Breathe To Transform Anxiety - Patrick McKeown

0:00You're listening to the Mindful Mama podcast episode number 5666. Today we're talking about how to Breathe to Transform Anxiety with Patrick McKeown.

0:12Welcome to the Mindful Mama podcast. Here it's about becoming a less irritable, more joyful parent. At Mindful Mama, we know that you cannot give what you do not have. And when you have calm and peace within, then you can give it to your children. I'm your host, Hunter Clarkfields. I help smart, thoughtful parents stay calm so they can have strong, connected relationships with their children. I've been practicing mindfulness for over 25 years. I'm the creator of the Mindful Parenting course and teacher training, and I'm the author of the international bestseller Raising Good Humans, Raising Good Humans Every Day, and the Raising Good Humans Guided Journal.

0:52Hey, welcome back to the Mindful Mama podcast. So glad you're here. Today, we're talking to Patrick McKeown, who has taught breathing for health, mental, and physical performance since 2002. His latest book is The Breathing Cure for Better Sleep, and we're going to be talking about simple breathing practices to calm anxiety and boost overall well-being, why nasal breathing and balancing CO2 levels really matter, and practical exercises to reduce stress for adults and for kids. So this is all very science-backed, and I know it's going to help you breathe easier and feel more grounded. So let's dive into this episode.

1:40If you're a nurse or future nurse, you know how challenging and rewarding this career can be. Hi there. I'm Nurse Mo, creator of the Straight A Nursing Podcast. I'd love for you to join me every Thursday as I teach nursing concepts and share tips to help you succeed in school and at the bedside. Each episode breaks down often complex information so it's easy to understand, so you can feel more confident whether you're taking an exam or taking care of patients. So subscribe to the Straighten Nursing Podcast, and I'll see you on Thursday. Patrick, welcome to the Mindful Mama Podcast. I'm so glad you're here.

2:20I'm delighted. Thanks very much, Hunter, and especially if this is going to be one of your first discussions on breathing, huh? I know. It's crazy because I've been wanting to get someone to talk about breathing because my husband went through a whole experience over the last couple of years, actually, where in 2019, he had like a panic attack in Paris when we were in Paris. But with my kids, we were at like this fair. He had to leave. It was like a whole big thing.

2:52And He had these panic attacks, and he had been going through all these different things to help him. What is this? I mean, he went to the ER a couple times, and they gave him downers to suppress his panic attacks. And he discovered a breathing protocol. And I don't know which one it is, but he discovered a breathing protocol and realized that he had been doing shallow breathing. and it had been leading to this whole problem. And now he's so religious about it, but it's turned around his life enormously as far as anxiety and things like that goes. It's not like he seemed like he was a terribly anxious person before all this started happening.

3:42But it's been so fascinating to watch that. So I've been like, wow, I have to find someone to talk about this because this is really changing people's lives. And I know you have maybe, you probably have a similar story of like how this inspired you, but maybe you could, I don't know, speak to that. What first inspired you to study breathing? And maybe you have some insight into what happened for my husband too, I don't know. I think anybody who works in breathing, we always start it because of our own issues. You know, that's really what drives us into it. So I was a kid growing up with asthma, and with asthma you have a stuffy nose.

4:18And if you have a stuffy nose, you're more likely to outbreed. And if you might breathe, you're more likely to breathe faster in upper chest. And that in turn can affect your sleep quality and it can also put you into an increased stress response because, you know, how we breathe is telling the brain either we are safe or we are not. Simple as that. And I remember I initially left school at 14 years of age because I felt that the school system or the curriculum just wasn't for me. I wasn't a disruptive kid in class, but I was a kid that was sitting there. And while my eyes would have been looking at the teacher, my attention wasn't.

4:56And my attention was stuck in my head. And in junior school, up until about the age of 11, I was very bright. I was pretty much top of the class. And in high school, I went from the top of the class to the bottom of the class. And out of a sense of frustration, I left it. I ended up going back to school one year later. did my final, and then I got into university, and I had to work hard, and I mean that I spent all of my hours, teenage years, young adult, studying to get through exams. I then read a newspaper article, that was back in 1998, it said two things, breathe in the net through your nose, I wasn't doing that, it said breathe light, breathe slow, I wasn't doing that either, I started putting into practice, I taped my red clothes that night, and I taped my red clothes the second night and I woke up the second morning with the best night's sleep ever.

