James Nestor never intended to become a breathing expert. The science journalist stumbled into the field after attending a breathing class to address chronic respiratory problems suck as pneumonia, bronchitis, wheezing, and snoring.
What happened next changed the trajectory of his career: within 15-20 minutes of alternating slow and fast breathing, his entire body was drenched in sweat, an experience so profound that he couldn’t dismiss it.
Years later, while covering the World Freediving Championship, Nestor watched athlete William Trubridge dive 330 feet on a single breath and disappear underwater for five minutes. When he asked how freedivers accomplished such feats, they credited breathing techniques and claimed these same methods improved blood pressure, respiratory health, and even bone density on land. This revelation launched Nestor on a multi-year research journey that culminated in his book Breath: The New Science of a Lost Art.
Why Breathing Became a “Lost Art”
The title reflects a troubling reality: despite centuries of scientific evidence, breathing’s impact on health remains largely ignored. Nestor discovered research from Harvard, Stanford, and the University of Pennsylvania showing that how we inhale and exhale affects everything from facial structure to asthma, allergies, sleep apnea, hypertension, and even psoriasis. Studies from 20, 50, and 100 years ago all reached similar conclusions, yet the medical establishment largely overlooked them.
The skepticism is understandable. Most people find it hard to believe that something as basic as breathing, an involuntary act we perform 25,000 times daily, could be so transformative when done correctly. Nestor himself was hesitant to pursue the topic, fearing the science might be “a complete bust”.
The Craniofacial Crisis
Nestor’s research took an unexpected turn when he explored why modern humans have crooked teeth. Unlike our ancestors or the 5,400 mammal species in the wild, modern humans frequently need braces and wisdom tooth extractions. The culprit? Our soft, processed diet over the past 300-400 years has caused our jaws to shrink.
Smaller jaws create multiple problems: teeth don’t have enough room and grow crooked, airways become restricted, and the roof of the mouth can penetrate into the sinuses, inhibiting nasal breathing. This explains why humans are now “the most plugged up animals on earth” and suffer disproportionately from snoring, sleep apnea, asthma, and even ADHD.
Patrick McKeown, who has taught breathing techniques for 18 years, experienced this firsthand. As a child, he was a chronic mouth breather with snoring, probable sleep apnea, fatigue, and poor school performance, yet no one in 20 years told him to breathe through his nose. He notes that 25-50% of children are persistent mouth breathers, and while some dentists and orthodontists understand the connection, they remain a minority.
The Stanford Mouth-Breathing Experiment
To understand how quickly mouth breathing damages health, Nestor and breathing therapist Anders Olsson conducted a radical 20-day experiment under the supervision of Dr. Jayashankar Nayak, chief of rhinology research at Stanford. For 10 days, they completely plugged their noses with silicone and tape, forcing themselves to breathe only through their mouths.
The results were alarming. Within the first night, Nestor’s snoring increased by 1,300%. Within three days, he was snoring for four hours per night instead of two minutes. Both participants developed sleep apnea where none existed before. Their blood pressure rose 15-20 points, stress levels increased, heart rate variability plummeted, and they experienced constant fatigue and dehydration.
When they removed the plugs and returned to nasal breathing, everything reversed: snoring disappeared, sleep apnea vanished, blood pressure dropped, and their biomarkers returned to healthy levels. All their data will be available online for verification.
The Nose as a “Use It or Lose It” Organ
Nestor discovered that the nose operates on a “use it or lose it” principle. Stanford breathing therapist Ann Kearney studied 200 patients with laryngectomies (surgical holes in the throat) and found that within 2-3 years of not using their noses, they became completely plugged, 100% obstructed.
Kearney herself was a chronic mouth breather scheduled for surgery. Instead, she focused on nasal breathing and within months, became a habitual nose breather without surgical intervention. She’s now organizing a 500-person study on nasal breathing’s effects on sleep apnea and snoring.
McKeown reports similar success from clinical practice: among 7,000 people he’s taught nasal breathing, only about 15 couldn’t establish it at 99.4% success rate. His rule of thumb: if someone can breathe through their nose for one minute after a simple nose-unblocking exercise, they can do it for life. The bigger challenge isn’t physical capacity but changing ingrained behavior.
Forgotten Medical Wisdom
The conversation reveals how medical knowledge gets buried. In the 1920s, research showed that 60-70% of tuberculosis patients were chronic mouth breathers, with clear correlation between mouth breathing and infection rates. One dental researcher, George Catlin, wrote about mouth breathing’s effects on children as early as 1909.
More recently, Dr. Christian Guilleminault at Stanford published research showing that infants who died from sudden infant death syndrome (SIDS) all had high-arched palates that could have been addressed, and the only preceding symptom was often a runny nose. Yet this critical information hasn’t reached most parents or practitioners.
