256: Patrick McKeown, Breathing Expert & Author: The Breathing Cure for Better Sleep (UARS, Apnea, Mouthbreathing, and more!)

Welcome to the Sleep As a Skill podcast. My name is Mollie Eastman. I am the founder of Sleep as A Skill, a company that optimizes sleep through technology, accountability, and behavioral change. As an ex sleep sufferer turned sleep course creator, I am on a mission to transform the way the world thinks about sleep.

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Each week I'll be interviewing world-class experts, ranging from researchers, doctors, innovators, and thought leaders to give actionable tips and strategies that you can implement to become a more skillful sleeper. Ultimately, I believe that living a circadian aligned lifestyle is going to be one of the biggest trends in wellness, and I'm committed to keeping you up to date on all the things that you can do today to transform your circadian health, and by extension, allowing you to sleep and live better than ever before.

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Welcome back to The Sleep As a Skill Podcast. Now, breathing is one of the most overlooked and most powerful levers for better sleep. In today's episode, I'm joined by Patrick McKeown, an internationally recognized breathing expert and author who has spent over 20 years helping people improve their sleep, health, and performance by changing how they breathe, especially at night.

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Patrick is the author of The Breathing Cure for Better Sleep and the Creator of Oxygen Advantage and BCO Clinic Methods. In this conversation, we explore how dysfunctional breathing contributes to snoring, sleep apnea, insomnia, and restless sleep, and how simple science-backed breathing techniques can improve oxygen delivery.

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Calm the nervous system and support deeper, more restorative sleep. If you feel like you're doing all the right things for sleep, but still are waking up tired, this episode may be the missing piece. Tune in to learn practical tools that you can start using tonight and discover why better breathing might be the fastest path for better sleep.

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So we're gonna get right into the episode, but first, a few words from our sponsors. As we head into the fall and vacation season, winds down IEA time when late nights irregular eating habits and indulgence tend to become the norm. It's time to get back on track with our health and of course our sleep.

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Uh, you know, I'm biased, but gotta say that. And sleep is your major to focus on as we head into the fall season and hopefully beyond. And that's why I recommend that if you're going to start taking some supplements on your sleep often, magnesium is a great place to begin. But not just any magnesium supplement, I do recommend getting the Magnesium Breakthrough by BiOptimizers Magnesium Breakthrough contains also.

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Oh my goodness. Before even hitting record, I was just sharing with our guest how excited I am for this episode for a number of reasons, but also because he is renowned in his field and his name has come up many, many times on this podcast and beyond. And I am holding his latest book, the Breathing Cure for Better Sleep.

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So this is gonna be fantastic. So Patrick, thank you so much for taking the time to be here. 

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Pleasure, delighted. Thanks very much, Molly. 

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Yes, thank you. And I know you're on a different time zone and making this all work, so really excited to dive in and maybe we can just kind of begin at the beginning of how you found yourself as such an expert in this field.

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I don't know, like it's, I suppose anybody with that goes into the field of breathing 

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Yes. 

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Or likely sleep. You, you, you start it off with yourself first, so 

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Same. Yeah, 

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same. And it's, it's so, so common and I suppose that it gives us an experience. We know then that we can make a difference. That we've made a difference to ourselves.

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We have that, that, that knowledge, and then we want to pass it on to others and we want to delve down that route. Like I was a kid growing up with a stuffy nose. I never realized that if you have a stuffy nose, it wreaks havoc on your sleep quality. 

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Hmm. 

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It also reduces your cognitive function, your ability to concentrations to hold your attention.

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And I was snoring. I was having undiagnosed sleep apnea. I didn't know it at the time, and that was in my early twenties. So as a chronic mouth breeder with a high narrow polish with jaws that are set back with a deviated septum, anatomically I'm not in a great place in terms of airway. 

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Yes. 

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And of course, that increases the risk of sleep apnea.

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So I always was waking up at a dry mart in the morning as a student. If I went out and had a few beers with friends, I'd come back and I would snore really heavily and I would wake up at a sore throat in the morning. Mouth snoring, causing trauma to the upper airways. And then I came across a newspaper article and it talked about the importance of breathing in and out through the nose.

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And it talked about changing your breathing patterns so that your breathing is light. Mm. So in other words, that you're not breathing hard and fast. So I was mouth breathing and breathing hard and fast. And you have that combination, but that's gonna increase your resistance to breathing. Your tongue is in the low resting posture, your airways are narrower, and that's increasing the risk of collapse.

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And then of course, when you stop breathing, um, from 10 seconds or morene, et cetera. 

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Mm. 

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So that night I taped my mouth closed using three M1 inch micropore tape. 

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Sure. 

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I also used the nasal dilator. I don't remember much of a difference. The following morning I kept nasal breathing the following day, and I did the same again the second night.

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And the second morning I woke up. And I woke up feeling refreshed and I can't ever remember having had that feeling before because I never would wake up feeling refreshed. So that got me into breathing straight away. I had a very, very quick inroad. I had pretty much instant results. You know, it was night and day and it was life changing and it was life changing to the point that I had a master's degree in a completely different subject and I totally changed careers.

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So my objective was to start teaching breathing, but this is going back to the late 1990s and breathing wasn't, it wasn't as better as well known as it is now. You know, especially what, what I teach functional breathing and breathing for health in your everyday breathing patterns as opposed to a breathing practice that somebody might do while they're on a yoga mat.

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That's not what I do. Um, I'm looking at the person's everyday breathing patterns. Seeing how does your breathing during the day influence your breathing during sleep? 

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So powerful and clearly powerful enough to change career course and now to be a foremost expert in this area. So to kind of further unpack that a bit, I know you mentioned the mouth teeth piece, and this is a big hot topic certainly in the area of health optimization, but sleep in general.

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Anything to even just starting there, for anyone that said, oh yeah, I've heard of that questioning, should they start beginning in on adding that into their nightly routine? Any callouts there of why that might be valuable? 

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Yeah, if you look at the literature, any papers which investigate mouth breathing versus nasal breathing during sleep mouth breathers always fare out worse.

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Yes, always. You know, there's increased risk of sleep apnea, there's increased snoring, um, there's increased oxygen desaturation, there's increased fatigue. Lighter sleep. You know, there's so much going on with mouth breathing. And the thing about the mouth is the bout simply is not for breathing. The nose serves as a function.

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It's specifically designed by nature. That air travels in and out through the nose. And when we have our mouth closed, we can have the tongue resting in the roof. The mouth. When the tongue is resting in the roof, the mouth, it's helping to open up some space at the back of the airway, so the airway is wider.

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And when the airway is wider, the airway is less likely to collapse. 

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Mm. 

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But also, when you breathe in and out through your nose, there is a signaling from your nose to the upper airway to later muscles. And also with nasal breathing, you have a better recruitment of the die from breathing muscle. And the die from breathing muscle is mechanically linked with the upper airway muscles in your throat.

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So many people, their airways collapse during sleep. In females, upper airway resistance syndrome is common. That doesn't necessarily mean that there's a collapse, but it means that. The narrowing of their airway during sleep increases the effort to breed and the increased effort to breed takes them outta sleep.

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Mm. 

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But they still have the same symptoms. 

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Yes. 

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You know, symptoms associated with anxiety, uh, sleepiness, increased risk of dementia, chronic fatigue syndrome, fibromyalgia, and you know, there will be medically unexplained symptoms and that's a subject that we should turn back to. 

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Yeah. 

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But with obstructive sleep apnea, that's very much a male disease and that's when the airway is collapsing.

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Um, if it collapses partially it's a hypopnea. If it lasts for 10 seconds or more, or if it collapses, totally is an apnea. So coming back to your mouth closure during sleep, it's an interesting thing. Now it's gone viral. Um, we should never wake up at a dry mouth in the morning, so if you wake up at a dry mouth in the morning, it's a red flag straight away.

