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Breathing Lessons for Sleep Apnea Sufferers

Proper breathing is fundamental to good health and vitality. It's also the most basic physiologic function that we must do to survive. Improper breathing can lead to illness, disease, and ultimately, death. Ancient Hindu cultures recognized this basic principle and developed very sophisticated breathing techniques that we now realize are scientifically sound when it comes to promoting optimal health, energy and life balance. These breathing concepts have spread across various continents to different cultures, but the basic fundamental principles remain the same. What Most Holistic Doctors Already Know Breathing means spirit in many languages (Hebrew, Latin, Greek, and Sanscrit), but not in English. In Latin, the word for breath and the word for soul are the masculine and feminine roots of the same root. In Greek, the two words are the same. Breathing is a natural physiologic function which continues, regardless of whether or not you notice it. It's controlled by two parts of the autonomic nervous system: the sympathetic and parasympathetic nervous systems. The sympathetic nervous system is the classic fight-or-flight half that's needed if you're in a fight or running from a tiger. The parasympathetic nervous system is the relaxation half, promoting sleep, digestion and reproduction. Inhalation is activated by the sympathetic nervous system and exhalation is activated by the parasympathetic part. When you slow down your breathing, your heart rate slows down. If you take a little longer exhaling relative to inhaling, then you're spending more time activating your parasympathetic nervous system. This is the physiologic reason why breathing techniques such as the relaxing breath is literally relaxing. These same concepts also apply to singing, humming or whistling. Notice that when you sing, you're spending up to 10 to 20 times longer exhaling relative to inhaling. By activating your vagus (parasympathetic) nerve, this is why you feel good when you sing. What Some Doctors Don't Know We all take it for granted that the physical air passageways that we breathe through is more than sufficient as conduits for air to travel into and out of our lungs. However, our upper air passageways are dynamically changing all the time, depending on your head position, weather status, allergies, emotions, moods, stress levels and even what you just had for lunch. Your nose is exquisitely sensitive to pressure or humidity changes, swelling or shrinking your internal nasal turbinates to significant degrees. Air passing through the nasal cavity is being filtered, humidified, and warmed before passing into the lungs. Any temporary or permanent blockage to proper breathing in this area can prevent optimal airflow into the lungs. In addition, the nose and sinus cavities make a gas called nitric oxide, which has two important beneficial properties. The first property is that nitric oxide is antimicrobial, both in the nose as well as in the lungs. This gas, when inhaled even in small amounts into the lungs, can increase oxygen absorption up to 20%. Not breathing through your nose for whatever reason has potentially detrimental effects on your health. What Most Doctors Don't Know Everyone in the Western, alternative and complementary fields of healing naturally assume that we are able to breathe properly at night. We now know that there are certain medical conditions such as sleep apnea where you have complete obstruction and repeated bouts of oxygen deprivation. Most practitioners still think that this typically occurs in some people who are overweight, snore, and have big necks. But now we know that even young, thin women who don't snore can have significant obstructive sleep apnea. Even more, many people who don't officially meet the criteria for obstructive sleep apnea still can have significant breathing pauses but wake up too quickly to be classified as an apnea. These are the patients that are commonly diagnosed with idiopathic hypersomnia. However, the bigger issue is that by definition, all modern humans are susceptible to breathing problems at night for the following reason: Due to jaw narrowing and dental crowding from a radical change in our diets, our tongues take up relatively too much space, and as a result, we're more susceptible to obstructing the airway when sleeping on our backs (supine) and in deep sleep due to muscle relaxation. In his classic nutritional text, Nutrition and Physical Degeneration, Dr. Weston Price documented these physical changes. Our ability to talk also positioned our voice boxes below the tongue, which can aggravate this process. Many modern humans can't sleep on our backs anymore since the tongue and voice box falls back the most in the back position. As a result, we compensate by sleeping only on our sides or stomachs. The problem is that it's not good enough. A simple cold or an allergy attack, or with even 5 to 10 pounds of weight gain, can cause more frequent obstructions occur, leading to less efficient sleep. Less efficient sleep leads to a physiologic stress response that can cause or aggravate a number of various medical conditions such as anxiety, depression, insomnia, cold hands, digestive problems, high blood pressure, etc. What I describe in my sleep-breathing paradigm is that all modern humans are on a continuum, where the one extreme end is called obstructive sleep apnea. The rest of us are lower down, but we creep up during various life stages, such as puberty, pregnancy, and menopause. A simple cold, by causing nasal congestion in a young, healthy woman, can cause her to toss and turn at night, due to repeated tongue collapse. Once the cold improves, sleep improves as well. What We All Must Know Breathing should never be taken for granted. We must do everything to make sure that proper breathing occurs not only during the day, but also at night. Many younger, thinner patients who complain of being tired all the time will also be found to have hypothyroidism, anemia, cold hands and feet, low blood pressure, anxiety, depression, or other various disorders. Later in life, as they slowly gain weight, they move up the continuum, and eventually will go into obstructive sleep apnea. Almost invariably, one or both parents will snore and have known or unknown cardiovascular disease. If you see a high-arched hard palate, an extra small mouth or a recessed jaw, or scalloping on the side of the tongue, ask about sleep position, fatigue issues, and sleep. You'll be surprised how often all these features come together to explain your chronic fatigue and various health problems.

