TRUST ME I KNOW WHAT I'm DOING

Speaker 1 (00:00)
Hi, I'm Amit Anand. I'm a pulmonary critical care and sleep medicine physician in Boston. I'm also a yoga teacher and a breathwork instructor. I'm so happy to spend time with you today and with Dr. Dan Dekker on this episode of Trust Me, I Know What I'm Doing.

Speaker 2 (00:23)
My name is Abhay Dandekar and I share conversations with talented and interesting individuals linked to the global Indian and South Asian community. It's informal and informative, adding insights to our evolving cultural expressions, where each person can proudly say, trust me, I know what I'm doing.

So periodically on Trust Me, I Know What I'm Doing, we share a spotlight conversation and feature brief chats with an individual from the community about a special topic or a unique endeavor. Now, while we truly should strive for mental wellness all the time, is Mental Health Awareness Month, and there's no more obvious place to focus our energy than on something we too often take for granted, our breathing. So I'm going to take a yogic approach, drawing from the teachings of both my parents who are yoga instructors and remembering some of the daily habits of my grandparents too.

Breathing is essentially the most outward demonstration of our prana, the Sanskrit word that refers to our innate universal life force. And through ayama, the Sanskrit word which means to regulate or control or lengthen, we can therefore use the practice of pranayama to not just consciously understand our breathing, but also optimize and even increase that life force and harmonize our mind, body and spirit. Now, whether it's deeply practicing this living science of pranayama,

or simply pausing briefly to become more conscious of our breathing, the benefits can be quite extensive for so many physical and mental concerns. So it was especially terrific to have a conversation about, well, breathing with Dr. Amit Anand, who is a pulmonary critical care and sleep medicine specialist and a master yoga teacher. Truly a breathing superhero. With an academic medicine background training in both Mumbai at KEM and in Boston at Harvard,

Amit has been a rigorous practitioner, clinical teacher and researcher. Fortunately, from many patients and students alike, he has taken his experience and integrated this evidence-based medical approach with an expertise in yoga training, meditation, breathwork and pranayama. Amit is the founder of Pranayama RX, leading live and online yoga workshops and pranayama courses. He's also the founder of Breathinance, a science-based breathwork experience

that integrates the yogic teachings of pranayama with resonant musical rhythms. I actually caught a live demo this year and I was struck by a few things. The importance of creating space for all of this. How little time was actually required versus the perception of what was required and the beautiful convergence of music, meditation and breathing. Now I know that all of you know this already, but the content and conversation here should not be taken as medical advice and is for informational purposes only. And because each person is so unique,

please consult your own healthcare professional team for any medical questions. And so as Amit and I caught up to chat, we started with the very basic question that was in front of both of us, particularly as doctors, in why we all tend to be so painfully unaware of our own breathing.

Speaker 1 (03:25)
I've asked myself that same question ever since I enrolled in medical school and more importantly since I trained as a fellow in pulmonary disease. You know, it's the first thing we do when we are born into this world. It's the last thing we will do when we leave. And between that...

first cry and that last gasp, it's a natural rhythm. It's a natural act that all of us are blessed to have. Unfortunately for some of us, you know, who are destined to struggle with our breathing, that's when we ask these questions in spades. You know, how do I breathe? How do I get better? How do I learn to breathe? And you know, as medical students, I'm sure you probably asked yourself this also. I mean, we've learned how to deal with chest pain. We learn how to deal with dyspepsia. We learn how to deal with

back pain. We don't really understand the language of breath, of dyspnea, of shortness of breath as we do some of the other symptoms and more importantly we were never taught in medical school how to teach our patients to breathe just by virtue of the fact that it's just happening.

Speaker 2 (04:32)
Yeah,

no, I mean, you're right. So we're not necessarily aware of this. And yet there are so many forces that are that are keeping us unaware of these things. And, know, you're bringing up a really good point when it comes to approaching problems. And we don't necessarily have a great awareness and cognizance of what, in fact, is our natural driver all the time. And, you know, especially in your career and with the

patients and people that you work with, what do you find are the ingredients as to like how this comes about in the first place?

Speaker 1 (05:10)
I think most people, know, I'm a pulmonologist. So I see a lot of patients with pulmonary disease and with sleep-related issues. know, breathing sits at the interface of a lot of what I do in the clinical realm. So they're coming to me, you know, with the shortness of breath issues. And that's forefront in my awareness and my consciousness because it's forefront in theirs. And when you start to sort of understand as to, know,

what it is that drives their symptoms, then you're kind of left with the real problem over here is that, yes, I can fix you with drugs, I can fix you with CPAC machines, I can fix you with inhalers, but I can't fix you with the basic wherewithal of teaching you how to use your breath as an instrument to really harmonize your physiology, to actually modify it for the better. And that's where I've kind of, you know,

gotten back to my own roots growing up in India, to sort of embrace some of those traditions of breath work and now incorporating those personally in my own life and certainly for the help of my patients.

