Frequently Asked Questions

Here at the Oxygen Advantage®, we love getting questions and feedback from our global community of students and breathing instructors. Here are some common questions, answered by Oxygen Advantage® founder, Patrick McKeown. If you don’t find the answer you’re looking for, head over to our science pages or contact us.

General Questions:

What is the difference between the Oxygen Advantage® and the Wim Hof methods?

The difference between the two methods is explained in this article: THE WIM HOF BREATHING METHOD & PATRICK MCKEOWN’S OXYGEN ADVANTAGE® 2 EXPERTS, 1 GOAL.

Can children and teenagers use the Oxygen Advantage® exercises?

Yes. There is a special children’s breathing re-education program, which you will find at This will always be available free of charge.

What is the difference between the two editions of The Oxygen Advantage book?

There is no difference. The book has two different covers because it is published separately in the USA and UK. The text is the same in both.

Is there an Oxygen Advantage® App?

Yes. Our mobile app can be downloaded here

Questions about the BOLT score:

When measuring my BOLT score, what is meant by ‘the first definite desire to breathe’?

It’s just the first distinct feeling that your body wants to resume breathing. You will experience it as involuntary contractions of your breathing muscles. Your breath at the end of the measurement should be fairly normal. You should not finish the breath-hold gasping for air.

I don’t understand what the BOLT score is.

BOLT stands for Body Oxygen Level Test. The BOLT score is the time in seconds that you can hold your breath on exhalation until the first definite desire to breathe. It is used as a simple objective measure of chemosensitivity to carbon dioxide (how sensitive your body is to the build-up of CO2 in the blood), or a measure of breathlessness. That’s it.

When is the best possible time to measure my BOLT score?

The best time in order to get an accurate reading is first thing in the morning, soon after waking.

I normally have a comfortable BOLT score of around 40 seconds. But on some days it is much lower. What could be the reason?

It is normal for the BOLT score to fluctuate. The measurement can depend on parameters including your diet, your level of exercise, how much you are talking and, for women, where you are in your menstrual cycle. This is why it is important that the BOLT score is measured first thing in morning before you expose your body to too many confounding factors.

Practicing Breath Holds and Exercises:

If I want to practice breath holds when walking in public can I do so without using my hand to pinch my nose closed? Is a no-hands breath hold even worth trying?

Yes, just hold the breath. You don’t need to pinch the nose.

To what extent should I hold my breath?

This is a personal thing. If you are suited to the breath holds, you can hold breath until you feel a moderate to strong air hunger. If you have certain conditions like panic disorder, you should only hold the breath to achieve a very light air hunger. If you are pregnant, don’t practice any breath holds.

When practicing to achieve air hunger and cadence breathing, is the idea to minimize the volume of air during the exercise? The instruction is to breathe LSD (light, slow, and deep). But when I try to breath light and slow during the 4 seconds in/6 seconds out it seems like I cannot take a deep breath. I don’t feel much movement in the lower two ribs. I was wondering if changing to a count of 6/7 seconds in and 8/9 seconds out would be a good idea where I can still breathe really light/slow, achieve air hunger and take a much deeper breath (really feel the expansion of the first two ribs)? Any thoughts on doing this?

These are really three different exercises:

  • Breathe light, biochemistry – the focus is on air hunger
  • Breathe light, biomechanics – the focus is on breathing with greater use of the diaphragm
  • Breathe light, cadence – the focus is on slowing the breath to six breaths per minute

When practicing the exercises for biomechanics and cadence, it is really important not to over breathe. It is common for people to breathe low, but in the process take full, big breaths, which disrupts the biochemistry. It’s all about balance. You don’t need air hunger while practicing biomechanics and cadence. But a light hunger will ensure that you are not over breathing.

The aim with all three exercises is to reduce the breathing volume, which is why it’s called Breathe Light. In terms of cadence, six breaths per minute has been recorded as optimum for many cardio-respiratory parameters in a large number of different scientific studies. Research (Bilo et al., 2012) directly shows how this impacts gas exchange. At 12 breaths per minute, 4.2 liters of air reaches the alveoli (the tiny air sacs in the lungs where exchange of oxygen and CO2 takes place). At 6 breaths per minute, it’s 5.1 liters.

Can diaphragmatic breathing happen without air volume? Can we expand our stomach without breathing? Does that not stretch the diaphragm?