5:49And that was it. I changed careers. I'd spent four years at university attaining a master's degree and I said, yeah, there was something really in it. And I mean something enormously in it. And here's the thing, Hunter. It wasn't about taking a full deep breath. It wasn't about the breathing that was being practiced typically in yoga. It wasn't often the breathing practice that's often taught in psychotherapy and psychology. it was actually about breathing lesser you know and it kind of flew in the face that everything that was out there but that's the conversation we're having wow that's fascinating i mean i i was also a mouth breather at night when i was a kid um although i slept like a log i don't know it changed at one point i had a dairy allergy i didn't know but uh but yeah so the breathing that I was taught was yoga breathing because I was certified as a yoga teacher a long time ago and learned all the different breathing modalities that yoga teaches you.

6:51And I think for my husband, he, I should have checked with him before I recorded this, but I think it was about breathing deeper, actually, that had to, that changed us because he had too much CO2 or something in his system or not enough. I can't remember which it is. Help me understand. Sure, sure. I suppose when we think about breathing, we need to look at it from three different angles. One is, how much air do you breathe every minute, every hour, every day? Really important question. And that's determined by how fast you breathe, your respiratory rate, by the size of each breath, the tidal volume.

7:31And that in turn gives you a minute ventilation. Now, if you are under-breathing, it's not good. If you are over-breathing, it's not good. But most people over-breathe. So it's the most common form of breathing pattern disorder. So I said earlier on that I was a chronic mouth breather and I was breathing fast or I was breathing upper chest. So typically that would be called chronic hyperventilation syndrome. And again, that is the most common form of breathing pattern disorder. So the person is breathing a lot of air, but it doesn't mean that there's oxygen delivery adequately to tissues and organs, including the brain.

8:05Because this is a strange thing when it comes to breathing. If I was to breathe more air, I don't bring in that much more oxygen into my blood. My blood is already almost fully saturated. But by breathing too much air, I get rid of too much of the gas carbon dioxide. And as I get rid of too much carbon dioxide from my lungs by simply just breathing it out, that in turn will reduce carbon dioxide in the blood leaving the lungs. and that's when the problems start. So when carbon dioxide in the blood goes too low, the blood vessels narrow, blood vessels constrict. And we have 50 ,000 miles of blood vessels throughout the human body.

8:42And our blood circulation is impaired by breathing too much air. But it's not just our blood circulation, also oxygen delivery. So discovered back in 1904, it's called the Bohr effect, B-O-H-R, that the main carrier of oxygen in the blood is hemoglobin, So that's the protein, the molecule that carries oxygen in the blood, mostly. And carbon dioxide is a factor that encourages or causes a reaction that hemoglobin releases oxygen more readily. So again, if that individual is breathing too much air, they're getting rid of too much carbon dioxide, and the loss of carbon dioxide drives up blood pH a little bit too high.

9:21So it becomes too alkaline. And in that instance, then, hemoglobin holds on to oxygen too strongly. And because the red blood cells are holding onto oxygen, they're not releasing it. Now, another factor that takes place is that we have 83 billion brain cells and brain cell excitability. So the firing of these brain cells are influenced by blood pH. And if our blood pH is too alkaline, as a result of breathing too much air, brain cells are excitable, overly excitable. and even with say for example the default mode network so these are the parts of the brain that light up when we are in rumination or mind wandering these regions of the brain are more active number one is if we are chronically mal breathing and number two if our co2 is too low so how does that how does that result what does that result in experience for a person what was that your experience oh increased stress increased stress difficulty concentrating spending a lot of time in thinking mode, can't get out of one's head, not able to hold attention of what they want to hold it upon.

10:27And the other aspect is poor sleep. The autonomic nervous system is an increased sympathetic drive. I think it's horrendous. And, you know, I'm not just saying it because I'm a breathing instructor. You know, we put all of the exercise out there for free. You know, so they're all in the public domain. But I'm going to come back to this, Hunter. Not all breathing exercises are the same. and when you were talking about your yoga training and you spoke about practicing many many different breathing exercise the question that I would have is did any of those exercises deliberately involve breathing less air to the point that you had air hunger and holding that air hunger for three or four minutes and that's a breathing exercise that is designed to reduce to help reduce over breathing to help bring back breathing volume towards normal to normalize carbon dioxide in the lungs and blood to improve blood circulation, improve oxygen delivery, stimulate the vagus nerve and balance the nervous system.

