Also by Patrick McKeown

Books:

The Oxygen Advantage: The Simple Scientifically Proven

Breathing Technique for Improved Sports Performance

Asthma Free Naturally

Close Your Mouth

Anxiety Free: Stop Worrying and Quieten Your Mind

Buteyko Meets Dr Mew: For Children and Teenagers

Always Breathe Correctly (for children aged 3-10 years)

Self-Help Online Training & DVD sets:

Buteyko DVD set for High Blood Pressure, Fatigue, Insomnia,

Chronic Hyperventilation, Asthma, Snoring and Sleep Apnea

Buteyko Mindfulness Method DVD set for Anxiety, Stress,

Panic Attacks, Depression and ADHD

Buteyko Clinic DVD set for Children and Teenagers

Online Training for HealthCare Professionals

For books and DVD sets, visit ButeykoClinic.com

IN THIS BOOK YOU WILL:

 Discover what the world's top sleep experts are

saying regarding the importance of nose
breathing during sleep

 Learn how your everyday breathing

determines your quality of sleep

 Practice simple breathing exercises to

significantly reduce snoring and obstructive
sleep apnea

 Discover the importance of breathing through

your nose for good quality sleep

 Learn how to decongest your nose, and sleep

with your mouth closed

 Identify the risk factors for sleep problems in

children

 In as little as seven days, experience better

quality sleep, wake up more alert and benefit
from improved day time energy levels
 Sleep with
Buteyko
Physician developed breathing re-education to
reduce snoring and obstructive sleep apnea.
Easy to apply and noticeable results
within seven days.

PATRICK MCKEOWN
www.ButeykoClinic.com
Published in the USA by Carol Baglia
of CorrectBreathing.com
 Published by: Buteyko Books
Loughwell, Moycullen, Co. Galway, Ireland
Web: www.ButeykoClinic.com
Email: info@Buteykoclinic.com
© Patrick McKeown 2011
Revised 2017

Cover design by Aurora Pérez Machío from

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

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

All rights reserved.

No part of this publication may be copied, reproduced or
transmitted in any form or by any means, without permission in
writing from the publishers. This book is sold subject to the
condition that it shall not, by way of trade or otherwise, be lent, re-
sold or otherwise circulated without the publishers prior consent, in
any form of binding or cover other than that in which it is published
and without similar condition including this condition, being
imposed on the publisher.
 Sleep that knits up the ravell'd sleeve of care,
The death of each day's life, sore labour's bath,
Balm of hurt minds, great nature's second course,
Chief nourisher in life's feast.

William Shakespeare, Macbeth

 Table of Contents

Introduction........................................................................... 1
Minimum Reading Requirement .......................................... 6

Meet Buteyko........................................................................ 9
All About Breathing Volume.............................................. 12
What Is Snoring? ................................................................ 15
What Is Obstructive Sleep Apnea? ..................................... 17
Implications Of Obstructive Sleep Apnea ......................... 33
Mouth Breathing During Childhood Increases
The Risk Of Lifelong Obstructive Sleep Apnea ................. 35
What Is Insomnia? .............................................................. 41
Joe Is Chronically Over-Breathing! .................................... 45
Good Breathing ................................................................... 47
Not So Good Breathing ...................................................... 48
How To Measure Your Relative Breathing Volume .......... 49
The Three Tenets To Normalizing Your Breathing ........... 53
The First Tenet: Breathe Through
Your Nose Day And Night ................................................. 54
How To Unblock Your Nose .............................................. 57
Nasal Breathe During Sleep................................................ 59
The Second Tenet: Correct Posture .................................... 62
The Third Tenet: Reduce Breathing Volume
To Create A Need For Air .................................................. 64
Reduced Breathing Summary ............................................. 69
Reduce Breathing Only Through Relaxation
Of The Respiratory Muscles ...............................................72
Reduced Breathing Daily Exercise Format .........................74
Reversing Insomnia ............................................................76
Breathing Exercise To Help Calm The Mind
And Stop Panic Attack ........................................................81
Correct Breathing During Physical Exercise ......................83
Food And Sleep...................................................................86
Applying The Buteyko Method For Sleep Disorders .........89

Simple Breathing Basics .....................................................97

Know How Oxygen Is Released To Provide Energy .....98
Nitric Oxide: A Most Important Molecule .......................104
Appendix ...........................................................................106
CPAP Therapy..............................................................107
Rhinitis, Snoring And Sleep Apnea In Adults ............110
Rhinitis, Sleep Disorders And ADHD In Children .....112
References .........................................................................115
Buteyko Books, DVDs And Online Self Help Courses ....129
Personal Coaching ............................................................130
 INTRODUCTION

L isten to the breathing of someone who is snoring and you

will find it to be noisy; those who snore draw in large
breaths of air while they sleep, and often breathe through the
mouth. If the person has obstructive sleep apnea, you may
hear a snore followed by complete silence as they stop
breathing for a period of up to one minute – or sometimes
more. Upon the resumption of breathing, large gasps of air are
then taken into the lungs. For someone with sleep apnea, this
cycle continues all night long; snoring, long pauses in
breathing, and intense gasping.
Both snoring and sleep apnea are forms of sleep-disordered
breathing, and can be improved and corrected by practicing
simple breathing exercises designed to change breathing
habits both day and night. When breathing becomes calmer
and lighter, an individual‟s sleep and overall health will
dramatically improve.
In 1997, I discovered the Buteyko technique as a method of
correcting my own breathing problems. Throughout my
childhood and into my early twenties I constantly breathed
through an open mouth. I experienced symptoms of wheezing,
breathlessness, and snoring, and was told by my university
dorm-mates that I regularly stopped breathing during sleep. It
was only in later years that I learned this condition to be
obstructive sleep apnea – a potentially dangerous form of
sleep-disordered breathing.

1
2
High school for me was a very frustrating time, as I didn't
have the concentration to stay alert during class, and needed
to study long hours to obtain decent grades. When a student‟s
energy levels and concentration are poor, they will struggle to
focus and perform well academically. Some of my teachers
simply considered me to be uninterested, while others gave
me positive support and encouragement, but no one – not
even my family doctor – suspected that I might have a sleep
disorder. Like millions of other teenagers, I fell between the
cracks of modern medicine.
In 1997, after graduating from Trinity College Dublin, I read
an article in an Irish newspaper about the work of Russian Dr
Konstantin Buteyko. Dr Buteyko‟s theory emphasized the
importance of two breathing habits: to breathe through the
nose both day and night, and to „breathe light‟. Using the little
information available at that time, I applied the Buteyko
Method, and I can honestly say that within a few days it
completely changed my life. My breathing was easier, my
sleep improved, I felt calmer, and my energy levels vastly
increased. Making the transition required time and energy, but
I was prepared to make the commitment to changing my
breathing habits after experiencing such significant results
within mere days of making the transition from mouth to
nasal breathing.
A number of years later I travelled to Russia to receive my
clinical training at the Buteyko Clinic of Moscow. I received
my accreditation from Dr Buteyko, and since 2002 have been
teaching the Buteyko Method to thousands of people with
breathing disorders, such as snoring and obstructive sleep
apnea.
The importance of good breathing habits is well documented
in medical literature; however few healthcare professionals
3
explain the importance of functional breathing to patients
suffering from sleep and respiratory problems. Addressing
poor breathing habits should be a first call to action, as this
approach is the most cost effective and long-lasting, involves
no side effects, and is very simple to implement. It may be the
case that many practitioners are unable to commit to the time
involved in teaching breathing exercises to patients. However,
when one adds up the personal, social and economic benefits,
it is time well spent.
Sleep disorders wreak havoc on health and quality of life.
Furthermore, sleep-disordered breathing is responsible for
many deaths - even road traffic accidents, when sleep-
deprived drivers fall asleep behind the wheel.
While breathing through the nose is important for adults, it is
even more important for children. Currently, more than half of
studied children in the Western world breathe through an open
mouth. This seemingly innocuous habit has notable long-term
effects, since persistent mouth breathing during childhood
causes negative alterations to the shape of the face, reduces
airway size and increases the risk of lifelong obstructive sleep
apnea. If a child is to grow into a healthy and happy adult,
good breathing habits are imperative during their formative
years.
The good news is that sleep experts are becoming increasingly
concerned about the impact of open mouth breathing during
sleep, especially for children. Among these researchers is Dr
Christian Guilleminault, a leading figure in the field of sleep
medicine who highlighted the issue in a 2015 research paper,
recognizing that “the case against mouth breathing is growing,
and given its negative consequences, we feel that restoration
of the nasal breathing route as early as possible is critical.”
The paper goes on to say that “restoration of nasal breathing
4
during wake and sleep may be the only valid „complete‟
correction of pediatric sleep disordered breathing.”1
Breathing is an involuntary activity – a function that we don‟t
usually need to think about unless we are experiencing
symptoms of breathing difficulty. However, our breathing can
be influenced by various factors of modern living and is
susceptible to change.
The manner in which we breathe during the day determines
how we breathe during sleep. If we have developed bad
habits, such as breathing through the mouth, periodic sighing,
or have noisy, noticeable breathing during rest, then this will
translate into more intense breathing during sleep.
Good breathing during rest should be light, gentle, calm and
through the nose. Snoring and sleep apnea is unlikely to occur
when breathing is through the nose and light during sleep. On
page 49 of this book, you can learn to measure your breath
hold time, which provides useful feedback on how light or
heavy you breathe.
While breathing habits can change in the wrong direction, it is
also possible to correct and improve the way we breathe by
practicing the exercises and guidance within this book, which
will help you to enjoy better sleep and lifelong health. The
benefits of breathing lightly through the nose are supported by
many references to medical papers and research, while the
techniques and breathing exercises will help you to change
your breathing habits for the better, forever.

5
 MINIMUM READING REQUIREMENT

f you‟re hard-pressed for time and just want to get to the

I crux of the exercises, then this section will get you started
and contains a number of useful tips.
This book has one main objective: to improve your breathing
during sleep. The exercises and techniques herein will help
you to breathe quietly at night, experience deeper sleep, wake
up more refreshed, and stay alert and focused during the day.
Central to the Buteyko Method is the Control Pause
measurement, which allows you to track your progress and
measure relative breathing volume during rest and sleep. You
can learn how to perform this easy test on page 49. As you
progress through the program, your Control Pause should
steadily increase, bringing with it huge benefits to sleep and
health.
To improve your Control Pause, it is important to apply three
basic tenets of breathing:
1) Breathe through your nose (page 54)
2) Adopt correct posture (page 62)
3) Practice Buteyko Breathing exercises (page 64)
A summary of what to do can be found on page 69.
The Buteyko Method is all about learning to breathe to
maximize body oxygenation, which in turn improves sleep
and general well-being. To achieve this, it‟s important to
understand how our bodies and breathing habits work
together. If you‟d like to know the science behind the theory,
then take a look at the section Simple Breathing Basics (page
97).

6
7
8
 MEET BUTEYKO

T he Buteyko Method was developed in the 1950s by

Russian doctor Konstantin Buteyko. Since then,
hundreds of thousands of people have practiced his method to
help a variety of conditions including snoring, sleep apnea
and insomnia.
As a young doctor, Buteyko spent many months sitting at sick
patients‟ bedsides, observing their state of health, and noticed
that patients‟ breathing became more intense as their health
deteriorated. As patients' illnesses advanced, he noted that
breathing movements from the chest and stomach increased,
breathing became more audible, breathing rate became faster,
and that the patients sighed and breathed more frequently
through their mouths.
These observations raised a fundamental question for
Buteyko: did his patients‟ illnesses contribute to their heavy
breathing or did their heavy breathing contribute to their
illnesses?
At the time, Buteyko suffered from severe high blood
pressure that continued to worsen. Based on his findings, he
experimented with slowing down his breathing so that less air
entered into his lungs. Reducing breathing to the point that
there is a tolerable feeling of air shortage helps to activate the
body‟s relaxation response, and this is likely to be the reason
that Dr Buteyko normalized his blood pressure without the
need for medication.
Over the following decades, Buteyko extensively researched
the connection between breathing habits and health, and

9
operated a dedicated laboratory to further his findings. His
breathing method was brought to the West in 1990 and is now
taught in many countries to correct a variety of conditions and
symptoms. The Buteyko Method has become a popular
technique for significantly improving asthma control, and in
recent years there has been a major shift in awareness of the
benefits of the method to treat sleep disorders, including
insomnia, snoring and obstructive sleep apnea.

