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In the twelfth episode of The Healing Terrain, Dr. Emily Hernandez is joined by Dr. Sachin Patel for a conversation about something every person does all day, every day: breathe.
Dr. Patel is a chiropractor, functional health practitioner, breathwork facilitator, educator, and practice coach. His interest in breathing grew from both personal and professional experiences, including seeing dysfunctional breathing patterns in people close to him and working with clients whose nervous systems appeared persistently activated.
His central message is simple: breathing is not merely an automatic exchange of oxygen and carbon dioxide. The route, rhythm, depth, and pace of each breath can affect physiology—and bringing awareness to those patterns may give people an accessible way to influence how they feel.
The Breath Is a Window Into the Nervous System
“They say the eyes are a window into the soul, but breath is a window into the nervous system,” stated Dr. Patel.
Breathing changes naturally with emotional and physical state. Fear, pain, exertion, concentration, and rest can each produce a different pattern. The relationship also works in the other direction: deliberately changing respiratory rate and timing can influence heart rate, blood pressure, heart rate variability, and other measures associated with autonomic regulation.¹
This two-way relationship is why Dr. Patel pays attention to a client’s breathing before discussing breathwork directly.
“Once we tell them we’re [watching] their breathing, they naturally start changing the way they’re breathing,” he explained.
He observes whether the person breathes through the nose or mouth, whether the chest or abdomen moves most, and how quickly the person breathes. These observations do not diagnose a disease, but they may offer useful context about tension, respiratory habits, and the person’s state at that moment.
Why Nasal Breathing Matters
For breathing at rest, Patel encourages keeping the mouth gently closed and breathing through the nose when it is comfortable and medically appropriate.
“Tongue gently placed in the roof of the mouth, breathing in and out through the nose,” he said. “If that’s all people did and drew their attention to that throughout the day, their health would improve.”
The nose helps warm, humidify, and filter inhaled air. The paranasal sinuses are also a major source of nitric oxide in the upper airway. Research has found that nitric oxide carried with nasal air can affect pulmonary function and oxygen exchange, although this physiology should not be reduced to a single percentage or universal outcome.²
“When we breathe through our mouth versus breathing through our nose, we’re actually creating a completely different type of air quality that’s coming into our lungs,” stated Dr. Patel.
Persistent difficulty breathing through the nose deserves evaluation rather than forced nasal breathing. Congestion, allergies, a deviated septum, enlarged tonsils or adenoids, and sleep-disordered breathing are among the issues a qualified clinician may need to assess.
Tongue Posture Helps Shape the Resting Pattern
Dr. Patel also discussed the resting position of the tongue. He recommends gently placing the tongue against the roof of the mouth, near the position used to make an “S” sound, without straining.
“When your tongue’s in that position, it’s naturally going to seal your mouth, which means you’re not going to be breathing through your mouth,” he said.
The tongue, palate, teeth, jaw, and airway are anatomically connected, and tongue posture is one part of oral function. But breathing difficulty, jaw pain, swallowing concerns, or suspected airway obstruction should be evaluated by an appropriately trained medical, dental, or myofunctional professional. A posture cue is not a substitute for identifying why someone relies on mouth breathing.
Breathing and the Oral Environment
The conversation also connected breathing route with oral health.
“The mouth is the beginning of the digestive system,” Dr. Patel stated.
Saliva helps buffer acids, wash the teeth and oral tissues, support the oral microbiome, and protect against demineralization. Habitual mouth breathing can contribute to oral dryness, which may alter this protective environment.
Research in children and adolescents has found associations between mouth breathing and oral-health concerns, including gingival inflammation and dental caries. These studies do not establish mouth breathing as the sole cause; oral hygiene, diet, anatomy, allergies, and other factors also matter.³
Waking with a dry mouth, frequently experiencing dry lips, or noticing persistent bad breath may be reasons to discuss breathing, hydration, medications, dental health, and possible airway issues with a clinician.
Match the Breath to the Task
There is no single breathing pattern for every situation. A person sprinting needs a different respiratory response than someone preparing for sleep.
“The way I breathe needs to match the task that I’m doing,” Dr. Patel explained.
For calm, balanced breathing, he suggests experimenting with an even inhale and exhale—often four to six seconds in and four to six seconds out—without forcing the breath. A slower respiratory rate can increase certain measures of heart rate variability, but individual responses vary, and lightheadedness is a signal to stop and return to normal breathing.¹
When the goal is to settle, Dr. Patel lengthens the exhale:
“We might breathe in for four and out for six.”
He also described two familiar practices:
- Box breathing: Inhale for four, pause for four, exhale for four, and pause for four.
- 4-7-8 breathing: Inhale for four, hold for seven, and exhale for eight.
These counts are guides, not requirements. Beginners can use shorter, comfortable counts and avoid strain. Anyone who is pregnant or has cardiovascular, pulmonary, neurological, or panic-related concerns should consult a clinician before using prolonged breath holds.
Use Existing Routines as Reminders
Knowing how to breathe differently does not guarantee that a person will remember to practice. Dr. Patel recommends attaching breath awareness to something already repeated throughout the day.
