Is Breathing More Than Inhale, Exhale?

By Tim Clark

I’ve always been a breather, for as long as I can remember, and for better or worse I still am. It’s a habit I can’t seem to kick.

Okay, I’m being a bit facetious there, but what I really mean is: as a massage therapist, breathing has always been an important part of how I work. I usually start and finish a massage treatment with three slow breaths, and with my hands in gentle contact with the client. I started doing it because I once had a massage therapist who did it, and I liked it. Now it helps me as a therapist to slow down and really join with my clients. I give warning that I’m going to do it and I explain why I do it. Often they join me, and it becomes a nice moment of co-regulation.

I also have a tendency to let the breath guide my massage strokes. For example, I might measure how long I spend on a given area by the number of breaths I take. Or I might deliberately exhale to signal to my muscles to let gravity take over when applying downward pressure.  

For some people, my emphasis on breathing makes immediate sense. They understand implicitly how breathing affects the way we feel. Others I’m sure have been weirded-out by it; why not just launch into the massage like a normal person? And others have approached it with curiosity. The most common question I get is, “Is that reiki?” But I have no background in reiki. My answer is always, “No, it’s just breathing.”

And that’s all it’s ever been. Something that felt good and right to me, that I trusted in a purely intuitive way.

For a few reasons, though, COVID-19 has had me thinking about my breathing more. There’s the mask-wearing and the whole ‘droplets and aerosols’ thing for a start.

But on top of that, Lockdown One hit and I couldn’t go into the offices of my corporate clients. I started running guided meditations for them online and suddenly I’m teaching people mindful breathing and diaphragmatic breathing and we’re imagining inhaling good energy and exhaling bad. I get nervous before the sessions, so I do some mindful breathing on my own and it really helps with the nerves.

I’m doing YouTube workouts and stretching routines at home to keep up some semblance of physical fitness and the instructors keep talking about the breath and telling me to do things like “breathe into the discomfort”. One even says, “Control your breathing, control your life.” Yikes.

And then in June, I hear about this new book that’s out by a US journalist, James Nestor, and it’s called Breath: The New Science of a Lost Art, and naturally I’m intrigued. I read the book and it really gets me thinking. Aside from developing a bizarrely heightened self-consciousness about my breathing while reading it, it gives me some information that makes me wonder why breathing (both our own and our clients’) is not a baseline consideration in my clinical thinking, alongside sleep, exercise and diet.

What does Nestor have to say?

1. Humans are terrible breathers

In fact, he says, we’re the worst breathers in the animal kingdom. Hopelessly inefficient. He posits that the evolution of our breathing to its current level of inefficiency is responsible for a cavalcade of poor health outcomes.

2. Shut your mouth  

Nestor and a colleague conduct a horrid-sounding experiment in which they tape up their own noses for ten days and then their mouths for another ten. The unpleasant effects of ten days of mouth-breathing are swiftly reversed (and then some) when they switch to nose-breathing, a result that Nestor backs up with a historical lit review, numerous case studies and more reliable science. The benefits of nasal breathing are the result of numerous factors:

  • Nitric oxide is produced abundantly in the sinuses, and only nasal breathing carries it into the lungs. Nitric oxide is handy for a number of things, especially dilating blood vessels, thereby regulating blood flow and pressure throughout the body, and assisting brain, heart and immune function.
  • Nasal breathing reduces the likelihood of snoring and obstructive sleep apnoea, both of which can be linked to a range of serious health problems.
  • Nasal breathing warms and humidifies the air we breathe, which helps to reduce throat and sinus irritation.
  • Nasal breathing means that the mouth doesn’t dry out so saliva can do its work, such as preventing dental problems.

3. Breathe out better

Most of us are not used to emptying our lungs completely when we breathe, so stale air sits around in the lungs. Fuller exhalations allow us to take in more fresh air. Also, using more of the diaphragm’s capacity (we typically only use 10%) takes pressure off the heart and stimulates gastrointestinal activity, as we’d expect with the autonomic emphasis on the parasympathetic nervous system that occurs during exhalation.