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Mm-hmm. It affects all ages. And I would estimate that 50% of the adult population wake up at a dry mouth in the morning. I would say it's pretty close to that in children as well. You, it could range from 45 to maybe 50, 55%. So there's so many things going on with open mouth breathing, but most definitely your sleep is lighter.

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Now I'm gonna say this, never force nasal breathing during sleep. So it's never just about getting a piece of tape and slapping it on your mouth and expecting that you're going to be breathing through the nose. And the other thing is, it's never just about taping your mouth. You have to look at your underlying breathing.

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Mm-hmm. 

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Because if your everyday breathing is off, if you have a stronger drive to breathe, if you're breathing is faster and your breathing is harder, if you're breathing upper her chest, all of that is going to impact your sleep. So, you know, taping the mouth closed is one thing. And I will also say that people with more, more moderate to severe obstructive sleep apnea, they should never tape their mouth closed.

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They should never cover them out. And the reason being is because those individuals need to mouth puff. Many of them need to mouth puff. 

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Hmm. 

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And if you prevent them from mouth puffing, you've increase their sleep apnea. So this is getting more attention in the last couple of years, and they have looked at studying individuals with moderate to severe sleep apnea.

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They tape their mouth, cover their mouth with a tape. Half of them are helped and half of them get worse. But the problem is you don't know which half. So whatever support that you use to bring the lips together, it must allow mouth puffing. Now I'm lucky enough, I did bring out a product and I, I'm not here to, to kind of promo it or anything like that.

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Mm sure. But it was, it was a product worn around the mouth to bring the lips together. And I first brought it out for children because I always felt uneasy with children. I had been working as a clinician. Teaching, breathing, rehabilitation. Since 2002, I've had thousands of people through my clinic, 30% of the people who will come in, come in with sleep problems.

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Hmm. 

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I work with insomnia, with snoring, with upper airway resistance syndrome, with obstructive sleep apnea. I was always uneasy with children because I do need children to breathe in and out through the nose. We start with teaching them different exercise during wakefulness exercises that are all free.

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Um, you know, there's a sleep hub that you, if any parent wants to find out, how can we help my child to switch to nasal breathing? We, we have all of the exercise free online. Um, and switching to nasal breathing with the child, but not to cover them out of the child because of course, what would happen if the child was to get sick.

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Um, it's, it's, uh, it's a low enough risk, but at the same time, the risk is there nonetheless. So that's why I brought out the tape that we wear that surrounds the mouth, pulling the lips together to allow nasal breathing. So coming back to it, there's a reason that this has gone viral? Yeah. Because people are getting benefit from it.

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Now. The medical community are not in agreement with it at the moment, and I can understand their points of view, but at the same time they're not looking into it. 

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Yeah. 

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You know, they're looking into it more so that they're not taking into consideration that people are feeling better. 

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Mm-hmm. 

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They're not taking into consideration even with individuals wearing A-C-P-A-P, if you have A-C-P-A-P because of obstructive sleep apnea, it's an entirely different ball game if you are nasal breathing with the CPAP using a nasal mask versus if you are oral nasal breathing using a full face mask.

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Mm-hmm. 

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Let's look at it this way. If I have obstructive sleep apnea and I'm wearing A-C-P-A-P, if I have a full face mask, typically, then it identifies that I breach through the nose and through the out. I'm a Nora nasal breathing. That my tongue is in the low resting posture. So I have my mouth open. I have a mask on my face.

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My mouth is open, I'm breathing through it. My tongue is in the low resting posture. My tongue is falling back into the throat. My mandible is set back. That and turn is further and narrowing the airway. The CP Pap P is designed to splint. Air is designed to administer air at a particular pressure to splint open the airway.

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So on one hand, the CPAP is designed to maintain an open airway, but on the other hand, the open mouth breathing is narrowing the airway. So now for the CPAP to work, you have to increase the pressure. The individual has a full face mask. There's an increased therapeutic pressure, there's increased risk of mask leak.

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It's more uncomfortable for the person, and it reduces compliance. Now there's an example in the medical world, the CP Pap machine is the gold standard of treatment for obstructive sleep apnea. Yeah. There's no distinction in switching from mouth to nose breathing for these individuals. 

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Mm-hmm. 

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There's no respiratory rehabilitation.

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There's no encouragement to breathe in and out through the nose. If you are a mouth breather, you're handed A-C-P-A-P with a full face mask, knowing that the full face mask reduces compliance, reduces efficacy, increased therapeutic pressure, and is fighting the very thing that the CP PAP is trying to address.

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Now, if we look at the work of Dr. Christian Mau, he was a Stanford based medical doctor. 

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Mm-hmm. 

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He coined the phrase obstructive sleep apnea. Yes. He also developed and coined, but he developed the Apnea hypopnea index and he coined Aary resistance syndrome. He first identified in children in 1982, and he identified it in adults in 1993.

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In his latter years, he's sadly passed on in his latter years. He spoke about the importance of maintaining nasal breathing both during the day and during sleep. 

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Yes. 

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So here's what who is considered to be a founding father of sleep medicine, talking about the importance of breathing in the neck through the nose, but yet if you were to go to a sleep clinic, there would be very, very little attention put on how you were breathing.

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And I will genuinely say this, if you want to change your sleep, start breathing in and out through your nose. Not your mouth. Never wake up at a dry mouth in the morning. 

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So good. Oh wow. I also heard rumors before he passed that he was proclaiming that also tongue posture and tongue ties would be a component of this.

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Have you heard that from him and or do you agree that that's a really important aspect for us to be exploring as it relates to sleep apnea? 

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Yeah, like he's written about it. I was lucky enough, I spoke at different conferences and he spoke too, so our paths crossed. I had dinner with him on a few occasions.

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I've shared a glass of wine with him on, on quite a few occasions and I had conversations of course, informal, which can be very, very helpful as well. 

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Totally. 

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So he has different papers looking at myofunctional therapy, which is a tremendous therapy, and myofunctional therapy is looking at helping to improve the function and tone of the upper airway muscles and the position of the tongue.

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Also myofunctional therapist will help identify if the individual has a tongue tie. And a tongue tie would be that the, the piece of string that's attached to the base of the tongue, the bottom of the tongue is too short and it's holding the tongue to the floor of the mouth. Now, in a young baby, that's problematic, but also when an adult, it's problematic.

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Mm-hmm. 

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Because of course, if your tongue is not able to get from the floor of the mouth, it's not able to rest in the pal. And as a result, then it's more likely to encroach the airway. Um, and from a cranial facial point of view, he spoke about that. He referenced Harville's work. Harold was a functional orthodontist back in the late 1970s.

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He did experiments who people would consider to be quite cruel today on young Reese's monkeys. He blocked their noses with, with silicon nose plugs. He forced the monkeys to breach through an open mouth. All of them out breathing monkeys. Their faces changed all of them. Now, what was interesting about that.

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The monkey's face changed the same way that the humans' face changed when the humans breathe through an open mouth. People are aghast when they hear the experiment on the monkeys, but people don't even think that there are millions of children partaking in these experiments because they too have an open mouth posture.

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There's very little awareness in terms of the healthcare community of the importance of nasal breathing for children and children who have persistent mouth breathing have a low run, low tongue resting posture, and they are more likely then to have C craniofacial abnormalities. 

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Yeah, 

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so their tongue isn't dressing in the roof of the mouth.

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We do need to tongue resting in the roof, the mouth, because that helps drive forward growth of the face. 

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Mm. 

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And when the lower half of the face grows forward, it helps to open up the airway. I was a mouth breather. My tongue was in the low resting posture. It's normal. If you're breathing through and upper mouth.

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Your tongue cannot rest in the roof to mouth, so your tongue is in the low resting posture. It narrow naturally narrows the airway. Also because the tongue is in the low resting posture, the maxilla tends to be a V-shaped and narrow. There's overcrowding of Tet and overcrowding of Tet is not a good sign.

