Sleep With Buteyko - Physician D - McKeown, Patrick

Table of Contents
TABLE OF CONTENTS
INTRODUCTION
MINIMUM READING REQUIREMENT
MEET BUTEYKO
ALL ABOUT BREATHING VOLUME
WHAT IS SNORING?
WHAT IS OBSTRUCTIVE SLEEP APNEA?
IMPLICATIONS OF OBSTRUCTIVE SLEEP APNEA
MOUTH BREATHING DURING CHILDHOOD INCREASES THE RISK
OF LIFELONG OBSTRUCTIVE SLEEP APNEA
WHAT IS INSOMNIA?
JOE IS CHRONICALLY OVER-BREATHING!
GOOD BREATHING
NOT SO GOOD BREATHING
HOW TO MEASURE YOUR RELATIVE BREATHING VOLUME
THE THREE TENETS TO NORMALIZING YOUR BREATHING
THE FIRST TENET: BREATHE THROUGH YOUR NOSE DAY AND
NIGHT
HOW TO UNBLOCK YOUR NOSE
NASAL BREATHE DURING SLEEP
THE SECOND TENET: CORRECT POSTURE
THE THIRD TENET: REDUCE BREATHING VOLUME TO CREATE A
NEED FOR AIR
REDUCED BREATHING SUMMARY
REDUCE BREATHING ONLY THROUGH RELAXATION OF THE
RESPIRATORY MUSCLES
REDUCED BREATHING DAILY EXERCISE FORMAT
REVERSING INSOMNIA
BREATHING EXERCISE TO HELP CALM THE MIND AND STOP PANIC
ATTACK
CORRECT BREATHING DURING PHYSICAL EXERCISE
FOOD AND SLEEP
APPLYING THE BUTEYKO METHOD FOR SLEEP DISORDERS
SIMPLE BREATHING BASICS
KNOW HOW OXYGEN IS RELEASED TO PROVIDE ENERGY
NITRIC OXIDE: A MOST IMPORTANT MOLECULE
APPENDIX
RHINITIS, SNORING AND SLEEP APNEA IN ADULTS
RHINITIS, SLEEP DISORDERS AND ADHD IN CHILDREN
CPAP THERAPY
REFERENCES
BUTEYKO BOOKS, DVDS AND ONLINE SELF HELP COURSES
Also by Patrick McKeown

Books:
The Oxygen Advantage: The Simple Scientifically Proven Breathing
Technique for Improved Sports Performance
Asthma Free Naturally
Close Your Mouth
Anxiety Free: Stop Worrying and Quieten Your Mind
Buteyko Meets Dr Mew: For Children and Teenagers
Always Breathe Correctly (for children aged 3-10 years)

Self-Help Online Training & DVD sets:
Buteyko DVD set for High Blood Pressure, Fatigue, Insomnia,
Chronic Hyperventilation, Asthma, Snoring and Sleep Apnea
Buteyko Mindfulness Method DVD set for Anxiety, Stress, Panic
Attacks, Depression and ADHD
Buteyko Clinic DVD set for Children and Teenagers
Online Training for HealthCare Professionals

For books and DVD sets, visit ButeykoClinic.com
IN THIS BOOK YOU WILL:
· Discover what the world's top sleep experts are
saying regarding the importance of nose breathing
during sleep
· Learn how your everyday breathing determines
your quality of sleep
· Practice simple breathing exercises to significantly
reduce snoring and obstructive sleep apnea
· Discover the importance of breathing through your
nose for good quality sleep
· Learn how to decongest your nose, and sleep with
your mouth closed
· Identify the risk factors for sleep problems in
children
· In as little as seven days, experience better quality
sleep, wake up more alert and benefit from improved
day time energy levels
Published by: Buteyko Books
Loughwell, Moycullen, Co. Galway, Ireland
Web: www.ButeykoClinic.com
Email: info@Buteykoclinic.com
© Patrick McKeown 2011
Revised 2017

Cover design by Aurora Pérez Machío from
www.apm-graphics.com and
Dragan Tovilovic from
www.bookclaw.com
Illustrations by Rebecca Burgess from www.RebeccaBurgess.co.uk
Typesetting by Goran Tovilovic from
www.bookclaw.com

ISBN-13: 9780956682376
The information contained in this book is not intended to serve as a replacement for
professional medical advice. Any use of the information in this book is at the reader’s
discretion. The author and the publisher specifically disclaim any and all liability arising
directly or indirectly from the use or application of any information contained in this book.
A health care professional should be consulted regarding your specific situation.

All rights reserved.
No part of this publication may be copied, reproduced or transmitted in any form or by
any means, without permission in writing from the publishers. This book is sold subject to
the condition that it shall not, by way of trade or otherwise, be lent, re-sold or otherwise
circulated without the publishers prior consent, in any form of binding or cover other than
that in which it is published and without similar condition including this condition, being
imposed on the publisher.
Table of Contents
Introduction
Minimum Reading Requirement
Meet Buteyko
All About Breathing Volume
What Is Snoring?
What Is Obstructive Sleep Apnea?
Implications Of Obstructive Sleep Apnea
Mouth Breathing During Childhood Increases
The Risk Of Lifelong Obstructive Sleep Apnea
What Is Insomnia?
Joe Is Chronically Over-Breathing!
Good Breathing
Not So Good Breathing
How To Measure Your Relative Breathing Volume
The Three Tenets To Normalizing Your Breathing
The First Tenet: Breathe Through
Your Nose Day And Night
How To Unblock Your Nose

Nasal Breathe During Sleep
The Second Tenet: Correct Posture
The Third Tenet: Reduce Breathing Volume
To Create A Need For Air
Reduced Breathing Summary

Reduce Breathing Only Through Relaxation
Of The Respiratory Muscles
Reduced Breathing Daily Exercise Format

Reversing Insomnia
Breathing Exercise To Help Calm The Mind
And Stop Panic Attack
Correct Breathing During Physical Exercise

Food And Sleep
Applying The Buteyko Method For Sleep Disorders
Simple Breathing Basics
Know How Oxygen Is Released To Provide Energy
Nitric Oxide: A Most Important Molecule
Appendix
CPAP Therapy
Rhinitis, Snoring And Sleep Apnea In Adults
Rhinitis, Sleep Disorders And ADHD In Children
References
Buteyko Books, DVDs And Online Self Help Courses
INTRODUCTION
isten to the breathing of someone who is snoring and you

will find it to be noisy; those who snore draw in large breaths of air
while they sleep, and often breathe through the mouth. If the person
has obstructive sleep apnea, you may hear a snore followed by
complete silence as they stop breathing for a period of up to one
minute – or sometimes more. Upon the resumption of breathing,
large gasps of air are then taken into the lungs. For someone with
sleep apnea, this cycle continues all night long; snoring, long pauses
in breathing, and intense gasping.
Both snoring and sleep apnea are forms of sleep-disordered
breathing, and can be improved and corrected by practicing simple
breathing exercises designed to change breathing habits both day
and night. When breathing becomes calmer and lighter, an
individual’s sleep and overall health will dramatically improve.
In 1997, I discovered the Buteyko technique as a method of
correcting my own breathing problems. Throughout my childhood
and into my early twenties I constantly breathed through an open
mouth. I experienced symptoms of wheezing, breathlessness, and
snoring, and was told by my university dorm-mates that I regularly
stopped breathing during sleep. It was only in later years that I
learned this condition to be obstructive sleep apnea – a potentially
dangerous form of sleep-disordered breathing.
High school for me was a very frustrating time, as I didn't have the
concentration to stay alert during class, and needed to study long
hours to obtain decent grades. When a student’s energy levels and
concentration are poor, they will struggle to focus and perform well
academically. Some of my teachers simply considered me to be
uninterested, while others gave me positive support and
encouragement, but no one – not even my family doctor – suspected
that I might have a sleep disorder. Like millions of other teenagers, I
fell between the cracks of modern medicine.
In 1997, after graduating from Trinity College Dublin, I read an
article in an Irish newspaper about the work of Russian Dr
Konstantin Buteyko. Dr Buteyko’s theory emphasized the
importance of two breathing habits: to breathe through the nose
both day and night, and to ‘breathe light’. Using the little information
available at that time, I applied the Buteyko Method, and I can
honestly say that within a few days it completely changed my life.
My breathing was easier, my sleep improved, I felt calmer, and my
energy levels vastly increased. Making the transition required time
and energy, but I was prepared to make the commitment to
changing my breathing habits after experiencing such significant
results within mere days of making the transition from mouth to
nasal breathing.
A number of years later I travelled to Russia to receive my clinical
training at the Buteyko Clinic of Moscow. I received my
accreditation from Dr Buteyko, and since 2002 have been teaching
the Buteyko Method to thousands of people with breathing
disorders, such as snoring and obstructive sleep apnea.
The importance of good breathing habits is well documented in
medical literature; however few healthcare professionals explain
the importance of functional breathing to patients suffering from
sleep and respiratory problems. Addressing poor breathing habits
should be a first call to action, as this approach is the most cost
effective and long-lasting, involves no side effects, and is very simple
to implement. It may be the case that many practitioners are unable
to commit to the time involved in teaching breathing exercises to
patients. However, when one adds up the personal, social and
economic benefits, it is time well spent.
Sleep disorders wreak havoc on health and quality of life.
Furthermore, sleep-disordered breathing is responsible for many
deaths - even road traffic accidents, when sleep-deprived drivers fall
asleep behind the wheel.
While breathing through the nose is important for adults, it is even
more important for children. Currently, more than half of studied
children in the Western world breathe through an open mouth. This
seemingly innocuous habit has notable long-term effects, since
persistent mouth breathing during childhood causes negative
alterations to the shape of the face, reduces airway size and
increases the risk of lifelong obstructive sleep apnea. If a child is to
grow into a healthy and happy adult, good breathing habits are
imperative during their formative years.
The good news is that sleep experts are becoming increasingly
concerned about the impact of open mouth breathing during sleep,
especially for children. Among these researchers is Dr Christian
Guilleminault, a leading figure in the field of sleep medicine who
highlighted the issue in a 2015 research paper, recognizing that “the
case against mouth breathing is growing, and given its negative
consequences, we feel that restoration of the nasal breathing route
as early as possible is critical.” The paper goes on to say that
“restoration of nasal breathing during wake and sleep may be the
only valid ‘complete’ correction of pediatric sleep disordered
breathing.”1
Breathing is an involuntary activity – a function that we don’t
usually need to think about unless we are experiencing symptoms of
breathing difficulty. However, our breathing can be influenced by
various factors of modern living and is susceptible to change.
The manner in which we breathe during the day determines how
we breathe during sleep. If we have developed bad habits, such as
breathing through the mouth, periodic sighing, or have noisy,
noticeable breathing during rest, then this will translate into more
intense breathing during sleep.
Good breathing during rest should be light, gentle, calm and
through the nose. Snoring and sleep apnea is unlikely to occur when
breathing is through the nose and light during sleep. On next link ,
you can learn to measure your breath hold time, which provides
useful feedback on how light or heavy you breathe.
While breathing habits can change in the wrong direction, it is also
possible to correct and improve the way we breathe by practicing
the exercises and guidance within this book, which will help you to
enjoy better sleep and lifelong health. The benefits of breathing
lightly through the nose are supported by many references to
medical papers and research, while the techniques and breathing
exercises will help you to change your breathing habits for the
better, forever.
f you’re hard-pressed for time and just want to get to the crux
of the exercises, then this section will get you started and contains a
number of useful tips.
This book has one main objective: to improve your breathing
during sleep. The exercises and techniques herein will help you to
breathe quietly at night, experience deeper sleep, wake up more
refreshed, and stay alert and focused during the day.
Central to the Buteyko Method is the Control Pause measurement,
which allows you to track your progress and measure relative
breathing volume during rest and sleep. You can learn how to
perform this easy test on next link . As you progress through the
program, your Control Pause should steadily increase, bringing with
it huge benefits to sleep and health.
To improve your Control Pause, it is important to apply three basic
tenets of breathing:
1) Breathe through your nose (link )
2) Adopt correct posture (link )
3) Practice Buteyko Breathing exercises (link )
A summary of what to do can be found on next link .
The Buteyko Method is all about learning to breathe to maximize
body oxygenation, which in turn improves sleep and general well-
being. To achieve this, it’s important to understand how our bodies
and breathing habits work together. If you’d like to know the science
behind the theory, then take a look at the section Simple Breathing
Basics (link ).
MEET BUTEYKO
he Buteyko Method was developed in the 1950s by Russian

doctor Konstantin Buteyko. Since then, hundreds of thousands of
people have practiced his method to help a variety of conditions
including snoring, sleep apnea and insomnia.
As a young doctor, Buteyko spent many months sitting at sick
patients’ bedsides, observing their state of health, and noticed that
patients’ breathing became more intense as their health
deteriorated. As patients' illnesses advanced, he noted that
breathing movements from the chest and stomach increased,
breathing became more audible, breathing rate became faster, and
that the patients sighed and breathed more frequently through their
mouths.
These observations raised a fundamental question for Buteyko: did
his patients’ illnesses contribute to their heavy breathing or did
their heavy breathing contribute to their illnesses?
At the time, Buteyko suffered from severe high blood pressure that
continued to worsen. Based on his findings, he experimented with
slowing down his breathing so that less air entered into his lungs.
Reducing breathing to the point that there is a tolerable feeling of air
shortage helps to activate the body’s relaxation response, and this is
likely to be the reason that Dr Buteyko normalized his blood
pressure without the need for medication.
Over the following decades, Buteyko extensively researched the
connection between breathing habits and health, and operated a
dedicated laboratory to further his findings. His breathing method
was brought to the West in 1990 and is now taught in many
countries to correct a variety of conditions and symptoms. The
Buteyko Method has become a popular technique for significantly
improving asthma control, and in recent years there has been a
major shift in awareness of the benefits of the method to treat sleep
disorders, including insomnia, snoring and obstructive sleep apnea.

