The Integrative Palliative Podcast

BreathNote: A Powerful Tool for Using Your Breath to Improve Wellbeing

• Delia Chiaramonte, MD • Season 3 • Episode 108

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Breath is powerful. We carry it with us, it keeps us alive, and it can either increase our stress or reduce it.

Slow breathing is a secret weapon for reducing the stress response, reducing anxiety and improving wellbeing.

This week you'll hear from Fernando David Pinon and Nancy Estaphanous, the co-founders of BreathNote. BreathNote is a unique and effective tool that uses music to guide relaxation breathing. It can be used in clinical settings, such as chemo suites or physician exam rooms, and it can be used individually by patients, families and clinicians to facilitate well-being.

In this episode you will not only learn about BreathNote and how it can be used to help pain, anxiety, and other discomforts, but you will experience it for yourself. 

 Whether you're seeking a personal wellbeing tool or a professional tool for patient care, our conversation provides insights into the power of music and breath.

How to contact Fernando and Nancy at Breathnote:
www.breathnote.com
partnerships@breathnote.com

Celebrating the heart-centered healer that you are,

Delia Chiaramonte, MD
www.integrativepalliative.com

Coping Courageously: A Heart-Centered Guide for Navigating a Loved One’s Illness Without Losing Yourself is available here: www.copingcourageously.com

A free guide for physicians to help reclaim your joy at work and in life https://trainings.integrativepalliative.com/pl/2148540010

Please review this podcast wherever you listen and forward your favorite episode to a friend! And be sure to subscribe!

Sign up to stay connected and learn about upcoming programs:
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Speaker 1:

Welcome to the Integrative Palliative Podcast, where we help physicians and other clinicians master the art of integrative symptom management so they can wholeheartedly care for themselves as they expertly care for their patients. Welcome everybody, I'm Dr Karimanti and I'm very excited about today's guests. Today, we have Fernando, david Pignon and Nancy Estefanis, who are co-founders of BreathNote, and that's going to be the focus of our conversation today. You'll find out all about BreathNote. Fernando is a visual artist and a composer, and Nancy is the owner of Nesta Event Group. They've created a way to guide people in the use of relaxation breathing techniques using music, and that's what I think is so important and new. And, in fact, the mission statement of their company is to improve wellness worldwide by making breathwork accessible through music. Welcome, fernando and Nancy. Thank you.

Speaker 2:

Thanks.

Speaker 1:

All right, so get us started. Tell us about BreathNote.

Speaker 2:

Well, I think there's the music element of it and then there's the business element of it, and the music element of it started originally just help with free diving. Both Nancy and I were training to be free divers and improving our breath world, and one of the biggest factors in being able to hold your breath is being relaxed and having a low heart rate, and so, you know, a lot of the training is for that reason. So I thought maybe if I can start composing music and timing it to the intervals of breathing, that would help me then just make it easy to slow down my breathing for extended periods of time. And then that was just, you know, my secret tool for training. So that's how the music started.

Speaker 2:

And then BreathNote evolved from there, because we started realizing how useful slow deep breathing was outside of just free diving. I mean, it was literally. We started laughing because everything that we would do as a Google search, you know, for slow deep breathing there ended up being a paper on it. So we were like, okay, well, maybe we should look a little bit more into how it can be used in different settings and really explore that more. So that's where BreathNote as a business and a music label came in and that's really just to make that music available to everybody.

Speaker 1:

The idea of relaxation breathing as a benefit is clear, but the hard thing for some people is to do it, to do it in a way that feels comfortable, to remember to do it, and that's why I think what you guys created is so interesting and valuable, because anything that can help people actually use relaxation breathing is a benefit. We know it works and still a lot of people don't do it. So why is that? It's hard to get to for some people and I think that's what you've really tapped into.

Speaker 2:

Thanks, yeah, I think it's good and just it provides a structure for that time and it's already. It does a lot of the takes the guesswork out. It's already pre-set for times that we've looked at that are like beneficial and that studies have been made or we've adapted the songs to work with clinicians in their settings. So in an ER setting there's a long wait time, but that's different than with a doctor who's seeing a patient for just their yearly checkup or whatever. So all of those situations we try to work with clinicians so that the music can fit in that environment, because a lot of times it's just it's timing and then just giving a structure to that time.

