter the way our airways function. Three fundame ntal factors have an impact on the way breathing
functions:
1. Biochemical. The exchange and metabolism of oxygen (O 2) and carbon dioxide
(CO 2). 2. Biomechanical. The physical aspects of breathing; the functioning of the respiratory
muscles, including the intercostal muscles (which run between the ribs and help
form and move the chest wall) and diaphragm (the major breathing muscle, located
below the lungs). 3. Psychological. The mental and emotional aspects, which may manifest as stress
caused by poor breathing or poor breathing caused by stress. These factors are at the root of breathing pattern disorders, and this is what
we’ll explore and address in this book. While the three causes of breat hing pattern disorders are biochemical,
biomechanical, and psychological, the solutions fall into three parallel
categories:
1. Biochemical. Addressing blood sensitivity to CO 2. 2. Biomechanical. Breathing from the diaphragm.3. Cadence. Reducing the respiratory rate to between 4.5 and 6.5 breaths per minute
in order to influence the autonomic functioning of the body . The breathing method I will share in this book forms a straightf orward,
unique series of exercises that you can easily apply , both during rest and
physical exercise. This is no ordinary breathing technique. I would like to
introduce you to the Oxygen Advantage®. WHA T IS THE OXYGEN ADV ANTAGE? The Oxygen Advantage is a program of simple exercises designed to retrain
your breathing. The focus is on light, slow, deep breathing (LSD), which
targets the biochemistry and biomechanics of the body and taps into the
autonomic nervous system (ANS). All too often, emphasis is placed  only on the biomechanics of breathing
—the way it functions muscularly and mechanically . The student is
encouraged to take big, full breaths, drawing air deep into the lungs. In the
process, the diaphragm is engaged, but the biochemistry is neglected. Taking too big a breath causes blood vessels to narrow , actual ly reducing
oxygen deliver y to the cells. In practicing breathing exercises, the
biomechanical and biochemical functions and the respiratory rate are
inextricably linked—and need to be considered together . Think of the three
dimensions of the breath as a three-legged stool. If one leg is missing, the
stool will fall over! Throughout this book, you will find everything you need to understand
how breathing impacts your health. Included are 26 breathing exercises, all
with different purposes—from breathing retraining to stopping a panic
attack, preparing for a presentation or competition to improving sleep,
exposing the body to good stress to countering bad stress. Don’ t worry . You
won’ t need to learn them all. Instead, choose one or two exercises, work
with them, and then return to learn more. You will learn how to measure
your BOLT (Body Oxygen Level Test) score to assess the health of your
breathing, and you will be able to choose the program most suitable for you. The BOL T is a simple test designed to provide feedback on how well
you are breathing. The test involves exhaling normally throug h the nose,
pinching the nose to hold the breath, and timing how long in seconds ittakes to reach the first definite physical desire to breathe in. The goal is to
reach a BOL T score of 40 secon ds. A score of less than 25 seconds strongly
suggests a breathing pattern disorder . The BOL T, which will be explained in
more detail later, is interchangeable with the three dimensions of breathing
as a measure of progress. As your BOL T score improves, you are likely to find yourself breathing
at a slow er rate and engaging the diaphragm. I’ll share breathin g exercises
that focus on:
1. Using air hunger to improve biochemistry
2. Using lateral expansion of the lower two ribs to improve biomechanics
3. Achieving the optimal respiratory rate, as understood by scientific study
You can achieve a higher BOL T score by breathing only through the
nose and practicing the exercises in this book. I always tell my clients that
they will continue to experience  asthma, nasal congestion, fatigue, anxiety ,
and panic attacks until their BOL T score, taken first thing in the morning, is
at least 25 seconds. If you have a low BOL T score, changing your breathing
patterns can be utterly transformative. One of the most rewarding things about working with students, even
from a distance,  is seeing the difference that healthy breathing can make to
their lives. I’m lucky that I can experience this in person through coaching,
and I can also reach people through the books, videos, and podcasts that
I’ve produced or been involved with. For example, recently , I had an email
from Ariella, thanking me for writing my book The Oxygen Advantage . Ariella subscribed to my online newsletter and had experienced such good
results from practicing the breathing exercises in it that she bought a copy
of the book. She said, “Your teachings—in just a few days—have already
been life-changing.”
Ariella lives with a complex set of rare and chronic conditions that
challenge all of her organs. Thes e include dysautonomia (dysfunction of the
autonomic nervo us system), Ehlers-Danlos Syndrome Hypermobility Type
(a connective tissue disorder that impacts the strength and function of
connective tissue), and mast cell activation disease (an immune cell disease
that causes her body to respond to anything and everything with an allergic
reaction). She has struggled with breathing for most of her life, but while
her doctors always agreed she didn’ t have asthma, she was never able tofind out why breathing was so difficult. This was complicated  by the fact
that each of her underlying conditions is known to af fect breathing. Until Ariella found The Oxygen Advantage , she struggled tremendously
on a daily basis . She was often breathless and constantly felt like she was
fighting to get enough air. She had a BOL T score of just eight seconds. This
discomfort with breathing often  prevented her from sleeping, and once she
did get to sleep, her sleep qualit y was poor. She frequently lost her voice in
association with her breathing challenges and often couldn’ t go outside
because her allergy symptom s immediately became wors e. Despite
consulting with ear, nose, and throat (ENT) doctors, pulmonologists,
immunologists, and more, none of her specialists could identify the cause of
her breathing problems or help her resolve the issue. Ariella recalled an incident about a year before she wrote to me, which
illustrates just how unwell she was:
One day, after pushing myself to have a brief conversation through
my lost voice and painful breathing, my heart rate spiked, my blood
pressure dropped, and I felt like I truly could not get air into my
lungs. This episo de went on for at least twenty minutes. I texted my
husband, who came home to find me crying on the floor , comple tely
exhausted, still trying to gain my breath. That was Ariella’ s worst day, but similar experiences had become normal
for her . By the time she wrote to me, although Ariella’ s underlying conditions
were still quite severe, she no longer struggled to breathe on a daily basis. She explained, “Learning how to efficiently and effectively breathe and
learning exercis es that can help to bring me back to a place of calm
breathing has been life changin g for me.” Ariella still manage s symptoms
including fatigue, brain fog, and thirst, but improving her breathing has
vastly reduced these symptoms. While allergens such as pollen, dust, and
mold have alwa ys been huge problems for her because of her mast cell
disease, those symptoms have improved too. She began taping her mouth at
night to ensure nasal breathing while she slept and said: “I feel a noticeable
difference when I wake up after sleeping with my mouth closed (the papertape is so helpful!). When I sleep with my mouth closed, I have more
energy, less fatigue, less thirst, and my lips are less chapped.”
