Atomic Focus: Enhancing Concentration, Flow States, & Attention Span

Patrick McKeown

Yeah, it’s great to be. Thanks very much, Tom.

Tom McCarthy

Yeah. You’re such a humble guy. You really are. You’ve impacted so many people and we were talking earlier and I heard a little bit about your journey, but I want you to share it with people. You’re an expert. I think you’re one of the people to go to in the world, on the planet, when it comes to learning how to breathe effectively for energy, health, focus, all these great things. But you didn’t start out by being a great breather did you?

Patrick McKeown

No, no. I suppose, I stumbled into this field. If somebody had a told me that I was going to be teaching, breathing for the rest of my life, I’d say you’re on acid or something. I’d say that it couldn’t be possible. I had very poor breathing as a kid growing up into my teenage years. And you know, you don’t just have poor breathing. You don’t just, like I was a mouth breather. My nose was stuffy. I was breathing a little bit faster and upper chest. And you’re typically in a fight or flight response. Your mind is agitated. My sleep was very much impacted. And I remember when I was a student at Uppsala University in Sweden. The students were telling me that I snoring, but then they would say that I stopped breathing completely. 

And I had no idea what that was. That’s obstructive sleep apnea, but that’s obviously, you know, a sign of obstructive sleep apnea is when you’re stopping breathing during sleep. But I was tired. And I can only look back, back in the years up as far as about 1998, that I was doing exams, I was studying. I didn’t have the concentration to do what I was doing. It’s not that it wasn’t intelligent, but how can you concentrate if you don’t have the energy? My breathing was really in a bad place. And I can think of all of the people that have dysfunctional breathing patterns, because it’s relatively common, but it affects more pockets of the population than others. 

But in a normal population, it’s about 20 to 30% of the population. However, in people with anxiety and panic disorder, in the literature it’s as high as 80%. So up to a different pockets of the population, a large cohort of dysfunctional breathing, and they’re not even aware of. And what’s more, you know, oftentimes when we hear about the breathe, we’re not taught about breathing from a biochemical point of view or, you know, there might be an emphasis on the biomechanics. 

There’s not necessarily an emphasis on the resonance frequency. So, you know, I read going back to 1997, I happened to cross a newspaper article and the article spoke about breathe through your nose and breathe light. And I was doing neither of those. I use the nose unblocking exercise to help decongestant nose. I switched to nasal breathing. I practice breathing less air. Now it was uncomfortable. Because when you breathe less air for a period of time, you build up carbon dioxide or carbon dioxide accumulates in the blood and you feel air hunger. But it was the first time that I noticed that my blood circulation, my temperature of my fingers started to increase.

Tom McCarthy

Yeah.

Patrick McKeown

I always had cold hands and cold feet. And I never knew, understood, I never realized that my blood circulation was influenced by my breathing. And the fact was that I was breathing a little bit too fast, a little bit too hard, and that was causing my blood vessels to constrict. And I’ll tell you a story. I remember going in to do an exam in Trinity College in Dublin. I was a bit anxious going into the exam hall. And I took a walk for about three or four minutes before going into the exam. And during the three and four-minute walk, this was back in 1996, I took these full big breaths. And I walked into that exam hall and I was totally spaced out. And it took me several minutes to get my head together. Can you imagine going into a high pressured situation and I had done the wrong thing. I had hyperventilated. 

And I watched yesterday just a brief interview by Dr. Rangan Chatterjee. He was interviewing a brain surgeon. And the brain surgeon spoke about, whenever he’s in a tricky situation during surgery. He said in quotes, “I’ve stopped myself from hyperventilating.” And by stopping himself from hyperventilation, he said that the people around him thinks that he has nerves of steel. And we have to bear in mind that when we’re in a stressful situation, the body physiology changes, but this is where we can tap into that physiology by having an understanding of the breadth. And it really is by breathing in and out through the nose and by breathing light and breathing slower and breathing deep.

Tom McCarthy

Yeah. And you’ve given us actually a lot already. I want everyone to think about what he’s saying. Because how many of us have learned like take a deep breath in, blow it out, ah right. And that’s actually, that’s not a great pattern–

Patrick McKeown

No it’s not. Well, if you like, if we look at the breath itself, we can stress the body or we can relax the body through the breath. And if I want to stress the body, what we could do is we can take a full, big breath in and a full big breath out. And a big breath in and a full big breath out. So we’re speeding up, we’re speeding up the breath. We’re increasing the breathing volume. That’s a stressor. But if I want to relax the body, it’s all in the exhalation. And we want to take a soft breath in through the nose and a really relaxed in a slow and gentle exhalation. Now, by having a relaxed and a slow and gentle exhalation, it stimulates the vagus nerve. This secretes the neurotransmitter acetylcholine, which causes slowing of the heart. And the heart rate is slowing down, the brain is interpreting that the body is in a safe environment. Now there’s a time that we want to be stressed, but too much stress is bad.