Speaker 3:

With breath. Note having it functionally work for you. So it's like a functional music that is timed to the intervals. So I mean I used to meditate and now I practice low, deep breathing because I found that it actually helps me to calm my body down first and then my mind kind of follows. This helps me because it relaxes my body more and then I can turn off my minds and just settle into the music.

Speaker 1:

Yeah, I love that. And what you brought up that is so powerful is the mind-body connection, that the mind impacts the body and then the body impacts the mind in both directions. And so tell us a little bit about this functional breathing music, because people listening may not really know exactly what we're talking about yet. What happens, what is it exactly? What is functional breathing music?

Speaker 2:

And I think you kind of prefaced it the right way in the mind-body connection that there's features in that that get to be exploited and part of that is the auditory motor synchronization, and with that it's just like when you listen to music and there's a beat to it, you start dancing to it. It's humans primarily that can do this. I think there's been an entrainment shown in a parrot that was pretty popular on YouTube a while back ago.

Speaker 1:

I think I saw that, yeah, yeah.

Speaker 2:

But I think those are the two cases, primarily, that they've seen. And really what that is just doing is that your muscles will sync up with a beat and with music and so if you can do that to train your diaphragm, then it takes a lot of the mental effort out of it and so it just makes it easy to sit for five minutes and almost makes it automatic because your muscles are moving with the music. And that's why it being functional music, it provides a function. It's not just an ambient to relax you in general, it's not background music, it's very specific.

Speaker 3:

So it's a chord that cues you to take a breath in A single note, will tell you to stop if it's box breathing and then the chord will cue you to breathe out again. So that's what we mean by it's functional and that it's queuing you through the 478 or the box breathing or 55 or the cyclic sigh or any of those proven techniques that other doctors have come out with. We're not physicians, we're not breath coaches. We're just taking the information that's already proven to work and giving you a auditory cue through beautiful music.

Speaker 1:

Yeah, that's so helpful. I want to repeat it one more time to make sure people get it. So there's you play a chord and we're going to hear it in a minute. You play a chord and we breathe in on the chord, we hold on the tone. We breathe out on the chord and we hold on the tone. Is that right?

Speaker 2:

Exactly, exactly, and before we go into that, just to speak more about the mind-body connection.

Speaker 2:

So the auditory motor synchronization is important at the start of it because the music is helping you pace the movement of your diaphragm and therefore it makes it easier to build muscle memory into it.

Speaker 2:

But I think the other way that it works is that at the end of that you do build up muscle memory and I was reading in a study called the Facial Breath that there is muscle awareness and that the muscles will react to a stressful event even before the mind does, as a protective mechanism. So if you do build up the muscle memory to slow, deep breathe, what I've found is in instances where I would have gone to panic, or I've been in a conversation and I definitely got frustrated and kind of get in a shut off mode. I started switching and I would just start slow, deep breathing Because at this point I've been making it so much that it just ingrained in my diaphragm. But so it does work. And so I think utilizing the mind-body connection, both in training the muscles and then having that response calm you down and help you before that stress or even escalates, is really, I think, where it's unique and most impactful.

Speaker 1:

Yeah, that's so interesting. I hadn't thought about that in terms of muscle memory and that we, our muscles, connect to the beat. But there's no question that when I used your tool, I didn't have to tell myself to breathe in on the cord, it just happened. Just like when you hear music with a lot of beat, your feet tap, it just happened.

Speaker 3:

And.

Speaker 1:

I didn't really think about that until you just mentioned that.

Speaker 3:

That's really fascinating, yeah kids tend to my niece and nephew. I was trying with them and I didn't have to give them any verbal instructions we want to, wanting it to be something that any language could pick up on. And then we found that some people needed the instruction. So we've added some instructional tracks to help people along. But then once that instruction happens, you just listen to the music and you can settle in. And he was just in the ER, he fractured his fibula practicing that so he wouldn't panic, so he can get himself to the ER. And then getting to the ER and waiting what to breathe there for four or five hours.