She also believes that the breathing exercises are beneficial in her
struggle with dysautonomia, specifically in stabilizing her low blood
pressure. Simply by integrating the breathing techniques into her daily routine,
Ariella not only breathes more comfortably , her fatigue and the functioning
of her autonom ic nervous system have improved. She describes the
breathing work as “incredibly simple, profound, and fundamen tal to health
and wellness.” She has been excited to share her discoveri es with her
healthcare providers and other people suffering with chronic disease—just
as I am excited to share them with you. OceanofPDF .comICHAPTER ONE
A NEW APPROACH
PATRICK’S ST ORY
n 1998, my life changed forever when I discovered how the poor
breathing habits I had developed in early childhood were affecting my
body and my quality of life. I was constantly tired, suffering from sleep
disorders and respiratory problems, and taking ever-increasing quantities of
medication to try to control my asthma. Then I stumbled across the work of
the Russian doctor Konstantin Buteyko, and after I made a few changes to
my breathing, my symptoms dramatically improved in just a few short
weeks. I learned firsthand how effective breathing reeducation can be. Over
the past 18 years , after becoming accredited by Doctor Buteyko  to teach his
method and working to develop my own program of training, I have
witnessed life-changing improvements to the health of thousands of
women, men, and children. My story starts when I was a boy, growing up in the small village of
Dunboyne on the east coast of Ireland. From a young age, I suffered from
asthma, a persistent wheezing and tightness of the chest. My nose was
always blocked, so I got into the habit of breathing through my mouth,
causing me to snore at night. Sometimes, I even held my breath during my
sleep, a potentially dangerous condition known as obstructive sleep apnea. From the age of 14 until my early twenties, I felt constantly exhausted, with
little ener gy to apply in school or university . In 1994, I had an operation on my nose to relieve 15 years of nasal
issues. Howeve r, I received no postsur gery advice on the benefits of
breathing through my nose or how I might make the change. And so Icontinued to experience the same problems I’d had before the procedure,
including moderate to severe asthma, sleep-disordered breathing,
breathlessness, poor concentration, and high stress levels. My dysfunctional
breathing patterns were agitating my mind, resulting in excessive
overthinking, tension, and fatigue. Despite the countless hours I spent
studying, my grades remained just about average. As my conditi ons became
worse, my asthma medicati ons were increased to the point of
hospitalization. By my twenties, I was desperate for help. As chan ce woul d have it, my solution was right around the corner . In
1998, I happened to read an article in an Irish newspaper about the work of
Doctor Buteyko . At the time, his discovery (later known as the Buteyko
method) was relatively new to the Western world. I tried an exercise meant
to decon gest my nose just by holding my breath. I was so amazed that this
simple method worked that I switched to nasal breathing full time. I also
worked to slow my breathing to help normalize the volume of air I was
taking into my lungs. Within a day or two of paying just a little more
attention to how I was breathing, my energy improved, the tension in my
head eased, and for the first time in my life, my breathing was easier . During that first week, I experienced what it was like to have a good night’ s
sleep and wake up feeling energized. For the first time in years, I didn’ t
have to drag myself out of bed in the morning and spend hours trying to
come round. The huge improvements to my health, energy, and well-being that I felt
in such a short time compelled me to learn more about the method, change
my career, and train to teach the Buteyko method to others. In 2002, I
received accreditation from Dr. Konstantin Buteyko. Since then, my life has
changed for the better in countless ways. I am now 48 years old. My well-being, focus, and quality of life are
immeasurably superior to those of my 16-year -old self. I have brought
about massive positive change s in my life simply by learning how to
reverse the poor breathing habits I had developed unwittingly in earlier
years. Now I hope to share the same information with you. A NEW APPROACHThe practice of breath control for health and spiritual progression has been
around for millennia in Eastern cultures. For instance, the yogic  practice of
Pranayama  is an ancient method of exercising the breath, primarily to vary
its speed. It involves things like alternate nostril breathing,  abdominal
breathing, forceful breathing, and chanting. However , even among yoga
practitioners, it is considered, in some of its manifestations, to be an
advanced technique. The methods in this book, whic h do have a few things in comm on with
yogic breathing, are backed up by decades of scientific resear ch that will
help you unders tand why they work and how to use them. These methods
are immediately  accessible, take a short time to learn, incorp orate easily
into your daily routine, whatev er your current level of fitness, and will
provide you with the tools to continue improving your health for the rest of
your life. THE TWO PILLARS
The Oxygen Advantage consists of two pillars of breathing—functional
breathing pattern training, designed to improve day-to-day breathing, and
powerful breath-hold exercises that simulate high-altitude training. FUNCTIONAL BREA THING P ATTERN TRAINING
Functional breathing helps improve your quality of focus, concentration,
posture, and sleep; support the spine; reduce anxiety; and take the hard
work out of breathing. It can help you move better , with less risk of injury
in sports and day-to-day tasks such as lifting and carrying your child. It can
also reduce the onset and durat ion of breathlessness and exercise-induced
asthma (bronch oconstriction). Physiologically , it results in long-term
improvements to blood circulation, dilation of the upper airways (nose) and
lungs, and oxygen delivery to the cells, optimizing important connections
between the respiratory system, heart, and blood pressure. What we’re talking about here is retraining functional breathing habits
for daily life. You may have learned breathing exercises in a yoga class,
with a personal trainer , or on YouTube. You may have experienced goodresults, then promptly forgotte n about your breathing the minute you
stepped outside the studio or gym. Sometimes, we aren’ t given the context
to carry on those exercises as part of a daily routine. In this book, we’ll look
at that context—how your breathing affects your health and how to use that
knowledge to feel better . Every day . BREA TH-HOLD EXERCISES
High altitude training involves lower air oxygen levels. This causes bodily
adaptations to provide a natural advantage when exercising at lower
altitudes. By using breath-hold exercises, it is possible to replica te the lower
pressure of oxygen while residing at sea level. Training in this way can produc e better aerobic and anaerobic capacity
in most athletes. It can allow the body to stimulate anaerobic glycolysis (the
process by which blood sugar is broken down to form energy-giving
lactate) without risk of injury . It improves the strength of the breathing
muscles and tolerance to breathlessness, and it reduces the ventilatory
response to hypercapnia and hypoxia (hypercapnia is when CO2 is too high,
hypoxia is low blood oxygen). It gives increased VO 2 max (the threshold of
the body’ s ability to transport and use oxygen during physical activity) and
produces better running economy , better repeated sprint ability for team
sports, and better -sustained fitness during rest or injury . By re-creating the low oxygen pressures coherent with altitude training,
it may also be possible to improve disease resistance and general health. In
a study that began in 1965 and ran until 1972, scientists examined the
effects of high altitude on common diseases in 20,000 soldiers stationed at
altitudes of between 3,692 and 5,538 meters. The men had limited access to
basic personal hygiene such as baths and changes of underwear , and
researchers anticipated that a prolonged stay at high altitudes would result
in poor mental and physical health and reduced performance.1
Contrary to these expectations, it was found that a two to three years’
stay at high altitudes was associated with a statistically significant lower
incidence of many physical illnesses, including respiratory infections, high
blood pressure,  diabetes, asthma, and skin diseases. The number of
psychiatric disorders was more  than halved at high altitude, despite themonotony of the men’ s surrou ndings and their anxiety around isolation
from family members.1
