Who would have thought that making such a small change to your breathing could have such a massive impact on your health? The list of benefits is endless—from increased cardiovascular fitness, lower blood pressure and improved heart rate variability to the filtration of viruses, better sleep quality and reduced stress. In addition, breathing through the nose can clear the mind, improve dental health, and decrease asthma symptoms. It could even improve your erections. If you want to understand how all this is possible, simply take a look at this month’s blog.
For me, the summer break is a time to unwind. I spend the time in my garden, listening to podcasts and music. I read books, socialise with friends, and if I’m lucky, I lie in the sun. The rest gives me time to think and reflect.
This summer, I found myself listening to a health-based podcast series by Dr Rangan Chatterjee called Feel Better, Live More. A couple of episodes on breath caught my attention, and led me to the two books which formed the main reference for this article.
Before this summer, I would have told you that I was quite knowledgeable on this subject—after all, breath is one of the key principles of Pilates. How wrong I was! Whilst I certainly understood the mechanics of breathing and why we use lateral breath when learning Pilates, I had no idea of the importance of nasal breathing, nor why we should keep each breath small and slow.
In a future article, I may discuss the issue of breath size and rate, but on this occasion, I’ll focus on nasal breathing and why it is so much healthier than breathing through your mouth.
Open the Airways
If I asked you to do an impression of a gormless person, what would you do? I would stand with rounded shoulders, my head thrust forward, and my mouth open wide. Mouth breathing is commonly associated with a lack of intelligence, yet up to 50 per cent of people mouth breathe at some point of the day or night—they can’t all be idiots.
Mouth breathing is a common cause of snoring, and a condition called sleep apnoea, where the afflicted person stops breathing for long periods through the night. Sleep apnoea not only causes disturbed sleep but leads to serious health problems, including high blood pressure and heart disease. Mouth breathing causes these conditions because it decreases the pressure on the tissues at the back of the throat, which collapse and close as they become loose. This creates less space for air.
Nasal breathing, on the other hand, forces the air against the tissues at the back of the throat, making the airway wider. In addition, nasal tissue has an exciting attribute—its erectile, just like the genitals. As air flows through it, it engorges with blood and stiffens, which ensures it stays open.
Better Oxygen Uptake
In The Oxygen Advantage, author Patrick McKeown explains that nose breathing can increase the amount of oxygen that enters the bloodstream with each breath by as much as 20 per cent (1). This is due, in part, to the resistance to airflow which comes from exhaling through our nose, keeping the air in our lungs a little longer.
Oxygen uptake is further increased by a chemical called nitric oxide, which is produced in the nasal cavity, paranasal sinuses, and the lining of all the blood vessels throughout the body.
Until the 1980s, scientists thought nitric oxide was toxic, but in 1992 the journal Science proclaimed it ‘molecule of the year’. They went on to described it as ‘a startlingly simple molecule that unites neuroscience, physiology and immunology, and revises scientists’ understanding of how cells communicate and defend themselves.’ (2)
Some of you may have heard of this little molecule before—it is the chemical that led to the development of Viagra. In fact, in a study investigating the relationship between nasal polyps (which block the nose causing mouth breathing), and erectile dysfunction, scientists discovered a correlation between these conditions. Furthermore, they found that those men who had their polyps removed to allow nasal breathing were more likely to regain their erections too (3).
As we breathe in through our nose, nitric oxide is picked up and carried to our lungs, opening the airways, and dilating the blood vessels, allowing more oxygen into the blood. Not only does this increase our oxygen uptake, but it also prevents high blood pressure, lowers cholesterol, and keeps our blood vessels young and flexible, preventing clots. So why would anyone breathe through the mouth and miss out on all those benefits?
Impurities, Germs and Bacteria
The nasal passages consist of six maze-like bones, called turbinates. They look like conch shells and are covered in a mucus membrane that warms the breath and filters particles. In addition, tiny little hairs called cilia line the nasal cavity. The mucus that covers the turbinates traps impurities, and then the cilia move this impure mucus through the nostrils, down the throat and into the stomach, where it is destroyed by acid.
This ciliary movement also increases the production of nitric oxide by the nasal cavity. Nitric oxide has antiviral and antimicrobial properties and acts as a first-line defence against micro-organisms. In a 2020 article, Could nasal nitric oxide help mitigate the severity of COVID-19?, the authors argue that nasal breathing may reduce the viral load and symptoms of those who contract the disease (4). I find this fascinating, especially when it comes to mask-wearing. I have noticed that I’m inclined to mouth breathe in my mask. As a result, my mouth gets dry, and my throat can feel sore by the end of the day. Am I simply swapping a natural form of defence for an artificial one? It has taken a bit of effort, but I now ensure I close my mouth and let nitric oxide perform its magic.
The part of our nervous system that deals with automatic bodily functions, such as blood pressure, heart rate, sweating, and pupil dilation, is called the autonomic nervous system (ANS). The ANS has two parts: the parasympathetic nervous system (PNS) manages all the relaxing components, including digestion, tissue repair, and sexual desire; while the sympathetic nervous system (SNS) is in charge of our stress system—it is the SNS which primes us if we need to run from danger, for example.
