--:-- Mel Robbins: Hey, it's your friend Mel, and welcome to the Mel Robbins podcast. I'm normally really excited about what you and I talk about here on the podcast, but today I am so jacked up because I just read this book called *The Breathing Cure*. It is by this dude named Patrick McKeown, and I am still recovering from what I learned because I basically discovered that for 54 years, I have been breathing wrong.
--:-- Mel Robbins: I am what scientists refer to as a mouth breather. And I'm not supposed to be. And neither are you, by the way. You and I are supposed to be nose breathers. Why? Well, because breathing in and out of your nose improves your health, your focus, your sleep, your mood, and reduces your anxiety.
--:-- Mel Robbins: I'm so blown away by this research that I fast-tracked this author and the world's leading expert on breath to come teach you and me everything we need to know. And this is not going to be a lecture. I will slow him down and I'm going to ask him to walk us through breathing exercises so we can learn as we're listening.
--:-- Mel Robbins: But before we welcome him to the show, I want you to just stop and consider how important breathing is. You can live without food for weeks. You can live without water for days. But your breath? You can't go without it for more than just a few minutes. Your breath is the through line of your whole life. From the very first breath that you took when you were born to the very last breath that you'll take on the day that you die.
--:-- Mel Robbins: And my mission today is to make every single breath that you and I take from this moment forward truly count because the science is undeniable. The quality of your breathing determines the quality of your life. And I'm just thrilled that today you and I are going to get coached by the world's leading expert on functional breathing for better health. So get ready for more focus, less pain, better sleep, honestly, a better you.
--:-- Mel Robbins: It is an honor to introduce you to Patrick McKeown, who is a fellow of the Royal Society of Biology in the UK. His research is widely regarded. He's an international bestselling author of 10 books on the science of breathing. He's the founder and CEO of The Oxygen Advantage. His techniques are used by Olympic athletes, top business executives, and my personal favorite, the lead singer of Coldplay.
--:-- Mel Robbins: In his work with our elite military, Patrick teaches snipers how to change mental states and keep a steady hand, which means he can sure as heck teach you and me how to use our breath to stay steady and perform our best in our day-to-day life by simply leveraging your breath. Please help me welcome Patrick McKeown to the Mel Robbins podcast.
--:-- Patrick McKeown: It's a pleasure. Thanks very much, Mel. Great to be here.
--:-- Mel Robbins: Well, I want to start with what might seem like a really stupid question. Can you explain the purpose of breathing to all of us?
--:-- Patrick McKeown: Yes. As human beings, what do we survive on? We eat food, we drink water, and we breathe air. And when oxygen meets with the food that we eat, it generates energy. So the human organism is fueled by the air that we breathe. In essence, it's as simple as that.
--:-- Mel Robbins: Well, what we're going to learn today from you, and one of the reasons why I am so excited to talk to you, is that while breathing is really simple, most of us are doing it incorrectly. So I would love to start with how are we supposed to breathe and what are we doing wrong?
--:-- Patrick McKeown: Yes, that's a good question. People often talk about the quality of air that we are breathing—be out in the countryside, be at the seaside, don't be breathing polluted air. But what about the quantity? What about how we breathe? Breathing is very delicate. It's very susceptible to change. It's very susceptible to the food that we eat, the lifestyle that we lead, the trauma, the stress that we experience, the excessive talking, the sedentary lifestyle, the office-based jobs.
--:-- Patrick McKeown: Many factors influence breathing. And for some of us, we're more prone to developing poor breathing patterns than others. And very often it becomes a habit. And we have to think of it—it's such a vital function. We can live without air for just a few minutes. And the importance of a function is determined by how soon the organism perishes when we switch it off.
--:-- Patrick McKeown: Breathing should be subtle. It should be light. And breath should be undetectable. The perfect person breathes as if they do not breathe. Your breathing should be so smooth that the fine hairs within the nostrils do not move. And if you look at the breathing of a healthy person, their breathing is nose. It's light. It's slow. And it's low. And it's pretty much undetectable. And if they do physical exercise, their breathing is pretty light for the given intensity of physical exercise they are doing.
--:-- Mel Robbins: What are we doing wrong?
--:-- Patrick McKeown: Well, the foundation of breathing is breathing in and out through the nose, Mel. When I'm working with anybody, I'll always ask, like, what does your mouth do when it comes to breathing?
--:-- Mel Robbins: I've never really thought about it. What does my mouth do when I breathe? Doesn't it just suck in air?
--:-- Patrick McKeown: If you breathe through your mouth, what part of the body moves? So if you look down at your chest, if you take a breath through the mouth...
--:-- Patrick McKeown: And as you breathe through the mouth, you'll notice that your breathing is faster and your breathing is more upper chest.
--:-- Mel Robbins: Yes. I can't get it down. I feel like it stays tight, just under my boobs. It's like right in there.
--:-- Patrick McKeown: So then we have to ask, what effect does that have in the physiology? Well, mouth breathing, faster breathing, and upper chest breathing is activating a greater fight or flight response.
--:-- Mel Robbins: Wow. So breathing in and out of your mouth activates a stress response. Whoa. So how should we be breathing?
--:-- Patrick McKeown: Our breathing should be in and out through the nose. There was an American ear, nose, and throat doctor back in 1976 called Dr. Morris Cottle. C-O-T-T-L-E. And he said that the human nose is responsible for 30 functions in the human body.
--:-- Mel Robbins: Really?
--:-- Patrick McKeown: Yeah. I couldn't find his list, so I wrote my own list of 30 functions. I could go through them now if you want.