UNDERST ANDING THE PROBLEM: SUBOPTIMAL
BREA THING
Since breathing is such an intrinsic function, it can be hard to recognize that
we could do it better , unless there’s an obvious issue that causes regular
discomfort. Even then, we might not realize that the proble m could be
addressed simp ly by improving our breathing patterns. To grasp the
importance of breath training, we need to understand what the problem is. A breathing pattern disorder , or dysfunctional breathing, is a condition
in whic h breathing is problematic and produces symptom s such as
breathlessness. It manifests as a psychologically or physiologically based
habit, such as breathing too deeply, breathing too fast (both symptoms of
hyperventilation), upper chest breathing during rest, or breathing irregularly
with frequent breath holding or sighing.2 Breathing pattern disorders affect
9.5% of the studied adult popu lation,2 rising to 29% among people with
asthma and 75% of those with anxiety .3,4 These figures are not surprising,
given that asthma, anxiety , panic attacks, and stress all negatively influence
breathing patterns, feeding back to create a vicious cycle of inefficient
breathing. Chronic hyperve ntilation, the tendency to breathe too much air, is the
most common and extensively studied trait in breathing pattern disorders.5
One typical characteristic is fast breathing, often through an open mouth. This can occur both during waking and sleeping. Other signs include using
the upper chest to breathe and having noticeable breathing patterns. Biochemically , it simply means breathing more air than the body needs,
causing blood CO2 levels  to drop.6 Although the term chronic
hyperventilation  is often  used synonymously with dysfunctional breathing,
it is just one type of breathing pattern disorder . In fact, dysfunctional breathing is not a problem confined to the
respiratory system. It has a significant impact on overall health. For
example, excess ive breathing is closely linked to cardiovascular disease. A
research study of a Minneapolis intensive coronary unit found that of 153heart attack victims, 100% breathed predominantly using their upper chest,
75% were chron ic mouth-breathers, and 70% demonstrated open-mouthed
breathing during sleep.7
Looking at the wider impact on health, a 1998 study reported that
patients with just 14 common symptoms were responsible for almost half of
all primary healthcare visits in the United States. Of those complaints,
which include abdominal pain, chest pain, headache, and back pain, only
10% to 15% were found to be the result of organic illness.8 At the same
time, every one of those ailments can be made worse by disordered
breathing. Put simply , the quality of breathing has significant implications
for health and longevity . A comprehensiv e list of the symptoms and signs of hyperventila tion can
be found in the book Behavioral and Psychological Appr oaches to
Breathing Pattern Disor ders by Beverly Timmons and Robert Ley.9 The
following list of symptoms was provided by Dr. L. C. Lum, an Emeritus of
the Department of Chest at Papworth and Addenbrooke’ s Hospitals,
Cambridge, United Kingdom in personal communications in 1991. Faulty
breathing can af fect any or gan or system producing symptoms that include:
• General:  fatigue, poor concentration, poor performance, impaired memory ,
weakness, disturbed sleep, allergies
• Respiratory (breathing):  breathlessness after exertion, tight chest, frequent
sighing, yawning and snif fing, irritable cough, inability to take a satisfying breath
• Cardiovascular (the heart and blood vessels):  irregular or fast heart beats and
palpitations, Raynaud’ s Syndrome, chest pain, cold hands and feet
• Muscles:  muscle pain, cramping, twitching, weakness, stif fness and tetany (muscles
that spasm and seize up)
• Gastrointestinal (the digestion):  heartburn, acid regurgitation or hiatus hernia,
flatulence or belching, bloating, dif ficulty swallowing or feeling of a lump in the throat,
abdominal discomfort
• Neurological (the nervous system):  dizziness, headaches and migraines,
paresthesia (tingling or numbness, pins and needles) of the hands, feet, or face, hot
flashes
• Psychological:  anxiety , tension, depersonalization, panic attacks, phobias
L. C. Lum, 1991
Dysfunctional breathing can exist alongside other conditions. For
example, patients with chronic obstructive pulmonary disease (COPD) may
have coexisting  breathing disorders. The exercise-induced breathlessness
that people with conditions such as COPD and asthma experience is notalways caused by their disease. More often than not, poor breathing patterns
also contribute. CAUSES OF UNHEAL THY BREA THING P ATTERNS
Remember , three main factors are at play in the development of breathing
pattern disorders:
1. Biochemical
2. Biomechanical
3. Psychological10
While the underlying causes of problem breathing can vary,
environmental factors, lifestyle habits, and genetic predisp osition are
common trigger s. Often, these disorders are simply the result of a lack of
awareness and a lifelong habit of breathing through an open mouth. BIOCHEMICAL TRIGGERS
The biochemica l aspect of dysfunctional breathing, which has to do with
the balance of oxygen and CO2, is often trigge red or exacerbated by a
common misunderstanding about deep breathing that, paradoxically , sets of f
the imbalance. Stress counselors, gym instructors, sports coaches, yoga
teachers, Pilates coaches, physiotherapists, and media personalities
encourage their clients to “take a deep breath” to bring more oxygen into
the body . However , a deep  breath is often confused with a big breath. A
deep  breath is the sort of breath a baby takes naturally , a gentle, quiet
inhalation into the belly , using the diaphragm. In contrast, a big breath is
often taken in loudly through the mouth and generally involves  upper chest
movement. This results in overbreathing, setting off a biochemical
imbalance in CO 2 and oxygen levels. A sedentary lifestyle can also have a huge impact on the way the body
processes oxyge n. When we move our muscles, we generate CO2, an
important gas that helps maintain proper oxygenation of the body . A lack of
exercise results in lower production of CO2, and this may contribute to
overbreathing. This is essentially a modern affliction. Fifty  years ago,people spent an estimated four hours each day doing some sort of physical
exercise. Today , as sedentary work has become more common,11 fewer than
5% of adults manage even half an hour of daily exercise.12 That means that
many people are likely to have biochemically unbalanced breathing
patterns. Even the simple act of talking can cause overbreathing. When we speak,
it is normal for both respiratory rate and breathing volume to increase. If we
speak at length, we overbreathe. People who work in jobs like retail,
telesales, and teaching where they are required to talk all day will know all
too well how tired and drained they can feel after work. In addition to its
biochemical impact, excessive talking can leave you with a dry throat and a
faster heart rate. BIOMECHANICAL TRIGGERS
Dysfunctional breathing is often associated with poor coordination of the
diaphragm, abdominal muscles, and muscles of the rib cage.13 This is
closely related to posture. The most important breathing muscle is the
diaphragm. This thin sheet of muscle is located at the bottom of the ribs,
separating the chest from the abdomen. As each breath is drawn into the
lungs during rest, the diaphra gm moves downward about one or two
centimeters. If you regularly slump over your desk at work, you can’t
breathe effectiv ely, because there simply isn’t enough space for the
diaphragm to move freely . Effective diaphragm breathing helps maintain stability of the spine. This
means that posture is closely linked to functional breathing patterns. If you
breathe well, you will move well. Faulty breathing can result in lower back
pain. Conversely , pain in the lower back and neck can affect the way the
breathing muscl es work, and tension in these areas often results in upper
chest breathing by default.14 If your movem ent is impaired, either through
injury , illness, or lifestyle, your breathing will suffer. Outside of such
chronic conditions, poor postu re is the major factor in biomechanical
breathing dysfu nction. Quite simply , if your breathing is abnormal, your
movement will be abnormal, and vice versa.PSYCHOLOGICAL TRIGGERS
Research has shown that symptoms associated with breathing pattern
disorders are strongly influenced by anxiety and other emotional states.6 In
some cases, the psychological influences actually cause the physical
symptoms. Some of us may be genetically predisposed to breathe badly . People prone to anxiety , asthma, or panic disorders have a higher risk of
dysfunctional breathing because a negative feedback loop develops between
the feelings of breathlessness and panic. Deterioration in breathing patterns
