Welcome to Pushing The Limits, the show that helps you reach your full potential with your host Lisa Tamati, brought to you by lisatamati.com.
Lisa Tamati: You're listening to Pushing The Limits with your host, Lisa Tamati. Fantastic to have you guys back again. I hope you're ready for an epic interview. I have New York Times bestselling author, Patrick McKeown. Professor Patrick McKeown is our guest. He is a legend in the field of breathing. He was educated at Trinity College, but he completed his clinical training in Russia and was accredited a breathing coach, a renowned physician, Dr Konstantin Buteyko. Buteyko is a type of breathing methodology if you like. He has trained elite military Special Forces, SWAT teams, Olympic coaches, athletes. And he's advisor to the extreme performance Training Center XPT, by big wave surfer, Laird Hamilton—many of you will know who that crazy man is—and has taught more than 700 breathing instructors across 45 countries, and he has actually courses on this. He has written a number of books. The one that really changed my life and my outlook on breathing and what it's all about and how it impacts so many different areas of our health in our life was The Oxygen Advantage. So I really highly recommend getting that book.
We also had on the podcast just a couple of weeks back, James Nestor, who is also another New York Times bestselling author of a book called Breathe. And again, both of these guys come to many of the same conclusions, slightly different aspects and angles that they come from, but this stuff is really really mind-blowing for foundational health.
We're always talking about nutrition and exercise, but we often forget about breathing and sleep. And these two are as fundamental as our food and our exercise. If you don't get your sleep and your breathing patterns right and often those two are combined because you won't be breathing right at night if your mouth breathing, then doesn't matter what food you put in, doesn't matter what type of exercise you do, you won't be getting the best out of your body. And we're all about optimising performance and health on the show and being preventative. So I'm really, really excited. It's a great long interview with Patrick who was sitting in Ireland.
But before we go over to Patrick, just a reminder, if you haven't read my book, yet, my latest one, Relentless: How a Mother and Daughter Defied the Odds, why the heck not? It's an epic read, if I do say so myself. But this book was two and a half years—took me to write the book. It is a real mindset book about overcoming the odds and coming back from the brink of death and defying what the medical fraternity symbols and impossibility to do. And we've done it. And it outlines the mindset that's required, the therapies that I undertook. It's just packed full of information that will help you in your life, whether you're just trying to overcome some sort of obstacle or challenge in your life, or whether you're really wanting a bit of a roadmap for a brain injury. Or if you're just wanting to know about some of the latest biohacking in the information out there, then make sure you grab that book, you can get that at lisatamati.com. Or if you're in New Zealand, you can get it in bookshops. It's also available on Amazon and on Audible. And just all of those big digital platforms right around the world. It's called Relentless, don't forget that name—Relentless and How a Mother and Daughter Defied the Odds.
If you're wanting to work with me at some stage, if you need run coaching, we have Running Hot Coaching, which is our online run training system. We do personalised, customised training programmes made specific to you and your goals. No matter what level you're at, whether you're running your very first 5k or you're doing your 100th ultramarathon, we can tailor a plan that's made specifically for you. If you're running into burnout, if you're running into injuries, if you just don't know where to start, or how to optimise your run training, then Neil, my business partner and my longtime coach, eeks those sciences. Neil Wagstaff and I would love to help you. We do full video analysis as well as the customised training planes, and you get a one on one session with me. It's a great package. So make sure you go and check that out at runninghotcoaching.com.
And for the last thing is our epigenetics programme. We've been talking about this for quite a while now. If you haven't done that, you're really missing out because you need to understand what your genes are all about in order to avoid all the trial and error. Instead of going, 'What is the keto diet right for me? Is paleo right? Or should I do this type of exercise? Or what time of the day should I train'? Or understanding everything about yourself and your genes, every part that your genes has on your life, whether it's about your mind, your social, your environment, your career—all of this is covered in this amazing programme. It's not just food and exercise, although that's a big part of it.
If you want to know about that programme, you can join us on one of our free webinars. We do that every two weeks, and you can register, and it's in the show notes, epigenetics.lisatamati.com. Or if you just head over to my website lisatamati.com and hit the ‘Work With Us’ button, and you'll see our epigenetics programme listed there. Go and find out all about it. Or if you've got any questions, just reach out to me email@example.com. Right over to the show now with Patrick Mckeown all the way in Ireland.
Well, hi, everyone, and welcome back to Pushing The Limits. Today I am super, super excited because someone that I just absolutely admire and think is absolutely wonderful, I have on the show. Professor Patrick McKeown, welcome to the show and very excited to have you on.
Patrick McKeown: Thanks very much, Lisa. I love that title. It's the first time anybody has ever called me professor. So yes, hopefully, it sticks.
Lisa: Well, it's in your Wikipedia, it must be there, it must be right. If anybody deserves that title, you deserve that title because I mean, the amount of books that you have published, Patrick is just absolutely phenomenal. And you have a brand new book coming out as we speak. Apparently, it's gone to the publishers today. So I did want to—before we get into the big interview, the new book is called?
Patrick: The Breathing Cure.
Lisa: The Breathing Cure.
Lisa: Everybody go and get The Breathing Cure as soon as it hits the bookshelf. It may not be out in some countries yet. So in New Zealand, you're gonna have to wait a little weeny while but this is—by the looks of it—an absolute like a seminal work. I really like everything in the kitchen sink, by the looks of the size of it. So I'm keen to dive into it.
I've come to know you through The Oxygen Advantage, your previous book. It's been a game-changer for me. And I was just desperate to share the information and to disseminate it to people that follow me and my crowd down here and share the insights because I think the stuff is just—I know you've been shouting it from the rooftops for a couple of decades now. But I know how slow things are to get around the world. And it's through books, and it's through podcasts that we're able to share directly.