--:-- Mel Robbins: I want to hear about something because I think, okay, I smell, I sniff. I tend to get very prone to sinus infections and bronchitis and that kind of stuff. So it also gets clogged. Those are basically the three things that my nose does.
--:-- Patrick McKeown: Yes. When you breathe through your nose continuously, oxygen uptake in the blood increases by nearly 10%. When you breathe through your nose during physical exercise, the gas carbon dioxide is higher in the blood. When carbon dioxide increases and blood pH drops, the red blood cells release oxygen more readily to the tissues and organs. So if you, during rest or during physical exercise, breathe in and out through your nose, you're going to increase not only oxygen uptake, but also oxygen delivery to the working muscles and tissues and organs, including the brain.
--:-- Mel Robbins: You said that breathing in and out of your nose increases the amount of oxygen versus breathing out of your mouth. Why does that matter?
--:-- Patrick McKeown: I think it's very important. Oxygen is really the fuel for the human being. And if, for example, we are not getting enough oxygen delivery to the brain, if there's insufficient blood flow or oxygen delivery, it can increase brain cell excitability. So brain cells become more excitable. We're thinking more, we're more prone to anxiety. We can influence the blood flow to the brain by changing our breathing patterns. And it's not about taking the full big breath.
--:-- Mel Robbins: That's pretty cool. Can you tell us how else breathing through your nose can help you?
--:-- Patrick McKeown: Other factors that you wouldn't consider are visual or spatial awareness. Throughout our evolution, if we were in a wide open space, we had to be able to see what was ahead of us, but also to scan the environment for predators. And that's higher with nasal breathing versus mouth breathing. Memory and attention is higher with nose breathing versus mouth breathing. There's greater recruitment of the diaphragm. And the diaphragm breathing muscle isn't just for respiration, but it provides stabilization for the spine. So 50% of people with lower back pain have dysfunctional breathing.
--:-- Patrick McKeown: And as you breathe through your nose, you spoke about bronchitis. We have to think of the gas called nitric oxide. This gas was first discovered on the exhale breath of the human being in 1991. This gas is antiviral, it's antibacterial, it redistributes blood throughout the lungs, it helps to open up the airways. So people with respiratory complaints, but people who are prone to COVID. When we think of the hundreds of thousands of people with asthma and bronchitis and bronchiectasis and COPD and different respiratory illnesses, why are we leaving them breathe through their mouths? And nobody seems to be telling them, breathe through your nose.
--:-- Patrick McKeown: And that was my first kind of steps into the whole world of breathing. My own personal journey was having asthma. I was a mouth breather for years because if we have inflammation in the lungs, that same inflammation will travel up to your nose. And when your nose is stuffy, you're two to three times more likely to have a sleep problem, to snore, to have obstructive sleep apnea. And of course, this then is affecting your mental health. This is affecting your concentration. This is affecting your attention span.
--:-- Patrick McKeown: Now, I talk about even for children. Karen Bonnock is a researcher from the United States, and she did a study in Stratford-upon-Avon in the UK, looking at children from age six months to 57 months. It was over a few years. She looked at 11,000 British kids. Children who were snoring or apneic—having stopping breathing for two breaths or more during sleep—and mouth breathing, those kids if untreated by age five had a 40% increased risk of special education needs by age eight.
--:-- Patrick McKeown: Now we're not just talking about quality of life, we're talking about lifetime impact of chronic mouth breathing. And 25 to 50% of studied childhood population mouth breathe. So Mel, this is a topic that doesn't even come top of the list. In actual fact, it doesn't even come on the list. And in the last few years, we've started to see a greater awareness of breathing, and probably because it's too simple. But at the same time, breathing is not that simple either.
--:-- Mel Robbins: I love absolutely everything that you said. And I want to take a gigantic neon yellow highlighter and make sure as you're listening to us, you understand the single biggest takeaway that Patrick has just explained, which is if you want to have a change in your health, a change in your stress, a change in the pain that you may feel or the sleep that you cannot get, you have a free treasure trove inside your body if you simply start to change from mouth breathing to nose breathing.
--:-- Mel Robbins: I remember writing a book back in 2010 called *Anxiety Free*, and I spoke about this paper that was published in 1988. And the paper said that the brain by regulating breathing regulates its own excitability. And then I was listening to a podcast by the neuroscientist Dr. Andrew Huberman about two months ago, and he cited the exact same statement and sentence. And it's funny how things come around, but this is the importance of breathing and the importance of knowing how to breathe right.
--:-- Patrick McKeown: If, for example, we are breathing the way you described during the introduction—and that's kind of the acute panic attack—but say, for example, somebody who's just breathing a little bit faster, a little bit harder, upper chest breathing, irregular breathing patterns—that's present in a minimum of 10% of the general population, but up to 75% of the anxiety and panic disorder population. So 75% of the population with anxiety and panic disorder have dysfunctional breathing. It's not just that stress levels change our breathing. Of course, when we are stressed, our breathing changes, but our everyday breathing is feeding into our stress levels.
--:-- Mel Robbins: Who doesn't want to be more resilient? And the other thing about stress is when we have a lot of mind activity, it's impossible to do mindfulness. We have to think of this ourselves. The next time that we're having a really bad day and there's a lot of thoughts going through our minds—and I don't suffer from anxiety, but of course things happen, that's the way it is as human beings—I can change my breathing patterns without having to be so aware of my breath to help to bring the body and mind into balance. And that's the thing about breathing.