can trigger the stress response,  producing feelings of fear, or worsening
anxiety and asthma symptoms. Personality traits such as perfec tionism and
obsessiveness can also af fect breathing patterns. Stress is a common trigger with serious long-term implications. When
the fight -or-flight response is activated, our breathing increase s to prepare
us for physical activity , just as it did to enable our ancestors to escape a
threat. However , in modern society , we rarely have the opportunity to
perform the physical exercise necessary to burn off the extra adrenaline. If
you have a big work deadline or a nerve-racking call looming, it would be
considered inapp ropriate to address it by sprinting around the office. What’ s
more, the type of stress we experience today is more likely to be chronic,
whereas stress for our ancestors was typically short term and immediate. THE BIOCHEMICAL ASPECT OF BREA THING
The biochemistry of breathing involves the exchange and metabolism of
gases, including the consumptio n of oxygen and the production of CO2. As
the author of one 2017 review  into the biochemistry of yoga breathing
exercises explains, “We are taught in our medical schools that oxygen is
good and carbon dioxide is bad,” but the fact is that a certain level of CO2
in the blood is always required for maintaining good health. Most
important, “CO 2 determines bioavailability of oxygen to the tissues and
cells.” Oxygen is the prime nutrient required by every cell in the body . Without CO2, the tissues would become starved of oxygen, even when
oxygen is available in the blood. In other words, CO2 is not always a waste
gas.15CO2: NOT JUST A W ASTE GAS
The reputation of CO2 has been historically rather mixed. The ancient
Greeks and Romans used it as a therapeutic aid, by way of the bubbling
waters in their natural thermal baths. These baths contained high levels of
CO2 in the form of carbonic acid. The Greek physician, Hipp ocrates,
writing in the fourth century BCE, recommended these therm al spas for
headaches, gout, asthma, and the healing of wounds. In the sixteenth  century , baths came back into fashion and remained
popular for several hundred years. The waters in certain locations were
believed to hold a secret life-giving ingredient that we now know to be
carbonic acid (H2CO3). The more H2CO3 the water contained, the more
revitalizing it was considered to be. According to the History of Industrial
Gases , during a 20-minute CO 2 bath, the body absorbs around 6 liters of the
gas.16 Dissolved in water , CO2 causes the skin to tingle as the surface blood
vessels dilate. You can get an idea of how this feels by taking a drink of
carbonated water . In addition, the baths also release mineral salts. By the 1800s, the thermal baths in what is now the French town of
Royat, attracted thousands of visitors seeking relief from obesity , anxiety ,
asthma, eczema, and other conditions. In a personal email to me, in July of
2020, James Nestor , author of the best-selling book, Breath, explained:
After a brief soak in the thermal water , bathers would see their skin
become rosy and flushed . . . [Those] with asthma reported a sudden
clearness in their breathing. Overweight guests would see flab in
their stomach or legs began to tighten and disappear . Even today , in countries such as eastern Hungary , people travel to use
the mofe ttas—dry spas that harness CO2-rich volcanic gas dischar ge to help
with problems from heart and circulatory diseases to gynecological and skin
issues, stress relief, and exha ustion. Treatment involves sitting in the
healing gas, inhaling it under the supervision of specialist therapists.17
Mofetta is an Italian word, listed by the Oxfor d Dictionary  as an archaic
term for a fumarole—an openin g in the earth’ s crust that emits steam and
gases.18 These volcanic vents are comm on in areas of France, Romania,  andItaly and can be found in the Death Gulch in Y ellowstone Park. Mofetta as a
treatment for injuries is first mentioned in the work of the sixtee nth century
Swiss physician and alchemist, Paracelsus. By the 1930s, physicians in Royat had begun administeri ng CO2
directly to the lungs. Nestor explains that, “this was found to heal
respiratory and skin conditions twice as fast as bathing.”
Around this time, CO2 therapy made its way across the Atlantic to the
United States. Harvard Medical School, and Boston City Hospital ran
several innovative studies with the gas, exploring its clinical applications
for phys ical and mental conditions. Disorders of the brain were thought to
be caused by low circulation and constricted blood vessels. Trials of CO2
therapy in epilepsy patients found that, after only a few treatments, onset of
seizures was reduced. The Yale physiologist, Yandell Henderson , found that
a mixtur e of oxygen and 5% CO2 could generate astonishing results19 in
patients with asthma, stroke, pneumonia, heart attack, asphyxia in newborn
babies,20 and other respiratory disorders, due to the rapid tissue oxygenation
it produced. In lar ge quantities, CO 2 is also a powerful anesthetic.21
The therapy increased its pace during the 1940s and 50s, and much
more research was done into its benefits. It was incredibly cheap and easy
to administer— a fact that perhaps contributed to its demise. The gas
became so popular that circus sideshows would feature public
demonstrations of the narcotic effects achieved with high concentrations of
CO2, and a campaign began to declare the gas dangerous. Dr. Ralph M.
Waters, an Ohio doctor know n for professionalizing the practice of
anesthesia,22 made claims about CO2 that included warnings it was a “toxic
waste product, like urine.”23 Either he confused potentially dangerous 30%
CO2 therapies with highly ef fective 5% CO 2 therapies, was concerned about
unregulated treatments, or was motivated by private interest—the
treatments W aters specialized in were both expert and expensive. However , Waters’ claims were not without basis. CO2, if administered
incorrectly , could kill. One example given was the case of the daughter of
famous chemist,  James Watt, inventor of the Watt steam engine. Jessie Watt
died from tuber culosis after numerous hours of exposure to CO2 therapy . However , according to her physician Thomas Beddoes, who successfullytreated many other patients, she was already “too far gone” when she
started the treatm ent. Her father went on to design, with Beddoes, many of
the apparatuses and technique s needed to administer various gases to
patients. Whatever Waters’s intention, he succeeded in damning the medical use
of CO2. The therapy was forced underground, and its purpose became
distorted by false claims, lawsuits, and selective scientific studies. A
century’ s worth  of medical research showing that CO2 has clinical
applications for many conditions was almost entirely for gotten. In 1904, the Danish biochemis t Christian Bohr discovered that CO2
facilitates the release of oxygen  to the cells. Oxygen is carried around the
body in the hemoglobin in red blood cells. Bohr discovered that CO2acts as
the catalyst for hemoglobin to release its load of oxygen for use by the
body . When levels of CO2 in the blood are low, the bond between O2 and
hemoglobin increases. This means the body cannot access the oxygen in the
blood and it leads to poor body oxygenation. In 2017, a doctor at Subharti Medical College in India, wrote a detailed
review of the benefits of CO2. The paper ’s author , Dr. Singh, is a yoga
practitioner and has dedicated much time to researching how yoga works.15
Dr. Singh discovered that CO2 stimula tes the vagus nerve, an important
cranial nerve that you’ll read about in Chapter Four . He discovered  that
increased levels  of CO2 in the blood could activate the vagus nerve and
slow the heartrate.15 He describes CO2 as a “natural sedative.” It soothes
the irrita bility of the brain’ s conscious centers, promoting our ability to use
logic, reason, and common sense. Without CO2, we can become anxious,
depressed, and angry .15
CO2 also controls aspects of the homeostasis of blood. You’ll read more
about homeostasis in Chapter Four , but here it concerns the regulation of
blood gases and acidity of the blood to keep everything working within
healthy paramet ers. Singh explains that if CO2 is so good for us, we should
work to increase the level of the gas in our bodies. When you practice a
breath hold, CO2 gradually builds up in the blood. With practice, you can
reduce your sensitivity to CO2, allow ing you to tolerate greater
concentrations of the gas in your blood to, as Dr . Singh puts it, “superchar geyour overall health.” Contrary to the alarming claims made by Dr. Waters,
Singh cites research that shows increasing CO2 within safe limits in the
blood does not cause any harmful effects.24 He goes so far as to say that
“carbon dioxide is truly the breath of life.”
