Investigation on the effect of oral breathing on cognitive activity (2021)(ncbi.nlm.nih.gov)
ncbi.nlm.nih.gov
Investigation on the effect of oral breathing on cognitive activity (2021)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8228257/
193 comments
I know the paper is lacking in evidence, but it proposes such an interesting phenomena. It's worth exploring more.
It made my mind jump to perhaps a second, potentially worse outcome of mouth breathing - seeding the lung mucosa with oral flora. That seems like it could enhance the spread and inflammation. And cause deleterious downstream impacts such as slightly increased risk of cancer, pulmonary diseases, etc.
It made my mind jump to perhaps a second, potentially worse outcome of mouth breathing - seeding the lung mucosa with oral flora. That seems like it could enhance the spread and inflammation. And cause deleterious downstream impacts such as slightly increased risk of cancer, pulmonary diseases, etc.
Note that the experimental blocks were short, in the order of a few minutes, and was mixed between both nasal and oral breathing. Now imagine that whatever cause can spread that rapidly to the brain and have a noticeable effect there. Then orally breathing a full day (which is quite common when you have a cold) would lead to total cognitive degradation. You'd need a very peculiar mechanism to explain why that wouldn't happen.
There's a massive hole in the methodology. If I tell you "do this complex mental task, oh by the way be conscious of your breathing the whole time," that is going to have impact on your capacity to focus on the task.
Really it can get that bad?
Pat Volkerding, Slackware maintainer, suffered from Actinomycosis in 2004 - quite a chilling read [0].
> To help me avoid more tooth decay my dad bought me one of those fancy
> rechargable electric toothbrushes that really powers away the plaque.
> It also creates a fine aerosol mist of plaque, and I started to wonder
> if 4 years of using this brush had caused me to breathe in some of this
> plaque mist and moved an infection into my lungs.
I quickly learned to keep my mouth closed while brushing my teeth.
Wait toothbrushes are a concern?
Everything is a concern. It's not often that humanity gets it right the first time, so the trick is to be ready to make changes when new verifiable data comes to light.
Thank you for saying that. I personally always found it confusing that people at some point simply say 'I am done learning anything new' as if their current model of the world is already perfect. I might understand there is a physical memory limit, but I sincerely doubt it is even scratched for most people.
I understand the evolutionary underpinnings for it ( 'what I did got me this far did it not?' ), but it is still not a great excuse for a conscious being.
I understand the evolutionary underpinnings for it ( 'what I did got me this far did it not?' ), but it is still not a great excuse for a conscious being.
It's not as if it's a hard limit, and you become incapable of absorbing additional facts beyond a certain point. If anything, the human mind seems best adapted to ongoing learning, as it seems to store (and discard) information in terms of relational strength.
> people at some point simply say 'I am done learning anything new'
Yeah, it's not good to do that, but how is that related?
The "evolutionary underpinnings" are a sound rationale, not an excuse. Not for completely eschewing new information but being conservative in making changes.
Yeah, it's not good to do that, but how is that related?
The "evolutionary underpinnings" are a sound rationale, not an excuse. Not for completely eschewing new information but being conservative in making changes.
Dental procedures and even tooth brushing increase blood bacteria levels. In addition to aerosolizing, they also reach circulation through gingival lesions caused by the procedure. Once in the blood, they can colonize the heart and cause endocarditis.
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.107.7...
https://pubmed.ncbi.nlm.nih.gov/12212870/
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.107.7...
https://pubmed.ncbi.nlm.nih.gov/12212870/
I knew a guy once who had very serious heart trouble after a teeth-cleaning. This is not even an unknown phenomenon -- cleaning your teeth does make small wounds in your gums, and oral bacteria can get into your bloodstream.
[deleted]
survirtual(4)
Looks like they were trained in nasal breathing and asked to close their mouths during the nasal breathing session.
"Unexpected activity appeared in the superior and inferior frontal gyri independent of working memory" - seems their brain was focused on properly executing these nasal breathing instructions/training - which would be expected.
Doesn't say too much considering sample size.
A better study could be configured by observing twins (one with broken nose at one point, leading to majorly deviated septum and inherently limiting nasal breathing vs the other twin)
"Unexpected activity appeared in the superior and inferior frontal gyri independent of working memory" - seems their brain was focused on properly executing these nasal breathing instructions/training - which would be expected.
Doesn't say too much considering sample size.
A better study could be configured by observing twins (one with broken nose at one point, leading to majorly deviated septum and inherently limiting nasal breathing vs the other twin)
Given that breathing is a normal, natural activity, there should also be a "ground state" MRI where someone normally does nasal breathing is examined without being given any instructions to do so. I also don't see how they conclude from this the effects of "prolonged" breathing activity.
Their strong claims relative to the sample size and the quality of the experiment makes me doubt their level of motivation to do proper science. Just another flimsy paper used to pad resumes.
Their strong claims relative to the sample size and the quality of the experiment makes me doubt their level of motivation to do proper science. Just another flimsy paper used to pad resumes.
Anecdotal evidence, but I've noticed how Magnus Carlsen, the current best chess player, is often mouth breathing when very focused in a game. When I was a kid I often also caught myself mouth breathing when focused on a videogame, and I think this is a common tendency for people.
I wonder if this really has a negative impact, or rather a positive one.
I wonder if this really has a negative impact, or rather a positive one.
Without devising a research project with flawed methodology that nonetheless gets published, my wild-ass guess would be that conscious cognitive function is maximized by allowing breathing to be managed by the unconscious mind.
Maybe he opens his mouth because it's the most comfortable thing to do in the moment.
Maybe he opens his mouth because it's the most comfortable thing to do in the moment.
Some people have insufficient airflow through the nose. If you look at Magnus‘ nose (and midface), it looks slightly recessed, which could result in partial airway blockage. Him mouthbreathing could be a strategy to get more air in. I‘m not sure that can be generalized.
It could also be that he has to consciously keep his mouth closed, and when he’s deep in a match he stops concentrating on it.
Interesting. I have a strong subconscious urge to keep my mouth shut -- not kidding, I think inspired by watching Mary Poppins as a kid: "Mouth closed, Michael, we are not a codfish." So even when I am most focused, my mouth is always closed.
I often catch myself grinding my teeth while being focused. Which of course makes mouth breathing impossible.
When I am really focused for a long time, this even causes my jaw to become stiff and speaking becomes very difficult for a while.
