Chapter 11: Breathing Less, Nasally, and without Pharyngeal Tension
In chapter 3 we said that smooth flow rates, long intervals, increased tidal range, and breathing assertively were the four rules of diaphragmatic breathing. Hopefully by now you have practiced these, along with paced breathing, and have learned what diaphragmatic breathing feels like and how to sustain it. You should feel comfortable breathing for several minutes at a rate around 4 second inhalations, and 6 second exhalations. This chapter will return to the topic of breathing, offering more background, and more breathing techniques to complement what you have already learned.
Almost all self-help books today tell you to breathe with your belly without giving you any real guidelines on how to do so. Then they tell you that you are not inhaling enough air, and thus are not getting enough oxygen. This is usually not the case. Most of us, especially those with stress issues, over-breathe involving rapid cycles of heavy inhaling and exhaling. This excessive breathing is called hyperventilation and results in abnormally high levels of oxygen and low levels of carbon dioxide. Inordinate oxygen intake, can be just as bad as insufficient oxygen intake. Like overeating, overbreathing amounts to too much of a good thing. People who are hyperventilating severely are sometimes given a paper bag to breathe into because their oxygen levels are too high and their carbon dioxide levels are too low. Rebreathing exhaled carbon dioxide trapped in the paper bag can help to return balance.
During stress, thoracic breathing is accentuated to meet the anticipated increases in oxygen demands. If the anticipated event never arrives, there is no increase in physical activity, and the extra oxygen is never used. This is the cause of hyperventilation. A common criterion for hyperventilation is 30 liters per minute, and many people breathe normally in this range (Timmons & Ley, 1994). Conventional medicine deems 5 to 6 liters of air per minute (at around 500 milliliters of air per breath) as normal (Naifeh, 1994). This would be about as much air in three empty 2-litre soft drink bottles. It is likely that you, like most of us, inhale significantly more than this. The diaphragmatic breathing retraining regimen outlined in Chapter 3 will reduce the amount that you hyperventilate, and potentially provide you with the relief of symptoms you didn’t even know you had.
I was a chronic hyperventilator and I was well acquainted with the symptoms: dizziness, poor concentration, muscle tension, cramps, irregular and rapid heartbeat (tachycardia), heart pounding (palpitations), and gastrointestinal upset. Because over-breathing is hard work, it leads to exhaustion, chest tightness, and chest pain. Hyperventilation also leads to feelings of breathlessness, choking, or smothering. It is strongly associated with nasal congestion, tightening of the airways, fatigue, tremor, shakiness, tight muscles, stiffness, muscle pain, weakness, chest pain, constriction of blood vessels, asthma, rhinitis, and snoring (McKeown, 2015). Ironically, many body tissues are actually deprived of oxygen during hyperventilation. This is especially true in the brain, leading to reduced mental function (Sauty & Prosper, 2008). Hyperventilation and other defensive breathing habits are thought to be major factors in medical conditions that are caused or aggravated by mental stress (psychosomatic diseases). These include headaches, back aches, nausea, dry mouth, sweaty palms, insomnia, ulcers, and many others.
In the 1950s Russian physiologist Konstantin Buteyko developed a now popular breathing program to counteract hyperventilation. Today it is called the Buteyko method and is used for asthma, anxiety, and to increase pulmonary function in athletes. Reviews of the medical literature have come to different conclusions about the strength of evidence supporting the Buteyko method (Rosalba, 2008), but it has a large number of steadfast adherents. The method uses breath holding, resistance breathing, and breath restriction exercises to counteract overbreathing. The practice focuses on reducing breathing movements until you feel a tolerable air shortage and hunger for air. I do not recommend reducing breathing to the point of air hunger per se, but I do recommend the bread and butter of the Buteyko system: 1) breathing through the nose, and 2) breathing “slower and less.”
Nose Breathing and Resistance Breathing
Resistance breathing is any kind of breathing that creates resistance to the flow of air. You can create resistance by breathing through clenched teeth, pursed lips, or a straw. Resistance breathing forces the breathing musculature to work harder and thus strengthens it substantially over time. Because it takes more time, and disallows air gulping, it forces the diaphragm to do the work.