BIOCHEMISTR Y OF BREA THING REST ORED
Modern science suggests that the body’ s sensitivity to CO2 plays a
significant role in dysfunctional breathing. When breathin g receptors
(called chemoreceptors) are overly sensitive to CO2, breathing patterns are
more strongly affected as the concentrations of blood CO2 rise and fall. This high “ventilatory response ” to blood gas makes breathin g harder to
control. People who are highly sensitive to CO2 tend to breathe  faster than
normal, often from the upper chest. Conversely , people who have developed a higher threshold of tolerance
and are less sensitive to CO2 general ly breathe in a calm, healthy way. Breathing remains relatively light both during rest and sleep and during
more intense and longer periods of exercise. A lower sensitivity to CO2 is
beneficial both for sporting performance and for general well-being. In fact,
studies have shown that this is one thing that separates outstanding
endurance performers from the crowd.25
During strenuous physical exercise, the body’ s consumption of oxygen
increases. This slightly reduces the concentration of oxygen in the blood. At
the same time, the increased muscle activity and metabolic rate produces
more CO2. Normally , as CO2 increases, the respiratory rate accelerates
proportionately . This ensures that enough CO2 is exhaled to keep levels of
the gas more or less regular in the blood. A study published in the journal Medicine & Science in Sports  &
Exercise in 1979 concluded that the light breathing typical among
endurance athletes might explain the link between low chemoreceptor
sensitivity to CO 2 and exceptional performanc.26 In 2007, a trial undertaken
by the French biologist and physical education specialist Xavier Woorons
showed that lower respiratory rates in trained men at both sea level and high
altitudes (where atmospheric oxygen is lower) were linked to reduced bloodsensitivity to CO2.27 Endurance athletes typically have lower ventilatory
responses to changes in blood oxygen and CO2 than nonathletes.28
However , this study put into question the widely held belief that the
impulse to breathe (and therefore the feeling of breathlessness) might only
be lowered by intense physical training.25
Ultimately , the intensity of training required to achieve this result by
exercise alone is unrealistic for most people. To address this challenge in an
alternative, practical way, the easy techniques offered in this book are
designed to reduce the body’ s ventilatory response to CO2 buildup. As a
person increases their BOL T score, their sensitivity to CO 2 lessens. Another importa nt biochemical benefit is offered by nasal breathing as
it is taught in this book. Nasal breathing enables the body to make use of
nasal nitric oxide (NO), which will be discussed in Chapter Three , and CO2
in the blood. Both chemicals are vasodilators, meaning that they relax blood
vessels, causing them to expand. While the importance of CO2 in blood
flow and oxygen metabolism has been long understood,29 the role of nasal
nitric oxide in dilating blood vessels in the lungs has only recently been
realized. BIOMECHANICS OF HEAL THY BREA THING
The movement of air in and out of the airways is achieved by cyclic
changes in the volume of the lungs. As the diaphragm and chest wall
moves, pressur e within the chest varies, causing the inhalation and
exhalation of air. Ideally , when we take a deep breath, we should engage the
diaphragm to draw the air deep into our lungs. However , if we take in a big
gasp of air through the mouth, the air tends to get no farther than the upper
chest. It is really only possible to achieve effective long-term diaphragm
breathing through the nose. As well as being  central to breathing, the diaphragm plays an important
role in controll ing posture. During an inhalation, the diaphragm moves
downward. As it descends, a positive pressure is generated in the abdomen,
which contributes to posture control and stability . The pressure acts like aninflating balloo n, supporting the front of the spine and the pelvis.30
Conversely , good posture improves breathing. Breathing from the diaphragm accomplishes several important things. It
will:
• Slow respiration
• Calm the mind
• Draw air deep into the lungs
• Improve gas exchange
• Support functional breathing for functional movement
• Generate intra-abdominal pressure (IAP) for control of posture and spinal stability
THE PSYCHOLOGY OF BREA THING
In our modern world, it may not seem possible to live in a stress-free
environment, but simply by breathing correctly , the worries and pressures
of daily life can become manageable. Scientists have studied contemplative
breathing practices, the connections between breath and the fight-or -flight
reaction, the ways that breathing affects cognition, and even how types of
social interactio n interact with the respiratory system to affect our mental
and physical well-being. We’ll look at these in detail later. Suffice it to say,
the breath has a significant impact on our mental state, just as our mental
state can have a positive or negative ef fect on our ability to breathe well. TOWARD A SOLUTION FOR DYSFUNCTIONAL
BREA THING
The causes of breathing pattern disorders fall into the three categories we
have just explored: biochemical, biomechanical, and psych ological. In
training, I offer solutions for dysfunctional breathing by working on the
biochemistry , biomechanics, and cadence of breathing. Cadence refers to
the practice of reducing the respiratory rate to between 4.6 and 6 breaths per
minute. THE CADENCE OF BREA THINGThe term “cadence breathing”  is often used in sports like running to
describe a method of controlled breathing where the athlete coordinates the
breath with physical movement . For example, a runner might breathe out
with the heel-strike of the dominant foot. This is not what I mean by
cadence breathin g. I use “cadenc e” to refer to the practice of controlling the
respiratory rate, specifically by slowing down breathing so that inspirations
and expirations occur at a rate of 6 breaths per minute (bpm). Exercises designed to slow breathing on a long-term basis can reduce
breathlessness and improve performance during intensive physical
training.31 It also benefits overall physic al and mental health. Countless
studies have demonstrated that reducing the cadence of the breath to 6 bpm
optimizes oxyge nation, stimula tes blood pressure receptors, reduces dead
space in the lungs, curbs the onset of inflammation, increase s heart rate
variability , and builds vagal tone (we’ll look at those last two in Chapter
Four ). Dead space is the volume of a breath that is inhaled but does not
participate in gas exchange. At the end of each inhalation, the space in the
upper and lower airways fills with air. This space includes the nasal cavity ,
throat, and trachea or windpipe. Around 150 milliliters of this inhaled air
leaves the body unchanged, having failed to reach the alveoli, the small air
sacs in the lungs where gas exchange takes place. Slowing the respiratory
rate reduces the air lost to dead space, and provides more time for more
oxygen to dif fuse from the lungs into the blood. Let’s do the math:
• Tidal volume (V T). The normal volume of air entering the lungs during one
inhalation while at rest
• Respiratory rate (RR). The number of breaths per minute (bpm)
• Minute ventilation (MV). The volume of air that enters the lungs during one minute
(respiratory rate multiplied by tidal volume) RR x V T = MV32
The following calculations clearly show what happens when the
respiratory rate is reduced from  12 breaths per minute to 6 breaths per
minute. The first calculation uses a tidal volume of 500 milliliters per
inspiration, whic h represents the average for a healthy young adult at rest.33
The second uses a tidal volume of 1,000 milliliters, representing the
doubled breathing volume when the breath is slowed by half. Bothscenarios use the equation RR × VT = MV to calculate the volume of air
breathed in through the nose. To calculate the air that reaches the alveoli,
