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Dr Rangan ChatterjeeHow Breathing Through Your Nose Will Change Your Life with Patrick McKeown
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Chapter summaries
Patrick's Story: From Mouth-Breathing Asthmatic to Nasal Breathing
Rangan introduces why breathing matters, and Patrick explains he wrote the book after 20 years as a mouth breather with worsening asthma and sleep. A newspaper article telling him to breathe through his nose and breathe lightly, plus a breath-hold exercise, brought rapid improvement.
- •Patrick was a mouth breather for about 20 years with worsening asthma, poor sleep and stress
- •A 1998 newspaper article said to breathe through the nose and breathe lightly
- •A breath-hold exercise to open his nose cut his rescue medication use by about 50% in a week
- •Patrick cites a Cochrane review putting dysfunctional breathing at about 9.5% of the general population, and much higher in anxiety, panic disorder and depression
Modern Stress, Sleep and Why Breathing Gets Overlooked
Patrick describes how mouth breathing, long-term stress and dysfunctional breathing patterns persist, noting Da Costa syndrome in Civil War soldiers. He cites sleep physician Christian Guilleminault's late emphasis on restoring nasal breathing and says a dry mouth on waking signals poor sleep.
- •Between 25% and 50% of studied children persistently mouth breathe, and adults over 40 are more than six times as likely to have the mouth open in sleep
- •Long-term stress changes breathing, and the dysfunctional pattern can remain and feed back into stress
- •Da Costa syndrome in returning American Civil War soldiers is an early account of this
- •Guilleminault wrote about the critical importance of restoring nasal breathing during wakefulness and sleep
- •Waking with a dry mouth means you are not getting deep, refreshing sleep
Why Nasal Breathing Beats Mouth Breathing
Rangan asks why it matters where you breathe. Patrick says the mouth has no breathing function, while the nose does many jobs, engages the diaphragm, raises oxygen uptake and delivery, and calms the nervous system.
- •Dr. Morris Cottle said the nose is responsible for 30 functions
- •Nose breathing targets the diaphragm, which is linked to emotions, while mouth breathing pushes toward fight or flight
- •Blood oxygen pressure rose 10% when people were made to breathe through the nose, per a 1988 finding
- •Emotions, sleep and breathing are interlinked, and Patrick gives self-check questions
- •Both hosts discuss awareness of breathing at night and late eating
Late Eating, Sleep Apnea and the Tongue's Position
Responding to Rangan's observation that late meals make nasal breathing at night harder, Patrick explains how belly weight impairs the diaphragm and how tongue position affects the airway. He sets out what better sleep requires.
- •Eating late affects appetite and may affect the diaphragm
- •Belly weight impairs diaphragmatic movement and reduces lung volume
- •With the mouth open the tongue sits low and can fall back into the throat, raising obstructive sleep apnea risk
- •Better sleep needs nose breathing and slow, regular diaphragmatic breathing
Processed Food, Inflammation and Jaw and Face Development
Rangan raises babies' breathing, modern stressors and processed food. Patrick discusses orthodontist John Mew's and Weston Price's observations on diet, crooked teeth and mouth breathing, while Rangan links processed food to inflammation. They then cover how breastfeeding, tongue tie, soft foods and air quality shape jaw development.
- •Mew's skull studies and Price's Hebridean observations tie diet changes to crooked teeth and mouth breathing
- •Crooked teeth can mean the jaw is too small for the tongue, raising later sleep apnea risk
- •Rangan describes inflammation from processed food potentially affecting the airways
- •Tongue tie, bottle feeding and soft foods reduce the muscle effort that shapes the face
- •Patrick used functional orthodontics with his daughter, who has a narrow maxilla
Mouth Breathing, Facial Development and Harvold's Monkey Studies
Rangan asks whether early stimuli shape the jaw and attractiveness. Patrick links form and function, describes his own compromised airway, and cites Harvold's monkey experiments showing nose blocking altered facial growth. He criticises the lack of attention to how asthmatics breathe.
- •Patrick says good looks reflect airway function and facial development
- •His own childhood mouth breathing, asthma and stuffy nose likely contributed to a compromised airway
- •Harvold blocked monkeys' noses and their faces grew differently, then trended toward normal once plugs were removed
- •Mouth breathing and malocclusion were reported as far back as 1909
- •Rangan says doctors' training never covers how asthma patients should breathe
Asthma Medication, Patrick's Mouth Taping and It's Never Too Late
Patrick takes the story through his childhood asthma, medications and school struggles, and the morning of alertness after taping his mouth at 25 or 26. Both stress that breathing work complements rather than replaces asthma medication, and Patrick says it is never too late, citing a near-70-year-old marathoner.
- •Patrick had three hospitalizations and years of medication, and says he does not replace medication with his techniques
- •Rangan stresses people should not stop inhalers without medical advice
- •He woke with unprecedented alertness after taping his mouth on the second night
- •Patrick still tapes his mouth nightly
- •A client near 70 ran a marathon breathing only through her nose, and Patrick says there is never a time not to start
Slow, Diaphragmatic Breathing Versus 'Take a Deep Breath'
Patrick calls the advice to take a deep breath when stressed nonsense and says to do the opposite of stressed breathing. He explains why nasal breathing is needed to restore diaphragmatic breathing.
- •Stressed breathing is faster, shallower, sighing and chest-based
- •The goal is regular, slow, diaphragmatic breathing through the nose
- •The nose is connected to the diaphragm and the mouth to the upper chest
- •Patrick suggests gently slowing breathing to a slight air hunger
Reassuring Parents: Nasal Breathing, Nitric Oxide and Everyday Protection
Rangan addresses parental guilt and asks what to say to those whose children missed early development. Patrick suggests observing the child, using gentle breath holds to decongest the nose, and encouraging nasal breathing, and explains the role of nitric oxide in sterilising and opening the airways.