--:-- Patrick McKeown: So coming back to oxygen delivery and blood flow. For example, if there's insufficient oxygen, we're more prone to fatigue. We have 50,000 miles of blood vessels throughout the human body and our breathing is influencing how dilated or not they are. And people with poorer breathing are more likely to have cold hands and cold feet. It's not just the blood circulation in the hands and feet that's a problem, it's throughout the body.
--:-- Mel Robbins: So one of the things that I read on your website and in your books was you said, breathing is not just for relaxing. It is an incredible tool when you get intentional about how you breathe every day to fight stress. And that's exactly what I want to talk about, how we can get intentional about our breathing every day, Patrick. So let's take a quick pause. I want to hear a word from our sponsors because they allow us to bring this to everybody around the world for zero cost. And everyone, when we return, Patrick is going to start coaching you and me through functional breathing for better health. Don't go anywhere.
--:-- Mel Robbins: Welcome back. I'm Mel Robbins and I'm here with Patrick McKeown. He's written 10 books. He's one of the world's leading experts and researchers on the science of breathing. And he is going to teach us right now how to stop being a dysfunctional breather and to start breathing in a functional way in and out of your nose so that you can get the maximum health benefit. Okay, Patrick, take it away.
--:-- Patrick McKeown: Okay. So the first exercise that I'm going to start off with is small little breath holds. And this is going to introduce you to a means of helping to activate a relaxation response. And then from that, I'm going to show you an exercise to decongest the nose.
--:-- Mel Robbins: Oh, great.
--:-- Patrick McKeown: Because if you have a stuffy nose, inevitably it's going to cause mouth breathing. And then I will do breathe light and then breathe low and slow. Okay. So I'm going to go from one sequence into another. And this can be—it will be no more than five minutes. And we're going to cover a bit of ground. So I think people will have to replay this.
--:-- Mel Robbins: Okay, let's do this. And for those of you driving, just focus on breathing in and out of your nose, low and slow as you're listening to these exercises, because I don't want you to take your hands off the wheel or your attention off the road. You can always come back to this when you're not driving, or you can watch this on YouTube as well when you get back home. All righty. Patrick, let's go. That first exercise you were talking about was about holding your breath. You called it breathing holds. And you said we're going to do this in order to activate a relaxation response. I'm game. Let's go.
--:-- Patrick McKeown: So the first exercise, Mel, that I would like you to do—when the mind is racing and you're not feeling informed of focusing on your breathing—simply hold your breath in an exhalation. Take a normal breath in through your nose and out through your nose and pinch your nose and hold. And hold for five, four, three, two, one. Let go and just breathe normal now for about two to three breaths or even four breaths. Not to change your breathing, just breathing normal.
--:-- Patrick McKeown: And again, take a normal breath in through your nose and out through your nose and pinch your nose and hold. Five, four, three, two, one. Let go. And now just breathe normal for three to four breaths. So you're just breathing normal. The small breath hold will help to stimulate the vagus nerve, which secretes a neurotransmitter called acetylcholine, which causes the heart rate to slow down and the brain interprets that the body is safe.
--:-- Patrick McKeown: And again, take a normal breath in through your nose and out through your nose and pinch your nose and hold. Five, four, three, two, one. Let go. Breathe in through your nose. So now you're just breathing normal for three to four breaths. And then a couple of repetitions, then I will show you how to go from this to decongesting your nose.
--:-- Patrick McKeown: And again, normal breath in through your nose and out through your nose and pinch your nose and hold. Five, four, three, two, one. Let go and breathe in through your nose. Also as you hold your breath, nitric oxide is pooling inside your nasal airway. Then when you let go, you're breathing in. You're carrying this nitric oxide into your lungs. Nitric oxide is antibacterial, antiviral. It's a bronchodilator. So for bronchitis, this is your natural way to help open up the lower airways.
--:-- Patrick McKeown: Last one. And again, normal breath in through your nose, out through your nose, pinch your nose and hold. Five, four, three, two, one. Let go.
--:-- Mel Robbins: Can I ask you a question?
--:-- Patrick McKeown: Yes.
--:-- Mel Robbins: So when you say "breathe normally," you mean not like how we normally breathe. You mean breathe in and out of your nose, right?
--:-- Patrick McKeown: Great. Well, that's how we should be.
--:-- Mel Robbins: Well, I just—most of us are probably mouth breathers. So I just wanted to make sure everybody's getting the coaching that when he's cuing us to breathe normal, Patrick means in and out of your nose. And one thing I will tell you is even after the first round of breathing in and out of my nose, then pinching and holding for five, I started to feel almost that sensation of going down in an elevator. Like you really start to feel the pressure that you're not even aware that is built up in your body start to lower. So it had an immediate impact on me.
--:-- Patrick McKeown: That exercise is very much an exercise we do with people who are prone to high stress, racing mind, panic disorder. See, the thing about breathing is every time that we get into a difficult situation, our breathing changes. And when we start playing with the breath, we can often relive the situations in our history. So I'll give you this example. Somebody who's coming into me with panic disorder.
--:-- Patrick McKeown: Every time that they've had a panic attack in the past, they've been breathing faster and harder in upper chest and they're feeling suffocated. Now, even just placing attention on their breathing can make them anxious. And if I start doing any breathing exercises that alter the volume of breathing and it brings on air hunger, it can tip them into a panic. So we have to be very careful too about breathing in terms of tailoring the breathing exercises to suit the individual.
--:-- Patrick McKeown: Now, the next exercise, I'm going to show you how to go from this to decongesting your nose. So now we're going to go on to the nose unblocking exercise. However, not to do this if somebody is prone to panic disorder or anxiety or pregnant or cardiovascular issues.