Many people use “elevation training masks” during exercise to create intense pulmonary resistance to strengthen the muscles of respiration. These masks are meant to simulate the benefits of training at high altitude. I think that the masks can be helpful. However, if you are a defensive breather, or you breathe defensively while wearing them, they are just going to strengthen your defensive breathing habits. I imagine that the masks might be very useful when used with diaphragmatic breathing. However, breathing through the nose is a free and easy alternative to train resistance breathing.
Because the nasal passages are narrower than the oral one, taking a full breath through the nose takes significantly more time and effort. It takes 50% more work to breathe exclusively through the nose compared to breathing exclusively through the mouth. It is hard work for the diaphragm and will make it stronger fast. Also it forces you to breathe more slowly, at an even pace. A number of researchers agree that, “one cannot easily hyperventilate when breathing through the nose (Fried, 1993).”
People switch from nose to mouth breathing when they feel nervous. You may have never noticed it but you probably switch from nose to mouth breathing constantly as your stress levels fluctuate during the day. Breathing through the nose is uncomfortable for many people in social situations. I was very uncomfortable nose breathing in my twenties, thinking that people would think I look “barefaced,” “bold-faced,” and insolent. It looked disrespectful precisely because I was uncomfortable doing it. Once you become complacent breathing through the nose, with mouth closed, you can get away with sporting a highly expressionless face. Spend time breathing with your mouth shut more often. Practice it in public and in social situations. Notice how difficult it can be in certain situations, and how you have the repeated impulse to switch to mouth breathing. If you allow yourself to resort to mouth breathing when you feel stressed or nervous your composure will be stymied.
Many people claim that because of nasal obstruction or congestion that they are not able to breathe through their nose. After having my nose broken I thought that I would never be able to breathe through my nose again. Anytime I tried, I simply could not get enough air. After a year of daily, paced breathing, I noticed that my diaphragm had strengthened to a point where nose breathing was suddenly an option. It became clear that the real reason that I couldn’t breathe through my nose was chronic, distressed breathing. The more time you spend breathing shallowly, the harder it is to breathe through the nose. The more paced breathing you practice, the easier nose breathing becomes.
Many people perform alternate nostril breathing exercises where the index finger is used to close each nostril for several seconds, one at a time. Many hypotheses have been advanced regarding why breathing through only one nostril seems to have a calming effect on people. I think it works simply because it narrows the breathing bottleneck even further, necessitating that each breath is even slower and smoother. Try it. There are many guided alternate nostril breathing exercises online.
Just like you don’t let dry eyes keep you from widening your eyes, or dry lips keep you from smiling, don’t let a stuffy nasal cavity keep you from breathing through your nose. You might want to try nasal irrigation, a personal hygiene practice that is used to flush excess mucus and debris from the nasal cavity and sinuses. Also make an effort to breathe through the nose while chewing. Because I can breathe through my nose now, I can close my mouth while chewing. Thus much to the pleasant surprise of my friends and family, I no longer smack my lips
A. Hyperventilating man breathing into paper bag; B. Man running with training mask; C. Man with tape over mouth to ensure nose breathing.
Most mammals breathe exclusively through their nose with their mouths closed but there are a few exceptions. Some mammals will breathe through the mouth when engaging in intense cardiovascular activity. Others use mouth breathing for evaporative cooling, like a dog panting on a hot day. Many mammals will breathe through their mouth during an aggressive confrontation. Usually the dominant animal will keep its mouth closed, and the subordinate one will open the mouth and pant nondiaphragmatically. Many dog trainers interpret nose breathing as defiant and mouth breathing as acquiescent. The dog that pants quickly with an open mouth is usually seen as the most obedient. Chronic mouth breathing, like hyperventilation, is a submissive, handicapping signal. Otherwise, mammals breathe almost exclusively through their nose. When a mammal is seen breathing through its mouth it is taken by veterinarians as a sign of sickness, or serious injury.