When I am really focused for a long time, this even causes my jaw to become stiff and speaking becomes very difficult for a while.
Mouth breather here, that's good to hear :) Always feels a bit like using a straw to draw air through my nose for me, possibly choir practice as a kid impacted it too.
[deleted]
How much of this is just them breathing deeper as a result of more conscious focus on it?
Bit like breaths (in my experience) tend to be deeper and more "purposeful" even if the doctor says take a normal breath.
Struggling a bit to convey this right but you get the idea hopefully...
Bit like breaths (in my experience) tend to be deeper and more "purposeful" even if the doctor says take a normal breath.
Struggling a bit to convey this right but you get the idea hopefully...
Not very strong:
> Twenty-two healthy participants (mean age, 22.27 ± 1.42 years) performed a two-back (2B) working memory fMRI task
And then they looked only at the pictures in the MRI they supposed indicated more cognitive function, and ignored task performance.
> Twenty-two healthy participants (mean age, 22.27 ± 1.42 years) performed a two-back (2B) working memory fMRI task
And then they looked only at the pictures in the MRI they supposed indicated more cognitive function, and ignored task performance.
Hopefully closing the mouth does not affect the postprocessing algorithm of the MRI software (remember tons of fMRI studies invalid due to software artifacts [1]). I guess it really far to easy to generate such results, but difficult to really validate them.
[1] https://www.sciencealert.com/a-bug-in-fmri-software-could-in...
[1] https://www.sciencealert.com/a-bug-in-fmri-software-could-in...
They did look at task performance, it's just the oral breathing being marginally quicker and marginally less accurate wasn't statistically significant.
If there's no difference in task performance, an alternative explanation is that for the nasal breathing test participants wasted cognitive cycles on remembering to keep their mouth closed (versus oral breathing participants who had their nose plugged)...
If there's no difference in task performance, an alternative explanation is that for the nasal breathing test participants wasted cognitive cycles on remembering to keep their mouth closed (versus oral breathing participants who had their nose plugged)...
[deleted]
Sadly, people with allergies and/or deviated septums often breathe through their mouth. Also... breathing through your nose increases nitric oxide in the upper airway.
I am (was) one of those people (allergies and slightly deviated septum). I started to really breath through my nose about two years ago. I always thought that it would not be possible, because I felt that I could not get enough air. I started practicing while cycling to work everyday. At the beginning it really felt super hard (especially since I have to ride up the hill, about 200m altitude difference), but after a few days of this, it was not hard anymore and I started to breath exclusively through my nose without problems. I think that allergies, although still present, are less intense and it doesn't impair me to breath properly. So, just try.
> I started practicing while cycling to work everyday.
For doing cardio I was told/taught (by whom I can't remember) to generally breathe in through your nose and out through your mouth.
This allows for air to come in through the path that your body was 'designed' to do it, but you can also expel carbon dioxide more quickly (so the theory goes).
For doing cardio I was told/taught (by whom I can't remember) to generally breathe in through your nose and out through your mouth.
This allows for air to come in through the path that your body was 'designed' to do it, but you can also expel carbon dioxide more quickly (so the theory goes).
I'm sorry, but how does this work? HIIT, for example, gets me up to requiring 40 breaths per minute for the oxygen. There is simply not enough airway cross-section across the nose to take in air at this rate. During allergy season, when one nostril is completely blocked, it's impossible to do for even basic metabolic function.
The whole point of HIIT is to tax your aerobic system. One can easily do work outs within the ranges of energy production that don't go into anaerobic respiration. For example you can do high load lifting in short burst and just use your ATP stores, which generally means for a count of 10 or less, with enough time in between to replenish the ATP fully. Or you can do aerobic exercise at a pace where your body has enough oxygen to always be using glucose to keep up with ATP usage (Zone 2 training).
The original author probably was limiting their bicycle cadence to something that they could do continuously with their nose closed. I personally do something similar while running and weight training. It was hard at first, but your body gets stronger and more capable at exchanging CO2 over time. I wouldn't try this with HIIT though, and generally think that HIIT is a terrible training methodology as it leave you sore and incapable of doing more work outs as the processing of lactic acid is harmful if not damaging to muscle cells.
The original author probably was limiting their bicycle cadence to something that they could do continuously with their nose closed. I personally do something similar while running and weight training. It was hard at first, but your body gets stronger and more capable at exchanging CO2 over time. I wouldn't try this with HIIT though, and generally think that HIIT is a terrible training methodology as it leave you sore and incapable of doing more work outs as the processing of lactic acid is harmful if not damaging to muscle cells.
> For example you can do high load lifting in short burst and just use your ATP stores, which generally means for a count of 10 or less, with enough time in between to replenish the ATP fully
This is true, but you rarely see anyone actually doing it at the gym. It’s been a while but I recall that fully replenishing ATP requires around 3 minutes between sets, and most people rest for less than half that.
This is true, but you rarely see anyone actually doing it at the gym. It’s been a while but I recall that fully replenishing ATP requires around 3 minutes between sets, and most people rest for less than half that.
You're correct, although ATP is generally replenished to around 70% after a minute, and is muscle dependent, so you can work on another muscle group while one rests.
I generally do a set of 10 or less, wait 1 minute, do another set and then do some yoga for the remainder of 3 minutes. I then switch to another muscle group and do the same. When I switch back to the original muscle group an additional 3 minutes have past or 5 minutes since the last set for that group. This allows for some oxidative stress, which stimulates mTor and thus mitochondrial growth, but also allows me to do more sets in a work out in less amount of time. I'm generally done in 30-45 minutes, but work out daily at home.
While ATP takes a good amount of time to replenish, lactic acid take twice as long to clear out. So you really need to be resting 8-10 minutes between HIIT work outs, or just go home from the soreness. This doesn't seem as ideal if you don't want to spend all day in the gym.
I generally do a set of 10 or less, wait 1 minute, do another set and then do some yoga for the remainder of 3 minutes. I then switch to another muscle group and do the same. When I switch back to the original muscle group an additional 3 minutes have past or 5 minutes since the last set for that group. This allows for some oxidative stress, which stimulates mTor and thus mitochondrial growth, but also allows me to do more sets in a work out in less amount of time. I'm generally done in 30-45 minutes, but work out daily at home.