the 150 milliliters of dead space is taken into account. Breathing at 12 br eaths per minute:
Air entering the nose: 12 bpm × 500 mL = 6 liters
Air reaching the alveoli: 12 bpm × (500 mL – 150 mL) = 4.2 liters
Breathing at 6 br eaths per minute:
Air entering the nose: 6 bpm × 1000ml = 6 liters
Air reaching the alveoli: 6 bpm × (1,000 mL – 150 mL) = 5.1 liters
At 12 breaths per minute, the volume of air that reaches the alveoli is 4.2
liters. At 6 breaths per minute, it increases to 5.1 liters. This represents a
20% increase in breathing ef ficiency . These figures are backed up by research, which has confirmed that the
increase in blood oxygenation in slow breathing is due to a proportionately
greater volume of air reaching the alveoli instead of remaining in dead
space.34 This has implic ations for sports, climbing altitude, endurance, and
performance. It also has applic ations for respiratory disorder s and heart
disease. According to a 2008 paper , respiratory rate is a crucial “vital sign” when
it comes to identifying serious illness.35 Vital signs are the measurements
that doctors monitor at least once a day in patients on acute wards. Those
include pulse rate, temperature, blood pressure, and respiratory rate. Unfortunately , multicenter reviews have found that documentation in many
hospitals is poor. Respiratory rate is often not recorded, even in cases where
the patie nt’s primary illness is a respiratory condition. This is despite the
fact that fast breathing has been shown to predict heart attack and admission
to intensive care.35
Crucially , research shows that a respiratory rate of more than 27 bpm is
the most import ant predictor of heart attack in hospital wards,  and that in
medically unstable patients, fluctuations in the speed of breathing are much
greater than changes in systolic blood pressure or heart rate. This has led to
the conclusion that respiratory rate could provide a more accur ate measure
of at-risk  patien ts than other vital signs. A 2005 study reported that 21% ofward patients who breathed at between 25 and 29 bpm died in hospital.36
Another paper from 2007 showed that just over half of the patients on
general wards who suffered cardiac arrest or needed to be admitted to
intensive care had a respiratory rate of more than 24 bpm.35 In 95% of
cases, these people could have been identified as high risk as many as 24
hours before they became seriously unwell. As we will discover throughout this book, while most of us will not fall
into these high-risk categories, there are huge benefits to be gained from
slowing down the breath. IS YOUR BREA THING “HEAL THY” BREA THING? Considering the importance of breathing and its role in regulating and
delivering oxyge n to every single cell in the body , it’s surprising to find that
few people understand the basic rules. The common advice to “take a deep
breath” inevitably results in more air in the lungs but less oxygen reaching
vital systems. So why are the benefits of light, undetectable breathing so
little known? First, while it is difficult to know the exact reason, the
Western human pschye typical ly leans towards the idea that louder and
bigger is better . Second, the practice of taking noticeable, full breaths as
often espoused in yoga—a technique that contradicts the original intention
of yoga masters—may have contributed to the wrongly held idea that bigger
is better in terms of the breath. There are two possible ways to usefully measure the breath. The first is
to count the number of breaths per minute. The second is to determine the
size of each breath. The normal breathing rate for a grown adult at rest can
be anywhere between 9 and 16 breaths per minute,37 but most people take
10 to 12 breaths, inhaling around half a liter (500 milliliters) of air per
breath. Therefore, the average air volume is around 6 liters per minute. If you want to determine if you are overbreathing, you won’ t find the
answer just by counting the number of breaths you take per minute. You
must also take the size of each breath into account. When I look at a
person’ s breathi ng, I observe them from the moment they walk into the
room, checking whether they breathe through their nose or mouth,
observing the size of each breath, noting whether breathing movements arefrom the upper chest or from  the abdomen, estimating the number of
breaths per minute, and seeing if there is a natural pause betw een breaths. Healthy people breathe gently , quietly , calmly , and effortlessly with a
natural pause on the exhalation. Each breath is taken in and out through the
nose, even during light physical  exercise such as walking. There should be
no feelin g of breathlessness during rest. If you are breathing in a healthy
manner , you should not even be aware of your breath. Observing your own breathing habits is a worthwhile exercise. Find a
quiet place to sit calmly for a few minutes, and follow the movements of
your breathing:
• Are you breathing through your nose or mouth? • Is your breathing abdominal or from the upper chest? • How big is the “wave” of each breath? • As soon as you breathe out, do you need to breathe back in immediately , or is there
a natural pause between your breaths? • Is it easy for you to see the movements of your breathing? If your breathing is noticeable and requires effort during rest, it is likely
your breathing has room to improve. Throughout the rest of this book , I will help you look at your everyday
breathing habits  and help you understand how your breathing patterns
influence the way you breathe during sleep, rest, exercise, and even sex. As
you practice each exercise, you will learn how it will impact the
biochemistry , biomechanics, or cadence of your breath. You will discover
how light, slow, deep (LSD) breathing improves all three dimensions of
functional breathing, separately and simultaneously . Ultimately , nasal
breathing will provide the foundation for you to achieve healthy breathing
patterns, gain control over your autonomic nervous system, and build a
better relationship with your diaphragm. OceanofPDF .comICHAPTER TWO
EXERCISES FOR ADULTS AND CHILDREN
n this chapter , you will find all the breathing exercises you need to
develop a personalized program  suitable for your own needs and level
of fitness. Beginning with your BOL T score, these exercises are
categorized so you can easily identify what you can and should practice,
depending on your specific health condition and goals. The second part of this book  contains detailed explorations of the
science of breathing as it perta ins to various health conditions and some
case studies describing how real people just like you have benefited from
these exercises. However , if you are anything like me, you will want to get
into it right away and maybe read up on the research later, which is why I
decided to get to the point and begin the book with the exercises. Also,
since we each begin life with a breath, it seems fitting to start the process of
introducing you to the Oxygen Advantage by addressing the practical
matter of breathing. The following exercises can be powerful. If you are pregnant and in
your first trimes ter, please do not practice any of the breathing exercises. In
your second trimester , you can practice gentle nose breathing and slow, low
breathing with relaxation. If you have any serious medical condition(s),
please get the all-clear from your medical doctor before practicing the
exercises in this book. Do not practice any exercises involving  holding of
the breath to create a strong air hunger . I hope you find this new experience with the breath inspiring, and I urge
you to commit to daily practice  of the exercises. For a little effort, I know
you will experience significant rewards in health, fitness, and mental well-
being.OceanofPDF .comSECTION ONE: FUNCTIONAL BREA THING
THE BOL T
Before we begin, it’s time to test your breathing. I use a measure ment called
the BOL T, or Body Oxygen Level Test. It’s a simple exercise that serves as
a useful  way to appraise breath ing patterns. You can use it as you work