In 1882 George Catlin wrote the book Shut Your Mouth and Save Your Life, where he extolled the virtues of nose breathing. He was a European traveling in America where he observed a large proportion of Native Americans breathing exclusively through the nose. He even saw mothers encouraging their infants and children to breathe with their nose. If a baby opened its mouth to breathe, the mother would gently push the baby’s lips together to ensure nasal breathing. He compared this to Europe where it seemed to him that everyone breathed with their mouths.
Modern day hunter gatherers are known to be nose breathers and even most of the persistence running they do during prolonged hunts is accomplished with the mouth closed. As you get better at nose breathing force yourself to breathe exclusively through the nose during exercise. Keep tissues with you, blow your nose frequently, and train as often as you can with the mouth closed. Many nose breathing adherents recommend taping the mouth shut at night regularly to strengthen nocturnal nasal breathing. They claim, and I agree, that it helps you to fall asleep more quickly, stay asleep longer, and wake feeling energized.
Months of paced breathing made it possible, but breathing exclusively through the nose was still a challenge for me when I started. Inspired by the writings of Konstantin Buteyko, I forced myself to do it. It took about 3 weeks until I was breathing with a closed mouth all the time. You haven’t accomplished it until every time you think to notice, you find yourself breathing through the nose. Half way in I developed a small cold from the effort because I weakened my respiratory system by forcing nose-breathing. It would probably be best to allow yourself at least a few months to make a comfortable transition to exclusive nose-breathing. If your chest and diaphragm ache very slightly upon waking you are making progress. If they ache through the morning, you are overdoing it. Teaching myself to breathe through my nose made diaphragmatic breathing much easier and gave me a whole new level of composure and poise. Breathe through the nose as much as possible, it calms your mind and turns your breathing musculature into a powerful, relentless, irrepressible bellows.
The Slowest Smallest Breath
When you breathe with a smooth flow rate you should feel that your breath proceeds at an even tack. You should be able to hear and feel a constant stream of breath that doesn’t vary in speed. I think that the best way to perfect a smooth flow rate is to take breaths where you breathe as little and as slowly as possible. When you do this the tumultuous discontinuities (apneic disturbances) that we discussed in Chapter 3 become magnified and you are in the perfect position to “iron them out.”
Breathing slowly like this feels dangerous. Some of the most archaic brain areas ring their alarm bells when they can tell that we are forcing diaphragmatic breath. Deep down our unconscious is afraid that overexerting the diaphragm will lead to death by some form of cardiorespiratory failure. It is afraid that we will ignore the pain signals from our weary breathing musculature and succumb to catastrophe. A little bit of diaphragmatic fatigue is not going to kill you. In fact, people can survive with the diaphragm completely paralyzed. You don’t want to push it too hard for hours at a time, but you must get past this instinctual dread of utilizing the diaphragm. To do this embrace the feeling of “suffocating” yourself with the slowest, smallest breath. These breaths, the inhalations as well as the exhalations, should feel like prolonged, streamlined sighs that “ooze” in and out of your body. At first I could only breathe in this way for a few breaths at a time, but now this is my default. At first I was worried that I wouldn’t be able to get enough air. Slow breathing is actually extremely efficient because it doesn’t take any breaks. As you may recall, slow and steady allowed the proverbial tortoise to beat the hare.
Taking slow breaths will strengthen your diaphragm and teach your mind to control it on a very precise and fine-grained scale. This will put an end to hyperventilation. Taking small, slow breaths will also help to improve your blood’s oxygen-carrying capacity and also increase the maximum volume of oxygen that you can use in exhaustive exercise. This is known by athletes as VO2 max and is highly coveted (McKeown, 2015). It will also make your breath extremely quiet.