While ATP takes a good amount of time to replenish, lactic acid take twice as long to clear out. So you really need to be resting 8-10 minutes between HIIT work outs, or just go home from the soreness. This doesn't seem as ideal if you don't want to spend all day in the gym.
That's what I thought too, but after reading the book "Breath" by James Nestor (as others have mentioned in this thread) I decided to try that. And it really works. I think that if you exhale to fast and inhale immediately, then you are not really getting rid of all the CO2 that you could/should. So, by doing it at a slower rhythm, then you get more efficient in getting air in and CO2 out.
What opened things up for you? I suffer from allergies, and have a slightly deviated septum, and I've tried so many sprays (caused dependency), breathing strips (falls off in the night), and even 3D printed a small cradle that would force my nose to open wider as I slept, which proved to be nothing short of annoying. I'm always open to trying new methods.
What kind of sprays - Afrin type (oxymetazoline)? The dependency on those can be pretty awful. My ENT prescribed Azelastine, an antihistamine nasal spray that has worked wonders for me. It appears to raise the threshold for allergic reactions which can include swelling of the nasal passages. I knew I needed it in the Spring but I've found that if I don't use it daily I snore really badly, so I think that general house dust is causing some trouble. My wife is much happier now that I'm using it again.
Yep, Afrin and the like. They open things up nicely, for a time, then I have to keep using it or I spend a week feeling extremely blocked before returning to my baseline of annoyingly blocked.
I have not heard of Azelstine, and will bring that up to my doctor, thanks!
I have not heard of Azelstine, and will bring that up to my doctor, thanks!
I use to use sprays but at some point just stopped, because they were nor really helping. For some years I just accepted that my nose does not work properly. There were always some moments were I could use my nose but then it would get blocked. It was only after I read a book (Breath by John Nestor) that I started really trying. And it really worked! I wouldn't say that it will work for everyone, since I have no data and this is not my field, but many things from the book make sense and it is worth a try.
I had the surgery to have my deviated septum fixed and it was a good decision. First, I could breathe through my nose. Another huge benefit, though, was that all those sinus infections that couldn't drain kept turning into ear infections -- that just stopped.
The recovery from the surgery wasn't too bad for getting back to work -- I think I missed two days and the weekend. But the healing process gave me incredible headaches for about two months which went away entirely. Mine was badly deviated, though.
The recovery from the surgery wasn't too bad for getting back to work -- I think I missed two days and the weekend. But the healing process gave me incredible headaches for about two months which went away entirely. Mine was badly deviated, though.
Ok, but did you try exercising?
I mean this seriously:
your body naturally dilates your entire respiratory system in response to oxygen demand - and not by a trivial amount.
As someone who has a suspected less than perfect septum, and experiences allergies from time to time, I have gone from simply noticing the dilation effect to actively pursuing it as a remedy.
Which is to say, if I stay the night somewhere with indoor cats, I alleviate the symptoms by going for a run …
YMMV. IANAD. HNY!
I mean this seriously:
your body naturally dilates your entire respiratory system in response to oxygen demand - and not by a trivial amount.
As someone who has a suspected less than perfect septum, and experiences allergies from time to time, I have gone from simply noticing the dilation effect to actively pursuing it as a remedy.
Which is to say, if I stay the night somewhere with indoor cats, I alleviate the symptoms by going for a run …
YMMV. IANAD. HNY!
It sounds like you need a CPAP machine or the like.
CPAP is nice, but it can be a pain in the ass ; 9 months in I'm still struggling to use it consistently, with heavily deviated septum, allergies, seasonal sniffing. When I can consistently keep the mask on (nose) without feeling like I'm drowning, for at least a week, I get quite the refreshed feeling. Quite rare though... Tried all possible machine tunings, products, herbs, massages, activities... Still not there yet. And the surgeon isn't convinced I'll get better sleep even with deviated septum surgery, says he'd need to correct stuff 'behind' too. There's the 'mouth and nose' mask option but that leaks far more and is even more harder to sleep with...
Seems if you breathe from your mouth when you grow up, your tongue isn't parked up, pushing on your palate, and your jaw and face bones don't grow up correctly and it's very hard to correct as an adult. I get bone and articulation pains with the CPAP machine, since my tongue is now parked correctly it pushes hard...
Get your kids looked at. It's all hereditary for me (deviated septum) and I regret no-one telling me to get it looked at seriously when younger.
Seems if you breathe from your mouth when you grow up, your tongue isn't parked up, pushing on your palate, and your jaw and face bones don't grow up correctly and it's very hard to correct as an adult. I get bone and articulation pains with the CPAP machine, since my tongue is now parked correctly it pushes hard...
Get your kids looked at. It's all hereditary for me (deviated septum) and I regret no-one telling me to get it looked at seriously when younger.
I had that surgery, more than once, and I have trouble breathing when I sleep. I'm finding it hard to get a CPAP (I'm abroad in a non-English speaking nation so that's probably a factor). Have you tried taping your mouth closed? If you're definitely safe using the CPAP then you might try it, that's my plan.
Aside from that, I've found yoga and meditation that uses the breath as an object helps with my breath quality when awake, and recently I'm trying hot/cold contrasts (a hot bath and cold shower) as outlined in this Huberman Lab podcast[1]. I've noticed that my sinuses are clearer afterwards. That could be the steam or another reason, it is hard work though!
> I regret no-one telling me to get it looked at seriously when younger.
Me too, I had terrible advice, from medical professionals too. They didn't seem to care so I'm heartened by the recent findings which, even though they scare the hell out of me because it underlines all the problems I face and most likely will face, those walking behind us may have an easier road.
[1] https://hubermanlab.com/the-science-and-health-benefits-of-d...
Aside from that, I've found yoga and meditation that uses the breath as an object helps with my breath quality when awake, and recently I'm trying hot/cold contrasts (a hot bath and cold shower) as outlined in this Huberman Lab podcast[1]. I've noticed that my sinuses are clearer afterwards. That could be the steam or another reason, it is hard work though!
> I regret no-one telling me to get it looked at seriously when younger.
Me too, I had terrible advice, from medical professionals too. They didn't seem to care so I'm heartened by the recent findings which, even though they scare the hell out of me because it underlines all the problems I face and most likely will face, those walking behind us may have an easier road.
[1] https://hubermanlab.com/the-science-and-health-benefits-of-d...
