Nose, Mouth, and Facemasks
By: Santiago Flórez
Voices in order of appearance
Santiago Flórez (Narrator)
Mark Williams, professor of respiratory physiology
Megan Reynolds, clinical research
Dr. Jayakar V. Nayak, MD, PhD Nose and upper airwaves expert
Campbell Will physiotherapist and breathwork coach
Belisa Vranich clinical psychologist and founder of the breathing class.
[Breathing and guitar chord] 0:003
Santiago [Narration] 00:04
Let’s start with this question: Can wearing a facemask make us breathe through our mouth instead of our nose?
Last year I noticed that whenever I was using a facemask I breathed more through my mouth than my nose.
This became more obvious in winter. When I was not conscious about my breathing the mask would soon develop moisture and get gross and wet. But if I was conscious of breathing with my nose the mask would remain dry.
Some recent studies from around the world suggest that facemasks can promote mouth-breathing, reduce the amount of oxygen in the blood, cause dizziness and headaches, and make the skin feel hotter while increasing itching and irritation .
I reached out to the scientists that wrote those studies and most of them never responded.. In one of the few responses I got. A German scientist explained his refusal to be interviewed, by saying that face masks had become too politically divisive.
I decided to reach out to other experts whose work and expertise could help me answer the question: could the use of a face mask encourage me to breathe through my mouth?
I asked Dr. Mark Williams a professor who studies how humans breathe
Mark Williams 1:12
Certainly the case when you cover your face, you tend to mouth breathe instead of nasal breathing…Obviously, the longer your mouth breathes [it] will dehydrate the airways.”
Santiago [Narration] 01:18
And to Megan Reynolds a clinical researcher.:
Megan Reynolds 01:20
I don’t know. That’s a good question. And I’m not sure exactly how we would be able to test or measure that
Santiago [Narration] 01:25
And Doctor Jaykar Nayak
Dr. Nayak 01:27
I don’t think they’re there for a COVID and use of masks and fear of getting an infection for example, or something like that. Channeled your brain to say let me breathe through my mouth.
Santiago [Narration] 01:36
So no definitive answer. And that is ok. Science is a slow, cumulative, rigorous process that avoids simple sweeping conclusions.
Let’s start with Megan’s research.
Megan Reynolds 01:47
My name is Megan Renylods and I’m a clinical researcher associate at Baylor Scott and White Sports Therapy and Research at the Star.
Santiago [Narration] 01:54
She was part of a team that aimed to find the effects and safety of facemasks during physical activity.
Megan Reynolds 01:59
In the midst of a global pandemic, we were able to recruit 31 participants to come to our facility two times over the course of several weeks and do a cardiopulmonary exercise test. And then we were able to do one of their sessions wearing a facemask and one without. To identify the impact of wearing a mask during physical exercise or physical activity.
Santiago [Narration] 02:20
The study did not find evidence of increased carbon dioxide or less oxygen in our blood. Indicators between the two runs were very similar. However participants reported feeling more exhausted and got tired faster when using a facemask.
Megan Reynolds 02:34
And our main takeaways were that it affected performance perception in, um, their psychology or what was going on with them while they were exercising
Santiago [Narration] 02:43
The team recommended being aware of the changes in perception and modifying time and intensity of physical activity to be able to exercise safely while using a facemask.
Doctor Nayak thinks that face masks did not encourage me to mouth-breathe. But wearing a mask might have helped me became aware of it:
Doctor Nayak 02:59
I have several patients who came to me because they started taking yoga, cause they’re in their thirties and they’re like, you have to close your mouth and breathe through your nose And they couldn’t.
Santiago [Narration] 03:09
He is a sinus and nasal specialist who works at Stanford University as associate professor. Because COVID-19 enters the body through the nose he has experienced their effectiveness first hand.
Doctor Nayak 03:20
Suddenly the surgeries I was doing were among the most highest risk, dangerous in the world. Everything I did, put a scope in the nose, or just looked in the nose, put a spraying in the nose surgery. And those are all aerosol generating. I had never had COVID. ER docs will tell you that they haven’t had a cold, generally speaking, ‘cause they’re wearing masks all the time.