11:24This is a breathing exercise that's so simple and yet it's not being taught. What's being taught is the opposite. So we have a belief in the Western world that the more air we breathe the better. You're stressed, take a deep breath. You know, you're in yoga practice, take more air into your lungs, you're hearing people around you breathe. We need to have a conversation here. Why are we doing a breathing exercise that can be depleting ourselves, depleting breath flow and depleting oxygen delivery. You know, so that's what my premise is. That's what I want to get out there.

12:00Stay tuned for more Mindful Mama podcast right after this break. Is there a baby in your life who's about to start solid foods? This can be such a confusing and stressful time. As a mom of seven, I really struggled with spoon feeding my oldest baby. But once I realized that babies can safely feed themselves real wholesome foods using the principles of baby led weaning, feeding the rest of my babies became an actually enjoyable experience instead of something that I used to dread. Hi, I'm Katie Ferraro, college nutrition professor and dietician specializing in baby led weaning. And I host the baby led weaning made easy podcast.

12:38Each week we cover evidence-based safe infant feeding practices for parents and caregivers of babies who are 6 to 12 months of age. So if you're confused by all the conflicting info you hear about starting solid foods, or you want easy, actionable tips on how to safely prep food for your baby or introduce allergenic foods or figure out when to drop a milk feed, we cover all that and more, plus interviews with the world's leading feeding experts in two new episodes each week. Search Baby Lead Weaning wherever you listen to podcasts and happy feeding. So you're saying that holding the breath is changing the blood flow and the chemistry in this positive way to kind of reduce our stress, reduce our fight, flight, or freeze.

13:21Yeah, say for example, say somebody who comes into me is panic disorder. I'll describe your husband, not your husband per se, but a very common feature that I would see with panic disorder patients. I see their breathing. They are breathing faster than normal. So their respiratory rate could be 16, 17, 18, 19, 20 breaths per minute. I look at their tidal volume and their tidal volume could be, it can be normal and it can be higher and they can have irregular breathing patterns. And they often feel that they are not getting enough air. They feel that they can't take a deep breath. They're also breathing more into the upper chest.

13:59They don't have a natural pause after exhalation. And this is their normal everyday breathing. So their normal everyday breathing, every minute, every hour, every day, this is how they breathe. So they are breathing in a way that's generating stress. And they're also breathing in a way that they are teetering on the brink of symptoms. So that individual then goes into a crowded place or goes to a fairground or is driving a car and all they need is a small little bit of stress. And that in turn can generate feeling of air hunger. But then we have to ask the question, how does their body interpret that sensation of air hunger?

14:36So people with dysfunctional breathing who are prone to panic disorder, many of them, they can misinterpret those symptoms as calistrophic. So the air hunger then causes them to unknowingly breathe faster and harder, which in turn is hyperventilation, which is generating an increased panic symptoms and anxiety. They may start to feel now that the heart rate is quite strong. They may feel that they are not getting enough air. They may feel chest tightness, or they feel that they are choking or suffocating. And of course, that feeds back into their stress response. So we need to look at how is the person breathing in their everyday life.

15:12It's absolutely key. And not for them to go to a psychotherapist and the psychotherapist to tell that person, take a few deep breaths. That's not what that person should be doing. Instead of that person breathing faster and harder and upper chest with a regular breathing through an open mouth, they need to start in an edge of the nose. They need to start breathing lighter. So it's not about holding the breath, but it's about softening their breath. And like I would say to anybody listening to this, you know, if you're in a safe environment and you're not driving a car, just gently soften the speed of your breath in.

15:46So slow down the speed of your breath in, almost that it's imperceptible, and then have a really relaxed and a slow and a gentle breath out. and just soften the breath relative to how you are breathing. And by softening the breath, you will be breathing less air, so, you know, to have less breathing movement. So I need you to breathe about 30 % less air into your body. And with that, you will feel air hunger. And air hunger is telling you that there's an increase of carbon dioxide in the lungs and blood. And it's the increase of carbon dioxide that's helping to improve your blood circulation. Pay attention to the temperature of your hands.