So for everyone listening, Patrick is a breathing expert, for the want of a better description because that really sums it all up. You're a Buteyko Breathing expert, but you're so much more than that picture. Patrick, can you just give us a bit of a background about you, your career? And why the heck did you get into breathing?
Patrick: Yes, I fell into it. If I had ever said, if somebody said to me that I was going to choose a career in teaching breathing, I'd say ‘There must have been on something’. And I was a kid growing up with asthma, teenager, but asthma. Into my college years, asthma was getting progressively worse. And the asthma you kind of live with. And I was taking medication, but I wasn't under great control, and I'm wheezing a lot. And it was my sleep that was the big issue. I was waking up exhausted, not so much—in primary school. Up to the age of 11, I was very bright in class. I was well up there at the top of the class. And something happened when I went into secondary school, and I went from pretty much top of the class down to the bottom of the class.
Patrick: And I knew it because I can remember as a kid, you're drawn back, and you're saying like, ‘I used to be able to keep up with all the kids and now I couldn't’. But it was my sleep. I was falling asleep in class, and I never put a connection. I was a chronic mouth breather at the time. And this is normal with asthma because if you're wheezing with asthma, you're just feeling that you're not getting enough air. So you're gonna breathe through your mouth. But also if you have inflammation of your lungs, you're more likely to have a stuffy nose. So why is it chronic mouth breather?
And mouth breathing is keeping that kid, and teenager, and adult perpetually in that fight and flight response because you're breathing fast and you're breathing upper chest, you're more prone to snoring. I was a heavy snorer as a teenager. And I was also taught when I went to university, and I was staying in dorms there, students were telling me that I was stopping breathing during sleep.
Lisa: Oh, wow.
Patrick: And you know what, I had no idea what this was, but this is obstructive sleep up there. And so for me to get grades, I had to really work hard, and that's why I often failed. Why on earth are 25 to 50% of study children persistently mouth breathing?
Patrick: And Lisa, nobody—nobody in the industry is doing much about it.
Patrick: There are a few brilliant orthodontists, and there are a few brilliant medical doctors. But there's a great ear, nose and throat doctor from New Zealand, Dr Jim Bartley and this man has been advocating the benefits of nose breathing for 20 years.
Patrick: Now, he's few and far between. And can you imagine, ear, nose and throat doctors, they're treating the nose, but they're not actively encouraging people to use it.
Patrick: And I had an operation of my nose in 1994, and nobody told me to breathe through it afterwards. And you know what? If we have a behaviour of mouth breathing all the way through childhood for say 10-15 years, and then suddenly we get the nose fixed. It's not just enough to treat the nose; we need to change the behaviour.
Patrick: So from 1994 to 1998, I kept on breathing through an open mouth. And then I read a newspaper article, and the newspaper article said two things. It said the people would ask my need to be breathing in and out through their nose, and people would ask my need to be breathing light. And I knew I was doing neither of those things because I'd always hear my breathing, I was caught for breath and my asthma was more out of control than typically what it should have been and partly that was my fault as well at the time. But kids being kids and teenagers, etc.
And that night, I made a concerted effort. Well, that day, I use nose and blocking exercise to help open up my nose. I was feeling our hunger switch to it. And I taped my mouth closed at night, and I wore Breathe Right Strips in my nose as well, just to make sure my nose stayed open because I had nasal congestion. And I woke up the first morning, kind of getting used to it. The second morning, I persisted with it, I was feeling suffocated, I kept going with it. The second morning, I woke up. And it was the best night's sleep that I had in about 15 years.
Patrick: And that first week, my wheezing reduced by about 50%. Now some people might not believe that, but that is absolute genuine.
Patrick: I spent four years in a university in Dublin, Trinity College in Dublin, studying economics and social sciences. And I was in the corporate world. And I never was going to teach this, but just two years later, I was driving from one end of the country to the other. And I just got a good feeling or a hunch, but I just had a feeling 'God, I'd love to be teaching breathing'. And I knew firsthand the difference that it made to me. And you know what, that made a big difference...
Patrick: ...because people could say, 'Well, it's a load of nonsense, and the theory doesn't stand up'. And that's what I was told. And I said, 'Listen, couldn't be, could be. Look, the difference to me'. It's not just—it can't be some doctor said it was placebo.
Patrick: I said, 'Listen, you can't just—this can't be just down to placebo'. And it wasn't just my asthma. It was my sleep quality. But it was also, I had focused on concentration for the first time.
Patrick: And people ask you what does that mean? And I mean, focus on concentration is, if you wake up within 10 or 15 minutes, you're gonna open up a book that's fairly complex, you can read it, and you can hold your attention there. And I wasn't able to do that in school. So, you can imagine that kids and teenagers and even, say a CEO, say somebody's working in any job that's using the mind whereby they have to concentrate. And society does demand us to concentrate. Concentration is demanded of us. But nobody teaches us how.
Patrick: The medical, sorry—the educational profession, now, so giving out about the medical profession first...
Patrick: ...and now we’re getting on about education profession.
Lisa: You go for it.
Patrick: These kids because I was the child in school—in secondary school, which is high school. I'm not sure if you call it secondary school.
Lisa: Yes. We call it high school, yes.
Patrick: And but basically, I would be looking at the page, but my attention wasn't on the page because I was lost and tosh. I was absolutely absorbed in my mind. And I read the page, and to the outside observer would look as if I'm looking at the page, but I am. But my attention wasn't there.
Patrick: And this is where children are graded as being intelligent or academically gifted or whatever. And nobody's taking into consideration these kids sleep.
Patrick: Nobody is taking into consideration these kids, they have racing minds. And it's not just about treating with Ritalin or something like that. ADHD is very much related to poor sleep and children, and there has been papers on it. And this topic has been studied. And one researcher, Karen Bonuck, she left a study in Stratford-upon-Avon, she conducted 11,000 children, a big population over eight years. And she concluded that sleep disorder breathing, which includes snoring and kids, if untreated by age five, these children have a 40% increased risk of special education needs by age 8.