--:-- Mel Robbins: Oh, OK.
--:-- Patrick McKeown: Now, despite that, it's actually relatively safe. So with this exercise, Mel, you take a normal breath in through your nose and out through your nose and you pinch your nose, just gently hold your nose and just nod your head up and down, holding your breath. And keep holding your breath. Keep holding, keep holding, keep holding your breath, keep holding. And let go there and breathe in through your nose.
--:-- Patrick McKeown: So when you do a breath hold after an exhalation—so if you hold your breath after a normal exhalation—that will help to decongest the nose. Now, we need to do it five or six times. Now, you could simply breathe in and out through your nose, hold your nose and jump up and down on one leg. It's movement associated with the breath hold that helps to open up the nose.
--:-- Mel Robbins: I got worried about how much you were counting. I'm like, how long am I holding this? Oh, my God.
--:-- Patrick McKeown: So whenever you're ready, take a normal breath into your nose. Only normal.
--:-- Mel Robbins: So I'm going to have to just do that again. So remember about the subtlety of the breath. Just a light breath. Patrick, there's nothing subtle about me. Here we go. Light breath in, everybody. A light breath into your nose and a light breath out through your nose. And just gently hold your nostrils to stop breathing and nod your head up and down as you hold your breath. And keep relaxing into the body as you're holding your breath.
--:-- Patrick McKeown: Now, it's a very normal thing to hold your breath. Kids, if they go swimming, they'll do breath holds all the time. Now, as you hold your breath here, it's activating a slight stress response, which will help to open up the nose. And now let go, Mel, and breathe in through your nose. So the key to help decongesting the nose is to hold the breath for at least 30 seconds or so. But I would say when you start off, always start off gentle. And just tune in on how your body is reacting to breath-holding.
--:-- Mel Robbins: I'll tell you what just happened. I literally feel like my nostrils are now the size of a Tootsie Roll. They widened up and all of a sudden it was super clear because my allergies are starting to kick in. And it worked that second time in particular.
--:-- Patrick McKeown: It's a very reproducible technique. I've used it with thousands of people. And we had a small pilot study involving 26 people at a hospital here in Limerick in Ireland. And a three-month follow-up—symptoms of rhinitis, which are stuffy nose and runny nose, etc.—had reduced by 70%. But I thought that pilot study, which was published as an abstract, I thought it would lead the way to generate some curiosity into a bigger study. It never happened. And that study took place 10 years ago. But despite that, the exercise works. So it's for people to try.
--:-- Mel Robbins: We're here now and I felt like it worked. And this is—again, I have so many elementary questions that I'm almost embarrassed to ask this one.
--:-- Patrick McKeown: Oh, please do.
--:-- Mel Robbins: What coaching do you have for people that are so used to mouth breathing that breathing in and out of their nose just feels weird? How do you make this the new default given the health benefits?
--:-- Patrick McKeown: So there's two parts to it. People have to understand about the importance of nose breathing. And in comparison to the mouth, the nose does all the work when it comes to breathing. And the second aspect of it then is breathing exercises. Gentle exercises, just for example, starting off with the two that we just did. And we also use a very simple tape around the mouth that's elasticated, that pulls the lips together.
--:-- Mel Robbins: I have your tape.
--:-- Patrick McKeown: That's the one.
--:-- Mel Robbins: I have your tape. I have no samples here. I'm going to put it on right now, everybody. Last night I taped my—we're going to get into mouth taping, but I literally—
--:-- Patrick McKeown: You have to stretch it, Mel, about 30 or 40%. So it's only when you stretch it that you'll feel the tension.
--:-- Mel Robbins: Oh, I didn't even take off the sticky part. Okay. So everybody, it's like the shape of a—oh, yeah. And I stretch it by about 30 to 40%. I'm not that strong. Okay. Like that?
--:-- Patrick McKeown: Not too much, not too little. Maybe a little bit less.
--:-- Patrick McKeown: And you're just stretching it and then placing it surrounding the mouth. And the elasticated tension should be pulling the lips together. So you should feel some tension there.
--:-- Patrick McKeown: So with children and teenagers, we very much use that as a training tool during wakefulness. Because kids are kids and they get distracted and they're watching television, they're on iPhone, the mouth is open.
--:-- Mel Robbins: Right.
--:-- Patrick McKeown: But for some adults as well. So part of this is the training during the day. So if an adult has the mouth open and they forget about it, the tape will automatically remind them to breathe through the nose. And it's all about changing habits.
--:-- Mel Robbins: It definitely signals that I shouldn't be breathing under my mouth. Having the mouth open.
--:-- Patrick McKeown: Yeah. Well, this is cool. And bear in mind, the one thing about the nose is that the more we breathe through it, the better it works. But normally what happens is the nose gets stuffy, the person feels uncomfortable breathing through the nose, they switch to mouth breathing, and when they switch to mouth breathing, it increases their nasal stuffiness. So again, it's a vicious circle.
--:-- Patrick McKeown: So I would also say to people that when you first switch from mouth to nose breathing, remember this is the natural way to breathe in and out through the nose. And even if you feel a slight air hunger or a slight feeling that you're not getting enough air, stick with it. The benefits far outweigh the disadvantages. And the other aspect of it is if you continue walking with your mouth closed, the body adjusts to it. And you then can do physical exercise with less ventilation. So it's almost as if you're training your body to do more with less.