Oh getting a CPAP was a breeze here in France and I didn't/don't have to pay a cent, neither for diagnosis nor for renting the machine nor the quite serious tech support and follow-up. So, while the rest of the French health system seems to be collapsing, this still works.
And it's (IMO) clever, since it's such a game changer for most of the people I met who use it, many costly ailments disappear. It's probably a winner for overall productivity and a great reducer of sick days and late-life healthcare.
And it's (IMO) clever, since it's such a game changer for most of the people I met who use it, many costly ailments disappear. It's probably a winner for overall productivity and a great reducer of sick days and late-life healthcare.
> started to really breath through my nose about two years ago
How? And despite your allergies, septum that were preventing it?
How? And despite your allergies, septum that were preventing it?
I did a similar process about two years ago. Started after reading Breath by James Nestor. The book doesn't prescribe anything but gives a very wide perspective of possibilities. I think what really did it for me was breath holding exercises.
This is exactly how I got motivated! The book really helped me. Nice to hear that it also helped you.
Reading through this article and comment thread makes me feel like I should be using a throwaway account to admit that I've been worried for years about the proportion of time I breath through my mouth due to feeling that I don't get enough air through my nose.
This sentence, "Every participant practiced becoming familiar with oral breathing until the participants could naturally switch their breathing pattern from nasal breathing" made me feel like I must be an alien.
I will say however that there are a fair number of comments in this thread that are not really up to the standard I'd expect from HN. I'm quite intrigued to see "mouth breathers" referred to in such derogatory terms. What kind of social indoctrination has triggered that response?
This sentence, "Every participant practiced becoming familiar with oral breathing until the participants could naturally switch their breathing pattern from nasal breathing" made me feel like I must be an alien.
I will say however that there are a fair number of comments in this thread that are not really up to the standard I'd expect from HN. I'm quite intrigued to see "mouth breathers" referred to in such derogatory terms. What kind of social indoctrination has triggered that response?
The book Breath by James Nestor really sparked a popular awareness about breathing.
I read this few months ago. I did not like it.
That was published in 2020. It doesn't feel like the root cause of the opinions being voiced in the comments.
I haven't been able to really breathe through my nose my entire life. I've really never had any negative effects from it. Not cognitive (that I know of), top of my class, now a SWE. Not dental, haven't had a cavity in 40 years. Not physical, I used to run track in HS/College and often got on the podium. Nor illness, I haven't had any sinus infections.
It's possible I just don't know what I'm missing, but (highly anecdotally) I haven't felt I've suffered having to breathe thru my mouth at all. Maybe it'll take me out when I get older, but I also don't know the difference.
It's possible I just don't know what I'm missing, but (highly anecdotally) I haven't felt I've suffered having to breathe thru my mouth at all. Maybe it'll take me out when I get older, but I also don't know the difference.
> ”Also... breathing through your nose increases nitric oxide in the upper airway”
But that’s a good thing, right? Nitric oxide being a vasodilator and bronchodilator, it promotes and regulates good respiratory function.
But that’s a good thing, right? Nitric oxide being a vasodilator and bronchodilator, it promotes and regulates good respiratory function.
Maybe the periodic olfactory stimulus is useful to the brain in non-olfactory ways? The study says:
> previous studies have observed [...] there was a decline in working memory performance for [...] olfactory memory task caused by oral breathing in healthy adults
referring to "Respiration Modulates Olfactory Memory Consolidation in Humans" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6596216/
Anecdotally, I find that listening to repetitive music can be surprisingly helpful when programming. I can imagine repetitive stimuli of other forms having a similar effect.
> previous studies have observed [...] there was a decline in working memory performance for [...] olfactory memory task caused by oral breathing in healthy adults
referring to "Respiration Modulates Olfactory Memory Consolidation in Humans" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6596216/
Anecdotally, I find that listening to repetitive music can be surprisingly helpful when programming. I can imagine repetitive stimuli of other forms having a similar effect.
Considering how tightly memory and smell are connected, plus the effects gastrointestinal health has on cognition...your suggestion isn't even remotely the weirdest thing that could be true about the human body and brain.
As some people have already mentioned, this study needs more support.
Just think about this, if you go to gym, do some sport, crossfit, whatever, you'd know it is certainly impossible for a human being anywhere on the planet, to even run 200 mts. without oral breathing at some point. If you keep doing physical activity your body eventually would have gone through years of orals breathing just by doing regular physical activity.
You actually need to breath by the mouth to increase the air pumped to the lungs, without that you rapidly exhaust the nose capability and you can't perform beyond marginal movement, i.e. you can fastly walk, but you won't run for long just by breathing by your nose.
So it looks a lot like from the point of view of evolution, our bodies are precisely made to breath by the mouth for short periods, which eventually account for long periods, and hours, months or years in the long run.
So it looks a bit like oral breathing is an expected normal function of the body.
ok, it is not that is a perfect function, or that it will keep you healthy at a 100% of the attempts, but is - this is my take - probably that breathing by the mouth is one more body function, a standard one, evolved to be regularly used, with some trade-off, cost / benefits involved.
It looks like we are beginning to underping those tradeoffs, but it is actually almost impossible to live normally without using those functions.
An example could be using teeth, which leads to quite a lot of bad issues in the mouth and probably affect lungs, the hearth, and a lot more. But you can't just stop eating and oral hygiene goes so far, it won't fully prevent issues, eventually something is going to fail there.
Just think about this, if you go to gym, do some sport, crossfit, whatever, you'd know it is certainly impossible for a human being anywhere on the planet, to even run 200 mts. without oral breathing at some point. If you keep doing physical activity your body eventually would have gone through years of orals breathing just by doing regular physical activity.
You actually need to breath by the mouth to increase the air pumped to the lungs, without that you rapidly exhaust the nose capability and you can't perform beyond marginal movement, i.e. you can fastly walk, but you won't run for long just by breathing by your nose.
So it looks a lot like from the point of view of evolution, our bodies are precisely made to breath by the mouth for short periods, which eventually account for long periods, and hours, months or years in the long run.
So it looks a bit like oral breathing is an expected normal function of the body.
ok, it is not that is a perfect function, or that it will keep you healthy at a 100% of the attempts, but is - this is my take - probably that breathing by the mouth is one more body function, a standard one, evolved to be regularly used, with some trade-off, cost / benefits involved.
It looks like we are beginning to underping those tradeoffs, but it is actually almost impossible to live normally without using those functions.
