Long Covid Workshop with Patrick McKeown - Practical Breathing Exercises for Long Covid (subtitled)

this presentation is practical breathing exercises to help with long cove and also what to look out for what's the expected progress how would you have to determine your progress and various considerations with that we will also be joined by vicky armstrong who has been dealing with lancovid for about 14 months and she will talk about her journey and the exercises etc that she has practiced and of course the experience that she has met my name is patrick mckeon and the technique will be taken from the buteyko clinic method and also from the oxygen advantage i'm going to start off with sharing a screen and looking at what symptoms are involved with long coverage these symptoms typically are persisting as i said for several months after the onset of infection shortness of breath so a common denominator here is that people have difficulty even talking putting sentences together and we use brett whole time as a measurement of progress or at least to give us some feedback of the degree of functional breathing patterns people with a high shortness of breath or strong shortness of breath will have a reduced breath hold time during rest we can use breath whole time to gauge the degree of breathlessness during rest and that will also provide an insight of breathlessness during physical exercise and also how fast and hard the person is breathing during sleep another feature of long covet can be tachycardia and this is when the heartbeat is elevated to up to 180 beats per minute even as a result of sitting or standing as a result of postural or titanic syndrome tachycardia syndrome a feature can be chest pain fatigue dizziness sign copiat exertion passing out and exertion and brain fog many of these symptoms they really remind us of people with chronic fatigue syndrome over the years that the central nervous system that the entire nervous system is so taxed and the progress that we make with doing the breathing exercises is a very gentle and it's very very slow response and progress because if we go too quickly it can be over taxing on the individual and it can set them back so the real primary message here is that the breathing exercises need to be tailored to the individual's breathing pattern and for the person to go very very gentle the condition is overwhelming affectingly it's overwhelmingly affecting women aged between 20 and 50 years and prior to infection many of these patients have good health and i've seen athletes i've seen really really healthy women and you know doing lots of physical exercise etc and dealing with lung covered so tests post infection are usually coming back negative and um just to to bear that in mind sorry i'm still letting people in and i'm just moving on through so the unfortunate thing with lancovid is that you don't know where it's going and people can be taking one step forward and two steps back and they don't know if they're what's going to trigger relapse or when it will happen and everybody is different and as vicki has described it's a 14 14 month roller coaster so you can imagine that this is going to bring on a lot of anxiety and with that it's going to change breathing patterns breathing is going to become faster and shallower so you have a condition that's feeding into fast and shallow breathing but you also have the associated anxiety with it which is contributing to fast and shallow breathing fast and shallow breathing is a normal response to the feeling of suffocation but when one is feeling suffocated it is entirely the worst way to breed because it's inefficient and it's not economical and we'll go through that how to breed to improve blood oxygen saturation and it's just based on normal physiology so the control pause is a measurement that we use to assess people's breathing functional breathing patterns and what i would like you to do is i would like you to measure your own control pause this is also called the bolt score from the oxygen advantage it's the length of comfortable breath hold time and to measure your control pause you just need the timer the measurement goes as follows you take a normal breath in and out through your nose and you pinch your nose with your fingers and you stop breathing it's not the length of a maximum breath hold so to measure your control pause you have normal breathing in and out through the nose then take a normal breath in through your nose a normal breath out through your nose pinch your nose with your fingers and time it in seconds how long does it take until you feel the first step in the desire to breathe and then to let go and to resume normal breathing so it's very important that your breathing following the breath hold is normal that you you're not out of breath and if you find that you have to take big breaths or you have exaggerated breathing following the stopping of the breath well then you've pushed it a little bit too far we have seen quite a number of people with long coved having breath hold times of as low as three seconds the significance of this is that you can track your breathing patterns and you can track your degree of breathlessness by virtue of your breto time during wakefulness so anytime that you want to assess your breathing patterns sit down for about five minutes take a normal breath in and out through your nose pinch your nose with your fingers and time it in seconds until you feel the first definite desire to breathe or the first involuntary movement of your breathing muscles and then let go and to breathe in through your nose and your breath upon the resumption of breathing should be normal a functional breathing pattern is when the breath whole time is greater than 25 seconds and as i said many people have width long covered have a breath hold time of as low as 3 seconds the lower your breath hold time the greater the feelings of suffocation and the more breathing is labored so your breathing is harder and faster it will involve a significant effort to breathe it's also upper chest breathing irregular breathing and hyperventilation so for example people with a breath hold time of between three to ten seconds their breathing is going to be quite labored and many of the breathing exercises that we would have practiced traditionally won't be suitable to them so instead we have to give them breathing recovery exercises very gentle exercises and the key here is the lower your breath hold time and the more labored you're breathing the lighter the dose in other words go very easy with the exercises but do them frequently so don't spend so much time doing them but when you do do them to do them frequently so i'm just going to move on and the control pause or the bolt score or the bretol time it must be that it depends on your bolt score but the breathing exercises must be so gentle so that they do not tax the nervous and cardiovascular systems and it's a short dose in short duration of air hunger is necessary most cannot do physical exercise and they cannot do physical exercise because of pots so and also if you have a breath hold time of about three or four seconds you are going to be too breathless during physical exercise and as a result you're much better off just doing the breathing exercises sitting a key aspect of this is that when you finish a session you should be able to do that whole session again so whenever you feel that whenever you finish a session you should have enough energy that you can continue to do the session and so that's really about as well listening listening to your body and paying attention to it and going very very gentle and i said earlier on that you know when i was working with people with chronic fatigue syndrome over the years that if we went in too strongly with the exercises it would cause so much fatigue and it would set people back and it's the exact same thing we're going here i have a feeling and also the reports from people who are working with lancovet is that some people are many people we don't know for sure but that people who can be infected with blancovid are type a personalities and very much in the sympathetic activation go go go so they're go getters and that the nervous system can be tipped into that small kind of fight-or-flight response as a result of society and everything else now of course when you're a type a personality in your go-go you're going to use the same approach when you have something such as long covered and there's a chance that you can put too much effort in so it's very important another aspect of this is the central nervous system and the nervousness the autonomic nervous system that we achieve a balance and we achieve a balance between relaxation and stress so for example when you have a persistent condition either if you are physically or mentally unwell that you can be in that over stimulation or hyperactive arousal and what we want to do is we want to dampen the stress response and we want to activate the body's relaxation response and we also want to stimulate the vagus nerve and by doing that we can help with recovery because we can help to bring a balance in the autonomic nervous system so that's where these exercises are going the control pause if you find that your breath hold time reduces and we described your breath hold time as being the length of your comfortable retro time if it's reducing then make an adjustment to your routine for that day because you know paying attention to it if you find for example that you're a little bit over you're a little bit fatigued your breathing has deteriorated because this is normal you know as i said one step forward and two steps two steps back that when you find that your breathing is not up to par or your breathing pattern has got a little bit worse will then decrease the duration of the breathing session but increase the frequency of it and these are the exercises that i'll go through so just bear with me for a little while here breathing recovery exercise to do it for sit during sitting maybe one to three minutes every hour or pay attention you know to how you are feeling and to bear in mind that when you're finished a session you should be able to do that session again so don't push yourself to the point that um you're you're pretty much taxed as a result of it another exercise to do could be breathe life for 30 seconds one minute breathe out for 30 