--:-- Mel Robbins: There's so much to cover. But first, we need to take a break and hear a word from our sponsors who are bringing us all of this amazing information at zero cost. And everybody, breathe in and out of your nose, listen to our sponsors, and stay with us because we'll be right back.
--:-- Mel Robbins: Welcome back. I'm Mel, and I'm here with the amazing Patrick McKeown. He's a bestselling author. He is one of the world's leading experts on breathing for better health. So, Patrick, can you just bottom line it for people about what happens—like what's wrong with breathing out through your mouth? We know the benefits of breathing in, but what goes wrong when you're constantly breathing in and out of your mouth?
--:-- Patrick McKeown: The biggest one is that you lose moisture. There's a 42% greater water loss breathing out through the mouth. And losing moisture—if your mouth is dry and you're losing moisture from the body, of course you're more likely to be dehydrated, but that will impact your dental health. Gum disease, bad breath, for example, chapped lips.
--:-- Patrick McKeown: But the other problem about breathing out through the mouth during rest is that it's a fast exhalation. And see, when we think about the body's relaxation response, it's all in the exhalation. It's not really in the inhalation.
--:-- Mel Robbins: Wait a minute. It's not about the breath in? But it seems like that's what everybody says, right? I mean, think about it, everybody. If you're in a yoga class or a meditation class, "Let's take a deep breath in," right? So if it's not about the inhalation, it's about the exhale. What do we have to pay attention to in the exhale in order to activate the relaxation response?
--:-- Patrick McKeown: You can take a fast breath in or you could take a slow breath in. But really, when it comes to activating relaxation during rest, it's the speed of the exhalation. If you breathe out fast, it's a stressor. So if you breathe in fast and out fast, it's a stressor. It's not just how you breathe that way during stress, but if you deliberately breathe that way in your everyday, you're telling the brain that the body is under threat. You're going into this fight or flight response. And of course, your brain is here to protect you and your brain wants to get you out of the situation. So you don't want to be breathing fast going into a boardroom meeting because while you're going in in person, your brain wants you to get out of there as quick as you can.
--:-- Patrick McKeown: So coming back to mouth breathing, if you breathe out through the mouth, there's less resistance to your breathing. It's a faster breath out. And it's a bigger exit ramp because the mouth is bigger than your nostril.
--:-- Mel Robbins: So breathing in and out of your nose—if I'm tracking correctly—one of the added benefits is that the exhale is going through something smaller than your mouth. So it slows you down. And in preparing to talk to you, we came across that Stanford study that you cite. And I thought this was super cool—that your breath is like your brain's remote control, that there are actually neurons in your brain watching your breath. And when you start to breathe faster or out of your mouth, it signals to another part of your brain that something's wrong.
--:-- Mel Robbins: So I want to make sure you listening to Patrick and all of this research and the 10 books that he's written—what he is saying to you is that learning how to breathe in and out of your nose has extraordinary benefit for lowering stress, for lowering anxiety, for being able to focus. You're also coaching athletes and high performers because your breath and being somebody that can breathe in a slow and steady fashion out of your nose helps you with focus. And so can we break down just the mechanics of the ideal normal breathing? Like how many breaths in and out should you take in, let's say, a minute?
--:-- Patrick McKeown: So typically during rest, it's about 12 to 14 breaths. But the only caveat there is how much air is involved with each breath—the tidal volume. So we can't just focus on the respiratory rate. We also need to focus on tidal volume because ultimately it's the volume of air that we are breathing. And if we breathe too much air, less oxygen is delivered throughout the body. So this is another aspect. There's a myth out there that if you want to bring more oxygen throughout the body, you take this full big breath. But if you take this full big breath, you're getting rid of too much carbon dioxide. The loss of carbon dioxide will cause your blood vessels to constrict and also red blood cells to hold onto oxygen more readily.
--:-- Mel Robbins: Can you coach me through this? Because if I take a big breath—like if I go in through my mouth and I'm like, I'm trying to get a breath right—what happens as I go to get oxygen is my shoulders come up and I feel my chest pinch and I feel my stomach suck in and I actually can't get a deep breath because I can't get it below my boobs. I can't get it down into that really satisfying full breath. Is that what you're talking about when you talk about the flow or volume or whatever?
--:-- Mel Robbins: Yeah, there's two aspects. One is when you were talking about there, you're talking about shallow breathing, which is not ideal either. So we do want to breathe low with good recruitment of the diaphragm. How do you do that? The best way to do that is in the nature of the nose.
--:-- Patrick McKeown: So if you, for example, if you place your hands either side of your lower ribs. Okay, so everybody, unless you're driving a car, I want you to cup your ribcage.
--:-- Mel Robbins: Are we cupping the ribcage or are we going underneath it?
--:-- Patrick McKeown: Just at the base of the ribs.
--:-- Mel Robbins: Just at the base of the ribs. Got it.
--:-- Patrick McKeown: And as you breathe in, you're just gently directing your lower ribs to move outwards.
--:-- Mel Robbins: Oh, how do you do that?
--:-- Patrick McKeown: And as you breathe out, you're directing your lower ribs to move inwards. And the aspect is to hold your sides because normally when people put it on their belly, they're pushing and pulling their belly irrespective of their breathing. So that's why you have your hands on your side. So Mel, as you breathe in, you're just gently guiding your ribs out. And as you breathe out, your ribs are gently moving in. Now, that's a deep breath in the true sense of the word. We don't hear it. You're breathing in and out through your nose. And you're breathing slow. And you're breathing low. Now we can slow it down. If, for example, during rest, we want to have the ideal breath to help to bring the body and mind into balance, that's between 4.5 to 6.5 breaths per minute. So let's practice that with low breathing for just one minute.
