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Nasal Breathing 101: What Is Disordered Breathing?

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How Do You Breathe?

On the face of it, it sounds like a ridiculous question.  But the truth of the matter is most folks aren’t doing the best they can, and the numbers are getting worse.  Sleep apnea cases are on the rise, about 1 in 12 Americans suffer with asthma, and over 100 million Americans (that’s one in every three people) suffer with some form of allergies.  These are astronomical figures.

Poor breathing patterns can change the shape of your face, reduce tissue oxygenation throughout the body, make sleep less restorative, increase stress, lowers CO2 levels, and slows down metabolism.

In one form or another, poor breathing mechnics are a contributing factor to every modern ailment we see today.  

A lack of oxygen to the brain means it will not be able to function at full capacity.  Consider the fact that your 3lb brain uses up 25% of the oxygen and 80-90% of glucose stores found in the body.

Better blood supply to the brain means a better functioning brain.  If the brain doesn’t have the oxygen and nutrients it needs, then you’re not functioning to your fullest potential.

About the Methods I Use

Dr. Konstantin Buteyko received his medical training at the First Medical Institute of Moscow.  During his medical studies, he started a project focusing on observing patients’ breathing rates and their correlation with the seriousness and forecast of their ailments. 

Early on, he found a connection between his patients’ outcomes and their breathing patterns.  As a patient’s condition worsened, their breathing rate escalated.  Buteyko claimed to have found a pattern where breathing deepened as death neared, enabling him to anticipate the imminent demise of a patient based on the depth of their breaths, sometimes even down to the day or hour.

His method, known as the Buteyko Method, started formally being studied in the late 1950s.  The Buteyko method emphasizes the importance of nasal breathing.  Put simply, nasal breathing protects the airways by humidifying, warming, and cleaning the air entering the lungs.  For example, many individuals with asthma have problems sleeping at night, which may be attributed to poor posture and mouth breathing.  

Buteyko noticed that by keeping the nose clear and encouraging nasal breathing during the day, night-time symptoms can improve. Strictly nasal breathing during physical exercise is another key element of the Buteyko method, but it is something that should be eased into depending on one’s physical fitness level.

The Buteyko Methods are exercises focused on breath control: consciously moderating either breathing frequency or volume.  In many ways, it is like learning how to ride a bike.  With practice, the techniques become more intuitive, and the exercises may be phased out as the condition improves.

There is a quantifiable progression marker known as the Control Pause (CP), which measures the amount of time between breaths that an individual can comfortably hold his/her breath.  Symptoms tend to decrease as the CP increases.  

There is also an emphasis on relaxation, which is something that goes against many popular present-day breathwork practices.  

By the early 1980s, the Russian authorities, impressed by Buteyko’s achievements, granted him an official trial, termed as “approbation,” involving asthmatic children in a Moscow hospital. 

Even though the experimental design differed significantly from the standard controlled trials prevalent in the West, the outcomes were compelling enough to convince the State Medical System to endorse the method for widespread use.  His methods are the ones I and many other practitioners use today to retrain healthy breathing patterns with folks of all ages, ranging from children to the elderly.

Using the Buteyko Method

Other researchers have put this method to the test as well.  In this study, the authors brought in subjects from the community and tracked them for twelve weeks (January to April in 1995).  The ages of the participants ranged from 12 to 70 years old.  To participate, they must have reported a history of asthma and were actively taking medications for it.  After recruiting 39 participants, they were broken up into a control group and Buteyko Breathing Technique (BBT) group.

After 12 weeks of BBT, the experimental group had

Lung function was also measured initially and at three months.  There was no significant difference in minute volume prior to the trial:

However, after three months there were significant changes.  The authors found that the BBT group was much more efficient with their air intake compared to the control group:

In other words, those in the BBT group were able to extract more oxygen from less air compared to the control group.  Also, the participants who used the BBT method reduced hyperventilation and their use of B2 ­agonists. The authors noticed a trend toward reduced inhaled steroid use and better quality of life.  These are wins all around!

I say this so that you realize the methods are no joke and back by actual trials.  I also understand that these methods fly in the face of many popular breathwork techniques you will find on the internet today.  I will address why later.

For now, let’s define what disordered breathing is and how Modern Humans can start taking control of their health for free. 

What is Dysfunctional Breathing?