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To hear Dr. Park's interview with master Yoga teacher and Feldenkrais expert on the proper principles of breathing for better health and better sleep, click here.

Attention All Mouth Breathers – 5 Important Reasons Why You Must Breathe Through Your Nose

If you’re a chronic mouth breather because of a stuffy nose, you’re not alone. As the weather chills and allergies and colds abound, and nasal congestion becomes a common trend, mouth breathing inevitably follows-especially when you’re sleeping. I’m sure you’ve seen many passengers asleep on the subways and trains, head and pitched back, mouth wide open, and snoring louder than a diesel engine. Mouth breathing can surely ruin your social image, but that’s nothing compared to the havoc it can wreak on your health.

 

5 Potent Benefits of Breathing through Your nose

One of the most important reasons to breathe through your nose is because of a gas called nitric oxide that’s made by your nose and sinus mucous membranes. This gas is produced in small amounts, but when inhaled into the lungs, it significantly enhances your lung’s capacity to absorb oxygen, increasing oxygen absorption in your lungs by 10-25%. Nitric oxide also can kill bacteria, viruses and other germs. This is why you often hear fitness and yoga instructors emphasize inhaling and exhaling through your nose during workouts.

Also, if you can’t breathe well through your nose, your sense of smell will suffer and therefore your sense of taste, since your smell and taste buds are connected. This can lead to disturbances in your appetite and satiation levels, wreaking havoc on those struggling with weight issues.

Your nose also has vital nervous system connections to your lungs and heart. Not breathing well through your nose can alter your heart rate and blood pressure, as well as increase your stress responses.

Your nose makes about 2 pints of mucous every day. If your nose isn’t working properly and mucous isn’t cleared, the stagnant mucous can lead to infections such as sinusitis or ear infections, not to mention bad breath.

Lastly, not breathing well through your nose can aggravate snoring or obstructive sleep apnea. Nasal congestion alone doesn’t cause obstructive sleep apnea, but it can definitely aggravate it. If your palate and tongue structures are predisposed to falling back easily due to sleeping on your back and muscle relaxation in deep sleep, then having a stuffy nose can aggravate further collapse downstream. Untreated obstructive sleep apnea can lead to chronic fatigue, depression, anxiety, weight gain, high blood pressure, heart disease, heart attack and stroke.

Knowing all these benefits of breathing through your nose, however, doesn’t help much if you don’t know why you’re not able to do so.  To stop mouth breathing, the first thing you must do is to figure out what’s blocking up your nose.

What Can Stop Up Your Nose

Nasal congestion is something everyone experiences now and again. Yet, if you’re trying to prevent this from happening it’s important to explore the various reasons behind why and when this occurs.

Here are five of the most common reasons for a stuffy nose:

"I Have a Deviated Septum"

By definition everyone has a slightly crooked (deviated) nasal septum. There are various reasons for having a deviated septum, including trauma, but the most common reason is no reason at all. It’s just the way your nose developed. What’s more important than how deviated your septum is is what’s happening in front of an around your septum.