here are two main aspects to the way we breathe: breathing

rate and tidal volume. Breathing rate relates to the number of
breaths taken in one minute, and tidal volume relates to the amount
of air taken with each breath. The volume of air we inhale is
measured in liters, and measurements are usually taken over one
minute.
A healthy breathing rate is 10 to 12 breaths per minute, with each
breath drawing in a volume of 500 milliliters. In a full minute, this
provides the body with a total volume of 5 to 6 liters. 1 A normal
breathing pattern should be quiet, still, calm, relaxed, regular,
through the nose and driven by the diaphragm.
If you listen to the breathing of someone who snores or has sleep
apnea, without a doubt you will find it to be noticeable, relatively
fast and noisy. People who suffer with snoring and sleep apnea
breathe in more air than average, and commonly take 15 to 20
breaths per minute, with each breath taking in more than the
normal 500ml of air. Assuming that each breath is approximately
700ml, the average breathing volume for a person who snores or
has sleep apnea is 10 to 15 liters of air per minute. To use food
intake as a comparison, this is akin to eating 6 to 9 meals each day!
A normal breathing volume of 5 to 6 liters of air per minute ensures
that the blood is almost fully saturated with oxygen. Habitually
breathing a volume of air greater than normal – a condition that is
clinically described as ‘chronic hyperventilating’ – does not add any
more oxygen to the blood, however. It is like pouring more water
into a glass that is already filled to the brim – unnecessary and
excessive. Instead, the bad habit of breathing too much every
minute, every hour, and every day causes a detrimental reduction of
carbon dioxide in the lungs and blood.
Contrary to popular assumption, carbon dioxide is not just a waste
gas. In fact, it performs a number of vital functions in the human
body, including o ffloading oxygen from red blood cells to tissues
and organs, including the heart and brain. For oxygen to be released
from the red blood cells, carbon dioxide must be present. Over-
breathing causes too much carbon dioxide to be removed from the
blood through the lungs, resulting in less oxygen being delivered to
tissues and organs. The relationship between carbon dioxide and
blood oxygenation was discovered in 1904 by Danish physiologist
Christian Bohr and is known as the Bohr Effect. Carbon dioxide also
plays a vital role in relaxing the smooth muscle that is embedded in
the airways and blood vessels, facilitating improved breathing and
blood circulation. For more on the role of carbon dioxide, see link .
Practicing the breathing exercises in this book increases carbon
dioxide in the blood, which in turn improves blood flow and the
delivery of oxygen to tissues and organs. Therefore, in addition to
helping with sleep-disordered breathing, the exercises are very
effective for improving blood circulation and can have a positive
impact on overall health.
People who sleep with an open mouth breathe large volumes of air
into their body all night long. Breathing through the mouth causes
narrowing of airway space,2 and also reduces blood flow and oxygen
delivery to the brain, which often contributes to a feeling of
exhaustion during the day, and difficulty in getting up in the
morning.
WHAT IS SNORING?
noring, often the subject of jokes about rattling the windows

and waking the baby has a much more serious side. Left untreated,
snoring may progress into sleep apnea, high blood pressure or
cardiovascular complaints.
Snoring worsens with age, gender, obesity, alcohol intake, cigarette
smoking and nasal obstruction. It can be extremely disruptive to
sleep for both sufferer and sleeping partner. Snoring occurs when a
large volume of air passes through a narrow space, causing
turbulence in the soft palate, nose or back of the throat. There are
two factors at play here: the first is that the snorer is breathing too
noisily and heavily during sleep; the second is that their upper
airways may be narrow due to nasal congestion or structural issues.
The question to ask is whether they would still snore if their
breathing was calm and quiet.
Healthy non-snorers breathe quietly through their nose during the
night. Their sleep is deep and undisturbed, and they wake up feeling
refreshed.
People who breathe heavily during the night, on the other hand,
may experience a wide array of symptoms, such as snoring, sleep
apnea, disrupted sleep, insomnia, frequently needing to use the
toilet, and waking up fatigued with a dry mouth, sore throat, and a
blocked nose.
People who snore do so through their mouth, their nose, or both.
Snoring through the mouth is easiest to address – such snoring
stops when one learns to breathe through the nose during sleep.
(Explained on next link )
By learning to unblock the nose, switching to nasal breathing, and
normalizing breathing volume, breathing will become quiet, calm,
and still during sleep, and both types of snoring will cease.
Other treatments for snoring, such as nasal decongestants, nasal
strips, surgery, and dental appliances, aim to expand the airways to
make more room for airflow. However, while it is important to
consider airway size when addressing snoring and obstructive sleep
apnea, it is also vitally important to consider breathing volume.
Buteyko breathing exercises are specifically intended to change
breathing volume towards normal, and are an effective adjunct to
the treatment of snoring and sleep apnea.
pnea is a Greek word meaning ‘without breath’. There are

three types of apnea that occur during sleep: central, obstructive,
and a third type of mixed apnea which is a combination of the two.

Central Sleep Apnea
Central sleep apnea results from the brain failing to send the signal
to breathe. The person stops breathing during sleep and no effort is
made by the breathing muscles to resume breathing. Eventually, the
brain sends the right signals and breathing resumes. While central
sleep apnea is a rare condition in the general population, some
children and adults diagnosed with obstructive sleep apnea can also
have an occurrence of central sleep apnea.

Obstructive Sleep Apnea (OSA)
During your school days, y ou may remember reading about Joe the
"fat boy" from the Pickwick Papers written by Charles Dickens in
1837. Joe ate food in great quantities and was liable to fall asleep
during any situation. His breathing was heavy, he snored, and he
was continuously sleepy.
“Sleep!” said the old gentleman, “He’s always asleep. Goes on
errands fast asleep, and snores as he waits at table.”1
Originally described as Pickwickian syndrome, this type of
breathing was later categorized as obstructive sleep apnea
syndrome by Dr Christian Guilleminault. In the early 1970s, while
working at the Stanford University Sleep Disorders Clinic, Dr
Guilleminault teamed up with cardiologists to monitor the blood
pressure of sleeping patients. The team discovered that when
patients stopped breathing during sleep, their blood pressure
dramatically increased. When this continued over time, the increase
to blood pressure became permanent, occurring both day and
night.
Needless to say, obstructive sleep apnea exerts considerable stress
on the body, often resulting in poor health. People with obstructive
sleep apnea experience decreased quality of life and functional
capacity, alongside a markedly increased risk of cardiovascular
disease and death. There is growing evidence that OSA is also
associated with an increased risk of diabetes and cancer, and
constitutes a major treatable risk factor for hypertension, coronary
artery disease (CAD) and stroke.2
(A list of the symptoms resulting from sleep apnea can be found
on link .)
The prevalence of obstructive sleep apnea continues to increase,

and shows no sign of abating. In a 2009 paper published in the
journal Sleep Medicine, Dr Kevin Finkel and colleagues from the
Washington University School of Medicine, reported that
obstructive sleep apnea (OSA) affects approximately 20% of US
adults, of whom about 90% are undiagnosed.3
In a separate telephone poll of 1,506 adults in the USA, results
showed that 31% of men and 21% of women indicated a high risk of
OSA. For obese people, this figure jumps to as high as 57%.4
Obstructive sleep apnea is the most common type of sleep apnea in
humans, and involves a repetitive pausing of the breath during sleep
caused by the collapse of the upper airways (nose, nasal passages,
throat). Breathing may stop for as long as one minute or more, even
as the brain continues to send signals to the breathing muscles to
breathe.
Upon resumption of breathing, the individual takes a number of
large gasps of air into their lungs, snores for a period of time, and
then stops breathing again. This cycle of snoring, apnea, gasping,
and snoring continues all night long.
During an episode of apnea, the sleeper may not even be conscious
of holding their breath, or the racket created as they resume
breathing. It is usually their sleeping partner who lies awake,
listening and worrying, sometimes too fearful to go to sleep. Often,
snorers are urged by their partner to visit their family doctor to get
the condition checked out. The doctor, in turn, will usually refer the
snorer to a sleep clinic, where they may participate in a study on
how they breathe during sleep. This study is called a
polysomnogram and can be conducted overnight at the sleep clinic
or at home. During the study, brain activity, eye movement, heart
rate, blood pressure, breathing and blood oxygen saturation are
recorded. The most important data during the sleep study is known
as the apnea hypopnea index (AHI).
The apnea hypopnea index was developed by Dr Guilleminault and
is still used today to characterize the presence and severity of sleep
apnea. The AHI is generally expressed as the number of apneas and
hypopneas per hour:
· An apnea describes a complete stopping of the breath during
sleep for ten seconds or longer
· A hypopnea describes a reduction to breathing flow of greater
than 30% during sleep, lasting for 10 seconds or more, which causes
a decrease to blood oxygen saturation of at least 4%
An AHI of 5 to 15 is classified as mild obstructive sleep apnea; 15 to
30 is moderate OSA; 30 or more is severe OSA.
People who experience snoring and obstructive sleep apnea
breathe intensely. As part of my work, I am a frequent flyer, and
during long haul flights, drowsiness often sets in with some
passengers falling asleep. As their sleep deepens, I have a habit of
listening intently to their breathing, and sad as it seems- I
sometimes count the number of breaths per minute as well as
getting a sense of the speed and amplitude of each breath. Time and
time again, I witness that people who snore and who stop breathing
during sleep demonstrate a fast inspiration as they take a large
volume of air into their lungs with each breath. In other words, their
breathing is hard, which in turn increases the negative pressure in
the upper airways sometimes causing collapse and stopping of
breathing. In examining the relationship between breathing and
obstructive sleep apnea, it is important to consider two factors;
namely; the speed and volume of breathing as well as the diameter
of the upper airways.
In considering the speed and volume of breathing in causing
collapse of the upper airways, imagine a collapsible paper straw. If
you were to place one end of the straw in your mouth and inhale air
forcefully through it, the pressure would cause the inner walls of the
straw to collapse in on themselves. If you continued to draw air in
through the straw, the collapse would become more severe. In
engineering terms this is called the Bernoulli Principle: as fluid (or
in this case, air) flows, negative pressure develops at the periphery
of the flow. As the flow velocity increases, so too does the negative
pressure.5 In other words, the faster one inhales and the larger the
breathing volume, the higher the negative pressure and the greater
the force of collapse.
In essence, this is what happens during obstructive sleep apnea.
The individual breathes out, and just as they are about to breathe in,
the negative pressure created by trying to take air into the lungs
causes the walls of the upper airways to collapse. As the breath hold
continues, the breathing center in the brain sends messages to the
diaphragm to resume breathing. As the diaphragm contracts to draw
air into the lungs, increased negative pressure enforces the breath
hold.
The second factor is the width of the upper airways which includes
the nose, nasal passages and collapsible tube of the throat. People
with narrow upper airways – such as adults who persistently
breathed through their mouth during childhood – are more prone to
obstructive sleep apnea. To ensure normal development of the
upper airways, it is vital that children are encouraged to breathe
through the nose. The narrower the upper airway, the greater the
speed of air as it flows into the lungs which in turn increases the
negative pressure.5 Consider what happens when using a gardening
water hose. As you choke the hose and reduce the diameter, the
speed of the flow of water increases.
During the pause in breathing, oxygen is continually extracted by
the cells to power the functions of the body but is not replenished by
breathing. After a time, the oxygen de-saturation of the blood
decreases enough to partially wake the brain and resume breathing.
The sleeper finally takes in a breath with a loud gasp, followed by a
series of heavy and intense breaths.
When the breath is stopped during sleep for a period of time, it is
normal for the individual to resume breathing with a series of gasps
as they suck much-needed air into their lungs. However, during this
catch-up period of breathing, too much carbon dioxide is lost from
the lungs and blood. To restore carbon dioxide levels to normal,
breathing reduces, which may be responsible for initiating the next
instance of apnea.6 This in turn causes another collapse of the
airways and the cycle repeats throughout the night.
Upper airway muscle tone determines the ability of the airways to
remain open during sleep. As we get older, the upper airway
muscles lose tone, resulting in a reduced ability to maintain an open
airway during sleep. For this reason, strengthening the upper
airways with orofacial myofunctional therapy along with breathing
re-education becomes imperative. According to Joy Moeller who has
been teaching myofunctional therapy for over three decades, this
non-invasive method involves neuro-muscular re-education of the
oral facial muscles through a series of exercises designed to:
· Eliminate oral habits (nail biting, thumb sucking and lip licking)
· Improve static and dynamic tongue position
· Improve lip seal
· Enhance nasal breathing
· Promote proper chewing and swallowing
The history of myofunctional therapy dates back to the 15th
century in Italy.7 In 1906, American orthodontist Alfred Rogers
taught exercises for the facial and throat muscles, and in 1918 he
wrote a paper entitled Living Orthodontic Appliances in which he
stated that proper functioning of the muscles of the face would
correct crooked teeth, thus highlighting the importance of good
facial muscle habits.7
Awareness of myofunctional therapy has surged in recent decades,
due in part to the publishing of papers in its support by prominent
sleep doctors including Dr Christian Guilleminault.
Most procedures for improving obstructive sleep apnea involve
attempting to open the airways – either by bringing the lower jaw
forward with surgery or dental appliances, or by using a continuous
positive airway pressure (CPAP) machine to splint open the airway
at night. The CPAP machine, which is considered the gold standard
for treatment of sleep apnea, was invented by Australian doctor
Colin Sullivan. The CPAP machine is a small unit comprising a hose
attached to a mask. The sleeper wears the mask at night, and the
machine blows air through the hose and into the mask at a pressure
sufficiently powerful to splint open the upper airways during sleep.
(See link for an examination of the research investigating
compliance and side effects of this approach.)
While the CPAP machine and the use of dental appliances to
advance the lower jaw are relatively successful in their own right,
they only target one half of the problem. To deal with sleep apnea on
a more permanent basis, it is also necessary to correct breathing
volume. Any engineer considering the diameter of a tube (or in this
case, airway) will also need to take into account the flow (breathing
rate and volume) – after all, one is entirely dependent on the other.
When researching the connection between breathing volume and
obstructive sleep apnea I was surprised to see that it was seldom, if
ever, measured during a sleep study. In fact, I could only find one
study which measured this correlation during sleep apnea. The
study, which investigated the breathing of twenty obese men with
OSA and normal lung function, found that they breathed 15 liters of
air per minute – approximately three times the healthy average. 8
In my quest to find further evidence of this link I researched the
incidence of obstructive sleep apnea in patients with diagnosed
asthma. People who suffer from asthma experience a far higher
incidence of obstructive sleep apnea than their non-asthma
counterparts, and many research papers have concluded that as the
severity of asthma increases, so does obstructive sleep apnea. For
example, one paper demonstrated that approximately 74% of
people with asthma also experience nocturnal symptoms of airflow
obstruction.9 In another study, it was found that obstructive sleep
apnea-hypopnea was significantly more prevalent among patients
with severe asthma, compared to those with moderate asthma, and
more prevalent for both asthma groups than control groups without
asthma.10 Given the relationship between asthma and OSA, it is
sensible to assume that treating one disorder will result in the
other's better control and vice versa.11 The Buteyko Method has long
been associated with improving asthma control, reducing symptoms
and the need for asthma medication. Currently, there are sixteen
clinical trials investigating the Buteyko Method for asthma with all
trials reporting positive results.
Even for children, the Buteyko Method is shown to be an efficacious
adjunct to conventional management. In one study involving 35
mouth breathing children with mild to moderate asthma, findings
show improved sleep, reduced school absenteeism and improved
lung function scores.
Just as with OSA, children and adults with asthma perform better
with nasal and light breathing. As each breath is drawn through the
nose, the gas nitric oxide is carried into the lower airways where it
helps sterilize the air, open the airways and improve arterial oxygen
uptake. Since nitric oxide is continuously released from the sinuses
into the nasal cavity, breathing light through the nose enables a
higher concentration of this miracle gas to enter the lungs and
perform its work.12 Nitric oxide concentrations of 50–200 parts per
billion (ppb) are transported to the lungs with every nasal
inhalation compared with 10 ppb during mouth breathing. 13
The link between asthma and obstructive sleep apnea is relatively
easy to explain, since we know that respiratory rate increases and
lung function decreases as asthma severity worsens.
The faster speed of breathing creates increased negative pressure
in the upper airways, causing the walls of airways to be sucked
inwards. Just as a CPAP machine works by sending a positive
pressure of air to splint open the airways, it follows that reducing
negative pressure by slowing down breathing can help prevent
collapse of the airways in the first place.
In terms of the reduction to lung function, the upper airways (nose
and throat) and lower airways (lungs) are mechanically linked such
that the upper airways function better when asthma is under good
control with improved lung function. 6 Conversely, when asthma is
under poor control, lung function reduces and the upper airway
collapses more easily thus contributing to apneas. Studies also show
that the majority of people with asthma also have nasal congestion 14
which in turn contributes to mouth breathing and as we shall see in
the following section, this causes increased risk of sleep apnea.