Speaker 2:

Yeah, it's a four hour visit, for sure.

Speaker 3:

And I think you had said that one of the doctors in the office had said to you that if people were just slow and deep breathe they probably wouldn't even need to be in the ER. They could be seen the next day and eliminate all the overflow of people just panicking.

Speaker 1:

Yeah, that's such an important concept is that you really need to practice it before you need it. And so if you try to deep breathe for the first time when you're in pain or you're really upset, then it's much harder to access. If you build up the muscle memory which I hadn't thought about but the practice, the muscle memory, the just experience of learning how to slow your breathing, then you can access it when you need it. This is why I think what you do is so interesting. Getting people to do it when nothing is wrong is harder because it's not always on your own. As enjoyable To just do breathing on your own when nothing particular is happening, but to connect it to music, which I think pretty universally is a positive experience, I think is really a powerful way to get people to practice before they need it. So they have that tool when they do break their leg and go to the ER or have a meeting that gets them agitated or a fight with a loved one or something like that.

Speaker 2:

And I think it's also well. There's two things. One is that in those settings there's opportunities to introduce the music and slow, deep breathing so that when the doctor does come in, they're not facing this super agitated patient. Everybody always comes in there like, OK, deep breath before we do this, but it'd be nice if you didn't even have to tell them that, because the patient's already calm from breathing slowly. So I think there's opportunities in the patient journey where you can use music, because it's so such a fluid medium and can fit in so many places. And I think it's been interesting, though, that even though we think about it for the patient or for people that are in an anxious state as we've been working with clinicians and they've been using it they themselves have found themselves using slow, deep breathing to calm themselves down. I think Nancy's got a good story.

Speaker 3:

Well, a friend of mine is a dentist and we read an article about breathing out dental fear so I was like, oh, I have to reach out to her and then you take every other chime in the room. I didn't realize how much she goes through the psychological factors of every person that comes through her door hates her. No one wants to go to the dentist, no one likes the dentist, no one's out and there's actual people that have real issues with getting dental work done. She has some anxiety issues, I think herself in general, like she just recently got into a car accident and now she's afraid to drive when it's raining.

Speaker 3:

So she actually utilized slow, deep breathing in those instances for herself so that she could focus on the road and be calm during those moments and not panic, and using it in the office with her patients as well who were super anxious, where she felt like she couldn't even work on them until they had the opportunity to just relax themselves. So we have like a little worksheet that just has like the benefits of oral hygiene and blah, blah and slow, deep breathing, how it helps with your breath smelling good, and all the facts or whatever, just to give them some information. And then in there it has a QR code to like before you while you're waiting for your appointment or while you're waiting in between seeing the dentist, you can practice this to help calm you down. So she said that it's been helpful for her, and some of her patients she's given it to that have real anxiety issues. So it's nice to kind of see it in use for the physician as well as for the patients.

Speaker 1:

Yeah, absolutely. In the integrative palliative world, taking care of the clinician is as important as taking care of the patient, because it allows the healing powers of the clinician to flourish, whereas if we're anxious and tight, we're not as good at our job. So I think that's a great idea. In a moment we're going to listen to it, but I wanted to have one question before we do that. You've talked a bit about people being in the waiting room of an ER or a doctor's office. Are you thinking that it would play in the ambient music or that people would have be listening in their own earphones to this functional breathing music? How does that work?

Speaker 2:

Well, there's actually a couple of different ways and I think all of them are viable, which is depending on who the demographic is and setting. I feel like a lot of times in the waiting room out front. If you're in a big group, it may be impractical to have music on, but a lot of people do have their headphones with them and a lot of places also have a television on at the front.

Speaker 1:

So what would be the ideal way for a patient to use it if they're in the doctor's office or in the ER waiting, for example?