Wings in Your Nose

Turbinates are wing-like structures that attach to the sidewalls of the nasal cavity, opposite the midline nasal septum. They normally smooth, warm, humidify, and filter the air that you breathe, but they also become enlarged and produce mucous when inflamed. Turbinates also swell and shrink alternating from side to side, which is a normal neurologic process called the nasal cycle.

Is It An Infection or Allergies?

If you have allergies, a cold or any kind of infection, then your turbinates will swell up, clogging your nose with lots of mucous production. Contrary to popular belief, the color of the mucous has no relation to bacterial vs. viral infections.

Flimsy Nostrils

Once you have inflammation and swelling inside your nose, for some people, depending on the configuration of your nose, your nostrils can literally cave in as you inhale. Different noses have differently shaped nostrils with various nostril thicknesses. The more narrow your nose, the more likely your nostrils can cave in. People who undergo cosmetic rhinoplasty are more at risk years later, since narrowing the nose can weaken the support structures of the nose.

A Nervous Nose?

Some people’s noses are extra sensitive, especially to weather changes, like temperature, humidity, and pressure changes. Certain chemicals, scents and odors can set off a reaction as well. Many people mistakenly think this reaction is an allergy, but it’s really your nasal nervous system over-reacting to the weather or to odors. One of the most common reasons is from poor quality sleep, which causes a low-grade stress response, which can heighten your senses.

It’s All Under Your Nose

A chronically stuffy nose doesn’t happen by itself. Usually it’s part of a bigger picture, where the entire upper and lower jaws are more narrow and constricted, in addition to more narrow nasal cavities. I’ve described this process in my book, Sleep Interrupted, where due to modern human’s eating soft, mushy, processed foods, our jaws are much more narrow than normal, with dental crowding. Bottle-feeding, which is another modern, Western phenomenon, is also thought to aggravate this problem.

If you have a stuffy nose, it can also aggravate soft palate and tongue collapse when in deep sleep, due to muscle relaxation. With more obstruction, more stomach juices are suctioned up into the throat and nose, causing more swelling and more nasal congestion. All this from smaller and more narrow jaws.
 

Long-term Nasal Saline Irrigation: Helpful or Harmful?

For many people with obstructive sleep apnea, nasal congestion and chronic sinus infections are a common problem. Nasal irrigation with saline is a natural way of clearing nasal and sinus passageways. The Neti-Pot is a yogic variation of saline irrigation that became much more popular after Oprah’s recommendation. Many of my patients that have tried this method report good results, with better breathing and less sinus pressure and headaches.

 

A recent study showed that contrary to popular belief, irrigating the nose on a daily basis over a long-tern period may actually make things worse. Researchers studied 68 people who used nasal saline irrigation every day for one year. In those that stopped after one year, 62% had a significant drop-off in the number of infections, compared with those that continued irrigating their noses. 

 

The authors of the study proposed that the likely reason for this finding is that frequent irrigation depletes nasal mucous, which contains several important defense mechanisms, including antibodies, lactoferrin, and lysozyme. It’s also known that the nose produces nitric oxide, which also has antimicrobial properties. 

 

These results are a bit conflicting with what many of my patients report, but there may be some good reasons to follow their recommendations. Besides the reasons mentioned above, saline acts as a mild decongestant, which is similar to the over-the-counter decongestant, Afrin, but not as strong. This is why you can breathe better after irrigation. One of the reasons why you can’t use Afrin for more than 3 days is because of the rebound effect, where after the medicine wears off, your nose gets stuffy again, making you use it more and more frequently. Nasal saline, although not as bad as Afrin, also has a mild rebound effect. This is why some people use it 2 to 4 times every day.

 

It’s also been shown that if the salt concentration is a bit saltier than your nasal membranes’ concentration, the cilia that help to move the mucous blanket down into your throat become paralyzed.

 

If used for short-term periods, such as during an acute sinus infection, it can be useful (just like Afrin), but this study’s result shows that long-term use may be more harmful.

 

My feeling is that if you feel better and you don’t get as many infections, keep doing it. After a few weeks or months, you can experiment by stopping the irrigation and see what happens. 

