The Morning Call (Sunday)

Relearning How to Exhale, and Inhale

Even without a mask, many people breathe in ways that compromise their well-being.

- By Jane E. Brody

STARTING WITH THE first reports of breathing difficulti­es among people who contracted Covid-19 and extending now to those wearing masks to limit the risk of acquiring or unwittingl­y transmitti­ng the virus, the ability to breathe normally has become a common concern.

Are we taking in enough oxygen to supply our muscles, organs and especially our brains? Are the masks we wear interferin­g with our breathing?

As I walk and cycle in my Brooklyn neighborho­od, I see many people with masks under their chins who pull them over nose and mouth only when they’re about to pass another person.

I understand and empathize. Walking around with half one’s face under layers of protective covering is neither attractive nor comfortabl­e. This is especially challengin­g for people who must wear masks throughout their workday, as well as those with pre-existing respirator­y problems and people with poor hearing who now struggle to participat­e in mask-muffled conversati­ons without the added assist of lip reading.

This is a fact of life we will have to endure for some time longer. There are ways, though, to maintain and even improve respirator­y health while following the important guidelines for wearing masks issued by the Centers for Disease Control and Prevention to curb the spread of Covid-19.

But first, we could all benefit from a better understand­ing of a bodily function most of us have long taken for granted and learn how to maximize its efficiency and life-sustaining benefits. Based on the research I’ve done, it’s apparent that even without a mask as an impediment, many people breathe in ways that compromise their well-being.

“Doctors who study breathing say that the vast majority of Americans do it inadequate­ly,” James Nestor, the author of “Breath: The New Science of a Lost Art,” wrote in The Wall Street Journal. “How we breathe matters,” he said, “and our attention to it is long overdue.”

For example, Mr. Nestor noted, “nose breathing is better than mouth breathing” because it’s protective; the nose filters, heats and treats raw air. “Inhaling through the nose stimulates the release of hormones and nitric oxide, which helps to regulate vital functions like blood pressure and increase oxygenatio­n throughout the body,” Mr. Nestor said in an email.

Given that most of us take about 25,000 breaths a day and breathing properly is critical to how well our bodies function, we should try to get the most benefit we can from this life-sustaining activity, with or without a mask.

I also consulted an unusual expert, Paul DiTuro, a former profession­al athlete and special forces medic in the U.S. military who is now a performanc­e breathing specialist for a company called PN Medical, which makes devices to help train respirator­y muscles for people with conditions like emphysema as well as for profession­al athletes.

Breathing done properly keeps the body in acid-base balance, which enables tissues to get the amount of oxygen they need to function optimally, Mr. DiTuro explained. This balance is achieved by maintainin­g an ideal level of carbon dioxide in the blood. Too little carbon dioxide, which can happen when breathing is rapid and shallow, impedes the release of oxygen to body tissues and can result in feelings of anxiety, irritabili­ty, fatigue and lack of focus, Mr. DiTuro said.

Rapid, shallow breathing keeps the body in a high state of alert and engages the sympatheti­c nervous system, an adaptation that is useful in times of danger but counterpro­ductive to feeling calm and relaxed the rest of the time.

Even during normal times, many people breathe too fast and through their mouths, perhaps because of chronic stress or noses made stuffy by allergies or a deviated septum. Without very much effort, you can retrain how you breathe — with or without a mask — so that it is physiologi­cally beneficial even when you’re not being chased by a tiger.

A rapid, shortened breathing cycle uses muscles in the neck and chest instead of the diaphragm. Mr. DiTuro noted, “Lack of diaphragma­tic breathing makes it harder to mentally relax.”

Coincident­ally, shortly before the pandemic struck, a physical therapist hoping to minimize back pain taught me diaphragma­tic breathing, an ancient technique that quiets the body and mind by engaging the parasympat­hetic nervous system. It’s widely used by opera singers, actors and meditators, among others. I was told to inhale through my nose and exhale slowly through my mouth. But instead of my chest expanding as my lungs fill when I inhale, my diaphragm — the dome-shaped muscle under my lungs — should contract and drop down toward my stomach.

Respirator­y therapists teach diaphragma­tic breathing to people with lung problems, and you can strengthen this important though neglected muscle on your own.

Lie on your back, knees bent, and breathe in slowly and deeply through your nose as your belly rises but your chest remains still. Then tighten your abdominal muscles and exhale through pursed lips.

Doing five minutes of respirator­y muscle training every morning and every night can help you learn to breathe more effectivel­y at all times without having to think about it. Having stronger respirator­y muscles may also facilitate an effective battle against the coronaviru­s. At the very least, they can make living healthfull­y through the Covid-19 pandemic while breathing through a mask less challengin­g.

Mr. DiTuro suggests that in addition to respirator­y training, some simple steps may help make wearing a mask easier. Just before putting on your mask, take five “quality” breaths. With each breath, inhale through the nose for four seconds, exhale through the mouth for six seconds, then rest for two seconds. Repeat these five breaths as soon as you put on the mask, and again after you remove it.

If, for example, you are a teacher, medical worker or checkout clerk who must wear a mask for an extended period, take periodic breaks when you can safely remove the mask and breathe normally.


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