Tom McCarthy

Right.

Patrick McKeown

And to give you an example. Very soon, in the next week I worked with elite shooters in the police. And we would be talking about how to change breathing patterns, when an officer runs into a situation. And you can imagine an officer is running into a situation. They’re going to be hypervigilant. The heart rate is ramped up. Their breathing rate is fast. Now, if that officer is overly stressed and they have a gun. If they make a mistake, lives, you know, can be lost. And that’s, in that situation, the situation is that the stress could be too high. So we want to train the person how to downregulation. So it’s always different states, depending on the person. And many people, you know, they are would increased sympathetic drive. 

But I suppose it’s really about coming back to your everyday breathing patterns, Tom. I was in the court, well back in 1998, 1999. And I didn’t like it. And when I look back, it wasn’t necessarily the job and the competitive pressures that was the problem. What was the real problem was my own physiology. I was already in that fight or flight. I had poor sleep. And when you were in that state, you’re not in a good stage in terms of, you know, applying yourself to reach your full potential.

Tom McCarthy

Yeah. No way. Well, and like you, I had the, I wish I would have learned what you learned at an earlier age like you did. But I grew up a mouth breather too, because my nose was always stuffy. And I just thought, you know, I’ve got stuffy nose, so breathe through the mouth, and my sleep wasn’t that great and. But I don’t think I learned it until I was you know, in my maybe 40-years old. So now it’s been, you know, 20 years of, you know, I’m 60 now. So 20 years of breathing through my nose, which made a huge impact. But oh my gosh, I wish I would’ve learned it earlier, but thank God I did learn it. And so even if someone’s 60-years-old and learning it now, now’s a great time. When I look at the book, it says, you know, The Breathing Cure is the title of the book. And you’ve got, you know, asthma, children’s breathing, you know, COVID, diabetes, epilepsy, insomnia, pain mobility, high blood pressure. Like breathing can impact all those things.

Patrick McKeown

Yes, yes. And the research shows that it can. Because if you look at the research over the last 30 years. If we were set up at heart rate variability and heart rate, variability is an objective measurement of vagal tone. So say for example, therapists have old would, you know, the client would come in to the therapist and the therapist would monitor the client’s pulse rate.

Tom McCarthy

Right.

Patrick McKeown

And as the therapist was feeling the client’s pulse rate, monitoring the speed of their heartbeat, they’d also be watching the client’s breathing. And what the therapist is looking for, is there a difference in the time in between heartbeats on the inhalation versus the exhalation.

Tom McCarthy

Right.

Patrick McKeown

The person who is in good balance with the autonomic nervous system, their heartbeat is in random, but it’s also in rhythm. So on the inhalation, the heartbeat should be faster. And on the exhalation, the heartbeat should be slowing down. So this synchronicity is called respiratory sinus arrhythmia. Now for a person who is stressed and this could be it either emotional stress or a physical stress. They don’t always have that variation in their heartbeats. So during the inspiration, their heartbeat is timing, but during the expiration, their heartbeat is the same or similar to our timing.

Tom McCarthy

No variation?

Patrick McKeown

There’s no variation. Whereas, you know, it’s not a, it’s not a metronome. We need that variation. So in terms of then, through the breath, we can influence what’s called a baroreflex. And these are baroreceptors in the major blood vessels in the carotid arteries and in the aorta. And we can influence that by a number of ways. Nose breathing during sleep helps to improve heart rate variability. Breathing light, and this is actually where you breathe less air. So say for example, I’d have my own students coming in. I have them maybe one hand on their chest, one hand just above their navel. And I have them tune into their breathing pattern and really slow down the speed of the air coming into the nose, in a really relaxed in a slow and gentle exhalation. And a very soft breath in and a really relaxed and slow and gentle exhalation. And the whole purpose is to breathe less air not more.

Tom McCarthy

So was percentage? When you say like the average person when they breath in air, are they breathing to maybe 70% of what they used to breathe? Is there anything that they can kind of? What does feel like?

Patrick McKeown

70% is a good, is a good indicator.

Tom McCarthy

About 70% good.

Patrick McKeown

Yeah. So say for three or four minutes. You’re typically sit down, focus on your breathing and take in 30% less air than what you’re used to. And by doing that, you’re going to create air hunger. And this signifies that carbon dioxide has increased in the blood. Now as carbon dioxide increases, it stimulates the vagus nerve, it has a vagotropic effect. And it’s also likely to be strengthening the baroreflex. So one way of tapping into the autonomic nervous system is by breathing lesser air. 