Speaker 2 (06:17)
But when you hear that, when you actually share this with patients, when you share this exact same ethos that you just shared just now, whether with friends and anybody who's willing to listen for that matter, when you do share that, do you naturally feel that there's a switch that has to go off for people to recognize that basic fact of breathing is happening all the time?

We're doing it as we speak, literally, right? And yet it's not, it is that one simple thing that we take for granted and yet could be at the root of so many solutions to the things that we go through in health and otherwise. So what's it like when you start seeing that kind of switch come across or that aha moment come about for the people that you work with?

Speaker 1 (07:10)
No, it's extremely rewarding. You know, when I start to share some of this knowledge, some of this teaching with them, and I sort of literally give it back to them in terms of, you know, you just need to stop what you're doing. Stop listening to even me as your physician. Listen to yourself as your own ⁓ teacher, as your own...

as your own instrument, if you will, to pay attention to what's happening inside of you. And in the very process of just listening and observing, there's a slowing. And when they start to slow their breath down, they start to become much more aware of the nuances of the struggle within. They sometimes tend to have a little more clarity in terms of what's driving their symptom process.

Speaker 2 (07:58)
Hmm.

Speaker 1 (08:00)
And that's when I start to kind of dive in a little deeper. But it's so rewarding because most of them, especially when I see them in clinic, have gone through the gamut of therapy and they're coming to me, you know, as, hey, what can I do to help me get better and stay well?

Speaker 2 (08:16)
It's interesting you use that word sort of like you, once you start becoming a lot more cognizant of it, things slow down and you're conscious of it and you're much more aware, but in a way that actually extends out maybe your thinking process. And yet again, in 2025, we are just not in a set of structures that really prioritizes perhaps that slowness. So how do you help

people really become more conscious of that stillness, that slowness, that awareness, and becoming a lot more breathing conscious in their daily lives when there are so many forces working against that.

Speaker 1 (09:00)
I think the first thing that I do is to actually make them aware of what's driving their state of storm, if you will. You know, we all live in hyper fast, hyper distracted environments where we're being constantly bombarded, you know, from the outside.

Our attention span, unfortunately, as a species has gotten shorter and shorter and shorter. And we see this with our children all the time, you know, their social media and gadgets. You bring them to the awareness of, let's just have a conversation. Let's just put things down. Let's just face each other in the eye and talk. And that in and of itself is sometimes a challenge, you know, for some of my patients. When they're able to settle and engage in a face-to-face, then it's much easier to kind of tell them, okay, now let's actually focus on.

what it is that's driving your visit today. You your, your dis-ease of breath that, you know, manifests as asthma or COPD or what have you. And in that little moving from the outside to moving within, it becomes an aha for them. All right, I can focus on my breath. can slow my breath. can modify my posture. I can make it happen as much as I'm letting it happen.

Speaker 2 (10:13)
Do you find that, because you mentioned the word using yourself as almost a vehicle or an instrument here, and do you find that while you are, it's important for you to be self-aware and use your own mechanisms of breathing as the instrument, do you find that people really need support through peers, support through others, support through coaches to get to that point in the first place, especially if they are so distracted and so

perhaps unaware of their own breathing.

Speaker 1 (10:44)
Most definitely Abhay, all of us, you know, when we're starting to learn something new, we need a guide. We need a path. We need a book. We need a podcast maybe. Yeah. And once you have the right teacher and you know, sometimes you have to go through many to realize the one. ⁓ and in that moment, then it becomes, all right, this is what I need to do. This is who I need to engage. This is what I need to do for myself. And these are the people I need to share this with. So, you know, it's an

one-on-one instruction in the beginning, leading to commune or community, know, of breathers, if you will. And then once you sort of engage them in that learning and once they've learned these steps, then they become their own, you know, sort of resource pool, if you will. Yeah. Yeah. They're learning from each other, asking each other, researching for each other and teaching each other.

Speaker 2 (11:39)
Yeah, there's no better mechanism of learning than just being aware of your own system and your own patterns. And so, you know, a lot of empowerment there. That's, that's as well. I've heard you speak on this, you know, live and in person, but I'm just curious for those who are watching or listening and may have, you know, maybe some background in this or have been influenced by their parents or their grandparents in some of this, but how do you really describe perhaps the basics of pranayam and

that consciousness of breathing. What's the kind of simple background of this?