An example could be using teeth, which leads to quite a lot of bad issues in the mouth and probably affect lungs, the hearth, and a lot more. But you can't just stop eating and oral hygiene goes so far, it won't fully prevent issues, eventually something is going to fail there.
According to the book "Breath" by James Nestor, elite athletes were able to improve their performance by nasal breathing at all times. Apparently this innovation made a big impact at one of the Olympics, and has been part of training regimens ever since.
Oral breathing during exercise is a crutch for the body.
Oral breathing during exercise is a crutch for the body.
Sample size of 1 but I will do a 20km tempo run at about 4.00min/km and nose breathe the whole way. I also have a deviated septum.
Gonna sound like a kook here but mouth taping improved my sleep.
Mouth taping? How and why did you start doing this? :o
I tape my mouth because I hated waking up with a dry mouth that tasted horrible. I've also read that this contributes to tooth decay.
It's just a small piece of tape, as big as half a fingernail. It's placed on my lips right in the middle, and it works more by reminding my brain to keep my mouth closed and less by actually mechanically holding my mouth shut. If my nose is stuffed, I can just open a slight gap between my lips to breathe through. Otherwise, though, when my mouth is that close I will automatically close my lips and breathe through my nose through the night, which anecdotally improves my sleep quality and reduces morning breath.
It's just a small piece of tape, as big as half a fingernail. It's placed on my lips right in the middle, and it works more by reminding my brain to keep my mouth closed and less by actually mechanically holding my mouth shut. If my nose is stuffed, I can just open a slight gap between my lips to breathe through. Otherwise, though, when my mouth is that close I will automatically close my lips and breathe through my nose through the night, which anecdotally improves my sleep quality and reduces morning breath.
Did you try the chin-strap method also?
https://www.wikihow.com/Sleep-with-Your-Mouth-Closed
https://www.wikihow.com/Sleep-with-Your-Mouth-Closed
Thanks for the link. If I sleep on my back my jaw slackens and moves back toward my throat and blocks the throat or at least constricts and I snore. I tried a device like a mouth guard that captures the lower teeth but the pressure on my front teeth of holding my jaw up hurt. If I sleep on either side then my jaw doesn't fall back and all is good.
This was my exact experience.
Chin straps don't work with me. My face shape is kinda flat, and my temporomandibular joint is kinda messed up and doesn't hold my teeth together naturally. The chin straps I've tried all pull my chin down towards the airway.
A mouth guard plus chin strap may work but yeah there's that front teeth holding up the whole chin pressure.
Chin straps don't work with me. My face shape is kinda flat, and my temporomandibular joint is kinda messed up and doesn't hold my teeth together naturally. The chin straps I've tried all pull my chin down towards the airway.
A mouth guard plus chin strap may work but yeah there's that front teeth holding up the whole chin pressure.
[deleted]
My girlfriend had jaw issues and was recommended this after a surgery by her doctor. I decided to give it a try aswell as I had heard about the potential benefits. Used to wake up with a terrible dryness and taste in my mouth. Doesnt happen anymore now. Strangely enough my dreams got more vivid. Also, eventually it became like such a ritual that I would feel like something was missing if I didn't tape up. It started to feel snug, like a weighted blanket.
I met a guy who did this to prevent snoring.
Unfortunately it only works for certain types of snoring. If it doesn't work for your, consult an ENT doctor.
Do chin straps work just as well? If you were getting enough air through your nose, why would your body switch mouth breathing when you're sleeping?
Used to have a chronically stuffy nose at night, maybe due to allergies. Probably thats when the bad habit started.
I guess a chin strap would work aswell.
I guess a chin strap would work aswell.
Breath by James Nestor. Great book.
Fantastic book. Immediately applicable insights. The single thing that improved my running distance is a few rules I made after reading this:
- never open your mouth while running,
- breathe in for 2 steps, out for longer, like 5 or 7 steps. Odd out steps ensure the cycle starts with foot falls from alternate feet, ensuring you don’t over-strain one side.
- don’t run so fast that you have to open your mouth
- never open your mouth while running,
- breathe in for 2 steps, out for longer, like 5 or 7 steps. Odd out steps ensure the cycle starts with foot falls from alternate feet, ensuring you don’t over-strain one side.
- don’t run so fast that you have to open your mouth
I also feel the same way about the book, very easy to implement some of the suggestions in the book.
And your comment is also easily applicable, haha. I implemented the same strategy while running after the book. One of my favorite books.
And your comment is also easily applicable, haha. I implemented the same strategy while running after the book. One of my favorite books.
[deleted]
Yeah, to expand on the parent comment James Nestor talked extensively about mouth breathing vs nasal breathing in his book. He even volunteered to plug up his nose for a study on the affects of mouth breathing. TLDR: he felt awful when only breathing through his mouth for a few weeks and his performance on various tasks was objectively worse.
It was that book that made me get a deviated septum / nasal blockage surgery which helped a lot.
It was that book that made me get a deviated septum / nasal blockage surgery which helped a lot.
I had my inferior turbinates reduced a week ago. Already I am breathing a lot better, and I can feel I'm not fully healed yet (gets better every day). Should have had it done years ago. Something (not sure what) caused the turbinates to become larger some time ago, giving me breathing trouble. It's incredibly liberating to be able to nasally breathe freely again. I might even go so far as to say (utterly unscientifically) that I feel that I'm thinking more clearly now too!
Doesn't the book specifically worn about the dangers and possible horrible outcomes of this procedure? I'm glad it worked for you and you found a trustworthy doctor to do it right.
Yeah, I asked my ENT about "empty nose" which Nestor mentions in the book and he told me he's never had anyone complain from all the procedures he did. That was good enough for me. I had the surgery and no issues.
What was your experience with the surgery? I’ve got a deviated septum and frequently struggle to breathe through my nose even through very light exercise.
I think it really depends on the severity of the deviation and blockage. Before I I had the surgery, the difference between nostrils was significant. Left side was normal and the right was like breathing through a very small diameter straw. Post surgery, I sleep much better and rarely snore. I feel more comfortable when running or biking long distances while only breathing through my nose. Do yourself a favor and get an evaluation if you have a blockage or deviated septum!
After the deviated septum and turbinate (?) reduction my breath improved noticeably, my sleep got better, my headaches were significantly reduced, and anecdotally I felt a lot less anxious. The ENT doctor told me "things were pretty deranged back there" after the surgery so it makes sense this would help.