Lisa: Wow, that is so shocking.
Patrick: Now, we have to bear in mind, if we have poor sleep, we wake up, we're feeling lousy, we're grumpy, we're not in good form. But the child, their brain is developing. And these kids, and it's relatively common, and most people don't consider it, the child who's snoring, 'Oh, it's cute'. It's not cute. No child should snore. No child should heavy breathe during sleep. If the child has heavy breathing during sleep, there may be an issue. It needs to be checked out.
Lisa: Wow, Patrick, that's a super introduction to this whole thing, because there's so much that I want to unpack there. I want to go into the whole childhood and facial development and all of that sort of stuff. And then yes, I've been asthmatic all my life. So I was an asthmatic since the age of two, I got diagnosed with asthma. And I always thought I just could not breathe through my nose.
Lisa: I was always, it was always congested. I have a very small mouth. Same story as you. I've got crooked teeth. I had to have all sorts of teeth stuff done to fix things. I have a very narrow—and I read your blog, and I just went, ‘I've heard before that nasal breathing is good’. And I'm an athlete. I'm an athlete who did ultra-distance running because I never had the capacity to do short distance. So I had a very strong mind. So I went with the long stuff, okay, but I ran through every most like pretty much every dessert on earth with my mouth open. And I wish somebody had told me this 20 years ago that there was a way to unblock my nose and that I could get a lot more VO2 max so that I could get a lot more performance if I'd hit my mouth closed. And then I wouldn't be constantly thirsty and constantly getting up all night and broken sleep, and in dental decay and problems because I always mouth breathe in bacteria. And they—always there's a knock-on after knock-on effect from this just in my life.
So when I read that I could clear my nose and I started doing the breath-hold exercise, which we'll talk about in a minute. Basically, your breath, hold your breath for as long as you can, and then you breathe in through your nose. And all of a sudden, after two or three breaths of doing that, I could unclear my nose and I was like holy heck this stuff works. And for the first few weeks, it was difficult, I had to—sometimes it took me five or six breaths. And when I would go for a run, and I would—I slowed myself down running so that I could actually breathe through my nose. And it would take me 10 minutes of warming up until I can actually get myself into nose nasal breathing. But I managed to do it, and I'm 52 years old and my career is over. Oh my god, how tragic because I never got to see what sort of a VO2 max I could have developed and my lungs could have been a lot better. And I wouldn't have had to have so much asthma medications which have huge impacts. I'm not saying that medications are bad, but they do have side effects that are quite pronounced.
So all of these knock-on effects, if I had just been taught these basics, and this is why I want to get a dive into the science with you today. A little bit about why do we need to nasal breathe, why is it really important that with children, we start this from a young, young age, and going into all the brilliant stuff that I learned in your last book and then even starting to delve into some of the stuff that you've been writing about this time. Because I think this is the missing pillar.
We have looked at food and exercise for the last—I'm a coach. We talk food and exercise every single day. Nobody has up until the last few years been talking stress reduction, and mindfulness, and calming the mind. And now people are getting into the breathing in the sleep. And those two are pillars that I think are absolutely crucial. And I'm stoked to see that more and more people are starting to discuss this.
So Patrick, let's start at the science. Let's start at nasal, Why do I need to breathe? Like I have a mouth, my mouth is bigger than my nose, my nose is always very narrow. Why the heck should I be concerned about breathing through the nose?
Patrick: I suppose if you look at the functions of the mouth, and if you were to ask yourself, what does the mouth do in terms of breathing? Does the mouth warm the incoming air? No. Does it moisten incoming air? No. Does it regulate volume? No. Does it harness nitric oxide which is an antiviral, given the time that we're in? No. Nitric oxide also is a bronchodilator, which helps people with asthma. It helps to open up the airways. And for example, people who would exercise-induced asthma or even just bronchoconstriction when the airways are narrowing. Nitric oxide also redistributes the blood throughout the lungs.
And it was back in 1988 that a researcher, Swift found that when individuals, following jaw surgery, when their jaws were wired shut, they were forced to continuously breathe through the nose. The PO2 in the blood, the oxygen pressure in the blood increased by 10%...
Patrick: ...by nasal breathing. Now it's Dr Jim Bartley's chapter that I've taken that out. And there's other two—there's another amazing doctor Dr Patrick McHugh and similar Mc name into my own, H-U-G-H though, McHugh. And he was investigating Buteyko method for asthma in New Zealand. I'm talking about. And I remember him saying, 20 years ago he was saying ‘This could save lives’. So you think, Lisa, 10% of the population having asthma, New Zealand, I'd say it's 8 to 10% similar enough to ourselves. Even the asthmatic population is not taught to breathe.
Patrick: And surely that makes logical sense. And it's not just that when you think of the nose, we think that the nose is only the part in the face. If we were to put the tongue into the roof of the mouth, and drag the tongue along the hard palate, all the way back to the soft palate. The roof of the mouth is the floor of the nose.
Patrick: So in actual fact, within the skull, we can argue that the nose is occupying more space than the mouth.
Lisa: For those who can't see Patrick's got a little side thing of a head, of a nose.
Patrick: So just an anatomical model here. So you're looking at the nose, here, you see the lips, you see the chin, and here we have the hard palate here. So we just said, ‘Put your tongue into the roof of your mouth and draw your tongue along the hard palate until you can feel the soft palate back’.
Patrick: Now, sitting above that is the nasal cavity. Now we look at that in-depth. There's a mucous blanket here, there's turbinates here, you've got sinuses here. The nose is directly linked to the brain. And if we look at the mouth, if we take air into that mouth, that air goes straight down the throat, the mouth does nothing for breathing never has.
