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Since the onset of the pandemic, many people have genuinely struggled with the requirement to wear a protective face mask — simply because they find it hard to breathe.
While those with genuine difficulties are exempt in many countries, nobody is talking about how we breathe inside the mask, or what can be done to make it easier. This is despite research that clearly identifies breathing through an open mouth as a contributing factor in high viral load, poor immune defense, and more severe forms of COVID.
In July 2020, when mask-wearing in public places had just been enforced in the UK, a medical doctor friend sent me an email.
He told me: “I went to the barber on Sunday. The barber had a mask on. All I could hear was fast breathing through the mouth while he wore the mask.”
My friend said that for several months, he had tried to convince more people to breathe through the nose, with or without a mask.
He discovered that people were often surprised to be asked how they breathe inside their mask. Many had never given it any attention.
More than 90% said they needed to breathe through an open mouth, because they couldn’t breathe nasally with the mask on.
The first thing to understand is that you don’t feel breathless in the mask because you are short of oxygen.
Yes, the mask naturally adds resistance to breathing.
However, the main reason you feel more breathless is to do with blood gases. It is because you are re-breathing exhaled air, which has a higher concentration of carbon dioxide.
You may remember from school science lessons that humans breathe in oxygen and breathe out carbon dioxide (CO2).
This is an oversimplification. Inhaled air contains around 21% oxygen, 79% nitrogen and 0.04% CO2.
When we breathe in, our lungs diffuse oxygen into the blood, where it is carried around the body in the hemoglobin in red blood cells. The air we exhale contains around 16% oxygen and 4% CO2.
CO2 performs a vital role in the oxygenation of the cells and organs. It is not just a waste gas.
In fact, it is the catalyst that causes hemoglobin to release its load of oxygen to the body.
It is CO2, not oxygen, that triggers the body to breathe. As levels of the gas increase in the blood, the respiratory centers in the brain signal to the body to breathe more.
All of which means that breathlessness is indicative of higher levels of CO2, or heightened sensitivity to CO2 (or both), not oxygen starvation.
The importance of breathing only through the nose, awake or asleep, with or without a face mask, cannot be stressed enough.
As my medical doctor friend explained: “When we mouth breathe, any virus has a direct route to our lungs. Masks plus nasal breathing will help keep the virus from entering the patient’s respiratory system.”
For many people, a basic awareness of what makes them breathless is reassuring. To know that they aren’t suffocating — they are simply re-breathing a perfectly safe concentration of carbon dioxide, which is increasing levels of CO2 in the blood and triggering the ventilatory drive.
If you find it hard to breathe in a mask, but want (or need) to wear one, there are a few things you can do to get more comfortable.
1. Make the switch to full-time nose breathing. This will help moderate your sensitivity to CO2, acclimatize you to the feeling of air hunger, and go some way to normalizing your breathing volume.
2. If you start to feel breathless and panicked while out and about, just slow down until your breathing is under control.
3. Practice slow, light breathing at six breaths a minute. Inhaling for four seconds and exhaling for six optimizes many important physiological functions, as well as activating the body’s relaxation response.
4. Practice many small breath-holds to condition your body to cope better with fluctuations in blood CO2.
Take a normal breath in and out through your nose, pinch your nose to hold your breath, and hold after the exhalation for two to five seconds, depending on your general level of breathlessness.
Let go of your nose and breathe normally through it for 10 to 15 seconds. Repeat this for a few minutes, many times a day. This exercise is also ideal for stopping a panic attack in its tracks.
Patrick McKeown is an internationally renowned breathing coach, author and speaker. He is creator of Oxygen Advantage®, founder of Buteyko Clinic International and a fellow of the Royal Society of Biology in the UK. Published works include research in the Journal of Clinical Medicine, and books including The Breathing Cure.
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