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Children have C crooked teeth. This isn't just about the aesthetics. If the teet are C crooked, it's telling you that the jaw is too small. Mm-hmm. If the jaw's too small, there's no room for the tongue. If there's no room for the tongue, the tongue is encroaching the airway. So these kids don't just have crocked teeth.

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These kids are likely to have a sleep problem. 

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So good. The, and drawing attention to this so that ideally we can address this at its root for the youth, and to your point, there's so many adults out there that now they're just finding out about this after the development has been done. So what do we do for, in those cases, like, I know you mentioned for in your case, that it sounded like a deviated septum, but what about those people that say, well, I'm gonna have to get surgery or correct these anatomical abnormalities.

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I'm sure there's also nuance here and there's a lot of individualized cases, but do you see the ability for people to be able to overcome these things? Or do they often need to have interventions like surgery once we become adults and we have these problems, what do you see there? 

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You know, in some instances, yes, but in many instances, no.

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When we talk about the human nose, I have a deviated septum. The question that I ask is, can I breathe through my nose? 

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Hmm. 

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So does it feel comfortable for me to breathe through the nose during rest? Does it feel comfortable to breathe through the nose during exercise? And does it feel comfortable to breathe through my nose during sleep?

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So, you know, when it comes to surgery of the nose, the real question to ask is, well, is the deviated septum or small nose or narrowing of the nasal airway, is it sufficient that it's causing a resistance to breathing? So ideally we do want to have a nose that functions well, that air can flow quite easily from the nose into the lungs and back out again.

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And that's very, very important. But anatomically, you know, if it, if say, for example, you have, if we think about the resistance to breathing, so what does resistance to breathing mean? You could ask, well, you could argue that resistance to breathing implies the effort that it takes or the difficulty it has in terms of air moving from the nose into the lungs and back out.

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If the airway is narrower, well, that increases the difficulty in that airflow because there's going to be an increased resistance to breathing there. If you hear a child breathing, it implies that there's some degree of resistance to their breathing. You should never hear a child breathing during sleep.

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The next stage of resistance to breathing could be louder, breathing, going into a snore. That can be a mouth snore or it can be a nasal snore. We can stop mouth snoring straight away a hundred percent. We can stop mouth snoring, which is the primary form of snoring, palatal, snoring, nasal snoring. We can reduce if the resistance to breathing is increased.

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Again, now we're going into severe resistance to breathing. This would cause a hypopnea. This is when there's a reduction in the flow of our breathing by 30% or more, and if there's a further resistance on top of that, then we can have a stopping of the breath. So resistance to breathing? It varies. So it goes from.

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Audible breathing all the way through the stopping of the breath itself. So coming back to your question Yeah. Does the nose do the job that the, for that person, and the only way, the only way that you really will know if you have a sleep issue is by doing a sleep study. Now I'm gonna talk about this.

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Okay. 

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Females breed. Females breed differently to men and females, sleep differently to men. 

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Mm. 

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And the sleep industry is very geared towards men. And the sleep industry is not geared towards women. The reason that I would say that is because women have a tendency not to get away with anything when it comes to the airway.

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And there is that condition called upper airway resistant syndrome, first identified in adults in 1993. So it's relatively recent. 

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Mm. 

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It's more common in females and it's common in females with a high upper pal. Our females who had teeth extracted say, due due to orthodontics, they had teeth extracted, which in turn made their top jaw, their maxilla smaller, and again, they don't have enough room for the tongue.

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It's common in younger females, and it's common in slim females, so they don't, they don't typically meet the classic profile that you would expect with somebody with a sleep issue. All it means is that they have some degree of airway narrowing, some degree, not much, not enough that their airways are collapsing or not enough, that there's a drop in their blood oxygen saturation.

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But that the resistance to breathing is enough to take them out of deeper sleep because when there is a, an increased difficulty to breed, it increases the effort to breed, and it's the increased effort to breathe that takes them out of deep sleep. So the female then, she's not snoring heavily. She's not stopping breathing.

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She doesn't have hypo apnea. Her blood oxygen saturation is normal. But she has multiple sleep fragmentations because when there's an increased effort for her to breed, she is taken out of slow wave sleep, deep sleep into lighter sleep, and she has multiple fragmentations and she's waking up feeling exhausted, but also with a greater tendency towards an anxiety profile.

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See men when they are sleepy, they're tired, they're more likely to be fatigued. Women with upper airway resistance syndrome are more likely to have mental health issues, anxiety, panic disorder, rumination of the mind as a result of poor sleep. Now, when that female goes, she knows there's something up.

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Okay? She might do the the Pittsburgh Sleep Quality Index, for example, and she says, oh my God, I'm really tired. I know there's something wrong. I'm gonna do a sleep study. Okay? The sleep study will come back in the morning and the doctor might say, well, your a HI is less than five events per hour. You don't have sleep apnea.

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You're not stopping breathing. There's nothing wrong with your breathing during sleep. Your blood oxygen saturation never went below 92%. So you're absolutely fine, but just she's exhausted because the sleep study in more commonly doesn't take into consideration respiratory effort related arousals. So anytime a female does a sleep study, she should ask, does your sleep study check if I have respiratory related effort?

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Arousals? Because that's the big one when it comes to females. Now another part of upper airway resistant syndrome is lower arousal threshold, which is common in females. 

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Mm-hmm. 

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Now it's, it's in men too, but it seems to be more common in females. So what is lower arousal threshold? It just means that you wake up quite easily from sleep.

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Hmm. 

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So say for example, there's an increased effort to breed the body senses, there's an increased effort to breed. So what does the body do? Take you outta deep sleep into light sleep, but possibly. It brings you into full wakefulness. So you're waking up. So you're waking up at three o'clock in the morning, which affects about 30% of the population, 10% chronically, but it affects more women than it does men.

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Now that female, she's awake three o'clock, four o'clock, possibly five o'clock, she's waking up feeling exhausted. So her symptoms are going to be similar to a man having obstructive sleep apnea. But if she does a sleep study, it's not really taking into consideration the lower asal threshold. She has reduced sleep efficiency.

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She's spending eight or nine hours in bed, but it doesn't mean that she's spending eight or nine hours of sleep. She could be in bed for nine hours and she could be asleep for five of those hours because of the multiple sleep fragmentations. And then you could ask, well, what's the treatment for it then?

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Upper airway resistance syndrome is quite different, and it's in a totally different continuum. It's not from snoring to sleep apnea. It's not that upper airway resistant syn resistance syndrome falls, fromwhere in the middle. It's a separate, it's a separate condition. Um, how do you treat it? And the treatment is typically CPAP, but this is where we need to have a much greater attention and awareness on how everyday breathing impacts your breathing during sleep.

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I wrote a scientific review paper on this back in 2021. Um, I wrote about two ear, nose, and throat doctors, but I wrote a specifically with how your everyday breathing impacts obstructive sleep apnea. But we can still apply all of that to airway resistant syndrome. If you change your breathing patterns and you have your tongue resting in the roof them out, and you're breathing light and breathing slow with good recruitment of the diaphragm.

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Number one is because your breathing is steadier, your breathing is lighter. Your breathing is slower. There's not so much difficulty in that air traveling from the nose into the lungs. Conversely, if you have somebody with poor breathing and they are breathing faster and harder, as that air is drawn into the lungs, the faster and harder breathing will increase negative pressure in the airway to contribute to increased resistance and increased collapse of the airway.

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So our everyday breathing pattern really makes a difference. And combining that then with myofunctional therapy, that would've been what Dr. Christian GUI and always advocating can help that. Even again. And the thing about this is once you learn these skills, you have them for life. You're not dependent on something like A-C-P-A-P machine.

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The CPAP machine works. The problem is that people can't tolerate it. 

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Mm-hmm. 

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50% of people tolerate it and 50% of people can't tolerate it. And if you're a young female waking up feeling exhausted with lower arousal threshold. The question that I would ask is, will you tolerate A-C-P-A-P? Because you are already a light sleeper.