Patrick: And also, the other thing about mouth breathing is if you look down at your chest, and if you take a breath through your mouth, what part of the body moves? Typically chest breathing is activating the upper chest, and it's also causing faster and harder breathing. And physiologically, this is putting us into a fight or flight response.
So, how we breathe—breathing—we can change breathing patterns to improve them. And we can influence the major disciplines of medicine. One is respiration, asthma, people with COVID recovery, people with sarcoidosis, people with COPD, etc. The mind psychiatry, people with anxiety, people with depression, PTSD, panic disorder, gastrointestinal, people with IBS, for example. And functional movement, dentistry, another discipline.
Patrick: So, when we're talking about—and sleep, and we can influence this to a breathing. So just to give you an example, when we're looking at functional breathing, I emphasised a large in terms of the biochemistry in The Oxygen Advantage.
Patrick: And the biochemistry refers to the amount of air that you breathe, the volume of air that you breathe per minute. And the volume of air that you breathe per minute is the respiratory rate multiplied by the size of each breath, the volume of each breath...
Patrick: Yes, correct. And the respiratory rate is the number of breaths per minute. And normally, it's about four to six litres during rest for an adult. And the asthma population is breathing 10 to 15 litres.
Patrick: And also, 75% of the anxiety population have dysfunctional breathing, that's what the literature is saying. 75%. Now you can imagine people with just even a racing mind because, yeah, not everybody is going to say, ‘I've got anxiety’. But let's just look at a racing mind, which is so common, that's going to be impacted by our breathing. And when I see people coming in with a racing mind, and I look at their breathing, I very often see faster breathing...
Patrick: ...just a little bit faster. It's not that the person is having a panic attack, it's just their breathing is a little bit faster. Maybe the respiratory rate is 16 breaths per minute plus. They have upper chest breathing. They can often have irregular breathing patterns. So you see that their breathing might be fairly normal, but then they have a big sigh out of the blue.
Patrick: So it's irregular. So there's fluctuations in their breathing. And mouth breathing and not always mouth breathing, but switching from mouth to nose breathing, etc. Now, with that person, I would look at their breathing as we look at any person's breathing. From a biochemical point of view, we have them breathe light, and I'll go to an exercise in a second. And light breathing is whereby we deliberately reduce the volume of air that they are breathing in order to increase carbon dioxide in the blood a little bit.
Patrick: A carbon dioxide is not just that waste gas. When we increase carbon dioxide, the blood vessels dilate, they open. It's very common for people with slightly faster and harder breathing to have cold hands and cold feet.
Lisa: That’s great, yes.
Patrick: So, you can imagine the 70,000 miles of blood vessels trapped in the human body are constricted.
Patrick: Or constricted due to that slightly faster and harder breathing. So for the person with anxiety, for the person with brain fog, for the person who's switched on and can't switch off, we need to get increased blood flow and oxygen delivery to the brain, and we don't do that by breathing hard. And there is an idea out there, and it's taught in many yoga studios.
Lisa: Deep breathing. Take a deep breath.
Patrick: Deep breathing and big breaths. And how do we know that if you go into a yoga studio? And yoga is brilliant.
Patrick: It's tremendous. It's giving people so many—a lot of help. But what I would say to you is do all your yoga, but do it with silent breathing, that's all. Do all of the postures but just have silent breathing. So the person with anxiety, we want to increase blood flow and oxygen delivery to the brain. This has a calming effect on the central nervous system on the brain. The second aspect is that we teach them to breathe low. And this is with lateral expansion or contraction of the lower ribs. The reason being is because of the connection between the diaphragm and the mind. So the diaphragm is connected to the brain. And when we do breath low, I think it is definitely—there's definitely a feedback. And the phrenic nerve also plays a role there in respiration. And it's likely—like the vagus nerve is innervating the diaphragm. So it's likely that it's the vagus nerve that's communicating that information back. So when we breathe low, it's telling the brain things are fine because I think through every evolution—I was talking all day yesterday, sorry. Just going to take water.
Lisa: Yes, no problem. Need a bit of vagal nerve stimulation yourself, probably after all the stress of getting the book out.
Patrick: Well, yesterday, I had a filming for a documentary for the first four hours, and then I had a podcast with Ben Pakulski, and then I did two and a half, a two hour and a half-hour training afterwards. So, you're talking for eight hours it's...
Lisa: You need to breathe correctly.
Patrick: But it can be a bit demanding, so again. So, coming back to the person with anxiety. So yes, biochemistry point of view, let's get blood flow and oxygen delivery to the brain. Biomechanics, let's get the diaphragm working as the connection with the mind. And also, resonance frequency breathing. So by slowing down the response rate between 4.5 and 6.5 breaths per minute, it's stimulating the vagus nerve. And as your listeners will know, the vagus nerve is this nerve that's wandering, trapped in the human body, innervating all of the major organs, and 80 to 90% of the feedback is from the vagus nerve back to the brain.
So throughout our evolution, every time that we, as human beings, were confronted by stress, it was always accompanied by faster and upper chest breathing. Those stress and faster and upper chest breathing go hand in hand, if we get stressed today, our breathing gets faster, harder, upper chest. But if we are breathing faster, harder and upper chest as part of our everyday breathing pattern, as 75% of people with anxiety and panic disorder are, that's telling the body that's telling the brain.
Lisa: We are in danger.
Patrick: So, how do we change and switch this off? Well, when we start practising to breathe light, breathe slow, and breathe deep and the acronym that I use is LSD. So light, slow and deep breathing. The feedback then is from the body back to the brain. And the brain is interpreting it that the body is in a safe environment because the body would not be breathing light, slow and deep if there was danger.
Lisa: Yes, indeed.