The Oxygen Advantage® program emphasizes deep, slow and light breathing to engage the diaphragm. During inhalation, the diaphragm moves downwards and there is lateral expansion of the lower two ribs. This creates intra-abdominal pressure. You could technically move the diaphragm by pushing the tummy out. The diaphragm is a striated muscle like the muscles that move the skeleton and can be consciously controlled. But without the air, there is no intra-abdominal pressure, so no load to strengthen the muscle. It would be a bit like lifting weights without the weights.

Why is it easier to do breath hold exercises while walking or jogging than while sitting down?

Many people find this. It is likely, in part, to be due to the distraction. The body can cope better with air hunger during movement. Also, sitting can compress the diaphragm.

Why does my blood oxygen drop during and after these exercises? My oxygen goes to 93/95%. My heart rate goes to 53bpm. That’s not healthy right? I believe it’s only temporary. Is the goal to get my body and brain used to this volume of breathing?

During reduced volume breathing (breathe light to breathe right), blood oxygen saturation might drop a little. That is fine as long as you are not stressed. If in doubt, please stop practicing the exercises. Seek out an instructor who can help you.

Are there any videos demonstrating the advanced high-altitude training techniques?

Yes, there are video lessons available as part of the online video course, or in our Advanced Instructor Training certification.

Questions About Nasal Breathing:

Is breathing both in and out through the nose essential?

Breathing out through the nose is preferable to exhaling through an open mouth. When you exhale through the nose, heat and moisture is retained in the body. Mouth breathing causes the loss of 42% more water from the body. Nasal exhalation also causes greater resistance to airflow, which contributes to better gas exchange in the lungs. For the same reason I also discourage the practice of breathing in through the nose and breathing out through pursed lips. Pursing the lips may prolong the exhalation, but so does nasal breathing.

Do you have any practice for getting rid of nasal congestion without using medication?

Yes, as long as you are in reasonably good health, you can practice the MBT (Maximum Breathlessness Test) which you will find on the homepage. Repeat the exercise five times. Until your breathing patterns have improved, it is normal for the nose to block again. Simply repeat the exercise whenever necessary, work to improve your BOLT, and over time you will begin to experience less congestion. You could also try the nose unblocking exercise.

Are people who have larger nostrils at an advantage in terms of breathing?

Yes. Particularly in terms of maintaining nasal breathing during physical exercise. For people with small nostrils I recommend NasalDilator.

Have you any advice for someone with a deviated septum attempting nasal breathing? In your opinion, do you think surgery is necessary?

Around 60% of the general population has a deviated septum. For the vast majority of these people, continued and comfortable nasal breathing is possible. If your nose feels stuffy, practice the nose unblocking exercise. Try the exercise six times. If you can breathe through your nose for one minute, you can do so for life.

Does the production of nitric oxide (NO) in the nasal airways contribute to increased levels of NO in the blood?

The nitric oxide that is produced in the paranasal sinuses and inhaled during nasal breathing is not the same as the NO that is produced in the cells or dietary NO. The effects of NO from the nose are isolated to the airways and lungs.

Questions About Breathing and Sleep:

Is it okay if I tape one nostril all the time even in bed? I want to reduce my breathing volume.

No, I would not advise taping one nostril during sleep. This could cause greater negative suction pressure in the throat which will increase the risk of airway collapse. If you want to reduce your breathing during sleep, wear the Buteyko belt at night to add a little extra resistance to the breath. You can purchase this in our store.

Which snoring strap do you recommend?

Snoring straps are not recommended because they can pull the jaw backwards and reduce airway size. Compromised airway size can increase the risk of airway collapse during sleep and actually increase the likelihood of snoring or obstructive sleep apnea. If you want a sleep breathing support to help with snoring, try MyoTape. The tape surrounds the mouth, gently bringing the lips together to ensure nasal breathing during sleep. Read more and purchase MyoTape.

The Oxygen Advantage® and Sport:

I am trying desperately to nose breathe whilst jogging but my nose starts to run after about a minute. I end up reverting to mouth breathing. Any advice?

Yes, this is normal. Bring a tissue with you. It does dry up in time and the body will adapt. But even in cold air, the nose will run. See the benefits of running with the mouth closed: How to breathe while running

Does EPO (erythropoietin) help with general performance for those who are not competing and just want a boost to workout in gym or running distance?

Yes, EPO increases the oxygen-carrying capacity of the blood. However, there are many benefits from the Oxygen Advantage® exercises in terms of endurance and general performance. EPO is just one of them.

For athletes who are injured or about to go into surgery and can’t go out and run, what breath holding techniques could help maintain the level of endurance?