Speaker 1 (12:14)
Well, mean, Supranayama is one aspect of the Ashtanga yoga tradition of India. It emphasizes using breathing as the catalyst to manipulating or extending that element of view that is vital energy. So it's breath as an instrument to enhance the vitality principle within you.

It's a 6,000 year old tradition and I'm not the first. certainly won't be the last. I mean, there are many, many schools of Pranayama out there, but what I bring to this perhaps with my background being a pulmonologist is the safety net that science provides. having done this on myself now for, the better part of 12 years and having really studied the effects of certain practices, both for the well breather or the sick breather. I do it in a way that kind of

provides that safety with scientific validation. And if I had to put it in just one sentence, pranayama is about teaching oneself to become a slow frequency, initially large volume and subsequently small volume, upright in posture, nasal breather. Slow, initially large, subsequently small nostril breather.

So all of the wisdom that's out there is basically funneled and kerneled into some of these teachings and making you a slow breather, much more upright and aware.

Speaker 2 (13:47)
That comes with some major adjustments for people. And then of course, not only requires the buy-in, if you will, but then the sustained practice. And as someone now concentrates on this, again, studies their own breathing and really some of the historic and cultural background behind it, but then also the science behind it, are they themselves, again, their own learning lab with this? Because...

at the end, if you're practicing these principles of slowing things down, breathing through your nose, staying upright, and then seeing the benefits, is that itself the acceleration for continuing this and sustaining it? And obviously nothing that we're talking about here is frank medical advice, but it's really more living advice, so to speak. So what tends to accelerate people after they start this journey?

Speaker 1 (14:42)
So that's a really, really important question, you know, in terms of how long does one need to do it to develop a consistent habit? Obviously in the beginning, you for the first two or three months, there's a discipline, there's an effort, there's a time that's dedicated to this practice. I mean, when I started doing this in India, I was doing it for almost seven hours a day. And there is no way one can sustain that kind of habit, you know, living the kind of lives that we do over here.

About 20 to 30 minutes of a practice, once a day or twice a day, starts to make a huge difference in your life outside of the practice. So even though you are establishing a certain state with the slow upright nostril practice, suddenly it starts to become a trait outside of the practice. So without even knowing it very sweetly, you start to resonate with the memory of that practice outside of it.

When you get to that stage where you suddenly say, oh my God, I'm actually breathing slowly, uprightly through the nose, even though I'm not doing it, you become even more breath aware. And the more breath aware you are, the more breath aware you will want to be. And so it kind of is a self-fulfilling prophecy or practice in some ways is that, yes, you can dedicate 15, 20 minutes of time to it every day, but

there will be times when you naturally are attracted to doing this for even longer. And sometimes even if you don't do it, you still have the benefits of the practice when you're not doing it. So it's a lovely, lovely teaching, learning practice just by virtue of what it affords you even when you're not doing it.

Speaker 2 (16:27)
Well, and I love the notion of catching yourself perhaps at first unaware and yet then finding yourself, wow, yes, I devote this time to the practice, but even unknowingly I'm already doing these things. And that just must be a lovely surprise. You mentioned time, of course, right? mean, people concentrate and meditate on some of this awareness for hours at a time and then devoting 15, 20 minutes a day. And yet some people, some of the

friction and barriers to this might even, that might even be tough to devote 15, 20 minutes a day. Are there mechanisms or suggestions that you have for people who can't devote that time, but even just to be conscious for one minute, for two minutes, are there quick tips that allow for that person, you know, to also participate and be more aware?

Speaker 1 (17:20)
Yeah, so at the outset I would say that if you can't make five minutes a day, even once a day for this, then you probably need to do it five minutes twice a day.

Speaker 2 (17:31)
Right? Yes. There's there's there's that for sure.

Speaker 1 (17:37)
What we have created, Abhay, in the last eight to nine months is actually incorporating musical rhythm with the breath work as a rhythm. It's a kind of synergizing melody with the rhythm of breaths to kind of make it more engaging, because who doesn't like music? You know, I mean, everyone's either exercising to music, writing to music, swimming to music, sometimes even meditating before music, listening to it before you fall asleep. So...

Our platform, we've started to engage a little bit of soothing rhythms set to heartbeats, which synchronize with the rhythm of breath. And there are these rhythms, these sounds with the breath that even if you do it for two or three minutes, it's so soothing to your internal dialogue that suddenly three minutes feels like, three seconds. So that's one crutch that we've started to use. There are times in the day when you just need to, you know,

take a time out for yourself. Give yourself a little snack of breath, maybe for two or three minutes rather than a coffee or a diet coke. That might just be a wonderful substitute that might be even more health promoting for you.