10
11
 ALL ABOUT BREATHING VOLUME

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

breathing rate and tidal volume. Breathing rate relates to
the number of breaths taken in one minute, and tidal volume
relates to the amount of air taken with each breath. The
volume of air we inhale is measured in liters, and
measurements are usually taken over one minute.
A healthy breathing rate is 10 to 12 breaths per minute, with
each breath drawing in a volume of 500 milliliters. In a full
minute, this provides the body with a total volume of 5 to 6
liters.1 A normal breathing pattern should be quiet, still, calm,
relaxed, regular, through the nose and driven by the
diaphragm.
If you listen to the breathing of someone who snores or has
sleep apnea, without a doubt you will find it to be noticeable,
relatively fast and noisy. People who suffer with snoring and
sleep apnea breathe in more air than average, and commonly
take 15 to 20 breaths per minute, with each breath taking in
more than the normal 500ml of air. Assuming that each breath
is approximately 700ml, the average breathing volume for a
person who snores or has sleep apnea is 10 to 15 liters of air
per minute. To use food intake as a comparison, this is akin to
eating 6 to 9 meals each day!
A normal breathing volume of 5 to 6 liters of air per minute
ensures that the blood is almost fully saturated with oxygen.
Habitually breathing a volume of air greater than normal – a

12
condition that is clinically described as „chronic
hyperventilating‟ – does not add any more oxygen to the
blood, however. It is like pouring more water into a glass that
is already filled to the brim – unnecessary and excessive.
Instead, the bad habit of breathing too much every minute,
every hour, and every day causes a detrimental reduction of
carbon dioxide in the lungs and blood.
Contrary to popular assumption, carbon dioxide is not just a
waste gas. In fact, it performs a number of vital functions in
the human body, including offloading oxygen from red blood
cells to tissues and organs, including the heart and brain. For
oxygen to be released from the red blood cells, carbon dioxide
must be present. Over-breathing causes too much carbon
dioxide to be removed from the blood through the lungs,
resulting in less oxygen being delivered to tissues and organs.
The relationship between carbon dioxide and blood
oxygenation was discovered in 1904 by Danish physiologist
Christian Bohr and is known as the Bohr Effect. Carbon
dioxide also plays a vital role in relaxing the smooth muscle
that is embedded in the airways and blood vessels, facilitating
improved breathing and blood circulation. For more on the
role of carbon dioxide, see page 98.
Practicing the breathing exercises in this book increases
carbon dioxide in the blood, which in turn improves blood
flow and the delivery of oxygen to tissues and organs.
Therefore, in addition to helping with sleep-disordered
breathing, the exercises are very effective for improving blood
circulation and can have a positive impact on overall health.

13
People who sleep with an open mouth breathe large volumes
of air into their body all night long. Breathing through the
mouth causes narrowing of airway space,2 and also reduces
blood flow and oxygen delivery to the brain, which often
contributes to a feeling of exhaustion during the day, and
difficulty in getting up in the morning.

14
 WHAT IS SNORING?

S noring, often the subject of jokes about rattling the

windows and waking the baby has a much more serious
side. Left untreated, snoring may progress into sleep apnea,
high blood pressure or cardiovascular complaints.
Snoring worsens with age, gender, obesity, alcohol intake,
cigarette smoking and nasal obstruction. It can be extremely
disruptive to sleep for both sufferer and sleeping partner.
Snoring occurs when a large volume of air passes through a
narrow space, causing turbulence in the soft palate, nose or
back of the throat. There are two factors at play here: the first
is that the snorer is breathing too noisily and heavily during
sleep; the second is that their upper airways may be narrow
due to nasal congestion or structural issues.
The question to ask is whether they would still snore if their
breathing was calm and quiet.
Healthy non-snorers breathe quietly through their nose during
the night. Their sleep is deep and undisturbed, and they wake
up feeling refreshed.
People who breathe heavily during the night, on the other
hand, may experience a wide array of symptoms, such as
snoring, sleep apnea, disrupted sleep, insomnia, frequently
needing to use the toilet, and waking up fatigued with a dry
mouth, sore throat, and a blocked nose.
People who snore do so through their mouth, their nose, or
both. Snoring through the mouth is easiest to address – such
snoring stops when one learns to breathe through the nose
during sleep. (Explained on page 59.)
15
By learning to unblock the nose, switching to nasal breathing,
and normalizing breathing volume, breathing will become
quiet, calm, and still during sleep, and both types of snoring
will cease.
Other treatments for snoring, such as nasal decongestants,
nasal strips, surgery, and dental appliances, aim to expand the
airways to make more room for airflow. However, while it is
important to consider airway size when addressing snoring
and obstructive sleep apnea, it is also vitally important to
consider breathing volume. Buteyko breathing exercises are
specifically intended to change breathing volume towards
normal, and are an effective adjunct to the treatment of
snoring and sleep apnea.

16
 WHAT IS OBSTRUCTIVE SLEEP APNEA?

pnea is a Greek word meaning „without breath‟. There

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

Central Sleep Apnea

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

Obstructive Sleep Apnea (OSA)

During your school days, you may remember reading about
Joe the "fat boy" from the Pickwick Papers written by Charles
Dickens in 1837. Joe ate food in great quantities and was
liable to fall asleep during any situation. His breathing was
heavy, he snored, and he was continuously sleepy.
“Sleep!” said the old gentleman, “He‟s always asleep. Goes
on errands fast asleep, and snores as he waits at table.”1
Originally described as Pickwickian syndrome, this type of
breathing was later categorized as obstructive sleep apnea
syndrome by Dr Christian Guilleminault. In the early 1970s,
17
while working at the Stanford University Sleep Disorders
Clinic, Dr Guilleminault teamed up with cardiologists to
monitor the blood pressure of sleeping patients. The team
discovered that when patients stopped breathing during sleep,
their blood pressure dramatically increased. When this
continued over time, the increase to blood pressure became
permanent, occurring both day and night.
Needless to say, obstructive sleep apnea exerts considerable
stress on the body, often resulting in poor health. People with
obstructive sleep apnea experience decreased quality of life
and functional capacity, alongside a markedly increased risk
of cardiovascular disease and death. There is growing
evidence that OSA is also associated with an increased risk of
diabetes and cancer, and constitutes a major treatable risk
factor for hypertension, coronary artery disease (CAD) and
stroke.2
(A list of the symptoms resulting from sleep apnea can be
found on page 33.)

18
The prevalence of obstructive sleep apnea continues to
increase, and shows no sign of abating. In a 2009 paper
published in the journal Sleep Medicine, Dr Kevin Finkel and
colleagues from the Washington University School of
Medicine, reported that obstructive sleep apnea (OSA) affects
approximately 20% of US adults, of whom about 90% are
undiagnosed.3
In a separate telephone poll of 1,506 adults in the USA,
results showed that 31% of men and 21% of women indicated
a high risk of OSA. For obese people, this figure jumps to as
high as 57%.4
Obstructive sleep apnea is the most common type of sleep
apnea in humans, and involves a repetitive pausing of the
breath during sleep caused by the collapse of the upper
airways (nose, nasal passages, throat). Breathing may stop for
as long as one minute or more, even as the brain continues to
send signals to the breathing muscles to breathe.
Upon resumption of breathing, the individual takes a number
of large gasps of air into their lungs, snores for a period of
time, and then stops breathing again. This cycle of snoring,
apnea, gasping, and snoring continues all night long.
During an episode of apnea, the sleeper may not even be
conscious of holding their breath, or the racket created as they
resume breathing. It is usually their sleeping partner who lies
awake, listening and worrying, sometimes too fearful to go to
sleep. Often, snorers are urged by their partner to visit their
family doctor to get the condition checked out. The doctor, in
turn, will usually refer the snorer to a sleep clinic, where they
may participate in a study on how they breathe during sleep.
This study is called a polysomnogram and can be conducted
19
overnight at the sleep clinic or at home. During the study,
brain activity, eye movement, heart rate, blood pressure,
breathing and blood oxygen saturation are recorded. The most
important data during the sleep study is known as the apnea
hypopnea index (AHI).
The apnea hypopnea index was developed by Dr
Guilleminault and is still used today to characterize the
presence and severity of sleep apnea. The AHI is generally
expressed as the number of apneas and hypopneas per hour:
 An apnea describes a complete stopping of the breath
during sleep for ten seconds or longer
 A hypopnea describes a reduction to breathing flow of
greater than 30% during sleep, lasting for 10 seconds
or more, which causes a decrease to blood oxygen
saturation of at least 4%
An AHI of 5 to 15 is classified as mild obstructive sleep
apnea; 15 to 30 is moderate OSA; 30 or more is severe OSA.
People who experience snoring and obstructive sleep apnea
breathe intensely. As part of my work, I am a frequent flyer,
and during long haul flights, drowsiness often sets in with
some passengers falling asleep. As their sleep deepens, I have
a habit of listening intently to their breathing, and sad as it
seems- I sometimes count the number of breaths per minute as
well as getting a sense of the speed and amplitude of each
breath. Time and time again, I witness that people who snore
and who stop breathing during sleep demonstrate a fast
inspiration as they take a large volume of air into their lungs
with each breath. In other words, their breathing is hard,
which in turn increases the negative pressure in the upper

20
airways sometimes causing collapse and stopping of
breathing. In examining the relationship between breathing
and obstructive sleep apnea, it is important to consider two
factors; namely; the speed and volume of breathing as well as
the diameter of the upper airways.

In considering the speed and volume of breathing in causing

collapse of the upper airways, imagine a collapsible paper
straw. If you were to place one end of the straw in your mouth
and inhale air forcefully through it, the pressure would cause
the inner walls of the straw to collapse in on themselves. If
you continued to draw air in through the straw, the collapse
would become more severe. In engineering terms this is called
the Bernoulli Principle: as fluid (or in this case, air) flows,
negative pressure develops at the periphery of the flow. As the
flow velocity increases, so too does the negative pressure.5 In
other words, the faster one inhales and the larger the breathing

21
volume, the higher the negative pressure and the greater the
force of collapse.
In essence, this is what happens during obstructive sleep
apnea. The individual breathes out, and just as they are about
to breathe in, the negative pressure created by trying to take
air into the lungs causes the walls of the upper airways to
collapse. As the breath hold continues, the breathing center in
the brain sends messages to the diaphragm to resume
breathing. As the diaphragm contracts to draw air into the
lungs, increased negative pressure enforces the breath hold.
The second factor is the width of the upper airways which
includes the nose, nasal passages and collapsible tube of the
throat. People with narrow upper airways – such as adults
who persistently breathed through their mouth during
childhood – are more prone to obstructive sleep apnea. To
ensure normal development of the upper airways, it is vital
that children are encouraged to breathe through the nose. The
narrower the upper airway, the greater the speed of air as it
flows into the lungs which in turn increases the negative
pressure.5 Consider what happens when using a gardening
water hose. As you choke the hose and reduce the diameter,
the speed of the flow of water increases.
During the pause in breathing, oxygen is continually extracted
by the cells to power the functions of the body but is not
replenished by breathing. After a time, the oxygen de-
saturation of the blood decreases enough to partially wake the
brain and resume breathing. The sleeper finally takes in a
breath with a loud gasp, followed by a series of heavy and
intense breaths.

22
When the breath is stopped during sleep for a period of time,
it is normal for the individual to resume breathing with a
series of gasps as they suck much-needed air into their lungs.
However, during this catch-up period of breathing, too much
carbon dioxide is lost from the lungs and blood. To restore
carbon dioxide levels to normal, breathing reduces, which
may be responsible for initiating the next instance of apnea.6
This in turn causes another collapse of the airways and the
cycle repeats throughout the night.
Upper airway muscle tone determines the ability of the
airways to remain open during sleep. As we get older, the
upper airway muscles lose tone, resulting in a reduced ability
to maintain an open airway during sleep. For this reason,
strengthening the upper airways with orofacial myofunctional
therapy along with breathing re-education becomes
imperative. According to Joy Moeller who has been teaching
myofunctional therapy for over three decades, this non-
23
invasive method involves neuro-muscular re-education of the
oral facial muscles through a series of exercises designed to:
 Eliminate oral habits (nail biting, thumb sucking and
lip licking)
 Improve static and dynamic tongue position
 Improve lip seal
 Enhance nasal breathing
 Promote proper chewing and swallowing
The history of myofunctional therapy dates back to the 15th
century in Italy.7 In 1906, American orthodontist Alfred
Rogers taught exercises for the facial and throat muscles, and
in 1918 he wrote a paper entitled Living Orthodontic
Appliances in which he stated that proper functioning of the
muscles of the face would correct crooked teeth, thus
highlighting the importance of good facial muscle habits.7
Awareness of myofunctional therapy has surged in recent
decades, due in part to the publishing of papers in its support
by prominent sleep doctors including Dr Christian
Guilleminault.