Patrick: That's how we can almost trick the primitive brain. And then the brain is going to send signals back to the body, on the basis that the body is in a safe environment. Now, even just for people with anxiety, and say, PTSD, I'm thinking of all the people going to counsellors, all the people doing cognitive behavioural therapy, which is all great. They're going to their psychiatrist or psychologist. But how many of them are taught functional breathing patterns? Not just to take a deep breath, and not just to breathe a breathing exercise for five minutes just to help calm the mind. It's everyday breathing.
Lisa: Yes, that’s...
Patrick: I, when somebody comes into me, I want to look at their breathing and say, 'Listen, I want to change your breathing, not just here. But when you walk down the street, when you're driving your car, when you're lying in bed at night’. And then we could touch on sleep, think of people who are snoring, people who have obstructive sleep apnea. And I just wrote a medical paper that's with Dr Carlos O'Connor, who's a wonderful ear, nose and throat doctor from Madrid and Dr Plaza. And it's 10,000 words, and we submitted it for publication to the medical journals and we went through the peer review process. Yesterday, we got word it's been accepted for publication
Lisa: Wonderful, yes.
Patrick: And this is the first time looking at breathing re-education. And I mean, looking at it from a multitude of perspectives, and the impact on obstructive sleep apnea. Now an Australian researcher Rosalba Courtney has looked at it as well. But what I was looking for is just getting some debate on this topic because if we think of the number of people with obstructive sleep apnea.
Lisa: Yes, my mum would be one.
Patrick: Yes, for sure. It's 26% of men up to age 50.
Patrick: And from age 50 to 70. It's 43% of men.
Patrick: And for females, it's 9% of females up to age 50. But when the female goes through menopause, postmenopausal women, it increases by 200 to 300%.
Patrick: So, it increases typically to about 27%, are there?
Lisa: Why is that? Is it this drop on the estrogen levels causing changes in the muscular tear or what is it?
Patrick: It is, yes, exactly. It's definitely due to the hormones because you're not getting hormonal fluctuations. And maybe that it's progesterone that's protective for the younger female. But I think also fat deposits. As we get a little bit older, we tend to put a bit of fat around the belly. And when we put fat on the belly, the diaphragm breathing muscle doesn't work so well.
Lisa: This is why you fix it into bed.
Patrick: When the diaphragm breathing muscle isn't working so well, the throat is more liable to collapse. So the diaphragm in the upper airway, the lateral muscles and the throat are connected. But even if I was just to say, like, I always use the example, people would ring me up and say, 'Well, how can you fix snoring' and I said, 'Listen, do this. I said make the sound of a snore through your mouth', and they go like this. And I say, 'Now close your mouth, and try and snore through your mouth'. You can't. So, the mouth snoring stops. And now make a sound of a snore through your nose. And it goes like this.
Patrick: Now, what I'd like you to do is really breathe slowly, and have a really slow breath, enter your nose, and a really relaxed and a slow, gentle breath out through your nose, almost, that you're hardly breathing and a very slow breath in. Almost, that you're hardly breathing and a really relaxed, slow breath out. And as you breathe really slowly, try and snore through your nose. And you can do it, but it’s more difficult.
Lisa: You can. Yes, you can.
Patrick: It’s going to be more difficult.
Patrick: And this is where—when you think of an engineer, if you were thinking even a plumber, can you imagine a plumber coming to the house. And you're saying, 'I need to get some water from one end of the house to the other'. And the plumber is thinking about, 'What size pipe can I use here'? The plumber is going to consider the size of the pipe is going to be determined by the flow of the water.
Patrick: And if there's a large flow of water, the plumber is going to choose a large pipe. While in sleep medicine a lot of the attention is on the airway, it's on the pipe, but there's very little attention on the flow. Because if you have somebody who is breathing harder and faster, our typical person with asthma is a prime example. And it's known that as asthma severity increases, so does obstructive sleep apnea.
Patrick: People with asthma are tired. And why is their obstructive sleep apnea increasing is because when their asthma gets a little bit bad, a little bit worse, they breathe faster, they breathe harder. They're taking in more air, they're breathing upper chest, the more likely to have the mouth open.
Patrick: And this is causing the negative—increased negative pressure and turbulence in the upper airway. And this is waking individuals up or arousing them from sleep. So...
Lisa: And then the whole sleep disorder thing, like, I read a book by Matthew Walker.
Lisa: Dr Matthew, yes, Dr Matthew Walker and hoping to get him on the show next. And that was just a mind-blowing book as well, because these go hand in hand. If you're not sleeping correctly, all of the knock-on effects of every pillar of health, it doesn't matter what good food you're putting in and what good exercise you're doing...
Lisa: ...you are not going to be good if you're not breathing, and if you're not sleeping.
Lisa: So this is absolutely fundamental. What you're saying is this is a fundamental of—so pretty much every area of the body this is affecting so whether you've got brain fog...
Lisa: ...whether you've got thyroid issues, whether you've got hormonal issues, whether you've got exercise difficulties, whether you got asthma, all of these things, ADHD and children and they could have at the base, this breathing problem and let's talk about it.
Patrick: Yes, there's no question that it’s possible.
Lisa: Can’t make money out of this, Patrick.
Patrick: Well, I think that's part of it. And the other thing is, I read many books on sleep, but very few people talk about nose breathing, and that is the elephant in the room. And I remember I was in a Sleep Congress, I think it was Bordeaux in France. But I've always been kind of travelling to them. But one Dr Christian Guilleminault, who coined the phrase obstructive sleep apnea.
Patrick: He's considered to be one of the founding fathers of sleep medicine. I remember him standing up in one of the conferences, and he said to the room of medical doctors, pretty much all healthcare professionals with an interest in sleep. And he said, 'We've been talking about everything, borrowed the elephant in the room, and the elephant in the room is restoring nasal breathing’.