Speaker 2 (18:39)
Yeah.

I love that concept of having a kind of breath snack, if you will. That's a great way to put that. coming back to this concept, because when we first met, this was something that you were doing as a shared demo of sound meditation and ujjayi breathing. Some of these things, of course, are so interwoven into pranayama and yoga, but particularly some of the work you're doing with musician and executive Clint Valladares, maybe you can share...

⁓ a sentence or two about how the entire kind of breath in and you know, phenomenon at least took shape for you.

Speaker 1 (19:23)
Yeah, so, you know, this started in real form about four and half years ago, the first year of the pandemic, when, between my ICU duties, there was some downtime, ⁓ and I would start to teach breathwork online to anyone who was interested, just by virtue of the fact that, you know, it afforded me peace, it afforded me clarity, and there were people who were struggling with their breath anyways. And Clint happened to be on one of those...

courses and he's at the Berklee College of Music in Boston. We sort of met many years ago and then through serendipity, you know, it was online again. And I teach, or I was teaching, you know, to the metronome that most people use, you know, for breathing. And he suddenly said, you know, why can't music be your metronome? And I said, that was an aha moment also. You know, why not?

And he started to create these rhythms, set to heartbeat, very soothing, that reminded you of certain memories when you were younger, that were very warm to the experience of the particular breath practice. And then we started to play this online for the other participants and it was like, give me more, give me more. That's when it was born in terms of the concept of...

synergizing these two therapies, if you will, music as therapy, breath as therapy, to maximize their power exponentially.

Speaker 2 (20:51)
And I know there's a lot of science and there's a rich tradition of kind of sound meditation and how sound interfaces physiologically, you know, for us and provides a very therapeutic environment for health and wellness. I want to come back to one concept out of all of this. mean, you you're someone who has had, speaking of rich tradition, I mean, you're someone who has been very, very much entrenched and had a front row seat to the basics of academic medicine and

pulmonary practice now, coming from both training in India and of course, practice and learning and training here at some of the world's best institutions. Sometimes, of course, Western medicine practice tends to sort of dominate in the minds of so many. And as physicians in this style of practice, did you have to in some ways kind of unlearn or reframe?

some elements of your thinking in order to integrate and weave yoga and pranayama and breath inance into your own medical practice and perhaps not unlearn, but maybe even relearn some things so that this can, you know, no pun intended harmonize very well.

Speaker 1 (22:11)
Yeah, absolutely true. mean, there was not really an unlearning. There was really a yearning, if you will, within me of trying to bring these two aspects of healing together. You know, what I had learned even in India in the Western paradigm, I had credential over here in Boston in the academic setting. But then there was this wisdom aspect of me, you know, that was all around me now practicing as

a student that I wanted to share with my patients, number one, who are really very receptive, you know, with the complementary integrative approach to medicine really sort of spearheaded now over the past few years, but even my colleagues. And I was surprised by that. You know, a lot of us in medicine, we don't know any better.

It's just by function of the way we are trained. If we were exposed to some of these traditions, some of these learnings earlier on in our medical curriculum, I am sure it would inform the way we practice. And so when I started to share this, you know, more and more with colleagues, not only in the pulmonary and the sleep world, but across the spectrum, cardiologists, neurologists, ENT doctors, psychiatrists, primary care physicians, there was

teach us so that we can teach them. Yeah. So it was very heartwarming to know that we've actually only been closet yogis, if you will. It's now we're just coming out.

Speaker 2 (23:49)
Yeah, it's great to think of all of us as sort of closet yogis. But on top of that, think finding ways to apply this at the bedside as practitioners, but then also as humans, we've already hinted at this, but there's so many barriers to this, whether it's time, it's effort, it's energy, it's motivation. And then even frank skepticism about practices like this, because they require patience, they require slowness, they require

to some degree, an element of buy-in. How do you not only just maybe combat this, but especially in an age where trust in medicine and science is a precious commodity, how do you cultivate that trust? In a practice and a science that is thousands and thousands of years old, that is not simply being amplified by one or two people here.

Speaker 1 (24:42)
I'm heartened by the fact that there is a lot of research that has happened over the last five years on breath. There is still a lot of interest on this topic, not only in the West coast, but also in the corridors of academia on the East coast. I'm actually collaborating at this point in time with three people at Harvard looking at breath as a tool for helping patients with insomnia, spinal cord injury, interstitial lung disease.

where, where, where. mean, they don't seem to connect at all, but there is interest. So I'm hopeful that the research will validate some of this so that it becomes more mainstream, especially for the people who accept science as a means of helping themselves.