Most procedures for improving obstructive sleep apnea

involve attempting to open the airways – either by bringing
the lower jaw forward with surgery or dental appliances, or by
using a continuous positive airway pressure (CPAP) machine
to splint open the airway at night. The CPAP machine, which
is considered the gold standard for treatment of sleep apnea,
was invented by Australian doctor Colin Sullivan. The CPAP
machine is a small unit comprising a hose attached to a mask.
The sleeper wears the mask at night, and the machine blows

24
air through the hose and into the mask at a pressure
sufficiently powerful to splint open the upper airways during
sleep. (See page 107 for an examination of the research
investigating compliance and side effects of this approach.)
While the CPAP machine and the use of dental appliances to
advance the lower jaw are relatively successful in their own
right, they only target one half of the problem. To deal with
sleep apnea on a more permanent basis, it is also necessary to
correct breathing volume. Any engineer considering the
diameter of a tube (or in this case, airway) will also need to
take into account the flow (breathing rate and volume) – after
all, one is entirely dependent on the other.
When researching the connection between breathing volume
and obstructive sleep apnea I was surprised to see that it was
seldom, if ever, measured during a sleep study. In fact, I could
only find one study which measured this correlation during
sleep apnea. The study, which investigated the breathing of
twenty obese men with OSA and normal lung function, found
that they breathed 15 liters of air per minute – approximately
three times the healthy average.8
In my quest to find further evidence of this link I researched
the incidence of obstructive sleep apnea in patients with
diagnosed asthma. People who suffer from asthma experience
a far higher incidence of obstructive sleep apnea than their
non-asthma counterparts, and many research papers have
concluded that as the severity of asthma increases, so does
obstructive sleep apnea. For example, one paper demonstrated
that approximately 74% of people with asthma also
experience nocturnal symptoms of airflow obstruction.9 In
another study, it was found that obstructive sleep apnea-

25
hypopnea was significantly more prevalent among patients
with severe asthma, compared to those with moderate asthma,
and more prevalent for both asthma groups than control
groups without asthma.10 Given the relationship between
asthma and OSA, it is sensible to assume that treating one
disorder will result in the other's better control and vice
versa.11 The Buteyko Method has long been associated with
improving asthma control, reducing symptoms and the need
for asthma medication. Currently, there are sixteen clinical
trials investigating the Buteyko Method for asthma with all
trials reporting positive results.
Even for children, the Buteyko Method is shown to be an
efficacious adjunct to conventional management. In one study
involving 35 mouth breathing children with mild to moderate
asthma, findings show improved sleep, reduced school
absenteeism and improved lung function scores.
Just as with OSA, children and adults with asthma perform
better with nasal and light breathing. As each breath is drawn
through the nose, the gas nitric oxide is carried into the lower
airways where it helps sterilize the air, open the airways and
improve arterial oxygen uptake. Since nitric oxide is
continuously released from the sinuses into the nasal cavity,
breathing light through the nose enables a higher
concentration of this miracle gas to enter the lungs and
perform its work.12 Nitric oxide concentrations of 50–200
parts per billion (ppb) are transported to the lungs with every
nasal inhalation compared with 10 ppb during mouth
breathing.13
The link between asthma and obstructive sleep apnea is
relatively easy to explain, since we know that respiratory rate

26
increases and lung function decreases as asthma severity
worsens.
The faster speed of breathing creates increased negative
pressure in the upper airways, causing the walls of airways to
be sucked inwards. Just as a CPAP machine works by sending
a positive pressure of air to splint open the airways, it follows
that reducing negative pressure by slowing down breathing
can help prevent collapse of the airways in the first place.
In terms of the reduction to lung function, the upper airways
(nose and throat) and lower airways (lungs) are mechanically
linked such that the upper airways function better when
asthma is under good control with improved lung function.6
Conversely, when asthma is under poor control, lung function
reduces and the upper airway collapses more easily thus
contributing to apneas. Studies also show that the majority of
people with asthma also have nasal congestion14 which in turn
contributes to mouth breathing and as we shall see in the
following section, this causes increased risk of sleep apnea.

Mouth versus Nose Breathing

In Morbis Popularibis, Hippocrates observed that nasal
polyps were associated with restless sleep.15 The relationship
between nasal obstruction, mouth breathing, snoring and sleep
apnea is well documented,16-20 and for decades the Buteyko
Method has been successfully implemented to help control
these conditions.
Persons with a history of nasal congestion due to allergy are
almost twice as likely to have moderate to severe sleep
disorders than those without nasal congestion.21

27
As we have already seen, the upper airways collapse when the
negative pressure generated as air is inhaled into the body
exceeds the ability of the muscles of the upper airways to
keep the airways open. Breathing through the nose or mouth
during sleep has implications on the messages sent to the
muscles of the upper airways. Researchers have found that the
muscle activity of the upper airways in keeping the airways
open is higher during nasal breathing than oral breathing.22
As air is drawn in through the nose, messages are sent to the
upper airway muscles to open in order to let the air pass into
the lungs. Conversely, there is a marked reduction in the
opening of the upper airways during mouth breathing. This
inevitably will contribute to collapse of the upper airways
causing cessation of breathing.23
It is interesting to note, that as we get older there is an
increased likelihood of breathing through the mouth during
sleep. Research highlights that persons over 40 years of age
are six times more likely than younger people to spend more
than 50% of their sleep time breathing through the mouth and
nose combined. This is not good news as over 40s are already
at an increased risk of sleep disorders including snoring and
sleep apnea. Ideally, breathing should exclusively be through
the nose during sleep.24
In comparison with breathing through the nose, mouth
breathing during sleep reduces the diameter of the upper
airway to create a greater resistance to breathing.25 One study
shows that mouth breathing during sleep makes it up to 2.5
times more difficult to breathe (upper airway resistance) as
compared with nasal breathing in normal people.25 Mouth
breathing during sleep is also more likely to cause the airways

28
to cool and dry out, leading to inflammation and further
narrowing of the airways.
Anyone who has ever had a little too much to drink of an
evening will know how it feels to wake the following morning
with your throat dry and raw. The same thing happens when
you breathe through your mouth at night, as the excess air
inflames and narrows the airways. The body expends energy
to condition incoming air within the upper airways before it is
drawn to the lungs. Taking too much air in through the mouth
traumatizes the upper airways, leading to inflammation.
The amount of saliva in the mouth and throat plays an
important role in keeping the upper airways open.26 Mouth
breathing and possibly fast breathing through the nose will
cause saliva to dry up. The increased stickiness of the upper
airways contributes to collapse and makes it more difficult for
the airways to reopen upon resumption of breathing.27 It is
important that the areas of the throat and mouth remain moist
during sleep in order for the muscles to function properly.
This combination of larger breathing volume, stickier and
narrower airways is a recipe for obstructive sleep apnea.
Several research studies have showed how nasal breathing
offers a distinct advantage during sleep, resulting in fewer
incidences of obstructive sleep apnea than when a patient
breathes through the mouth at night.28 For example, in one
study, the apnea hypopnea index while breathing through the
mouth was measured at 43 per hour, while the nasal breathing
AHI was just 1.5.25
In one interesting study, which aimed to determine the effect
of a blocked nose during sleep, subjects slept with their

29
nostrils blocked on one night and open on another. Blocking
of the nose caused participants to wake up more often,
reduced the quality of their sleep and caused a significant
increase in sleep disorders.29 And in another study, to
determine the effects of breathing through the nose during
sleep, researchers found that the number of sleep disturbances
significantly reduced when participants wore porous paper
tape across the lips during sleep. In yet another paper, the
wearing of a chin strap to prevent mouth breathing
demonstrated the same or better results in improving severe
obstructive sleep apnea than the use of a CPAP machine.30

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

airway is impeded and a greater suction force is generated in
the throat and mouth causing collapse of the airway walls in
some people. The Starling resistor model (above image) of
upper airway collapsibility demonstrates that if there is an
obstruction at the opening to a tube, negative pressures can be
generated downstream.22
30
Although a weight of evidence documents that nasal
obstruction negatively influences sleep, there are a number of
papers showing that treating the nasal obstruction with either
nasal dilators, steroids or surgery brings about only a minor
benefit.31 It is important to note that treatment to improve
functioning of the nose is only likely to bring about benefits to
sleep if the individual switches to total nasal breathing during
sleep.
If the individual continues to breathe through an open mouth
after nasal surgery or other treatments, then it is unlikely they
will experience much improvement to their quality of sleep.
For this reason, it is important for healthcare professionals to
instruct their patients of the necessity of total nasal breathing
both during wakefulness and sleep. Otherwise, the effect
could possibly be reduced.
In 1994, I had surgery to alleviate the feeling of chronic
stuffiness in my nose. Despite the procedure, I continued to
breathe through an open mouth for the next few years. My
habit of mouth breathing was ingrained from childhood, and
with the pattern in motion, I didn't automatically switch to
nose breathing. To some extent, the surgery was wasted as I
wasn't aware of the importance of nose breathing or even how
to do it at that time. It was only after I learned of the Buteyko
Method that I made the switch to nose breathing and in a
matter of days experienced what it was like to wake up
refreshed.
If you want to sleep better and wake up feeling energized and
refreshed, apply the three main tenets of the Buteyko Method:
breathe through your nose, adopt a correct posture and breathe
light. Another excellent way to assist with addressing

31
obstructive sleep apnea is myofunctional therapy, which
consists of neuro-muscular re-education of the oral facial
muscles. Through a series of exercises, participants improve
tongue position, enhance nasal breathing and strengthen the
upper airways. Further information on myofunctional therapy
is available from Academy of Orofacial Myofunctional
Therapy.

32
 IMPLICATIONS OF OBSTRUCTIVE
SLEEP APNEA

Adults
 Excessive daytime sleepiness (falling asleep while
eating, talking or driving)
 Waking up tired
 Causing sleeping partner to worry (while the sufferer
may be unaware of sleep disturbance)
 Loud snoring
 Problems with memory and concentration
 Morning or night headaches (affecting approximately
50% of patients)
 Heartburn or reflux
 Needing to visit the bathroom during the night
 Elevated blood pressure during the day, increasing the
risk of hypertension and heart disease
 Blood oxygen desaturation

33
Children younger than five years of age
 Frequent waking
 Snoring
 Sweating
 Mouth breathing
 Restlessness
 Failure to thrive

Children over five years of age

 Snoring
 Short attention span
 Poor academic performance
 Behavioral problems
 Bed wetting
 Not growing as quickly as they should for their age

34
 MOUTH BREATHING DURING CHILDHOOD
INCREASES THE RISK OF LIFELONG
OBSTRUCTIVE SLEEP APNEA

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

breathe through the mouth. Persistent breathing through the
mouth during childhood can lead to poor development of the
facial structures, causing an undeveloped chin, narrow face
and nostrils, a high and narrow upper palate, gummy smile,
crooked teeth, sunken cheeks and eyes, and a larger nose.1-4
Breathing through the nose with the tongue in the correct
resting posture helps to ensure normal development of the
face and jaws, producing good airways, pleasant facial
features, a good-sized nasal cavity, and straight teeth.5,6
In understanding the role of nasal breathing in facial
development, it‟s important to understand that the position of
the tongue influences the growth of the face. When a growing
child breathes with the mouth closed, the tongue is able to rest
in the roof of the mouth and shape the jaws in a wide U shape,
as well as guiding forward growth of the jaws to develop a
good upper airway. A wide facial structure with well-
developed jaws not only produces a more attractive looking
face but is healthier as well. Well-developed jaws and airways
are crucial for athletic performance and significantly reduce
the risk of lifelong obstructive sleep apnea. The illustration
below conveys the facial features associated with nose
breathing and correct tongue posture during childhood.

35
If the mouth is hanging open, the tongue is not able to rest in
the roof of the mouth. Try it for yourself: rest three-quarters
of your tongue against the roof of your mouth, then open your
mouth and try to breathe. It‟s not easy.
Chronic mouth-breathers have a low resting tongue posture
which leads to narrow jaws and overcrowding of teeth.7-9 It is
even more important to recognize that mouth breathing causes
the face to sink downwards, meaning the jaws don‟t develop
adequately on the face. The result is increased risk of lifelong
sleep-disordered breathing (including obstructive sleep
apnea),10-14 poor academic performance,15 behavioral issues
and a less attractive face.
The following illustration conveys craniofacial changes
associated with persistent mouth breathing during childhood.