Patrick: And he first started writing about this back in 2012, 13, or 14. And I'll quote, in terms of pediatrics, that's where his interest was asked. But it's not just for pediatrics, it's also for the adult population. He said, 'The only valid and complete correction of pediatric Sleep Disorder breathing is restoration of nasal breathing both during wakefulness and sleep'.
Lisa: And sleep, yes.
Patrick: Now, you have the top sleep doctor in the world saying is, 'And it's going to take 20 years for this information to trickle down'. We know that 50% of the adult population have their mouth open during sleep. And if you have your mouth open, if the listener is waking up with their mouths open during sleep, sorry, if they wake up with their mouth open, if they have a dry mouth in the morning.
Patrick: It's telling them that they are sleeping at least part of the time with their mouth open. So if the mouth is dry in the morning, you're not likely to be waking up feeling great.
Lisa: It’s a warning sign. Just on that note, before I read your book, I've also read James Nestor’s book Breath, which was another seminal work.
Patrick: Excellent book.
Lisa: Amazing, amazing man. Incredible work. I was mouth breathing the whole time. Obviously, I've been doing that my entire life. I used to have to get up and go to the toilet four, five, six times a night like it was—I sort of thought, 'Oh, it's some sort of hormone or menopause or some drama going on'. When I taped my mouth shut for the very first time, I slept through, and I had to get up once to go to the load.
Lisa: And I've worked out with—because I used to drink a ton in the night because I was just so dry and I don't have any of that now. And I can't remember the science behind it. But it was something to do with antidiuretic hormone and my body not producing as much urine because it's not—I forget the science. But it was just, like, that alone for my sleep was game-changing. And I think I really want people to, like, we've been talking about taping your mouth. And that sounds like a torturous thing. I must admit, like the first I read your book, and then I was like, 'Yes, I don't know, I might die. If I take my breath, my mouth shut'. I was quite frightened.
And then I saw a video. I think it was you just showing that it was just a tiny piece of this way, like vertically, not right across the whole mouth, like you see on some internet videos. Don't do that. So that I knew that I could break it if I was panicky and if I really needed to open my mouth to breathe and I had a blocked nose. And so I did it for the first time.
Patrick: Another option that we brought out for children because of course, even for kids, we don't want to be putting the tape even if it's a small amount. But this was brought out for children specifically. And then of course for the adult population.
Lisa: Oh, wow.
Patrick: It's called Myotape
Lisa: I’ll put the links in the show notes.
Patrick: So it's cotton tape. And I'm just taking off a piece of it here.
Lisa: Yes, for people on the podcast. So he's got this orange piece of tape that goes around the mouth. Okay, so just holds the mouth together. That's a good luck, Patrick.
Patrick: It's a good look and enhances anybody's romance life. Now the next one that we're bringing out is going to be skin colour. But it's an elasticated tape, and it's also having to activate the muscles around the mouth called the orbicularis oris muscle. So, there's a number of things what we did it for. It was a training tool for children.
Patrick: So for instance, we would have children go through all of the exercises decongesting the kids' nose, getting the children breathing through the nose, kids walk in and a week later, mouth is wide open again.
Patrick: So we're saying we're helping, we're changing breathing pattern, but we're not necessarily changing the behaviour of nasal breathing and mouth breathing. So I said to the kids, then this is three, four years ago, ‘I need you to start taping your mouth during the day. If you're watching television, if you're playing with toys, if you're doing your homework’, and the kids started doing the taping, half an hour a day to about an hour a day if they were watching a television programme, and it was a total game-changer.
Patrick: And this was really getting that—forming that habit of nose breathing. And then I was thinking about kids want to talk, and kids want to—they want to drink water. And this is where the Myotape came out. So that the children can have the tape. And if they're watching television, and if they forget about breathing through the nose, as soon as they might open the mouth, the tape holds their lips together, and it tells them to breathe through the nose.
Lisa: That’s system retraining.
Patrick: And the other thing is we feel a much more comfortable with children wearing this during sleep once we've established that kids can nasal breathing during the day. And it's not the adenoids that's the issue. And getting children breathing through their nose during sleep. And it's really, really vitally important. In terms of—you touched on it earlier on, Lisa, craniofacial development...
Lisa: Yes, I want to get into it.
Patrick: I have the high upper narrow palate. My nose, one nostril is smaller than the other, and my mandible has been set back, my maxilla is set back, my airway is compromised. And the problem with this is this has been debated in dentistry for a hundred years. Can you imagine an industry of individuals armed with medical or dental degrees and debating about the impact, is it mouth breathing which is causing crooked teeth? Or is the child born with a small mouth and all of this? And it's really crazy stuff. And it's so unfortunate because why are up to 50% of studied children persistently mouth breath. And I see the role of the dentist. I wrote about this in the new book, 'The role of the dentist has such an important function’, their job—because they can identify the risk factors in sleep disorder breathing in children'.
Patrick: We don't go to medical doctors very often, especially as adults. But we go to our dentist every six months, and the dentist can see the risk factors. For example, they can see if the airway is compromised, they can see straight away because they're used to looking into the mouth.
Patrick: Does the child have a high upper palate?
Patrick: And the high upper palate has severe consequences. There was a paper published in 2012 in the European Journal of Pediatrics, Dr Christian Guilleminault is the co-author of it, looking at seven infants who died as a result of sudden infant deaths and how they died abruptly during sleep.
Patrick: All of the kids had a high upper narrow palate.
Patrick: And the only thing that they had proceeding death was a runny nose.
Lisa: Wow, so they just couldn't breathe.
Lisa: And just suffocated.
Patrick: Exactly. That's—they died of hypoxia during sleep. So you can imagine that these young babies, young infants, they already have a high upper narrow palate. So their nasal cavity is already infringed. And all it took was a runny nose or nasal congestion because young infants can't automatically switch to mouth breathing, they have to continue trying to breathe through the nose.