seconds so you have air hunger one minutes rest read light for 30 seconds one minutes rest and practice this for five minutes every hour so again using your breathable time is a measure of your progress and if your breath told time is if it's decreasing go easier with the exercises but do them more frequently the control pause it's or the body oxygen level test we want to increase it by practicing the breathing exercise and also to measure breath toll time before and after so if you do a series of breathing exercises you want to check has your breath hold time increased as a result of doing the breathing exercise and ideally it does and so again it's it's you know it's not just about your breath whole time as a measurement of your progress but it's also about how effortful is your breathing what's the speed of your breathing how hard and fast are you breathing are you upper chest breathing and how suffocated do you feel how breathless are you this is the progress and this was taken from um somebody who has long covered and you see that time here is in months so it's unfortunately it's a long haul and again it reminds me of chronic fatigue syndrome people with severe chronic fatigue syndrome we would always say that you have to give it about six months or so now you could make progress a lot quicker than that but you have to give it the time whereas people with asthma coming in we could expect a lot quicker progress and in terms of people feeling a difference quite quickly you know a lot sooner so you see here that the control pause or the both score which is your breath hold time you'll see that it's making some progress you'll have a dip and it's making progress you have a dip in other words it's not linear that you're going to have ups and downs and the objective that we want is to improve your both score but also to improve your breath control and this is very very important and we do that by restoring nasal breathing the nose is the only organ in the human body that does any role in terms of the breath and our mouth does absolutely nothing so for example when people talk about breathing and people ask the question well should i be breathing in and out through my nose or should i be breathing in through my nose and out through my mouth etc you have to bear in mind that your mouth performs absolutely no function whatsoever in terms of the breath that it's all performed by the nose so it's really really important that you continue with nasal breathing even if you feel if you're feeling that you have air hunger and you know you're feeling that your breathing is labored don't switch to mouth breathing to alleviate the feeling of air hunger make sure you continue to breathe in and out through the nose because that's very very important i'm just conscious that there's many people waiting to come in and i'm trying to let them in but for some reason they are not coming in so just a small distraction here at this end the first exercise that i'm going to start off with is the breathing recovery exercise and the breathing recovery exercise is going as follows the whole key about the breathing recovery exercise is only hold your breath for half your control pause or both score at that time so this is a pretty important point and when for example i was working with individuals with a breath hold time of three seconds how would you expect them to breathe well their breathing is going to be very fast their breathing is going to be shallow breathing is going to be upper chest so they already have air hunger and they are already feeling suffocated now if i ask them to breathe in for four seconds and out for six seconds it's not going to happen because you know you cannot do it if you're already feeling air hunger but what we do instead is we do many small breath holes and this exercise goes as follows you take a normal breath in and out through your nose you pinch your nose with your fingers to hold your breath and you stop breathing for half your control pause or half your bolt score so if your control pause is three seconds well then your breath hold during the exercise is only for about two seconds or so in other words you don't want to hold your breath that causes your your to lose control of your breathing at this point here so i'm going to start off with that exercise and we're going to do that for a couple of minutes and you know as i said listen to your body as well you don't want to push it to the point that you're losing control of your breathing and it is a fairly easy exercise so the exercise goes as follows take a normal breath in through your nose and knife through your nose and pinch your nose and hold your nose one two let go breathe in through your nose and to breathe normal for ten to 15 seconds and again take a normal breath in through your nose and now through your nose and pinch your nose and hold one two let go breathe in through your nose and breathe normal for 10 to 15 seconds and again take a normal breath in through your nose and now through your nose and pinch your nose and hold one two let go breathe in through your nose and to breathe normal for 10 to 15 seconds and again take a normal breath in through your nose and out through your nose and pinch your nose and hold one two let go breathe in through your nose and to breathe normal for ten to fifteen seconds and again take a normal breath in through your nose and knife through your nose and pinch your nose and hold one two let go breathe in through your nose and breathe normal for 10 to 15 seconds and again take a normal breath in through your nose and now through your nose and pinch your nose and hold one two let go breathe in through your nose and breathe normal for 10 to 15 seconds so the whole key with this exercise is to do the exercise and to do it frequently and to do it often so maybe for example one to three minutes you could do it one to three minutes every hour or one to three minutes every half hour depending on your breath hold time if your breath hold time is very low as i said three four seconds only hold it for half your betrayal time at that time so the objective is restoring laser breathing we spoke about that um light breathing we're going to practice we're going to talk about humming slow breathing and low breathing and hydration of course is a necessary feature now during the light breathing it can be normal that your blood oxygen saturation drops a little bit and this is because of the increase of carbon dioxide in the blood in other words when you reduce the volume of air that you breed there is a gas called carbon dioxide that increases in your blood because it cannot leave your body so quickly through the lungs and it's the feeling it's the gas air it's the gas carbon dioxide that generates the feeling of air hunger so the feeling of air hunger that's occurring as a result of breathing less air is due to an accumulation of carbon dioxide now when carbon dioxide increases in the blood the affinity of hemoglobin for oxygen reduces so hemoglobin starts to release oxygen more readily and this can cause a drop in the blood oxygen saturation so what i would say is that when you are doing the gentle reduced volume breathing exercises if you see your blood oxygen saturation dropping a little bit it's normal and we would see this with a normal individual not infected say for example are not recovering from lung covid that if the blood oxygen saturation as measured by pulse oximetry if it's normal at 97 percent then we would see that the spo2 would drop down to about 95 during the reduced volume breathing so if you see a drop to your blood oxygen saturation during the reduced volume breathing it's it's normal the suggested program you measured your breath hold time earlier on and if your breath hold time is between three and ten seconds well your breathing is quite effortful and labored it's very important for you to measure your bold score every every morning after waking keep keep an eye on your bolt score keep an eye on your breath total time and the main exercise is breathing recovery sitting and the breath hold should be no longer than half your vote score we spoke about this during week one i suggest about three to five minutes every hour and week two onwards to practice five to ten minutes every hour in other words increase the duration of the exercise from week two onwards and i am sticking with this exercise because it's the best exercise to do when your bose score is so low there are wonderful breathing exercises but they are not going to be suitable when your breathing is so labored um because you know even breathing in for four seconds a night for six seconds reducing the respiratory rate down to six breaths per minute it all makes sense and interior of course and practice for many people it's a wonderful exercise not for this group so stick with your small little breath holes the small little breath holes will help to bring a canvas to your breathing they also help to harness nasal nitric oxide because as you breathe in and out and hold your nose one two nitric oxide is pulling a little in the nasal cavity and then when you let go of your nose you're carrying this nitric oxide and you're drawing it into your lungs a nitric oxide is a bronchodilator and it helps to open up the airways but it's also antiviral and it's antibacterial so it's a very important gas that's produced in the nasal sinuses and it also helps to redistribute blood throughout the lungs nose breathing too will increase the pressure of oxygen and the blood and it's known to increase it by about 10 so even though you were feeling breathless and you're feeling suffocated don't open your mouth because mouth breathing involves fast and shallow breathing and it's not ideal in terms of gas exchange taking place in other words oxygen taking place from the lungs into the into the blood so if possible with your low breath hold time practice no slow and low breathing and the reason being is because if we were to look at the human lungs so say for example and i'm not going to have a great diagram here the greatest concentration of blood flows in the lower lobes of the lungs but if you're breathing through an open mouth you typically breathe fast and shallow and it is normal when your boat scores are so low that you breathe fast and shallow there's a poor gas exchange taking place here by switching to nose breathing you harness nasal