James Nestor’s “Breath” Got Everyone Asking Why We Breathe Wrong. Here Is What Your Orthodontist Should Be Doing About It.
In 2020, science journalist James Nestor published Breath: The New Science of a Lost Art. It sold more than a million copies. Nestor appeared on the Joe Rogan Experience podcast (#1506) to explain why modern humans breathe wrong — why we’re mouth breathers, why our jaws are narrower than our ancestors’, why we snore, why we’re tired, and why all of it is connected to a change in diet and lifestyle that has happened over the last few centuries.
The response was enormous. Millions of people started taping their mouths shut at night. Nasal breathing became a cultural wellness topic. And somewhere in that conversation, a very important question got raised and then mostly dropped:
If the jaw got narrower over generations, and if that narrowing is driving breathing problems — what can actually be done about it?
That question is where airway orthodontics begins.
Watch: James Nestor on five ways to improve your breathing (11 min):
What Nestor Got Right
Nestor’s core argument rested on real science. The key claims:
- Modern human jaws are narrower than our ancestors’. Corruccini’s anthropological work, and subsequent studies, confirm that industrialized populations show significant increases in dental crowding, high palates, and narrow arches compared to pre-industrial populations eating unprocessed food. The cause is multifactorial: processed foods reduce the chewing forces that drive jaw development; soft diets during childhood, reduced breastfeeding, and chronic mouth breathing all remove the developmental forces that shape jaw width.
- Mouth breathing is not benign. Nasal breathing generates nitric oxide (produced in the sinuses), which vasodilates airways, sterilizes inhaled air, and regulates blood pressure. It maintains proper CO2/O2 balance, filters and humidifies air, and generates the intraoral pressure and tongue-palate contact that shape jaw development during growth. Mouth breathing bypasses all of this — and chronically, it perpetuates the narrow jaw conditions that caused mouth breathing in the first place.
- The nasal airway and the palate are anatomically connected. This is the structural key. The upper jaw forms the floor of the nasal cavity. A wide palate = a wide nasal floor = more nasal airway volume. A narrow palate = a narrow nasal floor = reduced nasal capacity and a higher likelihood of defaulting to mouth breathing. Orthodontics and nasal breathing are not separate topics — they are the same anatomy.
- Sleep-disordered breathing is an epidemic driven partly by this anatomy. Nestor cited Christian Guilleminault extensively — the Stanford sleep pioneer who spent decades arguing that craniofacial anatomy, specifically jaw structure, is the primary driver of most sleep-disordered breathing, and that treating only the soft tissue consequences without addressing the structural cause produces incomplete results.
Nestor’s book is a popularization, not a peer-reviewed text, and some of his specific claims are contested or overstated. But the structural thesis — that narrower modern jaws are driving a breathing crisis — is supported by legitimate research and represents a real clinical argument.
What Nestor’s Book Could Not Tell You
Nestor was a journalist, not a clinician. The book ends with breathwork practices — the Buteyko method, slow breathing protocols, mouth taping — but does not fully address what to do when the problem is not just a breathing habit but a structural jaw architecture problem that is physically limiting nasal airway volume.
Changing how you breathe when awake is valuable. Taping your mouth at night may help some people. But if the palate is narrow, the tongue has nowhere to rest, and the nasal passage is structurally compressed — no breathing technique will resolve the underlying anatomy.
That is where the clinician’s work begins.
What Airway Orthodontics Does About It
Dr. Yoram Kohanzadeh is the first and only certified airway orthodontist in Southern California. He has pursued post-graduate training specifically at the intersection of jaw development, nasal breathing, sleep-disordered breathing, and orthodontics — the exact clinical territory that Nestor’s book opened a public conversation about.
His practice, Smile By Dr. K, operates from Northridge and Newbury Park, serving patients across the San Fernando Valley, Chatsworth, Thousand Oaks, and West LA.
The approach:
For Children (Age 4–12): BioX Expansion
The earlier this is addressed, the better the outcome and the simpler the intervention. The midpalatal suture — the growth plate at the center of the upper jaw — is open and responsive through puberty. During this window, gentle palatal expansion using BioX can widen the upper jaw, increase nasal airway volume, create room for adult teeth, and improve nasal breathing capacity — without surgery, without pain, and with lasting structural change.
This is the intervention that Nestor’s book describes in terms of anthropological “rewilding” — recreating the wider jaw dimensions that our ancestors had — and that orthodontists like Dr. K actually know how to deliver clinically.
Early treatment, typically starting at age 4–5, produces the most significant results with the least intervention. Each year of delay narrows the window and may require more invasive approaches to achieve the same result.
For Adolescents: Non-Extraction Expansion Before Alignment
The standard response to crowded teeth in teenagers is to extract premolars to create room. This is exactly the approach Nestor and Guilleminault critique — making an already-narrow jaw smaller in order to fit fewer teeth into it.
At Smile By Dr. K, orthodontic treatment — including Invisalign and braces — is designed around arch expansion first. The jaw is developed toward its natural width, adult teeth are accommodated within that expanded arch, and the airway and nasal breathing capacity improve alongside the cosmetic result.
For Adults: Assessment and Coordinated Care
For adults who already have narrow jaws, the situation is more complex, but not hopeless. My BioX Expansion protocol has shown success in growing the maxilla non-surgically, even in cases well beyond the age most clinicians consider viable. I’ve seen it work in a patient as old as 68. For adults who aren’t candidates for BioX, minimally invasive adult palatal expansion (MARPE) is a research-backed alternative, using temporary anchorage devices to reopen the suture without surgery. Mandibular advancement through orthodontic treatment can improve tongue space and reduce airway collapsibility. Oral appliance therapy for sleep apnea, custom mandibular advancement devices, are also evidence-based alternatives to CPAP for many adults with OSA, and an orthodontist with airway training is uniquely suited to fit them properly, should Biox or MARPE not reduce the sleep apnea completely.
The Sleep Apnea Connection: Not Separate From Orthodontics
Obstructive sleep apnea in both children and adults is defined as a structural problem — the airway collapses under the negative pressure of inspiration during sleep. The structural drivers are: soft tissue crowding (enlarged tonsils and adenoids in children), low muscle tone in the pharyngeal walls, tongue that falls backward, and — most fundamentally — a jaw architecture that leaves the airway with insufficient room.
Nestor’s book popularized the idea. Guilleminault’s research documented it clinically. The American Academy of Sleep Medicine acknowledges jaw advancement procedures among OSA treatments. The research on palate expansion improving pediatric OSA is now represented in multiple systematic reviews and meta-analyses.
This is not fringe medicine or wellness culture. It is structural anatomy, supported by research, delivered by a clinician with specific post-graduate training in this area — which is what makes Dr. K’s practice genuinely different from a general orthodontics office that adds “airway” to its marketing language.
What This Means Practically
If you read Breath and thought “I need to figure out my jaw” — this is who you see.
If your child snores, mouth breathes, or is struggling behaviorally in school, and you want someone who looks at the whole picture instead of just teeth alignment — this is who you see.
If you are an adult considering Invisalign or braces and you want treatment that considers your airway alongside your cosmetics — this is who you see.
The conversation Nestor started in 2020 deserves a clinical answer, not just a wellness protocol. Airway-focused orthodontics is that answer.
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Serving patients in Northridge, Chatsworth, Newbury Park, Thousand Oaks, West LA, and across the San Fernando Valley.
Dr. Yoram Kohanzadeh is the first and only certified airway orthodontist in Southern California. James Nestor’s “Breath” is referenced for context; this post does not represent the views of the author. Sleep apnea is a medical condition requiring physician diagnosis and treatment.