Now, if that was spotted, and all the mum or dad has to do with our tongues wearing gloves, put it into the baby's mouth, and apply gentle pressure for 10 seconds, because the maxilla is pliable, and they can gently just expand it. Or you can have a pediatric dentist able to do it with small devices. This is crazy stuff.
Lisa: No one, it’s just not, no one, like, no local dentist would know about this. I can guarantee you.
Patrick: They don't know about it. I went down to my local dentist to my column. And I asked him, does mouth breeding have any effect on craniofacial development? And he said 'No'. And I said, 'Okay, that's—I'm not even gonna bother here'. And it's so unfortunate. And there's absolutely no question, like, if we look at one study by Harvold, he was a functional dentist from Canada, and he was working I think in the United States. He got a group of young rhesus monkeys back in the 1970s.
Lisa: I read that study, yes.
Patrick: And he surgically buffed their noses to force the monkeys to mouth breath. And all of the mouth breathing monkeys, they develop the same craniofacial abnormalities as we see in humans.
Patrick: Now, that's and furthermore, when he removes the silicon nose plugs to allow the monkeys going back to nasal breathing, that in many instances, the shape of the face corrected itself.
Patrick: So then I look at a paper by an orthodontist, a well-known orthodontist in the United States called Dr Katherine Vig, and she's married to an orthodontist. So, she knows a bit about dentistry. And she says ‘We can't rely on horrible studies because he totally blocked the noses of the monkeys. And total nasal obstruction is rare in human beings’. Now, she missed the point. It's not whether the nose is totally blocked, or half blocked, or partial, whatever.
Patrick: It's whether part cause the abnormalities was mouth breathing, that's all we need to know. So if a child is persistently breathing through an open mouth for a period of time, and let's say it's six months, six months would be say mouth breathing syndrome, is that sufficient to cause craniofacial abnormalities.
Patrick: And there's one brilliant orthodontist from Australia, from Sydney. His name is Dr Derek Mahony. Now, for some reason, it's Mahony in Australia. But, Mahony is an Irish name. And he has been writing and working in terms of functional orthodontics. I don't know for how many years, and he's got a team of ear, nose and throat doctors. He's a really well-respected orthodontist. And I remember reading an interview that he did. I wrote in one of the books, he was on television, and there was a parent with a child and the parent. The child had crooked teeth. And the parent is bringing her child to one dentist, one orthodontist, and the orthodontist is insisting ‘We need to extract teeth here’. And the parents are saying, 'God, I don't want to, I don't want my child to have extraction of teeth'. So then she brought her child to Dr Derek Mahony, and Dr Derek Mahony says, 'No, we don't need to extract teeth. The problem is that the teeth are overcrowded. Not because the teeth are too big. The problem is that the jaw is too small. So let's gently expand the maxilla to make room for all teeth'. But here's the most important thing. What fits into the mouth is the tongue. And if we have a small mouth, there's not enough room for the tongue. And if there's not enough room for the tongue, it's more likely to encroach back into the airway. So orthodontics, if it's involving extraction of teeth, it's increasing the risk of obstructive sleep apnea for the rest of that child's life.
Lisa: Holy, how many kids have their teeth pulled.
Patrick: Oh, sure it is. And it's this is...
Lisa: And this is like a—and this is what I get frustrated with the whole medical and people know who listened to my podcast. Why? Because I've had some pretty horrific stories to tell about my family. But it seems that it takes 20 to 30, sometimes 50 years for the actual stuff that's happening in the studies and the clinical and the lab settings to filter into actual clinical daily practise, it seems to be a lag of at least 20 years for most things and...
Patrick: But Lisa, you know what? That some things are just common sense, we don't need studies to realise that as human beings...
Patrick: We've been equipped with a nose and let's start using it, for us, for children, our ancestors were nasal breathers. Most of the animal kingdom with the exception of a dog and a dog is using its mouth to breathe...
Lisa: And to cool down, yes. But let's look at the—because I remember in James Nestor’s book and the—he went and had a look at the skeletons of our ancestors.
Lisa: So 400, 500 years old, 1000 years old. And what was really interesting to me, and which you've touched on here is that they all had straight teeth, and they have much bigger jaws, and they have forward-facing jaws where we've often got—like, you and I both got receding...
Lisa: ...recessed jaws, tiny mouths, crowded teeth, etc. And he's sitting in his studies of looking at hundreds of skulls and talking to anthropologists and people that have studied these skulls that we just had straight teeth all the time.
Lisa: And one of the reasons he said was that we didn't have mushy food. We tend to chew on really hard food, whether it was carrots and steak, or whatever the case may be. And now we have porridge and yogurt, and all these soft, mushy processed foods, and that contributes to the fact that our mouths are getting smaller, and therefore our airways are getting smaller. And our tongue has remained big—.too big for this area. So I was like, 'Wow', and if I look at—because I'm of Maori descent, so native New Zealand. My father was Maori. And if I look at some of the photos of my ancestors...
Lisa: ...they're the very, very early photos that they were—they have, and there are only a few around, but they all had beautiful big strong jawlines. And now in my generation, my brothers and I, we've all got problems with our dental work, especially me. Is this a reason I've got asthma? No one in my family prior to this generation had asthma. Is that a contributing factor? I mean, there may be other things at play. But I want people, like one of the other factors that he brought to bear or you, it was in your book, so I think about the baby suckling on the breast.
Lisa: Breastfeeding is a crucial for that development of the jaw. Can you explain that a little bit because people out there listening with little babies?