 

Since this study didn’t look at cultures or x-rays, there’s no proof that these were true bacterial infections. Recent studies also show that the vast majority of what may feel like sinus infections are actually a variation of a migraine headache. Furthermore, it’s been shown that nasal saline doesn’t really go into your sinus passageways. It works by decongesting your nasal passageways, which indirectly opens the passageways to your sinuses.

 

Do you irrigate your nose with nasal saline every day? If so, for how long? Are you having less sinus "infections" as a result of irrigating on a regular basis? Please enter your answers in the comments box below.

The Hidden Truth About Allergies Revealed

Everyone knows that allergies cause sneezing, itchy, watery eyes, and nasal congestion and that for some people these symptoms can be more severe than for others. For these people allergies can feel like a curse, making them feel sleepy, irritable and downright miserable. There are many medical explanations for allergies, including the theory that the body is overreacting to the typical allergens.

But there’s one other reason why some people with allergies are more affected than others, and this has to do with their jaw size. If you had normal-sized jaw anatomy, then it’s less likely an allergy attack would bother you; in fact, it’s less likely you’ll even have allergies in the first place. Let me explain.

Why Your Jaw Size Matters

If you have smaller than normal jaws, it means that there’s less space for your tongue, so it takes up relatively too much space, especially when you’re on your back due to gravity. Even worse, whenever you’re in deep sleep, due to muscle relaxation, you’ll stop breathing to wake up and turn over. During these breathing pauses, a vacuum effect is created temporarily, which literally suctions up your normal stomach juices into your throat and nose. It’s been shown that stomach bacteria and digestive enzymes can be found in sinus and lung washings. This leads to inefficient sleep, which eventually makes your nervous system and immune system overactive.

This is why it’s important to avoid eating too close to bedtime. The more juices you have in your stomach, the more it’ll come up and cause nasal inflammation. And since alcohol is a strong muscle relaxant, indulging in a glass of wine before bedtime can make you stop breathing more often and cause more stomach juices to come up into your throat, in addition to heightening your immune and nervous systems.

What You May Not Know Will Surprise You

Sometimes, what seems to be allergy symptoms may not be related to allergies at all. Whether or not your allergy testing is positive, you may be suffering from non-allergic rhinitis or chronic rhinitis, which is linked to sleep breathing problems or silent acid reflux (LPRD). With non-allergenic rhinitis, your nose becomes sensitive to temperature, pressure, humidity changes, chemicals, odors, and emotions. Non-allergic rhinitis responds somewhat to allergy medications, so you may think you have an allergy problem.

One of the most under-appreciated things that most allergy sufferers (and doctors) don’t think about is getting a good night’s sleep. It’s been shown that lack of quality (or quantity of) sleep can adversely affect your immune system through the following mechanism: a low-grade physiologic stress response is created which heightens your immune system, making it over-react to common pollens or other allergens. (The same process occurs with your nervous system, too). So how does this relate to allergies?

Hay Fever Defined

Hay fever (or allergic rhinitis) results in congestion, sneezing, runny nose, irritated eyes and other annoying symptoms for more than 35 million Americans every year. It occurs when your body has an allergic reaction to something in your environment. During this time of the year, ragweed is the most common cause of hay fever, though mold, pet dander, dust mites and cockroaches can also cause allergies year-round.

When your body comes in contact with these allergens, your immune system kicks into overdrive. At the initial allergen exposure, the body creates an antibody called immunoglobulin (IgE), which rests on a type of white blood cells called mast cells. After repeated exposure to the same allergen, a massive release of histamines and other inflammatory mediators occurs. The end result—runny nose, watery eyes and sneezing.

When Allergies Cause You Misery

Obviously, a little sneezing and congestion never hurt anyone. For most people, these symptoms are no more than a mere nuisance and most can get by without any medications or for others, simple over-the-counter medications (see chart). However, some people with allergies feel completely miserable, with poor sleep and severe daytime fatigue.

As I alluded to in my book Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired, anything that causes swelling or inflammation in your nose or throat can set off a vicious cycle where due to narrowing of the upper air passageways, the soft tissues of the throat (palate and/or the tongue) start to obstruct your breathing, which creates a vacuum effect in your throat that suctions up normal stomach juices into your throat. This causes more swelling and inflammation in your throat and nose, aggravating this self-perpetuating cycle.