through the exercises in this book, and indeed for the rest of your life, to
understand where you are now and track your progress. When we are told to hold our breath, the natural instinct from childhood
is to take in a big breath and hold it until we feel ready to burst . This is not
what we mean by “breath holding” in this context. Indeed, breath holding
tests that focus on the maximum time you can hold an inhalation are
unreliable becau se they can be subject to differences in lung volume and
even to personality traits like competitiveness. On the other hand, breath
holding after  exhalin g ensures a more consis tent lung volume, both for the
individual and measured across a group of individuals. The BOLT involves holding the breath after exhaling until the first
involuntary movements of the breathing muscles or the first definite desire
to breathe. Scientists have prove n that holding the breath in this way cannot
be influenced by training or will power .1 This means that the reading is less
subjective and more accurate. Your BOL T score provides ef fective feedback on functional breathing as
well as on exerc ise tolerance, and as such can be a good indicator of fitness. It is also an excellent objective measure of breathlessness. The BOL T score is influenced by several factors. These include:
• Chemosensitivity to carbon dioxide (CO)
• Bronchoconstriction in the lungs or airways (narrowing of the airways af fects breath-
hold time)
• Level of discomfort felt in the diaphragm during the breath hold
• Anxiety and other psychological or emotional influences.Since 1975, scientists have demonstrated that breath-hold time offers a
useful index of sensitivity to CO2 due to the relationship betwe en the
respiratory impu lse and the pressure of CO2. When we hold our breath, our
lungs are not able to get rid of CO2, and so it accumulates in the blood. The
length of time it takes for our brain to react to this increase of blood CO2 is
directly related to our body’ s sensitivity to CO2 (respiratory
chemosensitivity). Because CO2 provide s the primary stimulus to breathe
in, breath holding is a power ful method for inducing the sensation of
breathlessness. Research has proven that the breath hold test provides a
great deal of information about the onset and duration of dyspnea (shortness
of breath).1 The length of time you are able to voluntarily hold your breath
during the BOL T provides an indirect indicator of sensitivity to CO2
buildup in the blood. In his 2010 book Exercise Physiology , the author William D. McArdle
claims that for a person with normal breathing patterns, the breath-hold
time after exhalation, before the desire to breathe triggers inhalation, is
about 40 seconds.3 However , in my experience, while many athletes who
attend the Oxygen Advantage training do eventually achieve a BOLT score
of 40 seconds, very few people have a BOL T score of 40 seconds on their
first day. The normal score to expect from an athlete is around 20 seconds. People with asthma, childhood asthma, rhinitis, or anxiety and panic
disorders often have a BOL T score of just 10 to 15 seconds. The breath hold time in indivudals with breathing pattern disorders,
including chronic hyperventilation, tends to be lower .4 As the BOL T score
increases, respiratory rate decreases, and the natural pause following
exhalation increases. When the BOL T score is 40 seconds, the typical
respiratory rate is eight to ten breaths per minute.
_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:

        THE  
BREA THING  
CURE
OceanofPDF. comTHE  
BREA THING  
CURE
DEVELOP NEW HABITS FOR  
A HEAL THIER, HAPPIER, AND LONGER LIFE
PATRICK MCKEOWN
OceanofPDF. comHumanix Books
 
The Breathing Cure
Copyright © 2021 by Patrick McKeown
All rights reserved
 
Humanix Books, P. O. Box 20989, W est Palm Beach, FL 33416, USA
www. humanixbooks. com  | info@humanixbooks. com
 
No part of this book may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or by any other information storage and retrieval
system, without written permission from the publisher. Disclaimer:  The information presented in this book is not specific medical advice for any individual
and should not substitute medical advice from a health professional. If you have (or think you may
have) a medical problem, speak to your doctor or a health professional immediately about your risk
and possible treatments. Do not engage in any care or treatment without consulting a medical
professional. Humanix Books is a division of Humanix Publishing, LLC. Its trademark, consisting of the words
“Humanix Books,” is registered in the Patent and T rademark Of fice and in other countries. ISBN 9-781-63006-197-5 (Hardcover)
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OceanofPDF. com“A new scientific truth does not triumph by convincing its opponents and making them see the light,
but rather because its opponents eventually die and a new generation grows up that is familiar with
it. ”
MAX KARL ERNST LUDWIG PLANCK
“From my own experience I know that, used correctly, the breath can be truly transformative. My
goal is therefore to enable you to take responsibility for your own health, to prevent and significantly
reduce a number of common ailments, to help you achieve your goals, and to of fer simple,
scientifically based ways to change your breathing habits for life. ”
PATRICK MCKEOWN
OceanofPDF. comCONTENTS
Foreword
Introduction: Are Y ou Breathing Comfortably. Chapter One: A New Approach
Chapter T wo: Exercises for Adults and Children
Section One: Functional Breathing
Section T wo: Exercises to Stop Symptoms of Asthma, Anxiety, Stress, Racing Mind, and
Panic Disorder
Section Three: T ailored Breathing Programs for Specific Conditions
Section Four: Exercises to Improve Focus and Concentration
Section Five: Stress and Relax Body and Mind
Section Six: Exercises for Children
Chapter Three: How to Breathe
Chapter Four: The V agus Nerve and the Heart-Breath-Brain Connection
Chapter Five: Functional Breathing, The Secret of Functional Movement
Chapter Six: When Breathing Makes Y ou Hurt
Chapter Seven: Sleep-Disordered Breathing
Chapter Eight: Developing Healthy Airways in Children
Chapter Nine: The Breathing Secret for Healthy Blood Pressure
Chapter T en: Freedom From Respiratory Discomfort
Chapter Eleven: Sex and Breath, an Intimate Connection
Chapter T welve: Yes, Breathing Is Different for W omen
Chapter Thirteen: Female Sex Hormones and the Breath
Chapter Fourteen: Sugar, Sugar
Chapter Fifteen: Seizure Control and the Breath
Chapter Sixteen: Join The Breathing RevolutionChapter Seventeen: Is Nasal Breathing Y our First Line of Defense Against
Coronavirus. Resources
Acknowledgments
OceanofPDF. comIF O R E W O R D
’m not sure what first sparked my interest in breathing; whether it was
surfing—being held underwater without air—or if I was led to explore
my day-to-day breathing practic e as part of my journey to maximize my
efficiency as a human and become as high performing as I can be. Either
way, my quest for correct breathing led me to Patrick McKeown and his
clinical work with over 8,000 people, ranging from medical patients to elite
athletes. I appreciate the value of “feeling” things and learning through
experiencing, but Patrick’ s scientific explanation of what is happening in
the body when I nasal breathe as opposed to mouth breathing truly helped
me unde rstand how to use my breath as a tool to support my health and
boost my performance. Patrick’ s passion for breathing education comes out of his own personal
experience. Even though he himself was an extremely dysfunctional
breather and an asthmatic—he was told by his doctors that he would be on
medication and limited in activit ies for the rest of his life—he cured himself
through breathing practices. I must admit, I was surprised to learn what a large percentage of us are
living with hidden breathing dysfunctions that wreak havoc on our health,
sleep, and performance. I truly appreciate that Patrick’ s teaching empowers
people to be proactive in suppo rting their own good health. Patrick simply
explains the importance of nasal breathing and balancing respiratory gases