A number of eastern arts, such as Tai chi, yoga, and qi gong recognize the importance of quiet, gentle breathing. Qi gong master Chris Pei explains: “Generally speaking there are three levels of breathing. The first one is to breathe softly, so that a person standing next to you does not hear you breathing. The second level is to breathe softly so that you do not hear yourself breathing. And the third level is to breathe softly so that you do not feel yourself breathing.” The Chinese practice of Taoism defines ideal breathing as “so smooth that the fine hairs within the nostrils remain motionless.” In the 6th century BC Chinese philosopher Lao Tze said that “The perfect man breathes as if he is not breathing.” I am inspired by these quotes and I believe that quiet breathing is an indicator of diaphragmatic health. However, unless you are sitting quietly the breath cannot always be inaudible. Don’t suppress your breath in an effort to make it quiet, and don’t be embarrassed by the sound of your breathing. Rather, be proud for others to hear how smooth and deep it is.
When you perform exercise 13 above imagine that you are training to be the best in the world. Pretend that the national pastime consists of stepping up to the plate, pressing your nostril against a microphone, and taking the smoothest inhale, and the smoothest exhale you possibly can. You want to inspire the entire stadium, as well as the folks watching at home, with how constant and unperturbed your breath is. We may never get the opportunity to show off in this way. However, if we breathe as if we are training for it, the results will significantly affect our every word, thought and action.
Many breathing exercises utilize breath holding. There are many that ask you to hold your breath between each inhalation and exhalation. The popular 4-4-6-2 exercise asks you to inhale for 4 seconds, hold your breath for 4, exhale for 6, hold the breath for 2, and then repeat. Try it. This is a drill, sometimes called box breathing, that is utilized by the military to calm and rehabilitate tactical athletes and war fighters. I think that breath holding exercises like these are fine and can be helpful, but they are not part of this program because I think it can be counterproductive to practice holding the breath. Breath holding may confuse the respiratory system, making you more likely to hold your breath in the future without being aware of it. Because of the strong association between breath holding and anxiety I think this is counterproductive. I should mention that studies show that meditative breath holding make participants more aware of their heartbeat, and calm the sympathetic nervous system by activating the vagus nerve. Many people are fond of breath holding exercises, and I don’t want to dissuade you from performing them, but I think that “smallest slowest breath” activity above is preferable.
There is a simple breath holding test that can provide you with an indication of your tolerance for carbon dioxide build up. Buteyko adherents call it the “control pause” and it has also been called B.O.L.T. or the “blood oxygen level test” (McKeown, 2015). Start by taking a deep breath in while lying down and then exhale most of it. Then close your mouth, pinch your nose, and time yourself to see how long it takes for you to start to experience air hunger. This first desire for air will occur with an involuntary contraction of the diaphragm. The diaphragm automatically starts to push and pull to get breathing going again. The amount of time it takes for you to feel this sensation is a good measure of general breathing health. Many people will experience diaphragmatic contractions between 10 and 20 seconds. Practitioners hold that an ideal breather will not experience this until 30-40 seconds. It is best to take your BOLT score first thing after waking because you cannot influence your breathing during sleep and a BOLT score taken upon waking will be based on your natural breathing rate set by your brain’s respiratory center. Nose breathing, paced breathing, and using the four rules will help improve this score.
Rapid, Shallow Breathing
I believe that insufficient skill in consciously coordinating the initiation of inhalation and exhalation is a manifestation of trauma. Building better coordination over the switch between breaths may make you a less hesitant, more confident breather. One reason I believe this is so is that chimpanzees perform rapid panting displays on a daily basis. They make dominant pant hoots and submissive pant grunts. These vocalizations are set to almost violently fast breathing. They basically scream while switching between inhalations and exhalations at around. The pant hoots switch between .5 and 2 per second, and the pant grunts switch between 2 and 10 per second. Google these terms, and try to recreate them yourself. You will find them very difficult at first, yet make great progress over the course of just a few days
It is also very important to spend time everyday not trying to control the breath. Forget about the rules of diaphragmatic breathing sometimes and let the unconscious breath regulation modules do what they will. Completely avoiding breathing on short intervals is like being an endurance runner that never sprints. Stated simply, allow yourself to breathe shallowly sometimes.