nitric oxide and nasal nitric oxide will help to redistribute the blood throughout the lungs but also by practicing low and slow you have to redistribute the air throughout the lungs and it's not about breathing more air it's also about when we're thinking of breath itself we have to think of the respiratory rate which is the number of breaths per minute multiplied by the tidal volume which is the air drawn into the lungs during one breath to give us minute ventilation which is the volume of air breathers in one minute and if i give you this example here imagine you're breathing 20 breaths per minute and the tidal volume is 300 ml that brings you're bringing in six liters of air into the body but after six liters how much of this air actually gets down into the smaller sacs and the lungs for gas exchange take place to find out we have to subtract dead space and dead space is the air that remains in your nasal cavity in the throat in the trachea and the bronchi and the bronchioles so with the same example here we have 300 mil subtract 150 ml which is dead space and to find out how much air is getting down into the smaller sacs in the lungs the answer here in this instance is three liters in other words if you're breathing fast and shallow in this example fifty percent of the air drawn into the body is left in dead space that's why fast and shallow breathing is is not ideal as i said it's inefficient so no slow and low is a great mantra and i know it's not the easiest to do but what you want to do is you want to do the small breath hold exercise very frequently and throughout the day to build up your bolts for to build up your breath hold time and when your breath will time gets to closer to 10 seconds then it's a lot easier to practice no slow and low breathing now you can start off easy you don't have to for example practice breathing in for five seconds a night for five you could practice breathing in for two seconds now for two seconds or in for three seconds now for three seconds in other words it's the degree to which you were able to slow down your breathing is going to improve breathing efficiency and if you wear breathing in for three seconds and out for three seconds so for example you slow down the respiratory rate to 10 breaths per minute and the tidal volume you allow to increase proportionately to 600 mil it still gives you six liters as before so minute ventilation is six liters but now if we look at the volume of air that's reached small air sacs in the lungs and we subtract dead space which is 150 you see in this instance that minute ventilation has increased to 4.5 liters simply by changing the respiratory rate even though we kept minute ventilation the same so always kind of have that idea in your head any time you're caught for breath try not to breathe fast and shallow regardless of whether it's long covered or any other condition that you have or even anxiety and panic disorder always dementia is nose slow and low to breathe in for three seconds and out for three seconds ideally is to have your hands either side of your lower ribs so your main breathing muscle is separated just at the base of the ribs you can't really feel it but you know you can feel the base of your ribs here and to put your hands either side of your lower ribs and then as you breathe in you should feel the lower ribs gently moving outwards and as you breathe out you should feel your lower ribs gently moving in and you can be breathing in for three seconds to breathe in two three out two three in two three out two three in two three out two three in two three out two three in two three out two three in two three out two three in two three out two three so slowing down the speed of your breathing is advantageous and it's advantageous for that reason you get a better gas exchange taking place you've got a better transfer of oxygen from the lungs into the blood now breathing light is very important because of course breathing is not just about the speed of your breathing it's not just about the depth of your breathing but it's also about the biochemistry and the biochemistry it's often the dimension that's overlooked and it's very unfortunate because if you have a habit of breathing too hard and too fast you get rid of too much carbon dioxide from the blood through the lungs and what happens then is that it can increase your sensitivity to the buildup of the gas in other words the primary stimulus to breathe is carbon dioxide is not is not oxygen unless your oxygen levels drop to about half so every breath that you take is driven by a build up of the gas carbon dioxide but if we are overly sensitive to the accumulation of carbon dioxide it means that our breathing can be hard and fast we want to help to slow down our breathing and to reduce the respiratory rate and to achieve normal minute ventilation and the whole mantra here would be light slow and deep breathing and we do that by doing these simple exercises so what i would like you to do is to put one hand on your chest and one hand just above your navel and this is the breed light exercise from the oxygen advantage book or from the other books and to have your attention on your breathing you're focusing your attention coming into your nose and as you're breathing through your nose really slow down the speed of the air coming into your nostrils and at the top of the breath have a total feeling of relaxation and a slow and a gentle exhalation now you will see that this breathing exercise could be challenging for people with a very low breath hold time and that's why we start off with the small brittles and once again the objective of this exercise is to take a very soft and slow gentle breath coming into your nose and a really relaxed and a slow and a gentle exhalation a very soft and gentle breath coming into your nose and a really relaxed and a slow and a gentle exhalation a very soft and gentle breath as it enters the nostrils and the really relaxed and a slow and gentle exhalation you were doing this correctly if the volume of air drawn into your lungs is less than what it was before you started and you know that you're doing it correctly if you feel air hunger air hunger is not signifying that your oxygen is dropped but it's signifying that carbon dioxide levels have increased so when you breathe less air carbon dioxide increases in the blood because it cannot leave the body so quickly through the lungs and as carbon dioxide increases in the blood you feel their hunger but it's very important to expose your body to the feeling of air hunger because this then reduces what's called the ventilatory response to carbon dioxide so it's kind of ironic but by practicing breathing less air in the long term you're able to slow down your breathing and breathe light so oftentimes the drive to breathe that fast and harder breathing pattern is driven by an intolerance to the build-up of carbon dioxide so if you have a strong response to the accumulation of carbon dioxide your breathing will typically be harder and faster breathing and harder and faster breathing during rest harder and faster breathing during exercise and harder and faster breathing during sleep so by breathing less air you increase carbon dioxide now you might notice a few things happening with this just pay attention to this live in your mouth is it less more or the same when you breathe slightly less air and you're feeling air hunger and an air hunger that's tolerable it shouldn't be stressful and the air hunger shouldn't be so strong to cause involuntary contractions of the diaphragm in other words that you should maintain good breathing control during the air hunger it stimulates the vagus nerve and by stimulating the vagus nerve this is a nerve that's wandering throughout the human body and it's innervating most of the major organs 80 to 90 percent of the nervous is from the body up to the brain and by stimulating the vagus nerve it secretes a neurotransmitter called acetylcholine which causes the slowing of the heart and when the heart rate slows down the brain interprets that the body is safe and the brain in turn will send signals of calm to the body so stimulating the vagus nerve will help to bring a balance in the autonomic nervous system it helps dampen that stress response and over activation or hyper arousal can be a common feature of people with long covert so we want to achieve a balance we want to dampen the stress response we want to increase the relaxation response and also by doing this exercise and by breathing slow and by breathing low we can help to strengthen or to make more sense of the barrel receptors which are pressure receptors in the major blood vessels the sensitivity of your borrow reflex is a very important indicator of how well your autonomic nervous system is is functioning so when you think of the autonomic nervous system being taxed with people with long coved well it's very important that we're able to we're able to target specifically and we can do that via breathing exercises but of course the whole thing about this is to go very gentle depending on your both score depending on your breath hold time the lower your betrayal time as i said the more gentle you go with the exercises but the more frequently you do it so i'm going to go back to the sliding or sorry to the slides and we spoke about breathing in for three seconds now for three seconds with your hands and your lower ribs and breathing low with very little movement of the chest and go gentle with this you know it's not about feeling a strong sensation of air hunger it's not about um getting stressed when you're doing it but it's just gently working with it and if you can breathe in for three seconds and breathe out for three seconds and the only reason that i've put down three seconds in and out that would be six that would be sorry yeah a breath every six seconds or ten breaths per minute it's because the both score is between three and ten seconds now with a higher both score so you're practicing doing the breathed the breath hold exercise the small breath hold exercises and as your breath whole time your both score starts to increase then you can do um spend a little bit more time doing exercises a common feature of lancovid and also with clovid is that the nose is congested and you can decongest your nose by holding the breath the exercise to help decongest the nose is as follows now