Steps You Can Take

During allergy seasons (trees during the spring, ragweed during the fall, molds all year round), there are a number of conservative step you can take to lessen your symptoms, to more formal medical treatments:

● Stay indoors during high pollen counts with air conditioning (check pollen counts on pollen.com)

● Wash your hair before going to bed if you’ve been outdoors during the day. You don’t want to rub your face on your pollen-contaminated pillow all night long

● Most plants release pollens in the early morning, so if possible stay indoors until after 10AM. Pollen and molds can also be high in the late afternoon and early evening hours

● Wash your bedding every week in very hot water

●Invest in allergy-free bedding (if you’re allergic to dust mites)

● Try the Asian custom of taking off your shoes before entering your living spaces. Think about all the microscopic dust, pollen, molds and dirt that get tracked into your house, where your toddler is crawling on.

● Invest in a HEPA filter for your bedroom

● Keep pets out of the bedroom

● Remove rug or carpeting from the bedroom

● Finish eating at least 3-4 hours before bedtime

● Avoid alcohol within 3-4 hours of bedtime

● Regularly practice yoga, breathing, tai chi, or some form rhythmic meditative breathing (which also includes swimming).

A few natural and/or herbal remedies include:

● Regular irrigation with nasal saline. There are many options, including a Neti-pot, saline sprays, mists, pumps and squeeze bottles. The key is to find something you’re comfortable with that you’ll use every day. ●

Butterbur and stinging nettle extracts are two herbs that have anti-allergy properties. You can find them at any health food store or order them online. If the above conservative options are not good enough, you can try any of these over-the-counter allergy medications:

● Loratadine (brand name Claritin, Allavert, etc.) or Zyrtec. Zyrtec is stronger, but has a slightly higher chance of making you drowsy. If you take it regularly at night before you got to bed, this any potential drowsiness won’t be an issue and this effect wears off after a few days. ● Diphenhydramine (Benadryl). This is an older, stronger antihistamine, which can definitely make you drowsy. It’s also used to severe allergic reactions and rashes.

● Oxymetazoline (Afrin) can be used for severe nasal congestion only occasionally and should be used no more than 2-3 days at a time.

If you also have nasal congestion, then you can get the "-D" version of the various antihistamines. The D stands for decongestant, which is usually an oral version of phenylephrine or pseudo-ephedrine. This can sometimes be stimulating, so if you’re sensitive to these medications, don’t take it just before bedtime. If you have high blood pressure or a heart condition, talk to your medical doctor before taking these specific medications.

There are a number of prescription medications for allergy: Allegra (which should be coming out over-the-counter soon), nasal steroid sprays (Flonase, Nasonex, Rhinocort, Nasacort, Veramyst), and Singulair. Astelin is an antihistamine nasal spray. Different people respond differently to each of these medications, so it’s important to talk to your doctor about which one may be right for you. My preference for moderate to severe allergies is to use one of the topical nasal steroid sprays on a regular basis, since it works much better at preventing allergies, as well as treating it. In general, these sprays are not absorbed into the body in significant amounts and can be used for long periods.

Allergy shots (immunotherapy) are another option that you may want to consider if your allergies don’t respond to medications or if you don’t want to depend on medications as much. With immunotherapy, the sufferer receives regular injections of purified allergen extracts for between two to five years. The goal of immunotherapy is to rewire the immune system so it no longer overacts to allergens and causes hay fever.

Putting It All Together

If you have an underlying sleep-breathing problem such as obstructive sleep apnea or upper airway resistance syndrome (most people to some degree—I explain why in my book, Sleep, Interrupted), then it’s likely that you’ll have some kind of allergies or nonallergic rhinitis, whether mild or severe. Not only will your nose be overly sensitive to allergens or weather changes, it can also be irritated by your stomach juices.