--:-- Mel Robbins: Okay. If you like. Yeah, I would. Can I ask a question?
--:-- Patrick McKeown: Of course.
--:-- Mel Robbins: Before we do this exercise. So what I'm gathering from this is that I'm a mouth breather with bad breath who's causing myself stress and anxiety because I'm signaling to my brain with my shallow breathing that something's wrong. And that I always thought deep breathing because I practice yoga was this belly breath. And so I've always focused on inflate and deflate the stomach. And what you're talking about when you cup kind of the bottom of your ribs, because I want everybody to get this. You can watch it on YouTube, but for those of you listening to Patrick and to me, I want you to really get this, that it's really more of a horizontal thing. You're not inflating your stomach. You're making your bottom rib cage expand and come back in. And I'm realizing that so much of my breathing pattern has been almost like vertical up and down. And I hadn't been thinking about that. So that was super, super helpful. And you said that in a normal, just going about your life, you're not trying to relax. You're just trying to focus. You're going through your day. You're not trying to stress yourself out. You're getting the benefit of normal in and out of your nose breathing. You said that it would be somewhere between 10 to 14 breaths in and out of your nose in a minute. And now what you're about to show us is that for relaxation, you can do this kind of deeper breathing where you fill your diaphragm horizontally, your ribcages move out, but it's for four to six times a minute. Is that what we're about to do?
--:-- Patrick McKeown: Okay, great. I just want to make sure everybody's following. And just coming back to the diaphragm, like when the diaphragm, which is the main breathing muscle, and it separates our chest from our abdomen. So during inhalation, the diaphragm is moving downwards. And it's the movement of the diaphragm downwards that draws air into the lungs. But as the diaphragm is moving downwards, you will have some movement to your front. So you will have some belly movement and movement to your sides and movement to your back. It's a good gauge of the generation of what's called intra-abdominal pressure, that when you breathe in, that your ribs are gently moving out. Because this is what's giving you a good indication of the recruitment of the diaphragm and from that then stabilization of the spine. So the diaphragm breathing muscle is really important because when you breathe with good recruitment of the diaphragm, it's also a calming effect on the mind. The diaphragm and the brain are connected. So earlier on, you were talking about that work by Stanford, which I think is so cool that there's a structure in the brain that's literally spying on our breathing. Now we can use that to our advantage. Don't breathe fast. Don't breathe shallow because you're telling the brain that you're under threat and your brain is going to arouse you from sleep and put you into this stress mode. So now we're talking about five minutes to spare. And instead of just scrolling aimlessly, wasting time on our mobile phone, give ourselves a little bit of attention, getting attention out of the mind and holding your attention to your breath, which in turn is training your brain to be focused, but not just about awareness. It's also about changing the physiology. So if you have your hands again, just gently on either side of your lower ribs. And as you're breathing in, that you're breathing in for a count of five. So you're breathing in 2 3 4 5, out 2 3 4 5, in 2 3 4 5, out 2 three, four, five, in, two, three, four, five, out, two, three, four, five, in, two, three, four, five, out, two, three, four, five. Now say for example if we have somebody with pretty poor breathing and they're breathing 20 breaths per minute, I would say don't go from 20 breaths down to six all of a sudden. Gently soft in your breathing, but do it, slow it down to a level that's comfortable for you. So if you're starting off, what you could be doing is maybe breathing in for two seconds and out for three. So during rest, we always need to think of the exhalation. It should be about one and a half to two times the inhalation, the length of the inhalation.
--:-- Mel Robbins: Could you say that again about the length of the exhalation versus the inhalation with the normal nose breathing? Because you've said repeatedly, the exhalation is the most important part.
--:-- Patrick McKeown: Yeah, the speed of the exhalation during rest should be about one and a half to two times that of the inhalation. And you can play with it. If I'm having a meeting that's pretty intense, I don't want to go into that meeting breathing fast and shallow. I will deliberately, in that situation, nobody even knows what I'm doing. I could be sitting down or I could be standing outside the door waiting to go in. I will just take a soft breath into my nose. I don't even time it. A soft breath into my nose and a really slow and relaxed and gentle breath out. Because by doing that, I'm telling my brain that everything is okay. And I'm also taking my attention out of my mind and onto the breath to put the critical mind aside, because I want to go into that meeting and I want to be in a state of mind that I'm fully there, that I'm listening with all of my attention, not just lost in thought. Now, I would say, don't wait until the important meeting before you start to do it. Start bringing it into your way of life. There's a really well-known doctor from Italy called Bernardi, and he did a study back, I think it's in 2000. He looked at the breathing that was taking place when people were saying prayers of different faiths. So one was mantras and the other was the rosary, which is the prayer from the Catholic faith. And both, whether it was a mantra or the rosary, both of them lowered the respiratory rate down to six breaths per minute. Now, I think there's something really brilliant in this, that when we think of people who are saying prayers, it wasn't just from a spiritual and psychological aspect, but it was also the effect it was having on their body and mind physiologically. And it's so cool that this information was always out there. And now it's time to start embracing it.
--:-- Mel Robbins: Well, it's one of the reasons why I asked you the question in the very beginning, what's the purpose? And I was thinking about it kind of from a neurological, scientific standpoint, but there's something so much deeper that it really is the quality of your life that you have within you if you take the advice and you apply this research to your life and you start to teach yourself how to use the tool of normal nose breathing and longer exhales, that this is something that your body was hardwired with a natural intelligence. And it's so cool that the research shows that when people are in a state of being present, in a state of purpose, in a state of deeper connection, your body naturally drops into this kind of breathing. Are there other specific types of breathing that people need to know about that either reduce stress or that you should use in certain situations?