you can get an idea of how open or closed your nose is by just using the screen on your mobile phone and just place the screen underneath your nose close your mouth and breathe onto it and you will see that a halo is left on the screen you will notice that a halo might be more on one side than the other indicating that one side of your nose is a little bit more stuffy than the other to help open up your nose you can do the following exercise bear in mind don't do this if you're pregnant or if you have serious medical conditions but also if your breathing is very labored you have to go easy you don't want to hold your breath for too long that it causes you to lose control of your breathing at the end this exercise to decongest the nose is as follows take a normal breath in through your nose and out through your nose and pinch your nose and hold your nose and as you hold your nose gently hold your breath and nod your head up and down don't hold it for too long that you lose control of your breathing and because again depending on your bolt score but we have used this with many people with covid and the feedback is that it it works now that exercise will only temporarily decongest your nose until you get your breto time higher so i would also say to students if you are suffering from nasal congestion and this may be just you could have you know rhinitis that your nose is blocked for one hour a day most days of the year that when you do the nose and blocking exercise which involves taking a normal breath in and out through your nose and holding your breath for a relatively long time until you feel a moderate to strong air hunger but letting go and resume breathing in and out through your nose with good breath control this exercise will temporarily decongest your nose but when you get your bow score or your breath hold time above 20 seconds your nose is more permanently free so the whole objective here is to use this exercise any time your nose gets stuffy but keep working on your bow score and as you increase your bow score you will find that your symptoms of the nose are much less and i'm talking about rhinitis here i'm talking about inflammation of the nose runny nose etc and the problem with this stuff he knows is that if you have a stuffy nose your sleep is impacted so it has been known that people with with nasal obstruction they are two to three times more likely to have moderate to severe sleep disordered breathing so i'm just going to move down here again so here i'm sorry this is still a bold score of between three to ten seconds continued and using the nose and blocking exercise while sitting humming also with slightly prolonged exhalation humming is an excellent exercise to help stimulate the vagus nerve but also to harness nasal nitric oxide and the way to do this would be take a very soft breath in through your nose and then just gently home in the exhalation but after you hum and the exhalation make sure you breathe back in through your nose now bear in mind if your boat score is very low again this is going to be challenging but just do your best with it so even if you were just to take a breath in through your nose and then form in the exhalation um but after that make sure that you breathe in through your nose and if you were to do that several times every hour the humming will have to vibrate the nasal passages but also nitric oxide which is pooling in the in the paranasal sinus sinuses is emptied into the nasal cavity so that when you breathe through your nose you're carrying this nitric oxide into your lungs and nitric oxide is antiviral as i said earlier on it's antibacterial and it helps to redistribute the blood throughout the lungs so coming back to this relaxation is also very important when your bose score is quite low and you want to help improve or to get a balance in the autonomic nervous system you can download a free 20 minute relaxation from the buteyko clinic app which is available on android or itunes another aspect is to sleep in a well ventilated room and also to make sure that your mouth is closed during sleep it's very very important now the tape that i refer to here is called myotape which is my own type the reason that i've referred to this tape here is because the tape it surrounds your mouth and it doesn't actually go across the lips because if your breath told time is between three and ten seconds it would be normal that you would feel apprehensive about putting a tape across your lips because of the air hunger but if you start off during the day by having a tape surrounding the mouth it will get you used to more nasal breathing and then to practice it during sleep you should never wake up in a dry mouth in the morning and that goes for any of us you know as i said earlier on it comes back to what's what are the functions of the nose versus the mouth does the amount of any function and the answer is no when it comes to breathing it has zero functions it doesn't moisten it doesn't warm the air it doesn't regulate volume it doesn't do anything and mouth breathing is typically activating the upper chest and it's faster and harder breathing and also when you breathe through your mouth during physical exercise um you're more likely for example exercise induced bronchial constriction you would have less oxygen transfer from the lungs into the blood and also less oxygen transfer from the blood to the tissues because when you do your physical exercise with the mud closed carbon dioxide increases a little in the blood and you will feel this by virtue of air hunger and this of course depends on the intensity of your exercise but as carbon dioxide increases in the blood hemoglobin release oxygen more readily so my point here is that carbon dioxide is not just a waste gas that people often say it's not just as simple breathe in as much oxygen as you can and get rid of this waste gas carbon dioxide in actual fact the release of oxygen from the red blood cells to the tissues and organs that carbon dioxide plays a role there that is carbon dioxide increases in the blood and blood ph drops and hemoglobin which is the main carrier of oxygen in the blood hemoglobin releases oxygen more readily and this is called the board effect so we're coming back to both score still of between three and ten seconds and i'll do a recap on this because this is very challenging for any person experiencing this and you know if your bowl score or your bet hold time is as low as three seconds you will barely be able to string a sentence and that's why it's very important that we tailor the breathing exercises here both the dose of the breathing exercises but also the duration the expected progress here is to increase your both score to above 10 seconds in about two to four weeks and i've kind of kept it open-ended that it's a very slow progress and just to bear in mind that yes you might have some progress and then you might have some setbacks so just a quick recap when you're both score is really really low because this is a common feature of long coved measure your bold score every morning after waking practice the breathing recovery setting exercise but your breath total time should be no longer than half your both score so if your bold score is three seconds your breath total time should be about two seconds during week one practice three to five minutes every hour now if you feel more comfortable doing five to ten minutes every year then do that but listen to your body and remember what we said at the start once you finish the session you should feel that you have enough energy to do that session again in other words don't push yourself to the limit week two onwards practice five to ten minutes every hour and again i've left it quite open-ended here so that you can choose depending on how you're feeling at that time if possible gentle nose slow and low breathing it's really important try not to breathe through your mouth even if you're feeling breathless because mouth breathing is just you know it's ironic that when you when we are feeling suffocated we revert to mouth breathing and fast and shallow breathing but mouth fast and shallow breathing is absolutely the worst way to help alleviate the feelings of suffocation if you switch to nose slow and low breathing and gently slow down your breath you may not be able to slow it down too much but do your best and another aspect of slowing down the breath is if you can prolong the exhalation you have to bring the body into relaxation so if you think of it in terms of the stress response in the human body whenever we get stressed our breathing becomes faster and especially the exhalation whereas if we take you know when we're stressed our breathing is harder and faster and if we want to activate the body's relaxation response almost think of the exhalation not so much the inhalation as you draw air into your nose the vagus nerve steps back a little bit so the inhalation is more under the control of the the stress response the sympathetic nervous system and the exhalation is primarily under the control of the body's relaxation response the parasympathetic nervous system if you take a soft breath in through your nose it could be fast or it could be slow but typically we say go slow as i said the inhalation doesn't matter too much so the inhalation is into your nose would say a soft breath in through your nose and then if you have a really relaxed and the slow gentle breath out through your nose the relaxed and slow gentle exhalation that stimulates the vagus nerve so anytime if you're feeling stressed during the day always bring your attention onto your breathing and use this and even if you do this for about 90 seconds it will help to alleviate stress because you will start to feel calmer it's a really really good trick to do and you're taking a very soft breath coming into your nose and a really relaxed and a slow and gentle exhalation because when you breathe out slow and relaxed you were telling the brain that everything is okay and when the brain senses that everything is okay the brain will send signals of calm but if you're breathing in fast and out fast and that's the problem as well when we have a very low breto time and we have fast and labor breathing that we are more likely to be in hyperarousal because our breathing is fast and shallow and through them out so you have the physiology of fast shallow breathing kicking