Now, the ironic thing about breathing less air is, when you practice breathing less air, even though you feel a little bit uncomfortable because of the air hunger, you’ll have increased watery saliva in the mouth. And this is telling you that the body has downregulation. So the vagus nerve, when the body is going into relaxation, it typically manifests as increased watery saliva. Now conversely if we get stressed, the mouth goes dry. So say for example, a person who was overstimulated tried today and they can’t switch off during sleep. We teach them to downregulate. And what you said earlier on, if somebody has nasal congestion, they are two to three times more likely to experience sleep problems. 

Those sleep problems include snoring and obstructive sleep apnea. So for somebody with sleep disorder breathing, including insomnia as well, we have them downregulation, downregulate the autonomic nervous system by breathing light and by breathing slow. They feel air hunger, but the body and mind is going into relaxation. Now coming back to the baroreflex, because this is afraid central component of the functioning of the autonomic nervous system. You want the baroreceptors in the blood vessels to be very sensitive to changes in blood pressure. If our blood pressure increases, the baroreceptors should send immediate signals to the blood vessels to dilate and the heart rate to come down, so that blood pressure normalizes. And conversely if blood pressure goes too low, the baroreceptors should send immediate signals to the blood vessels, to constrict and the heart rate to increase to normalize blood pressure. 

The sensitivity of the baroreceptors are how strong the baroreflexes is influencing vagus nerve or vagal nerve tone. And the vagus nerve is wandering throughout the human body. And about 80 to 90% of the information by the vagus nerve is from the body to the brain. Now we can tap into the vagus nerve, as I said earlier, by breathing light, but also by breathing slow. And this is slowing down the respiratory rate to between 4.5 and 6.5 breaths per minute, with a good average being six breaths per minute. But also by breathing low that if we breathe and we’re having optimal amplitude of the diaphragm, by increasing tidal volume, we can stimulate the vagus nerve. 

Now, if you look down at conditions whereby heart rate variability is reduced. So people with anxiety, panic disorder, depression, diabetes type one, epilepsy, asthma, COPD, fibromyalgia, chronic fatigue, and the list goes on you know. And this is where we can influence this stage. And by helping to strengthen the baroreflex, we are improving the autonomic nervous system even to the point of inflammation. So a neuroscientist called Kevin Tracy. And in 1998, and I think he was based in New York. He had an idea that if you stimulated the vagus nerve, that it would stop inflammation in its tracks. Now his colleagues were outside of his lab, placing bets that he wouldn’t do it. But he did, he was able to show it. And he then showed it in human beings by electronically stimulating the vagus nerve. He could reduce rheumatoid arthritis. So this is something when we consider how harmful inflammation can be throughout the human body.

Tom McCarthy

Yeah.

Patrick McKeown

And one of the ways is, by stimulating the vagus nerve, that it can block pro-inflammatory cytokines, which are chemical messengers that trigger inflammation. So again, another example of how health and breathing can come together. Now, it’s not that I’m saying that breathing is a cure all. I’m not saying that. But if we look at the major disciplines of medicine. If I looked at sleep and I had a, I had an article published in the Journal of Clinical Medicine about three months ago. It was looking at the phenotypes of sleep apnea and breathing. Now obstructive sleep apnea is very common in the western world. It affects about 26% of men aged between 30 and 50 years of age and 43% of men aged between 50 and 70 years of age. It affects about 9% of females between 30 and 50. But once the female, when she goes through menopause, post-menopausal women, sleep disorder breathing increases 300%.

Tom McCarthy

Wow.

Patrick McKeown

So with sleep apnea, the typical treatment is a CPAP machine. But the problem with this is that 50% of people abandon it after about six weeks. If you change your breathing patterns, you will influence your risk of sleep apnea. Number one, if you have your mouth to open, you’ll have greater risk of sleep apnea. The tongue is more likely to fall into the throat. Mouth breathing is turbulence in the upper airway. Moisture is soft out of the upper airway, contributing to inflammation. But also when you breathe through your mouth, you’re typically engaged the upper chest. If we think of the muscles in the throat during wakefulness, our throat doesn’t collapse. But during sleep, these muscles can become lazy and they don’t have to maintain that open airway. But these muscles are connected with the diaphragm breathing muscle. 

Now, if we’re breathing through the mouth, we’re typically engaging the upper chest. We have reduced output through the diaphragm. If we breathe through the nose, and if we breathe low, we increase lung volume. And by increasing lung volume, the throat is stiffer anatomically. So the diaphragm is mechanically linked, with the upper airway dilator muscles. But also there’s a gas called nitric oxide. Nitric oxide was first discovered in the exhale breath of the human being in 1991. Nitric oxide performs a number of very important functions in the human body. It’s an endocrine messenger. And it’s thought that nitric oxide also plays a role in sleep, but it’s not fully understood.

When you breathe through your nose, you carry nitric oxide laid in there down your throat. And this seems to have some impact on the functioning of the upper airway dilator muscles. Now in the times that were in ish, COVID, there was a paper published by a journal under Elsevier in 2020. And the paper was could nasal breathing, mitigate the effects of COVID-19. I know that nobody has been talking about the importance of nose breathing. But your nose produces nitric oxide. Nitric oxide, by breathing through it. It’s antiviral, it’s antibacterial. And it’s the first line of the fence in terms of airborne viruses and bacteria coming into the human body.