Mouth versus Nose Breathing
In Morbis Popularibis , Hippocrates observed that nasal polyps were
associated with restless sleep.15 The relationship between nasal
obstruction, mouth breathing, snoring and sleep apnea is well
documented,16-20 and for decades the Buteyko Method has been
successfully implemented to help control these conditions.
Persons with a history of nasal congestion due to allergy are almost
twice as likely to have moderate to severe sleep disorders than
those without nasal congestion.21
As we have already seen, the upper airways collapse when the
negative pressure generated as air is inhaled into the body exceeds
the ability of the muscles of the upper airways to keep the airways
open. Breathing through the nose or mouth during sleep has
implications on the messages sent to the muscles of the upper
airways. Researchers have found that the muscle activity of the
upper airways in keeping the airways open is higher during nasal
breathing than oral breathing.22
As air is drawn in through the nose, messages are sent to the upper
airway muscles to open in order to let the air pass into the lungs.
Conversely, there is a marked reduction in the opening of the upper
airways during mouth breathing. This inevitably will contribute to
collapse of the upper airways causing cessation of breathing. 23
It is interesting to note, that as we get older there is an increased
likelihood of breathing through the mouth during sleep. Research
highlights that persons over 40 years of age are six times more likely
than younger people to spend more than 50% of their sleep time
breathing through the mouth and nose combined. This is not good
news as over 40s are already at an increased risk of sleep disorders
including snoring and sleep apnea. Ideally, breathing should
exclusively be through the nose during sleep.24
In comparison with breathing through the nose, mouth breathing
during sleep reduces the diameter of the upper airway to create a
greater resistance to breathing.25 One study shows that mouth
breathing during sleep makes it up to 2.5 times more difficult to
breathe (upper airway resistance) as compared with nasal
breathing in normal people.25 Mouth breathing during sleep is also
more likely to cause the airways to cool and dry out, leading to
inflammation and further narrowing of the airways.
Anyone who has ever had a little too much to drink of an evening
will know how it feels to wake the following morning with your
throat dry and raw. The same thing happens when you breathe
through your mouth at night, as the excess air inflames and narrows
the airways. The body expends energy to condition incoming air
within the upper airways before it is drawn to the lungs. Taking too
much air in through the mouth traumatizes the upper airways,
leading to inflammation.
The amount of saliva in the mouth and throat plays an important
role in keeping the upper airways open.26 Mouth breathing and
possibly fast breathing through the nose will cause saliva to dry up.
The increased stickiness of the upper airways contributes to
collapse and makes it more difficult for the airways to reopen upon
resumption of breathing.27 It is important that the areas of the throat
and mouth remain moist during sleep in order for the muscles to
function properly.
This combination of larger breathing volume, stickier and narrower
airways is a recipe for obstructive sleep apnea.
Several research studies have showed how nasal breathing offers a
distinct advantage during sleep, resulting in fewer incidences of
obstructive sleep apnea than when a patient breathes through the
mouth at night.28 For example, in one study, the apnea hypopnea
index while breathing through the mouth was measured at 43 per
hour, while the nasal breathing AHI was just 1.5.25
In one interesting study, which aimed to determine the effect of a
blocked nose during sleep, subjects slept with their nostrils blocked
on one night and open on another. Blocking of the nose caused
participants to wake up more often, reduced the quality of their
sleep and caused a significant increase in sleep disorders. 29 And in
another study, to determine the effects of breathing through the
nose during sleep, researchers found that the number of sleep
disturbances significantly reduced when participants wore porous
paper tape across the lips during sleep. In yet another paper, the
wearing of a chin strap to prevent mouth breathing demonstrated
the same or better results in improving severe obstructive sleep
apnea than the use of a CPAP machine.30
Lastly, if the nose is congested, the opening to the upper airway is

impeded and a greater suction force is generated in the throat and
mouth causing collapse of the airway walls in some people. The
Starling resistor model (above image) of upper airway collapsibility
demonstrates that if there is an obstruction at the opening to a tube,
negative pressures can be generated downstream.22
Although a weight of evidence documents that nasal obstruction
negatively influences sleep, there are a number of papers showing
that treating the nasal obstruction with either nasal dilators,
steroids or surgery brings about only a minor benefit. 31 It is
important to note that treatment to improve functioning of the nose
is only likely to bring about benefits to sleep if the individual
switches to total nasal breathing during sleep.
If the individual continues to breathe through an open mouth after
nasal surgery or other treatments, then it is unlikely they will
experience much improvement to their quality of sleep. For this
reason, it is important for healthcare professionals to instruct their
patients of the necessity of total nasal breathing both during
wakefulness and sleep. Otherwise, the effect could possibly be
reduced.
In 1994, I had surgery to alleviate the feeling of chronic stuffiness in
my nose. Despite the procedure, I continued to breathe through an
open mouth for the next few years. My habit of mouth breathing was
ingrained from childhood, and with the pattern in motion, I didn't
automatically switch to nose breathing. To some extent, the surgery
was wasted as I wasn't aware of the importance of nose breathing or
even how to do it at that time. It was only after I learned of the
Buteyko Method that I made the switch to nose breathing and in a
matter of days experienced what it was like to wake up refreshed.
If you want to sleep better and wake up feeling energized and
refreshed, apply the three main tenets of the Buteyko Method:
breathe through your nose, adopt a correct posture and breathe
light. Another excellent way to assist with addressing obstructive
sleep apnea is myofunctional therapy, which consists of neuro-
muscular re-education of the oral facial muscles. Through a series of
exercises, participants improve tongue position, enhance nasal
breathing and strengthen the upper airways. Further information on
myofunctional therapy is available from Academy of Orofacial
Myofunctional Therapy.
IMPLICATIONS OF OBSTRUCTIVE
SLEEP APNEA
Adults
· Excessive daytime sleepiness (falling asleep while eating,
talking or driving)
· Waking up tired
· Causing sleeping partner to worry (while the sufferer may be
unaware of sleep disturbance)
· Loud snoring
· Problems with memory and concentration
· Morning or night headaches (affecting approximately 50% of
patients)
· Heartburn or reflux
· Needing to visit the bathroom during the night
· Elevated blood pressure during the day, increasing the risk of
hypertension and heart disease
· Blood oxygen desaturation

Children younger than five years of age
· Frequent waking
· Snoring
· Sweating
· Mouth breathing
· Restlessness
· Failure to thrive

Children over five years of age
· Snoring
· Short attention span
· Poor academic performance
· Behavioral problems
· Bed wetting
· Not growing as quickly as they should for their age
MOUTH BREATHING DURING CHILDHOOD
INCREASES THE RISK OF LIFELONG OBSTRUCTIVE
SLEEP APNEA
t is inevitable that a child with a blocked or stuffy nose will

breathe through the mouth. Persistent breathing through the mouth
during childhood can lead to poor development of the facial
structures, causing an undeveloped chin, narrow face and nostrils, a
high and narrow upper palate, gummy smile, crooked teeth, sunken
cheeks and eyes, and a larger nose.1-4
Breathing through the nose with the tongue in the correct resting
posture helps to ensure normal development of the face and jaws,
producing good airways, pleasant facial features, a good-sized nasal
cavity, and straight teeth.5,6
In understanding the role of nasal breathing in facial development,
it’s important to understand that the position of the tongue
influences the growth of the face. When a growing child breathes
with the mouth closed, the tongue is able to rest in the roof of the
mouth and shape the jaws in a wide U shape, as well as guiding
forward growth of the jaws to develop a good upper airway. A wide
facial structure with well-developed jaws not only produces a more
attractive looking face but is healthier as well. Well-developed jaws
and airways are crucial for athletic performance and significantly
reduce the risk of lifelong obstructive sleep apnea. The illustration
below conveys the facial features associated with nose breathing
and correct tongue posture during childhood.
If the mouth is hanging open, the tongue is not able to rest in the
roof of the mouth. Try it for yourself: rest three-quarters of your
tongue against the roof of your mouth, then open your mouth and
try to breathe. It’s not easy.
Chronic mouth-breathers have a low resting tongue posture which
leads to narrow jaws and overcrowding of teeth. 7-9 It is even more
important to recognize that mouth breathing causes the face to sink
downwards, meaning the jaws don’t develop adequately on the face.
The result is increased risk of lifelong sleep-disordered breathing
(including obstructive sleep apnea), 10-14 poor academic
performance,15 behavioral issues and a less attractive face.
The following illustration conveys craniofacial changes associated
with persistent mouth breathing during childhood.
Breathing through the nose is also very important to ensure good
quality sleep. After a night spent breathing intensely through the
mouth, a child will wake up exhausted, resulting in poor
concentration and frustration at school. 16 If this continues over a
period of time, a psychological evaluation and possible diagnosis of
attention deficit hyperactivity disorder (ADHD) may follow.
Whenever I speak to a parent whose child has been labeled with
ADD, my first piece of advice is to check their sleep habits. Are they
breathing through their mouth? Are they twisting and turning
during the night, waking up with the bedclothes tangled in the
morning? Do they snore or hold their breath during sleep? Is their
breathing audible? Answering yes to any of these questions suggests
that the child is suffering the detrimental effects of sleep disordered
breathing. Nasal breathing is of the utmost importance if you wish to
improve your child’s quality of sleep. Any adult will understand the
knock-on effect of crankiness and frustration when they have a poor
night’s sleep – so how can a child face the day with boundless
energy if their sleep isn’t right?
Enlarged tonsils and adenoids often play a role in children with
sleep disordered breathing. Clinically, it is recognized that
enlargement of these tissues is often associated with habitual
breathing through the mouth. The typical standard of care in the
Western world is for children to undergo surgery to remove
enlarged tonsils and adenoids. With the obstruction removed from
the upper airways, both breathing and sleep usually improve.
However, if the child does not switch to nasal breathing, though they
may experience short-term improvements after an
adenotonsillectomy (T&A), continued breathing through the mouth
may lead to abnormal impacts on airway growth with a high risk of
sleep apnea returning in the months or years ahead. 17
Dr Christian Guilleminault’s research found that children with
missing teeth, whether due to extractions as part of orthodontic
treatment or due to genetically missing teeth, suffered an increased
risk of obstructive sleep apnea. It is vitally important that children
retain all of their adult teeth. If teeth are removed as part of
traditional orthodontic treatment, the jaws move inwards, thereby
reducing the diameter of the upper airway. A smaller upper airway
increases resistance to breathing – a contributing factor in
obstructive sleep apnea.
Overcrowding of teeth is not necessarily due to the teeth being too
big for the jaws. More likely, it is that the jaws are too small to
adequately house all teeth, which can be caused by thumb sucking
or mouth breathing.
If your child is seeking orthodontic treatment, insist that the
orthodontist creates a functional appliance to gently expand the
child’s jaw to make room for existing teeth rather than extracting
teeth. For more on this subject, visit RightToGrow.org, a patient-led
website set up to increase awareness of the negative impact of
extractions and retractive orthodontic treatment.
Breastfeeding is a beneficial way to ensure nasal breathing during
the first months of an infant’s development. However, if a child is
tongue tied, breastfeeding can be very difficult for both baby and
mother. To express milk from the breast, the baby’s tongue needs to
move freely up and down. If the tongue is tied to the floor of the
mouth due to a short frenulum, the baby doesn’t get enough milk
and the mother often gets very sore.
At an AAMS (Academy of Applied Myofunctional Sciences) sleep
conference in Bordeaux, one speaker explained how midwives in
sixteenth century France grew an extra-long fingernail to release
tongue ties soon after birth. Bizarre as it may sound, this precaution
may have been the difference between life and death for many
children. Our ancestors knew the importance of free movement of
the tongue, while today tongue-ties in newborns too often go
undetected.
Breastfeeding is obviously important for providing proper
nutrition, but it also serves another vital function in infant
development as it encourages the baby to work the muscles of their
face and jaw. And while introducing the bottle is often necessary, it
simply doesn’t provide a sufficient workout to help ensure nasal
breathing and adequate development of the jaws. As bottle feeding
is a fact of life in today's modern world, parents who are aware of
the deleterious effects of chronic mouth breathing can address the
issue much sooner by applying the Buteyko Method along with
Orofacial Myofunctional Therapy. (Orofacial Myofunctional Therapy
is an excellent therapy to help with obstructive sleep apnea in
children and adults. See aomtinfo.org)
On a personal note, I understand the necessity of both parents
having to work full time in order to support a family and mortgage.
And while most mothers would love the opportunity to nurse their
child for the first six months to one year of life, many are not in a
position to do so. I also understand the negative effects of tongue tie
and congenitally missing teeth, as my daughter experienced both. In
order to reduce the risk of lifelong obstructive sleep apnea, I
continually encourage her to breathe through her nose. I also had
her tongue tie addressed as well as early functional orthodontic
treatment using an appliance called an ALF, which I am happy to
state has produced tremendous results in gently expanding her
jaws. With this information in hand, I am fortunate that I can help
minimize the risk of my daughter developing lifelong sleep
problems. Above all else, I don't want her to go through the same
sleep problems that I experienced until the age of 25 years.
The negative effects of chronic mouth breathing are recognized
within the medical and dental profession, yet it seems that very few
parents are aware of it. A 2012 paper published in the International
Journal of Pediatrics investigating the long-term changes to facial
structure caused by chronic mouth breathing noted that this
seemingly ‘benign’ habit in fact has immediate and/or latent
cascading effects on multiple ‘physiological and behavioral
functions’. The paper even suggested that habitual mouth breathing
may be connected to sudden infant death syndrome (SIDS). 18
WHAT IS INSOMNIA?
nsomnia is one of the most common sleep disorders, affecting

between 25-30% of the general population, with 10% of people
presenting chronic complaints and seeking medical help. 1 Insomnia
is a state in which you are never fully asleep and never fully awake.
Characteristics include a difficulty falling asleep, staying asleep,
waking early and interrupted or non-restorative sleep.
The cause of insomnia is often connected to psychological roots
such as anxiety, depression, periods of prolonged stress, a reaction
to a traumatic event, or an overactive mind. Anyone who has had
trouble sleeping will relate to the frustration of not been able to fall
asleep due to persistent thoughts that refuse to switch off.
If you suffer from insomnia, practicing the Reduced Breathing
exercise in this book will help to quieten your mind and bring your
body into relaxation. (See link ) This technique works in two ways:
by paying attention to your breathing you take attention away from
the mind, thereby reducing thought activity; and by reducing
breathing volume your body is able to deal with the physiological
aspects of stress by activating the relaxation response.
Light, disturbed sleep leads to waking up feeling lethargic, lowering
productivity, and increasing stress levels.2 In addition, researchers
have consistently reported a relationship between poor sleep and
high blood pressure. This connection may be explained by the bodily
stress insufficient sleep places on the nervous system. 3 All in all;
poor sleep reduces your quality of life, and is often connected to the
way you breathe at night.
n this section, Buteyko meets ‘Joe’, a patient suffering from

snoring and sleep apnea, teaches him to recognize the effects of
over-breathing, and explains how to reverse it.
Buteyko explains to Joe: “ Quite simply, your lifestyle over the years
has changed your breathing. Now you regularly breathe through
your mouth day and night. You sigh quite often, especially when you
get a little stressed. Your breathing is sometimes noisy during the
day and at rest, and I can see visible movements in your tummy and
chest when you breathe.
“And, of course, when you breathe heavily during the day, it follows
that you will also breathe heavily at night. Joe, you are here to
address your snoring and sleep apnea. This might surprise you, but
they are connected, and have a single contributory factor: over-
breathing!”
“Over-drinking, over-eating, lack of exercise, stress, stuffy rooms
and excessive talking all cause over-breathing. And your over-
breathing is severely affecting your health. It contributes to your
nose becoming blocked. It disrupts your sleep and it can result in
snoring, sleep apnea and insomnia.”
“But everybody I meet advises me to take deep breaths and fill my
lungs with oxygen,” Joe says, “How can I be sure that what you are
telling me is true?”
Buteyko explains that none of these people understand how oxygen
is released from red blood cells. “If they knew about the Bohr Effect,
they wouldn’t advocate heavy breathing or taking big breaths.”
“When Lavoisier discovered oxygen, he likened the human body to
fire. Just like fire, the human organism consumes oxygen and gives
off carbon dioxide. However, this is not the complete story. Not all
oxygen is good, which is why we have antioxidants. Not all carbon
dioxide is bad – in fact, several healthy bodily functions are very
dependent on this gas. It is very important that we have the correct
partial pressure of both gases within our body. However, when we
breathe in excess of bodily requirements, our health is negatively
affected.”
Buteyko then tells Joe to forget about the theory for a moment, and
asks him how he feels when he breathes heavily through his mouth
for a few minutes.
Joe knows only too well. “When I do that, I feel dizzy and light
headed. My brain does not function as well.”
Buteyko is happy that Joe has discovered the connection between
breathing too much and less oxygen reaching the brain.
Most people in the Western world over-breathe. It is a factor of
modern living, but how it affects each individual depends on genetic
predisposition.
Buteyko asks Joe whether he wakes up tired in the morning. Joe
replies, “Yes, I do.”
Buteyko explains that this too is related to the way he breathes.
GOOD BREATHING