- •Parents can watch for snoring and restless sleep in children
- •Simple, free exercises are available to help children decongest
- •Nitric oxide from the nose acts as a bronchodilator and sterilises air
- •Rangan describes keeping his mouth closed and holding his breath around smoke
Nasal Breathing During Exercise
Patrick explains why to breathe through the nose during exercise, citing a study where recreational athletes using nasal breathing reached full work rate with 22% less ventilation. Rangan notes Eliud Kipchoge appearing to breathe through his nose, and Patrick lists factors needed to sustain it.
- •Nose breathing during exercise brings less airway trauma and engages the diaphragm for core stability
- •Persisting for six to eight weeks reduces ventilation at the same intensity
- •A six-month study reported 39 vs 49 breaths per minute and 22% less ventilation at full work rate
- •Nasal cavity size and breath-hold time influence how well nasal breathing is sustained
The BOLT Score and CO2 Tolerance
Patrick walks through how to measure the BOLT score and why 25 seconds is the minimum target. He links breath-hold time to CO2 sensitivity, sleep apnea phenotypes and anxiety, and describes a gradual 'teaspoon of suffocation' approach for panic-prone people.
- •Breathe normally through the nose for five minutes, exhale, pinch the nose and time to the first definite urge to breathe
- •A breath-hold of at least 25 seconds was associated with an 89% chance dysfunctional breathing is absent
- •Improving breath-hold time reduces chemosensitivity to carbon dioxide
- •For sleep apnea, Patrick says focus on flow as well as the airway
- •Panic-prone people should build exposure to air hunger gradually
Unblocking the Nose, Slow Breathing and the Autonomic Nervous System
Responding to the common 'my nose is blocked' question, Patrick details the walking breath-hold to decongest the nose with safety cautions. Both discuss breathing as information, and Patrick explains how six breaths per minute affects the vagus nerve, heart rate variability and baroreceptors.
- •Breath-hold exercises repeated six times can open a stuffy nose, with cautions for high blood pressure and pregnancy
- •Nasal obstruction tends to persist until the BOLT score reaches 25
- •A Stanford study identified a brain structure that relays calm or agitation depending on breathing speed
- •Six breaths per minute is linked to vagal stimulation, higher heart rate variability and baroreceptor sensitivity
- •Breath-holding is a small stressor that can drive adaptation
Exhale Breath Holds, Sports Performance and Mind Stillness
Patrick distinguishes exhale from inhale breath holds and explains how they lower blood oxygen and raise CO2, citing a rugby study with large repeated sprint gains. He describes using breath holds before presentations, and the discussion turns to living in the head, breath holds as default mindfulness, and starting small when anxious.
- •Inhale holds make it harder to lower blood oxygen saturation than exhale holds
- •In a Woorons study of 21 rugby players, repeated sprint ability rose from 9 to 14.7 versus 9 to 10.4 in controls
- •Patrick uses five breath holds before presenting to get alert but calm
- •Rangan says breath holds shut off thinking and bring you into the body
- •For anxious people Patrick suggests five-second holds with 10 seconds of normal breathing
Parkrun, Efficiency and Letting the Nose Set the Pace
Prompted by a friend's running results, Rangan asks why parkrun participants should train nasal breathing. Patrick cites water loss, dental health, heart failure research and dead space, and both advise letting nasal breathing dictate pace, with recovery benefits.
- •Breathing out through the mouth means 42% greater water loss
- •Mouth breathing is tied to dry mouth, gum disease, cavities and chapped lips
- •Slowing breathing to six per minute reduced breathlessness in Bernardi's heart failure patients
- •Fast shallow breathing wastes air in dead space
- •Patrick's heart failure client raised oxygen saturation from 92% to 96% with slower, deeper breathing
Yoga's Original Teaching on Light Breathing
Rangan asks how light breathing fits with yoga. Patrick tells of Robin Rothenberg's book Restoring Prana, which traces how early yogic texts spoke of subtle, conserved breath, and notes that animals are nasal breathers.
- •Early yoga texts described subtle breathing and conserving the breath
- •Rothenberg's Restoring Prana documents how yoga breathing instruction changed
- •Patrick says animals other than dogs are innate nasal breathers, switching to the mouth when stressed or sick
- •Yogic sayings fit with breathing light and slow
Wim Hof Method Compared with Patrick's Approach
Rangan asks about Wim Hof's technique. Patrick explains hyperventilation lowers CO2, allowing long holds, and reasons it likely does not increase oxygen delivery but acts as a sympathetic stressor. He warns never to breath-hold underwater.
- •Wim Hof style breathing blows off CO2, so long holds are possible because the urge to breathe is delayed
- •Patrick says the method is a stressor that triggers adrenaline and adaptation, though he lacks all the answers
- •He suggests it may cause a left shift of the oxygen dissociation curve and reduce delivery
- •Rangan says different techniques serve different roles
- •Patrick warns that hyperventilating before underwater breath holds can cause blackout and death
Mouth Taping, Changing Habits and Closing Takeaways
Rangan asks about mouth taping, and Patrick explains its use with clients and children, the need to change behaviour after nasal surgery, and neuroplasticity. The episode closes with Patrick's top tips and where to find his resources.
- •Patrick has used mouth taping with every client and developed kids' tape, available via myotape.com
- •Fixing the nose isn't enough; behaviour must change, with relapse risks after adenoidectomy and tonsillectomy
- •Habit change takes 60 to 70 days, not 21
- •Rangan calls nasal breathing a free performance enhancer
- •Patrick's takeaways: observe breath and mind, nose, slow, light and diaphragmatic breathing, plus breath holds for two weeks