Speaker 2:

Yeah. So what we found is in the triage room or in the free op or when you're getting your exam in those rooms it's generally just quiet. You're in there by yourself. So in those settings we actually do have speakers and just with a touch of a button you can have the music playing. So what works is when they come in for triage and the doctor's giving you the cuff to take your blood pressure and taking your vitals at that step afterwards they leave and within that time period that they're gone, that's when you can play the music and have the patient doing some slow, deep breathing before the doctor comes in. According to the study on dental fear and breathing out dental fear, they did show that the dentist had quick visits because a lot of the patients were more receptive to instructions, they were less fussy and so it did speed up the actual visit.

Speaker 3:

And so to answer that, it's a platform online so you can easily just wait, if you have Wi-Fi, listen to it in your headphones, listen to the playlist or have the speakers that he's mentioning. They are Bluetooth enabled, but they actually have the SD card with the music already pre-populated, so it doesn't need Wi-Fi, it just needs you basically just put it on and then you can leave the room and say breathe along with this. In an instance where I used it, I actually used it during a procedure. For me, it was better to listen and breathe along to the music than listen in silence or just sit there in silence or hear about what was happening, so it actually helped me. In the physician afterwards she's like that was actually really smooth and a lot of people have an issue with this. She's like I really think that that helped.

Speaker 1:

Makes me think also about radiation oncology. People have to be kind of attached to the table to stay in one place and often get very anxious about that. That's very interesting. So you could, as a clinician, you could play it in the room or you could have a way that the patients are just listening through their earphones.

Speaker 2:

Right, right, and then they can. Also, since it's online, they can then listen at home, which is useful again. And when we were talking with anesthesiologist, she mentioned the use of an incentive spirometer. A lot of times after surgery, they have the patient to use that and that's part of the procedure. So the music is great because it works. With that incentive spirometer, you know you can pace your breathing as well as the force of your breathing, and then you know how long you're doing it for, because it's already set into the time. So and that's part of why we keep getting surprised is that, like in every direction we turn, it's useful.

Speaker 3:

So yeah, and to a point it is. The challenge is getting people to utilize it, and I think you know I have a friend who's going through a third round of chemo family members who have hypertension, just general stress and anxiety of work and kids and life, and I do think that there's something we said about the community of doctors bringing it up to them to say this is helpful, this is something that you should practice, this is something that you should do, just like brushing your teeth twice a day?

Speaker 1:

Yeah, absolutely. You guys said a couple of things that I think were really interesting. One is about incentive spirometry. The reason they do that is so that you don't get pneumonia After a surgery. So the other place for this is postoperatively. It seems to me and you're so right, Nancy that if the surgeon said this is part of your well-being plan, so you don't come back here with a pneumonia, that would be very impactful, and I also love that you said this idea that this is a health maintenance behavior, kind of like exercise and brushing your teeth and, you know, getting your cancer screenings. That learning, teaching yourself to do slow, deep breathing, really is a health maintenance behavior, not just an anxiety management thing. I don't think a lot of people talk about it in that way. I think that's really powerful.

Speaker 2:

Yeah, I think that you phrased it well right there that it's a health maintenance and not just something you do when you're in crisis, but something you do so that you can prepare for crisis.

Speaker 1:

Right, and if you're human, you'll have crisis, right, like that's just part of being human. So it's not. There's really nobody that shouldn't be doing this. Everybody should be doing this as part of their health maintenance.

Speaker 3:

So I mean we joke around that it's like useful from the womb to the tomb through having a child and the pregnancy part of it, or even getting pregnant and that's stressful for a lot of people. To making sure that your baby's not stressed all the way through. You know what you do in the palliative care space. That we think would be helpful for everybody at every stage of their lives and which is why we're also working with a lot of schools to get this program into classrooms. New York City actually recently made a mandate to make slow breathing and mindful breathing a practice two to five minutes a day in every New York City public school mandatory.

Speaker 1:

Wow, well, that could change the world.