HOW TO MEASURE YOUR RELATIVE
BREATHING VOLUME
measurement called the Control Pause (CP) was developed

by Buteyko to measure relative breathing volume. Quite simply, it is
the length of time you can comfortably hold your breath following
an exhalation. All you need is a watch or clock with a second hand to
measure your Control Pause.
1. Take a small, silent breath in, and a small, silent breath out.
2. Hold your nose with your fingers to prevent air from entering
your lungs.
3. Count how many seconds until you feel the first signs of air
hunger.
4. At the first sign of air hunger, you may also feel the first
involuntary movements of your breathing muscles. Your tummy
may jerk. The area around your neck may contract.
5. Your inhalation at the end of the breath should be calm.
6. Release your nose and breathe in through it.

Please take note of the following important points before you start:
· The breath is held until the first stress to breathe or the first
involuntary movements of the breathing muscles. It is not a measure
of the maximum length of time that you can hold your breath.
· Your CP only measures your breath hold time. It is not an
exercise to correct your breathing.
Remember that taking your CP involves holding your breath only
until the first involuntary movements of your breathing muscles. If
you have to take a big breath at the end of the breath hold, then you
have held your breath for too long. It is interesting to note that
researchers have reported the breath hold time to be shorter in
snorers than non snorers.1
From time to time, I observe persons with obstructive sleep apnea
reach an unusually long Control Pause despite displaying relatively
noticeable breathing. In other words, their Control Pause is not
reflective of their breathing pattern. In this situation, I don't use the
Control Pause, and instead encourage the person to breathe through
their nose and practice reducing their breathing towards normal
levels. As breathing volume and speed normalizes, the severity of
their obstructive sleep apnea reduces.
To make progress, you must be aware of the following guidelines:
· You will feel better each time your CP increases by 5 seconds.
· If your CP does not change, you will not feel better.
· Your CP should increase by 3 to 4 seconds each week, especially
during the first few weeks. Progress will slow when the CP reaches
20 seconds.
· The most accurate CP is taken first thing after waking. This
measurement is most accurate since you cannot influence your
breathing during sleep, and your morning CP is therefore based on
your breathing volume as set by your respiratory center.
· Taking your CP throughout the day will give you feedback on
your breathing at different times.
· The most important CP is taken first thing in the morning. Soon
after waking, sit up on the bed and take your CP. Your goal is to
achieve a morning CP of 40 seconds for 6 months.
THE THREE TENETS TO NORMALIZING YOUR
BREATHING

THE FIRST TENET: BREATHE THROUGH YOUR
NOSE DAY AND NIGHT
earning to breathe permanently through the nose is the first

step to addressing over-breathing. The nose serves a number of very
important functions:
· Warms and humidifies incoming air.
· Removes a significant amount of germs and bacteria.
· Results in more regular breathing (chaotic breathing disturbs
blood gases, which can play a role in experiencing stress).
· Improves oxygen uptake in the blood.1
Conversely, mouth breathing contributes to various common
symptoms and conditions:
· Results in a dry mouth, which increases acidification of the
mouth and can result in more dental cavities and gum disease.
· Contributes to dehydration.
· Proven to significantly increase the number of occurrences of
and severity of apneas.
While it is very important that the mouth is closed for both children
and adults during the day, it is absolutely vital that the mouth is
closed during sleep. A closed mouth during sleep helps ensure that
the tongue rests at the roof of the mouth. When we sleep with our
mouth open, the tongue falls back and makes the airway smaller and
the floppy bits vibrate loudly with each inhalation to result in
snoring. When the sagging of the mouth and throat develops into a
total inward collapse of the airways, the sleeper becomes unable to
breathe and experiences an apnea.
Nasal breathing performs at least thirty functions on behalf of the
body.1 Along with providing a sense of smell, the nose is nature’s
way of filtering and preparing air before it enters the lungs.
Since the nostrils are much smaller than the mouth, nasal breathing
creates approximately 50% more resistance in comparison to
mouth breathing during wakefulness, resulting in a 10-20% greater
oxygen uptake in the blood.1 Conversely, in individuals without nasal
congestion, resistance in the upper airway is lower during sleep
while breathing through the nose as opposed to the mouth. 2
Breathing optimally through the nose not only increases blood
oxygenation, but also increases the amount of oxygen delivered to
tissues and organs.1
Contrary to the popularly-held opinion to breathe ‘in through the
nose and out through the mouth’, it is in fact more advantageous to
breathe both in and out through the nose. Not only does nasal
breathing facilitate better body oxygenation, but it also helps to
prevent a blocked nose and generally allows for easier breathing
during rest and exercise.
Studies have shown that exhaling through the mouth can result in
the loss of heat and up to 42% more water than exhaling through
the nose.3,4 This increased heat and water loss may result in
symptoms of nasal obstruction (blocked nose) and difficulty
breathing. In a vicious cycle, a blocked nose encourages the
individual to continue mouth-breathing and perpetuates the
condition. Somewhat counter-intuitively, breathing through the
nose can help to keep the airways unblocked, prevent dehydration,
and improve healthy breathing volume. Practicing breath hold
techniques can also be used to easily decongest the nose.
In one research study, the effects of breath holding on nasal
resistance were assessed, and it was found that holding the breath
for 30 seconds or longer helped to open up the nasal passages to
make breathing easier.5 In addition, the study discovered that
physical exercise also decreased nasal resistance. This is of
particular relevance to anyone with nasal obstruction or hay fever.

To unblock your nose, try the following exercise:
· Take a normal, silent breath in through your nose.
· Allow a normal, silent breath out through your nose.
· Hold your nose with your fingers to prevent air from entering or
escaping.
· Nod your head up and down or sway your body until you feel a
medium-to-strong need for air.
· Hold your breath for as long as you comfortably can.
· Let go and breathe in through your nose.
· Calm your breath immediately.
Wait for one minute and repeat. Repeat five or six times until your
nose is completely free. Practice the exercise any time your nose
feels blocked to temporarily decongest your nose. Your nose will be
more permanently free when you are able to reach a Control Pause
of over 25 seconds.
The above exercise was included as part of a study undertaken by
Dr Adelola and colleagues from the Department of Otolaryngology at
Limerick University Hospital in Ireland to investigate the
effectiveness of the Buteyko technique on the nasal symptoms of
patients with asthma.
Results showed a 70% reduction of nasal stuffiness in asthma at a
three-month follow-up.1
racticing nasal breathing during the daytime can be achieved

easily with a little focus. But what about at night? How can you keep
your mouth closed when you sleep?
An effective way of ensuring that you continue to breathe through
the nose during sleep is the technique of using paper tape to keep
the mouth closed. You can buy one-inch paper tape at any chemist
or drug store – I recommend the 3M Micropore brand. A tailored
variation of the tape is called LipSealTape which is available from
LipSealTape.com. Another useful product is called SleepQ+
(available online), a reversible adhesive gel that keeps the lips
closed to prevent involuntary mouth breathing during sleep.
Though it might feel strange at first, wearing tape or SleepQ+ while
you sleep quickly becomes a comfortable habit that helps you to get
a good night’s sleep.
The benefits of nose breathing during sleep include:
· Calm, restful, uninterrupted sleep
· Fewer wakings during the night, and more likelihood of
sleeping straight through the night
· Waking up feeling rested, clear headed and energized
· Being more productive during the day as your alertness and
concentration improves
How to use paper tape at night:
Tear off about 6 inches (10 centimeters) of paper tape. Fold over a
small piece at one end to make removal easier. Dry your lips with
your fingers. Draw your lips inwards and place the tape horizontally
to cover your mouth. Go to sleep with your mouth closed.
You may find when you first try taping your mouth you feel as if you
aren’t getting enough air. The reason for this discomfort is due to
the fact that your body has become accustomed to your heavy
breathing through the mouth. But it can adapt – it only takes a short
space of time before you get used to breathing through your nose
instead. After a couple of weeks of practice, and with lighter
breathing and a higher Control Pause, you will find it more
comfortable to breathe through your nose during sleep.
If you are really struggling with breathing through your nose during
sleep, there is a solution to help you adjust. Wearing a nasal dilator
can help to open your nasal passages and make breathing easier as
you become used to breathing through your nose at night. There are
two products on the market which serve this purpose: Breathe Right
strips (which are available over the counter) and the Mute (which is
available from MuteSnoring.com). Wearing these products will make
the transition a lot easier.
If you need help adjusting to nasal breathing at night, try wearing
the paper tape, LipSealTape or SleepQ+ across your mouth as well
as a nasal dilator. This may not help your romantic life, but it will
certainly help your sleep. You will find a remarkable difference to
the quality of your sleep, and no doubt your sleeping partner will
appreciate the change as well. (For videos on applying both the tape
or SleepQ+, visit our YouTube Channel; ButeykoClinic.)
Please note: this method is not suitable for children under five-
years-old. Any child taping their mouth at night must be able to
remove the tape if they feel the need to. If during the night you find
it difficult to breathe while using LipSealTape or SleepQ+, then wear
a nasal dilator to assist easier airflow through the nose. Try not to
revert to mouth-breathing during sleep which will only make your
symptoms worse. Important: do not use tape at night if you are
feeling nauseous or have been drinking alcohol.
The second tenet of correct breathing is good posture. Slouching
compresses the diaphragm and results in breathing from the upper
chest. Ventilation perfusion describes the ratio of the amount of air
to the amount of blood reaching the small air sacs in the lungs per
minute. In a perfect situation, the oxygen provided from breathing
would be just enough to saturate the blood fully with oxygen.
Poor posture, breathing through the mouth and gravity can lead to
a situation where the higher parts of the lungs receive more
ventilation, and the lower parts greater amounts of blood. Adopting
a good posture and breathing through the nose helps with a more
efficient matching of blood flow to ventilation.1
Become aware of your posture when you sit, and how it affects your
breathing.
The ideal sitting position is the ‘horse rider’:
· Sit at the edge of chair with your feet tucked underneath
· Imagine a piece of thread drawing you upwards from the top of
the back of your head
· Imagine the spaces between your ribs widening
Learn to be aware of your posture when you sit, walk, and run.
THE THIRD TENET: REDUCE BREATHING VOLUME
TO CREATE A NEED FOR AIR
uteyko explains the third tenet to Joe, which involves

creating a need for air through relaxation of the respiratory
muscles:
“To normalize your breathing volume, you need to practice simple
relaxation exercises. This is achieved by bringing a feeling of
relaxation to your body and silently encouraging your breathing to
decrease to the point where you feel a tolerable hunger for air.
When the body experiences a sustained shortage of air, the
breathing center in the brain is reset to a lower breathing volume,
encouraging calmer and gentler breathing. As you become
accustomed to keeping your breathing quiet, it will gradually
become a permanent breathing habit.”
Joe: “Buteyko, I’m confused; what is a hunger for air and how strong
should it be?”
Buteyko: “Hunger for air means experiencing the urge to breathe
more. It is a feeling of breathlessness, similar to what you might
experience if you go for a brisk walk. It can also be described as
feeling slightly suffocated.
“Ideally, you will feel a tolerable need for air. This need for air
should be the same as that experienced during the Control Pause
measurement. If you reduce your breathing too much, the air
shortage is no longer tolerable and your breathing muscles will jerk
and heave. When the breathing muscles spasm, it is a sign that you
should stop the exercise and wait for about thirty seconds before
resuming gentle, reduced breathing through relaxation.
“Initially, you will only be able to tolerate a shortage of air for a
short period, maybe fifteen seconds or so, until your tummy muscles
begin to jerk. However, with practice, and as your Control Pause
increases, it will become easier to maintain a gentle air shortage
over a number of minutes.”
Joe: “Okay, I’ll try.”
Joe puts his hand on his chest and tummy and focuses on his
breathing. He feels the air entering and leaving his nose. He feels the
air hitting the back of the throat. He also feels his chest and tummy
moving. To improve his awareness, Joe spends several minutes
paying attention to the slightly cooler air entering his nose and the
slightly warmer air leaving his nose.
When he has achieved a good awareness of his breathing, Joe starts
to silently give himself the following reminders: “Relax my chest,
relax my tummy, allow my breathing to reduce, slow down, and
quieten.”
In addition to this mental encouragement, Joe also brings a sense of
inner relaxation to the area around his chest and tummy.
While bringing a feeling of relaxation to his body, Joe takes a
smaller breath in than he is used to, and allows a slow, gentle
relaxed breath out. He feels his chest and tummy relaxing.
Small breath in; relaxed breath out.
He mentally instructs his body to relax and, as his body relaxes, his
breathing becomes quiet and calm.
Joe now shows far less breathing movement from his neck
downwards. His breathing is almost invisible. He feels a tolerable
need for air.
Buteyko: “Joe, you are doing wonderfully well. You have created a
hunger for air. I know this because I can see that you are
concentrating on your breathing. Your breathing movements have
relaxed and have been reduced by about thirty per cent. I also know
that you have air shortage because your eyes are glassy. There is a
shine to them. You feel warmer as the reduced volume of breathing
helps open up blood vessels and improves blood circulation. Finally,
you are experiencing increased saliva in your mouth which indicates
activation of the body’s relaxation response.”
· Follow your breathing for a minute or so. Feel the slightly
colder air as it enters your nose, and the slightly warmer air as it
leaves your nose;
· Encourage the area around your chest and tummy to relax;
· Bring a feeling of relaxation to your body;
· Silently encourage your breathing to slow down and quieten;
· Slow down the speed of air as it enters and leaves your nostrils,
or take a shorter breath than you feel you need, and allow a relaxed
breath out;
· Allow your breathing volume to reduce to the point that you
feel a tolerable need for air;
· Try to sustain this hunger for air for a few minutes.