Stretch and Flex the Diaphragm
The next activity provides a great maneuver to stretch and contract your stale, stiff diaphragm. This exercise will bring it blood, and help make it stronger and better at its job. Think back to the hiccup activity from Chapter 3. When simulating a hiccup you instinctually sealed off your glottis (vocal cords) and contracted your diaphragm. A hiccup is simply a rapid inhalation that is impeded by closure of the glottis so that no air can enter the lungs, creating a brief vacuum. By restricting the flow of air, closure of the glottis isolates the diaphragm in a fixed position, allowing it to flex isometrically. From here, try to breathe in. With the glottis closed you won’t be able to but trying to will pull the central tendon of the diaphragm up into the thoracic cavity, lifting and stretching the entire diaphragm as well as the organs attached to it. Again, I thought I originated this, but after entering a description into a search engine found that it is a variant of an age-old yoga pose called Uddiyana Bandha, or “flying abdominal lock.”
There are other ways to isolate and contract the diaphragm isometrically. Breathing deeply from a number of yoga positions offer challenging opportunities for diaphragmatic growth. I want to strongly encourage you to try a full inhalation from forward fold, or plow position because these positions decrease the volume of the abdominal cavity, making slow, full breaths hard work with a big payoff.
Breathe Through both the Nose and Mouth Simultaneously
It is uncomfortable for most of us to breathe through both the nose and the mouth simultaneously. Do you ever do it? To try, simply breathe in a way that you can feel air passing through both your nostrils and your teeth and lips. At first, the only palpable sensations seem to come from these areas of the face, but after a while, you notice that both of the deep pharyngeal structures in the back of the throat are open. Breathing like this teaches you how to control these areas, and also how to relax them. Usually when you breathe through your nose, you unknowingly cut off the passage between your mouth and trachea. To see this, look in the mirror and open your mouth wide in a well-lit room (alternatively use a flashlight). When you look into the back of your throat, you can see a fleshy, finger-like structure above the back of your tongue (this is the uvula). Keep your eye on it and start breathing through your nose. You will probably notice that the tongue rises up and obscures the uvula, sealing off your mouth from the breath. Do not let this happen. Practice breathing through the mouth and nose while keeping an eye on your uvula. It will feel unnatural at first, but keep at it. Obstructing the channel between the mouth and trachea during nose breathing involves bracing the tongue against the uvula, this is unnecessary and neurotic. Try maintaining this relaxed tongue posture, breathing through the nose even when the mouth is closed. Whenever you breathe through the nose, whether the mouth is open or closed, the tongue and pharynx should be completely relaxed in this way.
Not only do most people obstruct mouth breathing when they breathe through the nose, but they also obstruct nose breathing when they breathe through the mouth. When you breathe through the mouth, do you constrict your nasopharynx? The nasopharynx is an opening in the back of the throat, just behind the uvula, where the nasal passage meets the soft palate. Most people constrict the nasopharyngeal sphincter when mouth breathing causing it to hold considerable amounts of tension. In fact, my nasopharyngeal sphincter was highly tense and painful. Contraction of the nasopharynx is a natural reflex that occurs during swallowing to prevent food or liquid from going up into the nose, but it is never necessary during breathing. I believe that habitually closing off either the nose or the mouth during breathing is a form of trauma. When I breathe in through both nose and mouth, I can feel muscles throughout my pharynx, and throat relax. This in turn, dissipates facial tension. I think that the main reason why people do not do this habitually is that they think that they look intimidatingly reposed while doing it. Your face goes dead and you look “too calm.” I believe though that pairing it with diaphragmatic breathing over a few weeks will make it look natural. As discussed above, exclusive nasal breathing (with the tongue not touching the uvula) is preferable, but if you are going to breathe through your mouth, breathe through the nose as well.
A. Nasal breathing, oral pathway obstructed; B. Mouth breathing, nasal pathway obstructed; C. Nasal and mouth breathing, no obstruction; D. Nasal breathing with mouth closed, yet oral pathway is unobstructed.