The term ‘Dysfunctional Breathing’ doesn’t have a precise definition, but it generally includes…

Some of the traits associated with dysfunctional breathing include:

Spotting Mouth-Breathing

Generally, those who tend to mouth-breathe have…

Contrast this to those who are nasal breathers:

If you notice any of the signs of mouth-breathing, the key is to start practicing the opposite:

Measuring Your Breathing

You can measure how optimal your breathing patterns are by utilizing a measurement known as the Control Pause (CP):

  1. Take a normal breath in & out through the nose
  2. Pinch your nose shut and hold your breath
  3. Time the number of seconds it takes until you feel the first definitive urge to breathe OR you experience an involuntary movement of your breathing muscles.

An optimal CP is > 40 seconds.  Those with a CP < 20 seconds may be struggling with chronic health concerns.  

Where are you right now?  No judgment, just something to keep in mind going forward.  This is the primary quantifiable marker you can use to track your progress.

What Causes Dysfunctional Breathing?

There are many traits associated with dysfunctional breathing.  There usually isn’t one ‘true’ cause, rather a constellation of lifestyle factors that all play a role:

If you have a CP <20 seconds, you likely experience at least one of the following:

The Physiology of Breathing

Definitions

Hypercapnia

Hypocapnia

Hypoxia

Breathing Volume

The normal breathing volume for adults at rest is between 4-6 liters of air per minute.  This is greatly increased in cases of asthma (13-15 [±3] L/min) and sleep apnea (15 [±3] L/min).  In other words, these folks need more air to get the same amount of oxygen.  They are less efficient with the air they breathe.

In order to understand the numbers, we need to a basic understanding of atmospheric pressure.  An atmosphere (atm) is a unit of measurement equal to the average air pressure at sea level at a temperature of 15°C (or 59°F).

Atmospheric pressure is measured at 760 mmHg.  21% of the atmosphere is oxygen.  We can calculate the value 760 mm Hg x .21 = 160 mmHg PO2 in the atmosphere on Earth.  This mixes with “old air” in alveoli and ends up around 105mmHg with each inhalation.  

Contrast this with CO2, which makes up about 0.04% of the atmosphere.  Atmospheric CO2 mixes with high CO2 levels from residual volume in the alveoli to arrive at PCO2 of 40 mm Hg.

Tidal volume is the volume of air during quiet breathing. Respiratory Rate (Ventilation Rate) is the number of breath cycles per minute. Minute volume is the amount of air that enters the lungs over sixty seconds.  You get the minute volume by multiplying these two numbers:

Dead space refers to a percentage of air that enters the respiratory system and does not reach the alveoli.  In one breath, the last 150mL of air remains in the dead space of the lungs.  

Understanding these numbers will give you a better understanding as to why breathing more slowly is important.  Decreasing the respiratory rate and increasing tidal volume has been shown to improve ventilation efficiency.

Example:

If minute ventilation is adequate, breathing can be lighter when through the nose slowly and diaphragmatically!

Designed by Nature

Why does this matter?  The lungs are the primary player in the gaseous exchange of O2 and CO2 in the body.  Without healthy lungs, we wouldn’t survive as human beings.  The lungs are the interface that connects us with Nature and the plant world.  They link photosynthesis with cellular respiration.

This is also where it might get confusing for some people.  Technically, there are two types of respiration: cellular and external.  The confusion comes about because they are both intimately connected.

Cellular Respiration 

External Respiration 

Knowing that, it shouldn’t surprise you that the lungs have an incredibly important job.  

Imagine the size of a tennis court (75m²) of a thin plastic sheet stuffed into a 3L bottle.  That is the amount of surface area of the lungs.  This is what must interface with atmospheric air.  

As you might imagine, the lungs have many functions, including:

I think we often take it for granted that trees and plant life use light to create the oxygen we breathe.  I also find it incredibly interesting that the structure of the lungs resembles tree branches inside of us.  It is one of those genius design choices from Mother Nature we take for granted.

The lung “branches” are broken up into two zones: the conducting zone and the respiratory zone.  The conducting zone consists of larger airways that lead from the atmosphere to the exchange surface of the lungs.  The respiratory zone is made up of smaller branches, where the O2-CO2 exchange occurs.  This exchange occurs in alveoli, which are grapelike clusters at the ends of the terminal bronchioles. The thin walls of the alveoli do not contain muscle because muscle fibers would block rapid gas exchange. Gas exchange occurs by diffusion through the thin walls.