4. Breathe slower

The finer details of this one I admit are somewhat beyond me but basically: taking fewer breaths per minute helps to balance the oxygen and carbon dioxide levels in our bodies which, Nestor argues, prevents numerous chronic health problems, improves athletic performance and extends longevity. He does cover breathing techniques like Tummo and the Wim Hof method, which use rapid, heavy ‘overbreathing’ therapeutically, but rightly points out that they need to be used cautiously and deliberately. For your regular, day-to-day breathing, he draws on research suggesting the ‘ideal breath’ is 5.5 seconds in and 5.5 seconds out – just under five-and-a-half breaths per minute – in a smooth wave-like flow.

5. Chew more.

Here’s where it gets evolutionary. Nestor shows how, because our diet has evolved to favour soft cooked and processed foods, the physical make-up of the human skull has changed. Our mouths, generally speaking, are smaller and more cramped, our jaws more misaligned, and our airways narrower, creating a perfect environment for all manner of breathing obstructions. The solution? Well, maybe dental or surgical interventions, yes. But more conservatively: more hard chewing.

And that’s the gist of it. (He covers a number of other specific breathing approaches but I’ll let you read about them for yourself.)

If Nestor’s arguments are to be believed, we could be making better use of respiratory science in our work as massage therapists.

We’re in the privileged position of being able to observe, up close and over an extended period of time, just how our clients breathe. We can see if it’s deep or shallow, rapid or slow, easy or laboured. We can see how it changes over the course of a treatment. We can see if different positions – supine, prone, side-lying – impact on the way our clients breathe. We can see if the breath is going into the belly or the chest. We might be able to tell if it’s going through the nose or the mouth, or even if the client snores.

We can draw our clients’ attention to their breathing. We might offer them solid research on specific problems they’re experiencing, or we might simply pique their curiosity to learn more about their breathing and to give it the same kind of attention they give to exercise, diet and sleep.

We can factor in to our clinical thinking the potential for a link between inefficient breathing and other presenting conditions such as insomnia, anxiety, fatigue, hypertension and chronic respiratory problems. We can certainly refer our clients for further investigation if we suspect they might have obstructed breathing.

During COVID-19 conditions, we can encourage and model nasal breathing as a way of dealing with the obstruction caused by mask-wearing. Intriguingly, nasal breathing may also provide a line of defence against the virus by reducing the viral load inhaled. (James Nestor interviews expert Patrick McKeown about both of these topics here.) And fresh research from Sweden suggests that nitric oxide from nasal breathing might even play a role in fighting coronavirus particles in the lungs.

Perhaps most importantly, we can do our own research and become more informed on the subject. While being neither the first nor last word on the topic, Nestor’s book is a great place to start. While it’s a little embarrassing to admit, his discussion of mouth-taping made me curious enough to try it and I’ve now been taping my mouth before bed every night for nearly two weeks. It’s a weird look, I’m sure, but during that time my restless leg syndrome has left me alone completely, and the only time I had a nightmare (to which I’m usually very prone) was one night when the tape came loose and I woke up mouth-breathing.

Now, I’m not going to extrapolate anything of too much clinical significance from that – not here, anyway – but at least my eyes have been opened to possibilities I had not previously considered. I hope down the line I’ll be able to do the same for a client or two.

About the Author

Tim Clark is a massage therapist and psychotherapist in Melbourne. While unable to massage during lockdown, Tim Clark has kept his hands in shape. Tim made 53 macramé pot plant hangers, which will be on sale soon.

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  1. An excellent article. Shallow breathing often caused by stress can also contribute to neck problems and overuse of the scalenes.

  2. Thanks Tim. Even reading this I was analysing my breathing patterns as switched from mouth to nose breathing. A bit like mentioning the word “posture” and suddenly sitting up straight.

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