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And if you're a light sleeper and now you're wearing a mask with a tube and a a machine or a device, you know, is that going to be enough to keep on waking you up as well? You know, so I think there's a conversation to be had about sleep. We need to differentiate, differentiate between women's sleep and men's sleep.

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You know, even if a female has an a HI, in other words, if she has between two and five events per hour, so technically she doesn't have sleep apnea, it's equivalent in symptoms to a man having an a HI of 15 events per hour. 

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Mm. Wow. 

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And the thing is, the female, again, she goes to the sleep study, she'll be told there's nothing wrong with her, but clearly she knows there's something up.

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But the problem is nobody seems to know why or what. That's gonna drive up her anxiety. That's gonna drive up her hyper arousal. That's going to increase. Her lower Assal threshold. She's ruminating at night, she's waking up more frequently, putting her into an increased stress response. And the increased sympathetic drive during sleep carries forward into the day and back into the next night.

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So you have a vicious cycle. 

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Oh, wow. And upper air resistance syndrome. What is your preference? Are you seeing the possibilities still distinguish this if people are educated of how to read the results of a at home sleep lab? Or do you often urge people to go in lab? Any call outs there? 

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The thing is, Molly, that that at home sleep lab doesn't typically monitor or register for s Yeah.

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Respiratory effort related arousals. 

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Sure. 

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And a lot of the sleep labs in hospitals don't either. 

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Mm. 

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So you really, I think for a female, it's very, very important that you know that she does check. Does this sleep clinic, the sleep study that I'm doing, is it looking at rares. Um, because it's quite subtle.

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And the other thing is looking at lower arousal threshold. 

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Mm-hmm. 

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Now you can identify lower arousal threshold to some degree from a sleep study as well. So typically hypopnea are about 58%. You know, so the ratio of hypopnea to apnea is 58% is hypopnea, so you're not having full blown apnea. You're having much more partial reductions or partial collapse of the air to cause reduction in breathing.

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The a HI is typically less than 30. So these individuals don't have severe obstructive sleep apnea and their blood oxygen saturation doesn't go below 82.5%. And if you score two out of three, so if you were to allocate one for each of those, and you have two, it indicates then that you have lower AAL threshold.

‍

And lower AAL threshold is very much associated with hyper arousal. 

‍

Mm-hmm. 

‍

We, we have to think of the nervous system here. Yes. Now poor sleep puts us into an increased sympathetic drive. But increased sympathetic drive will put us into poor sleep. And, you know, people then the most common, um, way to help with low rle threshold or insomnia is sedatives.

‍

Mm-hmm. But of course, they're not without side effects. And I think 8.6% of the US population takes sleeping pills. 

‍

Mm. 

‍

So they are taking something to help activate the rest and digest response. But you know, another way to do it, you could use breathing exercises to dampen the stress response. To increase relaxation.

‍

You could be breathing light, breathing, slow breathing, low nasal breathing during the day, nasal breathing, during physical exercise, nasal breathing during sleep with the tongue, resting in the roof, the mouth. There's a lot that we can do. Now, the other thing that I would say is if you wake up at three o'clock in the morning, it's a very frustrating time to wake up.

‍

Yes. 

‍

Because. You're after having a few hours of sleep, but yet you're not awake enough to get up, but you're not tired enough to fall back asleep. So there's a reduction in sleep drive, and you also have a pressure to fall asleep because you know that you're going to be up for work at seven o'clock or six o'clock and you know, if you don't fall asleep, you're going to be absolutely exhausted when you wake up.

‍

And of course now there's a pressure on you to fall asleep and that's gonna hamper the very thing that you want to achieve. 

‍

Yeah. 

‍

So what do I do with my clients? I have them listen to a guided audio. So about 15 years ago, I started first recording guided audios. They were 20 minutes and they were scripted to bring in relaxation with breathing exercises that if my client wakes up at three o'clock in the morning, I would like them at the time.

‍

Well, it was CDs back then. Yeah. Um, they would play a CD and they would simply listen to the cd. And when they're listening to the guided audio. They're handing the problem over to something else. So all they're doing is just sitting there or, and they're lying in bed at this time. They're listening to the CD and they're following the instruction with the cd.

‍

And the CD is guiding them back into sleep. And that's the way we do it still, because I just feel it's so challenging to try and fall back asleep at three, three o'clock in the morning. And there is always a tendency for the mind to ruminate. Mm-hmm. The mind latches onto thoughts. The mind is thinking, there's things coming into the mind at three o'clock in the morning that it's almost like, it's like a broken record.

‍

And of course that helps. That doesn't help us fall back asleep. So Yeah. Distracting yourself by listening to a guided audio can be very, very helpful. And they're free. Like what I'll do is I'll send you a link at the end. There's a sleep hub. 

‍

Great. 

‍

Um, it's, it's in the QR code from the book by the way.

‍

Sure. 

‍

But I can send you the link. And we have ones for teenagers, one for menopause. Ones for individuals Norm, like any person who's waking up in the morning. So, yeah. 

‍

Oh, that's so fantastic. And to underscore that, we did have, if anyone wants to look further into the thought piece, we interviewed the heads of the study, the Mind After Midnight that spoke to sort of the circadian rhythm nature for thoughts, which is fascinating that the types of thoughts we might be having at 3:00 AM are gonna be very different than a 3:00 PM.

‍

Slew of thoughts, even just the knowledge that we tend to go towards more of that kind of black and white thinking, catastrophic thinking, and sadly, suicidality rates going up in the wee hours of the morning. So very real world consequences, unfortunately, if people are maybe not aware of what's at play.

‍

But the more we can educate and shed light on this, and then also to your point, bring in these tools to help maybe shift gears out of that sympathetic nervous system over to potentially that more parasympathetic response. That's fantastic. So we'll definitely get that in the show notes. And so what you're pointing to too, I'm so grateful that you're sharing about this upper air resistance piece.

‍

How often this is missed because we'll see that all the time where people say, oh yeah, I got tested and they said I was fine. And yet if we peel back the layers, upper air resistance syndrome is so commonly missed. So I appreciate you sharing of the need to kind of, I'm sad to say that, so people have to do so much homework to kind of get that proper diagnosis at the moment.

‍

But for right now, kind of doing our due diligence to find ourselves, practitioners that are in these conversations are able to kind of peel back more of this information. And just a quick. Question outta curiosity. Are you seeing so often we'll hear these talking points around how women become as we age, then getting post, you know, 40, 45, et cetera, maybe become more one-to-one with our likelihood of men to getting sleep apnea.

‍

Do you see that that's just a result of hormonal shifts or now we're just, uh, compounding effect of all of this poor sleep over so many years? Or is it just anyone's guess as to why that happens? What do you see there? 

‍

Yeah, I think there's a number of different factors. Um, progesterone helps to protect the airways during sleep.

‍

Sure. 

‍

So, um, progesterone as a hormone will have to stiffen the airway, so it's less likely to collapse. Women who are younger, um, that are susceptible to obstructive sleep apnea typically have lower progesterone. Mm. And post menopause progess progesterone production is, is low. As a result, then the airway is more likely to collapse, so it doesn't have the protective effect of progesterone.

‍

The second thing is, once either male or female hit a certain age, we start putting on weight, different body weight. Weight in the abdomen is not good because it reduces the movement of the diaphragm. If there's a reduction in the movement of the diaphragm, it reduces tidal volume and the TRO is more liable to collapse.

‍

So whenever we think about the airway, we cannot think about the upper airway in isolation to the lower airways. They're linked. If you have a problem with your lungs, you typically have a problem with the upper airways. And people with asthma and breathing problems will typically have a problem with sleep.

‍

So it's not just that they have a problem with the lower airways. 

‍

Sure. 

‍

So abdomen, so belly fa will imp pinch the movement of the diaphragm. The other place that we put on when we put on a bit of weight is the fat we, the, the tongue gets fatter. And the tongue gets bigger, occupies more space. And of course if the tongue is too big for the mouth, well it's only going to go back into the tr back into the airway.