36
Breathing through the nose is also very important to ensure
good quality sleep. After a night spent breathing intensely
through the mouth, a child will wake up exhausted, resulting
in poor concentration and frustration at school.16 If this
continues over a period of time, a psychological evaluation
and possible diagnosis of attention deficit hyperactivity
disorder (ADHD) may follow.
Whenever I speak to a parent whose child has been labeled
with ADD, my first piece of advice is to check their sleep
habits. Are they breathing through their mouth? Are they
twisting and turning during the night, waking up with the
bedclothes tangled in the morning? Do they snore or hold
their breath during sleep? Is their breathing audible?
Answering yes to any of these questions suggests that the
child is suffering the detrimental effects of sleep disordered
breathing. Nasal breathing is of the utmost importance if you
wish to improve your child‟s quality of sleep. Any adult will
understand the knock-on effect of crankiness and frustration
when they have a poor night‟s sleep – so how can a child face
the day with boundless energy if their sleep isn‟t right?
Enlarged tonsils and adenoids often play a role in children
37
with sleep disordered breathing. Clinically, it is recognized
that enlargement of these tissues is often associated with
habitual breathing through the mouth. The typical standard of
care in the Western world is for children to undergo surgery to
remove enlarged tonsils and adenoids. With the obstruction
removed from the upper airways, both breathing and sleep
usually improve. However, if the child does not switch to
nasal breathing, though they may experience short-term
improvements after an adenotonsillectomy (T&A), continued
breathing through the mouth may lead to abnormal impacts on
airway growth with a high risk of sleep apnea returning in the
months or years ahead. 17
Dr Christian Guilleminault‟s research found that children with
missing teeth, whether due to extractions as part of
orthodontic treatment or due to genetically missing teeth,
suffered an increased risk of obstructive sleep apnea. It is
vitally important that children retain all of their adult teeth. If
teeth are removed as part of traditional orthodontic treatment,
the jaws move inwards, thereby reducing the diameter of the
upper airway. A smaller upper airway increases resistance to
breathing – a contributing factor in obstructive sleep apnea.
Overcrowding of teeth is not necessarily due to the teeth
being too big for the jaws. More likely, it is that the jaws are
too small to adequately house all teeth, which can be caused
by thumb sucking or mouth breathing.
If your child is seeking orthodontic treatment, insist that the
orthodontist creates a functional appliance to gently expand
the child‟s jaw to make room for existing teeth rather than
extracting teeth. For more on this subject, visit
RightToGrow.org, a patient-led website set up to increase
awareness of the negative impact of extractions and retractive

38
orthodontic treatment.
Breastfeeding is a beneficial way to ensure nasal breathing
during the first months of an infant‟s development. However,
if a child is tongue tied, breastfeeding can be very difficult for
both baby and mother. To express milk from the breast, the
baby‟s tongue needs to move freely up and down. If the
tongue is tied to the floor of the mouth due to a short
frenulum, the baby doesn‟t get enough milk and the mother
often gets very sore.
At an AAMS (Academy of Applied Myofunctional Sciences)
sleep conference in Bordeaux, one speaker explained how
midwives in sixteenth century France grew an extra-long
fingernail to release tongue ties soon after birth. Bizarre as it
may sound, this precaution may have been the difference
between life and death for many children. Our ancestors knew
the importance of free movement of the tongue, while today
tongue-ties in newborns too often go undetected.
Breastfeeding is obviously important for providing proper
nutrition, but it also serves another vital function in infant
development as it encourages the baby to work the muscles of
their face and jaw. And while introducing the bottle is often
necessary, it simply doesn‟t provide a sufficient workout to
help ensure nasal breathing and adequate development of the
jaws. As bottle feeding is a fact of life in today's modern
world, parents who are aware of the deleterious effects of
chronic mouth breathing can address the issue much sooner
by applying the Buteyko Method along with Orofacial
Myofunctional Therapy. (Orofacial Myofunctional Therapy is
an excellent therapy to help with obstructive sleep apnea in
children and adults. See aomtinfo.org)
On a personal note, I understand the necessity of both parents

39
having to work full time in order to support a family and
mortgage. And while most mothers would love the
opportunity to nurse their child for the first six months to one
year of life, many are not in a position to do so. I also
understand the negative effects of tongue tie and congenitally
missing teeth, as my daughter experienced both. In order to
reduce the risk of lifelong obstructive sleep apnea, I
continually encourage her to breathe through her nose. I also
had her tongue tie addressed as well as early functional
orthodontic treatment using an appliance called an ALF,
which I am happy to state has produced tremendous results in
gently expanding her jaws. With this information in hand, I
am fortunate that I can help minimize the risk of my daughter
developing lifelong sleep problems. Above all else, I don't
want her to go through the same sleep problems that I
experienced until the age of 25 years.
The negative effects of chronic mouth breathing are
recognized within the medical and dental profession, yet it
seems that very few parents are aware of it. A 2012 paper
published in the International Journal of Pediatrics
investigating the long-term changes to facial structure caused
by chronic mouth breathing noted that this seemingly „benign‟
habit in fact has immediate and/or latent cascading effects on
multiple „physiological and behavioral functions‟. The paper
even suggested that habitual mouth breathing may be
connected to sudden infant death syndrome (SIDS).18

40
 WHAT IS INSOMNIA?

Insomnia is one of the most common sleep disorders,

affecting between 25-30% of the general population, with
10% of people presenting chronic complaints and seeking

41
medical help.1 Insomnia is a state in which you are never fully
asleep and never fully awake. Characteristics include a
difficulty falling asleep, staying asleep, waking early and
interrupted or non-restorative sleep.
The cause of insomnia is often connected to psychological
roots such as anxiety, depression, periods of prolonged stress,
a reaction to a traumatic event, or an overactive mind. Anyone
who has had trouble sleeping will relate to the frustration of
not been able to fall asleep due to persistent thoughts that
refuse to switch off.
If you suffer from insomnia, practicing the Reduced Breathing
exercise in this book will help to quieten your mind and bring
your body into relaxation. (See page 64) This technique works
in two ways: by paying attention to your breathing you take
attention away from the mind, thereby reducing thought
activity; and by reducing breathing volume your body is able
to deal with the physiological aspects of stress by activating
the relaxation response.
Light, disturbed sleep leads to waking up feeling lethargic,
lowering productivity, and increasing stress levels.2 In
addition, researchers have consistently reported a relationship
between poor sleep and high blood pressure. This connection
may be explained by the bodily stress insufficient sleep places
on the nervous system.3 All in all; poor sleep reduces your
quality of life, and is often connected to the way you breathe
at night.

42
 In the next section of the book,
Buteyko meets Joe and guides him
through the Buteyko Method.
To create a more user friendly
experience, part of the text is written
in conversational style.

43
44
 JOE IS CHRONICALLY OVER-BREATHING!

n this section, Buteyko meets „Joe‟, a patient suffering from

I snoring and sleep apnea, teaches him to recognize the
effects of over-breathing, and explains how to reverse it.
Buteyko explains to Joe: “Quite simply, your lifestyle over
the years has changed your breathing. Now you regularly
breathe through your mouth day and night. You sigh quite
often, especially when you get a little stressed. Your breathing
is sometimes noisy during the day and at rest, and I can see
visible movements in your tummy and chest when you
breathe.
“And, of course, when you breathe heavily during the day, it
follows that you will also breathe heavily at night. Joe, you
are here to address your snoring and sleep apnea. This might
surprise you, but they are connected, and have a single
contributory factor: over-breathing!”
“Over-drinking, over-eating, lack of exercise, stress, stuffy
rooms and excessive talking all cause over-breathing. And
your over-breathing is severely affecting your health. It
contributes to your nose becoming blocked. It disrupts your
sleep and it can result in snoring, sleep apnea and insomnia.”
“But everybody I meet advises me to take deep breaths and
fill my lungs with oxygen,” Joe says, “How can I be sure that
what you are telling me is true?”
Buteyko explains that none of these people understand how
oxygen is released from red blood cells. “If they knew about
the Bohr Effect, they wouldn‟t advocate heavy breathing or
taking big breaths.”
45
“When Lavoisier discovered oxygen, he likened the human
body to fire. Just like fire, the human organism consumes
oxygen and gives off carbon dioxide. However, this is not the
complete story. Not all oxygen is good, which is why we have
antioxidants. Not all carbon dioxide is bad – in fact, several
healthy bodily functions are very dependent on this gas. It is
very important that we have the correct partial pressure of
both gases within our body. However, when we breathe in
excess of bodily requirements, our health is negatively
affected.”
Buteyko then tells Joe to forget about the theory for a
moment, and asks him how he feels when he breathes heavily
through his mouth for a few minutes.
Joe knows only too well. “When I do that, I feel dizzy and
light headed. My brain does not function as well.”
Buteyko is happy that Joe has discovered the connection
between breathing too much and less oxygen reaching the
brain.
Most people in the Western world over-breathe. It is a factor
of modern living, but how it affects each individual depends
on genetic predisposition.
Buteyko asks Joe whether he wakes up tired in the morning.
Joe replies, “Yes, I do.”
Buteyko explains that this too is related to the way he
breathes.

46
GOOD BREATHING

47
NOT SO GOOD BREATHING

48
 HOW TO MEASURE YOUR RELATIVE
BREATHING VOLUME

A measurement called the Control Pause (CP) was

developed by Buteyko to measure relative breathing
volume. Quite simply, it is the length of time you can
comfortably hold your breath following an exhalation. All you
need is a watch or clock with a second hand to measure your
Control Pause.

1. Take a small, silent breath in, and a small, silent breath

out.
2. Hold your nose with your fingers to prevent air from
entering your lungs.
3. Count how many seconds until you feel the first signs
of air hunger.
4. At the first sign of air hunger, you may also feel the
first involuntary movements of your breathing
49
 muscles. Your tummy may jerk. The area around your
neck may contract.
5. Your inhalation at the end of the breath should be
calm.
6. Release your nose and breathe in through it.

Please take note of the following important points before you

start:
 The breath is held until the first stress to breathe or the
first involuntary movements of the breathing muscles.
It is not a measure of the maximum length of time that
you can hold your breath.
 Your CP only measures your breath hold time. It is not
an exercise to correct your breathing.
Remember that taking your CP involves holding your breath
only until the first involuntary movements of your breathing
muscles. If you have to take a big breath at the end of the
breath hold, then you have held your breath for too long. It is
interesting to note that researchers have reported the breath
hold time to be shorter in snorers than non snorers.1
From time to time, I observe persons with obstructive sleep
apnea reach an unusually long Control Pause despite
displaying relatively noticeable breathing. In other words,
their Control Pause is not reflective of their breathing pattern.
In this situation, I don't use the Control Pause, and instead
encourage the person to breathe through their nose and
practice reducing their breathing towards normal levels. As
breathing volume and speed normalizes, the severity of their

50
obstructive sleep apnea reduces.
To make progress, you must be aware of the following
guidelines:
 You will feel better each time your CP increases by 5
seconds.
 If your CP does not change, you will not feel better.
 Your CP should increase by 3 to 4 seconds each week,
especially during the first few weeks. Progress will
slow when the CP reaches 20 seconds.
 The most accurate CP is taken first thing after waking.
This measurement is most accurate since you cannot
influence your breathing during sleep, and your
morning CP is therefore based on your breathing
volume as set by your respiratory center.
 Taking your CP throughout the day will give you
feedback on your breathing at different times.
 The most important CP is taken first thing in the
morning. Soon after waking, sit up on the bed and take
your CP. Your goal is to achieve a morning CP of 40
seconds for 6 months.

51
52
THE THREE TENETS TO NORMALIZING YOUR
BREATHING

53
THE FIRST TENET: BREATHE THROUGH YOUR
NOSE DAY AND NIGHT

L earning to breathe permanently through the nose is the

first step to addressing over-breathing. The nose serves a
number of very important functions:
 Warms and humidifies incoming air.
 Removes a significant amount of germs and bacteria.
 Results in more regular breathing (chaotic breathing
disturbs blood gases, which can play a role in
experiencing stress).
 Improves oxygen uptake in the blood.1

54
Conversely, mouth breathing contributes to various common
symptoms and conditions:
 Results in a dry mouth, which increases acidification
of the mouth and can result in more dental cavities and
gum disease.
 Contributes to dehydration.
 Proven to significantly increase the number of
occurrences of and severity of apneas.
While it is very important that the mouth is closed for both
children and adults during the day, it is absolutely vital that
the mouth is closed during sleep. A closed mouth during sleep
helps ensure that the tongue rests at the roof of the mouth.
When we sleep with our mouth open, the tongue falls back
and makes the airway smaller and the floppy bits vibrate
loudly with each inhalation to result in snoring. When the
sagging of the mouth and throat develops into a total inward
collapse of the airways, the sleeper becomes unable to breathe
and experiences an apnea.
Nasal breathing performs at least thirty functions on behalf of
the body.1 Along with providing a sense of smell, the nose is
nature‟s way of filtering and preparing air before it enters the
lungs.
Since the nostrils are much smaller than the mouth, nasal
breathing creates approximately 50% more resistance in
comparison to mouth breathing during wakefulness, resulting
in a 10-20% greater oxygen uptake in the blood.1 Conversely,
in individuals without nasal congestion, resistance in the
upper airway is lower during sleep while breathing through
the nose as opposed to the mouth.2 Breathing optimally
55
through the nose not only increases blood oxygenation, but
also increases the amount of oxygen delivered to tissues and
organs.1
Contrary to the popularly-held opinion to breathe „in through
the nose and out through the mouth‟, it is in fact more
advantageous to breathe both in and out through the nose. Not
only does nasal breathing facilitate better body oxygenation,
but it also helps to prevent a blocked nose and generally
allows for easier breathing during rest and exercise.
Studies have shown that exhaling through the mouth can
result in the loss of heat and up to 42% more water than
exhaling through the nose.3,4 This increased heat and water
loss may result in symptoms of nasal obstruction (blocked
nose) and difficulty breathing. In a vicious cycle, a blocked
nose encourages the individual to continue mouth-breathing
and perpetuates the condition. Somewhat counter-intuitively,
breathing through the nose can help to keep the airways
unblocked, prevent dehydration, and improve healthy
breathing volume. Practicing breath hold techniques can also
be used to easily decongest the nose.
In one research study, the effects of breath holding on nasal
resistance were assessed, and it was found that holding the
breath for 30 seconds or longer helped to open up the nasal
passages to make breathing easier.5 In addition, the study
discovered that physical exercise also decreased nasal
resistance. This is of particular relevance to anyone with nasal
obstruction or hay fever.