in an anxiety response and of course we also have with long coven that people don't know where this is going they don't know what's going to trigger them or when they could be triggered so you have anxiety from that aspect of it and anxiety then is going to make breathing harder and faster which in turn is going to feed back into the hyper arousal of the nervous system so always try and do your best to gently soften the breath nose slow and low now as your both score increases so we went yeah i'm just doing a recovery not a recovery but a refresher here use the nose and blocking exercise while you're sitting and humming with a slightly prolonged exhalation with breath control is very important to help stimulate the vagus nerve and you can be doing this really whenever you feel like it you know i said one minute 10 minutes daily but you know i don't think it's taxing to to home every now and again and the other thing about humming is that it will help to extend the exhalation which activates the body's relaxation response relaxation upon waking and before sleep is very very important sleep in a well ventilated room wear myotape during sleep and the expected progress we spoke about now when you're both scored then is improving your breathing is becoming a little bit lighter and you've got better control so now you could increase the dose of the exercises but i've kept the exercises pretty much the same the breathing recovery setting you could be practicing this now for five to ten minutes three times daily but i would also bring in the breathe light exercises air hunger so one is hands on chest and tummy which i did earlier the next exercise is what i'm going to do now is the finger underneath the nose and this is helping to breathe light and when i talk about breed light with air hunger this is about increasing carbon dioxide in the blood and exposing your body to the increased carbon dioxide to help reduce the ventilatory response to carbon dioxide in other words that your breathing becomes lighter so you deliberately breathe less air and in the long term then your breathing becomes more comfortable more under your control and you'll find it a lot easier to breathe in the neck through your nose because you won't feel air hunger you know it's normal that if you have a very low ball score it's normal that you will feel our hunger how do you alleviate your hunger well you practice breathing exercises to breathe less air which initially will generate our hunger but by generating that air hunger by doing the exercises it helps you to improve your breathing patterns so that your everyday breathing you don't have that air hunger and you will know by virtue of the improvement of your both score every time your ball score or your control pause increases by five seconds air hunger is decreasing so just bear that in mind the finger underneath nostril is simply you have your finger underneath your nose as follows and you're placing your attention on the airflow coming onto your finger you're taking a very soft slow gentle breath coming into your nose and a really relaxed and a slow and gentle breath out and i would like you to practice this i would like you to breathe a little bit less air you're taking a very soft gentle breath coming into your nose and a really relaxed and a slow and gentle breath out through your nose your finger is a good barometer of the airflow coming out of the nose can you breathe so gently almost that you feel hardly any air coming onto your finger and also use this as a measure of your concentration how long are you able to hold your attention on your breathing before your mind is wandering and if you find that your mind is wandering a lot you can use these technique these techniques not only as a means of helping to hold your attention on your breathing but also using the techniques to get that balance in the autonomic nervous system which is very very important and this can be measured via heart rate variability increasing blood flow to the brain stimulating the vagus nerve and also when you have a feeling of air hunger your mind is more likely to be anchored onto the breath so i often say that you know people who are anxious and 75 of the anxiety and panic disorder population have anxiety sorry 75 of the anxiety and panic disorder disorder population have dysfunctional breathing and maybe you know many of these people have tried meditation and they have tried mindfulness but they are going to find it very frustrating because if you have dysfunctional breathing your physiology is in that fight or flight so it's very important to use breathing exercise to bring a balance in the autonomic nervous system in the balance in the automatic functioning of your body and by doing that your system calms down and when your system comes down it's easier to pay attention to the airflow coming onto your finger so it's much easier to practice mindfulness when you have your physiology normal and when you have deep sleep and deep sleep is really about breathing in the night through your nose i spent 20 years breathing in the night through my mouth waking up feeling absolutely exhausted in the morning and you know going into school and university and required to concentrate and not being able to hold our attention and of course i'm not unique there are millions of people in the same boat we have to change our breathing patterns to change states so coming back to lancovid we use this exercise to stimulate the vagus nerve to increase carbon dioxide in the blood a little bit and the purpose being to achieve a lighter and slower breathing pattern so in other words so for example um when i measure people's um who are quite breathless and they have a low breath all time their respiratory rate could be 20 breaths to 25 breaths per minute it's too fast how do we bring down the respiratory rate we bring down the respirature rate by breathing less air because when you reduce the ventilatory response to carbon dioxide the respiratory rate naturally reduces but if i just said to that group of 20 of individuals who are breathing 20 to 25 breaths per minute if i just said to them breathe in for five seconds and out for five seconds it's the progress is going to be slow and the risk is that as they breathe in for five seconds i don't know how much air they are breathing in for five seconds you know they could be breathing in very light which would be ideal for five seconds a night for five seconds or they could be breathing in this full big breath in for five seconds a night for five seconds in other words it's not just about the respiratory rate we have to bear in mind the tidal volume um and if you just look at the respiratory rate and forget about the title volume when there's a huge piece of the puzzle being missed here so coming back to this exercise you have your finger underneath your nose as follows you're paying attention to the slightly colder air coming into your nose and the really relaxed and a slow and gentle exhalation and the very soft and slow gentle breath coming into your nose and the really relaxed and a slow and gentle exhalation i would like you to breathe out so slowly onto your finger almost dash if your finger was a feather that the feather is not moving so you can imagine an opera singer of old they practiced with conservation of the breath they would sing with a candle flame held about eight inches from their face and the whole purpose was to have such conservation of the breath that they could sing and project their vice with conservation that they wouldn't blow out the kind of thing i need you to breathe out with such conservation of the breath that you feel hardly any air onto your finger you're taking a very soft gentle breath coming into your nose and a really relaxed and a slow and gentle exhalation a very soft gentle breath coming into your nose and a really relaxed and a slow and gentle exhalation a very soft and gentle breath coming into your nose and a really relaxed and a slow and gentle exhalation so with that exercise you will be able to achieve that when you're both score is probably about 13 14 15 seconds onwards if it's less you'll find it difficult enough to do so you can always go back to the small breath told exercise so i'll just go through those again if you're feeling that your your breathing is just too suffocating and that you're feeling your hunger that's too strong the best exercise always to start off it is the emergency exercise we use it for people with asthma people with copd and people would land over it take a normal breath in through your nose and knife through your nose pinch your nose and hold one two three four five let go breathe in through your nose and breathe normal then for about 10 to 15 seconds the breath hold is between three and five seconds or no longer than half your your control pause or your bolt score and again take another breath in through your nose out through your nose pinch your nose and hold one two three four five let go breathe normal for 10 to 15 seconds and again take a normal breath in through your nose and out through your nose and pinch your nose and hold one two three four five let go breathe in through your nose and to breathe normal for 10 to 15 seconds so if you are finding the exercise a little bit too difficult do the small breath tools instead mini recovery so i'm just going to continue on to the next slides so we spoke i just demonstrated there the breathing recovery sitting and you're practicing this for five to ten minutes three times daily we practice at the start we practice hands-on chest and tummy to develop air hunger recently we've just done finger underneath nostril and another exercise which is pretty good is hands cupping face and the reason being is because it can help to pool carbon dioxide now just bear in mind that your hands are if your hands are clean you feel comf if you feel comfortable cupping your hands to do it as follows and this is based on the old brown paper bag that used to be used if people were having a hyperventilation attack if somebody was having a panic attack and their breathing is labored and they're feeling suffocated they're sometimes told to breathe in and out of a brown paper bag on the purpose of the brown paper bag is to pool carbon dioxide inside in the bag so they're breathing out carbon dioxide from their nose or mouth into the bag carbon dioxide pools inside