On the other side of the alveoli, deoxygenated blood is pumped through the right side of the heart and pulmonary artery.  Once the deoxygenated blood reaches the alveoli, there is an exchange of CO2, O2, nutrients, and waste products.  

One microliter of blood contains 4.7 to 6.1 million (male adult) red blood cells (RBC).  RBCs are made in the bone marrow and have a lifespan of about 120 days.

Oxygen molecules that enter the bloodstream bind to hemoglobin, a protein found in red blood cells. Hemoglobin is the primary oxygen carrier in the blood.  Each hemoglobin molecule can bind to four oxygen molecules, allowing for efficient transport of oxygen throughout the body.

Hemoglobin is a porphyrin.  Porphyrins are a group of organic compounds that play a crucial role in various biological processes. They are characterized by a large, cyclic structure composed of four modified pyrrole rings linked together. The core structure is known as a porphine.

One of the most well-known porphyrins is heme, which is an essential component of hemoglobin. Heme contains an iron ion at its center and gives blood its red color.  In chlorophyll, the iron is swapped for a magnesium atom, and therefore changes the color and function.

From here oxygenated blood enters the heart and exits again into the circulation via the left ventricle and the arterial system.  As blood flows through the arteries, oxygen is delivered to cells.

Inside the mitochondria of these cells, oxygen is used in the process of cellular respiration to break down glucose and other nutrients, creating water and generating ATP.

During this process, CO2 is produced and eventually must be expelled.  It is transported back to the lungs through the venous system, dissolved in plasma or bound to hemoglobin, to be released from the body during exhalation.  

Again, this is ultimately how cellular respiration and photosynthesis are intimately linked.

What is the Primary Stimulus to Breathe?

An increase in your carbon dioxide levels is the body’s primary stimulus to breathe.  It is NOT oxygen. 

The regulation of breathing is determined by receptors in the brain.  They monitor the concentration of CO2 along with the pH level & oxygen levels (to a lesser extent).  There is a large reserve of O2 in the bloodstream.  For context, O2 levels must drop from 100mmHg to about 50mmHg before the brain stimulates breathing.

The breathing stimulus primarily resides in the brainstem.  The brainstem is the most primitive part of the brain.  It begins at the base of the skull and extends upwards 6-8 cm.  The inspiratory center sends impulses down the spinal cord and through the phrenic nerve which innervates the diaphragm, intercostal nerves and external intercostal muscles- initiating inspiration.  At some point the inspiratory center decreases firing, and the expiratory center begins firing.

Normally PCO2 is around 40mmHg.  An increase of PCO2 above this level stimulates the medullary inspiratory center neurons to increase their rate of firing. This increases breathing to remove more CO2 from the blood through the lungs.

On the other hand, decreased PCO2 (below 40mmHg) causes the respiratory center neurons to reduce their rate of firing to below normal.  This leads to a drop in rate and depth of breathing until decreased PCO2 rises to normal.

However, breathing more than what the body requires over a 24-hour period conditions the body to increased breathing volume.

The pH:CO2 Link

Normal pH is 7.365 which must remain within tightly defined parameters (this blog has more details).  If pH is too acidic and drops below 6.8, or too alkaline rising above 7.8, death can result.  Carbon dioxide forms bicarbonate through the following reaction:

CO2 + H2O <—>H2CO3 <—> H+ + HCO3−

CO2 dissociates into H+ and HCO3– constituting a major alkaline buffer which resists changes in acidity.

If you offload CO2, you are left with an excess of bicarbonate ion and a deficiency of hydrogen ion.  In other words, you are left with a more BASIC environment.

During short term hyperventilation, breathing volume subsequently decreases to allow accumulation of carbon dioxide and normalization of pH.  Over time, the pH will return to healthy levels.

If over-breathing continues for hours/days, bicarbonate excess is compensated by renal (kidney) excretion.

Hypocapnia (low CO2) and pH shift are almost immediate, but adjustment of bicarbonate takes time, on the order of hours-to-days.  

In this case, the chronic hyperventilator’s pH regulation is finely balanced (although not ideal for good health).  Low acid (the consequence of hyperventilation) is balanced against the low level of blood bicarbonate maintained by renal (kidney) excretion.  This can be an adequate response short-term, but long-term can impact mineral and electrolyte balance in the body negatively.