Santiago [Narration] 03:39
I asked him what is the most surprising thing he has learned after 12 years as a doctor, surgeon, and researcher.
Doctor Nayak 03:45
The first thing I would say is how much the nose can influence your well-being. It really can affect, um, so many aspects of your quality of life, and can bring you in, some people do their knees. They literally sometimes can’t even work anymore. They’re on disability because of sinus infections that have led to chronic pain.
Santiago [Narration] 04:09
And these issues can have inmese consequences. Studies have shown that In the United States the healthcare costs of nasal problems are around 8 billion dollars a year.
And according to the World Health Organization Chronic Pulmonary Disease or COPD is the third leading cause of deaths worldwide. With 2.23 millions deaths in 2019. Studies suggest that up to 75% patients with COPD – have problems breathing through their nose.
So I was shocked when Doctor Nayak told me
Doctor Nayak 04:40
You know just on a general basis, nasal research is still very much in its infancy. There is no NIH Institute dedicated to disorders of the upper airway and the nose. It just doesn’t exist. Ear, and the hearing research is very well-funded and they’re 40 years ahead, I’ll say, of the nasal researchers.
Santiago [Narration] 05:00
According to Doctor Nayak ( There are less tools and metrics to understand sinus nasal complications. And it is very hard to find funding for research, as nose problems are not considered a pressing problem.
And is it important to study the nasal problems? And to breathe through our noses?
If the objective of breathing is to provide oxygen to our bodies while getting rid of carbon dioxide. Would it not be better to breathe through our mouths that are bigger?
Mark Williams 05:25
Mouth breathing is a false economy really, it means you lose fluid as well. (7:08 – 7:13)
Santiago [Narration] 05:31
That was Mark Williams
Mark Williams 05:33
I work at the University of South Wales. I suppose I’m a respiratory physiologist.
Santiago [Narration] 05:37
Who also wrote the book Breath: An inspired History
Mark Williams 05:40
Our natural position is to breathe through our nose. Because our nose filters the air, it’s an air conditioner unit, your nose.
Santiago [Narration] 05:49
This means that the nose takes the air we inhale and: (7:29 – 7:32)
Mark Williams 05:52
It humidies it, it cleans it. And it takes back some of the moisture that you lose.
Santiago [Narration] 06:00
Mark explained to me that within our nose we have several structures covered in a sticky layer of mucus that traps pollution particles, such as dust and pollen. The blood vessels in the nose also warm the air we breathe. And when we breathe with our mouth we lose the sense of smell!
Basically the nose cleans, warms, and humidifies air to protect our lungs.
Talking with Mark I understand at least one part of my question. When I breathe with my mouth it’s easier to get dehydrated .
So if I have been breathing with my mouth. Are there any steps I can take to stop and improve my breathing?
Campbell Will, is an Australian physiotherapist who encountered the importance of good breathing while working with lung cancer patients in ICUs and medical wards.
Intrigued by the relationship between breath and health he decided to learn the Wim (Vim) Hof breathing method. Also known as the IceMan, Wim (Vim) Hof is a dutch athlete and wellness trainer whose method is based in breath control, cold exposure, and meditation. In 2014 scientists injected e-coli to 12 participants who successfully used his breathing method to fight the bacteria. He is famous for using his method to withstand freezing temperatures.
Campbell still remembers one of his final tests during the certification process in
Campbell Will 07:18
Mount Sněžka, which is on the border of the Czech Republic and Poland wearing board shorts and a pair of shoes. It was -15 Celsius outside when we summited the mountain. It was a 4 hour hike. Which for someone like me, who’s from the tropics, right. I used to hate the cold. I’m very comfortable in the tropical heat. To be standing in below zero temperatures surrounded by snow, hiking up a mountain, just wearing a pair of board shorts. Really just kind of completely changed my perspective of what I thought was possible.
Santiago [Narration] 07:48
I’m not ready to climb a mountain in winter with just shorts, yet. But I do want to learn what I can do to breathe better. Campbell tells me, the first thing is to learn the correct technique.