This process supports observations that children who were bottle-fed as infants have higher rates of allergies later as children. It’s been suggested that bottle-feeding promotes jaw narrowing and dental crowding, which leads to smaller airways. This occurs despite the protective effects of the mother’s antibodies in breast milk, since it may be given in a bottle. So the next time you suffer from seasonal allergies or even year-round allergies, resist the temptation to simply take a pill. Go down the list of conservative options I’ve outlined, and most importantly, optimize your sleep quality. Any activity that’s calming and relaxing to your nervous system (yoga, breathing exercises, tai chi, swimming) can also help to alleviate your symptoms. Many of you will be surprised to find that conservative and simple lifestyle changes can lead to many more allergy-free, symptom-free days.

The Deviated Septum Myth

Dr. Park debunks one of the most common myths about the nose.

The Deviated Septum Myth

Do You Have Flimsy Nostrils?

Is your nose stuffy all the time? Dr. Steven Park describes a commonly missed condition that may explain the reason for your chronically stuffy nose.

My First Apnea?

Dr. Mack Jones suggested that I get tested for sleep apnea in response to my last post about feeling depressed all last week from what I thought was the gloomy weather. He may have a point here. Last week, as I was dozing off to sleep, my wife did mention that I stopped breathing suddenly and started breathing again after a short snort. I vaguely remember it happening. It was also a time when my nose was a little stuffy. Technically, this wasn’t an apnea, since it lasted only a brief second or two. On a sleep study, it would be classified as a respiratory event related arousal (RERA).

 

Having just passed my 42nd birthday, I’ve come to terms with the fact that this was bound to happen eventually. I’ve said again and again that all modern humans are susceptible to breathing problems while sleeping, and I’m no exception. The only comfort I take is the fact that I did undergo a sleep study many years ago to see what it was like, and it revealed an AHI of 1, which is considered "within normal limits."  It did show that I had some mild disruptions in my deep sleep stages. I suspect it may creep up slowly as I get older. Fortunately, my weight has not changed—if anything, it’s gone down since I began running regularly. 

 

More recently, I’ve been sleeping well, and my energy level is pretty good, despite that fact that our 5 month old has been up at night repeatedly due to teething.

 

There’s now even more reason for me to follow the advice I give to my patients: don’t eat late, exercise regularly, keep your nose clear, and don’t sleep on your back. The one thing I’ll have to work on is to try sleeping more on my side since that brief obstructive episode happened while I was on my back. I’ll keep you posted.

5 Simple Ways You Can Sleep Better While Traveling

There are many resources available regarding tips for travel while on vacation, but one thing that can definitely ruin your vacation is poor sleep. You may never think that you will suffer from sleeping problem until it happens, and by then, it’s too late. Besides the various stresses of travel, including delayed flights, misplaced luggage, or traveling with children, the last thing you need is to lay down in your hotel bed, and start tossing and turning, unable to sleep. If you are a poor sleeper to begin with and especially if you normally can’t sleep on your back, then the following travel tips could prevent your vacation from turning into a disaster.

 

 

 

7 Tips to Breathe Better Through Your Nose

Most people take breathing through their nose for granted. But for many chronic mouth breathers, breathing through the nose is a struggle, if not impossible. Not only is their quality of life diminished, but they’ll also have a variety of other health-related conditions such as dry mouth, snoring, fatigue, and poor sleep. In my last article I addressed 5 reasons why it’s important to breathe through your nose. In this article, I’ll talk about 7 ways that you can breathe better through your nose naturally. 

Before I discuss the various ways to breathe better, a short anatomy course in in order. The nasal septum is a thin piece of cartilage and bone that splits your nasal cavity right down the middle. No one has a perfectly straight septum; everyone’s septum is slightly curved. Sometimes, nasal trauma can shift or move the septum away from its’ midline position. The nasal turbinates are wing-like structures that line the sidewalls of your nose. It’s covered with a mucous membrane, and normally it helps to smooth, warm and humidify air. The turbinates and sinuses also produce about 2 pints of mucous every day. The turbinates swell and shrink, alternating from side to side every few hours. This is called the nasal cycle. 

The front side walls make up your nostrils, which are soft cartilages covered on the inside and outside with skin. The back of your nose is one big cavity (called the nasopharynx), and the passageway turns down 90 degrees into the back of your throat. The nasopharynx is also where your ears connect via the Eustachian tubes. 