That said, I still do the neti pot every day since I wouldn't say my breathing is "completely" clear.
That said, I still do the neti pot every day since I wouldn't say my breathing is "completely" clear.
One of my friends had this issue for years and he said that it did wonders for his sleep quality and general clarity of mind. The recovery period was apparently terrible -two weeks of not being able to breathe through your nose at all while experiencing significant sinus pressure/headaches- but it must be worth it because he said he would do it again.
Thanks for expanding. I am a big fan of the book. Some of Nestor's podcast appearances after the book are also great - similar content as the book in podcast format, some hosted by docs and other experts.
curious to hear what the outcomes were for you on deviated septum? I got a CPAP machine which helps a lot with night sleep but then realize that even during the day I'm congested so I'm not optimally breathing.
the other suggestion from the ENT doctor was that I removed both my tonsils and get my uvula chopped off. so I'm deciding between the septum operation and/or tonsil operation
the other suggestion from the ENT doctor was that I removed both my tonsils and get my uvula chopped off. so I'm deciding between the septum operation and/or tonsil operation
After the deviated septum and turbinate (?) reduction surgery my breath improved noticeably, my sleep got better, my headaches were significantly reduced, and anecdotally I felt a lot less anxious. The ENT doctor told me "things were pretty deranged back there" after the surgery so it makes sense this would help.
That said, I still do the neti pot every day since I wouldn't say my breathing is "completely" clear.
That said, I still do the neti pot every day since I wouldn't say my breathing is "completely" clear.
Getting my nose fixed after 25 years made me wish I had it fixed 24.5 years before. There is no question about it for me that it is one of the best things I've ever done. All the sinus and ear infections I got because my nose couldn't drain are behind me now.
Also had my turbinates reduced at the same time.
Also had my turbinates reduced at the same time.
I've found that keeping my nose hair trimmed makes a big difference in nasal breathing air-flow and inhalation ease. And by trimmed I mean using a battery powered trimmer with the circular cutting head with slots and getting as far back as I can reach with that.
alright you've sold me on testing this idea out
22 people in the study :eyeroll:
You can dismiss a study with 22 participants as unscientific, if they could have reasonably done a study with many more participants, or if someone else has already done so.
In this case, it's an fMRI study. fMRI access is expensive, and analysing results is time consuming. It's reasonable to start small. If the smaller study comes up with anything interesting, then you can do a larger study later to confirm, and the experience you gained in the smaller study will help you design the larger one.
In this case, it's an fMRI study. fMRI access is expensive, and analysing results is time consuming. It's reasonable to start small. If the smaller study comes up with anything interesting, then you can do a larger study later to confirm, and the experience you gained in the smaller study will help you design the larger one.
You probably should dismiss the results if they publish the study of 22 people rather than doing that larger follow-up.
Shouldn't all studied publish their results, regardless of followup studies? Also, assuming they don't already have funding for the larger study, it seems they would need to publish in order to garner attention from the study to secure the future funding.
I think the nose warms air as one of its functions. I've been trying to breathe in through the nose running, and breathe out through the mouth (at least in the winter when there's more than just air that would be released from the nose otherwise). I find that my nose hurts because the air feels cold and I start to feel inflammation - this happens indoors as well. This is separate from the capacity issue, and feels like my body telling me not to do that anymore.
When I was a small child I had an operation in my nose that did something - that my mom doesn't remember. To this day I imagine they removed or fixed something and no one knows what they removed or did, I woke up in a recovery room with my nose bleeding (inpatient procedure). I had terrible allergies as a kid.
When I was a small child I had an operation in my nose that did something - that my mom doesn't remember. To this day I imagine they removed or fixed something and no one knows what they removed or did, I woke up in a recovery room with my nose bleeding (inpatient procedure). I had terrible allergies as a kid.
General question for anyone with an opinion. Is it common knowledge in your society/culture/family that "mouth breathing" is a bad thing?
I'm really fascinated by this because some of the comments I've been reading here are very opinionated but I don't know what they are based on.
I'm really fascinated by this because some of the comments I've been reading here are very opinionated but I don't know what they are based on.
There has been a social stigma against breathing through your mouth in the UK for as long as I can remember, with it being associated with negative qualities like being undisciplined, unathletic, dimwitted, along with it being considered an impolite thing to do.
I doubt this was part of the curriculum, but in fitness classes at school we were told that breathing through your nose with your tongue pressed against the roof of your mouth helps develop your face/jaw and that breathing through your nose moistens the air and helps filter it. We were also told that it's not necessary to breath through your mouth when you're out of breath as you won't get or don't need more oxygen and that you risk hyperventilating this way, instead we were told that you should breath using your diaphragm to help mix the air in the lungs and that you should hold the breath for about as long as you inhale/exhale if you can help it. This sort of breathing exercise seems pretty common in any fitness/exercise related guide I've seen too.
As far as other countries/cultures go, any country that has a strong yoga/meditative culture likely considers breathing through your mouth to be bad too, but this is just speculation on my part. Pranayama is thousands of years old for instance and is primarily concerned with controlling and reducing your breathing, which is hard to do if you're not breathing through the nose.
I doubt this was part of the curriculum, but in fitness classes at school we were told that breathing through your nose with your tongue pressed against the roof of your mouth helps develop your face/jaw and that breathing through your nose moistens the air and helps filter it. We were also told that it's not necessary to breath through your mouth when you're out of breath as you won't get or don't need more oxygen and that you risk hyperventilating this way, instead we were told that you should breath using your diaphragm to help mix the air in the lungs and that you should hold the breath for about as long as you inhale/exhale if you can help it. This sort of breathing exercise seems pretty common in any fitness/exercise related guide I've seen too.
As far as other countries/cultures go, any country that has a strong yoga/meditative culture likely considers breathing through your mouth to be bad too, but this is just speculation on my part. Pranayama is thousands of years old for instance and is primarily concerned with controlling and reducing your breathing, which is hard to do if you're not breathing through the nose.
For what it’s worth, I’ve only heard this term in my (American) culture for the past 5 or so years.
My first exposure to the term was via internet memes where “mouth breathing” was conveyed as existing only with those who were mentally impaired. Check out the Urban Dictionary link someone else responded to you with in a different comment thread for more context.