Speaker 3:

Gosh, you know, if you start it from a practice as a kid and you just know I brush my teeth two times a day and I slowly breathe two times a day, or whatever that is, then it would make a huge difference in just managing conflict in general from every phase of your life. So that's why we feel like this is super powerful and that we just want to be able to get it out to positions so that they can also tell their community and their patients about a new resource and a tool that just makes it that much more accessible.

Speaker 1:

Yeah, that's such a great point because we know that that slow, deep breathing stimulates the parasympathetic nervous system, which is the opposite of the sympathetic nervous system. So it's the opposite of the stress response. It stimulates the relaxation response. And when we're in the relaxation response, our mind is different. We don't feel so threatened, we don't react so negatively or with anger we can. Our frontal lobe is more in charge than our amygdala, which is the emotional brain. So the science behind the value of this kind of breathing is clear and I love what you just said, that this really is another tool to get people to actually do it. Because, just like exercise, you can understand, exercise and think about it all you want, but if you don't actually do it, you don't get the same physiologic change and this is the same. So any tool that makes it easier for people to put this into their life is valuable, and that's what you guys have. So is it okay with you if we experience what this is like?

Speaker 2:

One of the big differences in the functional breathing music is when you look at beats per minute. Beats per minute is what you typically pace music at. You know dance music will be at a high beats per minute and you know somber relaxing is very low beats per minute and low beats per minute and music is usually 40, 40 beats per minute. But when you're using it to guide slow, deep breathing we're going down to six beats a minute. So it's extremely, extremely slow.

Speaker 1:

So that was really beautiful and what I got from it is that I felt the same pleasure in listening to music as I would if I were just listening to music, but also the connection to the breathing. And I really like that a lot personally because I have listened to other relaxation apps that just give you a tone. You know, breathe in here as a tone, breathe out, but that's the extent of the experience. It doesn't have the musicality. Also, and I really appreciate that about what you do, because it's pleasurable to listen to.

Speaker 2:

Right, thank you. Yeah, I found there are different ways to pace your breathing and there are those apps that we found to have a you know a tone here or there which is fine at the front of it, but when you're trying to do that for 10 minutes and you're trying to do that every day, it just gets, it's just not in it. Just that's why nobody practices slow. Yeah, I mean, they have the like visual orbs and they have.

Speaker 3:

There's a lot of things, but you're also looking at a screen or watch your accounting, so it's just less. People don't practice it because it's not as enjoyable to do and it's not, so this just makes it a little bit more, you know, I don't know enjoyable. I just listen to it before we go to bed. We just turned on the speaker, we fall asleep to it, you know. So it's just. Yeah, it's a nicer way to practice.

Speaker 1:

It just is that. That's what really strikes me is that it's enjoyable, as opposed to something that you feel like you should put into your, like you have to do it because it's good for you. People listen to music. I listen to music on purpose for no reason, just because it's enjoyable, and this feels to me like it has both those things together, which I really appreciate.

Speaker 2:

Yeah. So it's nice because you can have it in, you know more of an office setting and it's kind of unobtrusive in the background. But then if you want to tune into it you can, and then it kind of paces you. So and what's fun is that, using the same format, we started making music where we're putting ambient sounds behind it. So it's that music combined with ocean sounds or with the sounds of rain and forest. We have some with brown noise, with white noise, we've also done some that are going to have theta waves behind it, so that it is kind of geared more towards sleeping. So it's it's really been fun to not only see where the music is now but see how it's developing.

Speaker 3:

you know, for all these very more specific applications, and we're working with definitely some pro athletes to put their success mantras or their encouragement mantras on top of the audio. So, and even in the, I think there was a psychologist that does what does she do?

Speaker 1:

Hypnotherapy, hypnotherapy.

Speaker 3:

And she said that she needed unobstructed calming music for 45 minutes and needed and was losing her voice and needed to be able to put audio cues for people that she was putting under and she wanted to be able to do it in a nice way. And you know that was a solution because we can do custom tracks. That's the benefit of having a recording team and production team and having a musician that can, you know, create that music. And we also have other musicians that are amazing at the flute and guitar so we can add in other music, but just following the same structure, to cue you, so it doesn't have to just be the piano. But yeah, no, we like the flexibility of it, the customization of it. So you know, if a sleep doctor says that they want track, that's, you know, an hour long or 40 or 42 minutes long or whatever, we can also customize it for use.