56
 HOW TO UNBLOCK YOUR NOSE

To unblock your nose, try the following exercise:

 Take a normal, silent breath in through your nose.
 Allow a normal, silent breath out through your nose.
 Hold your nose with your fingers to prevent air from
entering or escaping.
 Nod your head up and down or sway your body until
you feel a medium-to-strong need for air.
 Hold your breath for as long as you comfortably can.
 Let go and breathe in through your nose.
 Calm your breath immediately.
Wait for one minute and repeat. Repeat five or six times until
your nose is completely free. Practice the exercise any time
your nose feels blocked to temporarily decongest your nose.
Your nose will be more permanently free when you are able
57
to reach a Control Pause of over 25 seconds.
The above exercise was included as part of a study undertaken
by Dr Adelola and colleagues from the Department of
Otolaryngology at Limerick University Hospital in Ireland to
investigate the effectiveness of the Buteyko technique on the
nasal symptoms of patients with asthma.
Results showed a 70% reduction of nasal stuffiness in asthma
at a three-month follow-up.1

58
 NASAL BREATHE DURING SLEEP

P racticing nasal breathing during the daytime can be

achieved easily with a little focus. But what about at
night? How can you keep your mouth closed when you sleep?
An effective way of ensuring that you continue to breathe
through the nose during sleep is the technique of using paper
tape to keep the mouth closed. You can buy one-inch paper
tape at any chemist or drug store – I recommend the 3M
Micropore brand. A tailored variation of the tape is called
LipSealTape which is available from LipSealTape.com. Another
useful product is called SleepQ+ (available online), a
reversible adhesive gel that keeps the lips closed to prevent
involuntary mouth breathing during sleep.
Though it might feel strange at first, wearing tape or SleepQ+
while you sleep quickly becomes a comfortable habit that
helps you to get a good night‟s sleep.

The benefits of nose breathing during sleep include:

 Calm, restful, uninterrupted sleep
 Fewer wakings during the night, and more likelihood
of sleeping straight through the night
 Waking up feeling rested, clear headed and energized
 Being more productive during the day as your
alertness and concentration improves

59
How to use paper tape at night:
Tear off about 6 inches (10 centimeters) of paper tape. Fold
over a small piece at one end to make removal easier. Dry
your lips with your fingers. Draw your lips inwards and place
the tape horizontally to cover your mouth. Go to sleep with
your mouth closed.
You may find when you first try taping your mouth you feel
as if you aren‟t getting enough air. The reason for this
discomfort is due to the fact that your body has become
accustomed to your heavy breathing through the mouth. But it
can adapt – it only takes a short space of time before you get
used to breathing through your nose instead. After a couple of
weeks of practice, and with lighter breathing and a higher
Control Pause, you will find it more comfortable to breathe

60
through your nose during sleep.
If you are really struggling with breathing through your nose
during sleep, there is a solution to help you adjust. Wearing a
nasal dilator can help to open your nasal passages and make
breathing easier as you become used to breathing through
your nose at night. There are two products on the market
which serve this purpose: Breathe Right strips (which are
available over the counter) and the Mute (which is available
from MuteSnoring.com). Wearing these products will make
the transition a lot easier.
If you need help adjusting to nasal breathing at night, try
wearing the paper tape, LipSealTape or SleepQ+ across your
mouth as well as a nasal dilator. This may not help your
romantic life, but it will certainly help your sleep. You will
find a remarkable difference to the quality of your sleep, and
no doubt your sleeping partner will appreciate the change as
well. (For videos on applying both the tape or SleepQ+, visit
our YouTube Channel; ButeykoClinic.)
Please note: this method is not suitable for children under
five-years-old. Any child taping their mouth at night must be
able to remove the tape if they feel the need to. If during the
night you find it difficult to breathe while using LipSealTape
or SleepQ+, then wear a nasal dilator to assist easier airflow
through the nose. Try not to revert to mouth-breathing during
sleep which will only make your symptoms worse.
Important: do not use tape at night if you are feeling
nauseous or have been drinking alcohol.

61
 THE SECOND TENET: CORRECT POSTURE

The second tenet of correct breathing is good posture.

Slouching compresses the diaphragm and results in breathing
from the upper chest. Ventilation perfusion describes the
ratio of the amount of air to the amount of blood reaching the
small air sacs in the lungs per minute. In a perfect situation,
the oxygen provided from breathing would be just enough to
saturate the blood fully with oxygen.
Poor posture, breathing through the mouth and gravity can
lead to a situation where the higher parts of the lungs receive
more ventilation, and the lower parts greater amounts of
blood. Adopting a good posture and breathing through the
nose helps with a more efficient matching of blood flow to
ventilation.1
Become aware of your posture when you sit, and how it
affects your breathing.
The ideal sitting position is the „horse rider‟:
 Sit at the edge of chair with your feet tucked
underneath
 Imagine a piece of thread drawing you upwards from
the top of the back of your head
 Imagine the spaces between your ribs widening

Learn to be aware of your posture when you sit, walk, and

run.

62
63
 THE THIRD TENET: REDUCE BREATHING
VOLUME TO CREATE A NEED FOR AIR

B uteyko explains the third tenet to Joe, which involves

creating a need for air through relaxation of the
respiratory muscles:
“To normalize your breathing volume, you need to practice
simple relaxation exercises. This is achieved by bringing a
feeling of relaxation to your body and silently encouraging
your breathing to decrease to the point where you feel a

64
tolerable hunger for air. When the body experiences a
sustained shortage of air, the breathing center in the brain is
reset to a lower breathing volume, encouraging calmer and
gentler breathing. As you become accustomed to keeping your
breathing quiet, it will gradually become a permanent
breathing habit.”
Joe: “Buteyko, I‟m confused; what is a hunger for air and how
strong should it be?”
Buteyko: “Hunger for air means experiencing the urge to
breathe more. It is a feeling of breathlessness, similar to what
you might experience if you go for a brisk walk. It can also be
described as feeling slightly suffocated.
“Ideally, you will feel a tolerable need for air. This need for
air should be the same as that experienced during the Control
Pause measurement. If you reduce your breathing too much,
the air shortage is no longer tolerable and your breathing
muscles will jerk and heave. When the breathing muscles
spasm, it is a sign that you should stop the exercise and wait
for about thirty seconds before resuming gentle, reduced
breathing through relaxation.
“Initially, you will only be able to tolerate a shortage of air for
a short period, maybe fifteen seconds or so, until your tummy
muscles begin to jerk. However, with practice, and as your
Control Pause increases, it will become easier to maintain a
gentle air shortage over a number of minutes.”
Joe: “Okay, I‟ll try.”

65
66
Joe puts his hand on his chest and tummy and focuses on his
breathing. He feels the air entering and leaving his nose. He
feels the air hitting the back of the throat. He also feels his
chest and tummy moving. To improve his awareness, Joe
spends several minutes paying attention to the slightly cooler
air entering his nose and the slightly warmer air leaving his
nose.
When he has achieved a good awareness of his breathing, Joe
starts to silently give himself the following reminders: “Relax
my chest, relax my tummy, allow my breathing to reduce,
slow down, and quieten.”
In addition to this mental encouragement, Joe also brings a
sense of inner relaxation to the area around his chest and
tummy.
While bringing a feeling of relaxation to his body, Joe takes a
smaller breath in than he is used to, and allows a slow, gentle
relaxed breath out. He feels his chest and tummy relaxing.
Small breath in; relaxed breath out.
Small breath in; relaxed breath out.
Small breath in; relaxed breath out.
He mentally instructs his body to relax and, as his body
relaxes, his breathing becomes quiet and calm.
Joe now shows far less breathing movement from his neck
downwards. His breathing is almost invisible. He feels a
tolerable need for air.
Buteyko: “Joe, you are doing wonderfully well. You have
created a hunger for air. I know this because I can see that you
are concentrating on your breathing. Your breathing
67
movements have relaxed and have been reduced by about
thirty per cent. I also know that you have air shortage because
your eyes are glassy. There is a shine to them. You feel
warmer as the reduced volume of breathing helps open up
blood vessels and improves blood circulation. Finally, you are
experiencing increased saliva in your mouth which indicates
activation of the body‟s relaxation response.”

68
 REDUCED BREATHING SUMMARY

 Follow your breathing for a minute or so. Feel the

slightly colder air as it enters your nose, and the
slightly warmer air as it leaves your nose;
 Encourage the area around your chest and tummy to
relax;
 Bring a feeling of relaxation to your body;
 Silently encourage your breathing to slow down and
quieten;
 Slow down the speed of air as it enters and leaves your
nostrils, or take a shorter breath than you feel you
need, and allow a relaxed breath out;
 Allow your breathing volume to reduce to the point
that you feel a tolerable need for air;
 Try to sustain this hunger for air for a few minutes.

69
 REDUCE BREATHING ONLY THROUGH
RELAXATION OF THE RESPIRATORY MUSCLES

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

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

72
 REDUCED BREATHING DAILY EXERCISE
FORMAT

Buteyko advises Joe to reduce his breathing for one formal

session each day. A typical format for such a session is as
follows:
 Sit and relax for a few minutes
 Measure your Control Pause (CP) - see page 49
 Practice five minutes of relaxation to create an air
shortage
 Rest with normal breathing for half a minute
 Practice five minutes of relaxation to create an air
shortage
 Rest with normal breathing for half a minute
 Practice five minutes of relaxation to create an air
shortage
 Rest with normal breathing for half a minute
 Practice five minutes of relaxation to create an air
shortage
 Wait five minutes and measure your final CP
 Your final CP should be twenty percent higher than at
the start

74
Initially, it‟s better to practice this exercise when you are not
distracted. Go to a quiet room. Turn off your mobile phone.
Over time, you will be able to allow your breathing to relax
and become quiet in any situation.
Another option is to listen to the attached CD, which is
designed to instill relaxation and guide you through reduced
breathing. Listen to this CD as soon as you go to bed. It is
twenty minutes in length. While listening, ensure that you feel
a tolerable air shortage for the entire twenty minutes.

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

75
 REVERSING INSOMNIA

O ur modern lives are so busy and frantic that our minds

are bombarded with tens of thousands of thoughts each
day, without a break, but since everyone is caught up in it,
few see it for what it truly is. This endless cycle of thought
contributes to insomnia. To quieten the mind and improve
your breathing, try to devote twenty minutes to yourself every
day.
By observing the breath, calming your inner body, and
allowing your breathing to reduce, the body‟s relaxation state
is activated. In addition, the practice of watching your breath
acts in a meditative way and is very helpful to calming the
mind. Your mind will be far less distracted by thought while
you are relaxing your body and experiencing a shortage of air.
Breathe less and give yourself a break from your mind.
If you have never connected with your inner body before, try
the following exercise:
 Sit quietly in a comfortable position, hold your hand in
front of you and close your eyes. Can you feel your
hand? Can you tell that your hand is there? Bring
attention to your hand. Hold your attention there.
 After twenty seconds or so, when you are sure that you
can feel your hand, bring attention to your arm. With
your eyes still closed, hold your attention on your arm.
 Next, bring your attention as far as your shoulder.
Sense the subtle bodily sensations as far as your
shoulder. Feel the inner body.

76
  When you can comfortably hold your attention on
your entire arm, gently move your attention across
your chest. Feel the inner chest. Sense the inner chest.
Encourage this area to relax. You can help relax it
further by physically tensing and relaxing your chest.
Tense and relax, tense and relax.
 When you have a good sense of the area of your chest,
bring attention to the area around your tummy. You
can also help the area around your tummy to relax by
physically tensing the tummy and then relaxing it. To
do this, gently exhale and pinch your nose with fingers
to hold your breath, and then try to gently breathe in
and out while holding your breath for five seconds or
so. This technique will help to activate a dormant or
tense diaphragm.
 A stressed mind will always manifest in the tummy.
Encourage this area to relax. Encourage this area to
still. Encourage this area to be quiet.

