To Breathe, or Not to Breathe, That is the Question: The Face Mask Controversy

I couldn’t understand why my head was throbbing. I wasn’t feeling well at all. There was no fever or any other signs or symptoms of an infection. I had eaten a healthy dinner before starting my 12-hour overnight shift in the ICU. 

It was 3 AM, and my four patients were relatively stable. I decided to go to the break room to eat a snack. A few minutes after taking off my N95 mask, my headache went away completely. I felt my scalp with my fingers and noticed two deep crevices where the tight elastic bands had left their marks. The mask had clearly cut off blood flow to my scalp.

After returning to the nursing station in front of my patients, I noticed that I was more clear-headed and less anxious. The few minutes of escape from my mask with unrestricted blood flow to my scalp and normal breathing without a mask was liberating.

The Face Mask Controversy

During the past few months of the coronavirus pandemic, there have been a number of recommendations by The World Health Organization (WHO) and the US Centers for Disease Control (CDC) that have been reversed, or even contradictory. The recommendation for using a face-mask is one of such guidelines, with conflicting studies, changing recommendations, and even a study publication retraction. 

Several studies from past pandemics as well as recent ones suggest that using a face mask (non-N95) may lower the rate of virus transmission. Other studies have refuted such findings. However, I am not going to address whether or not face masks can potentially reduce infections. There are so many variables that affect rates of transmission, I don’t think there ever will be a definitive answer. What I wish to focus on in this blog article are the documented side-effects of using a face mask.

Comparing Apples to Oranges

In contrast to rigorously controlled research studies, regular people who wear face masks us a variety of different masks. There are countless other variables, such as the fit, facial shapes and sizes, mask materials, and even your ability to breathe normally without a mask. To ask whether or not a face mask works is not the right question. What we should be asking is, to what degree does a specific type of mask, if worn and used properly, offer protection from transmitting or being infected with the coronavirus, compared to the potential side effects. Just like any prescription medication, there are side effects. Some people will have more side effects than others.

Known Complications of Face Mask Use

Any type of mask or covering over your nose and mouth produces resistance to breathing in both directions. The higher the resistance, the more the potential for side effects. The N95 respirators have the highest level of resistance, which is necessary to filter out 95% of small particles the size of the coronavirus. Cloth masks have the least resistance to airflow, thus being the most comfortable of all the different options. 

However, partially restricting your airflow during breathing can potentially cause several different problems (to various degrees depending on the amount of airflow resistance):

  1. Retention of carbon dioxide (CO2). When you breathe out, CO2 is exhaled. Your normal breathing process is an intricate balance between breathing volume, respiratory rate, breathing pathways (nose vs. mouth), and airflow processing by the nose (filtration, humidity, warming, etc.). This has profound effects on respiratory physiology and acid-base (pH) balance. One study found that CO2 levels can increase, but only to a mild degree.
  2. This study revealed that using an N95 mask for 3 hours resulted in nasal congestion.
  3. Increased rates of headaches were found in users of N95 respirators, leading to lower levels of optimal usage. This is what I experienced.
  4. Surgical masks lower 6-minute walking test performance.
  5. Surgical masks were found to increase heart rate and lower oxygen levels in surgeons, although to a small degree.
  6. Surgical masks are designed to be used for short-term periods—a few hours at most. They are also disposable. Prolonged use will cause higher moisture levels with increasing degrees of bacterial overgrowth.

Masks Can Make Things Worse For Certain People

For certain populations, such as people with COPD, claustrophobia, and nasal congestion, using a face mask may cause more problems. For example, if you are normally a mouth breather, your breathing patterns are already not optimal, since bypassing the nose leads to lower levels of nitric oxide. This gas is made in the sinuses, and when inhaled into the lungs, increases oxygen uptake by 10%. It also has documented anti-viral, anti-bacterial, and anti-fungal properties. This study found that Nitric oxide lowered SARS Coronavirus replication by 82%.

To Breathe or Not to Breathe is Not the Right Question

To be honest, any one of the potential side effects from mask usage may not cause significant problems, but multiple issues along with pre-existing medical (COPD, claustrophobia) or anatomic problems (deviated nasal septum) is likely to alter your ability to focus, energy levels, or productivity. Not to mention the negative psychological and relational consequences of having to use a mask all the time.

I argue in my book Sleep, Interrupted that most modern humans are already compromised in our ability to breathe normally through our noses, and especially through our throats at night. As a society, we have forgotten the art and science of how to breathe optimally. Being forced to use facemasks for long periods only worsens this problem. 

Please note: I reserve the right to delete comments that are offensive or off-topic.

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