In this altered equilibrium, small amounts of over breathing induced by emotion can cause large falls of carbon dioxide and, consequently, more severe symptoms.

The Oxygen Dissociation Curve

The oxygen dissociation curve represents the relationship between the partial pressure of oxygen (pO2) in the blood and the saturation of hemoglobin with oxygen (SaO2). This curve illustrates how readily hemoglobin binds to and releases oxygen molecules under varying levels of oxygen tension in the blood.

The curve is well known for its sigmoid shape, as a small decrease in pO2 results in a significant drop in oxygen saturation, facilitating the release of oxygen to the tissues.

Various factors can affect the position and shape of the oxygen dissociation curve, including pH, temperature, and the presence of substances like CO2.  For example, a decrease in pH (a more acidic environment) or an increase in temperature shifts the curve to the right, promoting the release of oxygen to tissues, whereas an increase in pH (alkalosis) or a decrease in temperature shifts the curve to the left, enhancing oxygen binding.

Understanding the oxygen dissociation curve is crucial for understanding blood pH, respiratory, and cardiovascular health.  Shifts in the curve can affect oxygen delivery to tissues and influence treatment for those in low-oxygen environments, poor breathing mechanics, acidosis, and certain types of anemia.

For example, over-breathing reduces the delivery of oxygen to tissues and organs.  Exercising muscle are hot and generate CO2.  They benefits from increased unloading of O2 from its capillaries.

The Power of Nitric Oxide (NO)

Nitric oxide (NO) is released in the nasal airways in humans. Human sinuses have been measured to produce10 parts per million (ppm) of NO.  During inspiration through the nose this NO will follow the airstream to the lower airways and the lungs.

NO plays an important role in…

Compared with oral breathing, inhalation of NO (via nasal breathing) caused an overall significant blood flow shift from the base of the lung toward the apex.  This results in more homogenous blood flow distribution along the height of the lung.

NO is scavenged by hemoglobin when diffusing into the blood and is thereby rapidly inactivated.  This is while inhaled NO primarily affects vasodilation of the lung only.

As far as supporting the immune system, NO has been shown to:

In humans, higher basal levels of exhaled NO are associated with fewer symptoms of the common cold.  This suggests that nasally-produced NO represents one of the body’s endogenous defense mechanisms against viruses in the airways.  Conditions associated with reduced nasal NO production are associated with recurrent respiratory infections and inflammation.

Filtration and humidifying effects of the nose on inhaled air and increased NO levels in the airways.  This allows the immune system more time to mount an effective response.

Why Nasal Breathing?

To put it simply, nasal breathing increases circulating blood O2 and CO2 levels, slows the breathing rate and improves overall lung volume.  Many lower respiratory tract diseases like asthma and COPD are associated with both breathing pattern disorders as well as significant upper respiratory ailments.

Turns out that alternating between patent (open) and congested passages in the two nasal cavities for periods of 1 to 7 hours affects breathing patterns. Breathing predominantly through the right nostril leads to heightened left-brain activity and improved verbal performance, while favoring the left nostril increases right brain activity and enhances spatial performance.

Airway resistance is incredibly important as well.  The nose offers twice the resistance to breathing compared to the mouth (Swift et al., 1988). This elevated resistance leads to an increase in total lung volume. In a study examining arterial oxygen pressure (PaO2) levels, patients who were required to breathe through their nose experienced a nearly 10% increase.  Additionally, nasal breathing is associated with higher levels of end-tidal CO2 (ETCO2), possibly due to increased dead space.

During exercise, nasal breathing leads to a decrease in FEO2 (fraction of expired oxygen), suggesting an enhanced extraction of oxygen from the air during exhalation, and an increase in FECO2 (fraction of expired carbon dioxide), indicating a rise in the proportion of exhaled air containing carbon dioxide (Morton et al., 1995). This equates to efficient oxygen extraction and carbon dioxide elimination.  There have been newer studies that have verified these initial findings as well.  

NO from the back of your nose and your sinuses into your lungs. This short-lived gas dilates the air passages in your lungs and blood vessels.  NO is continuously released into the nasal airways through nasal breathing.  While we know this happens, the mechanism as to how this occurs is still unknown.

The concentration of NO depends on the flow rate of air.  This means that nasal NO concentrations are HIGHER at LOWER flow rates.  Of course, if you are mouth breathing, you will get none of these benefits.