If any part of the anatomy that I described becomes obstructed partially or completely, you’ll feel stuffy in your nose. Usually it’s not one thing, but usually due to a combination of different reasons. For example, if you have a mildly deviated septum, suffering from mild allergies will swell up your nasal turbinates, narrowing you nasal passageways. This may not be enough to clog up your nose, but if you have flimsy nostrils or had rhinoplasty in the past that weakened the nostrils, then breathing in with a stuffy nose may trigger your nostrils to collapse. 

Starting from the tip of your nose, the first thing you must do is to find out if you have flimsy nostrils. If you have a very narrow nose, or if your nostril openings are very narrow and slit-like, then you may be prone to having flimsy nostrils. Try this experiment: Take both index fingers and press them just besides your nostrils on your cheek. While firmly pressing on your cheeks, lift the cheek skin upwards and sideways, pointing towards the outer corners of your eyes. Take a deep breath in. Can you breathe much better through your nose? Let go and try it again. If this maneuver works for you, you may benefit from using nasal dilator strips at night (one brand is called Breathe-Rite). Sometimes, the adhesives on these devices are not strong enough, or end up irritating the skin. Another way of treating this condition are various internal dilators (such as Nozovent, Breathewitheez, Nasal cones) that you can find over the counter or over the internet. 

Second, try using nasal saline sprays. You can use the simple spray bottles that put out a fine mist, to more sophisticated methods such as aerosol cans or even using a Water-pik machine (there’s a nasal adaptor that you can buy for this). Another popular variation is something called a Nedi-pot, which uses gravity to pour salt water into your nose and sinuses. You can either use prepared saline packages, or mix your own recipe (one cup of lukewarm water and 1/2 teaspoon of sea salt or Kosher salt with a pinch of baking soda). Whatever method you use, you’ll have to do it frequently to get maximum results. Besides cleansing out mucous, pollutants and allergens, saline also acts as a mild decongestant. 

Third, try not to eat anything within three hours of going to bed. If you still have food or juices lingering in your stomach when you go to bed, it can leak up passively into your throat and not only prevent a good night’s sleep, but these same juices can also leak up into your nose, causing swelling and inflammation. In addition, many people will also stop breathing once in a while, which creates a vacuum effect in the throat which actively suctions up your stomach juices into your throat and nose. 

Fourth, try to avoid drinking alcohol close to bedtime. Not only does alcohol irritate the stomach, it also relaxes your throat muscles as you sleep, which aggravates the process described in the previous paragraph. 

Fifth, if you have any known allergies, especially if it’s something in your bedroom, try to either remove it or or lessen your exposure to it. For example, many people are allergic to dust or molds, and if you have carpeting, or an area rug, it can harbor these allergens. Frequently washing your bed sheets in very hot water also helps. Investing in a quality HEPA filter should help even more. If you have any pets, consider keeping them out of your bedroom. If conservative measure to control allergies is not good enough, consider seeing an allergist for a more formal evaluation. 

Sixth, get regular exercise, especially outdoors. Not only are you exercising your heart and your muscles, you’re also exercising the nervous system in your nose. Vigorous physical activity activates your sympathetic nervous system, which constricts the blood vessels that supply your nasal turbinates. This allows you to breathe better through your nose, with all the added benefits described in my previous article. 

Lastly, slow down and relax. Modern society has removed all the natural built-in breaks throughout the day. Along with all the information overload and constant stimulation, going nonstop all day only adds to the increased stress levels that everyone experiences. In between major activities, take a minute or so to stop what you’re doing and stretch, get up and move around, and do some deep-breathing exercises. Stress can tense up the muscles, causing you to breathe shallower, which causes physiologic changes that can ultimately aggravate nasal congestion. 

These simple 7 steps won’t help everyone, but If you can go down the list and apply all the steps, many if not most of you should feel some improvement in your ability to breathe through your nose. If you’ve tried all these steps and still can’t breathe through your nose, then seek medial help. An otolaryngologist (an ear, nose and throat doctor) is the best doctor to take care of this condition. 

If you are a chronic mouth breather, in addition to what I described above, your jaw is probably more narrow than normal, with some degree of dental crowding. Chronic mouth breathers also tend not to sleep well at night due to various degrees of breathing difficulty. I discuss these issues in my other articles (sleep apnea and upper airway resistance syndrome). 

 

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