How to breathe for better health

Breathing is such an essential part of life that we do not even think about it. It’s simply something we do that does not require conscious thinking, and many of us may think or have been told that breathing through the nose or mouth makes very little difference as long as air gets to the lungs. But nasal versus oral breathing can be a decisive factor in our health in many aspects, and one of the most “bang for buck” things to correct and improve if we want to achieve better health. And the best thing is, it’s free!

In the East, there are the words “qi” or “prana”, which relate to both the breath and energy, and many practices such as yoga or Tummo breathing (as popularised by Wim Hof) are based on regulating the breath in order to restore balance in the body and mind.

In Western cultures, breathing techniques such as coherence breathing or Butekyo breathing technique were similarly developed for therapeutic aims. These breathing techniques are often referred to as paced breathing and are based on slowing down the breath frequency, which has been associated with relaxation and well-being^1,2, while fast breathing can often increase focus and energy, but may also lead to anxiety and stress³.

Another component of breathing is the proper use of the diaphragm. Diaphragmatic breathing is slow and deep breathing that affects the brain and the cardiovascular, respiratory, and gastrointestinal systems through the modulation of autonomic nervous functions.

It not only appears to be effective for improving the exercise capacity and respiratory function in patients with chronic obstructive pulmonary disease, but may also help in reducing stress; treating eating disorders, chronic functional constipation, hypertension, migraine, and anxiety; and improving the quality of life of patients with cancer and gastroesophageal reflux disease and the cardiorespiratory fitness of patients with heart failure⁴.

The rate of breathing also has significant health effects on our nervous system. When someone experiences a panic attack, he or she often hyperventilates, which exhales out more carbon dioxide and changes the pH of the blood and this is picked up by chemoreceptors in the brain which registers an alarm signal but paradoxically also a sensation of “shortness of breath” or “lack of oxygen”, when actually the opposite is true – there is too much oxygen relative to carbon dioxide.

Slow paced breathing or 6 to 10 breaths per minute in healthy subjects has been show to positively impact parasympathetic activity as measured by increased Heart Rate Variability and Low Frequency power, and also the central nervous system activities, such as increased EEG alpha power and decreased EEG theta power, which are related to emotional control and psychological well-being⁵.

Obstructive Sleep Apnoea and breathing

Tell-tale signs of obstructive sleep apnoea syndrome (OSAS) are often snoring (usually a complaint from the bed partner), fatigue, poor concentration and memory, and daytime drowsiness. One of the factors contributing to OSAS is dysfunctional breathing, such as chronic hyperventilation, and there is a bi-directional relationship during wakefulness and disordered breathing during sleep⁶, , and people with apnoea are more likely to be mouth breathers⁷.

It is possible to restore nasal breathing with breathing re-education that also focuses on improving diaphragm function, slowing the respiratory rate and increasing tolerance to changes in arterial carbon dioxide pressure⁸.

The principles of breathing re-education is based on three dimensions, namely:

Biomechanical, breathe low to engage the diaphragm;
Biochemical, breathe light, reduce tidal volume and lessen chemosensitivity to CO2;
Resonant frequency—slow breathing at six breaths per minute.

This method of breath training is also known as the Butekyo breathing technique, first introduced by Dr. Konstantin Butekyo from Russia in the 1950’s.

There are also mouthguards and jaw devices prescribed to patients with OSAS that attempt to keep the airway open and mouth closed during sleep. I find that for patients with mild OSAS, a simple trick is to use a piece of tape over the mouth (either vertically over the central one-third of the lips, or horizontally over the full mouth – which can appear or feel more daunting), can often reduce the amount of snoring and improve subjective sleep quality and daytime wakefulness.

There are special mouth tapes sold by various companies, but I simply use surgical tape that provides sufficient adhesiveness without excessive pain in the morning when removing the tape to work. I personally have been doing this for several years and believe me, it has been a marriage saver!

Mouth breathing in children

Breathing properly especially for a growing child is as important as the other “basics” such as optimal nutrition, adequate and good quality sleep, movement, intellectual stimulation and emotional support.