I don’t recall ever hearing anything about “mouth breathing” in my society/culture/subculture before exposure to these memes, so I wonder if it’s a newer thing? If so, silly memes really are influencing our culture!
My first exposure to the term was via internet memes where “mouth breathing” was conveyed as existing only with those who were mentally impaired. Check out the Urban Dictionary link someone else responded to you with in a different comment thread for more context.
I don’t recall ever hearing anything about “mouth breathing” in my society/culture/subculture before exposure to these memes, so I wonder if it’s a newer thing? If so, silly memes really are influencing our culture!
>General question for anyone with an opinion. Is it common knowledge in your society/culture/family that "mouth breathing" is a bad thing?
Yes and no. Mouth breathing in and of itself isn't, socially, a negative.
However, in English[0][1][2], a "mouth breather" is also a euphemism for someone of below average quality and intelligence.
Not sure how that came to be, but that's the answer to your question.
[0] https://en.wikipedia.org/wiki/Mouth_breathing
[1] https://idioms.thefreedictionary.com/mouth-breathers
[2] https://www.definitions.net/definition/mouth%20breather
Yes and no. Mouth breathing in and of itself isn't, socially, a negative.
However, in English[0][1][2], a "mouth breather" is also a euphemism for someone of below average quality and intelligence.
Not sure how that came to be, but that's the answer to your question.
[0] https://en.wikipedia.org/wiki/Mouth_breathing
[1] https://idioms.thefreedictionary.com/mouth-breathers
[2] https://www.definitions.net/definition/mouth%20breather
I recommend the book Breath by James Nestor. A well researched book, in which he makes the case for nasal breathing.
That's not an answer to my question at all. I'm asking about the comments and attitudes that seem to treat mouth breathing as bad and wondering where they come from. I'm (relatively) sure that a book published in 2020 isn't the root cause.
Historically, it feels more like a class thing. A proper, civilized person would keep their mouth closed.
As for the current mouth vs nose and belly vs chest breathing, it really feels like a fad/cult. There seem to be a constant stream of very small "studies" with questionable methodologies with just enough results to warrant further investigation.
As for the current mouth vs nose and belly vs chest breathing, it really feels like a fad/cult. There seem to be a constant stream of very small "studies" with questionable methodologies with just enough results to warrant further investigation.
It’s been a thing in uk for hundreds of years and because of the internet cultures are merging.
I was raised in the American South.
I always thought "mouth breather" was referring to stupid, but tough guys who did so much fighting that their smashed noses don't work anymore.
Also, my nose has been broken a few times and I can't ever really get enough air through it...
I always thought "mouth breather" was referring to stupid, but tough guys who did so much fighting that their smashed noses don't work anymore.
Also, my nose has been broken a few times and I can't ever really get enough air through it...
Not an idiomatic expression in Brazil. There is some cultural behavior of my parents telling me to “close my mouth” as it was an inherent bad/impolite/ugly/improper thing.
Definitely yes. Parents tell their kids to "close their mouth" etc. Being seen in public with your mouth open is seen as impolite/a sign of some mental issues.
Generally when scientists see some phenomena they tend to view it through the lens of "what is a plausible mechanism for this observation?".
So the question is - what would be a plausible mechanism for oral vs nasal breathing having an impact on cognitive function?
So the question is - what would be a plausible mechanism for oral vs nasal breathing having an impact on cognitive function?
I'm not a native English speaker, but pretty good at it, but the word "induce" here gets me. Does "induce impaired cognitive function" mean something good, or something bad, for cognitive function?
Even as an English speaker, the abstract is hard to follow.
Bad. Induce means “to lead to”, from the Latin. Think ducts and dukes.
My left nostril appears to have collapsed at some point, I really should prioritise getting it sorted, it reduces the amount of air I can breath through my nose significantly, especially if one nostril is blocked.
The less 02 you breath in, the more the CO2 build-up and, per the Bohr effect, the more efficiently you'll absorb the 02. Just don't mouth breath and you'll be fine. Actually, you'll be healthier because of it.
Oddly enough, same happened to me many years ago. Only thing that helps slightly is Breathe Right strips. My father had the same issue so maybe our left nostril DNA got dented.
I didn't get a chance to read the full paper, so this may be covered, but do they account that the causality may be reversed?
Meaning that instead of nasal breathing causing more brain activity, instead the subjects had to concentrate more on consciously breathing through their nose and the activity is due to that? I.e., the brain activity is actually "causing" the nasal breathing?
Meaning that instead of nasal breathing causing more brain activity, instead the subjects had to concentrate more on consciously breathing through their nose and the activity is due to that? I.e., the brain activity is actually "causing" the nasal breathing?
Not breathing at all impairs cognitive functions even more significantly, even before the system shuts down [eg. divers that are running low on oxygen].
Though it is hard to measure what are the effects of panic and what stems the shortage of oxygen.
Though it is hard to measure what are the effects of panic and what stems the shortage of oxygen.
Lends some credence to the insult "mouth breather" doesn't it.
QQ, when I go running or exercising hard, I always end up mouth breathing. Is it harmful in this context?
No. Almost everyone will need to mouth breath while at max effort.
It may be beneficial to deliberately nose-breath as long as possible, especially at Zone2.
I try to transition to nose-in, mouth-out as a fallback before going mouth-in, mouth-out.
Honestly, I don't even know how big of an effect it has, but I've been trying it for the past year to test it out. Been training for over a decade so I just enjoy testing new things.
It may be beneficial to deliberately nose-breath as long as possible, especially at Zone2.
I try to transition to nose-in, mouth-out as a fallback before going mouth-in, mouth-out.
Honestly, I don't even know how big of an effect it has, but I've been trying it for the past year to test it out. Been training for over a decade so I just enjoy testing new things.
It's (also) a matter of capacity. You need to inhale a lot of air during exercise. Your nose is just too narrow.
I remember learning this when I was a child. what’s new about this?
The nose also does some dust/pathogens filtering.
Another reason to have my deviated septum repaired.
Just had mine fixed. On week 5 and still healing... recovery has not been fun but there has been an improvement.
How is your sense of smell. I worry about losing my permanently as a complication.
My sense of smell is as strong or stronger than ever. Though I did mostly lose it for a couple of weeks. The first week was pretty miserable, with my nose completely packed, the rest has been fine, overall not as painful as I thought it would be. For the first two weeks or so I lost the feeling in my upper lip and upper front teeth, this was alarming and no one mentioned it ahead of time but it cleared up. Just seems to take a long time to heal but it was worth it.
nose breathing is a must in tai chi
So the Yogi’s were right after all?