‍

And then we put fat pads on the throat itself, which narrows the airway. So, and you know, there's a vicious cycle here because say for example, you're starting having sleep apnea and you're stopping breathing during sleep. It's increasing sympathetic drive. This increases hormones such as ghrelin and reduces leptin.

‍

It stimulates appetite during the day. You have a greater tendency to eat more. You eat more food. You put on weight. You put on weight. And that in turn increases the risk of sleep apnea. Ugh. 

‍

Yes. 

‍

And it's difficult for people with obstructive sleep apnea to lose weight. And I know we have to start somewhere, but what I would say is.

‍

Start looking at your everyday breathing patterns and like, this is not about diagnosing, I'm not here to 

‍

Sure. 

‍

The only way you can diagnose sleep apnea is to do a sleep study. And the gold standard of treatment is A-C-P-A-P machine. And the second standard of treatment is typically mandibular advancement devices.

‍

Mm-hmm. 

‍

Now, neither of those, if you have insomnia and lower AAL threshold, you know you have to be looking also at that. And you know, that's very often dysregulation of the nervous system and that's where breathing can come in the muscle recruitment. Another phenotype in sleep apnea is up, upper airway, muscle recruitment.

‍

Are the muscles in the throat designed, which are designed to keep the airway open? Are they doing their job? And this is where myofunctional therapy will come in. So there's non-invasive therapies such as breathing reeducation, specifically Butte technique. So developed after by the rush by the Ukrainian doctor, Constantine Butte.

‍

His method and myofunctional therapy bring the two together to help with sleep quality. 

‍

Wow. So great. And I know certainly because you've had many books breaking down for us, more information on how to transform our relationship to our breath. And I know I mentioned at the start of this podcast too, the exciting fact that now you have one fully focused around sleep.

‍

So would you. Say that for anyone listening right now, since there are so many, I'm like struggling to pull back from 9 million questions. 'cause I know it's a huge topic. Would you suggest that for most people there would be so much benefit for them to be reading this book? Certainly if they have sleep apnea, but also if they suspect that they may, along with upper area resistance and any sort of disordered breathing and snoring.

‍

I mean, there's a lot there. And maybe if you have young kids and you're aiming to support their breathing by day and by night, is that often a good place for them to start to further unpack all of this? 

‍

The book is the information and the book is all of the breathing exercises. Also, when I'm writing a book like that, it's a serious topic.

‍

Yeah. 

‍

And I do have to bring into science, I do have to support it. I can't just say something without 

‍

Sure. 

‍

Being able to provide some solid foundation as best as possible. Sometimes the research is scanty. Um, but at the same time, we, we want to be able to, to join dots and trying to connect it here. So the book is a scientific book, but it's written in layman's terms.

‍

Sure. 

‍

Um, you know, in the first couple of chapters contain all of the breathing exercise that can, people can practice. There is a QR code as well throughout the book that brings people to a sleep hub. There's where they get free guided audios. There's also a two hour masterclass in sleep. 

‍

Mm. 

‍

So it brings you through all of the exercises as it applies to snoring, insomnia, and sleep apnea.

‍

And also then there's a children's program that's free, so the information can be readily accessible. Now we do use a tape and, you know, the tape that we use to ensure nasal breathing. Like if anybody is waking up at a dry mouth in the morning, I will genuinely say the biggest thing that I experienced.

‍

And also with many of my clients. And bearing in mind we have been using nasal breathing support for 23 years. The Myo tape, we've sold 16 million strips. Wow. So it's not that. This is just something that we are seeing for the first time. You know, we've over two decades, and I'm one of the few people, I can't think of anybody else who is putting a tape out there, but also works in breathing rehabilitation.

‍

I just didn't think of putting a tape out there without having any background information. You know, that's just the way it is. 

‍

Sure. 

‍

But if you do wake up at a dry mouth in the morning, it's absolutely vitally you start nasal breathing during the day. And even when you're doing physical exercise, you know when you're going for a walk, keep your mouth closed.

‍

If you're doing light exercise, moderate exercise, do your best to keep your mat closed. Yes, there's a time, if you're sprinting, if you're a competitive athlete, you're gonna have your mouth open. But then as soon as you slow down the pace and you can switch to nasal breathing, switch to nasal breathing.

‍

And it will also help improve your sports performance. Mm. Um, because of course, like part of my work is working in sleep and mental health and respiration, but the other part is about mental and physical performance. So I wrote a book called The Oxygen Advantage back in 2014, which it's very popular in terms of breathing circles, but that's all about mental and physical performance.

‍

But, you know, the two go hand in hand because if you look at any, any individual with poor sleep, it's not just that they have increased rumination or they're irritable, or they have cognitive difficulty. The problem is they're, they're not going to have good recovery when they do physical exercise.

‍

Individuals or athletes, when they do physical exercise with poor sleep quality, they've got increased heart rate, they've got lower heart rate variability, they've got an increased risk of injury, they've increased risk of concussion. You know, so even in terms of performance. Rumination and cognitive function for athletes that's going to be impacted by their sleep quality and quantity as well.

‍

So whenever we think it's not necessarily that we're looking at the problem, we're also looking at the performance part of it. How can you be at the best of your ability, either physically or mentally if you have poor sleep quality And absolutely sleep hygiene is important. You know, exposing yourself to daylight and the first thing in the morning, trying to minimize light in the evening time.

‍

Having sleep, consistency that you're going to bed at the same time pretty much every day, that you're waking up the same time every day. Not to have over, like last night I watched a true crime, um, program and Netflix or Amazon Prime. 

‍

Okay. 

‍

And it's total disaster. 

‍

Yeah, right. 

‍

And I was, I was lying there at two o'clock in the morning wondering what earth's going on.

‍

Now all was run through my head was this episode God about Becky Parker or some kid, you know, that was true crime issue that was going on in the uk. 

‍

Oh 

‍

man. And you know, like, and 

‍

yeah, 

‍

this is, we have to be very, very, um, careful what we expose ourselves to. And yeah, sometimes you'll, you'll do it, you'll watch the true crime, but then you realize, yeah, that totally messed up my sleep.

‍

Totally. 

‍

And then we figure it out and then we, we can make changes in the back of it, you know? 

‍

Yeah. But 

‍

yeah, there, there are things that we can be absolutely doing to help her sleep that are free effectively. Yes. They're, they're free. 

‍

So good. Okay. So anyone that is listening that may have diagnosed disordered breathing of some category and or just knows someone or is experiencing, and even seeing like these overly normalized things like snoring throughout the course of the night and then waking up with this dry mouth.

‍

So anyone that's hearing this that we see that there's evidence to support that we can at the bare minimum, reduce the severity of the instances of, say, sleep apnea, the amount of snoring purely by the changing the way we're breathing by day and night. Is that all accurate? Is there anything I 

‍

missed 

‍

there?

‍

Question. Okay, beautiful. 

‍

Absolutely no question. 

‍

Yeah, 

‍

like even if we think snoring, snoring is a nuisance and primarily like there's mouth snoring, which is when you're breathing through an open mouth and there's turbulent airflow causing vibration of the soft palate right at the back of the roof of the mouth.

‍

Then you have nasal snoring, which is turbulent airflow in the nasal firings where the nose is meeting the trout mouth snoring. Sounds a bit like this, so I'm not sure if that came true in the microphone. It did, but it did. 

‍

Yeah. 

‍

It's a very tr sound. 

‍

Yeah. 

‍

And I know there's people listening to here and to have a partner and the partner is snoring all, all night and it's probably a male and he is saying, no, I don't snore.

‍

And she records them. And what does she do then? She plays it back to him in the morning? 

‍

Yes. 

‍

If she listens to it, she'll know whether it's a mouth snore or a nasal snore based by the sound. Mm-hmm. So a mouth snore is throat and the nose snore is nasally. 

‍

Oh, 

‍

so you nose straight off. 

‍

It's great. 

‍

Now what I would say is test it.