Take a deep breath and notice how your body moves. Does your body expand in your shoulders or in your chest or in your belly?
Belissa Vranich 08:07
So the number one thing you can do for your breathing is make sure you are using your diaphragm rather than your shoulders to breathe.
Santiago [Narration] 08:16
That was Belissa Vranich (Branik)
Belissa Vranich 08:18
I’m a clinical psychologist, founder of the breathing class. I also have written two books on breathing, the latest one is called breathing for warriors.
Santiago [Narration] 08:27
The diaphragm is the muscle located under the lungs, below your rib cage and above your stomach.
Belissa Vranich 08:34
So I want you to put your hands at the bottom of your ribs. So they’ll end up being above your belly button, but really on top of your ribs as well
.
Santiago [Narration] 08:45
Take a deep inhale and push your belly and chest out. Inside your body the diaphragm is contracting giving the lungs room to expand.
Now exhale. Your diaphragm should expand pushing the air out of the lungs. Your belly and chest should contract.
This is called belly breathing or lateral expansion breathing. And is one of the most important things to do to improve your breathing.
Second, Campbell tells me I should breathe slower.
Campbell Will 09:14
Slow breathing is better physiologic. It’s better for the nervous system and it helps us improve our biomechanics. We open up those little air SACS, the alveoli
Santiago [Narration] 09:24
Alveoli are the tiny air sacs in the lungs where the blood exchanges oxygen for carbon dioxide.
Humans typically breathe between 12-20 times per minute. Scientists have found evidence that slow breathing, between 6–10 breaths per minute, could lead to decreased mortality and longer life expectancy.
Third, breathe as much as possible through the nose.
Campbell says the best thing to improve my breath is to check it occasionally and
Campbell Will 09:50
Every time I check my breath, I go to my nose. I go to my belly and I slow down, for two or three breaths
Santiago [Narration] 10:00
But what if I want to go further? What can I do to enhance my breath? Use my breath to improve at other activities? Like riding a bike.
Belissa Vranich 10:07
So you have over 10 pounds of breathing muscles in your body, but if you don’t train them separately from your sport, you can’t train them to exhaustion. So they don’t get stronger.
Santiago [Narration] 10:18
To strengthen my lungs Belisa recommends me the following breathing exercise
Belissa Vranich 10:23
Two minutes of bellows breath, the biggest inhale I can. Hardest exhale
[Bellows Breath in the background 10:25]
Santiago [Narration] 10:29
And I’m supposed to do this with my mouth as fast as possible.
And it is hard. You can hear me slow down.
By the end I was sweating, and could not even concentrate enough to talk in English.
Spanish speakers, I apologize for the foal language.
The idea is to mimic the breath I would have at the last lap of a race, but without the racing. With the goal of training the breathing muscles.
And I’m happy to report that after two weeks of practicing bellows breath I feel my performance while biking is improving. My commute feels shorter, hills are easier, and I got less tired.
But wait didn’t I just make the case that mouth breathing is bad and should be avoided? Well it’s complicated.
Campbell Will 11:34
When we kind of say, mouth breathing is bad and we should never do it, I’d like to see someone laugh or cry or verbally express themselves, or sing right. That is using the mouth.
Santiago [Narration] 11:45
And all this time I have been talking about breathing. I have been breathing with my mouth and nose.
Yes, constant mouth breathing is a bad idea. But mouth breathing is also part of the spectrum of the activities we humans can do.
So did facemasks make me breathe more through my mouth? With the information I have, I just don’t know. And I think it’s fair to say there is not a definitive answer, yet. I still use face masks in closed spaces. There is a lot more evidence that they provide protection for airborne diseases such as COVID-19. I’m just more conscious about breathing through my nose and taking water breaks when possible.
Breathing is also one of the most essential and unconscious things we do. And is something we take for granted despite its influence on our health.
Nasal research is still in its infancy and there is a lot to learn. But there is no simple answer. What is clear to me is that paying a little bit more attention to our nose and how we breathe can improve our quality of life.
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