REDUCE BREATHING ONLY THROUGH
RELAXATION OF THE RESPIRATORY MUSCLES
oe is delighted that he is doing the exercise correctly. He wants

to do more. He begins to reduce his breathing further by
deliberately tensing his tummy muscles. He tenses the muscles in
his tummy to reduce his breathing. He puts the brakes on his
breathing. This creates tension and a far stronger air shortage. His
tummy starts to jerk and his breathing rhythm becomes very
disrupted.
Buteyko: “Joe, the most effective way to reduce your breathing is
not through deliberate efforts. Do not try to constrict your breathing
movements by tensing the tummy or chest muscles. Breathing is not
something that can be forced into place.
“By encouraging your body, chest, and tummy to relax, your
breathing will automatically quieten. This alone can create a need
for air. If it does not, then encourage your breathing to become
quieter and calmer. Encourage your breathing to slow down and
relax. Encourage your breathing to reduce through your thoughts
and inner relaxation. But don’t tense your breathing muscles to
create the need for air.”

Buteyko advises Joe to reduce his breathing for one formal session
each day. A typical format for such a session is as follows:
· Sit and relax for a few minutes
· Measure your Control Pause (CP) - see link
· Practice five minutes of relaxation to create an air shortage
· Rest with normal breathing for half a minute
· Wait five minutes and measure your final CP
· Your final CP should be twenty percent higher than at the start
Initially, it’s better to practice this exercise when you are not
distracted. Go to a quiet room. Turn off your mobile phone. Over
time, you will be able to allow your breathing to relax and become
quiet in any situation.
Another option is to listen to my self help audio file which will guide
you through the reduced breathing exercise. To receive the file, send
an email to: info@buteykoclinic.com and state that you have the
kindle version of Sleep With Buteyko. Listen to the audio file as soon
as you go to bed. It is twenty minutes in length. While listening,
ensure that you feel a tolerable air shortage for the entire twenty
minutes.

SUMMARY
· Breathe only through the nose, and stop sighing. If you feel a
sigh coming on, swallow or hold your breath.
· Be aware of your breathing throughout the day.
· Incorporate gentle reduced breathing through relaxation into
your way of life. Breathe softly when in bed, in your car, watching
TV, or at work.
· Try to avoid deliberately interfering with your breathing by
tensing the area around your tummy or chest.
· Instead, use your thoughts to slow down and soften the breath.

REVERSING INSOMNIA
ur modern lives are so busy and frantic that our minds are
bombarded with tens of thousands of thoughts each day, without a
break, but since everyone is caught up in it, few see it for what it
truly is. This endless cycle of thought contributes to insomnia. To
quieten the mind and improve your breathing, try to devote twenty
minutes to yourself every day.
By observing the breath, calming your inner body, and allowing
your breathing to reduce, the body’s relaxation state is activated. In
addition, the practice of watching your breath acts in a meditative
way and is very helpful to calming the mind. Your mind will be far
less distracted by thought while you are relaxing your body and
experiencing a shortage of air. Breathe less and give yourself a break
from your mind.
If you have never connected with your inner body before, try the
following exercise:
· Sit quietly in a comfortable position, hold your hand in front of
you and close your eyes. Can you feel your hand? Can you tell that
your hand is there? Bring attention to your hand. Hold your
attention there.
· After twenty seconds or so, when you are sure that you can feel
your hand, bring attention to your arm. With your eyes still closed,
hold your attention on your arm.
· Next, bring your attention as far as your shoulder. Sense the
subtle bodily sensations as far as your shoulder. Feel the inner body.
· When you can comfortably hold your attention on your entire
arm, gently move your attention across your chest. Feel the inner
chest. Sense the inner chest. Encourage this area to relax. You can
help relax it further by physically tensing and relaxing your chest.
Tense and relax, tense and relax.
· When you have a good sense of the area of your chest, bring
attention to the area around your tummy. You can also help the area
around your tummy to relax by physically tensing the tummy and
then relaxing it. To do this, gently exhale and pinch your nose with
fingers to hold your breath, and then try to gently breathe in and out
while holding your breath for five seconds or so. This technique will
help to activate a dormant or tense diaphragm.
· A stressed mind will always manifest in the tummy. Encourage
this area to relax. Encourage this area to still. Encourage this area to
be quiet.
When you bring your attention to the inner body, you will find your
mind is calm. You cannot think and keep your attention on the inner
body at the same time. Humans are not simply composed of a head,
but most people in the Western world are unaware of their body
unless it feels pain. The only time that they truly bring attention to
their body is when something is wrong with it. Make it a habit to
take your attention out of your head and disperse it throughout your
body for a minute or so at a time. What is more important is the
number of times throughout the day that you take your attention
into your body as opposed to the length of time you hold your
attention there during one sitting. Your body is in a state of stillness,
and taking your attention into it will help bring the mind into
stillness.
As you go about your daily activities, try to identify the useless
thoughts going around your mind. Observe your thoughts. Be a
passive observer. What are you thinking about? What purpose do
the thoughts serve? Are they the same thoughts that you have been
thinking for the past weeks, months, years? Are your thoughts
beneficial? Do they help you or are they simply insane and repetitive
nonsense that serves no purpose?
According to the laboratory of neuroimaging at the University of
Southern California, the average person has approximately 70,000
thoughts per day.1 Of these, it is estimated that 80-90% are
repetitive and useless.
An active mind, constantly running through thought after thought,
is difficult to switch off at night. If you spend most of your waking
hours investing in repetitive and useless thoughts, how can you
expect to break the habit when you go to bed? The more active your
mind during the day, the more active it will be at night. This is why
people often revert to alcohol and prescribed medications to help
them sleep. But this does not work. Numbing the mind with alcohol
or medication does not address the active mind; it only serves as a
sticking plaster, offering a temporary solution.
The best way to tame the mind is to observe your breathing
throughout the day, become accustomed to relaxing both body and
mind, and address chronic over-breathing. To help relax the mind
prior to sleep, play the audio file as soon as you go to bed. (Obtained
by sending an email to: info@buteykoclinic.com ) Quite often you
will find yourself fall asleep before the recording ends.
BREATHING EXERCISE TO HELP CALM THE MIND
AND STOP PANIC ATTACK
ometimes, if there is so much agitation in the mind, or the

breathing drive is quite strong, holding attention on the inner body
or reducing the breath can be difficult. If you are struggling to calm
your mind and breathing, a very simple exercise called Many Small
Breath Holds is a good place to start:
Perform Many Small Breath Holds of 2 to 5 seconds each, as follows:

· Breathe in through the nose, breathe out through the nose, and
hold your breath;
· Hold your breath for 2 to 5 seconds;
· After each breath hold, breathe normally through the nose for 10
seconds or so. Don’t interfere with your breathing;
· Continue to perform a small breath hold followed by gentle nasal
breathing for 10 seconds or so until your mind has calmed.
· If the mind is particularly agitated, it may be necessary to
practice this exercise for ten minutes every hour.
CORRECT BREATHING DURING PHYSICAL
EXERCISE
oe: “So Buteyko, do I always have to do the Reduced Breathing

exercise while sitting, or can I make the same progress while
exercising?”
Buteyko: “Yes, you can. In fact, exercise is an important factor in
increasing carbon dioxide in the body, alongside reduced breathing
volume. Carbon dioxide is the end product created by the
metabolism, so the more we move our muscles the more carbon
dioxide we generate. Applying the three tenets to physical exercise
will ensure maximum progress.
“While exercising, stand up straight and imagine that a piece of
thread is gently lifting you up from the top of the back of your head.
Breathe only through your nose and bring a feeling of relaxation to
your chest and tummy.
“As you walk, jog or run with your mouth closed, continue to relax
the inner body. In particular, relax the area around your chest and
tummy. Use your thoughts to tell your body to relax. This is the
exact same process as reducing your breathing while sitting.
“The objective is to create a need for air. To make progress,
breathing should always be through the nose. Ensure that you walk
at a pace that lets you keep your mouth closed. Breathing must be
controlled and the air shortage should not become so strong that it
causes you to breathe through your mouth. If you feel the need to
open your mouth to breathe during physical exercise, it is a sign that
you are pushing yourself too hard. Slow down instead, and exercise
at a level that is right for you.
“It doesn’t matter what sort of physical exercise you do. The aim is
to create a feeling of breathlessness and produce a sweat while
keeping your breathing controlled and through the nose.
“You will know that you are breathing correctly during physical
exercise if your CP is higher when measured half an hour after you
complete your exercise than it was before you began.
Another benefit of physical exercise is that it tires your body. You
always sleep better when you are physically tired.”
Breath holds during physical exercise

Please note: This exercise is best suited to children, teenagers
and adults who are in relatively good health. If your CP is less than
ten seconds, or if you have a heart complaint, high blood pressure,
or moderate to severe sleep apnea, it is not advisable to practice this
exercise.
Try the following exercise to incorporate breath holds into exercise:
· Begin walking while breathing in and out through your nose;
· After a couple of minutes walking, breathe in and out gently
through your nose;
· Pinch your nose with your fingers to hold the breath;
· While holding your breath, walk up to 20 paces;
· When you release your breath, calm your breathing
immediately;
· Walk normally with your mouth closed for 30 to 60 seconds to
recover, and repeat again;
· Repeat a medium-strength breath hold six to eight times during
a 20-minute walk.
The above exercise is an excellent practice for children and
teenagers who may not grasp the concept of reduced breathing
through relaxation. Further information on applying the Buteyko
Method with children is available from www.ButeykoClinic.com
FOOD AND SLEEP
s always, Buteyko is his usual direct self as he consults with

Joe.
Buteyko: “Why are you overweight?”
Joe: “I don’t know. It’s hereditary. I’ve always been overweight.”
Buteyko: “Have you ever seen a fat person during a famine?”
Joe: “No, that is a stupid question. How could one be fat during a
famine?”
Buteyko: “That is correct. You are fat simply because you eat too
much or don't move your body enough.
“When you breathe less, your metabolic processes also improve,
and the gastrointestinal tract receives more oxygen. Your need for
food may diminish helping your appetite to reduce and normalize.”

A good way to lose weight is to reduce your breathing to a normal
level and listen to your body:
· Eat when you are hungry
· Eat until you are satisfied
· Stop eating three hours before you go to bed

The benefits of losing weight include easier and lighter breathing as
well as a reduced neck size. When we gain too much weight, the
increase in neck size can result in a narrowing of the upper airways.
This in turn increases the negative pressure as air is drawn into the
lungs and contributes to sleep apnea.
Buteyko: “Look at this word: Breakfast. Divide it up and you have
‘break’ and ‘fast’. The first meal in the morning is required to break
the fasting our bodies have been doing overnight. In other words, it
is natural to wake up with an appetite.”
“However,” Buteyko continues, “If you gorge yourself before

sleeping, you will not wake up hungry. You will still be digesting the
food that you ate the night before. Eating and drinking alcohol late at
night only contribute to insomnia.
“And here is another word that you are fond of: desserts. Try
spelling it backwards.”
Joe: “Stressed!”
Buteyko: “And that is exactly how your body is feeling. Too many
desserts are contributing to your stress levels!
“Finally, avoid foods that produce symptoms of nasal obstruction,
increased mucus, and reflux. Typically, these foods include dairy,
stimulants, and sugars. As your Control Pause increases, all three
symptoms will reduce in severity.”
APPLYING THE BUTEYKO METHOD FOR SLEEP
DISORDERS
· Measure your Control Pause each morning upon waking. With
every five second improvement to your Control Pause, you will feel
better and experience deeper sleep and improved energy levels.
· Breathe through the nose both day and night.
· Practice Reduced Breathing exercise for ten minutes by three
times daily, along with fifteen minutes directly before bed. (link ) (If
listening to the audio file, try to ensure that you feel an air shortage
during the exercise).
· Spend half an hour to one hour performing physical exercise
with nose breathing during the day.
· Avoid sleeping on your back.
· Sleep in a cool airy bedroom.
· Avoid looking at mobile phones or laptops for two to three hours
before sleep.
· Don't eat late at night as it disrupts sleep.

Buteyko tells Joe that as his CP increases, his sleep will become
deeper and his need for sleep will lessen. He quotes German
philosopher Friedrich Nietzsche who once said that “Sleeping is no
mean art: for its sake one must stay awake all day.”
To improve your sleeping habits, only sleep when absolutely
necessary, and try getting up half an hour earlier than you normally
do. You should not find that you feel more tired during the day.
Instead, you will be suitably tired so that when you do go to bed, you
fall asleep easily.
For a great night’s sleep, practice reduced breathing for 15 to 20
minutes before sleep (you can do this while watching some light
television or relaxing in bed):
· Place one hand on your chest and one hand on your tummy;
· Gently soften your breathing to create a tolerable need for air;
· Continue with this exercise for a period of 15 to 20 minutes;
· Not only is this an excellent way to help with sleep-disordered
breathing, it also helps you relax and fall asleep easier.
It is vital to breathe through your nose during sleep. (See link ) You

can tell if you have been breathing through your mouth at night as
you will wake up with a dry mouth (and most likely smelly breath –
mouth breathers also have a higher level of gum disease and teeth
cavities than nasal breathers!). Your mouth should be naturally
moist when you wake up in the morning; nasal breathing ensures
this.
If you have a tendency to mouth-breathe during the night it is
important to change to nasal breathing. Two options include
wearing LipSealTape across the lips and using the product Sleepq+.
When you breathe through your nose, you will experience a better
night’s sleep and feel more refreshed when you awake in the
morning. Taping the mouth at night or wearing SleepQ+ initially
may seem like a scary prospect but these techniques have been used
to great success in Buteyko Breathing clinics around the world and
do not take long to acclimatize to.
Gravity also plays a role in both snoring and sleep apnea. When you
lie on your back, there is no restriction to your breathing, and
therefore breathing volume grows larger, leading to a greater
severity in snoring. Sleeping on your back also encourages the
mouth to open, and as the lower jaw hinges downwards it impedes
on the upper airway, reducing airway diameter. Nasal resistance
also increases while lying on your back as a consequence of
increased mucosal congestion.1
During an assessment of 2,077 OSA patients over a period of ten
years, it was found that 53.8% had at least twice as many breathing
abnormalities while sleeping in the supine (back) position
compared with sleeping on their side.2
Dr Buteyko discovered that the best position for sleep was on the
left-hand side or on the tummy. Sleeping on your left side reduces
breathing volume due to the position of the heart, while lying on
your stomach restricts breathing due to the weight of the body.
Sleeping on the left-hand side also reduces heartburn. A study
published in the American Journal of Clinical Gastroenterology
discovered that subjects experienced significantly greater periods of
reflux when lying on their right-hand side.3
To help improve your sleep, it’s also important to avoid eating large
meals or drinking alcohol late at night. Although alcohol may send
you off to sleep quicker, it results in poor quality sleep and waking
in the middle of the night. Eating too late at night creates similar
problems as the body spends considerable energy digesting food
while in a state of semi-relaxation.
Another vital guideline for promoting better sleep is to reserve the
bedroom for sleeping, relaxation and sex. Your bedroom should not
be a place to watch television, work on the laptop or browse the
internet on your mobile phone. In fact, having as little technology as
possible in the bedroom will help to ensure a good night’s sleep. I
have attended a number of sleep conferences where technology is
increasingly implicated in contributing to poor sleep. According to
Phyllis Zee, Professor of Neuroscience at Northwestern University,
the light emitted from a laptop, tablet or mobile phone stimulates
the brain, delaying your ability to fall asleep.4
We are wired to be awake during daylight and go to sleep when it
gets dark. The nightly ritual to read an old fashioned book before
falling asleep has now been replaced by staring at back-lit tablets
and phones. When our eyes are exposed to bright light, the brain
stops secreting the relaxation hormone melatonin which is
responsible for creating feelings of sleepiness. According to Harvard
Health Letter, it is advisable to refrain from using a laptop or
electronic device for three hours before sleep.5
Your bedroom should also be kept at a cool temperature. A
bedroom that is too warm and stuffy will make you breathe heavier.
Ideally, leave the bedroom window slightly open to allow a
circulation of fresh air. This will help keep your breathing calm.
KNOW HOW OXYGEN IS RELEASED TO PROVIDE
ENERGY
or normal, healthy functioning, the body requires a certain

amount of both oxygen and carbon dioxide. It is widely recognized
that oxygen is a gas essential to life, but many people are surprised
to hear that carbon dioxide is not just a waste gas. In terms of
breathing, the two work hand in hand.
When we take a breath of fresh air into our lungs, oxygen passes
from the lungs to the blood where it is picked up and carried
through the blood vessels by a molecule called hemoglobin. This
oxygen-rich blood is then pumped by the heart throughout the body
so that oxygen can be offloaded to cells for conversion to energy. In
order to release oxygen from the blood, however, hemoglobin
requires a catalyst, which involves an increase in body temperature
and the presence of carbon dioxide (CO2 ).
Physical exercise is a perfect example of these conditions: when we
move our muscles, the body requires more oxygen to give us energy
and perform at a higher intensity. During exercise, body
temperature increases and cells produce carbon dioxide, allowing
extra oxygen to be released by the blood to the muscles and organs.
The concentration of carbon dioxide in the blood is determined by
our breathing. The habit of breathing in excess of bodily
requirements causes too much carbon dioxide to be exhaled from
the lungs, which in turn causes a reduction of the concentration of
CO2 in the blood. When carbon dioxide levels are less than adequate,
the transfer of oxygen from blood to muscles and organs is limited,
leading to poor body oxygenation.
This necessary presence of carbon dioxide was discovered in 1904
by the physiologist and Nobel laureate Christian Bohr, who
recognized that CO2 affects the release of oxygen from the blood to
tissues and organs.