Tom McCarthy

Yes.

Patrick McKeown

Our mouth does nothing. Our mouth is our whole that’s all it is. When you breathe through the mouth, air goes straight down the throat into the lungs. Our mouth performs no function in terms of the breath. And you know, I think it would had been heartfelt for, for authorities to put the information out there, encouraging people to breathe through the nose. And also, there’s just a few examples. Now you could talk about asthma. We could talk about the connection between the nose and the diaphragm, and the importance of the diaphragm not just for respiration, but for stabilization of the spine. 

So for example, 50% of people with lower back pain have dysfunctional breathing. But if I think of the anxiety population. The anxiety population are going maybe to their psychiatrist or their psychologist. They’re doing cognitive behavioral therapy. They’re doing mindfulness. CBT is not going to change respiratory physiology. If you have a person who was prone to anxiety, it’s not just that anxiety is causing their breathing to be fast and shallow, but they’re fast and shallow breathing is feeding back into the anxiety.

Tom McCarthy

Exactly.

Patrick McKeown

And this is the bi-directional feedback. And also if you talk to these people, they’re more likely to be tired. And if you’re tired, it’s going to affect your mental health as well. So if somebody comes into me with anxiety or panic disorder, I would show them exercises how to improve blood flow to the brain and it’s not by breathing hard. Because if you breathe hard, you get rid of too much carbon dioxide from the blood through the lungs and blood vessels constrict. And not only is our blood flow constricted due to hard breathing, but hemoglobin, which is the main carrier of oxygen in the blood. The bond between hemoglobin and oxygen is stronger when we breathe too hard. So here’s our person that I decide is coming in. We give them exercises to stimulate the vagus nerve, to calm the central nervous system, to increase blood flow and oxygen delivery to the brain, to slow down their breathing, to and target the diaphragm because of the connection between the diaphragm and the emotions, but also to look at their sleep. 

It’s very simple stuff. But the simple stuff has been overlooked. And I don’t know why, you know, when I look at this field over 20 years and I’m, you know, again, I don’t want to say that breathing is everything. Of course it’s not. But what I am going to say is this. People have overlooked the depth of it. It’s not just about this take in that deep breath. It’s not just about focusing on the biomechanics. You know, if you went into a studio and you’re hearing the instructor talking about breathing. And in the process the instructor is saying, now I would like you to fill your lungs from the bottom up, and you hear everybody breathing. You should never hear anybody breathing inside the studio. It doesn’t make sense. Because if you hear them breathing inside the studio, the likelihood is that they are over-breathing. And by over-breathing, they’re getting rid of too much carbon dioxide from the blood through the lungs, and this is reducing blood flow and oxygen delivery.

Tom McCarthy

Yeah. There’s so much done back there. It’s amazing. I love your passion too Patrick. Thank you. Let’s take couple of things and just kind of talk about them again. So people can really understand what you just said. So one of the interesting things was I used to have cold hands too, especially in the winter time. You know, it’s not that cold here in San Diego, but my hands will be a little cold. And so when I started doing the exercises that I read about through you breathing, I would, I started to notice that my hands were warmer, and that the blood vessels in the hands were like popping out and it was amazing. Like increasing circulation, just through changing my breathing. Now, when you, in the book that I first read, Oxygen Advantage and in The Breathing Cure, which people really need to get, it’s 500 pages. It’s got so much information, but really well written and researched. 

When I listened to your method or actually, ’cause I watched the course on YouTube, I did listen. But when I read about your methodology, you said light, deep, slow. So light, you already talked about, about 70% of what we’re used to breathing. That took some conditioning. I’m you know, I think I have it now, but it takes a little while to, you know, to have that air hunger and be okay with it. And then I even got one of your masks that I exercise with. And at first I like ripped it off after it, and then I’m like I can’t. And now I can go, you know, several minutes, ’cause I learned to relax and, and just know that that carbon dioxide build up actually is helping me versus some people think, no my oxygen, oxygenation needs to be at a hundred all the time. That’s, that’s actually a misconception, correct?

Patrick McKeown

Yes. You know, what is, one of the functions of carbon monoxide is it’s, it’s a key for unlocking oxygen from hemoglobin. And this was discovered back in 1904. A Danish physiologists called Christian Bohr, B-O-H-R. And he spoke about the car, the pressure of carbon dioxide in the blood as being important. Because as carbon oxide increases blood pH drops. And hemoglobin, which is a protein within the red blood cells. It’s the main carrier of oxygen. Hemoglobin releases, oxygen in the presence of carbon dioxide. Now, if I have a belief that it’s good to take these full big breaths, I’m going to be breathing harder. So I’m increasing the respiratory rate. I’m increasing the tidal volume. 