“Maybe for some people it’s every time I pick up my phone,” he said. “If you drive a lot, maybe it’s every traffic light. If you move through your house, maybe it’s every time you walk through a door or a threshold.”
This approach turns an existing action into a prompt. At the chosen cue, a person can simply notice:
- Am I breathing through my nose or mouth?
- Is my jaw tense?
- Am I breathing faster than the moment requires?
- Can I take one comfortable, quiet breath?
The objective is awareness, not perfect control. Breathing is dynamic, and the appropriate pattern changes with activity and circumstance.
Carbon Dioxide Helps Drive the Urge to Breathe
Dr. Patel devoted part of the episode to carbon dioxide tolerance. Although oxygen is essential, rising carbon dioxide is a major chemical driver of the urge to breathe. Rapid or excessive ventilation can lower carbon dioxide levels, while slower breathing may alter carbon dioxide and autonomic measures.⁴
Dr. Patel uses a breath-hold assessment often called the Body Oxygen Level Test, or BOLT score. After a normal exhale, a person holds the breath only until the first clear desire to breathe, then resumes normal breathing.
The test may help practitioners discuss breathing habits, but it is not a comprehensive measure of oxygenation, fitness, or health, and the episode’s specific score targets should not be interpreted as diagnostic thresholds. In particular, the claim that disease cannot exist above a certain breath-hold time is not established medical evidence.
Dr. Patel recommends gradually practicing slower exhalation as one way to become more comfortable with carbon dioxide. Breath-hold training, however, should never be done in water, while driving, while standing where a fall could cause injury, or in any setting where fainting would be dangerous.
What About Mouth Taping at Night?
Dr. Patel described mouth taping as a nighttime prompt for nasal breathing and shared positive experiences reported by some of his clients.
Early research has explored mouth taping in carefully selected people, including small studies involving mild obstructive sleep apnea, but the evidence remains limited and does not support treating it as a universal sleep intervention.⁵
Mouth taping may be unsafe for people with nasal obstruction, untreated sleep apnea, breathing disorders, nausea or reflux risk, impaired ability to remove the tape, or certain medications or medical conditions. Snoring, gasping, witnessed pauses in breathing, morning headaches, and excessive daytime sleepiness warrant medical evaluation. Taping the mouth should not be used to conceal possible sleep apnea or replace evidence-based treatment.
Begin With Awareness, Not Intensity
Breathwork can range from quiet observation to prolonged, emotionally intense sessions. Dr. Patel has seen people report powerful experiences during facilitated breathwork, but a strong response is not automatically a better or more therapeutic response.
For most people, the most practical starting point is also the simplest:
- Notice the resting breathing pattern
- Use comfortable nasal breathing when the airway is clear
- Relax the jaw and place the tongue gently on the palate
- Slow the breath without creating air hunger or dizziness
- Experiment with a slightly longer exhale to settle
- Pair breath awareness with an existing daily cue
- Seek evaluation for persistent nasal obstruction or signs of sleep-disordered breathing
The breath is always present, but that does not mean every breath practice is appropriate for every person. Gentle experimentation, attention to symptoms, and individualized guidance are more useful than chasing a target count or extreme breath hold.
As Dr. Patel put it, “The fastest way to slow things down is to slow down our breath.”
Listen to the Full Episode
Nervous System Regulation: Why Healing Gets Stuck is available on DrTalks, Apple Podcasts, Spotify, and YouTube.
References
1. Laborde S, Allen MS, Borges U, et al. Effects of voluntary slow breathing on heart rate and heart rate variability: a systematic review and a meta-analysis. Neurosci Biobehav Rev. 2022;138:104711. doi:10.1016/j.neubiorev.2022.104711
2. Lundberg JO, Settergren G, Gelinder S, Lundberg JM, Alving K, Weitzberg E. Inhalation of nasally derived nitric oxide modulates pulmonary function in humans. Acta Physiol Scand. 1996;158(4):343-347. doi:10.1046/j.1365-201X.1996.557321000.x
3. Kimura ACRS, de Arruda JAA, Drumond VZ, Martins-Júnior PA, Mesquita RA, Abreu LG. Dental Caries and Periodontal Outcomes in Mouth-Breathing Children and Adolescents: A Systematic Review. Int J Paediatr Dent. 2026;36(1):24-32. doi:10.1111/ipd.70022
4. Uryga A, Najda M, Berent I, et al. The impact of controlled breathing on autonomic nervous system modulation: analysis using phase-rectified signal averaging, entropy and heart rate variability. Physiol Meas. 2024;45(9). doi:10.1088/1361-6579/ad7778
5. Lee YC, Lu CT, Cheng WN, Li HY. The impact of mouth-taping in mouth-breathers with mild obstructive sleep apnea: a preliminary study. Healthcare (Basel). 2022;10(9):1755. doi:10.3390/healthcare10091755
This content is for educational purposes only and is not a substitute for individualized medical advice, diagnosis, or treatment.