When we inhale through our mouth, we activate our upper chest respiratory muscles, which leads to short breaths into the upper chest. The nerves that feed the upper chest are part of the SNS system, so this type of breathing will activate certain stress responses, increasing adrenalin production, blood pressure, and heart rate.
Whereas nasal breathing is synonymous with relaxation. It activates the diaphragm, which draws the breath deep into our lungs, expanding the belly. The nerves in the lower lungs are more associated with the PNS, so this type of breathing switches on the automatic parts of our nervous system that help us relax.
Take a moment to feel how the two different methods work for you. Sit upright and place one hand on your belly and the other on your chest. First, take a breath in through your mouth. I imagine that you will feel your chest lift as you inhale. Continue this for a minute or two and notice how you feel. Now close your mouth and breathe in slowly through your nose. I hope that your chest will stay still, and instead, you feel an expansion into your belly. Your diaphragm is a dome-shaped muscle that divides your lungs in your chest from your liver and other abdominal contents. As you inhale it will pull down to drag the air into the lungs. As it pulls down it draws the liver, stomach, and intestines into the abdomen. You will feel this as pressure unless you allow your tummy to expand. Keep breathing slowly through your nose for a few minutes and notice if you start to feel relaxed.
Clear your Head
In his best-selling book, Breath: The New Science of a Lost Art, author James Nestor puts himself through ten days of enforced mouth breathing by placing silicone in his nostrils. ‘We had no idea it was going to be that bad,’ said Nestor. ‘The snoring and sleep apnoea was so dramatic, and came on so quickly, that everyone was pretty floored.’ In just a few days, Nestor’s blood pressure rose thirteen points, his heart rate variability showed he was suffering from stress, and he stumbled around in a state of mental fog.
Breathing expert Patrick Mckeown writes: ‘It is well documented that habitual mouth breathing during waking and sleeping hours results in fatigue, poor concentration, reduced productivity and a bad mood.’ What I found of particular interest was his comment that people who talk for a living, such as teachers or salespeople, are likely to feel more tired than most. This is not because of increased activity but rather the increased mouth breathing associated with excessive talking. This fits with my own experience—when I teach classes and speak continually, I feel frazzled by the end of the day.
Mouth Acidity and Gum Disease
Mouth breathers often wake up in the night with a dry mouth and feeling thirsty. This is because we lose up to 40 per cent extra water when we exhale through our mouth (5). You can test this out yourself by exhaling onto a mirror with your mouth open and closed. You’ll find more condensation on the mirror when you breathe through your mouth.
Saliva—which keeps the mouth moist—plays a crucial role in the health of our mouth. It helps clear away food and bacteria and provides essential nutrients to the teeth and gums for good oral health. However, when we breathe through our mouth, it becomes dry of saliva and creates an ideal breeding ground for bacteria, leading to cavities, gum disease and bad breath.
Asthma and other Breathing Problems
Asthma is a common but very serious condition in which the airways narrow and swell, making breathing difficult. Mckeown states that asthma is an inflammatory condition of the entire airway track, from nose to lungs, and that people who have inflamed airways are more likely to have a blocked nose and therefore mouth breathe (6). He is adamant that people with breathing problems should be encouraged to nasal breathe, as it warms, moistens and filters the air and brings nitric oxide into the lungs—all of which open the airways. There are currently 19 clinical trials that show significant improvements in asthma through nasal breathing (7), and one showing a fifty per cent reduction in corticosteroid use in three to six months. Mckeown advises asthma patients with nasal congestion to practice regular nasal decongestion exercises (8).
There are many additional benefits associated with nasal breathing; I could have mentioned improved lymph drainage, quicker muscle recovery after exercise, or long-term improvements to cardiovascular fitness, all of which are further reasons to breathe through our nose rather than our mouth.
Mouth breathing at night is so detrimental to health that breathing experts Nestor and McKeown both advise mouth breathers to gently tape their mouth with surgical tape when they go to bed to encourage nasal breathing (1,5). In addition, McKeown’s book is full of exercise to help decongest the nose and exercise without panting like a dog.
Joseph Pilates wrote, ‘Breathing is the first act of life and the last. Our very life depends on it. Since we cannot live without breathing, it is tragically deplorable to contemplate the millions and millions who have never mastered the art of correct breathing.’ After reading these books, I must say that I would tend to agree with him.
(1) Mckeown, P. (2016). The Oxygen Advantage: Simple, Scientifically Proven Breathing Techniques to Help You Become Healthier, Slimmer, Faster, and Fitter
(3) Gunhan K, Zeren F, Uz U, Gumus B, Unlu H. Impact of nasal polyposis on erectile dysfunction. Am J Rhinol Allergy. 2011 Mar-Apr;25(2):112-5. doi: 10.2500/ajra.2011.25.3585. PMID: 21679515.
(4) Martel J, Ko YF, Young JD, Ojcius DM. Could nasal nitric oxide help to mitigate the severity of COVID-19?. Microbes Infect. 2020;22(4-5):168-171. doi:10.1016/j.micinf.2020.05.002
(5) Nestor, J. (2020). Breath: The new science of a lost art.
(6) Svensson S, Olin AC, Hellgren J. Increased net water loss by oral compared to nasal expiration in healthy subjects. Rhinology. 2006 Mar;44(1):74-7. PMID: 16550955.