They have been “nasal breathing” for centuries.
:-)
They have been “nasal breathing” for centuries.
:-)
Swimming makes you stupid eh?
It makes sense. Just trying to breathe from the mouth for a while makes me feel sick.
That is not a normal reaction.
Well, the word sick was too much. Not normal? I don't know it feels wrong.
A funnier title would be "NIH confirms mouth breathers really are stupid". :)
I was about to say, this reaffirms the word 'mouthbreather'
Why would someone breathe through their mouth if there's no nasal congestion. I'm pretty sure that you'd have to be cognitively impaired to begin with.
Can I ask where and how you developed your knowledge about the relationship between breathing and intelligence? Is this common knowledge where you are from? How often are you aware of how others are breathing? Is this something discussed in your family or friendship groups?
Someone who breathes through their mouth keeps their mouth open, which is easy to observe. Someone might keep their mouth open for other reasons, such as being overwhelmed or surprised. This might explain why the mentally impaired might be observed with their mouth open more often than normal people. I'm not sure if there's a connection, but if there is, I would assume that mental impairment is the cause rather than mouth breathing.
Come on that's half an answer! Is this something you've known for ages? Is it something you remember learning from adults when you were growing up? Why do you personally have an opinion about this at all?
No, I haven't heard of this connection until recently. I've seen 'mouthbreather' used as a derogatory term online, which is probably where I've seen it the first time.
Top entry for 'mouthbreather' on Urban Dictionary is from 2017: https://www.urbandictionary.com/define.php?term=Mouthbreathe...
Top entry for 'mouthbreather' on Urban Dictionary is from 2017: https://www.urbandictionary.com/define.php?term=Mouthbreathe...
Its way older than 5 years old. Wonderfalls (2004) had a character refered to the mouth breather in derogatory way. I know my brother used that in similar way growing up but im sure there are better/older references but those are mine.
Because:
1. Some people's nasal passages are partially or fully clogged.
2. Even when fully open, there is not enough airflow through the nose to facilitate anything more strenuous than light walking.
1. Some people's nasal passages are partially or fully clogged.
2. Even when fully open, there is not enough airflow through the nose to facilitate anything more strenuous than light walking.
Repeat after me: Your NOSE is for breathing, your MOUTH is for eating.
Great advice. I'll just pass it on to my autoimmune disorder to unclog my sinuses. /s
what disorder is this ? overproduction of mucus ? or inflammed tissue blocking air flow ?
The first. If you have some advice on this, I'll be extremely glad to follow up on it!
I wish, I think I developed a form of this. For a year or so I've been having huge episodes of nasal problems.
[0] it got to a point where I was physically exhausted from sneezing, abdominal cramps and nausea.. "surprising" to say the least
- large amount of mucus (I stopped counting tissue after the 1000 mark [0])
- strange consistency of mucus (thicker, and glue like)
- very narrowed nasal cavity
[0] it got to a point where I was physically exhausted from sneezing, abdominal cramps and nausea.. "surprising" to say the least
hi again,
this video about vitamin D physiology popped on youtube https://www.youtube.com/watch?v=fDBZM1n_uDE
apparently it's an important control molecule for the immune system
this video about vitamin D physiology popped on youtube https://www.youtube.com/watch?v=fDBZM1n_uDE
apparently it's an important control molecule for the immune system
Hey, Thanks for following up! My Vitamin D level is deficient. I want to somehow address this as well, let's see what effect it has.
I'm really intrigued about who told you this or how you (or they) determined this knowledge? In your society while growing up where people aware of how others were breathing and instructed them?
Is this knowledge more like right handedness vs left handedness, scrunch vs fold, sit or squat, not sleeping with fans or more like not drinking white wine with red meat?
Is this knowledge more like right handedness vs left handedness, scrunch vs fold, sit or squat, not sleeping with fans or more like not drinking white wine with red meat?
Except for when you’re performing any hard aerobic exercise, at which point you have to breathe through your mouth.
...and when you're intubated with an NG tube.
We are not designed for hard aerobic exercise.
What makes you believe that a species that evolved from persistence hunters is “not designed” for hard aerobic exercise?
Isn't the idea behind persistence hunting that it's long-term, low effort aerobic exercise? That is, our ancestors were good at maintaining low-speed pursuit for long distances, but not so great at sprinting after prey.
Sprinting is anaerobic.
And yet we’re remarkably good at it
Someone more athletic or fitter than you wouldn’t mouth breath at the level of activity you mouth breath at. Their capacity is higher.
Hard aerobic exercise is relative, clearly.
So? Hard aerobic exercise is hard. A fitter person will just be faster.
well I just meant it could be an area for improvement. It is possible to work your way to being more capable with just nasal breathing. Or sometimes you just have to be conscious you are mouth breathing and you'll be able to revert to nasal breathing. I didn't say you should never mouth breathe or somehow you are inferior to a super athlete.
That’s some solid advice right there.
Also, no jamming jam into the ear, ya hear?
Now, apart from the fun rendition (“mouth breathers are dumb”), this gives an interesting explanation on why I feel dumb when I’m congested.
Also, no jamming jam into the ear, ya hear?
Now, apart from the fun rendition (“mouth breathers are dumb”), this gives an interesting explanation on why I feel dumb when I’m congested.
And when breathing through your nose, remember not to sniff petrol from a can: https://www.youtube.com/watch?v=s1yeBmSFkC4
You’re just trying to take all the fun away.
Anyway, is glue still ok?
Anyway, is glue still ok?
Try having a bad asthma attack, and then get back to us :(
But where do we speak out of?
That doesn't prove anything. Apart from the problems in imaging connections, there's no reason to assume "more brain activation" means better cognitive functioning. Perhaps less is better, since a faster processing leads to a smaller BOLD response. There are more useful statistics in the article: the error rate and the response time. It looks as if "oral" was a bit faster, and had more errors. That might be enough to explain any imaging difference.
Does it mean impaired cognitive function? Well, that would depend on how strong your a prioris are. Is there any reason to assume it does? If not, then this most likely is a chance result. Perhaps oral breathing slightly impaired vision in the scanner or interferes with motor skills. Or perhaps it's the plug in the subjects' noses. This study needs a lot of additional support.