--:-- Patrick McKeown: Yes, when it comes to breathing, you can downregulate, which is inducing relaxation, or you can upregulate. So, for example, if you want to stretch your body and mind a little bit.
--:-- Patrick McKeown: Well, you could go for a jog with your mouth closed. It's a pretty safe way to do it.
--:-- Mel Robbins: Jog with your mouth closed?
--:-- Patrick McKeown: Jog with your mouth closed.
--:-- Mel Robbins: Do you have to be in amazing shape to do that? Because when I'm hiking up the mountain that I live on, I'm panting like a dog. I don't know that I could get up there with my nose.
--:-- Patrick McKeown: Well, when you're walking up the mountain, go with a pace that you can sustain nasal breathing. And if necessary, get a nasal dilator, which just helps to gently open up your nose. But also breathe no slow and low because your ventilation is going to be more efficient. Physical exercise anyway is a stress, but it's a good stress. But it should be dosed according to the individual needs of the person. Like I do breath holds with athletes. I will have them breathe in and out and hold their nose and they sprint for 40 meters without breathing.
--:-- Patrick McKeown: They then rest for 30 seconds and they sprint again for 40 meters without breathing. Or I could have a 400 meter sprinter. And in some of their trainings, when they're well warmed up, I would have them nose sprint for 360 meters and the last 40 meters that they have to stop breathing. So we do exercises to stress body and mind. If you want to stress your body and mind using breathing techniques, just dip your toe into the water and just see how your body feels. And you don't have to hyperventilate for 30 breaths and then do a long breath hold. That's doing the entire thing. If you want to do a stress, maybe hyperventilate if you want to do it for five breaths and then do a breath hold, but it's comfortable for you. We don't teach hyperventilation.
--:-- Mel Robbins: Gotcha.
--:-- Patrick McKeown: And the reason being is because my whole thing about breathing is I want to get a person's everyday breathing right. Let's get the foundation right first.
--:-- Mel Robbins: I love that.
--:-- Patrick McKeown: And then if they want to do that, the peak, we can do that. Get the foundation for everyday life nailed first: in and out of the nose, low and slow.
--:-- Mel Robbins: Can you tell us more about mouth breathing and snoring?
--:-- Patrick McKeown: There's been studies that investigated nose versus mouth breathing during sleep. The people who were breathing through their nose naturally during sleep always had a deeper sleep. So you can imagine a mouth breather during sleep. They're breathing faster. They're breathing harder. They're upper chest breathing. I'll give you this example. Do the sound of a snore through your mouth and it goes like this. [Makes snoring sound]
--:-- Mel Robbins: It does. Like a pig.
--:-- Patrick McKeown: And now bring your lips together and try and snore through your mouth with your lips closed. Only through your mouth try and snore. So try and snore through your mouth with your lips together.
--:-- Mel Robbins: I can't do it.
--:-- Patrick McKeown: So it's not possible. So mouth snoring stops once we get the mouth closed. The second snoring then is nasal snoring, which goes like this. [Makes nasal snoring sound]
--:-- Patrick McKeown: Now, if you take a very soft breath in through your nose and a really slow and relaxed and a gentle breath out and a very, very soft, silent breath through your nose and a relaxed and a slow and a gentle breath out, as you breathe very softly in and out through your nose, try and snore through your nose.
--:-- Mel Robbins: I can't.
--:-- Patrick McKeown: So mouth snoring, we can stop once we get the mouth closed. Nasal snoring, we can significantly reduce. The whole aspect in sleep medicine has focused on the airway, but they haven't focused on the person's everyday breathing. And it's our everyday breathing that's influencing our breathing during sleep. And this comes back to that study by Stanford. If you're breathing fast during sleep, it arouses you from sleep. Who gets aroused from sleep? People with insomnia. They're breathing fast during their sleep. Their brain is interpreting that the body is under threat and the brain wakes them up. And they're there two o'clock in the morning, three o'clock in the morning, four o'clock in the morning, thinking, thinking and thinking and thinking. And then they're waking up exhausted. And of course, that's going to affect their productivity, their focus during the day. So we need to look at the big picture.
--:-- Mel Robbins: So how does breathing impact your sleep? In terms of insomnia, there's two times it can manifest. And insomnia affects about 30 percent of the population.
--:-- Patrick McKeown: Wow.
--:-- Mel Robbins: And 10 percent have it chronic. One is that we go to bed at night but we don't fall asleep readily. Typically we should fall asleep in a few minutes. That's an ideal situation. But if we have overstimulation of the mind, we're not going to fall asleep so readily. So it's very important to be able to go into relaxation before we go to sleep. Now that would involve, I would say, use blue light filter glasses and follow sleep hygiene. Your bedroom is cool. It's airy, it's dark and all of that stuff. But also we need to tell the body that we're going into rest and digest. So you could be sitting down, you might be watching some light TV, you might have your blue light filter glasses on. And as you're sitting there, really take a soft breath in through your nose, almost that you're breathing less air. And that's what I would like you to do. You're taking a really soft breath in through your nose and you're having that light and a really slow, slow, slow, relaxed gentle breath out. And then when you need to breathe in again, instead of taking your normal 100% of the breath, maybe take in about 70% of the breath in and then a really soft and slow gentle breath out. And the whole aim is to breathe about 30% less air into your body than what you're normally used to. You know you're doing it correctly if you feel a slight air hunger. Now, as you do that, pay attention to the saliva in the mouth. So we'll continue for one more minute. I would like you to under breathe, Mel. I would like you to breathe in a way that you feel that you're not getting enough air.