When you bring your attention to the inner body, you will
find your mind is calm. You cannot think and keep your
attention on the inner body at the same time. Humans are not
simply composed of a head, but most people in the Western
world are unaware of their body unless it feels pain. The only
time that they truly bring attention to their body is when
something is wrong with it. Make it a habit to take your
attention out of your head and disperse it throughout your
body for a minute or so at a time. What is more important is
the number of times throughout the day that you take your

77
attention into your body as opposed to the length of time you
hold your attention there during one sitting. Your body is in a
state of stillness, and taking your attention into it will help
bring the mind into stillness.
As you go about your daily activities, try to identify the
useless thoughts going around your mind. Observe your
thoughts. Be a passive observer. What are you thinking about?
What purpose do the thoughts serve? Are they the same
thoughts that you have been thinking for the past weeks,
months, years? Are your thoughts beneficial? Do they help
you or are they simply insane and repetitive nonsense that
serves no purpose?

78
According to the laboratory of neuroimaging at the University
of Southern California, the average person has approximately
70,000 thoughts per day.1 Of these, it is estimated that 80-90%
are repetitive and useless.
An active mind, constantly running through thought after
thought, is difficult to switch off at night. If you spend most
of your waking hours investing in repetitive and useless
thoughts, how can you expect to break the habit when you go
to bed? The more active your mind during the day, the more
active it will be at night. This is why people often revert to
alcohol and prescribed medications to help them sleep. But
this does not work. Numbing the mind with alcohol or
medication does not address the active mind; it only serves as
a sticking plaster, offering a temporary solution.
The best way to tame the mind is to observe your breathing
throughout the day, become accustomed to relaxing both body
and mind, and address chronic over-breathing. To help relax
the mind prior to sleep, play the attached CD as soon as you
go to bed. Quite often you will find yourself fall asleep before
the CD ends.

80
 BREATHING EXERCISE TO HELP CALM THE
MIND AND STOP PANIC ATTACK

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

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

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

follows:
 Breathe in through the nose, breathe out through the
nose, and hold your breath;
 Hold your breath for 2 to 5 seconds;
 After each breath hold, breathe normally through the
nose for 10 seconds or so. Don‟t interfere with your
breathing;

81
 Continue to perform a small breath hold followed by
gentle nasal breathing for 10 seconds or so until your
mind has calmed.
 If the mind is particularly agitated, it may be necessary
to practice this exercise for ten minutes every hour.

82
 CORRECT BREATHING DURING PHYSICAL
EXERCISE

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

J Breathing exercise while sitting, or can I make the same
progress while exercising?”
Buteyko: “Yes, you can. In fact, exercise is an important
factor in increasing carbon dioxide in the body, alongside
reduced breathing volume. Carbon dioxide is the end product
created by the metabolism, so the more we move our muscles
the more carbon dioxide we generate. Applying the three
tenets to physical exercise will ensure maximum progress.
“While exercising, stand up straight and imagine that a piece
of thread is gently lifting you up from the top of the back of
your head. Breathe only through your nose and bring a feeling
of relaxation to your chest and tummy.
“As you walk, jog or run with your mouth closed, continue to
relax the inner body. In particular, relax the area around
your chest and tummy. Use your thoughts to tell your body to
relax. This is the exact same process as reducing your
breathing while sitting.
“The objective is to create a need for air. To make progress,
breathing should always be through the nose. Ensure that you
walk at a pace that lets you keep your mouth closed.
Breathing must be controlled and the air shortage should not
become so strong that it causes you to breathe through your
mouth. If you feel the need to open your mouth to breathe
during physical exercise, it is a sign that you are pushing
yourself too hard. Slow down instead, and exercise at a level

83
that is right for you.
“It doesn‟t matter what sort of physical exercise you do. The
aim is to create a feeling of breathlessness and produce a
sweat while keeping your breathing controlled and through
the nose.
“You will know that you are breathing correctly during
physical exercise if your CP is higher when measured half an
hour after you complete your exercise than it was before you
began.
Another benefit of physical exercise is that it tires your body.
You always sleep better when you are physically tired.”

Breath holds during physical exercise

Please note: This exercise is best suited to children, teenagers
and adults who are in relatively good health. If your CP is less
than ten seconds, or if you have a heart complaint, high blood
pressure, or moderate to severe sleep apnea, it is not advisable
to practice this exercise.

84
Try the following exercise to incorporate breath holds into
exercise:
 Begin walking while breathing in and out through
your nose;
 After a couple of minutes walking, breathe in and out
gently through your nose;
 Pinch your nose with your fingers to hold the breath;
 While holding your breath, walk up to 20 paces;
 When you release your breath, calm your breathing
immediately;
 Walk normally with your mouth closed for 30 to 60
seconds to recover, and repeat again;
 Repeat a medium-strength breath hold six to eight
times during a 20-minute walk.

The above exercise is an excellent practice for children and

teenagers who may not grasp the concept of reduced breathing
through relaxation. Further information on applying the
Buteyko Method with children is available from
www.ButeykoClinic.com

85
 FOOD AND SLEEP

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

with Joe.

Buteyko: “Why are you overweight?”

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

A good way to lose weight is to reduce your breathing to a

normal level and listen to your body:
 Eat when you are hungry
 Eat until you are satisfied
 Stop eating three hours before you go to bed

The benefits of losing weight include easier and lighter

breathing as well as a reduced neck size. When we gain too
much weight, the increase in neck size can result in a
narrowing of the upper airways. This in turn increases the
86
negative pressure as air is drawn into the lungs and
contributes to sleep apnea.
Buteyko: “Look at this word: Breakfast. Divide it up and you
have „break‟ and „fast‟. The first meal in the morning is
required to break the fasting our bodies have been doing
overnight. In other words, it is natural to wake up with an
appetite.”

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

sleeping, you will not wake up hungry. You will still be
87
digesting the food that you ate the night before. Eating and
drinking alcohol late at night only contribute to insomnia.
“And here is another word that you are fond of: desserts. Try
spelling it backwards.”
Joe: “Stressed!”
Buteyko: “And that is exactly how your body is feeling. Too
many desserts are contributing to your stress levels!
“Finally, avoid foods that produce symptoms of nasal
obstruction, increased mucus, and reflux. Typically, these
foods include dairy, stimulants, and sugars. As your Control
Pause increases, all three symptoms will reduce in severity.”

88
APPLYING THE BUTEYKO METHOD FOR SLEEP
DISORDERS

 Measure your Control Pause each morning upon

waking. With every five second improvement to your
Control Pause, you will feel better and experience
deeper sleep and improved energy levels.
 Breathe through the nose both day and night.
 Practice Reduced Breathing exercise for ten minutes
by three times daily, along with fifteen minutes
directly before bed. (page 64) (If listening to the
attached CD, try to ensure that you feel an air shortage
during the exercise).
 Spend half an hour to one hour performing physical
exercise with nose breathing during the day.
 Avoid sleeping on your back.
 Sleep in a cool airy bedroom.
 Avoid looking at mobile phones or laptops for two to
three hours before sleep.
 Don't eat late at night as it disrupts sleep.

Buteyko tells Joe that as his CP increases, his sleep will

become deeper and his need for sleep will lessen. He quotes
German philosopher Friedrich Nietzsche who once said that
“Sleeping is no mean art: for its sake one must stay awake all
day.”
To improve your sleeping habits, only sleep when absolutely
necessary, and try getting up half an hour earlier than you
89
normally do. You should not find that you feel more tired
during the day. Instead, you will be suitably tired so that when
you do go to bed, you fall asleep easily.
For a great night‟s sleep, practice reduced breathing for 15 to
20 minutes before sleep (you can do this while watching some
light television or relaxing in bed):
 Place one hand on your chest and one hand on your
tummy;
 Gently soften your breathing to create a tolerable need
for air;
 Continue with this exercise for a period of 15 to 20
minutes;
 Not only is this an excellent way to help with sleep-
disordered breathing, it also helps you relax and fall
asleep easier.
It is vital to breathe through your nose during sleep. (See page
59) You can tell if you have been breathing through your
mouth at night as you will wake up with a dry mouth (and
most likely smelly breath – mouth breathers also have a
higher level of gum disease and teeth cavities than nasal
breathers!). Your mouth should be naturally moist when you
wake up in the morning; nasal breathing ensures this.
If you have a tendency to mouth-breathe during the night it is
important to change to nasal breathing. Two options include
wearing LipSealTape across the lips and using the product
Sleepq+. When you breathe through your nose, you will
experience a better night‟s sleep and feel more refreshed when
you awake in the morning. Taping the mouth at night or
wearing SleepQ+ initially may seem like a scary prospect but
90
these techniques have been used to great success in Buteyko
Breathing clinics around the world and do not take long to
acclimatize to.

Gravity also plays a role in both snoring and sleep apnea.

When you lie on your back, there is no restriction to your
breathing, and therefore breathing volume grows larger,
leading to a greater severity in snoring. Sleeping on your back
also encourages the mouth to open, and as the lower jaw
hinges downwards it impedes on the upper airway, reducing
airway diameter. Nasal resistance also increases while lying
on your back as a consequence of increased mucosal
congestion.1
During an assessment of 2,077 OSA patients over a period of
ten years, it was found that 53.8% had at least twice as many
breathing abnormalities while sleeping in the supine (back)
position compared with sleeping on their side.2

91
Dr Buteyko discovered that the best position for sleep was on
the left-hand side or on the tummy. Sleeping on your left side
reduces breathing volume due to the position of the heart,
while lying on your stomach restricts breathing due to the
weight of the body. Sleeping on the left-hand side also
reduces heartburn. A study published in the American Journal
of Clinical Gastroenterology discovered that subjects
experienced significantly greater periods of reflux when lying
on their right-hand side.3
To help improve your sleep, it‟s also important to avoid eating
large meals or drinking alcohol late at night. Although alcohol
may send you off to sleep quicker, it results in poor quality
sleep and waking in the middle of the night. Eating too late at
night creates similar problems as the body spends

92
considerable energy digesting food while in a state of semi-
relaxation.
Another vital guideline for promoting better sleep is to reserve
the bedroom for sleeping, relaxation and sex. Your bedroom
should not be a place to watch television, work on the laptop
or browse the internet on your mobile phone. In fact, having
as little technology as possible in the bedroom will help to
ensure a good night‟s sleep. I have attended a number of sleep
conferences where technology is increasingly implicated in
contributing to poor sleep. According to Phyllis Zee,
Professor of Neuroscience at Northwestern University, the
light emitted from a laptop, tablet or mobile phone stimulates
the brain, delaying your ability to fall asleep.4
We are wired to be awake during daylight and go to sleep
when it gets dark. The nightly ritual to read an old fashioned
book before falling asleep has now been replaced by staring at
back-lit tablets and phones. When our eyes are exposed to
bright light, the brain stops secreting the relaxation hormone
melatonin which is responsible for creating feelings of
sleepiness. According to Harvard Health Letter, it is advisable
to refrain from using a laptop or electronic device for three
hours before sleep.5
Your bedroom should also be kept at a cool temperature. A
bedroom that is too warm and stuffy will make you breathe
heavier. Ideally, leave the bedroom window slightly open to
allow a circulation of fresh air. This will help keep your
breathing calm.

93
96
 SIMPLE
BREATHING BASICS

97
 KNOW HOW OXYGEN IS RELEASED TO
PROVIDE ENERGY

F or normal, healthy functioning, the body requires a

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

98
levels are less than adequate, the transfer of oxygen from
blood to muscles and organs is limited, leading to poor body
oxygenation.
This necessary presence of carbon dioxide was discovered in
1904 by the physiologist and Nobel laureate Christian Bohr,
who recognized that CO2 affects the release of oxygen from
the blood to tissues and organs.

99
According to the Bohr Effect, when there is an increased
pressure of carbon dioxide in the blood, pH drops and oxygen
is released more readily. Conversely, when carbon dioxide
levels are low, hemoglobin molecules are less able to release
oxygen from the blood. The way we breathe determines the
amount of carbon dioxide present in our blood, and therefore
how well our bodies are oxygenated.
Another function of carbon dioxide is that it relaxes the
smooth muscle embedded in airways, arteries and capillaries,
enabling smooth breathing and healthy blood flow. For those
genetically predisposed to asthma, the loss of CO2 caused by
over-breathing leads to constriction of the airways. By
breathing calmly and quietly, you will retain healthy levels of
carbon dioxide and your blood vessels and airways will
remain open and clear.
Carbon dioxide has profound effects on blood flow. An
increase of carbon dioxide causes an opening of the blood
vessels and increased blood flow, whereas a decrease to
carbon dioxide causes constriction of the blood vessels and
decreased blood flow.
Constriction of the blood vessels in response to breathing too
much air can reduce the amount of oxygen available to the
brain by 50%.1 For example, in humans 5% inhalation of
carbon dioxide increases blood flow supplying the brain by
50% and 7% inhalation of carbon dioxide causes a 100%
increase in blood flow.1 It is no coincidence that symptoms
like fatigue, anxiety and poor concentration are so common
nowadays, even amongst athletes – chronic over-breathing
contributes to all these issues.