‍

Can you snore through your mouth if your mouth is closed and you're only breathing through your nose? 

‍

Mm-hmm. 

‍

So if I close my mouth now. I cannot snore through my mouth. 

‍

Mm-hmm. 

‍

So once we get the lips together, breathing in and out through the nose, mouth, snoring stops a hundred percent. 

‍

Wow. 

‍

With nasal snoring.

‍

So nasal snoring will be contributed by two factors. One is the, the nasal anatomy. Does the individual have a stuffy nose? 

‍

Sure. 

‍

Do they have nasal polyps, deviated septum? Do they have a small nose? Do they have a nose with a resistance to breathing? In other words, it's quite difficult for air to travel through the nose and that's creating the turbulent air flow.

‍

There are exercise to help decongest the nose. So number one is we can help to alleviate the symptoms of rhinitis. And typically when somebody has a stuffy nose, whether it's chronic rhinitis or if it's hay fever, hay fever would be seasonal rhinitis. If whenever you have a stuffy nose, you're more likely to be tired.

‍

Hmm. These individuals never just have a stuffy nose. So we can show how to decongest the nose using simple breath told exercise. If you grin on YouTube, put in Patrick McKeown, unblock the nose, and you'll find exercise there that works straight away. In five minutes, you can have to alleviate nasal congestion.

‍

If you now improve your breathing patterns on top of that, that your breathing is lighter and slower through the nose, you're not trying to force so much air through your nose, that naturally then will reduce the turbulent air flow. So it's not just nasal snoring, isn't just about the anatomy. Nasal snoring is also about what's the flow expected to go through the nose.

‍

Mm. And if you have an individual going around during the day with their mouth open, breathing fast, breathing harder, that's not gonna suddenly correct itself during sleep. That person also breathes mouth fast and hard during sleep, or if they're switching to nasal breathing, they're breathing fast and hard through their nose during sleep.

‍

But that increases turbulent airflow. So the whole sleep industry has focused on only one thing. The airway. But the sleep industry has not focused on what goes through that airway. In other words, your respiratory rate and the tidal volume. How fast do you breathe, how hard you breathe. But poor breathing patterns are very common.

‍

You know, it is very common as a normal kind of feature of modern living. We are sitting, we are eating incorrect foods, we have stress. All of these things feed into our breathing. Our breathing is very susceptible to change, but at the same time, breathing is under our control. So, yeah, so if you're mouth snoring, you can stop it straight away.

‍

If you're nasal snoring, you can significantly reduce it. And one paper looked at wearing a mouth closure, getting them out clothes and switching to nasal breathing, reduced snoring by 47% in people with mild. There were mild sleep apnea, but their a HI also reduced by 47%. That was just by getting their met closed during sleep.

‍

That's not taking into consideration did these individuals have their tongue resting in the roof, the mouth, or these people breathing functionally with light, slow and deep breathing, you know? So, yeah, so you can improve on that. It's not just about mouth taping. We need to go way beyond that. Sure. But at the same time, we do want the my close during sleep.

‍

Okay. So good. Oh my gosh. All right. I'm gonna reign it in 'cause I have so many more questions for you, but we will respect your time. Now, every person that we do bring on the podcast, we do ask four questions around how they're managing their own sleep. And I'm fascinated to hear yours given your origin story and how this originally all began with your own sleep.

‍

And then after your decades of being in the field and making just such a difference for so many people. Can't wait to hear how this is all looking for you and bring it all, including the Netflix shows every now and again, whatever, whatever we can learn from. Okay, so the first question is, what is your nightly sleep routine looking like right now?

‍

Okay. I always have to go to bed before 10 30. 

‍

Okay. 

‍

And ideally 10:00 PM That's every, every night. 

‍

Love 

‍

that. I do my best to have sleep. Consistency all the way through the night, all the way through, including the weekend. Um, because I'm aware if I was to stay up 12, one o'clock one night, it's gonna take me one or two days then to recover, to get back into the swing of things.

‍

My routine, I always will have downtime in the evening. Um, it's just relaxing. I could read a book, I could watch some tv. I don't do anything too serious. But when I go to sleep itself, I always will do one thing and I tape my mouth always. Mm-hmm. I've done it on flights. And you could say, well, how on earth, or why does he need to tape his mouth?

‍

Surely after 27 years or 26 years, his mouth can stay closed. It's like a trigger for me. Yeah. As soon as I put it on, now I use our own tape. I can do a demonstration. I can show you how to tape. Without covering them out because again, 

‍

oh yes, please. 

‍

This here, because I know one thing that you were interested in is what's on my locker.

‍

That's on my locker, 

‍

yes. 

‍

And that is on my locker. Okay. So this here is a nasal dilator. Okay. This is, you see my nostrils? 

‍

Mm-hmm. 

‍

One is smaller than the other, and I have a deviated septum. Yeah. That's not good because if there's, if there's resistance to my breathing through the nose, it will increase resistance downstream.

‍

It'll increase resistance in the throat. So what I want to do is I want to help open up my nose. So this is a plastic device, and I put it into my nose and it's based on the cotton maneuver. 

‍

Yes. 

‍

And now my nose is kept open. 

‍

Amazing. 

‍

Yes. So it's flared open my nostrils. So I have that in, and then I take out a piece of tape.

‍

This is the one for beards. Now it's their own tape. It's a tape of a hole in it. A big hole. 

‍

Sure. 

‍

Because it doesn't cover them out. I stretch it about 30% surrounding them out, pulling the lips together, and I just gently activated it. It's cotton based taped. 

‍

Sure. 

‍

With elastic. So now it's pulling my lips together, but it allows mouth puffing with sleep apnea.

‍

So at the very start, I talked about if you are, people can check, check out the literature anyway on it. 

‍

Yeah. 

‍

If you have somebody with moderate to severe obstructive sleep apnea and if you cover cover their mouth, there's just as much a chance that they will get worse. As they will get better. 

‍

Yes.

‍

Because of mouth puffing. So whatever tape you use, it has to allow mouth puffing. Mouth puffing is like this. 

‍

Mm-hmm. 

‍

Simply puffing out through the mouth. Okay. You're breathing in through the nose and you're puffing out through the mouth. You can't block them out because then there's nowhere for the air to go.

‍

Mm. The air isn't able to leave the nose quickly enough. And if you stop them out, if you close them. Then that'll, that'll cause the person to stop breathing. So those are my two things. That's my nightly routine, nasal dilator and myo tape. Now, I also have a guided audio on my mobile phone. And when I wake up at three o'clock in the morning, or if I'm jet lag, say for example, and I'm in LA and I wake up at three o'clock in the morning in la, yes, I throw on a set of headphones and my phone is on flight mode, but I simply just play the guided audio.

‍

It's downloaded already, just played from the phone, listen to it. And I let that fall, me fall back to sleep, and it takes the pressure off me trying to think myself back to sleep, or breed myself back to sleep. I just listen to something. It's actually myself talking, but I listen to myself and then that brings me back to sleep.

‍

Wow. So good. And I'm so glad you demonstrated this as far as the differences because I think when, presumably when many people think about mouth tape, they're thinking about it going directly over the mouth, whereas this is distinct. So do you feel like that type of mouth tape or the surrounding the mouth, do you feel like that is distinct from the recommendations from the sleep community where they'll say, do not mouth tape until you have had a sleep test or gone in lab and you've verified that you do not have sleep apnea, upper air resistance syndrome, et cetera, then you can kind of earn your right to mouth tape.

‍

Do you feel like this is outside of that because of the fact that it allows for that puppy? Yes, 

‍

Molly. 

‍

Okay. 

‍

And I would say it on the basis of 16 million strips put out there. 

‍

Totally. 

‍

You know, and we have product liability insurance. 

‍

Yes. 

‍

And I've been in the field for 23 years. That's only putting people off.