16:21Can you improve the temperature of your hands by breathing a little bit less air. Can you activate the body's relaxation response, as evident by increased water sliving them out, by breathing light and soft and slow, and breathing less air to the point of air hunger? Can you feel sleepy? So here we can dampen the stress response and increase the body's relaxation response literally by just softening and slowing down the speed of the breath, which in turn will stimulate the vagus nerve, which is this nerve that's wandering throughout the human body, with 80 to 90 % of communication from the body up to the brain.

16:57And also, we have to bear in mind that the brain is constantly spying in our breathing. You know, we have a part of the brain right at the back of the brain called the pre-Botzinger complex. And within that part of the brain, there's a group of neurons. And all that function of those neurons is spying on our breath. So the brain knows via our breathing, at least it's one mechanism, whether the body is under threat or perceived threat, or whether the body is safe. But we should use this to our advantage. You know, too often, we are going through life, and we're constantly telling the brain that we are under threat, because we don't know the relationship between how should we breed versus how are we breeding.

17:44Okay, this is fascinating. So you started to kind of bring us, myself and the listeners, sort of through this type of breathing, and you're saying softening the breath. Would you mind doing that a little bit more deliberately so I can understand what you're saying? And I'm not sure exactly what I mean by softening the breath, but maybe if you could explain it in another way. Of course. What I would like you to do is, if you can, put one hand on your chest and one hand just above your navel. Okay. And just pay attention to the airflow that's coming in and out of your nose. So just to bring an awareness of your breathing, and don't worry about how you do it or anything like that.

18:22So it's not about getting it perfect. All we're doing is just working with the breath, how you are breathing right now. So you feel the airflow coming into your body, and you will feel the airflow as it leaves your body. There's your breath in, there's your breath out. There's your breath in. There's your breath out. There's your breath in. There. I didn't see that on the breath out. So for you to focus on your breathing and now just gently soften the speed of the air as it comes into your body. So you're feeling the airflow coming into your nose so you might feel that the airflow is a little bit colder.

18:57And as you can feel the airflow coming into your nose, can you soften the speed of the air coming into your nose almost as the breath in is imperceptible, that you feel hardly any air coming into your nose. So you're really slowing down the speed of the air coming into your nose. And then on the breath out is just to bring a feeling of relaxation to the body and to allow the air to leave the body effortlessly. So what you're thinking about is, what do I do just to soften the speed of the air coming into my nose, that I feel less turbulent airflow coming into my nose, almost that I hardly feel any air coming into my nostrils, that I'm breathing so soft that the fine hairs within the nose do not move.

19:42And then on the breath out, to have a really relaxed and a slow and a gentle breath out. And the breath out, the speed of the breath out should be about one and a half or two times the length of the breath in. Because with relaxation, it's not the inspiration, it's not the breath in that's really important, but it's the breath out. So whenever we have that slow and relaxed and a gentle breath out, we're telling the brain that we are safe, we're stimulating the vagus nerve. So you're doing a number of things there. Number one is having attention on the breath, and that can be a good barometer of your ability to hold attention on one thing.

20:19And of course, it's normal that the mind wanders, that's what minds do, but then you bring your attention back onto your breathing. But as you're bringing your attention onto the breath, you're really softening or slowing down the speed of the air coming into your nose, almost that you are hardly breathing at all. So if you were in a room and say, for example, there was a noxious smell, you would deliberately underbreed so that you're not going to be smelling so much air. So you can just imagine that. So you're really softening and slowing down the speed of the air coming in, and then you're having a relaxed and a slow and a gentle breath out.

20:58And by doing that, you breathe less air. And when you breathe less air, you feel air hunger. So to feel a sensation of breathlessness. And the sensation of breathlessness is not because oxygen is dropping, because oxygen does not drive your breathing. The primary driver to breathe is carbon dioxide. So by breathing less air, you're holding on to more carbon dioxide. And this gas is being produced by the body. All you have to do is breathe a little bit less air to hold on to a little bit more carbon dioxide. And as you hold on to carbon dioxide a little bit more in the lungs, it will increase in the blood leaving the lungs, and that in turn will dilate your blood circulation.