--:-- Mel Robbins: How do you do that?
--:-- Patrick McKeown: Take a very, very soft, gentle breath in, almost as if your breath in is imperceptible and a really relaxed and a slow and a gentle breath out. So gently soften and slow down your breathing so that you're taking 30% less air into your lungs. If you get stressed, just take a rest. But keep working on this because now what you're doing is you're telling the brain that everything is okay. And pay attention then to the saliva in the mouth. When we get stressed, our mouth tells us because our mouth goes dry. When we are ready for rest and digest, we feel sleepy. Digest, we have increased watery saliva in the mouth. So when we alter our breathing, we're stimulating the vagus nerve, which is secreting that neurotransmitter acetylcholine, which is telling the heart to slow down. The brain is interpreting that the body is safe. And the brain is also spying on our breathing at the same time and interpreting that the body is safe. So we feel sleepy. And we do this for 10, 15 minutes before we go to sleep.
--:-- Mel Robbins: I know that you recommend people try this tape on their mouth when they sleep. And I tried it for the first time last night. I used packing tape. I know that that's probably not what you recommend. And when I pulled it off this morning, I think I gave my upper lip a wax. I put it from the nose down so that the sides were exposed and I learned something really interesting. I put the tape on my mouth so that I would be cuing myself to nose breathe and it's how I sleep. And I'm a fantastic sleeper. And I realized I sleep predominantly with my mouth closed. My husband, on the other hand, he has this sound that he makes that goes, [makes snoring sound] it drives me freaking crazy. I know it's sleep apnea. I also know that 1 billion people around the world have obstructive sleep apnea, 1 billion. How does this nose breathing improve people's lives with obstructive sleep apnea?
--:-- Patrick McKeown: Okay. So obstructive sleep apnea is when the person stops breathing for 10 seconds or more during sleep, that will be an apnea. Or a hypopnea is when there's a reduction in the flow of their breathing due to partial collapse of the airways, that their blood oxygen saturation drops down by three or 4%. The problem with sleep apnea is that it arouses you from deep sleep, but it's very stressful on the cardiovascular system. There are four characteristics in obstructive sleep apnea. It's not just the anatomy. So insomnia that we spoke about earlier on is one of them. So it's very important to be able to downregulate. Upper airway muscle recruitment, getting these muscles to do their job is very important. There's a therapy called myofunctional therapy that's excellent for that. Mouth closed with the tongue resting up in the roof of the mouth with good recruitment of the diaphragm helps to open up the airway. Think of the typical middle-aged man. We're drinking a few beers. We're putting weight on the belly. This is impacting the movement of the diaphragm. We're now breathing more upper chest. This is reducing lung volume and the throat collapses more easily. Our diaphragm breathing muscle, as I said earlier, is connected with the brain, but the diaphragm is also connected with the upper airway dilator muscles in the throat. So coming back to mouth puffing and the mouth closed is really important with obstructive sleep apnea. You still need to allow them to mouth puff during sleep. And we were lucky with the design of the tape, the MyoTape, because it allows the mouth puffing. Whereas before that, we were using 3M one inch micropore tape, which is going right across the lips. But that doesn't allow mouth puffing. And that can make sleep apnea worse in some people. Just getting your mouth closed reduces sleep apnea severity by 33%. That's not looking at how do you improve your breathing patterns. If you have somebody with obstructive sleep apnea and they bring nose breathing into their everyday life, they learn to slow down their breathing. They learn to have good recruitment of the diaphragm, all simple skills that you bring into your everyday life. That will help your sleep apnea. For moderate to severe, overall, it helps when you get the mouth closed also. But for some people with moderate to severe, they need to be allowed to mouth puff. So whatever you use as support to get the lips together, make sure it allows you to mouth puff.
--:-- Mel Robbins: Got it. Well, I'm going to make sure to tape my husband's mouth with your tape, and I'm going to stop shoving him or pinching his nose when he goes [makes snoring sound]. Patrick, you are a gift to all of us. You have just given us all a free tool that we were born with to activate our natural intelligence, to lower our stress, to get better sleep, to be more present in our lives, and to learn how to access the profound power of breathing in and out of your nose, low and slow. I cannot wait to have you back on. We will link to all the resources in the show notes. Thank you. Thank you. Thank you.
--:-- Patrick McKeown: My pleasure. Thanks very much, Mel.
--:-- Mel Robbins: Wasn't that incredible? I want to make sure to tell you, in case no one else does today, I love you. I believe in you. And I believe in your ability to change your life. And how cool is it that you and I now know how to use our own breathing to change your life for the better? Alrighty, I'll talk to you in a few days. Is it McCowan? McCune? What is it, Donna? McCone? McCowan? McCune? Honey, will you say it again for me? McCune. Hold on one more second. I just saw Jesse say, what am I doing? I need to do that again. Already the wheels are off because of me. Patrick, this is how it's going to roll. That's for you, Andrea. I just had tacos for lunch and you know how I like to give you a little gift on the mic. That was awesome. You guys, boom, boom, boom. Great job everybody. Oh, and one more thing. And no, this is not a blooper. This is the legal language. You know what the lawyers write and what I need to read to you. This podcast is presented solely for educational and entertainment purposes. I'm just your friend. I am not a licensed therapist and this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I'll see you in the next episode.