Chronic mouth breathing results in several morphological changes and is known to cause ‘adenoid facies’⁹. Children whose mouth breathing is untreated may develop long, narrow faces, narrow mouths, high palatal vaults, dental malocclusion, gummy smiles, and many other unattractive facial features, such as skeletal Class II or Class III facial profiles.

These children do not sleep well at night due to obstructed airways; this lack of sleep can adversely affect their growth and academic performance. Many of these children are misdiagnosed with attention deficit disorder and hyperactivity¹⁰. Causes of mouth breathing may be multifactorial and attributable to anatomical factors, but treatment should be multidisciplinary, since mouth breathing remains even when dental and skeletal factors slow down¹¹.

Similarly, mouth breathing because of nasal obstruction can cause sleep disorders, and by day, it may give rise to symptoms similar to those of attention deficit hyperactivity disorder (ADHD)¹² , suggesting that breathing through the mouth instead of the nose can negatively impact brain function¹³. ADHD is reported to be associated with prefrontal cortex function¹⁴ and that activation of the prefrontal cortex and exertional dyspnoea are involved in patients with chronic obstructive pulmonary disease¹⁵.

Changes in cortical excitability observed in hypoxaemic patients with chronic respiratory insufficiency further suggest that chronic hypoxia can induce alterations in cerebral neuronal excitability¹⁶, suggesting that continued oxygen load on the prefrontal cortex from mouth breathing during the waking hours is one possible cause of ADHD arising from central fatigue.

One study that gave participants an eight-week training course with a real-time feedback device, instructing them to breathe diaphragmatically at four breaths per minute, noted that the intervention group had a significant decrease in negative affect, improvement on sustained attention, and a lower cortisol level after training¹⁷.

There are so many more aspects of breathing that simply cannot be covered by a brief article here, so I highly recommend two books on this subject of breathing that explains the science behind it in fascinating details – ‘Breath’ by James Nestor and ‘The Oxygen Advantage’ by Patrick McKeown. Happy breathing!

References

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Jerath R., Crawford M. W., Barnes V. A., Harden K. (2015). Self-regulation of breathing as a primary treatment for anxiety. Appl. Psychophysiol. Biofeedback 40, 107–115.
Homma, I., & Masaoka, Y. (2008). Breathing rhythms and emotions. Experimental Physiology, 93.
Hamasaki H. Effects of Diaphragmatic Breathing on Health: A Narrative Review. Medicines (Basel). 2020;7(10):65. Published 2020 Oct 15.
Zaccaro A, Piarulli A, Laurino M, et al. How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing. Front Hum Neurosci. 2018;12:353. Published 2018 Sep 7.
Breathing retraining in sleep apnoea: a review of approaches and potential mechanisms. Courtney R. Sleep Breath. 2020 Dec; 24(4):1315-1325.
Koutsourelakis I, Vagiakis E, Roussos C, Zakynthinos S. Obstructive sleep apnoea and oral breathing in patients free of nasal obstruction. Eur Respir J. 2006 Dec;28(6):1222-8.
McKeown, P., O’Connor-Reina, C., & Plaza, G. (2021). Breathing Re-Education and Phenotypes of Sleep Apnea: A Review. Journal of clinical medicine, 10(3), 471
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Sano, M., Sano, S., Oka, N., Yoshino, K., & Kato, T. (2013). Increased oxygen load in the prefrontal cortex from mouth breathing: a vector-based near-infrared spectroscopy study. Neuroreport, 24(17), 935–940.
Finger EC, Marsh AA, Mitchell DG, Reid ME, Sims C, Budhani S, et al. Abnormal ventromedial prefrontal cortex function in children with psychopathic traits during reversal learning.Arch Gen Psychiatry2008;65:586–594.
Higashimoto Y, Honda N, Yamagata T, Matsuoka T, Maeda K, Satoh R, et al. Activation of the prefrontal cortex is associated with exertional dyspnea in chronic obstructive pulmonary disease.Respiration2011;82:492–500.
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Ma X, Yue ZQ, Gong ZQ, et al. The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Front Psychol. 2017;8:874. Published 2017 Jun 6.

This article has been written for the Australasian Society of Lifestyle Medicine (ASLM) by the documented original author. The views and opinions expressed in this article are solely those of the original author and do not necessarily represent the views and opinions of the ASLM or its Board.