So I’m increasing minute ventilation and breathing too much air. And by breathing too much air, I get rid of too much carbon dioxide from the body. And as I lose carbon dioxide, my blood vessels constrict. But also as I lose carbon dioxide and blood pH increases, the bond between hemoglobin and oxygen strengthens. So it’s just one of those things in terms of, you know, breathing light. Now, it’s not that we want people to go throughout the day feeling air hunger, no. What we do is we have them practice reducing the volume of air that they breathe for five minutes here, 10 minutes there, and this helps to change their breathing patterns. 

And really what we’re looking to do is to reduce their ventilatory response to carbon dioxide. What does that mean? Carbon oxide does the primary stimulus to breathe. It’s not oxygen. Every breath that you take into your body is not driven by a change in oxygen. Your oxygen has to drop from a hundred millimeters of mercury, which is about normal down to 60, before the drop of oxygen stimulates breathing. You would have to be at a pretty good height for that to occur and in terms of elevation. So every breath that we take, the primary stimulus is carbon dioxide. But some people are more sensitive to the buildup of carbon dioxide than others.

Tom McCarthy

Right.

Patrick McKeown

A well-trained athlete will have a reduced ventilatory response to carbon dioxide A very unfit person, and especially maybe somebody who is overweight and their breathing is hard and fast. They can have a strong response to the buildup of carbon dioxide. A person with anxiety and panic disorder can have a strong response to the buildup of carbon dioxide. And if you have a strong response to carbon dioxide build up your breathing is harder and faster. And faster and harder breathing during rest and sleep, the brain interprets that the body is in an unsafe environment, and in that increased sympathetic drive. So we need to change the biochemistry of breathing. Now I understand it can be a little bit uncomfortable, but there’s something really positive in this. If we expose the body to a bit of discomfort. 

So I was giving breath holding exercises just about an hour before we were talking. And it had about 35 people going through a different breathing exercise. And I’m explaining to people. I’m going to give you a dose of suffocation. But I’m giving you a control of dose of suffocation. And I want you to relax into that. So you’re feeling uncomfortable, but you’re training yourself to relax into it. This in turn then is helping to improve your tolerance and your resilience. Because it’s not just that we are. You know, the feeling of suffocation is one of these kind of primordial fears.

Tom McCarthy

Yeah.

Patrick McKeown

It’s not a nice feeling, But we give you a controlled dose and this is desensitizing your body’s reaction to that. Now, of course, we’re looking to improve your breathing patterns, but it’s also helping you to withstand discomfort. So for example, when you feel a stress. So we’re stressing the body a little bit to make those adaptations. So I think there’s more in terms of just changing breathing patterns. But relaxing into discomfort can be important as well for the human body.

Tom McCarthy

I’ve made a big difference learning that from you for me too. As a kid, I had that fear of suffocation. I don’t like em’. My worse fear. So this has been super helpful. And so the, the three things, light. So about 70% of the volume.

Patrick McKeown

Yes.

Tom McCarthy

Deep though, that was the thing that I had like, hey, how do you go? How can it be light and deep? But, explain the deep part.

Patrick McKeown

So say for example, you’re main breathing muscle is the diaphragm, and it separates the torus, which is the chest from the abdomen. And you can’t really feel your diaphragm, but it’s located just at the base of your ribs.

Tom McCarthy

Yeah, right here. Yeah.

Patrick McKeown

Exactly right there. Now, if you place your hands on either side of the lower ribs. And the objective here is that as you breathe in that your ribs gently move outwards. And as you breathe out the ribs are gently moving in. Now, what I would like you to do is to continue doing that Tom. So as you breathe in your ribs are moving out and as you breathe out, your ribs are moving in. But now to really slow down the speed of the air. So as you breathe in, your ribs are moving out and as you breathe out, your ribs are moving in. 

Your breath is silent, your breath is soft, and your breath is smooth. Now you are breathing deep. You have minimum movement from the upper chest. As you breathe in, you’ll have lateral expansion of the lower ribs. As the diaphragm is moving downwards, you have movement to the front, movement to the sides. You will have some movements of the back. That’s deep breathing in the true sense of the word.

Tom McCarthy

Yeah, that’s awesome. It was deep, but the volume was still 70%. But it was, I could feel it. It was mental, I could feel it going down there, yeah. And then the other thing is–

Patrick McKeown

Animals, sorry to cut across you there. Animals can teach us a lot about breathing. You know, if you were to look at a horse, or if you were to look at the domestic cat or any animal. They will invariably be breathing in and out through their nose. Dog is not a great example because—

Tom McCarthy

Because they breathe too fast right, yeah.