the bike and then when they breathe in they are carrying that carbon dioxide richer air back into their lungs which in turn will increase carbon dioxide in the blood and one note about carbon dioxide is that your blood circulation is influenced by carbon dioxide so as carbon dioxide increases in the blood your blood vessels dilate so your blood vessels become wider and blood flow increases and not only does blood flow increase but oxygen delivery increases so you've probably experienced this anytime you get into a stressful state and you start breathing hard and fast and the next thing is you feel lightheaded why did you feel lightheaded well that can be a sign that you've been over breathing the more air you breathe the more your blood vessels constrict and the less oxygen that's delivered and that's why for example if you are practicing yoga or doing pilates or doing many modalities pay attention to your breathing it's not always good to over breathe um i know there's a point for stressor exercises when people over breathe but in the main you don't want to be over breathing because if you're over breathing you're depriving your body of blood flow and oxygen and you have 70 000 miles of blood vessels throughout the human body and they are influenced by the volume of air that we breed so our breathing should be light our breathing should be slow and our breathing should be low so this exercise is copying your hands as follows now try and have hardly any gaps between your fingers and this is safer than the brown paper bag because oxygen can come in through your fingers if you have a very low breath hold time don't make any adjustments to your breathing if you are making any adjustment to your breathing just make sure to breathe in nose and slow down your breathing a little bit and breathe low but if you have a breath hold time a bowl score or control pause of say 13 14 15 seconds plus then breathe light so the whole purpose of this exercise is you're cupping your hands as follows for those of you with a low breath hold time continue cupping your hands but breathe in two three out two three in two three out two three in two three out two three in two three out two three in two three out two three in two three out two three so for a low breath hold time nice and slow and maybe just bring it down to about 10 breaths per minute if you have a higher beta time you can do two things we can practice breathing in for five seconds and out for five seconds which is an ideal respiratory rate to help bring a balance in the autonomic nervous system because when you breathe in for five seconds and breathe out for five seconds you were reducing the respiratory rate to six breaths per minute this is helping to stimulate the vagus nerve but also to strengthen the barrel reflex and as you strengthen the bar reflex and stimulate the vagus nerve it increases your resilience and it's very important that we as human beings that we can go to into stress but also recover quickly and that's resilience that we can adapt to the environment so you can help improve your ability to adapt to your environment by practicing this exercise you can do it with your hands cut and i would like you to think of breathing nose breathing slow and breathing low and to breathe in two three four five out two three four five in two three four five out two three four five in two three four five out two three four five in two three four five out two three four five in two three four five out two three four five so just to continue with that so as i said the purpose of that exercise is to help stimulate the vagus nerve and to improve and strengthen the bar reflex but also an interesting aspect of that exercise is that it enhances alveolar ventilation so by slowing down the respiratory rate you can help to increase gas and improve gas exchange i'm just going to mute sorry there one second so i'm going to go back then to the presentation here and we're talking about a both score of 10 to 15 seconds and this will be your recovery suggested breathing exercises and we've been practicing these and teaching these breathing exercises for 20 years and i've worked personally with about 8 000 people um plus so we have seen the results over the years breathing low can be a very good exercise for people with with covet as well because of their difficulty in doing any of the exercises standing or sitting and breathing low with your knees bent and you're going to have your hands again at either side of your lower ribs and breathing in very light and slow in other words you don't have to take a full big breath to engage the diaphragm so when you are having your hands either side of your lower ribs breathe in very very softly because bear in mind the air hunger signifies an increased carbon dioxide in the blood which is very helpful so it's about light breathing don't over breed best during the practice to breathe a little bit less air slow breathing gently slowing down the respiratory rate that your breathing is a little bit slower than what it was before you started and also that you have air hunger and low breathing and i know that might sound how do you bring all three together but you can do it with practice so we practice this here breathing slowly in for three seconds and out for three seconds practicing it for three minutes five times daily and again a very gentle duration because we don't want to tax the nervous system for people with lung coverage humming with slightly a prolonged exhalation and i would suggest maybe don't have a formal approach here but whenever you think of it take a very soft breath in through your nose and hum with a gentle and prolonged exhalation to help stimulate the vagus nerve use the nose and blocking exercise if necessary and it's very important to get your mouth closed during sleep now as your bowl score improves you can spend more time doing the exercises and the breed light exercise is about generating that air hunger so the first breed light exercise we had was hands on chest and tummy breathing less air gently slowing down and softening the speed of your breathing to the point of air hunger the second exercise we did was finger underneath the nose taking a very soft breath in and a really relaxed and slow gentle breath out and you can also do the braid light exercise with hands clipping face breathing in very very softly and through your nose and the really relaxed and the slow gentle breath out are breathing in light and slow for three seconds and out for three or breathing in light and slow for five seconds and out for five seconds we spoke about breathing low which is very important you you could be doing this for five minutes two times daily and breathing slow breathing in for four seconds now for six seconds or breathing in for five seconds and out for five and they're quite similar breathing in for five seconds and out for five seconds has similar effects to breathing in for four seconds now for six both rates are are bringing it down to ten uh down to six frets per minute so it's 10 seconds and cycle of the breath humming with prolonged exhalation again using the nose and blocking exercise and wearing the myotape during sleep so you see that the exercise remained the same but we are increasing the duration of it and again 20 seconds plus breathing light breathing low breathing slow and here we're having the person practice 30 minutes of breed light 10 minutes of breed low 10 minutes of breed is slow so here you have 50 minutes and we're looking to achieve to about 50 minutes to an hour daily but this is not going to happen with somebody with a very low breath total time so when your bold score is 30 seconds now sorry when your bold score is 20 seconds now you can start pushing yourself a little bit because you're more resilient but it can take a few weeks to get to this point and again bear in mind that you might take one step forward and two steps back but your bold score improving the ball score is a really good sign that you're on the right track you'll notice the difference because your breathing is lighter and you have more control of your breathing walking for 10 minutes daily with nasal breathing especially for those who are not susceptible to to pots postural or to static tachycardia syndrome and if you do have parts speak with your your gp in terms of getting medication to help deal with the tachycardia and because the tachycardia of course can could bring on naturally it's going to bring on anxiety wearing the mario tape during sleep now if you want to read a little bit about it one book is called the breathing cure which is available internationally there's another new book out called atomic focus and then there's one for kind of sports performance it's called the oxygen advantage so these exercises are available they're available in different books and there's also instructors you take instructors throughout the world and also oxygen advantage instructors who will be able to help you if you have one-to-one because i think if for example i think you it's best for people to have somebody to assist them on the journey and to hold their hands especially during the relapses because motivation can be a very important part of this and you know keeping focused and staying on track and what to do if for example you do get a setback so reach out to um an instructor who can work you through the exercise i'm gonna just see if if vicky armstrong is is present um i'm not sure if she's if she's here you are great vicki yes and what i would like you to do is um just to it would be great to get an insight i'm not sure whereabouts you are in the room vicky okay i'm i'm vicky jones so i'm um up here so i'll just i'm just gonna start talking first of all i want to thank patrick um because this is this is so scary for those of us that are are affected by long covid um and by him applying his expertise we have tools now that can help us and these tools have personally helped me um long covert is so different from anything any of us have ever experienced because it is it is being driven by those suffering from long covid and it was never we've never heard of this before so i know all of you that have long covered it was something that didn't even cross your mind when you got covered so it's such a scary journey because you don't know what's coming down the road for you you you know we all have very very