Speaker 2 (25:29)
Right. And another means of cultivating that trust.

Speaker 1 (25:33)
Trust. And for those who don't, well, you have to meet them where they are and really understand their skepticism, understand their fears. And I think Brecht's work has also taught me to be a little more intuitive and a little more compassionate with respect to not just shutting down the conversation, not just closing the door for someone who's a skeptic. They, at some point in time, also want to help themselves. It's just that we need to have common dialogue in terms of how do we regain that trust and how do we speak their language.

Speaker 2 (26:03)
And let me make the balance measure of that too. There are those who practice and are certainly aware and reap the benefits of maybe some of the ⁓ Pranayam tools and yoga practice and even incorporate breath inance into their work, but yet they also do so blindly. And they may not have any kind of understanding of perhaps the science and the data and clinical trials and that which you may have expertise to.

How do you also modulate those folks who definitely are already incorporating this in their practice, but perhaps could benefit from some of the education that is the expertise that you're bringing as well?

Speaker 1 (26:45)
Yes, I mean, the way we teach this is with the struts of science. You know, we reference a lot of this. In fact, on breath and every lesson plan has at its end a capsule that speaks to the science. So if you're going to learn Pranayama from us, unfortunately, you're going to have to learn the science also. You close that capsule. But yeah, and that's totally fine. Yeah. And if you're doing it for wellness, if you're doing it for spiritual intent, all the power to you.

But the way we teach it, you will always have that tool, if you will, as a resource. And then it's kind of just, you know, helping them understand that, you know, when you do this practice, there are certain restraints to the methodology. You you never take it to the extreme. You're always doing it ⁓ to the edge, but with control, because that's the yama of pranayama.

so as to maintain that safety net for your own self. And that's again the difference between breathwork taught in other traditions and the way I see it and the way I teach it is that you have to be literally the master of your breath, of your practice.

Speaker 2 (27:57)
Yeah, and you know, so important to recognize really basic and important concepts like control and balance and limits and guardrails with the excitement and opportunity that's there to help so much, not just in our physical health, but our mental health as well. Let me get you out of here on this one because I think it's always so interesting how people have taken their own experiences, integrated.

such great knowledge and materials here, but also are continuing on their own journey. So I'm curious about your own perhaps surprises and lessons that you've learned mostly about yourself in this journey of medicine and pranayam and yoga and sound and meditation. What are some of the surprises perhaps that you've learned about yourself along the way?

Speaker 1 (28:46)
I think breath work as a practice really transformed me about 12 years ago. I've struggled with my own clinical work at times. I've struggled with teaching meditation and yoga. I've taught both for about 25 years. And it's when I sort of dove deep into this world of breathing that it all started to make sense for me in terms of...

How do I work the clinical realm? How do I work my yoga practice? It suddenly became a lot more tangible and a lot more consistent as an experience for me, both in meditation and even on the yoga mat. And certainly with patients, it gave me that sense of knowingness, that compassion, that nonverbal understanding. You know, when someone walks into the room, you already know what they're dealing with without even asking them a question. Yeah. So there were lots of moments like that along the way.

And then, you know, with COVID, it was the biggest aha moment for me as an ICU doc, when we were all sort of grappling with asphyxiation at some level, you know, whether it was physically, whether it was emotionally, whether it was intellectually. And that's when I said, you know what, rather than using this as a crutch only in my bad times, in my sick times, in my crisis moments, I'm just going to make this the work of my day. I'm just going to

flip the axis and say, I'm not going to compromise on this practice no matter what happens. And that was the other moment. Life actually became playful again. It became a game again. It became joyful again. So my relationship changed, my work changed, my career path now has changed. I'm no longer doing ICU work. I just hope to bring this knowledge, this teaching to anyone who has an interest now.

Speaker 2 (30:34)
I know that lots of people who are rediscovering or maintaining their relationship with their own breathing are finding all of this beneficial, liberating, empowering, and hopefully coming to many of those surprising aha moments that you have yourself. Amit, thank you so much for joining us for a little bit here. I know we're going to be driving and certainly steering people to all of your work, but we wish you all the best and thanks so much for taking some time today.

Speaker 1 (31:03)
It's my pleasure. Great spending time with you.

Speaker 2 (31:07)
And you can visit breathonance.com to learn more about Amit and his work and check out the show notes for links and more info. Now definitely check out Trust Me I Know What I'm Doing Everywhere and thanks to everyone for listening, subscribing, reviewing, watching, and sharing with your friends and family. If you have thoughts, suggestions, feedback, or just want to say hello, please drop a line to info at abhidharnadkhar.com. Till next time, I'm Abhay Dandekar