Patrick McKeown

They regulate body temperature. But even if you were to look at an infant baby. The infant baby will be breathing light, a healthy baby. Light, okay they’ll have a faster metabolism. So the respiratory rate is a little bit faster. But they will be breathing low. You don’t have to take full breaths to engage the diaphragm. It’s, can be light.

Tom McCarthy

And your methodology is try and, it’s not going to be perfect, but about six breaths a minute. And I, the way I’ve practiced it from learning you is about a four-second inhalation, deep inhalation, but then a longer six second exhalation. And it is amazing after you do that, you just feel so relaxed and you’re breathing in less air, your circulation, my circulation’s better. It’s awesome. So what a great methodology.

Patrick McKeown

You could as well. Like I suppose there’s three different things here with breathing. Because if you think of breathing, it’s like a three-legged stool. One leg of the stool is the biochemistry. The second leg we can say is the biomechanics, which is focused on optimal amplitude of the diaphragm. And the third leg of the stool then, we could be doing as cadence breathing. And that’s slowing down the respiratory rate to about six breaths per minute. And you could do it, so as you said, breathing in for four seconds and breathing out for six. 

And oftentimes we have people who have their hand out or side of their lower ribs, and they are breathing in two, three, four, out. Two, three, four, five, six. We’re having an extended exhalation to further activate the body’s relaxation response. Now you could breathe in for five seconds and then for five, and that’s pretty good at getting balanced. And you spoke about earlier on, I think it’s a common enough thing that people are on their emails, and they’re so focused on what they’re doing, that they forget to breathe or they stop breathing.

Tom McCarthy

Yeah.

Patrick McKeown

So to help restore that we bring in rhythmic breathing. And that could be breathing in for some people who are very poor breathing. I might do it for three seconds in and three seconds out and three seconds in and three seconds out, just to help restore rhythm. And it’s almost that we’re adopting new neuropathways that we’re changing the behavior of the person’s breathing from being irregular to rhythmic. And with somebody else who is better at breathing, we might do breathe in for five seconds and out for five. And out for five, sorry in for five and out for five. So we can help to restore your new neural pathways to change the behavior of breathing. You know, breathing, the brain changes. Now with neuroplasticity, scientists have realized that the human brain is malleable, it’s pliable, and we can change it by changing our patterns.

Tom McCarthy

So after some conscious awareness, after a while, then that breathing pattern just sticks and it becomes–

Patrick McKeown

Yes.

Tom McCarthy

More unconscious. I love it. Hey, one of the things that I also learned from you is taping my mouth shut.

Patrick McKeown

Yes.

Tom McCarthy

And I was telling you how my wife is like, you know, sometimes she’ll want to talk and I’ll go, I’ve got the mouth taped shut and like on dog on it. I gotta lift it up. You’ve actually have a tape where you can talk through it, that’s specially designed, that people can get an oxygen advantage. But talk about taping the mouth shut, not during the day, by the way, everybody, but this is when you sleep. Why is that an important habit for most people?

Patrick McKeown

Oh, it’s amazing. You know, 50% of the adult population wake up with a dry mouth in the morning. And if you wake up at a dry mouth, you’re more likely to be snoring. Like look at it this way. I’m going to make this sound of a snore through the mouth and it goes like this. And now I’m going to close my mouth and try and snore through my mouth. I can’t. So mouth snoring stops once you get them out closed. Now I’m going to make the sound of a snore through my nose and it goes like this. But now what I’m going to do is breathe really slowly through my nose. And I can’t snore so easily when I breathe slow. It’s not just about the airway that the resistance. You know when we think about turbulence to breathing, more often than not all of the focuses is on the airway, but very little focuses on flow. And during sleep, we need our lips together, our jaws relaxed, but our tongue resting on the roof of the mouth. 

Our tongue has got two places to be. It’s either in the roof of the mouth, or it’s falling back into the throat. And we don’t want to compromise the airway because a good airway is about the size of our tongue. And a poor airway is about the size in places of a Bic Biro to give you an example. Now if you’re breathing hard and fast through an narrowed airway, you’re increasing the turbulence in the airway, you’re increasing the negative pressure in the airway and the airway is more liable to collapse. For me and for thousands of people, I first started taping 20 whatever years ago. And I used to wake up feeling lousy in the morning. And, you know, I spoke about going in, as a kid, going into school and a university student. And society is demanding that we’re able to focus and that we can, you know, we can be attentive to what the teacher’s saying and that we can remember this information. But if you have a child going in with poor sleep, it’s not happening. 

How can it be? And you know, if we think of like Maslow’s Hierarchy of needs is often, you know, bandied about. And I have a revised hierarchy of needs for the modern day. Maslow’s Hierarchy of needs way back then it was fine. Let’s revisit it. The most fundamental thing we can do as human beings in today’s modern age is to get our sleep right. It’s not about necessarily sleep hygiene. Yeah you know what, don’t look into your phones. Don’t drink alcohol, don’t eat food late at night, have a culinary bedroom. All that is fine. The elephant in the room when it comes to sleep is breathing in and out through your nose. And that’s not just my words. 

