The Art of Breathing

Brought to you by CHYP’s Parenting Blog

August 2nd, 2021

By: Lonnie Zeltzer, MD

One way to reduce pain and distress for you and for your child is to learn to become nose breathers. Research has shown that mouth breathing contributes to many medical and psychological conditions, which can be improved just through the simple act of learning to breathe consistently through your nose.

I’m in the middle of reading a book called Breath, by journalist James Nestor. I always knew that yoga breathwork (called “pranayama”) was important but I never quite understood why.

I began learning Iyengar yoga many years ago after I found that I had no real hip on my right side. With a history of cycling, walking, and skiing, I was developing right hip pain and began limping, gaining weight, and developing high blood pressure because I was ignoring my pain (not a good practice for a pain specialist!).

An orthopedist found that I had bones rubbing against other bones and told me I needed to have a real hip created. Emerging from that surgery on crutches, and learning how to walk properly and climb stairs, I began to read about yoga.

For many years, I went twice weekly to classes taught by my friend and Iyengar yoga teacher, Beth Sternlieb. Initially I thought I needed yoga for core strength. I would look at pictures of yogis in what I called “pretzel poses” and thought that I could learn to walk and twist my body like the yogis did (meanwhile, I was still barely walking with crutches).

At that time, I believed that the body poses (“asanas”) were more important than the breath work. (In the Iyengar yoga tradition, pranayama is not taught early on and typically comes with advanced practice.)

In my UCLA research program, I developed a series of NIH-funded research studies with Beth on Iyengar yoga for teens with irritable bowel syndrome, young adults with rheumatoid arthritis, and young breast cancer survivors who had significant fatigue. I was also the research mentor for a UCLA psychology doctoral student studying Iyengar yoga for college students who had depression.

In all the studies, there were positive benefits from yoga, which I thought derived from the mindfulness that came with a focus on body poses (“asanas”), as well as the physical balance and strength in the body. I hadn’t thought about the breathing associated with yoga.

Over the last few years, I began a practice of yoga again with our pain program yoga teacher Allison Zarem, who started teaching me about the importance of the breath. I learned about Ujayii breathing and other pranayama breathing techniques, and began to feel their impact on my body.

This work led me to read the book Breath. What author James Nestor talks about is the enormous influence that breathing through the nose – and not through the mouth — has on sleep, mood, thought, energy, and pain. He describes how the advent of fire and cooked food (and eventually processed foods) affected breathing patterns over time, which led to changes in the shapes of our faces and jaws.

Ultimately, we developed smaller jaws with less room for teeth. This resulted in crooked teeth, snoring, and mouth breathing — including sleep apnea — which has contributed to fatigue, depression, and pain.

Changes with mouth breathing have created the need for orthodonture and extraction of molars to make room in smaller mouths to fit all the teeth. Bad breath (halitosis) typically is related to mouth breathing. Oral bacteria change with mouth breathing and that impacts tooth decay, as well as the mouth and gut microbiome.

Nestor describes an experiment led by a Stanford University ENT doctor. The doctor and another individual had many measurements taken and then had their noses plugged for three weeks so that they would become mouth breathers. After unplugging their noses and doing more tests, they plugged the center parts of their lips so that they could no longer mouth breathe.

What they found was significant depression, poor sleep, poor ability to think, and poor energy during their mouth breathing time compared to their nose-only breathing time. Nestor points to many other studies documenting the benefits of nose breathing and avoiding mouth breathing.

Nose breathing sounds so simple, but think of what you do during the night when you sleep — do you breathe through your mouth? Do you chew food with your mouth closed at all times? When you exercise, do you breathe through your nose or your mouth?

See if you can be aware of your child’s breathing patterns, as well as your own. Try solo nose breathing for a week and notice how you feel. Learn how to become a total nose breather to begin to feel healthier.


Lonnie Zeltzer, M.D., is a Distinguished Research Professor of Pediatrics, Anesthesiology, Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA and Immediate Past-Director of the UCLA Pediatric Pain and Palliative Care Program. She is a co-author on the Institute of Medicine report on Transforming Pain in America and is a member of the national steering committee assigned to provide directions for pain research at the National Institutes of Health (NIH).  She has received, among other awards, a Mayday Pain and Policy Fellowship and the 2005 Jeffrey Lawson Award for Advocacy in Children’s Pain Relief from the American Pain Society (APS).  Her UCLA integrative pediatric pain program received a 2009 Clinical Centers of Excellence in Pain Management Award from APS and a 2012 award from the Southern California Cancer Pain Initiative.  She is active in advocacy for pain care and research. She was an invited member of the Institute of Medicine National Expert Panel on pain in American and was a co-author of the IOM publication on the committee findings in 2011. She was an invited member of the Centers for Disease Control (CDC) Special Advisor on The State of Opioids in America. She is also an invited member of the FDA Committee on Analgesia, Anesthesia, and Addiction, where new pain-related drugs are given FDA approval or not, as well as an invited member of the Expert Advisory Committee on Hemoglobinopathies as a pain expert for the National Heart, Lung, and Blood Institute (NHLBI) at NIH.  She is also on an expert panel for the NIH on a national study on a mind-body intervention for teens with fibromyalgia. She is also a member of the national Autism Think Tank as a pain expert in autism. Her research includes yoga, mindfulness, hypnotherapy, and other self-help interventions, including mobile technologies, to help children and adolescents who have chronic pain, as well as understanding biopsychosocial pain mechanisms in irritable bowel syndrome, cancer, sickle cell disease, headaches, dysmenorrhea, and other conditions. She has over 350 research publications on childhood pain and complementary therapies, has written more than 80 chapters, and published her first book for parents on chronic pain in childhood (HarperCollins, 2005) and her second book for parents on chronic pain in children and young adults (Shilysca Press, 2016).