Intraoral Myofacial Release for the Nasopharynx
You have a large muscular knot behind your face that comes from constricting the nasopharynx during mouth breathing. This knot becomes tighter every time you feel stressed. It contributes to wincing and grimacing and it gets worse every day because it is never massaged or even touched. Here, I am advocating that you perform compression and self-massage specifically for your nasopharynx. It is very uncomfortable at first, but it gets easier every time, and it only takes a few weeks to completely get rid of the pain.
Provide compression to your nasopharynx by donning a plastic glove, putting your thumb into your mouth and up into your nasopharyngeal opening. This opening is where your nasal passage connects with your throat. To do this, insert the thumb into the mouth, as if you were sucking on your thumb. To find the opening you must feel around the roof of your mouth, traveling away from the teeth and towards the area where the hard roof of the mouth (hard palate) turns soft (soft palate). An inch behind (posterior) to this border is the uvula, the fleshy hanging structure. Just behind the uvula is the opening of the nasopharynx. The nasopharynx is an invagination that you want to explore and massage using either your left or right thumb. If you have never done this before, the opening will feel tight and painful, and pressing against it will initiate a gag reflex. The best way to bypass the gagging is to breathe diaphragmatically, preferably to a breath metronome. Within the first week, you will notice that it is less painful to probe, that your face feels calmer all the time, that mucus clearance is easier, and that your face looks at ease.
It is essential to employ paced breathing and focus concertedly on remaining calm before, during, and after this exercise. Influencing how your brain interprets intense forms of stimulation is incredibly decisive in how your body copes with them. I also recommend doing this while relaxing at home, before sleep. While you have the rubber glove on I recommend that you use the thumb to press into the muscular areas of the soft palate and use the thumb and forefinger to squeeze and compress the tongue to reduce the tension in these areas as well.
A. Nasal cavity and nasopharynx; B. Man inserting thumb into nasopharynx; C. Man squeezing tongue.
Pair Diaphragmatic Breathing with Anything and Everything
I believe that diaphragmatic breathing enhances the benefits of many forms of traditional and alternative therapy. This may include:
Medical and Mainstream Therapies: Yoga, psychotherapy, relaxation techniques, muscle and joint rehabilitation, mindfulness-based stress reduction, chiropractic, acupuncture, osteopathy, cognitive behavioral therapy, medical massage, neurotherapy, biofeedback, positive affirmation.
Exercise and Movement Based Therapies:
Gymnastics, pilates, Tai Chi, Qigong, Martial Arts, acroyoga, dance, the Gyrotonic method, Gyrokinesis, the Franklin Method, the Alexander Technique, Feldenkrais, Nia, chiwalking, ballistic stretching, proprioceptive neuromuscular facilitation, Laban Movement Analysis, somatics.
Complementary and Alternative Therapies: Meditation, prayer, electronic pulse massage, abdominal or visceral massage, kneading, petrissage, craniofacial manipulation, Gua sha and Mei Zen accupuncture, muscle stripping, active release technique, eye movement desensitization and reprocessing, reiki, autogenic training, hypnosis.
After you perform the breathing exercises from this chapter and from Chapter 3 for six weeks you will notice that many of the people that you know breathe 2 to 3 breaths for every breath that you take. Relative to the new you, everyone else will be hyperventilating.
Chapter 11: Bullet Points
- Distressed breathing causes hyperventilation, which is strongly associated with anxiety and has many negative symptoms.
- Taking exaggeratedly slow breaths will reduce distressed breathing and hyperventilation.
- Because nose breathing forces you to breathe more slowly it will strengthen the diaphragm and greatly reduce distressed breathing.
- Stretching the diaphragm, and contracting it isometrically, will make it stronger and increase its range of motion.
- Whenever you breathe through the mouth, breathe through the nose as well.
- Providing compression to the nasopharynx, soft palate, and tongue will remove trauma in these areas.