Mouth breathing causes lower diaphragmatic amplitude when compared to nasal breathing.  Mouth breathing negatively affects the respiratory biomechanics and exercise capacity of people.  Moderate forward head position may be a compensatory mechanism to improve respiratory muscle function.  The nose provides more resistance upon inspiration.  This creates more room for the diaphragm to contract more fully and maintain muscle strength.

How Should Humans Breathe?

Breathing is light, quiet, effortless, soft, through the nose, diaphragmatic, rhythmic, and gently paused on the exhale.  This is how human beings breathed until the comforts of modern life changed everything.

Generally, there are three levels to healthy breathing:

  1. Breathing SOFTLY enough that a person next to you cannot hear you
  2. Breathing softly enough so that YOU don’t hear your own breath
  3. Breathing softly enough so that you don’t FEEL your own breath

There are five basics you should follow for breathing:

  1. Breathe Through Your Nose

Nasal breathing humidifies, warms, and cleans incoming air.  Between 95-99% of pollutants will get trapped in the nasal cavity.  Mouth breathing is not as efficient for cleaning and warming air.  

  1. Breathe Light

The heavier one breathes, the more rapidly CO2 is depleted in the system.  You’ll also activate the sympathetic nervous system and enter the fight-or-flight response.  This is why relying on heavy breathing methods (like Wim Hof) are not a good idea in the long-term.  Your breathing should be virtually unnoticeable.  

  1. Breathe Diaphragmatically

Stimulation of the diaphragm is more easily triggered with nasal breathing.  This allows the lungs to fill up with more air easily and be more efficient with each incoming breath.  Deep breaths should be questioned and utilize the diaphragm.  They should not be short and held up in the chest.

  1. Breathe Slow

Frequent or rapid breathing ultimately depletes the body of CO2 and oxygen over time.  This is the opposite of what it should be.  Ideally, one should go through 6-8 breath cycles per minute.  That is one full breath cycle every 8-10 seconds.  

  1. Breathe While Being Cognisant of Your Posture

To get the most out of the air you breathe in, you have to be aware of how you carry yourself, literally.  Slouching, rounder shoulders, and a collapsed abdomen all negatively impact the ability of your diaphragm to fully contract, meaning you’ll never get the most out of the air you breathe in.  

Breathing is “so smooth that the fine hairs within the nostrils remain motionless.”– Blofeld J. (1978). Taoism: the road to immortality. Boulder, Shambala.

But What About My Other Breathwork Techniques?

Many breathwork techniques touted by yoga and Wim Hof ultimately end up causing more issues than they are worth.  

But they do have a place.  You can use them to quiet our mind or help release unwanted/trapped emotions.

However, most Modern Humans already have poor breathing pattern mechanics, and these techniques do not help this situation.  Many of the “powerful” techniques end up releasing even more CO2 in a system that needs more to begin with.  

Learning the fundamentals of breathing is infinitely more important than these trendy techniques. 

What Can You Do?

Start relearning how to breathe!  We all have to do it!

Massive improvements can be made in as little as twelve weeks when incorporating breath holds and the methods used in the Breathe Easy Masterclass.

This is the same method used by thousands, from elite athletes looking to gain the extra edge, to children who struggle with sleep apnea.  

If you have low energy, struggle with sleep apnea, snore, or just simply want the competitive edge over the competition, this course is for you.  

Check it out using this link!  

There will be more on this topic coming next week as well.

Until then!

I wish you the best of health!

Dr. Vincent Esposito

Want More?

Whenever you’re ready, there are two ways I can help you:

  1. Massive improvements can be made in as little as twelve weeks when incorporating breath holds and the methods used in the Breathe Easy Masterclass.  This is the same method used by thousands, from elite athletes looking to gain the extra edge, to children who struggle with sleep apnea.  If you have low energy, struggle with sleep apnea, snore, or just simply want the competitive edge over the competition, this course is for you.  

2. I take a comprehensive, individualized, one-on-one approach with every single person I work with.  Perhaps you have tried so many different routes to better yourself, but not see the progress you desire.   If you want clear action steps and a guide to help you lay the foundation for healing and feel confident in your body, this is for you.  If you want a partner who is committed to helping you master your own wellness, then schedule a FREE 15-minute call with my team to apply to get your health on the right track.

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