Interview with Patrick McKeown, one of the top teachers of the Buteyko method

McKeown leads a group demonstration of proper breathing, summarized as follows:

• Place one hand on your upper chest and the other on your belly; feel your belly move slightly in and out with each breath, while your chest remains unmoving.

• Close your mouth and breathe in and out through your nose. Focus your attention on the cold air coming into your nose and the slightly warmer air leaving it on the out breath.

• Slowly decrease the volume of each breath, to the point it feels like you’re almost not breathing at all (you’ll notice your breath getting very quiet at this point). The crucial thing here is to develop a slight air hunger. This simply means there’s a slight accumulation of carbon dioxide in your blood, which signals your brain to breathe.

After three or four minutes of air hunger, you’ll start experiencing the beneficial effects of CO2 accumulation, such as an increase in body temperature and an increase in saliva. The former is a sign of improved blood circulation; the latter a sign that your parasympathetic nervous system has been activated, which is important for stress reduction.

When you’re breathing properly, your breath will be so soft, quiet and light. It will not be visibly or audibly noticeable. By slowing down the speed of your breathing to the point where the hairs in your nose barely move, you can more easily enter into a calm, meditative state. Breathe less air into your lungs than what you were breathing before you started the exercise.

The air shortage should be tolerable and not at all stressful. If the air shortage is too much, take a break from the exercise for 15 seconds or so before resuming to it again. This type of breathing will also help lower your blood pressure, and can be a useful technique to address hypertension without drugs. You may also notice that you have less nasal congestion, allowing for easier breathing.

Breathing Exercise to Quell Panic Attacks and Anxiety

Another breathing exercise that can help if you’re experiencing anxiety or panic attacks, or if you feel very stressed and your mind can’t stop racing, is the following. This sequence helps retain and gently accumulate CO2, leading to calmer breathing and reduced anxiety. In other words, the urge to breathe will decline as you go into a more relaxed state.

  • Take a small breath into your nose, a small breath out; hold your nose for five seconds in order to hold your breath, and then release to resume breathing.
  • Breathe normally for 10 seconds.
  • Repeat the sequence several more times: small breath in through your nose, small breath out; hold your breath for five seconds, then let go and breathe normally for 10 seconds.

The Impact of Breathing on Sports Performance

The way you breathe also affects your heart. Typically, athletes who experience cardiac arrest or heart attacks are in prime physical condition and do not fit the model of someone with a heart problem. However, athletes do tend to breathe very heavily, for obvious reasons, and this alone can trigger a chain of events that could lead to cardiac arrest.

The loss of CO2 from heavy breathing constricts your blood vessels, causing reduced blood flow to your heart. As a result, oxygen delivery is reduced, and your heart requires oxygen for proper performance. Arrhythmia can occur when there’s insufficient blood flow and insufficient oxygen. Arrhythmia is when your pulse increases too much, causing it to become chaotic. In severe cases, the heart may stop.

While it may seem a bit counterintuitive to restrict breathing during physical exertion, this may actually be beneficial in a number of ways. According to McKeown:

“When you subject your body to a reduced concentration of oxygen, as is the case during high altitude training … you’re going into anaerobic metabolism, so you’re working without air. Your oxygen partial pressure is dropping to below normal.

Breath holding after an exhalation causes a decrease to the concentration of oxygen to trigger increased lactic acid. At the same time, carbon dioxide also increases leading to an increased concentration of hydrogen ions to further acidify the blood. Repeated exposure to increased acidosis- forces the body to adapt to it.

To neutralize hydrogen ions, the bodies buffering capacity improves which delays the onset of fatigue to improve anaerobic capacity. This allows athletes to continue to exercise longer or at a higher intensity for a given distance.13 Your spleen, which is an organ located just under your diaphragm (it’s basically your blood bank), contains about 8 percent of the total red blood cell count.

But if you’re doing altitude training or involving breath holding during exercise, the arterial saturation of oxygen is dropping. The spleen will sense this drop of oxygen, so it will release more red blood cells into circulation.

Another factor is that your kidneys, during high altitude training and during breath-hold exercise, become slightly hypoxic; there’s reduced oxygen in the blood. In response to that, your kidneys will synthesize a hormone called EPO, which stimulates the maturation of red blood cells in your bone marrow.

Finally, the diaphragm and other respiratory muscles may become exhausted during both short-term, high intensity exercise and more prolonged exercise such as marathon running. Holding the breath after an exhalation until a medium-to-strong need for air mobilizes the diaphragm, providing it with a workout and helping to strengthen it. A recent study involving elite athletes found that breath holding improved inspiratory muscle strength values by 14.9 percent.14

So, the benefits of incorporating breath-holding into walking, for instance, will lead to improved anaerobic capacity and respiratory muscle strength, along with improved oxygen-carrying capacity in red blood cells. We’ve heard of many athletes who have to do this unethically and illegally. But we should really tap into our body’s natural resource, because our body has everything that we need, if we know how to guide it.”