21:37It will improve your blood circulation 50 ,000 miles of blood vessels throughout the human body. So the ironic thing with that simple exercise is that you are breathing less air, but you're increasing blood flow to the brain by between 5 and 10 percent. You're increasing blood flow to the heart. You're increasing blood flow throughout the human body. And it's known that carbon dioxide in the brain, this has been known for 100 years, but yet there's a belief out there that oxygen is good and carbon dioxide is the poisonous waste gas. That's not something true. That is absolutely not true. So if anybody was to take anything from this, what I would say is anything that I'm saying here, do your own research on it and look at the physiology of respiration and look at the functions of carbon dioxide, that it does help to dilate your blood circulation.

22:26So if you have cold hands and cold feet or brain fog or difficulty concentrating, you know, could that be due to over-breathing, that you're breathing just a bit fast and a bit too hard? If you're feeling overly stressed, are you breathing faster and harder in upper chest, having irregular breathing patterns? And that's it, Hunter. You know, we have dysfunction under our control. It sounds like you're simplifying it. And I'm kind of relieved to hear one thing. One thing I teach is that when we want to relax our body, we want to extend our exhales because that helps us, helps the parasympathetic nervous system, you know, etc.

23:08Right. It's a little bit of a hack is to extend the exhales. But you're saying kind of like the overall breathing of our body, you know, we want it to be very subtle, very quiet, very, yeah. Am I getting that correctly? The first point that you said is absolutely correct. Like anytime that we want to tell the brain that we are safe, just focus on gently slowing down the speed of the exhale. And I would encourage people not necessarily to count it. And the only reason being is because very often I hear breathe in for four, hold for seven, breathe out for eight, breathe in for four, out for six.

23:47But let's look at somebody coming into, I worked with people with anxiety. I've had 3 ,000 clients just with anxiety and pain disorder. And you know, when you work with quite a number of clients now, I've also worked with for years, like I'm 23 years working with clients with breathing at 51 years of age. I spent as much time working with breathing as I have without it. And you see a client coming into you and that client, you know straight away if their breathing is generating a stress response. They typically are breathing maybe 18, 20 breaths per minute. It's common. And if that person then is told to breathe three breaths per minute or four breaths or six breaths per minute, it's too much for them.

24:25So I always want to ease my clients into it. You know, I'll say, look, your breathing is just a little bit faster. how about we slow it down, but not to slow it down to the point that it causes you to disproportionately take big breaths. So in other words, like somebody coming in with 20 breaths per minute, you ask them how they feel. They feel my breathing feels an effort. They already feel uncomfortable with their breathing. So then we should be thinking, like, why are they breathing this way? What are the drivers to breathe? And one of the primary drivers to breathe is carbon dioxide. And then we have to wonder, well, what's their chemo sensitivity to carbon dioxide?

25:02And then what's the relationship with the breathing? Like your husband's example of having a panic attack or how, you know, in that situation, how does he relate to his breathing? You know, what's his relationship with his breath? And even just asking him to bring his attention onto his breath, that may generate symptoms and signals of fear that may not happen ordinarily. So we always have to consider that, you know, dip our toes gently into the water. So it's coming back to the first thing that you said is absolutely correct. Whenever we want to tell the brain that we are safe, just take a soft breath in through your nose.

25:40You don't need to take in this full breath or anything like that. Just, you could have a normal breath in and then you have a relaxed and slow gentle breath out. So that's one exercise to tell the brain that we are safe. The second exercise is breathing less air. So that's when we soften the breath just a little bit more to the point of air hunger. So there's two differences to that exercise. One is without air hunger. The second one is with a little bit of air hunger, tolerable air hunger. Like, I'll give you a practical example. I spoke at the International Integrative Medicine for Mental Health there in San Diego on Sunday.

26:181 ,600 people attending it. Huge speakers, 30 of us, including Gabor Maté and Robert Lustig and other people. So it was a very influential conference. I'm getting up on stage, I speak for one hour, and I never like using slides. I like to get into a flow stage, and I like to speak for one hour without ems, butts, or anything else, and I don't prepare. Like somebody asked me, what should I do to prepare? I said, I wrote down three things. All I wanted to do was get across three things. Number one was breathing. As a speaker, that scares me going up to an hour without preparation. It is, but this is the thing, and that was genuine, like genuinely.