For injured athletes, I would recommend all the techniques involving functional breathing and breath holding. They are all explained in the book and online courses. Also, make sure you are nose breathing during wakefulness, exercise and sleep. As long as you can maintain a good BOLT, you will find it easier to get back into training.

Just to clarify before competition should I hold my breath? For how long and how many times in order to boost EPO?

Holding your breath directly before competition will not boost EPO, because the red blood cells take around three days to mature. Breath holding should be practiced every day. Do 5 reps twice daily.

When practicing breath holds as part of my Oxygen Advantage® training, what should the target be for Heart Rate Variability (HRV)? I did 6 sessions x 10 mins on a treadmill to change the types to see my body’s reaction (HRV vs Breath hold). I am new to this HRV thing and want to understand more by combining Oxy Adv.

It’s important to understand that different HRV readers give different kinds of readings. It’s also best to keep it simple, which is why I don’t give ‘ideal’ readings. In a webinar for our OA training, Dr. Jay T. Wiles, who is a Clinical Health Physiologist specializing in sports performance and holistic and integrative health, and board certified in biofeedback and Heart Rate Variability Biofeedback (HRVB), explained that the focus should be on self-comparison only. You’re looking to develop the ability to modulate your HRV, not to hit target readings.

HRV is improved by cadence breathing at 6 breaths per minute. The Oxygen Advantage® focuses more on changing the biochemistry and biomechanics of breathing, but this in itself will slow the respiratory rate leading to increased HRV. In essence, you don’t have to do anything specific to improve your HRV. Just do the exercises.

What about breathing for swimming? Does breathing through the mouth affect performance?

Mouth breathing during swimming is fine. Take one breath every five strokes. Work on increasing your BOLT score. This, and nasal breathing day and night outside of swimming will help your performance.

I’ve been practicing breath holding and nose breathing while exercising (HIIT and running) for the past 2 or 3 weeks. Two days ago, I ran an 8km race and was able to sustain nose breathing for the whole race with a heartbeat at +190-200bpm without difficulties! Truly amazing! Is it possible to overdo it with the breath-holds (maybe with the blood pH balance)?

Yes, adaptations do take place. To answer the question, breath holds should not cause too much stress. We teach people to hold the breath after an exhalation until moderate to strong air hunger, but never to extreme air hunger. You should always recover within a couple of breaths. Practice 5 reps twice daily. That is enough.

I compete in MMA and am currently trying to make the switch to nasal breathing and high-altitude simulation. I have already after a couple of weeks noticed improvements in cardio and composure. I have a question relating to the format of MMA competitions. with the rounds being 5 mins with 1 min rest in between, what is the best way to breathe during that one min rest in order to recover? Am I right in thinking that despite the urge to breathe rapidly, I should try and slow my breathing and nasal breathe as much as possible? Many thanks for your insight! Its changing my game!

The first few weeks of nose breathing will be tough. But this is where the body makes adaptations. It is necessary to be persistent during training, spending as much time breathing through the nose as possible. Also, you should never wake up with a dry mouth. Keep the mouth closed at night by taping the lips with MyoTape, which you can purchase in the online store. Then sleep is deeper, and focus is better. Before competition, practice five strong breath holds. During the rounds, take slow and deep breaths. Take fuller breaths but fewer of them. Also, make sure your BOLT score (40 seconds) and MBT score (80 paces) are good enough. See both tests on the homepage.

If the body produces more red blood cells, isn’t there a risk that blood becomes thicker?

Yes, there is a risk when hematocrit increases over 50%. You are unlikely to see this kind of increase from breath holding.

Would L-Arginine and L-Citrulline supplementation be useful to help increase Nitric Oxide levels?

Research has shown that both supplements improve endothelial function, which is important for the proper working of the blood vessels. And a research paper titled Nasal Nitric Oxide in Man, which is by Professors Lundberg and Weizberg, states that “intravenous application of L-arginine resulted in an increase in nasal NO levels. However, this is not something that I have expertise in so I would advise that you do your own research. Production of NO in the nose and blood are separate of each other. When we practice nasal breathing, it’s the nasal NO that we are working to harness, because this has a direct effect on the function of the lungs.


Healthy blood pressure changes all the time. But there are certain things to look out for. Read our article by trained breathing instructor and medical doctor, Dr. Charles Florendo for more info.

Instructor Training

For answers specific to the instructor training courses, see the FAQs on each certification page

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