According to the Bohr Effect, when there is an increased pressure of
carbon dioxide in the blood, pH drops and oxygen is released more
readily. Conversely, when carbon dioxide levels are low, hemoglobin
molecules are less able to release oxygen from the blood. The way
we breathe determines the amount of carbon dioxide present in our
blood, and therefore how well our bodies are oxygenated.
Another function of carbon dioxide is that it relaxes the smooth
muscle embedded in airways, arteries and capillaries, enabling
smooth breathing and healthy blood flow. For those genetically
predisposed to asthma, the loss of CO2 caused by over-breathing
leads to constriction of the airways. By breathing calmly and quietly,
you will retain healthy levels of carbon dioxide and your blood
vessels and airways will remain open and clear.
Carbon dioxide has profound effects on blood flow. An increase of
carbon dioxide causes an opening of the blood vessels and increased
blood flow, whereas a decrease to carbon dioxide causes
constriction of the blood vessels and decreased blood flow.
Constriction of the blood vessels in response to breathing too much
air can reduce the amount of oxygen available to the brain by 50%. 1
For example, in humans 5% inhalation of carbon dioxide increases
blood flow supplying the brain by 50% and 7% inhalation of carbon
dioxide causes a 100% increase in blood flow. 1 It is no coincidence
that symptoms like fatigue, anxiety and poor concentration are so
common nowadays, even amongst athletes – chronic over-breathing
contributes to all these issues.
So how do we ensure that we take in enough carbon dioxide? The
solution is clearly not to breathe more! We cannot inhale carbon
dioxide from the atmosphere; it is a by-product of metabolic
chemical reactions within the body. And while it is true that carbon
dioxide can be classed as a waste gas, we only exhale CO 2 to get rid
of the excess – it is vital that a certain amount of carbon dioxide is
retained in the blood for healthy body function.
Breathing too much can very easily become a habit. Modern living,
poor diet, stress, and a lack of exercise all contribute to resetting the
breathing center in the brain so that it becomes less tolerant to
carbon dioxide. With a low tolerance to carbon dioxide, breathing
volume will continue to be larger than normal. Chronic over-
breathing also results in the constriction of blood vessels and a
reduction in the amount of oxygen delivered to the cells, leading to
excessive breathlessness and poor exercise tolerance.
Carbon dioxide is produced through the body’s metabolism – when
oxygen meets with the food we eat to create energy, carbon dioxide
is generated. There are only two ways to increase the amount of
carbon dioxide in the body:
· By practicing breathing exercises to gently reduce the amount of
air we breathe
· By increasing metabolic activity through physical exercise
While exercise is beneficial, it is vitally important not to breathe too
much during physical activity, otherwise your efforts will be
counterproductive. Practicing the Reduced Breathing exercise (link )
will also increase the body’s tolerance to carbon dioxide, and should
be reflected in a steady improvement to your Control Pause from
week to week.
By taking less air into the lungs during rest or physical exercise,
carbon dioxide is able to accumulate in the blood. After just ten
minutes, the part of the brain that regulates breathing volume can
be reset to tolerate a greater amount of carbon dioxide. By reducing
breathing volume towards normal, blood vessels and airways dilate,
and oxygen is more readily released from the red blood cells. Each
time you practice Reduced Breathing exercises and reset your
breathing volume, you are one step closer to a permanent change to
optimal breathing patterns.

ealthy nasal breathing is vital to allow the body to utilize the

gases nitric oxide and carbon dioxide, both of which play a role in
opening the blood vessels. Christian Bohr demonstrated the
importance of carbon dioxide in blood oxygenation back in 1904,
but it was not until the 1980s that the incredible benefits of nitric
oxide (NO) were fully understood. Until then, nitric oxide was
considered a toxic gas, responsible for the environmental pollution
and smog found in overpopulated cities. In 1995 it was discovered
that nitric oxide production takes place in the paranasal sinuses, a
group of four air-filled spaces surrounding the nasal cavity. As we
breathe in through the nose, large amounts of NO are released
within the nasal airways.1 Nitric oxide then follows airflow to the
lungs where it serves a number of very important roles including
opening of the airways and increasing oxygen uptake in the blood. 2
Ventilation perfusion describes the ratio of the amount of air to the
amount of blood reaching the small air sacs in the lungs per minute.
In a perfect situation, the oxygen provided from breathing would be
just enough to saturate the blood fully with oxygen.
Two factors which negatively influence ventilation perfusion are
breathing through the mouth and gravity. This can lead to a
situation where the higher parts of the lungs receive more
ventilation, and the lower parts greater amounts of blood. Nitric
oxide produced in the nasal cavity helps with a more efficient
matching of blood flow to ventilation. With each breath drawn
through the nose, nitric oxide is carried into the lungs where it helps
to counteract the effects of gravity on blood flow in the lungs by
redistributing the blood more equally throughout the lungs. 3
RHINITIS, SNORING AND SLEEP
APNEA IN ADULTS
hinitis is an extremely common health problem affecting up

to 40 million people in the United States and between 10-25% of the
world’s population1 with prevalence varying within and among
countries.2,3,4,5
Typical symptoms of rhinitis include nasal congestion, a runny and
itchy nose, and sneezing. The eyes, ears, sinuses, and throat can also
be affected. Rhinitis can either be seasonal, occurring during certain
times of the year, for example after exposure to a trigger such as
pollen, or perennial, in which case it is characterized by symptoms
that last for an hour or more on most days throughout the year.
Breathing through a stuffy or runny nose can be uncomfortable, and
often encourages the individual to switch to breathing through the
mouth.
The effect of rhinitis on quality of sleep is well documented in the
medical literature, as indicated in a number of studies below:
Researchers Ohki and colleagues performed a study to determine
the relationship between oral breathing and nasal obstruction in
patients with obstructive sleep apnea. The study involved 30 control
subjects and 20 patients with snoring or sleep apnea. Researchers
found that chronic nasal obstruction and resultant mouth breathing
may induce obstructive sleep apnea.6
Lunn et al. note that “nasal congestion is associated with sleep-
disordered breathing and is thought to be a key cause of sleep
impairment in rhinitis. The end result is decrease in quality of life
and productivity and increased daytime sleepiness.” 7
One study, which involved 52 patients, concluded that “open-mouth
breathing during sleep is a risk factor for obstructive sleep apnea
(OSA) and is associated with increased disease severity and upper
airway collapsibility. […] The more elongated and narrow upper
airway during open-mouth breathing may aggravate the
collapsibility of the upper airway and, thus, negatively affect OSA
severity.”8
In a paper entitled, ‘ How does open-mouth breathing influence
upper airway anatomy?’, Lee et al. t ested the hypothesis that o pen-
mouth breathing during sleep may increase the severity of
obstructive sleep apnea. After an analysis of 28 patients, researchers
concluded that “open-mouth breathing is associated with reduction
of the retropalatal and retroglossal areas, lengthening of the
pharynx and shortening of the MP-H in the upper airway.” 9
After reviewing texts and articles on Medline, the Center for
Research Disorders in Cincinnati, Ohio concluded that obstructive
sleep apnea, sleep fragmentation, and disturbed sleep often result
from nasal obstruction. The authors of the paper observed that
“since breathing through the nose appears to be the preferred route
during sleep, nasal obstruction frequently leads to nocturnal mouth
breathing, snoring, and ultimately to OSA.”10 The paper advised that
allergic rhinitis and other upper respiratory disorders should be
treated more aggressively.
Considering the evidence, there is no doubt that mouth breathing is
a significant causal factor for sleep disordered breathing including
obstructive sleep apnea.
RHINITIS, SLEEP DISORDERS
AND ADHD IN CHILDREN
n a paper entitled, ‘Pediatric allergic rhinitis: physical and

mental complications’, researchers noted that allergic rhinitis has a
far more negative impact on the health of the child than just a runny
nose.1 “There are numerous complications that can lead to
significant problems both physically and mentally in the child who
suffers with allergic rhinitis. Under physical complications,
recurrent and/or chronic sinusitis, asthma, and snoring, impact
children with allergic rhinitis. Sleep disturbances, poor school
performance, and hyperactivity are all mental complications seen in
many children related to their nasal allergies.”
A Polish study noted that children with sleep respiratory disorders
wake up tired, with blocked noses, breathe through their mouth, tire
easily, have concentration problems, are irritated, and demonstrate
hyperactivity that may resemble ADHD symptoms. 2 The paper
further states that “long-term disease leads to exacerbation of all-
systemic symptoms, results in cardiovascular complications,
induces developmental inhibition and cognitive dysfunction, and is
responsible for school/social failures and reduced life quality.” 2
In a paper entitled, ‘A practical approach to allergic rhinitis and
sleep disturbance management’, Davies et al. comment that “sleep
quality can be significantly impacted by nasal congestion. This may
lead to decreased learning ability, productivity at work or school,
and a reduced quality of life.”3
A further study found similar conclusions, stating that allergic
rhinitis “can lead to impaired nocturnal sleep, and this impairment
results in daytime fatigue and somnolence, reducing both learning
and work efficiency and decreasing quality of life.”4
Data from 248 medical charts of mouth-breathing children were
analyzed to determine the prevalence of obstructive sleep disorders.
It was found that 58% of children were primary snorers and 42%
had obstructive sleep apnea. The paper concluded that, “primary
snoring and OSA are frequent findings in mouth breathing
children.”5
In a paper entitled, ‘The nose and sleep disordered breathing: what
we know and what we don’t know’, researchers performed an
analysis of medical literature on the subject. 6 The analysis confirmed
that “SDB (sleep disordered breathing) can both result from and be
worsened by nasal obstruction.” It was stated that “nasal congestion
typically results in a switch to oronasal breathing that compromises
the airway.” Furthermore, “oral (mouth) breathing in children may
lead to the development of facial structural abnormalities associated
with SDB.” The paper concluded that the change to mouth breathing
that occurs due to chronic nasal obstruction is a common pathway
for sleep-disordered breathing.
Treatment of children with ADHD and problem behavior commonly
involves medication or stimulants. An important question to ask,
considering the evidence above, is whether this approach is
necessary given the potential benefits from addressing allergic
rhinitis and improving the quality of sleep.
For example, researchers found that 28.1% of Singaporean children
snored and 6% habitually snored.7 “Atopy such as asthma, rhinitis,
and eczema was the strongest risk factor for habitual snoring in
Singapore, and the effect was cumulative.” The paper also noted that
“children attending psychiatric services in Singapore may also have
sleep disorders, the highest prevalence being in children with
attention deficit hyperactivity disorder.”7
Authors of the paper entitled, ‘Attention deficit hyperactivity
disorder and sleep disorder’, also note that “there is a clear
correlation between ADHD and sleep disorders” and that “by
improving these children’s sleep, the symptoms of ADHD are
diminished and thus avoid the need to administer psychostimulants,
which have undesirable side effects that produce a great deal of
anxiety in the parents of these children.”8
And finally, in a paper published in the journal Paediatrics ,
researchers concluded that “inattention and hyperactivity among
general pediatric patients are associated with increased daytime
sleepiness and – especially in young boys – snoring and other
symptoms of SDB. If sleepiness and SDB do influence daytime
behavior, the current results suggest a major public health impact.” 9
“Children undergoing evaluation for ADHD should be systematically
assessed for sleep disturbances because treatment of sleep
disorders is often associated with improved symptomatology and
decreased need for stimulants.”10
Bearing the documented evidence in mind, having a good night’s
sleep is imperative to the health of every child and adult. Treating
rhinitis is an absolute must in this regard: “Health professionals and
school personnel need to increase their awareness of the
ramifications of this disease and actively work to prevent
deterioration in both academic achievement and workplace
productivity.”11
CPAP THERAPY
he normal treatment for obstructive sleep apnea is a CPAP