‍

Mm-hmm. People can start straight away, get their mouth closed, have to tongue resting in the roof, the mouth, and start breathing in and out through the nose. And it, when you do a sleep study practice improving your breathing patterns first. If you go in and do a sleep study with your mouth wide open and your tongue resting in the low resting posture and you're breathing hard and fast, your a HI is going to be impacted by that.

‍

Mm-hmm. 

‍

So say for example, I go into a sleep study tomorrow. 

‍

Yes. 

‍

If I go with my mouth, open my tongue low resting posture, breathing hard, breathing fast, that will, that will all feed into a higher a HI. 

‍

Okay. 

‍

If I spend two weeks breathing in a natural my nose, practicing to breathe less air. So breathing light helps to reduce the chemo sensitivity to carbon dioxide, which is important because then that your breathing becomes lighter and slower, so there's less turbulent air flow and less negative pressure as the air is coming into the lungs, breathing light, breathing slow, and helping to breathe with good recruitment of my diaphragm.

‍

My A a HI is going to be totally different. 

‍

Yes. 

‍

I would expect in that two to three week period from the practice of those exercise that the a HI will drop by between 33 to 60%. And that's quite a significant drop. 

‍

Yes. 

‍

It's not just about taping them out, it's about improving the underlying breathing patterns.

‍

Mm. 

‍

Now we do need, of course, we need to get research with this. 

‍

Okay. 

‍

Um, the, the paper that I published is peer reviewed. It's in the Journal of Clinical Medicine. It's a decent enough journal. It's supported with 170 references, so it's all based on physiology. But I will say this, if anybody looks through the literature, look at the comparisons of mouth open breathing versus nasal breathing with sleep disorder, breathing.

‍

And in pretty much all instances, the individuals with their mouth open, who are breathing through it, will fare worse. They have increased severity of sleep apnea. So I would love to see medical doctors taking it more seriously in terms of the importance of nasal breathing. I would love that they would actually investigate it as opposed to just kind of giving opinions.

‍

Mm-hmm. 

‍

If they have seen what I've seen for 23 years, it would change their thinking. And I'm gonna say this, the sleep industry is not a success story. Only 15% of people with sleep apnea get diagnosed. 15%, 85% of people are undiagnosed. Of the 15% of people that get diagnosed, only 40% take up treatment. Of the 40% of people that take up treatment, only 50% of them will continue with treatment.

‍

So if you have a hundred people in the town with obstructive sleep apnea, only three of those people are treated at any one time. 97 of them are not being treated. Then we look at women's sleep. That is not a success story. Upper airway resistance syndrome gets hardly any attention. 

‍

Mm-hmm. 

‍

Then we look at children's sleep removal of the adenoids and tonsils is typically the gold standard of treatment for children with sleep disorder breathing.

‍

The efficacy of it was first investigated in 2010. Despite the practice being carried out since the 1970s. You will find the paper published by the American Thoracic Societies in the American Journal of Critical Care and Medicine. The lead order is battered charge. They looked at 578 children. They looked at what happens their a HI when you remove their tonsils and adenoids in it.

‍

Only 27% of the kids had their sleep apnea cured. 27%. 73% of these children? Yes. Their a HI come down quite a bit from 18 events per hour, down to four events per hour. But four events per hour is still clinically significant because it's bordering and moderate. So a conversation needs to be had about the current treatment in sleep.

‍

And there's a massive room for improvement. No other industry would say this is a success story. If that same success is a yardstick, and if that was applied to any other industry, it would be a total failure. 

‍

Ugh. So 

‍

true. So you know, they have to give it a chance. They have to look at everyday breathing patterns and how it impacts sleep.

‍

They have to talk about the importance of nasal breathing, which gets no attention even with people wearing CPAP. 

‍

Mm-hmm. 

‍

You know? So, you know, we are doing our best to put the information out there. And there is a reason that the public have drove and they literally have mouth taping has gone viral.

‍

There's no stopping that now. 

‍

Yes. 

‍

So it's really important that our medical doctors take heed of this and look into it. And I will say that yes, I do agree. Never force nasal breathing. That's one thing. 

‍

Sure, sure. 

‍

Number two, never cover them out of a child. Number three, if the person has heart issues or chronic nasal obstruction.

‍

Don't cover them out. Number four, if the person has obstructive sleep apnea, don't cover them out. Um, you know, and that's why like having something that helps to bring the lips together without covering them out is important. 

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Mic drop. Couldn't agree more. That was fantastic. And appreciate you kind of itemizing.

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'cause this is such a huge topic and there's so many nuances and sometimes it's appears that that can be much easier for people to make blanket statements without kind of sifting through. Right. So thank you. Thank you. That was beautiful. And our second question would be, what might we see in your morning sleep routine with the idea that how we start our day can impact our sleep?

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Yeah, totally. So I get up consistently as well. Consistently typically. Well my workplace is right close to my house. 

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Okay. 

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There, it's separate. So I have a clinic here, we have offices and I don't have far to go. 

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Yeah. 

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I have a strengthed condition coach that comes twice a week. So it comes of a Tuesday and comes of a Thursday.

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And all of our staff, we do an exercise routine. So what I will do is do exercise every week. Every morning, as soon as I get up, I typically have a cup of coffee. I'm not, I know that's not normally recommended. You should wait for 90 minutes or an hour or two hours or whatever. I haven't listened to that one.

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So I have my coffee. 

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Got it. Yeah. 

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I, I go from there. If it's a Monday, Wednesday, and Friday, I do my own routine on elliptical. And then what I will do is I will jump into the sauna. So that's my normal routine. 

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Sure. 

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On a Tuesday and Thursday, we have a strength and conditioning coach come in and we do our routine of one hour strength and conditioning.

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And that's, that's my routine. Mm. And say for example, then, if I've got a lot on, like today, I've got 12 hours, I will do a 20 minute downtime, rest and reset at some point during the day. So I do it in terms of. Optimizing mental performance. Mm. So, you know, this is, again, these are guided audios that I'd, I've used for many, many years and I find them useful.

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I find 'em very useful during the sleep if I wake up. But I also find 'em useful during the day if I need to kind of recover, recover mentally and re-energize to start off again. So that's it. Like, it's fairly straightforward. For years, I avoided doing physical exercise in the morning because I always felt the pressure to go into work.

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Yeah. 

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It wasn't good. I was putting on weight. 

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Yeah. 

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You know, I wasn't feeling the same amount of energy. Work was consuming me. Work consumes a lot of people. Work does have pressures. Um, and then at one point it says, you know, what the hell, like, I need to be giving myself some attention. So now I look after myself first.

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I look after myself first, and then I have the time to dedicate it to the work. And I think, you know, it's so easy to get caught up with the whole spiral of work, work, work, work. Without giving ourselves any attention. But we do have to look after ourselves. 

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Yes. 

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I can't do physical exercise in the evening.

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If I, if I don't get it in the morning, it's not gonna happen. 

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Ah, that's so good. And we've seen so many interesting studies that will point to the importance of movement and even very simple movement for sleep apnea. Like the big study in nature, we're finding at least 8,000 steps a day. Just basic walking, right?

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Yes. Reducing the severity of sleep apnea. So you're pointing to so many important aspects, and I know you already called out that visceral fat and some of these distinctions that if we set ourselves up for success during our days, then that can help usher us into richer sleep in the evenings. So really beautifully illustrated.

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And then I haven't heard a single person on the podcast yet on this question around the nightstand, call it a locker, I think you called it. Right? Oh, I love that. Okay. Yes, 

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yes. 

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So exotic setting. That's fantastic. So what might we see on your locker or in your environment? 

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Yeah, it's coming back to this two products that I use.

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Okay. And even I was in Vienna there the weekend. 

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Oh, nice. 

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I spoke in an airway Congress. It was work. I didn't see much of Vienna. 

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Yes. 

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I had my tape and I had my nasal dilator always, you know, I just feel it has to go with me because, you know, I suppose there's a comfort in knowing that your mouth is closed during sleep and you're waking up at a moist mat in the morning.