Speaker 1:

That's very cool because I know a lot of the people who listen are healers of various kinds, physicians and other clinicians, so that actually might be interesting to people that they could have something customized for the work that they do. I love that. So if somebody is convinced this is great, I want to either practice it for myself or I want to think about how I can bring it into my medical office. What does that look like? What do they do?

Speaker 2:

The easiest thing is they can just go to our website and it's breathnotecom, and if you go to that site on your home, there's a page for healthcare providers and it explains the product and how they can use it. And then we try to make it so it's like a toolkit for you guys and there's sheets that you can print out. That gives them instruction to the patients. It gives them some facts on how slow deep breathing can help with the condition that they may have, and then it has a link to the online playlist. So there's all of that is just go to breathnotecom and you can take it from there. And then, of course, if you have questions, you always feel free to email us. We always love to hear input from clinicians and how they're using it or how they think it would best be of use to them, and that you can email us at partnerships at breathnotecom.

Speaker 1:

Terrific, thank you. And so in a clinical setting, or even for an individual, do they buy a subscription for a certain amount of time to have access to the music? Is that how that works?

Speaker 2:

Yes, there's a subscription. It's an annual access pass and then, once you have the access pass, that lets you get discounted prices on any of the products that if you wanted to bring that into the office or into the triage room, it just gives you a big discount off of that.

Speaker 1:

Terrific, and tell us one more time. I know you said that you have speakers that come preloaded with the tracks. Is that another option?

Speaker 2:

Yeah, it's really nice. It's just a small speaker and we can put it so that it fits even on the desk where they have the computers, where the physicians assistants use them, and it's literally you just touch a button and it starts to play, and then you touch a button and it turns off. It couldn't be any simpler and it couldn't be any more faster. So we're really trying to just make it as easy as possible for for clinicians to use it, because, I mean, everybody knows that it's useful. Everybody knows slow deep breathing helps. All the statistics are there and also, if you are interested in the science, on the website we do put links to all of the articles and studies that we find. So if you're interested in the facial, facial breath or in breathing out dental fear and all those other kinds of informative material, we do have that on the site so that you can look at that as well.

Speaker 1:

Before we close up, is there anything that we missed? Any last thing that you want to share with everybody?

Speaker 3:

Just from our experience and knowing nurses and people in the space in the field, there's not a lot of time. Everybody is so stressed and there's minimal time and we, even in the school systems, it's like how do we find two minutes to slow down and breathe? But we want to make it as easy as possible. We're not adding something to people's plates to have to do or have to implement. It's something that we want to be available to all the staff, so we're not making it like an individual purchase for each person. It's a subscription for your office or for your department and that could be available for your patients and for your staff. So we really want it to be something that's easily accessible and widely utilized so everybody can chill. That's a great way to end.

Speaker 1:

Everybody just chill, just breathe and chill.

Speaker 3:

It's been a helpful tool for us, frankly, and we see that and we want to be able to share that.

Speaker 1:

Well, thank you, guys, so much for sharing your expertise and for bringing this new, exciting way to get everybody to do deep breathing and relax ourselves into the world. Thank you.

Speaker 2:

Yeah, thank you.

Speaker 1:

Thank you for having us All right, everybody. So your homework this week is to practice deep breathing. Ideally, you should go to their website, because there are some sample tracks you can listen to and you can practice it there, or you can practice it in any way that works for you. But let's all get in the habit of making deep breathing part of our wellness behavior so we all can chill out, be less anxious and be happier. Share this with somebody that you think could be interested in. Thanks so much for being here Bye-bye. This podcast is brought to you by the Integrative Palliative Institute. Visit our website, integrativepalliativecom. There you can access physician and clinician training, well-being coaching, free downloads and other cool stuff, and feel free to connect with me on LinkedIn and share your favorite episode with a friend.