(continuous positive airway pressure) machine. The patient wears a
mask over the face and air is applied at a pressure that exceeds the
airway opening pressure, thereby enabling the patient to breathe
without cessation. In simple terms, it may be best understood as a
small vacuum cleaner working in reverse, applying sufficient air
pressure to force the airways open.
The CPAP machine can resolve apnea for many sufferers, leading to
improved sleep quality, decreased sleepiness, and lower blood
pressure.1-4
However, the machine only helps the patient as long as they
continue to use it. On the downside, it does nothing to address the
major contributory factor of sleep apnea, namely chronic over-
breathing. Wearing a mask during sleep can be claustrophobic,
uncomfortable, cumbersome, inconvenient, and irritating. The air
produced by the machine is dry, which may cause rhinitis, a
dripping nose, a blocked nose, and nasal irritation. Even when the
mask is worn correctly, the feeling of the airflow is sometimes
described as putting one’s head out of a car window while the car is
moving at thirty miles per hour. Patients and their partners often
find the humming of the machine very distracting. In addition, the
machine has to be cleaned on a regular basis, but not all patients do
this according to guidelines.
Overall, while it is accepted as the gold standard of treatment, the
CPAP machine also has major shortcomings:
During one study of 300 patients referred to the London Chest
Ventilatory Support Unit, it was found that 96% of patients
complained of at least one side effect resulting from the CPAP
therapy, while 45% complained of a side effect from the nasal mask.5
In a study of 80 patients, researchers found that the most prevalent
side effects were disturbance of the mask during the night (71.3%),
dry mouth (47.5%), dry nose (46.3%), pressure marks from the
mask (41.3%), crusts within the nasal cavity (38.8%), and hearing
loss (26.3%). Mouth and nose dryness were considered the most
irritating side effects.6
A CPAP mask can also act as orthodontic headgear and gradually
move the teeth and the upper and/or lower jaw backward.
Unfortunately, reducing the width of the upper airway in this way
will only increase the risk of apneas. This effect can increase over
time and may or may not cause temporomandibular joint (TMJ)
disorders in some patients. These facial changes have been dubbed
‘Smashed Face Syndrome’.7
A paper published in The Canadian Respiratory Journal observed
that “compliance is a significant problem and has been incompletely
assessed in long-term studies.” After evaluating 80 patients to
determine long-term compliance with CPAP, the authors concluded
that “although many patients with OSA derive subjective benefit
from, and adhere to treatment with CPAP, a significant proportion of
those so diagnosed either do not initiate or eventually abandon
therapy.”8
The journal Sleep found that only 40% of 162 newly-diagnosed
patients who required CPAP therapy accepted the treatment. The
paper noted that compliance was higher in the higher
socioeconomic groups than the lower.9 Other researchers found that
“failure to comply with treatment has been reported to be as high as
25 to 50%, with patients typically abandoning therapy during the
first 2 to 4 weeks of treatment.”10
According to Broströ m et al., “Adherence to CPAP treatment is a
multifaceted problem including patient, treatment, condition, social,
and healthcare related factors. Knowledge about facilitators and
barriers for adherence to CPAP treatment can be used in
interventional strategies.”11
REFERENCES
INTRODUCTION
1. Seo-Young Lee, Christian Guilleminault, Hsiao-Yean Chiu, Shannon S. Sullivan. Mouth
breathing,“nasal dis-use” and pediatric sleep-disordered-breathing. Sleep and Breathing
(2015) Stanford University Sleep Medicine Division, Stanford Outpatient Medical Center,
Redwood City CA

1. McArdle William, Katch Frank L, Katch Victor L. Pulmonary structure and function. In:
(eds.) Exercise Physiology: Nutrition, Energy, and Human Performance. 1st ed. United
States: Lippincott Williams & Wilkins; Seventh, North American Edition; (November 13,
2009). P263.
2. Fitzpatrick MF, McLean H, Urton AM, Tan A, O’Donnell D, Driver HS. Effect of nasal or
oral breathing route on upper airway resistance during sleep. Eur Respir J. 2003 Nov;
22(5):827-32.

WHAT IS SNORING?
1. 1. Juliana Spelta Valbuza et al. Methods to increase muscle tonus of upper airway to
treat snoring: systematic review. Arq. Neuro-Psiquiatr. vol.66 no.3b Sã o Paulo 2008.

1. http://www.charlesdickensinfo.com/novels/pickwick-papers/the-pickwick-papers-
and-sleep-apnoea-charles-dickens/
2. John F. Garvey , Martino F. Pengo , Panagis Drakatos , Brian D. Kent .

Epidemiological aspects of obstructive sleep apnoea. J Thorac Dis. 2015 May; 7(5): 920–
929.
3. Kevin J. Finkel et al. Prevalence of undiagnosed obstructive sleep apnoea among
adult surgical patients in an academic medical center. Sleep Medicine . Volume 10, Issue 7
, August 2009, Pages 753–758
4. Hiestand DM . Prevalence of symptoms and risk of sleep apnoea in the US
population: Results from the national sleep foundation sleep in America 2005 poll. Chest.
2006 Sep;130(3):780-6.
5. Snoring and Obstructive Sleep Apnoea. David N.F. Fairbanks and Samuel A. Mickelson.
6. Jordan A, McSharry D, Malhotra A. Adult obstructive sleep apnoea. Lancet. 2014
Feb 22; 383(9918): 736–747.
7. Farrell C. Myofunctional orthodontics and myofunctional therapy. Ortho Tribune U.S.
Edition, AAO Preview 2012.
8. Radwan L, Maszczyk Z, Koziorowski A, Koziej M, Cieslicki J, Sliwinski P, Zielinski J.

Control of breathing in obstructive sleep apnoea and in patients with the overlap
syndrome. Eur Respir J. 1995 Apr; 8(4): p.542-545.
9. Bonekat HW, Hardin KA, Severe upper airway obstruction during sleep. Clin Rev
Allergy Immunol. 2003 Oct;25(2):191-210.
10. Julien JY, Martin JG, Ernst P, Olivenstein R, Hamid Q, Lemi?re C, Pepe C, Naor N, Olha A,
Kimoff RJ. Prevalence of obstructive sleep apnoea-hypopnea in severe versus moderate
asthma. J Allergy Clin Immunol. 2009 Aug;124(2):371-6. Epub 2009 Jun 26.
11. Abdul Razak , Chirakalwasan N . Obstructive sleep apnoea and asthma. Asian Pac
J Allergy Immunol . 2016 Dec;34(4):265-271.
12. Lundberg J, Weitzberg E. Nasal nitric oxide in man. Thorax .1999;(54):947-952.
13. Alejandro Sá nchez Crespo, Jenny Hallberg, Jon O. Lundberg, Sten G. E. Lindahl, Hans
Jacobsson,1,4 Eddie Weitzberg, Sven Nyrén. Nasal nitric oxide and regulation of human
pulmonary blood flow in the upright position. J Appl Physiol 108: 181–188, 2010
14. Michel Alkhalil , M.D., Edward Schulman , M.D., and Joanne Getsy , M.D.
Obstructive Sleep Apnoea Syndrome and Asthma: What Are the Links? J Clin Sleep Med .
2009 Feb 15; 5(1): 71–78.
15. de Sousa Michels Daniel , da Mota Amanda, Rodrigues Silveira, Nakanishi Má rcio
, Luiz Lopes Sampaio André, Ramos Venosa Alessandra. Nasal Involvement in
Obstructive Sleep Apnoea Syndrome International Journal of Otolaryngology. Volume 2014
(2014), Article ID 717419, 8 pages
16. Kim EJ, Choi JH, Kim KW, Kim TH, Lee SH, Lee HM, Shin C, Lee KY, Lee SH. The impacts
of open-mouth breathing on upper airway space in obstructive sleep apnoea: 3-D MDCT
analysis. Eur Arch Otorhinolaryngol. 2010 Oct 19.
17. Kreivi HR, Virkkula P, Lehto J, Brander P. Frequency of upper airway symptoms before
and during continuous positive airway pressure treatment in patients with obstructive
sleep apnoea syndrome. Respiration. 2010;80(6):488-94.
18. Ohki M, Usui N , Kanazawa H , Hara I , Kawano K .Relationship between oral

breathing and nasal obstruction in patients with obstructive sleep apnoea. Acta Otolaryngol
Suppl. 1996;523:228-30.
19. Lee SH , Choi JH , Shin C , Lee HM , Kwon SY , Lee SH . How does open-mouth
breathing influence upper airway anatomy? Laryngoscope. 2007 Jun;117(6):1102-6.
20. Scharf MB , Cohen AP Diagnostic and treatment implications of nasal obstruction in

snoring and obstructive sleep apnoea. Ann Allergy Asthma Immunol. 1998 Oct;81(4):279-
87; quiz 287-90.
21. Young T , Finn L , Kim H . Nasal obstruction as a risk factor for sleep-disordered
breathing. The University of Wisconsin Sleep and Respiratory Research Group. J Allergy
Clin Immunol. 1997 Feb;99(2):S757-62.
22. W.T. McNicholas. The nose and OSA: variable nasal obstruction may be more
important in pathophysiology than fixed obstruction. Eur Respir J 2008; 32: 3–8
23. Fitzpatrick M et al. Partitioning of inhaled ventilation between the nasal and oral
routes during sleep in normal subjects. Appl Physiol Articles in PresS. Published on
November 1, 2002
1
24. Madronio MR , Di Somma E , Stavrinou R , Kirkness JP , Goldfinch E ,
Wheatley JR , Amis TC . Older individuals have increased oro-nasal breathing during
sleep. Eur Respir J. 2004 Jul;24(1):71-7.
25. Fitzpatrick MF, McLean H, Urton AM, Tan A, O'Donnell DE, Driver HS. Effect of nasal or
oral breathing route on upper airway resistance during sleep. Eur Respir J 2003;22:827–
832
26. Lam JC , Kairaitis K , Verma M , Wheatley JR , Amis TC . Saliva production and
surface tension: influences on patency of the passive upper airway. J Physiol. 2008 Nov
15;586(22):5537-47.
27. Manisha Verma , Margaret Seto-Poon , John R Wheatley , Terence C Amis , Jason
P Kirkness . Influence of breathing route on upper airway lining liquid surface tension in
humans. J Physiol . 2006 Aug 1; 574(Pt 3): 859–866.
28. Rappai M, Collop N, Kemp S, deShazo R. The nose and sleep-disordered breathing:
what we know and what we do not know. Chest. 2003 Dec;124(6):2309-23.
29. Olsen KD, Kern EB, Westbrook PR. Sleep and breathing disturbance secondary to nasal
obstruction. Otolaryngol Head Neck Surg. 1981 Sep-Oct;89(5):804-10.
30. Vorona R et. Al. Treatment of Severe Obstructive Sleep Apnoea Syndrome with a
Chinstrap. J Clin Sleep Med. Dec 15, 2007; 3(7): 729–730.
31. Kohler M , Bloch KE , Stradling JR . The role of the nose in the pathogenesis of
obstructive sleep apnoea and snoring. Eur Respir J. 2007 Dec;30(6):1208-15.
MOUTH BREATHING DURING CHILDHOOD INCREASES THE

RISK OF LIFELONG OBSTRUCTIVE SLEEP APNEA
1. Doron Harari DMD et al. 2010, The effect of mouth breathing versus nasal breathing
on dentofacial and craniofacial development in orthodontic patients, The American
Laryngological, Rhinological, and Otological Society, Inc. 2010 Oct;120(10)
2. Lione R1, Buongiorno M1, Franchi L2, Cozza P1. Evaluation of maxillary arch
dimensions and palatal morphology in mouth-breathing children by using digital dental
casts. Int J Pediatr Otorhinolaryngol. 2014 Jan;78(1):91-5.
3. Grippaudo C1, Paolantonio EG1, Antonini G1, Saulle R2, La Torre G2, Deli R1.
Association between oral habits, mouth breathing and malocclusion. Acta Otorhinolaryngol
Ital. 2016 Oct;36(5):386-394.
4. Jefferson Y, General dentist: Mouth breathing: adverse effects on facial growth, health,
academics and behaviour. 2010 Jan- Feb; 58 (1): 18-25
5. Guilleminault C, Akhtar F . Pediatric sleep-disordered breathing: New evidence on
its development. Sleep Med Rev. 2015 Dec;24:46-56.
6. Kerr WJ, McWilliam s JS, et al. Mandibular form and position related to changes mode
of breathing – a five year longitudinal study. Angle Orthod 1987;59:91-96
7. D’Ascanio L, Lancione C, Pompa G, Rebuffini E, Mansi N, Manzini M. Craniofacial

growth in children with nasal septum deviation: A cephalometric comparative study.
International Journal of Pediatric Otorhinliaryngliogy. October 2010;74(10):1180-1183.
8. Baumann I, Plinkert PK. Effect of breathing mode and nose ventilation on growth of
the facial bones. HNO.1996 May;(44(5)):229-34.
9. Tourne LP. The long face syndrome and impairment of the nasopharyngeal airway.
The Angle Orthodontist .1990 Fall;(60(3)):167-76.
10. Kim EJ, Choi JH, Kim KW, Kim TH, Lee SH, Lee HM, Shin C, Lee KY, Lee SH.The impacts
of open-mouth breathing on upper airway space in obstructive sleep apnea: 3-D MDCT
analysis.Eur Arch Otorhinliaryngli. 2010 Oct 19.
11. Kreivi HR, Virkkula P, Lehto J, Brander P.Frequency of upper airway symptoms before
and during continuous positive airway pressure treatment in patients with obstructive
sleep apnea syndrome. Respiration. 2010;80(6):488-94.
12. Ohki M, Usui N, Kanazawa H, Hara I, Kawano K. Relationship between oral breathing
and nasal obstruction in patients with obstructive sleep apnea.Acta Otliaryngli Suppl.
1996;523:228-30.
13. Lee SH, Choi JH, Shin C, Lee HM, Kwon SY, Lee SH. How does open-mouth breathing
influence upper airway anatomy? Laryngoscope. 2007 Jun;117(6):1102-655.
14. Scharf MB, Cohen AP Diagnostic and treatment implications of nasal obstruction in
snoring and obstructive sleep apnea. Ann Allergy Asthma Immunli. 1998 Oct;81(4):279-87;
quiz 287-90.
15. KUROISHI, Rita Cristina Sadako et al. Deficits in working memory, reading
comprehension and arithmetic skills in children with mouth breathing syndrome:
analytical cross-sectional study. Sao Paulo Med. J. [online]. 2015, vol.133, n.2, pp.78-83 .
16. Blaiss MS. Pediatric allergic rhinitis: physical and mental complications. Rev Prat.
1996 Apr 15;46(8):975-9.
17. Guilleminault C, Sullivan S. Towards Restoration of Continuous Nasal Breathing as the
Ultimate Treatment. Goal in Pediatric Obstructive Sleep Apnoea. Enliven: Pediatrics and
Neonatal Biology. Sept 1st 2014.
18. Trabalon M, Schaal B. It Takes a Mouth to Eat and a Nose to Breathe: Abnormal Oral
Respiration Affects Neonates’ Oral Competence and Systemic Adaptation. International
Journal of Pediatrics. 2012. (207605 ):10 pages).

WHAT IS INSOMNIA?
1. Maria Basta , George P Chrousos , Antonio Vela-Bueno , Alexandros N
Vgontzas . Chronic insomnia and stress system. Sleep Med Clin. 2007 Jun; 2(2): 279–291.
2. Simon GE, Von Korff M. Prevalence, burden, and treatment of insomnia in primary
care. Am J Psychiatry. 1997;154 :1417–23.
3. MayoClinic. 2015. High Blood Pressure. [Online] Available at:

http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/
sleep-deprivation/faq-20057959. [Accessed 1 February 2017]

1. Varsha Taskar, Nigel Clayton, Mark Atkins, Zubair Shaheen, Patricia Stone, Ashley
Woodcock, Breath-holding Time in Normal Subjects, Snorers, and Sleep Apnea Patients.
Chest 1995;107;959-962

NIGHT
1. Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing
Disorders. 1st ed. Springer; 1994.
2. Fitzpatrick MF, McLean H, Urton AM, Tan A, O’Donnell D, Driver HS. Effect of nasal
or oral breathing route on upper airway resistance during sleep. Eur Respir J 2003;
22:827–832.
3. 3. 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.
4. Strohl KP, Arnold JL, Decker MJ, Hoekje PL, McFadden ER. Nasal flow-resistive
responses to challenge with cold dry air. J Appl Physiol. 1992 Apr;72(4):1243-6.
5. Hasegawa M, Kern EB.The effect of breath holding, hyperventilation, and exercise on
nasal resistance.Rhinology. 1978 Dec;16(4):243-9.

1. Adelola O.A., Oosthuiven J.C., Fenton J.E. Role of Buteyko breathing technique in
asthmatics with nasal symptoms. Clinical Otolaryngology.2013, April;38(2):190-191

1. Sá nchez Crespo A, Hallberg J, O. Lundberg J, Lindahl S, Jacobsson H, Weitzberg E,
Nyrén S. Nasal nitric oxide and regulation of human pulmonary blood flow in the upright
position. J Appl Physiol 108: 181–188, 2010.