100
So how do we ensure that we take in enough carbon dioxide?
The solution is clearly not to breathe more! We cannot inhale
carbon dioxide from the atmosphere; it is a by-product of
metabolic chemical reactions within the body. And while it is
true that carbon dioxide can be classed as a waste gas, we
only exhale CO2 to get rid of the excess – it is vital that a
101
certain amount of carbon dioxide is retained in the blood for
healthy body function.
Breathing too much can very easily become a habit. Modern
living, poor diet, stress, and a lack of exercise all contribute to
resetting the breathing center in the brain so that it becomes
less tolerant to carbon dioxide. With a low tolerance to carbon
dioxide, breathing volume will continue to be larger than
normal. Chronic over-breathing also results in the constriction
of blood vessels and a reduction in the amount of oxygen
delivered to the cells, leading to excessive breathlessness and
poor exercise tolerance.
Carbon dioxide is produced through the body‟s metabolism –
when oxygen meets with the food we eat to create energy,
carbon dioxide is generated. There are only two ways to
increase the amount of carbon dioxide in the body:
 By practicing breathing exercises to gently reduce the
amount of air we breathe
 By increasing metabolic activity through physical
exercise

While exercise is beneficial, it is vitally important not to

breathe too much during physical activity, otherwise your
efforts will be counterproductive. Practicing the Reduced
Breathing exercise (page 64) will also increase the body‟s
tolerance to carbon dioxide, and should be reflected in a
steady improvement to your Control Pause from week to
week.
By taking less air into the lungs during rest or physical
exercise, carbon dioxide is able to accumulate in the blood.
102
After just ten minutes, the part of the brain that regulates
breathing volume can be reset to tolerate a greater amount of
carbon dioxide. By reducing breathing volume towards
normal, blood vessels and airways dilate, and oxygen is more
readily released from the red blood cells. Each time you
practice Reduced Breathing exercises and reset your breathing
volume, you are one step closer to a permanent change to
optimal breathing patterns.

103
 NITRIC OXIDE: A MOST IMPORTANT
MOLECULE

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

the gases nitric oxide and carbon dioxide, both of which
play a role in opening the blood vessels. Christian Bohr
demonstrated the importance of carbon dioxide in blood
oxygenation back in 1904, but it was not until the 1980s that
the incredible benefits of nitric oxide (NO) were fully
understood. Until then, nitric oxide was considered a toxic
gas, responsible for the environmental pollution and smog
found in overpopulated cities. In 1995 it was discovered that
nitric oxide production takes place in the paranasal sinuses, a
group of four air-filled spaces surrounding the nasal cavity.
As we breathe in through the nose, large amounts of NO are
released within the nasal airways.1 Nitric oxide then follows
airflow to the lungs where it serves a number of very
important roles including opening of the airways and
increasing oxygen uptake in the blood.2
Ventilation perfusion describes the ratio of the amount of air
to the amount of blood reaching the small air sacs in the lungs
per minute. In a perfect situation, the oxygen provided from
breathing would be just enough to saturate the blood fully
with oxygen.
Two factors which negatively influence ventilation perfusion
are breathing through the mouth and gravity. This can lead to
a situation where the higher parts of the lungs receive more
ventilation, and the lower parts greater amounts of blood.
Nitric oxide produced in the nasal cavity helps with a more
efficient matching of blood flow to ventilation. With each
104
breath drawn through the nose, nitric oxide is carried into the
lungs where it helps to counteract the effects of gravity on
blood flow in the lungs by redistributing the blood more
equally throughout the lungs.3

105
APPENDIX

106
 CPAP THERAPY

T he normal treatment for obstructive sleep apnea is a

CPAP (continuous positive airway pressure) machine.
The patient wears a mask over the face and air is applied at a
pressure that exceeds the airway opening pressure, thereby
enabling the patient to breathe without cessation. In simple
terms, it may be best understood as a small vacuum cleaner
working in reverse, applying sufficient air pressure to force
the airways open.
The CPAP machine can resolve apnea for many sufferers,
leading to improved sleep quality, decreased sleepiness, and
lower blood pressure.1-4
However, the machine only helps the patient as long as they
continue to use it. On the downside, it does nothing to address
the major contributory factor of sleep apnea, namely chronic
over-breathing. Wearing a mask during sleep can be
claustrophobic, uncomfortable, cumbersome, inconvenient,
and irritating. The air produced by the machine is dry, which
may cause rhinitis, a dripping nose, a blocked nose, and nasal
irritation. Even when the mask is worn correctly, the feeling
of the airflow is sometimes described as putting one‟s head
out of a car window while the car is moving at thirty miles per
hour. Patients and their partners often find the humming of the
machine very distracting. In addition, the machine has to be
cleaned on a regular basis, but not all patients do this
according to guidelines.
Overall, while it is accepted as the gold standard of treatment,
the CPAP machine also has major shortcomings:

107
During one study of 300 patients referred to the London Chest
Ventilatory Support Unit, it was found that 96% of patients
complained of at least one side effect resulting from the
CPAP therapy, while 45% complained of a side effect from
the nasal mask.5
In a study of 80 patients, researchers found that the most
prevalent side effects were disturbance of the mask during the
night (71.3%), dry mouth (47.5%), dry nose (46.3%), pressure
marks from the mask (41.3%), crusts within the nasal cavity
(38.8%), and hearing loss (26.3%). Mouth and nose dryness
were considered the most irritating side effects.6
A CPAP mask can also act as orthodontic headgear and
gradually move the teeth and the upper and/or lower jaw
backward. Unfortunately, reducing the width of the upper
airway in this way will only increase the risk of apneas. This
effect can increase over time and may or may not cause
temporomandibular joint (TMJ) disorders in some patients.
These facial changes have been dubbed „Smashed Face
Syndrome‟.7
A paper published in The Canadian Respiratory Journal
observed that “compliance is a significant problem and has
been incompletely assessed in long-term studies.” After
evaluating 80 patients to determine long-term compliance
with CPAP, the authors concluded that “although many
patients with OSA derive subjective benefit from, and adhere
to treatment with CPAP, a significant proportion of those so
diagnosed either do not initiate or eventually abandon
therapy.”8
The journal Sleep found that only 40% of 162 newly-
diagnosed patients who required CPAP therapy accepted the
108
treatment. The paper noted that compliance was higher in the
higher socioeconomic groups than the lower.9 Other
researchers found that “failure to comply with treatment has
been reported to be as high as 25 to 50%, with patients
typically abandoning therapy during the first 2 to 4 weeks of
treatment.”10
According to Broström et al., “Adherence to CPAP treatment
is a multifaceted problem including patient, treatment,
condition, social, and healthcare related factors. Knowledge
about facilitators and barriers for adherence to CPAP
treatment can be used in interventional strategies.”11

109
 RHINITIS, SNORING AND SLEEP
APNEA IN ADULTS

R hinitis is an extremely common health problem affecting

up to 40 million people in the United States and between
10-25% of the world‟s population1 with prevalence
varying within and among countries.2,3,4,5
Typical symptoms of rhinitis include nasal congestion, a
runny and itchy nose, and sneezing. The eyes, ears, sinuses,
and throat can also be affected. Rhinitis can either be
seasonal, occurring during certain times of the year, for
example after exposure to a trigger such as pollen, or
perennial, in which case it is characterized by symptoms that
last for an hour or more on most days throughout the year.
Breathing through a stuffy or runny nose can be
uncomfortable, and often encourages the individual to switch
to breathing through the mouth.
The effect of rhinitis on quality of sleep is well documented in
the medical literature, as indicated in a number of studies
below:
Researchers Ohki and colleagues performed a study to
determine the relationship between oral breathing and nasal
obstruction in patients with obstructive sleep apnea. The study
involved 30 control subjects and 20 patients with snoring or
sleep apnea. Researchers found that chronic nasal obstruction
and resultant mouth breathing may induce obstructive sleep
apnea.6
Lunn et al. note that “nasal congestion is associated with
sleep-disordered breathing and is thought to be a key cause of
sleep impairment in rhinitis. The end result is decrease in

110
quality of life and productivity and increased daytime
sleepiness.”7
One study, which involved 52 patients, concluded that “open-
mouth breathing during sleep is a risk factor for obstructive
sleep apnea (OSA) and is associated with increased disease
severity and upper airway collapsibility. […] The more
elongated and narrow upper airway during open-mouth
breathing may aggravate the collapsibility of the upper airway
and, thus, negatively affect OSA severity.”8
In a paper entitled, „How does open-mouth breathing
influence upper airway anatomy?‟, Lee et al. tested the
hypothesis that open-mouth breathing during sleep may
increase the severity of obstructive sleep apnea. After an
analysis of 28 patients, researchers concluded that “open-
mouth breathing is associated with reduction of the
retropalatal and retroglossal areas, lengthening of the pharynx
and shortening of the MP-H in the upper airway.”9
After reviewing texts and articles on Medline, the Center for
Research Disorders in Cincinnati, Ohio concluded that
obstructive sleep apnea, sleep fragmentation, and disturbed
sleep often result from nasal obstruction. The authors of the
paper observed that “since breathing through the nose appears
to be the preferred route during sleep, nasal obstruction
frequently leads to nocturnal mouth breathing, snoring, and
ultimately to OSA.”10 The paper advised that allergic rhinitis
and other upper respiratory disorders should be treated more
aggressively.
Considering the evidence, there is no doubt that mouth
breathing is a significant causal factor for sleep disordered
breathing including obstructive sleep apnea.

111
 RHINITIS, SLEEP DISORDERS
AND ADHD IN CHILDREN

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

I mental complications‟, researchers noted that allergic
rhinitis has a far more negative impact on the health of the
child than just a runny nose.1 “There are numerous
complications that can lead to significant problems both
physically and mentally in the child who suffers with allergic
rhinitis. Under physical complications, recurrent and/or
chronic sinusitis, asthma, and snoring, impact children with
allergic rhinitis. Sleep disturbances, poor school performance,
and hyperactivity are all mental complications seen in many
children related to their nasal allergies.”
A Polish study noted that children with sleep respiratory
disorders wake up tired, with blocked noses, breathe through
their mouth, tire easily, have concentration problems, are
irritated, and demonstrate hyperactivity that may resemble
ADHD symptoms.2 The paper further states that “long-term
disease leads to exacerbation of all-systemic symptoms,
results in cardiovascular complications, induces
developmental inhibition and cognitive dysfunction, and is
responsible for school/social failures and reduced life
quality.” 2
In a paper entitled, „A practical approach to allergic rhinitis
and sleep disturbance management‟, Davies et al. comment
that “sleep quality can be significantly impacted by nasal
congestion. This may lead to decreased learning ability,
productivity at work or school, and a reduced quality of life.”3
A further study found similar conclusions, stating that allergic
rhinitis “can lead to impaired nocturnal sleep, and this
112
impairment results in daytime fatigue and somnolence,
reducing both learning and work efficiency and decreasing
quality of life.”4
Data from 248 medical charts of mouth-breathing children
were analyzed to determine the prevalence of obstructive
sleep disorders. It was found that 58% of children were
primary snorers and 42% had obstructive sleep apnea. The
paper concluded that, “primary snoring and OSA are frequent
findings in mouth breathing children.”5
In a paper entitled, „The nose and sleep disordered breathing:
what we know and what we don‟t know‟, researchers
performed an analysis of medical literature on the subject.6
The analysis confirmed that “SDB (sleep disordered
breathing) can both result from and be worsened by nasal
obstruction.” It was stated that “nasal congestion typically
results in a switch to oronasal breathing that compromises the
airway.” Furthermore, “oral (mouth) breathing in children
may lead to the development of facial structural abnormalities
associated with SDB.” The paper concluded that the change to
mouth breathing that occurs due to chronic nasal obstruction
is a common pathway for sleep-disordered breathing.
Treatment of children with ADHD and problem behavior
commonly involves medication or stimulants. An important
question to ask, considering the evidence above, is whether
this approach is necessary given the potential benefits from
addressing allergic rhinitis and improving the quality of sleep.
For example, researchers found that 28.1% of Singaporean
children snored and 6% habitually snored.7 “Atopy such as
asthma, rhinitis, and eczema was the strongest risk factor for
habitual snoring in Singapore, and the effect was cumulative.”
The paper also noted that “children attending psychiatric

113
services in Singapore may also have sleep disorders, the
highest prevalence being in children with attention deficit
hyperactivity disorder.”7
Authors of the paper entitled, „Attention deficit hyperactivity
disorder and sleep disorder‟, also note that “there is a clear
correlation between ADHD and sleep disorders” and that “by
improving these children‟s sleep, the symptoms of ADHD are
diminished and thus avoid the need to administer
psychostimulants, which have undesirable side effects that
produce a great deal of anxiety in the parents of these
children.”8
And finally, in a paper published in the journal Paediatrics,
researchers concluded that “inattention and hyperactivity
among general pediatric patients are associated with increased
daytime sleepiness and – especially in young boys – snoring
and other symptoms of SDB. If sleepiness and SDB do
influence daytime behavior, the current results suggest a
major public health impact.”9 “Children undergoing
evaluation for ADHD should be systematically assessed for
sleep disturbances because treatment of sleep disorders is
often associated with improved symptomatology and
decreased need for stimulants.”10
Bearing the documented evidence in mind, having a good
night‟s sleep is imperative to the health of every child and
adult. Treating rhinitis is an absolute must in this regard:
“Health professionals and school personnel need to increase
their awareness of the ramifications of this disease and
actively work to prevent deterioration in both academic
achievement and workplace productivity.”11