to create better health and mitigate illness, chronic disease, and injuries. The Oxygen Advantage  was a game-changing read and is one of the top
books we recommend at XPT, not only for health and fitness professionals
but for any individual looking to optimize the most important processes in
their body. If breathing and the breath is the essence of life, and it is meant to be
intuitive, then how do we find our way back to the basics. Patrick makes
this a comprehensive journey that anyone can use and share  with their
friends and family. Laird Hamilton, XPT Extr eme Performance T raining™
OceanofPDF. comIINTRODUCTION
ARE YOU BREATHING COMFORTABLY. magine a breathing technique that can increase uptake and delivery of
oxygen to cells, improve blood circulation, and even unblock the nose. Perhaps it can help open the airways of the lungs, enhance blood flow
and oxygen delivery to the brain, improve sleep, and bring calm ness to the
mind. It might even restore bodily functions disturbed by stress, build
greater resilienc e, and help you live longer. You might think this description
sounds far -fetched. But it isn’ t. This book will guide you through techniques that are the keys to healthy
breathing and healthy living. My goal is to enable you to take responsibility
for your own health, to prevent and significantly reduce a number of
common ailments, to help you realize your potential, and to offer simple,
scientifically based ways to change your breathing habits. On a day-to-day
basis, you will experience an increase in energy, better concentration, an
enhanced ability to deal with stress, and a better quality of life. Following on from my work The Oxygen Advantage, I’ll explore
breathing from three dimen sions—biochemical, biomechanical, and
cadence—with exercises and science to support functional movement of
muscles and joints, improve debilitating conditions such as diabetes,
epilepsy, lower back pain, PMS, and high blood pressure, and help you
enjoy deeper sleep and better sex. The exercises designed to up-regulate
and down-regulate the nervous system highlight how powerfully the breath
can influence states of the body. Finally, there is a section on the importance
of optimal breathing for childhood development. I am not exaggerating
when I say that no child will reach their full genetic potential unless nasal
breathing and functional breathing are restored. We enter the world with a breath, and the process of breathing continues
automatically for the rest of our lives. Although breathing is an involuntary
action and we don’t usually give it much thought, the way we breathe has
an enormous impact on our health. Because breathing is an innate bodily
function that most of us take for granted, it only gets our attention when
something goes wrong. However, minute-by-minute, breath fulfills its vital
role, providing the body with oxygen, regulating physical mechanisms in
the lungs, heart, and blood vessels, and even moderating the stress response. When breathing is below par, it creates problems throughout the
systems of the body. Researchers have listed up to 30 common symptoms
and conditions in which poor breathing patterns are a factor. 1,2 However,
because many sufferers breathe normally at least some of the time, it can be
hard to know if your breathing patterns are unhealthy. 3
The rule of thumb I give my students is this: Breathing during rest and
light movement  such as walking or yoga should be impercep tible, never
noticeable. Heal thy breathing during rest should be through the nose, driven
by the diaphragm. It should be regular, quiet, slow, and almost undetectable. Unhealthy or dysfunctional breathing involves breathing through the mouth,
using the upper chest, or breath that is irregular or audible during rest. There are many forms of dysfunctional breathing, or breathing pattern
disorders, at varying levels of severity. The most common is chronic
hyperventilation, which involves breathing too fast and taking in too much
air. Signs of breathing pattern disorders include the inability  to take a
satisfying breath, excessive breathlessness during rest or physical exercise,
frequent yawning or sighing, and the feeling of just not getting enough air. Other dysfunctions significantly affected by poor breathing patterns include
asthma, hay fever, snoring, sleep apnea, and associated psychological
conditions like anxiety, insomnia, and panic disorder. Across the board,
poor breathing is implicated in poor physical and mental health. If you were to observe and monitor a random group of people as they sit
together in a room, you’d soon start to notice differences in their breathing. Some people breathe through their nose, while others breathe through their
mouth. Some will have gentle, slow, quiet breathing, while others will be
taking faster, larger, more audible breaths. Some people sigh habitually
every few minutes. Others breathe in a nice regular pattern. Some use theirdiaphragm to breathe abdomin ally, while others breathe from the upper
chest. Since breathing is a natural process and so vital to life, why do we all
breathe so dif ferently. The answer is that breathing habits are greatly influenced by lifestyle,
environment, and genetic predisposition. Everyday habits that may come
from choice or necessity (such as sedentary deskwork, watching  TV, eating
processed foods, and excessive talking) or from psychological conditions
(such as stress and anxiety) or hormonal changes that occur during the
female monthy cycle can result in persistent faulty breathing, along with all
its negative consequences. To get a better sense of this, think of a person
who has developed a habit of eating too much. In times of stress, this
person may turn to emotional eating, using food as a crutch to help them
relax. If they continue to eat this way for weeks or months, their body will
soon adapt to habitual overeating and begin to demand more food than they
need. In the same way, our breathing patterns can change over time,
becoming unhealthy. These unhealthy breathing patterns can form in
childhood and even fundamentally alter the way our airways function. Three fundame ntal factors have an impact on the way breathing
functions:
1. Biochemical. The exchange and metabolism of oxygen (O 2) and carbon dioxide
(CO 2). 2. Biomechanical. The physical aspects of breathing; the functioning of the respiratory
muscles, including the intercostal muscles (which run between the ribs and help
form and move the chest wall) and diaphragm (the major breathing muscle, located
below the lungs). 3. Psychological. The mental and emotional aspects, which may manifest as stress
caused by poor breathing or poor breathing caused by stress. These factors are at the root of breathing pattern disorders, and this is what
we’ll explore and address in this book. While the three causes of breat hing pattern disorders are biochemical,
biomechanical, and psychological, the solutions fall into three parallel
categories:
1.
To enable readers to take responsibility for their own health, prevent and significantly reduce common ailments, and provide simple, scientifically-based ways to change their breathing habits.
What is the author's goal in writing this book?
The author, Patrick McKeown, has experienced the transformative power of correct breathing and has used it to cure his own asthma and improve his overall health.
What is the author's personal experience with breathing?
The author identifies the three dimensions of breathing as biochemical, biomechanical, and psychological.
What are the three dimensions of breathing, according to the author?
The author states that the three main factors that affect breathing patterns are biochemical, biomechanical, and psychological.
What are the three main factors that affect breathing patterns?
The BOL T score is a simple test designed to provide feedback on breathing patterns. It involves pinching the nose and holding the breath, and the goal is to reach a score of 40 seconds.
What is the purpose of the BOL T score, and how is it calculated?