REVERSING INSOMNIA
1. Laboratory of Neuro Imaging. 2015. Brain Traivia. [online] available
http://www.loni.usc.edu/about_loni/education/brain_trivia.php.[Accessed 1 February
2017]

1
1. Oksenberg A , Arons E , Greenberg-Dotan S , Nasser K , Radwan H .
[The significance of body posture on breathing abnormalities during sleep: data analysis of
2077 obstructive sleep apnea patients]. [Article in Hebrew] Harefuah. 2009
May;148(5):304-9, 351, 350.
2. Duggan CJ, Watson RA, Pride NB. Postural changes in nasal and pulmonary
resistance in subjects with asthma. J Asthma 2004; 41: 701–707.
1
3. Khoury RM , Camacho-Lobato L , Katz PO , Mohiuddin MA , Castell DO .
Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with
gastroesophageal reflux disease. Am J Gastroenterol. 1999 Aug;94(8):2069-73.
4. Northwestern University. [Online] Available:

http://www.cnn.com/2010/TECH/05/13/sleep.gadgets.ipad/ [Accessed 1 February
2017]
5. Harvard Health Letter. Blue Light has a dark side. [Online] Available:
http://www.health.harvard.edu/newsletters/Harvard_Health_Letter/2012/May/blue-
light-has-a-dark-side . [Accessed 1 February 2017]

1. Kety SS, Schmidt CF. The effects of altered arterial tensions of carbon dioxide and
oxygen on cerebral blood flow and cerebral oxygen consumption of normal young men. J
Clin Invest . 1948; 27: pp. 484–492

1. According to Jon Lundberg, professor of Nitric Oxide Pharmacologics at the world
famous Karolinska institute in Sweden, large amounts of NO are constantly released in the
nasal airways of humans. As we breathe in through the nose, NO will follow the airflow to
the lungs where it plays a role in increasing the amount of oxygen uptake in the blood.
Lundberg J, Weitzberg B. Nasal nitric oxide in man Thorax 1999; 54 : 947-952.
2. Lundberg J. Nitric oxide and the paranasal sinuses. Anat Rec (Hoboken). 2008
Nov;291(11):1479-84.
3. Sá nchez Crespo A, Hallberg J, O. Lundberg J, Lindahl S, Jacobsson H, Weitzberg E,

Nyrén S. Nasal nitric oxide and regulation of human pulmonary blood flow in the upright
position. J Appl Physiol 108: 181–188, 2010.

APPENDIX
CPAP THERAPY
1. Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, et al. Ambulatory blood pressure
after therapeutic and subtherapeutic nasal continuous positive airway pressure for
obstructive sleep apnea: a randomised parallel trial. Lancet. 2002;359:204-10.
2. Hack M, Davies RJ, Mullins R, et al. Randomised prospective parallel trial of
therapeutic versus subtherapeutic nasal continuous positive airway pressure on simulated
steering performance in patients with obstructive sleep apnea. Thorax. 2000;55:224-31.
3. Norman D, Loredo JS, Nelesen RA, et al. Effects of continuous positive airway
pressure versus supplemental oxygen on 24-hour ambulatory blood pressure.
Hypertension. 2006;47:840-5.
4. Shivalkar B, Van de Heyning C, Kerremans M, et al. Obstructive sleep apnea

syndrome: more insights on structural and functional cardiac alterations, and the effects of
treatment with continuous positive airway pressure. J Am Coll Cardiol. 2006;47:1433-9.
5. Kalan A, Kenyon GS, Seemungal TA, Wedzicha JA. Adverse effects of nasal continuous
positive airway pressure therapy in sleep apnea syndrome. J Laryngol Otol. 1999
Oct;113(10):888-92.
6. Verse T, Lehnhardt E, Pirsig W, Junge-Hü lsing B, Kroker B. [What are the side-effects
of nocturnal continuous positive pressure ventilation (nCPAP) in patients with sleep apnea
for the head-neck region?].[Article in German] Laryngorhinootologie. 1999
Sep;78(9):491-6.
7. Tsuda H, Almeida FR, Tsuda T, Moritsuchi Y, Lowe AA (Oct 2010). "Craniofacial
changes after 2 years of nasal continuous positive airway pressure use in patients with
obstructive sleep apnoea". Chest 138 (4): 870–4.
8. Wolkove N, Baltzan M, Kamel H, Dabrusin R, Palayew M. Long-term compliance with

continuous positive airway pressure in patients with obstructive sleep apnea Can Respir J.
2008 Oct;15(7):365-9.
9. Simon-Tuval T, Reuveni H, Greenberg-Dotan S, Oksenberg A, Tal A, Tarasiuk A. Low

socioeconomic status is a risk factor for CPAP acceptance among adult OSAS patients
requiring treatment. Sleep. 2009 Apr 1;32(4):545-52.
10. Zozula R, Rosen R Compliance with continuous positive airway pressure therapy:
assessing and improving treatment outcomes. Curr Opin Pulm Med. 2001 Nov;7(6):391-8.
11. Broströ m A, Nilsen P, Johansson P, Ulander M, Strö mberg A, Svanborg E, Fridlund B

Putative facilitators and barriers for adherence to CPAP treatment in patients with
obstructive sleep apnea syndrome: a qualitative content analysis. Sleep Med. 2010
Feb;11(2):126-30. Epub 2009 Dec 9.

1. Storms W, Allergic rhinitis-induced nasal congestion: its impact on sleep quality.Prim
Care Respir J. 2008 Mar;17(1):7-18.
2. Sly RM. Changing prevalence of allergic rhinitis and asthma. Ann Allergy Asthma
Immunol . Mar 1999;82(3):233-48; quiz 248-52.
3. Von Mutius E, Weiland SK, Fritzsch C, et al. Increasing prevalence of hay fever and
atopy among children in Leipzig, East Germany. Lancet. 1998;351:862.
4. Romano-Zelekha O, Graif Y, Garty BZ, Livne I, Green MS, Shohat T. Trends in the
prevalence of asthma symptoms and allergic diseases in Israeli adolescents: results from a
national survey 2003 and comparison with 1997. J Asthma . Jun 2007;44(5):365-9.
5. Lima RG, Pastorino AC, Casagrande RR, et al. Prevalence of asthma, rhinitis and
eczema in 6 - 7 years old students from the western districts of Sao Paulo City, using the
standardized questionnaire of the "International Study of Asthma and Allergies in
Childhood" (ISAAC)-phase IIIB. Clinics. 2007;62:225.
6. Ohki M, Usui N , Kanazawa H , Hara I , Kawano K .Relationship between oral

breathing and nasal obstruction in patients with obstructive sleep apnea. Acta Otolaryngol
Suppl. 1996;523:228-30.
7. Lunn M, Craig T. Rhinitis and sleep. Sleep Med Rev. 2011 Feb 10.
8. Kim EJ, Choi JH, Kim KW, Kim TH, Lee SH, Lee HM, Shin C, Lee KY, Lee SH. 1. The
impacts of open-mouth breathing on upper airway space in obstructive sleep apnea: 3-D
MDCT analysis. Eur Arch Otorhinolaryngol. 2010 Oct 19.
9. Lee SH , Choi JH , Shin C , Lee HM , Kwon SY , Lee SH . How does open-
mouth breathing influence upper airway anatomy? Laryngoscope. 2007
Jun;117(6):1102-6.
10. Scharf MB , Cohen AP Diagnostic and treatment implications of nasal obstruction

in snoring and obstructive sleep apnea. Ann Allergy Asthma Immunol. 1998
Oct;81(4):279-87; quiz 287-90.

1. Blaiss MS. Pediatric allergic rhinitis: physical and mental complications. Rev Prat.
1996 Apr 15;46(8):975-9.
2. Wasilewska J , Kaczmarski M Obstructive sleep apnea-hypopnea syndrome in

children [Article in Polish] Wiad Lek. 2010;63(3):201-12.
3. Davies MJ, Fisher LH, Chegini S, Craig TJ. A practical approach to allergic rhinitis and
sleep disturbance management. Allergy Asthma Proc. 2006 May-Jun;27(3):224-30.
4. Ferguson BJ. Influences of allergic rhinitis on sleep. Otolaryngol Head Neck Surg.
2004 May;130(5):617-29
5. Izu SC , Itamoto CH , Pradella-Hallinan M , Pizarro GU , Tufik S ,

Pignatari S , Fujita RR . Obstructive sleep apnea syndrome (OSAS) in mouth breathing
children.[Article in English, Portuguese] Braz J Otorhinolaryngol. 2010 Oct;76(5):552-6.
6. Rappai M , Collop N , Kemp S , deShazo R .The nose and sleep-disordered

breathing: what we know and what we do not know. Chest. 2003 Dec;124(6):2309-23.
7. Chng SY. Sleep disorders in children: the Singapore perspective. Ann Acad Med
Singapore. 2008 Aug;37(8):706-9.
8. Betancourt-Fursow de Jiménez YM , Jiménez-Leó n JC , Jiménez-Betancourt CS

. [Attention deficit hyperactivity disorder and sleep disorders].[Article in Spanish] Rev
Neurol. 2006 Feb 13;42 Suppl 2:S37-51.
9. Chervin RD , Archbold KH , Dillon JE , Panahi P , Pituch KJ , Dahl RE ,
Guilleminault C . Inattention, hyperactivity, and symptoms of sleep-disordered breathing.
Pediatrics. 2002 Mar;109(3):449-56.
10. Domínguez-Ortega L , de Vicente-Colomina A [Attention deficit-hyperactivity

disorder and sleep disorders].[Article in Spanish] Med Clin (Barc). 2006 Apr
8;126(13):500-6.
11. Borres MP. Allergic rhinitis: more than just a stuffy nose. Acta Paediatr. 2009
Jul;98(7):1088-92. Epub 2009 Apr 17.
BUTEYKO BOOKS, DVDS AND ONLINE SELF HELP
COURSES
Buteyko for High Blood Pressure, Fatigue, Insomnia, Chronic
Hyperventilation, Snoring, and Sleep Apnea by Patrick McKeown
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by Patrick McKeown
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Attacks and Depression by Patrick McKeown
The Oxygen Advantage online Digital Program by Patrick McKeown
Buteyko DVD set for Children and Teenagers by Patrick McKeown
Complete Instruction in Buteyko Clinic Method for Healthcare
Professionals by Patrick McKeown

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Table of Contents
TABLE OF CONTENTS
INTRODUCTION
MEET BUTEYKO
WHAT IS SNORING?
IMPLICATIONS OF OBSTRUCTIVE SLEEP APNEA
MOUTH BREATHING DURING CHILDHOOD INCREASES THE RISK
OF LIFELONG OBSTRUCTIVE SLEEP APNEA
WHAT IS INSOMNIA?
GOOD BREATHING
THE THREE TENETS TO NORMALIZING YOUR BREATHING
NIGHT
THE THIRD TENET: REDUCE BREATHING VOLUME TO CREATE A
NEED FOR AIR
REDUCE BREATHING ONLY THROUGH RELAXATION OF THE
RESPIRATORY MUSCLES
REVERSING INSOMNIA
BREATHING EXERCISE TO HELP CALM THE MIND AND STOP PANIC
ATTACK
CORRECT BREATHING DURING PHYSICAL EXERCISE
FOOD AND SLEEP
SIMPLE BREATHING BASICS
APPENDIX
CPAP THERAPY
REFERENCES
BUTEYKO BOOKS, DVDS AND ONLINE SELF HELP COURSES

Sleep With Buteyko - Physician D - McKeown, Patrick

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Table of Contents

How To Unblock Your Nose

Reduced Breathing Summary

Reduced Breathing Daily Exercise Format

Correct Breathing During Physical Exercise

isten to the breathing of someone who is snoring and you

he Buteyko Method was developed in the 1950s by Russian

here are two main aspects to the way we breathe: breathing

noring, often the subject of jokes about rattling the windows

pnea is a Greek word meaning ‘without breath’. There are

The prevalence of obstructive sleep apnea continues to increase,

Lastly, if the nose is congested, the opening to the upper airway is

t is inevitable that a child with a blocked or stuffy nose will

nsomnia is one of the most common sleep disorders, affecting

n this section, Buteyko meets ‘Joe’, a patient suffering from

measurement called the Control Pause (CP) was developed

earning to breathe permanently through the nose is the first

racticing nasal breathing during the daytime can be achieved

uteyko explains the third tenet to Joe, which involves

oe is delighted that he is doing the exercise correctly. He wants

ometimes, if there is so much agitation in the mind, or the

Perform Many Small Breath Holds of 2 to 5 seconds each, as follows:

oe: “So Buteyko, do I always have to do the Reduced Breathing

Breath holds during physical exercise

s always, Buteyko is his usual direct self as he consults with

“However,” Buteyko continues, “If you gorge yourself before

It is vital to breathe through your nose during sleep. (See link ) You

or normal, healthy functioning, the body requires a certain

ealthy nasal breathing is vital to allow the body to utilize the

hinitis is an extremely common health problem affecting up

n a paper entitled, ‘Pediatric allergic rhinitis: physical and

he normal treatment for obstructive sleep apnea is a CPAP

2. John F. Garvey , Martino F. Pengo , Panagis Drakatos , Brian D. Kent .

8. Radwan L, Maszczyk Z, Koziorowski A, Koziej M, Cieslicki J, Sliwinski P, Zielinski J.

12. Lundberg J, Weitzberg E. Nasal nitric oxide in man. Thorax .1999;(54):947-952.

18. Ohki M, Usui N , Kanazawa H , Hara I , Kawano K .Relationship between oral

20. Scharf MB , Cohen AP Diagnostic and treatment implications of nasal obstruction in

MOUTH BREATHING DURING CHILDHOOD INCREASES THE

7. D’Ascanio L, Lancione C, Pompa G, Rebuffini E, Mansi N, Manzini M. Craniofacial

3. MayoClinic. 2015. High Blood Pressure. [Online] Available at:

4. Northwestern University. [Online] Available:

3. Sá nchez Crespo A, Hallberg J, O. Lundberg J, Lindahl S, Jacobsson H, Weitzberg E,

4. Shivalkar B, Van de Heyning C, Kerremans M, et al. Obstructive sleep apnea

8. Wolkove N, Baltzan M, Kamel H, Dabrusin R, Palayew M. Long-term compliance with

9. Simon-Tuval T, Reuveni H, Greenberg-Dotan S, Oksenberg A, Tal A, Tarasiuk A. Low

11. Broströ m A, Nilsen P, Johansson P, Ulander M, Strö mberg A, Svanborg E, Fridlund B

6. Ohki M, Usui N , Kanazawa H , Hara I , Kawano K .Relationship between oral

10. Scharf MB , Cohen AP Diagnostic and treatment implications of nasal obstruction

2. Wasilewska J , Kaczmarski M Obstructive sleep apnea-hypopnea syndrome in

5. Izu SC , Itamoto CH , Pradella-Hallinan M , Pizarro GU , Tufik S ,

6. Rappai M , Collop N , Kemp S , deShazo R .The nose and sleep-disordered

8. Betancourt-Fursow de Jiménez YM , Jiménez-Leó n JC , Jiménez-Betancourt CS

10. Domínguez-Ortega L , de Vicente-Colomina A [Attention deficit-hyperactivity

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