different symptoms that we have to deal with on a daily basis so i think patrick said that um i actually got covered back in july 2020 um prior to getting covid i was a fitness trainer i used to be an international athlete i considered myself fit and healthy and [Music] covid has really changed my life i can no longer work finding things to help with the the symptoms that i've experienced have been pretty much non-existent from the medical community because like i said they don't understand what's happening to us so um the breath work i stumbled upon um probably in march and i read an article and started using some of the exercises that were suggested for people with long covid and they absolutely floored me and it was the first time i'd actually met people with long covid so seeing people who were on oxygen who were just lying in bed who were sitting on sofas and seeing the terror in their eyes when you're asked to hold your breath or to to breathe in for four and out for six and we're all sitting there going we can't do this even knowing that we were healthy people and it's it's such a difficult thing to come to terms with but when you start taking these things slowly when you start implementing them on a daily basis in small quantities you will feel improvements and we're like i said i understand we're all suffering from very different symptoms but you've got the symptom side of long covered and you've got the anxiety side of blonde covid so by using breath work you can then marry the two and sort of help alleviate the symptoms or decrease your anxiety because we all know it's i know it's scary and talking to your partner or someone who is helping you through this so that yes when you have anxiety time you know to revert to breath work because it will it will undoubtedly help you so i know that some of these exercises seem minuscule um when i first started doing breath work i my bolt score was nine and i've now been doing it for um seven months and my bolt score is 19. so this is this is a an improvement for me i'm incredibly grateful for it but it is it's not a linear progression there are some days my bolt score drops right back down and i know those are the days that i need to back off this is not like a training program you know when we train people when we do rehab for people we give them a graded exercise and this is not graded exercise this is about pacing yourself um i don't even like the word exercise anymore i use the word movement it's you're moving in a different direction because you are actually lit you have to listen to your body with with all of this and i think it's something long covered people have to learn it's like how am i feeling today if i got brain fog if i got symptoms what's my control pause telling me is going on with my symptoms because it's it's almost an indication that you may have you may be experienced a little bit of a relapse when your control pause go goes down um so those are the things i i keep an eye out for but i do the exercise every single day i get up in the morning um there's a boutique app that you can measure your control paws and you can watch it every single day i do that every single day um this whole thing about we don't understand what's going on with long covered but one of the things that i've looked into is that the long covid has damaged our vagus nerve so when patrick was talking about the autonomic nervous symp system our bodies are in this sympathetic we are fight or flight the whole time even when we're lying in bed even when we're resting our body from long covered is in fight or flight weave our vagus nerve is damaged so if you think of this breath work as a rehabilitation for your vagus nerve and do these exercises to improve your vagal nerve function and the strength of your vagus nerve then you're going to be stepping in the right direction um and like i said it's it's so slow i've i've changed my um breathing i nasal breathe throughout the day i nasal breathe at night now with using the tape i talked to so many people about breathing and how important it is because the other thing that is that i can't stress highly enough is this is your journey and you have to find a way to get through this this the stress that long covid unfortunately brings and by taking control of your breath to have something that you can return to in moments of stress and also to heal yourself i mean if if we were said if we were told that this breath work was healing our body we'd all be doing this every single day and as far as i know there's nothing out there apart from you know we've been told supplementation we've been told um so many different things you know there's all the natural healing the meditations but you know what it all comes back to your breath it all comes back to your body chemistry and this breath work is changing your body chemistry for the better so um that's kind of my little two cents worth excellent vicky thanks very much and just to reiterate what vikki was talking about via the vagus nerve there are a number all of the exercises that we practice today will help to stimulate it so for example the small brethols at the very very beginning will also help to stimulate the vagus nerve because if you increase carbon dioxide it has a vagotropic effect their research over the last 30 years has also pointed that when you slow down the respiratory rate to between 4.5 and 6.5 breaths per minute it helps to stimulate the vagus nerve but the problem is that if you do have breathlessness and long coverage you won't be able to slow down your breathing rate to between 4.5 and 6.5 breaths per minute so that's why i said just do it very very gently the breed light exercise whereby you're really softening the speed of the air coming into your nose and a really relaxed and slow gentle breath out feeling air hunger will help to stimulate the vagus nerve you will have an idea of when you're activating the body's relaxation response by virtue of the increased water is alive in your mouth and normally when we have people breathe less air once they don't go into a panic mode because of the air hunger so the air hunger should be tolerable and if you feel it's stressful take a rest but by breathing less air and it stimulates the vagus nerve and it activates the body's relaxation response you have increased watery slide in the mouth when we have increased watery slide in the mouth we know that the body is prepared for the digestion of food so the increased water if saliva is for helping with digestion so we are going into the rest and digest response and as vicky pointed out as well that people with long coverage and also people who are long term not well either emotionally or physically they can have reduced heart rate variability and it's very important that we help to target the autonomic nervous system to help bring about that balance nose breathing during sleep is really really important component to it i'm just going to go through the a couple of points of the last few points of the slide and then we will be kind of wrapping it up and i'll stay for a few questions if if any of you have questions dysautonomia is an impairment of the usual functioning of the autonomic nervous system and again it reiter reiterates with what vicky was talking about and the autonomic nervous system that controls your blood pressure temperature regulation and digestion and dysautonomia is an umbrella term covering a host of different conditions the cause of which many of which have to be fully understood and this is where that anxiety can come in because you know individuals their tests may come back as negative showing that nothing is wrong with them but yes they know that something is wrong but the the causes and the issues are not fully understood parts there was a question in the regards what is parts parts is postural or to static tachycardia syndrome and basically if you were to stand up or sit up your heart rate can increase by 30 40 50 beats per minute so you have an exaggerated fast heartbeat from the minor physical exercise an abnormal increase in heart rate that usually occurs after sitting or standing and a connection between parts and an inflammatory immune response in cases of covet 19. also by stimulating the vagus nerve it helps to control inflammation and this was discovered by a neuroscientist back in 1998 called kevin tracy that he electronically stimulated the vagus nerve in the rash and it showed that it could stop inflammation so that's why there also could be a connection here and we looked at pots there so the symptoms from long covered are too varied to be lumped together and i mentioned earlier on that they closely resemble chronic fatigue syndrome or emmy and in practice they really really do because we had the same issues and i made plenty of mistakes with people with chronic fatigue syndrome when i started working with them during the day because i never realized that i had to go so gentle and if i didn't go gentle i would put them into fatigue so exercise intolerance profound fatigue and symptoms are not textbook and this is the unknown in mount sinai hospital this was taken from you see the link at the bottom of an article that was published in the atlantic all the patients had low co2 levels when they first presented with for treatment and after practicing the breathwork exercises symptoms abated and the exercise that mount sinai would be breathing well one of them is breathing in for four seconds and out for six seconds in theory it makes a lot of sense but if you have a low breath hold time you're not going to be able to do it so what i would say is stick with the breathing recovery exercises and with lancovid they fall into two distinct categories one is that symptoms could be directly attributable to organ damage during the acute phase of the infection or the complications of treatment but the second group they have persistent symptoms even if they had just a mild initial disease so they don't have organ damage but yet they can have persistent symptoms and hyperventilation basically means over breathing that when your breathing volume is greater than what you need if if you have a low breath hold time it's you are more likely to hyperventilate and people with a low breto time and what i talk about low is that your bread told time is less than 25 seconds the lower your breath hold time the more likely you are to breathe