McKeown emphasizes that children who undergo tonsillectomy or adenoidectomy need respiratory rehabilitation afterward. Without it, research shows a 65% worsening in the apnea-hypopnea index within three years, because removing the obstruction doesn’t automatically restore nasal breathing habits.
The Breathing Techniques Debate
With numerous breathing methods, Buteyko, Wim Hof, holotropic, coherent breathing, and pranayama sometimes appearing contradictory, both Nestor and McKeown advocate for a generalist approach. Nestor intentionally researched all major techniques and concluded they each have valid applications for different people and situations.
He categorizes techniques as either foundational or “Breathing Plus”. The foundation involves slow, nasal, diaphragmatic breathing that most people should practice regularly. Once this foundation is established, more intensive practices such as holotropic breathing or the Wim Hof method can be beneficial.
Understanding Intense Breathing Practices
Nestor explains that practices like holotropic breathing work not by “oxygenating” the body as often claimed, but by temporarily depriving the brain of up to 40% of its oxygen, a controlled stress that can be therapeutic. Similarly, the Wim Hof technique deliberately activates stress hormones (adrenaline, norepinephrine, cortisol) to “flip a switch” and reset the nervous system.
The key is conscious control: spending 20 minutes in a high-stress state allows the body to spend the remaining 23+ hours in deep relaxation. Research by Matthijs Kox showed that people trained in the Wim Hof method could consciously modulate their immune response when injected with endotoxins, something previously thought impossible. This has implications for autoimmune diseases like type 1 diabetes, rheumatoid arthritis, psoriasis, and eczema, where patients report symptom reduction after learning to control their nervous and immune systems.
Nestor notes that similar benefits appear in other intense breathing practices like Sudarshan Kriya, suggesting that breathing is the “anchor” more than cold therapy, despite the emphasis Wim Hof devotees place on ice baths.
The Emphysema Pioneer Nobody Remembers
One of the most striking stories involves Carl Stough, a choral teacher who discovered that singers performed poorly because they weren’t exhaling properly. He developed diaphragmatic breathing exercises that dramatically improved vocal quality.
This caught the attention of the chief of emphysema management at a major VA hospital, who invited Stough to work with patients. What Stough found was shocking: for 50 years, hospitals had simply put oxygen masks on emphysema patients and left them to die. Worse, they propped pillows behind patients’ backs exactly wrong, since more lung capacity exists in the back than the front.
By teaching diaphragmatic breathing and proper positioning, Stough achieved what doctors called “medically impossible”. Patients who could barely breathe began walking around for hours. Several stopped needing supplemental oxygen and left the hospital. X-rays showed actual lung expansion, not reversal of tissue damage, but better use of remaining healthy tissue.
Yet when Stough left the hospital system after 10 years, his methods left with him. Today, emphysema treatment still focuses on bronchodilators, antibiotics, diet, and smoking cessation, with little mention of diaphragmatic rehabilitation.
The Economics of Slow Breathing
McKeown explains the physiological efficiency of slow breathing using dead space calculations. At 20 breaths per minute with 150ml of dead space per breath, three liters of air never reach the alveoli for gas exchange. Based on Luciano Bernardi’s research, reducing from 12 breaths to 6 breaths per minute while increasing tidal volume from 500ml to 1,000ml increases alveolar ventilation by 21%, close to the 20% figure Nestor cited for nasal versus mouth breathing efficiency.
Nestor adds that starting around age 30, humans begin losing lung capacity at about 12-15% by age 50 and down to teenage levels by age 80. This shrinkage often causes elderly people to switch to mouth breathing because they feel air-hungry. The solution isn’t faster, shallower breaths but slower, deeper diaphragmatic breathing that maximizes each breath.
He compares breathing to rowing a boat: you can take a million short strokes or a few powerful ones, both reach the destination, but efficiency differs dramatically.
The Path Forward
Both Nestor and McKeown see breathing awareness increasing, accelerated by the COVID-19 pandemic’s focus on respiratory health. Nestor notes that nasal nitric oxide has antiviral properties, and clinical trials are underway examining nitric oxide’s effects on COVID.
Nestor maintains 557 scientific references on his website for skeptics to verify his conclusions. He agrees with a researcher who told him years ago that “how we breathe is as important as how much we exercise and what foods we eat,” calling breathing the missing third pillar of health.
McKeown believes the medical community needs to break out of professional silos, looking beyond pathologies to prevention. Similarly, breathing practitioners need to recognize that different methods serve different purposes rather than insisting their technique is the only correct approach.
The science is clear and has been for over a century. What remains is translating this knowledge into widespread practice, teaching parents, training medical professionals, and making breathing education as fundamental as nutrition and exercise. Given that we take 25,000 breaths daily, even small improvements compound into profound health benefits.
Note: This article is based on a conversation between Patrick McKeown, breathing educator and creator of the Oxygen Advantage method, and James Nestor, author of Breath: The New Science of a Lost Art.