The Basic Buteyko Self-Test

Dr. Konstantin Buteyko developed a simple self-test for estimating your CO2 tolerance. He found that the level of CO2 in your lungs correlates to your ability to hold your breath after normal exhalation. Studies involving patients with cystic fibrosis and asthma have confirmed that the lower your breath-hold time, i.e. the amount of time you can hold your breath, the heavier you breathe in general.15,16,17,18 You can use a stopwatch or simply count the number of seconds to yourself. To do this test:

  • Sit straight without crossing your legs and breathe comfortably and steadily.
  • Take a small, silent breath in and out through your nose. After exhaling, pinch your nose to keep air from entering.
  • Start your stopwatch and hold your breath until you feel the first definite desire to breathe.
  • When you feel the first urge to breathe, resume breathing and note the time. The urge to breathe may come in the form of involuntary movements of your breathing muscles, or your belly may jerk or your throat may contract. Your inhalation should be calm and controlled, through your nose. If you feel like you must take a big breath, then you held your breath too long.

The time you just measured is called the “control pause” or CP, which reflects your body’s CO2 tolerance. Short CP times correlate with chronically depleted CO2 levels. Here’s what your CP time can tell you about your health and fitness:

  • CP 40 to 60 seconds: Indicates a normal, healthy breathing pattern and excellent physical endurance.
  • CP 20 to 40 seconds: Indicates mild breathing impairment, moderate tolerance to physical exercise and potential for health problems in the future (most folks fall into this category).
  • CP 10 to 20 seconds: Indicates significant breathing impairment and poor tolerance to physical exercise; nasal breath training and lifestyle modifications are recommended (potential areas are poor diet, overweight, excess stress, excess alcohol, etc.).
  • CP under 10 seconds: Serious breathing impairment, very poor exercise tolerance and chronic health problems; Buteyko recommends consulting a Buteyko practitioner for assistance.

How to Practice Buteyko Breathing Daily

The good news is you can improve your CP time by regularly performing the breathing method outlined below. For a demonstration, see the above video. For each five-second increase in CP, you will feel better and improve your exercise endurance.

While this exercise is perfectly safe for the vast majority of people, if you have any cardiac problems, high blood pressure, are pregnant, have type 1 diabetes, panic attacks or any serious health concern, then please do not hold your breath beyond the first urges to breathe. The following exercise is also very effective for decongesting your nose in just a few minutes:

  • Sit up straight.
  • Take a small breath in through your nose and a small breath out. If your nose is quite blocked, take a tiny breath in through the corner of your mouth.
  • Pinch your nose with your fingers and hold your breath. Keep your mouth closed.
  • Gently nod your head or sway your body until you feel that you cannot hold your breath any longer.
  • When you need to breathe in, let go of your nose and breathe gently through it, in and out, with your mouth closed.
  • Calm your breathing as soon as possible.

Repeat this exercise several times in succession, waiting about 30 to 60 seconds in between rounds. Be sure to do it on a regular basis, ideally daily. The fastest way to increase your CP is by learning to be mindful of your breathing on a moment-to-moment basis:

  • Always keep your mouth closed for breathing, even during exertion. If you’re exercising or exerting yourself to the point you have to open your mouth to gasp for air, slow down and avoid exerting yourself beyond the point where you can no longer breathe through your nose. This will help you avoid the hazards associated with overbreathing during exercise, such as doing damage to your heart.
  • Even when you breathe through your nose, try to breathe more lightly than you normally do; you should not be able to see your breathing in your chest or abdomen.
  • Control your breathing all of the time, especially in stressful situations.

Additional Resources

According to McKeown, most dysfunctional breathing patterns are rooted in the modern lifestyle. Contributing factors include:

Addressing these issues can also be helpful if you struggle with chronic overbreathing or mouth breathing. To learn more about the Buteyko Breathing Method, check out McKeown’s books, “The Oxygen Advantage,” “Close Your Mouth: Self Help Buteyko Manual,” and “Anxiety Free: Stop Worrying and Quieten Your Mind,” which can be found on and There’s also a website dedicated to children, called

Patrick McKeown is one of the top teachers of the Buteyko method — a breathing method named after the Russian physician who developed it. McKeown has been teaching the Buteyko Breathing Method full-time in his native Ireland and abroad for over a dozen years.