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Yeah. Now, the other thing that I like to do throughout today, Molly, is 

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mm, 

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I very often tryout today. I will take my attention outta my head and onto my breath and into the body. And I don't always do a formal practice. I typically would do something like that in the sauna. Okay. Again, that's my time. I'm sitting there.

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The heat is there. I bring my attention into the body. Mm. When we talk about rumination of the mind and overthinking during sleep, it is going to be influenced by our overthinking during the day. The more that we can bring our attention out of the mind and onto the breath and into the body and into present moment awareness, it helps to quieten taught activity.

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And that can also be helpful because if we are overthinking or worrying or anxious, it too can put us into an increased stress response. 

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Mm-hmm. 

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You know, when it comes to sleep, we have to think about rest and digest. The brain is never going to allow us to fall asleep if the brain interprets that the body is under thre.

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Yeah. 

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Now, Stanford Medical School identified back in 2017 the structure in the part of the brain in the pre bottinger complex, and they said that this part of the brain is literally spying on your breathing. 

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Mm. 

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If you're breathing faster, upper chest or irregular breathing. Your brain interprets that the body is under trash.

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Mm. 

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So the last five, 10 minutes before you go to sleep, as you're sitting there, whatever you're doing, start slowing down the speed of the exhalation. 

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Mm. 

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Take a soft breath in through your nose and relax, and a slow and a gentle breath out. And if you can soften and slow down your breathing to the point of a slight air hunger, pay attention to the SLI in your mouth.

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You typically will notice increased water sli in the mouth. Pay attention to the fact that you'll be getting sleepy, because now you're switching on the rest, rest response. You're feeling sleepy and digest response. You have increased water is live in them out, and that's conducive to sleep. Now the other thing is if you Google slow breathing Stanford, they also identified that if you breathe fast during your sleep, it'll arouse you from sleep because the, again, the brain is interpreted that the body is under trash.

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Sure. Mouth breathing is fast breathing. Nose breathing is typically slower breathing just by the, the effect of the nose in terms of slowing down the air, because of course, two nostrils are smaller than an open mouth, so nose breathing is slower and lower breathing, and that's why as well, or maybe at least one of the reasons.

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Why you're more likely to have deeper sleep and not to be spending so much time in light sleep. 

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Wow. So much information. Oh my gosh. Uh, I wish we could have you for hours. There's so much attached there and I so appreciate your work too for the mental health component and just what a difference in performance this could give for so many people.

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Not even just, you know, maybe they came in with the concept of, okay, well I wanna improve my sleep or my HRV and lower the number of apnea or what have you. And certainly we can do all those things and just maybe people might not have anticipated of the spidering into so many aspects of their health and wellbeing.

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So beautiful. And then the last question would be, so far to date, what would you say has made the biggest change to the management of your sleep? Or maybe said another way. Biggest aha moment in managing your sleep. 

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Oh, well I question nasal breathing during sleep. It's so, so simple. 

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Yeah. A hundred percent.

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So simple. 

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Okay. And also to clarify too, and I think we touched on this, but just in case anyone's listening and right now they are using A-C-P-A-P, they are using oral appliance. Is this something that you also see? Okay, fine. So you're using those great. And that this, there's absolutely all the advantages in the one, the oxygen advantage to start bringing in these practices 

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Totally.

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In conjunction, right? 

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Yes. 

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Yeah, 

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totally. 

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Okay. 

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I spoke about wearing A-C-P-A-P, if you have your mouth open Sure. It is. It's a distinct disadvantage in so many levels. Yeah. Whereas if you can switch to nasal breathing while wearing the CPA and switch to a nasal mask, you know, you've got less of a surface pressure.

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Yep. 

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Less risk of leak, higher adherence, higher compliance. 

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Mm-hmm. 

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And it's just more comfortable. The mandibular advancement device is a tremendous device for helping to splint open the airways. It's an anatomical intervention. 

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Mm-hmm. 

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But it doesn't address. Two things. Well, three things. It doesn't address high loop gain.

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High loop gain would be when you have unstable breathing during sleep. 

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Mm. 

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That's your everyday breathing patterns. From a biochemical point of view, it doesn't address lower AAL threshold. Mm. If you're a very light sleeper, the mandibular advancement device won't address lower rale threshold and it doesn't address muscle recruitment.

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So see, the problem with sleep is it's quite complex. Yeah. And obstructive sleep apnea, it's not just an anatomical issue. 

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No. 

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There's three non anatomical issues and 69% of people have one or more non anatomical issues. So while the mandibular advancement device is tremendous at having to open up the airway, if you have a person who's a very light sleeper and waking up at two or three o'clock in the morning, they're still gonna have exhaustion irrespective of the device.

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We also need to look at hyper arousal. 

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Mm-hmm. 

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We should be breathing, bringing in a breathing practice stair. The other option would be sedatives, so the person can choose. Sedatives to induce relaxation and sleep. Using a breathing practice to dampen the stress response, increase relaxation, improve sleep hygiene, get your mouth closed during sleep, like, you know, those are the calls.

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Um, but yeah, no, no, they go quite well with, with, um, the current treatments. 

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Ah, so good. Okay. So, because I think people are very clear in listening to this episode that we've only just scratched the surface of your knowledge mm-hmm. And wisdom on this topic, and we didn't, you know, there's a whole other area.

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I know you're fantastic as far as things that people could do for HRV. And many people I know do wanna improve their kind of stats, not just for stats sake, but for their experience of life. So there's so many other aspects that they could explore now. What would be the best steps for them to take to continue to learn from you, to check out those products you mentioned and beyond?

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Oh, I think the book would be a great place because it's cheap. It's $25 maybe, or $20. Everything is in it. 

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Yeah. 

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You, you've got a QR code in the book, you scan it, it brings you through to a sleep hub. But all of the materials that I talked about, it's, you know, so they're there. Um, myo tape would be the other part, you know, safe nasal breathing during sleep.

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So that website is myo tape.com. If you're on social media, um, tag us. You know, one channel is Myo Tape and the other channel is Butte or Clinic. Um, that's all about our sleep. And then we have Oxygen Advantage, which is about mental and physical performance. So different, we've different social media channels dependent on where you're, you're going to.

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But yeah, the book would be a great place to start. No, no doubt about that. 

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Yes, in case you're not seeing this, uh, the video, I'm holding the book and it is a prize possession. So much information in there. Highly suggest at the very least, taking those steps and then also continuing to follow your work.

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Check out your additional books and beyond. Do you have this one audible? Actually, I didn't double check that part. 

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It will be soon on auto well. Oh, yay. I think because, yeah. 'cause I think it was only released about a month or two ago, so it's quite new. 

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Yes. Okay. 

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Amazing. That's the next one that's on Autobus.

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It's just been recorded, so I'm not sure when it will be released, but it'll be pretty soon. 

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Pretty soon. Okay, great. All right, so if case somebody, they're so tired, they can't keep their attention, they could just listen to the information. 

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Totally, totally. Okay. Well thank you so much Patrick, for taking the time.

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I know it's later over there for you and I know you're in high demand, so it means so much. And you know, part of my commitment on the planet is to help support people in transforming their sleep. And so thankful for your commitment and clearly your ability to make such a difference for so many people.

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And beginning with yourself and transforming your own sleep apnea and beyond. So just the work is so important and would love to stay connected as far as what you're doing out there, especially in this world of sleep. It's fascinating and so needed. 

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Pleasure. You've got a great message, Molly. Thanks very much and keep up the good work.

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Oh, thank you. Right back at ya. You've been listening to The Sleep Is A Skill Podcast, the top podcast for people who wanna take their sleep skills to the next level. Every Monday I send out the Sleep Obsessions newsletter, which aims to be one of the most obsessive newsletters on the planet. Fun Facts.

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I've never missed A Monday for over five years and counting and it contains everything that you need to know in the fascinating world of sleep. Head on over to Sleep as a skill.com/newsletter to sign up.

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