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The title is not a tribute to the Anne Tyler novel, although we loved reading it as part of senior year reading list, thank you Ms. Beatty. It is to address the oft-neglected and sorely underestimated essential bodily function called respiration.

Your lungs respire between 12 and 18 times per minute, most of breathing going on entirely unnoticed. Which is a blessing - one less thing to focus on - but can also be a problem. Humans tend to hold their breath or respire shallowly when nervous or tense, and since more and more time in modern civilization is spent in the tense/nervous state, this breath-holding can result in a condition known as hypoxia.

The other medical residents and I used to play a game in the hospital when not seeing patients (which was rare but did occur). We'd get our hands on one of the readily available pulse oximetry monitors. These devices determine your blood oxygen saturation within seconds of being applied to your finger. 

We'd attach the pulse ox and hold our breath to see how low we could get our blood oxygen levels. As the seconds become whole minutes, we'd watch the reading fall from high 90s down to low 90s, into the 80s. Some breath holding adepts got their pulse ox reads down to the high 70s before gasping for air. Then they'd take a few deep breaths at which point it would rise again to the 90s. A pulse ox read anywhere between 100 and 90 is considered normal. Below that and you get sent home with an oxygen tank and a nasal cannula. Not the essence of sexiness, but reality for many pulmonary patients, such as those with COPD or emphysema (often caused by tobacco).

But what we found interesting in our breath-holding game was how quickly we could get the pulse ox reading to change, and how responsive it was to different breathing patterns. Breathe deeply and regularly, and if your lungs are working properly you easily saturate your oxygen with blood. Breathe shallowly and irregularly, as when nervous, tense, or preoccupied, and that number quickly falls into nasal cannula range.
How important are blood oxygen levels? Let's consider for a moment the fundamental physiological importance of oxygen. Why do we need it? Why can we go weeks without food, days without water, but only about 20 minutes without air?

(The longest time holding the breath underwater was 22 min 00 sec by Stig Severinsen of Denmark at the London School of Diving in London, UK, on 3 May 2012. Stig was allowed to hyperventilate with oxygen prior to the attempt, and did this for 19 minutes and 30 seconds.)

Simply, oxygen combines with breakdown products from the food we eat (mainly glucose) in a series of reaction whose ultimate product is ATP, the energy currency of the cell.

Note the oxygen molecule in red.
Without adequate oxygen, the body is unable to synthesize sufficient energy, even in the setting of an abundance of fuel (sugar, carbohydrate, etc.).

So if you find yourself feeling down or in the dumps, if you've lost that spring in your step, feel fatigued, blue, or undermotivated, despite getting adequate sleep, abstaining from tobacco, drinking in moderation if at all, eating an energy-rich phytocentric diet abundant in water and fiber, getting adequate vitamin D and other essential nutrients through sun and food plus a multivitamin if necessary, and exercising regularly (150 minutes of cardio and 2 strength sessions weekly), then it could be that you' to say this? Forgotten to breathe! Not entirely, or else you wouldn't be among the five or six people reading this post whose purpose is to serve as a reminder to mind your breathing. In other words, become consciously aware of the process, and breathe deeply and fully.

Respiration is one of the few bodily functions that is under both voluntary and involuntary control. Meaning you can consciously manipulate your breathing rate and depth, and if you don't feel like it (say in sleep) your lungs will continue to function anyway. Most other organs are either exclusively involuntary (like the heart, kidneys, liver, some would say the brain) or exclusively voluntary (like the legs, which won't finish that 3-mile jog unless you will them ahead).

So let's take a moment to become conscious of breathing with this simple exercise.

First, lie flat on your back, close your eyes, and empty your lungs of all the air.

Then, breathing in through your nose, completely fill yourself with air. Watch as first your belly rises (due to the diaphragm contracting against the organs), then as your thorax/chest expands. Breathing in through the nose is important, as tiny nose hairs help to filter air particles and the nasal passages help to moisten the breath and make it easier on the lungs.

Finally, exhale either through your nose or mouth.

Do this ten times twice a day.

Preferably in the morning first thing on wakening, and then again last thing before going to bed. The morning effort will set you on the path of mindful breathing, as well as fill your body with energy (or in this case the oxygen that is a precursor to energy) better than even the strongest cup of coffee. The evening exercise will help to relax you. In fact, you may nod off at night before even reaching the count of ten. It's happened to us more than once. We must have been tireder than we thunk!

Mindful breathing is called pranayama in the East. Prana is the life force. An apt term as indeed your life continues only so long as you keep respiring. The practice of deep breathing has become popularized on this side of the globe as a yoga and meditation technique, or for general relaxation. Athletes enjoy doing it while running, swimming, biking, or lifting as the regular breathing required by these disciplines fits right in. Just be sure to breathe deeply and slowly, as going too fast can lead to hyperventilation, dizziness, and disorientation.

Many practitioners of pranayama elect to recite a word or phrase (mantra) in time with the breathing. Soham is a Sanskrit term for "I am He," He representing the Self, the Absolute essence of all that is, reminding you of your connection with the divine. So can be recited mentally on inhalation, and ham on exhalation. If this sounds a bit airy-fairy to you, don't knock it till you've tried it. Or choose your own power phrase. Happy breathing.


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