faster upper chest and breathe harder and that will also reflect in harder faster and upper chest breathing during physical exercise and it can also affect your sleep so the symptoms from over breathing include dyspnea which is breathlessness tachycardia is racing heartbeat chest pain fatigue dizziness and sign copy passing out and in this paper here i was looking at the arterial blood gases to characterize patients with lung covid and they had out of 81 patients 19 of them had hypocatnia low carbon dioxide as compared to the remaining m62 and low carbon dioxide is when carbon dioxide is dropping below 35 millimeters of mercury this is where the breathing exercise can come in because the breed light exercise are about helping to restore normal carbon dioxide and this is when you're doing your small breath tools you're breathing a little bit less air and you're feeling the air hunger now on the ground we have a report from a doctor in the uk and he looked at this was only about two weeks ago arterial blood gases for the last 10 patients that he admitted would acute provide pneumonia all of whom had low blood oxygen saturation but 10 out of 10 of them had low carbon dioxide and he put the low carbon dioxide down to also fear and sympathetic activation because of the anxiety that your breathing is harder and faster and this is causing too much carbon dioxide to be removed from the body through the breath severe cases of lung covered usually accompanied by obvious drop to blood oxygen saturation but also carbon dioxide and it's really important that we keep breathing under control and nose breathing is the first foundation but light breathing slow breathing and low breathing now i just quickly go through a couple of papers here and this was one published by messino and he looked at the breto time of 57 individuals wit hospitalized with covert 19. and 24 healthy controls without it that if he got them to hold her breath for 20 seconds that they had a greater average oxygen desaturation so for example take a normal breath in and out through your nose pinch your nose and hold your nose for 20 seconds and if your blood oxygen saturation drops quite significantly maybe below 91 certainly below 88 percent um it can indicate that conditions are not ideal and the other aspect is that these individuals um and this was basically a hypothesis to test that adverse outcomes are independently associated with a greater average oxygen desaturation but also a longer maximum breath or duration now again if you have breathlessness don't hold your breath to the point you lose control of your breathing so i'm just kind of just bring it to the last slide and then i'll go to some questions and i just like to say there were a number of people who contributed to this presentation and dr ella from poland who is working with lancovet patience vicki armstrong who i'm really grateful for her insight but also for for talking because i think it's it's it's tremendous to have a personal experience to to try and piece information together dr collin spate from the united kingdom peter lakitas from hungary sean flott from the united states and bob solera and for their contributions in terms of the information that we put together and of course there are still unknowns and we don't know all of the answers but what we are looking at is in terms of simple breathing exercises just to help to bring about some control and really that's what what it's about i'm just going to look at the chat and um just for a few minutes and then we'll kind of wrap it up because and i'm not sure how many questions i'll get through um and i'll just spare me one second here so i'm going to kind of just to bring it together as well as vicky said don't expect your progress to be in a straight line but at the same time practice the exercises a little bit often and you'll never go wrong with the small breath hole exercises breathing in out through your nose holding your nose and holding your breath for three to five seconds and then breathing normal for 10 to 15 seconds and then breathe in through your nose out through your nose and hold your breath for three to five seconds and then breathe normal for 10 to 15 seconds and do that for three to five minutes every hour or if you feel comfortable do it for five to ten minutes every hour but just to bear in mind what vicky said that when you finish the session you should feel enough energy to do the session again the breath hold exercises are the mainstay and breathing in the neck through the nose and of course the mat closed at night i will just show you that the myo tape because just in case some of you are wondering um how on earth could you get your mouth closed at night we use a tape that surrounds the mouth and it comes the name comes from myofunctional therapy so myotape it surrounds them out as so and it brings the lips together with elasticated tension and this way then people can be breathing in and out with their nose but they don't feel the apprehension of putting the tape across her lips i would also say that if for example you're overly breathless during sleep don't lie down you're you're much better off sleeping in an incline and whether you elevate the bed or whether you put pillows or something behind you or whether you sit and sleep in an armchair because if you're elevated you're breathing you'll feel a little bit more control of your breathing and if you've got labor breathing lying down can be quite taxing the next aspect is when you feel comfortable with a little bit of control of your breathing always be aware of your breathing and try not to be heaving using the upper chest and this is kind of normal when your breath hold time is so low always think of the mantra at nose slow and low you may not do it perfect but the more you can slow down your breathing the better and also the more you can breathe low and having your hands either side of your lower ribs as opposed to on your abdomen so having your hands either side of the lower ribs and as you breathe in that the ribs are moving out and as you breathe out that the ribs are moving in and it's all relative even if you can slow down your breathing a little bit it's positive even if you can reduce your breathing volume a little bit it's positive and if you can breathe a little bit lower it's positive so don't worry about getting it perfect because it's going to be relative to your both score practicing it is going to depend on your both score as well the duration three to 10 seconds maybe do about three to five minutes every hour 10 to 15 seconds or 10 to 20 seconds you could increase it five to ten minutes every hour and by doing it consistent we want to improve breathing patterns but we also want to influence the autonomic nervous system and sleep is going to be a component of that as well if you feel comfortable doing some exercises standing up when you have a higher both score go for gentle walking with your mouth closed and now what i'm going to do is just have a quick look at some questions i have a deviated uh is a recording of this yes the recording will be put up on youtube and that's why i didn't really include anybody i just kept the screen and the presentation but you will find it on youtube when i started learning how to breathe a nose that i am clenching my stomach that made it difficult to do diaphragmatic breathing so the whole aspect is to have very gentle breathing with a relaxed area around the whole tummy area should be relaxed the chest should be relaxed there is a relaxation mp3 that you can download from the buteyko clinic app and it's a 20 minute guided breathing exercise to help just to bring you into relaxation and the thing about the breath is it's not about putting in effort it's about just focusing your attention on the airflow coming in and out of your nose and just gently slowing down your breathing slowing down the breath and so it's just gentle doing it and bring in relaxation with it and the other thing is that when you are working with breathing exercises not to deliberately interfere with your breathing muscles sometimes people with perfectionist tendencies they can put in too much effort patrick can i yes can i say something yeah um it's picky again i was just gonna say if if you are new to this it is gonna feel very uncomfortable because i i think one of the things is when we when we came into covid we were probably dysfunctional breathers so not only are you learning to breathe again but you're also um and i've got brain frog but you've got you you're also um it's a difficult thing to do i'm not finding words and sorry this is so you're trying to change a habit you know you're you're trying to change old ways as well as and you know i like i can totally understand it i can even though i twitch what i haven't experienced it but i can really really get it um vicky i think we're going to draw to a close just in terms of time and i'd like you just to to have the the final words like i said um this this is gonna help and i cannot thank patrick enough because this is you know saved me um i've had some very difficult moments during ron cobit and you know it's a little and often it's going to feel strange at the beginning but you're teaching your body a new habit a new healthy way to deal with anxiety and hopefully alleviate some of your long-covered symptoms so do not overdo it take it slowly and and hopefully you will all find some um helpful movement in the right direction you know to to better help thanks so much vicki um franz i just let you in and because we're going to draw it to a close thank you uh there's just one little addition i think uh building a new habit after having breathed so not naturally i think it's just very wise to find an instructor a coach or whatever an oxygen advantage instructor to help you along this path because it's a lonely path and it's sometimes you just need someone and i think it's good when you go to the oxygen advantage site and find yourself an instructor and that's all that i wanted to add to it okay i think it's a good point as well and buteyko clinic as well um thanks very much for joining everybody i hope that's been a benefit and uh to say good evening to everybody take care bye you

Channel: Oxygen Advantage®

Views: 35,717

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Id: JG6b0C32izA

Length: 95min 38sec (5738 seconds)

Published: Wed Oct 13 2021