114
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INTRODUCTION
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1. McArdle William, Katch Frank L, Katch Victor L. Pulmonary
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MOUTH BREATHING DURING CHILDHOOD

INCREASES THE RISK OF LIFELONG
OBSTRUCTIVE SLEEP APNEA
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HOW TO MEASURE YOUR RELATIVE BREATHING

VOLUME
1. Varsha Taskar, Nigel Clayton, Mark Atkins, Zubair Shaheen,
Patricia Stone, Ashley Woodcock, Breath-holding Time in
Normal Subjects, Snorers, and Sleep Apnea Patients. Chest
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THE FIRST TENET: BREATHE THROUGH YOUR
NOSE DAY AND NIGHT
1. Timmons B.H., Ley R. Behavioral and Psychological Approaches
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oral compared to nasal expiration in healthy subjects. Rhinology.
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Nasal flow-resistive responses to challenge with cold dry air. J
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HOW TO UNBLOCK YOUR NOSE

1. Adelola O.A., Oosthuiven J.C., Fenton J.E. Role of Buteyko
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Otolaryngology.2013, April;38(2):190-191

THE SECOND TENET: CORRECT POSTURE

1. Sánchez Crespo A, Hallberg J, O. Lundberg J, Lindahl S,
Jacobsson H, Weitzberg E, Nyrén S. Nasal nitric oxide and
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REVERSING INSOMNIA
1. Laboratory of Neuro Imaging. 2015. Brain Traivia. [online]
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APPLYING THE BUTEYKO METHOD FOR SLEEP

DISORDERS
1. Oksenberg A1, Arons E, Greenberg-Dotan S, Nasser K, Radwan
H. [The significance of body posture on breathing abnormalities
during sleep: data analysis of 2077 obstructive sleep apnea
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351, 350.
2. Duggan CJ, Watson RA, Pride NB. Postural changes in nasal and
pulmonary resistance in subjects with asthma. J Asthma 2004; 41:
701–707.
3. Khoury RM1, Camacho-Lobato L, Katz PO, Mohiuddin MA,
Castell DO. Influence of spontaneous sleep positions on
nighttime recumbent reflux in patients with gastroesophageal
reflux disease. Am J Gastroenterol. 1999 Aug;94(8):2069-73.
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5. Harvard Health Letter. Blue Light has a dark side. [Online]
Available:
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KNOW HOW OXYGEN IS RELEASED TO PROVIDE
ENERGY
1. Kety SS, Schmidt CF. The effects of altered arterial tensions of
carbon dioxide and oxygen on cerebral blood flow and cerebral
oxygen consumption of normal young men. J Clin Invest. 1948;
27: pp. 484–492

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NITRIC OXIDE: A MOST IMPORTANT MOLECULE
1. According to Jon Lundberg, professor of Nitric Oxide
Pharmacologics at the world famous Karolinska institute in
Sweden, large amounts of NO are constantly released in the nasal
airways of humans. As we breathe in through the nose, NO will
follow the airflow to the lungs where it plays a role in increasing
the amount of oxygen uptake in the blood. Lundberg J, Weitzberg
B. Nasal nitric oxide in man Thorax 1999;54:947-952.
2. Lundberg J. Nitric oxide and the paranasal sinuses. Anat Rec
(Hoboken). 2008 Nov;291(11):1479-84.
3. Sánchez Crespo A, Hallberg J, O. Lundberg J, Lindahl S,
Jacobsson H, Weitzberg E, Nyrén S. Nasal nitric oxide and
regulation of human pulmonary blood flow in the upright
position. J Appl Physiol 108: 181–188, 2010.

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APPENDIX
CPAP THERAPY
1. Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, et al.
Ambulatory blood pressure after therapeutic and subtherapeutic
nasal continuous positive airway pressure for obstructive sleep
apnea: a randomised parallel trial. Lancet. 2002;359:204-10.
2. Hack M, Davies RJ, Mullins R, et al. Randomised prospective
parallel trial of therapeutic versus subtherapeutic nasal
continuous positive airway pressure on simulated steering
performance in patients with obstructive sleep apnea. Thorax.
2000;55:224-31.
3. Norman D, Loredo JS, Nelesen RA, et al. Effects of continuous
positive airway pressure versus supplemental oxygen on 24-hour
ambulatory blood pressure. Hypertension. 2006;47:840-5.
4. Shivalkar B, Van de Heyning C, Kerremans M, et al. Obstructive
sleep apnea syndrome: more insights on structural and functional
cardiac alterations, and the effects of treatment with continuous
positive airway pressure. J Am Coll Cardiol. 2006;47:1433-9.
5. Kalan A, Kenyon GS, Seemungal TA, Wedzicha JA. Adverse
effects of nasal continuous positive airway pressure therapy in
sleep apnea syndrome. J Laryngol Otol. 1999 Oct;113(10):888-
92.
6. Verse T, Lehnhardt E, Pirsig W, Junge-Hülsing B, Kroker B.
[What are the side-effects of nocturnal continuous positive
pressure ventilation (nCPAP) in patients with sleep apnea for the
head-neck region?].[Article in German] Laryngorhinootologie.
1999 Sep;78(9):491-6.
7. Tsuda H, Almeida FR, Tsuda T, Moritsuchi Y, Lowe AA (Oct
2010). "Craniofacial changes after 2 years of nasal continuous
positive airway pressure use in patients with obstructive sleep
apnoea". Chest 138 (4): 870–4.
8. Wolkove N, Baltzan M, Kamel H, Dabrusin R, Palayew M.
Long-term compliance with continuous positive airway pressure

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 in patients with obstructive sleep apnea Can Respir J. 2008
Oct;15(7):365-9.
9. Simon-Tuval T, Reuveni H, Greenberg-Dotan S, Oksenberg A,
Tal A, Tarasiuk A. Low socioeconomic status is a risk factor for
CPAP acceptance among adult OSAS patients requiring
treatment. Sleep. 2009 Apr 1;32(4):545-52.
10. Zozula R, Rosen R Compliance with continuous positive airway
pressure therapy: assessing and improving treatment outcomes.
Curr Opin Pulm Med. 2001 Nov;7(6):391-8.
11. Broström A, Nilsen P, Johansson P, Ulander M, Strömberg A,
Svanborg E, Fridlund B Putative facilitators and barriers for
adherence to CPAP treatment in patients with obstructive sleep
apnea syndrome: a qualitative content analysis. Sleep Med. 2010
Feb;11(2):126-30. Epub 2009 Dec 9.

RHINITIS, SNORING AND SLEEP APNEA IN ADULTS

1. Storms W, Allergic rhinitis-induced nasal congestion: its impact
on sleep quality.Prim Care Respir J. 2008 Mar;17(1):7-18.
2. Sly RM. Changing prevalence of allergic rhinitis and asthma.
Ann Allergy Asthma Immunol. Mar 1999;82(3):233-48; quiz
248-52.
3. Von Mutius E, Weiland SK, Fritzsch C, et al. Increasing
prevalence of hay fever and atopy among children in Leipzig,
East Germany. Lancet. 1998;351:862.
4. Romano-Zelekha O, Graif Y, Garty BZ, Livne I, Green MS,
Shohat T. Trends in the prevalence of asthma symptoms and
allergic diseases in Israeli adolescents: results from a national
survey 2003 and comparison with 1997. J Asthma. Jun
2007;44(5):365-9.
5. Lima RG, Pastorino AC, Casagrande RR, et al. Prevalence of
asthma, rhinitis and eczema in 6 - 7 years old students from the
western districts of Sao Paulo City, using the standardized
questionnaire of the "International Study of Asthma and Allergies
126
 in Childhood" (ISAAC)-phase IIIB. Clinics. 2007;62:225.
6. Ohki M, Usui N, Kanazawa H, Hara I, Kawano K.Relationship
between oral breathing and nasal obstruction in patients with
obstructive sleep apnea. Acta Otolaryngol Suppl. 1996;523:228-
30.
7. Lunn M, Craig T. Rhinitis and sleep. Sleep Med Rev. 2011 Feb
10.
8. Kim EJ, Choi JH, Kim KW, Kim TH, Lee SH, Lee HM, Shin C,
Lee KY, Lee SH. 1. The impacts of open-mouth breathing on
upper airway space in obstructive sleep apnea: 3-D MDCT
analysis. Eur Arch Otorhinolaryngol. 2010 Oct 19.
9. Lee SH, Choi JH, Shin C, Lee HM, Kwon SY, Lee SH. How
does open-mouth breathing influence upper airway anatomy?
Laryngoscope. 2007 Jun;117(6):1102-6.
10. Scharf MB, Cohen AP Diagnostic and treatment implications of
nasal obstruction in snoring and obstructive sleep apnea. Ann
Allergy Asthma Immunol. 1998 Oct;81(4):279-87; quiz 287-90.

RHINITIS, SLEEP DISORDERS AND ADHD IN

CHILDREN
1. Blaiss MS. Pediatric allergic rhinitis: physical and mental
complications. Rev Prat. 1996 Apr 15;46(8):975-9.
2. Wasilewska J, Kaczmarski M Obstructive sleep apnea-hypopnea
syndrome in children [Article in Polish] Wiad Lek.
2010;63(3):201-12.
3. Davies MJ, Fisher LH, Chegini S, Craig TJ. A practical approach
to allergic rhinitis and sleep disturbance management. Allergy
Asthma Proc. 2006 May-Jun;27(3):224-30.
4. Ferguson BJ. Influences of allergic rhinitis on sleep. Otolaryngol
Head Neck Surg. 2004 May;130(5):617-29
5. Izu SC, Itamoto CH, Pradella-Hallinan M, Pizarro GU, Tufik S,

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 Pignatari S, Fujita RR. Obstructive sleep apnea syndrome
(OSAS) in mouth breathing children.[Article in English,
Portuguese] Braz J Otorhinolaryngol. 2010 Oct;76(5):552-6.
6. Rappai M, Collop N, Kemp S, deShazo R.The nose and sleep-
disordered breathing: what we know and what we do not know.
Chest. 2003 Dec;124(6):2309-23.
7. Chng SY. Sleep disorders in children: the Singapore perspective.
Ann Acad Med Singapore. 2008 Aug;37(8):706-9.
8. Betancourt-Fursow de Jiménez YM, Jiménez-León JC, Jiménez-
Betancourt CS. [Attention deficit hyperactivity disorder and sleep
disorders].[Article in Spanish] Rev Neurol. 2006 Feb 13;42 Suppl
2:S37-51.
9. Chervin RD, Archbold KH, Dillon JE, Panahi P, Pituch KJ, Dahl
RE, Guilleminault C. Inattention, hyperactivity, and symptoms of
sleep-disordered breathing. Pediatrics. 2002 Mar;109(3):449-56.
10. Domínguez-Ortega L, de Vicente-Colomina A [Attention deficit-
hyperactivity disorder and sleep disorders].[Article in Spanish]
Med Clin (Barc). 2006 Apr 8;126(13):500-6.
11. Borres MP. Allergic rhinitis: more than just a stuffy nose. Acta
Paediatr. 2009 Jul;98(7):1088-92. Epub 2009 Apr 17.

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 BUTEYKO BOOKS, DVDS AND ONLINE SELF
HELP COURSES

Buteyko for High Blood Pressure, Fatigue, Insomnia, Chronic

Hyperventilation, Snoring, and Sleep Apnea by Patrick
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Buteyko Mindfulness Method DVD set for ADHD, Stress,
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The Oxygen Advantage online Digital Program by Patrick
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Buteyko DVD set for Children and Teenagers by Patrick
McKeown
Complete Instruction in Buteyko Clinic Method for
Healthcare Professionals by Patrick McKeown

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 PERSONAL COACHING

I f you have faithfully followed the recommendations

included in this book and used the excellent resources but
are still having difficulties achieving the desired results you
may want to consider hiring a professional breathing coach.
Carol Baglia is a qualified and experienced Buteyko Educator
and Trainer in addition to being a Registered Respiratory
Therapist. She is based in the USA and since 2003 has been
passionate about helping others to breathe easier. Carol uses
online webcam services to privately instruct how to restore
normal healthy breathing. She also teaches breathing
retraining workshops in several locations and will travel to
assist clients. She operates Correct Breathing Concepts, see
www.correctbreathing.com or contact her by Email at:
carol@correctbreathing.com or phone: 216-952-7048

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 Visit our Websites:
www.ButeykoClinic.com
www.ButeykoDVD.com
www.OxygenAdvantage.com
www.ButeykoChildren.com
www.Snoring.ie

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