Patrick: You're correct in saying our ancestors had much better facial development than we do today. It's not even 400 years. I was in a dental dental clinic in, I think it was Lithuania, back about two years ago. And the dentist was a professor of dentistry at one of the universities, and she was commissioned with this task. The city in Lithuania had found graves of individuals—Lithuanian individuals—who were executed by the Russians in 1917 and because they rebelled. And she was commissioned with the task of trying to identify these individuals based on their skulls. And we looked at the skulls and photographs of the skulls. And when you were to see the forward growth of the skulls was incredible.
Lisa: Yes, just beautiful.
Patrick: And this is only 1917. This is 1917.
Lisa: Wow. Because our food has changed so drastically in 80 years.
Patrick: It has changed even, it's happening in one generation. And I think the first person to touch on this was a dentist called Dr Weston Price. And he wrote a book called Nutrition and Physical Degeneration, it was written back in... He went to the Maoris, he went to New Zealand, he went to Eskimos, and he went to all of these native indigenous tribes. He went to people off the Hebrides islands off the coast of Scotland. And he wrote on the Hebrides islands, they were living off fish and oatmeal and traditional food for thousands of years, and commerce started coming to the island, with sugar, with marmalade, with chocolate. First generation children become mouth breathers, first generation, that was it.
Lisa: From the sugar.
Patrick: And all the crowding of teeth and dental decay, etc. So there's no question there's a multitude of factors kicking in here. One aspect is the food that we're eating. Yes, it's too soft. And breastfeeding is not just about nutrition, but it takes effort for the baby to take the milk from the breast. And it's the effort, and it's the work of the muscles of the face as their breast feeding which is contributing to craniofacial growth. So a child who was given a bottle, it's so easy just to take the bottle. But a lot of babies have problems breastfeeding if they're tongue-tied. And back in the 15th and 16th century in France, the midwives—I know that sounds a bit gross, but the midwives had an extra long fingernail.
Patrick: And as soon as the baby was born, they'd open the baby's mouth. And if the baby had a tongue-tied they'd clip it with their fingernail.
Patrick: And that by clipping the tongue tie—tongue tie is that is just a piece of string that's holding the tongue to the floor of the mouth.
Lisa: To the floor of the mouth. Wow.
Lisa: Did they do that nowadays or they…?
Patrick: At least they probably do, but I'm not sure if they do a good job. I believe one country has made it kind of mandatory to some degree and it's Brazil.
Patrick: And Brazil is well—Brazil are years ahead in terms of the importance of nasal breathing and pediatrics.
Patrick: And it's probably driven by an individual. Dr Irene Marchesan, who started myofunctional therapy back in Brazil, maybe 30 years ago. Working from her apartment, and now she's got a university pretty much around her, people are doing PhD in myofunctional therapy.
Patrick: So coming back to it. So yes, breastfeeding is a factor. And it could be genetics there in terms of the nutrition that the mother is eating.
Patrick: And could this be also having a role that the baby then is born with...?
Lisa: Maybe genetic, it takes, yes.
Patrick: Yes. And here, this is why we haven't advanced because the basis is, is it chicken or an egg?
Patrick: Is the small mouth causing mouth breathing? Or is it the mouth breathing that's causing a small mouth, and you know what? It doesn't matter because regardless of the cause of it, if a dentist, a functional dentist recognises a child—this child has a high palate, and a narrow jaw, V-shaped jaw, the dentist has the skills to gently expand this, they can address the problem, they can address it.
Lisa: Can we do it as an adult?
Patrick: And did it with my own daughter. I've done this as an adult. So how you know is when you ask somebody to smile...
Patrick: You're checking to see if there's considerable black triangles, either side of your smile.
Patrick: So, if you were to ask somebody to smile, you could also do it. Get an idea. So if you see black triangles, either side you know then that the jaw is too small for the mouth, the jaw is too small for the mouth. I use the example in the book, Prince William, from the United Kingdom royal family.
Lisa: That’s right. I heard that on one of your podcasts.
Patrick: And because you'll find these photographs very easy, just put in, you're looking for an image of Prince William and Kate Middleton, and get a photograph of the two of them side by side smiling. And then count the number of teeth that you see in Kate's mouth, and then count the number of teeth you see in William’s. And you'll see that William’s mouth, William's jaw is significantly smaller than Kate's jaw. Now then we have to bear in mind, maybe William had orthodontics, and you can imagine, the royal family would have access to the best orthodontist in the land. And it's possible that the orthodontist had insisted on extracting teeth...
Lisa: And that makes the jaw smaller.
Patrick: ...and in an effort to correct that made the jaw too small, not enough room for the tongue and increasing the risk of sleep apnea.
Lisa: And this is...
Patrick: So, it happened to the royal family, how are the rest of us peasants?
Lisa: Well, I've definitely got the small mouth, so I know. And I've had a lot of work done on the teeth and it's better. I don't know whether this is connected. But my asthma has been better in the last few years, and it was earlier. I certainly had it worse as a child and then as an adult. But now that I've changed my breathing in—now, I just wanted to touch on this a little bit for athletes too, before we wrap up because I know you've got a big busy day ahead.
For athletes, this transition is quite a difficult one. It takes a bit of time to adjust your, like, to 24 hours breathe through my nose, I'm still not there. And I've been doing it for a few months, I forget when I get into my work, for example, I'm on the computer, and I'm quite stressed with some emails or something coming in. I'll get up and I'll just be—I'll hear myself sighing and then 'Oh no, I'm on back to mouth breathing again'. And I'll feel very stressed. And then I will chicken with myself. So it's a constant learning, and with my training as a runner, it has taken time, so I can't go and do my high-intensity interval training at the very top end because I can't yet control the nasal breathing. So, any advice for athletes? Because we have a lot of athletes listening to this and aspiring athletes.
Patrick: Yes, just before I do, I just send the last point in terms of expansion. So I had my maxilla expanded. And it was a tremendous orthodontist, Dr William Hang from California, and I used