The founding father of sleep medicine was a guy called Dr. Christian Guilleminault, based from Stanford Medical School. He passed on in 2019. And I remember, you know, we spoke at different congresses, sleep conferences. I was talking about breathing and sleep and he was talking about sleep apnea. And I remember him saying it over and over and over to the doctors in the audience, the importance of breathing through the nose. Now here we have the top sleep doctor in the world talking about nasal breathing, but the information hasn’t necessarily trickled down to the population. If you breathe through your nose, your sleep is likely to be deeper. You’re less likely to have sleep fragmentation. 

Nose breathing is slowing down your breath. Mouth breathing is faster breathing. If you breathe faster during sleep, there’s a greater turbulence in the airway, but also if you breathe faster in sleep, you’re more likely to be aroused from sleep. Because the body and the mind, the mind doesn’t, the brain is interpreting that the body is under threat. So people with insomnia, fast breathing can waking them up. Now sleep medicine has changed a lot in seven years. And even in sleep apnea, there’s a recognition that there’s four characteristics that contribute to sleep apnea, instead of just one. In other words, it’s not just an anatomical issue that the airway is compromised. 

There’s lots of what’s called loop gain, which refers to how stable is your breathing. Arousal threshold, to whether you are a deep sleeper or a light sleeper. An upper airway recruitment in terms of how well do the upper airway dilator muscles function. You can impact all of the phenotypes of sleep apnea by changing your breath. And so far, nobody has done research on it. And when I was writing the article with two ear nose and throat doctors. And we had it peer reviewed and published 10,000 word article. You’ll see it up on PubMed. And it’s breaking down the application of light, slow and deep breathing to the phenotype sleep apnea. Think about justice in terms of recovery, in terms of mental health and in terms of performance. Even drivers, you know, look at the amount of road traffic accidents in the United States that are related to driver fatigue. I think it’s 20%. Just even looking at that alone. 

Now for me, nose breathing was absolutely fundamental. And I woke up, the second morning I woke up, okay. I tape my mouth the first night. I wore nasal dilators too. Just breathe right strips to help open up the nose. And I woke up the first morning as kind of getting the hang of it. And I tried taping it again the second night, taping my mouth closed. And I woke up and it was just the most brilliant feeling, waking up feeling refreshed. You know, like we get used to fatigue, but we shouldn’t have to. I’m nearly 50 years of age now. I have better concentration and focus now than I did when I was 16. It shouldn’t be that.

Tom McCarthy

You’re still a young, man. You’re still a young, that’s fair to me. But no it is amazing when you know, the first taping. When I first started taping my mouth and I was like, okay, this is weird. Am I going to be able to get to sleep? And it just felt a little awkward the first night. Okay, try it again the second night, little less awkward, third night. And now I’m, you know, the sleep is deeper. I wake up more refreshed. My wife said, I used to have this pattern of not apnea but, or not even that much snoring. But I would like, like breathe out sometimes ’cause this would kind of get a post-nasal drip. And now, now it’s all through the nose. And one of the things you’ve talked about in the book, when you breathe through your nose at night, it starts to expand the nasal cavities. And then also it impacts the size of your, what you gave that example there versus–

Patrick McKeown

The airway.

Tom McCarthy

Like it starts to expand out so breathing becomes easier, right.

Patrick McKeown

Yeah. Like there’s, what’s called a Starling resistor model. And basically that refers to if there was a, if there was a resistance to your breathing upstream. So if you, for example, have a stuffy nose, the nasal congestion is going to cause increased resistance to your breathing downstream in the throat. And this is increasing the risk then of negative pressure. By breathing through your nose continuously, your nose works better. And by doing breathing exercises, you can help to decongestant the nose. Like anybody can try this exercise. This has been known since 1923. Don’t do this if you’re pregnant, or if you’ve got serious medical conditions. But if you have a stuffy nose or a head cold, breathe in through your nose and out through your nose, pinch your nose and hold your nose. And you could just gently nod your head up and down, holding your breath like this. And just keep on gently nodding your head up and down and holding your breath and holding your breath until you feel a moderate just kind of strong air hunger. Then let go, breathe in through your nose, wait a minute, and do it again, do that five or six times, your nose starts to open up. And the more you breathe through the nose, the better it works up. Your mouth is the problem when it comes to sleep. It imposes a bunch of resistance to breathing.

Tom McCarthy

Yeah. Mouth is a problem when it comes to sleep, I like that. And when you say breath hold there, everyone, he said, after the exhale–

Patrick McKeown

Yes.

