From: " To: "'Noam Sobel" Subject: Ideas - Confidential please Date: Mon, 17 Sep 2012 04:28:16 +0000 Noam — thanks for the opportunity. Am sending from my UW email so I don't get mixed up with the foundation interests (notably not in the neurosciences). Over the next 12-18 months I would like to lay the groundwork for redefining the role and function of the Autonomic Nervous System. At the end of this document are some options as to how we might proceed together. For some of the ideas I can think of how to do the experiments and the practical relevance — for others it is more about the recognition of an opportunity without a clear roadmap of how to find an answer. I think together we can. Please don't share these beyond you for now as they represent a bunch of years of thinking about these things and I really want to pursue them as original ideas that I can contribute to scientifically. • Changing our understanding of breathing Equal weight is given to nasal and oral breathing — and in fact, mechanically ventilated patients tend to bypass both. Focus has always been given to structural delivery of air to the lungs and little attention has been paid to the various pathways that feed into the neural process of breathing. Practitioners of yoga, athletes and even some small scale studies have asserted that nasal breathing slows heart rate and blood pressure. Alternatively, sleep experts and other scientists have shown that mouth breathers tend to be hypertensive and suffer from various co-morbidities as sleep apnea and obesity. This suggests that nasal breathing stimulates the parasympathetic nervous system and minimizes sympathetic tone while the converse is true for oropharyngeal respiration. If this is true, mechanically ventilated patients might always be in acute distress (from the perspective of the nervous system) unless a new type of mechanical ventilation can be created — or current ones adapted — that would engage the parasympathetic s