Tom McCarthy

You hold your breath. So actually you breathe out, but then you don’t breed back in. Very quickly, because well I know we’re running out of time here. But this has been such an awesome interview. I want to make sure that we also let people know at the end, how to get in touch with you, but talk about the test people can do. I think you call it the BOLT score. Where they can kind of test their, their breathing. And that, by the way, that one, I was pretty good at when I first did it. But now I’m up to that magic number. I think you said is 40 seconds.

Patrick McKeown

Yeah. Good stuff. Well done. So the BOLT score has been a test of breathlessness that has been used for about 50 years. And to measure your BOLT, you sit down for about five minutes, just allow your breathing to settle down. And just take a normal breath in through your nose and out through your nose, and you pinch your nose, with your fingers. And your timing at how long can you hold your breath for, until you feel the first definite desire to breathe, or the first involuntary of your breathing muscles. And then when you let go, your breathing should be fairly normal. So it’s not the lent of a maximum breathe hold. You’re just kind of, you’re having an over breath in and out through your nose and you’re holding your nose. And your timing, it’s a comfortable breath hold time. So it’s almost that your timing, how long does it take for the brain to react to the fact that you’ve stopped breathing.

Tom McCarthy

Yeah.

Patrick McKeown

Now professor Kyle Kiesel is a professor of physical therapy at Evansville University. And he looked at breath hold time as a measurement of functional breathing patterns. He investigated it with 51 individuals. There were 27 years of age. And his conclusion was that if your BOLT score was, same exact same measurements. If it’s above 25 seconds, there is an 89% chance that dysfunctional breathing is not present. So we want to establish a minimum of BOLT score of 25 seconds and a goal of 40 seconds. Now, some people will be surprised, maybe they’re BOLT score is 10 or 11 seconds, but that would indicate that your breathing is a little bit faster in upper chest, and that can impact your sleep. That can impact your focus, concentration, and resilience. It can impact your ability to do physical exercise. Because a person with a low BOLT score will, is more likely to experience disproportionate breathlessness. They’re more likely to gas out too soon. They’re more likely to feel muscle fatigue. So it’s a decent–

Tom McCarthy

Anxiety. And anxiety and nervousness and things like that. So a higher BOLT score probably correlates with lower levels of anxiety.

Patrick McKeown

Yes.

Tom McCarthy

Yeah, yeah. And so how do they increase their BOLT score? Not just by doing it over and over again, it’s through the light, deep, slow practice, right?

Patrick McKeown

Yeah, yeah. But even Tom, you know, going to the gym, do your exercise in the gym with your mouth closed. Yeah initially it’s a bit tougher because your nose is imposing a resistance to your breathing during wakefulness, and by breathing through your nose, carbon dioxide increases in the blood. So you feel increased air hunger. But if you do your physical exercise, breathing in and out through your nose, you’re adding an extra load onto the breathing muscles. 

This can help to strengthen and improve the function of the diaphragm. Nose breathing, you’re increasing carbon dioxide in the blood, and this can have produce your ventilator response to carbon dioxide, but ultimately you’re making your breathing much more efficient and economical. So if you do your physical exercise with the mouth closed. Now, what I would say to people is don’t sprint, with your mouth closed, because now you’re really going to be excruciating air hunger. But do your job with your mouth closed. Always remember this. Your mouth has no function whatsoever in terms of breathing, zero, none.

Tom McCarthy

Strong statement, but really, really true and powerful. I love it. So let’s, let’s share with people how they can get in touch with you. So your website is Oxygen Advantage?

Patrick McKeown

.Com.

Tom McCarthy

Yeah oxygenadvantage.com. You have some wonderful tools there. I, before I even contacted you for the summit. I had ordered your breathing mask, which really, which I use when I exercise, which is really cool. I have your belt that also is very helpful throughout the day to kind of create a little restriction around the, the diaphragm. Train that diaphragm to get stronger. The light, and also remind me to breathe light, deep and soft. So I love that. Your prices are, I thought super reasonable. So check that out. And then also The Breathing Cure is out now. It’s not out in the US though. The only place to get it I think it on your website, right?

Patrick McKeown

Yeah. So we haven’t, it’s in Europe. It’s going to be published in the United States by Humanix Books. And this is, it’s. I think the expected publication date is August of this year. There was a slight delay because of COVID. So you think the printers were just held back a bit. So yeah.

Tom McCarthy

Yeah. If you want to get it right away, go to Oxygen Advantage. I pre-ordered it on Amazon and then it’s, you know, months away, but I got one through Oxygen Advantage. And then also Patrick has offered a great gift for you that you can get and register for. It’s one of his trainings. I went through it, it’s phenomenal. He leads you through exercises, not only in breathing, but how to calm the mind and thoughts and so is fantastic. So Patrick, thank you so much. It’s really been amazing having you on. And I, as I said, I thought I knew a lot about breathing, but you have taught me so much more so, and I know you’ve helped so many people that are watching this too. So thank you so much for being part of our summit Patrick.

Patrick McKeown

My pleasure. Thanks very much, Tom.