Hyperventilation
The subject of hyperventilation is of considerable importance to many allergics. Opinions seem to divide doctors into two distinct groups: those who believe that hyperventilation – and not allergy – is the real cause of the patient’s symptoms and those who think that allergies trigger hyperventilation, which then leads to symptoms, but that allergies come first.
What is Hyperventilation?
The word means over-breathing: that is, breathing in excess of physiological requirements.
In the normal course of events air is drawn into the lungs. Oxygen is removed into the blood and, at the same time, carbon dioxide is given off as a waste product in the exhaled breath. We call this process respiration or, more correctly, external respiration.
The uptake of oxygen need not concern us here. The oxygen is tightly bound to haemoglobin (the red blood pigment) and remains at a fairly constant level provided the lungs are working normally. Carbon dioxide, on the other hand, dissolves directly into the plasma. A simple chemical reaction takes place, which may be represented by the equation:
CO2+H2O = H2CO3
Carbon dioxide + water = carbonic acid
Carbonic acid dissociates into H + ions and HCO3 – (bicarbonate) ions and this affects the acidity of the blood (the blood’s pH, for those with scientific knowledge).
Both the kidneys and the lungs control bicarbonate levels, the kidneys by selective excretion and the lungs by blowing off extra carbon dioxide. There are chemicals called buffers present in the blood that are able, to a certain extent, to ‘mop up’ excess acidic and alkaline ions, but there is a limit to how much they can regulate the body’s acid-alkali equilibrium.
You will now readily see that over-breathing will lower the carbon dioxide levels excessively, which will deplete blood bicarbonate and will in turn upset the body’s acid-base equilibrium enough to cause symptoms in susceptible patients.
Of course, we are talking about un-conscious involuntary over-breathing now, not something indulged in temporarily to order to play the bagpipes or some similar act. It is a bad habit that has become elevated to the status of a disease process.
Symptoms
The brain is susceptible even to tiny drops in carbon dioxide levels. It is not surprising, therefore, that a number of subjective symptoms can be produced, as well as objective responses. The table below lists the common symptoms that may be attributable to hyperventilation.
Hyperventilation Symptoms
For each category score 1 point for each symptom even if only one symptom within the category applies to you. Do not increase your score if you suffer from more than one of the symptoms in a category.
Mental States
Sensation of floating (feeling ‘spaced out’, ‘unreal’ or ‘distant’)
- Difficulty with memory
- Difficulty concentrating
- Mental confusion (‘racing thoughts’)
- Tension
- Anxiety
- Panic attacks
- Fear of crowds, shops, queues, stuffy places, artificial lights, lifts, trains, underground trains, etc. Feel physically ill, tight-chested, prone to collapse when faced by the above situation
- Temporary delusion
- Seeing things that are not there (hallucination)
- Quick temper
- Quick/easy tears
- Coma, stupor or convulsions-if hyperventilation is severe
Sleep
- Vivid/frightening dreams
- Waking in morning feeling ‘drugged’/headachy/fatigued/lethargic/with aching muscles
- Waking in the night choking/breathless/panicky
- Waking repeatedly soon after going to sleep
Eyes
- Blurred or double vision
- Distortion of perspective (‘the room tilts away’)
- Sensitivity to bright lights
Ears
- Vertigo (dizziness)
- Tinnitus (ringing/buzzing in ears) which varies from hour to hour
- Sounds seem distant or unusually loud
- Sensitivity to loud noises
Nervous System
- Lack of co-ordination/bumping into things/clumsiness ‘Tension headache/thick head/hangover-like state for large part of many days
- Headache during ‘attacks’/caused by exercise
- Migraine attacks
- Numbness/’deadness’/tingling in extremities, limbs, lips, face, tongue
- Feeling ‘electric’ – but not the electric shock one can get by making contact with an object
- Unpleasant sensations in skin/just below surface of the skin
- Cold/burning/aching/ ‘creeping’ feeling, commonly in the thighs/buttocks/ feet but maybe other parts of body
Autonomic Nervous System
- Emotional sweating/sweaty palms/armpits
- Easily blushing or going very pale
- Cold hands/feet (when rest of body is warm)
- Raynaud’s disease
Respiratory System
- Unreasonable breathlessness/air hunger/feeling of restricted chest
- ‘I do exercises to improve my breathing’
- ‘I do not breathe enough/breathe deeply enough’
- ‘Sometimes I stop breathing/have to remember to breath’
- Frequent sighs/yawns
- Cigarette smoke provokes other symptoms listed on this chart
- Singing voice becomes off-key/tuneless/husky
- Speaking/singing loudly provokes symptoms listed on this chart
- Speaking voice goes husky/feels strained
- Throat dry/’rough’/sore
- Asthma attacks now/in the past
Heart
- Rapid, slow or irregular heartbeat
- Blood-pressure changes easily
- Dull pain/ache in center of chest
- Angina/ coronary pain, but medical investigations prove negative
- Profound/ frequent fainting spells
Muscles
- Weakness/fatigue
- Exercise has to stop due to sudden unreasonable exhaustion
- Sudden loss of strength
- Hard exercise improves symptoms
- Muscles feel stiff or ‘in spasm’
- Muscles ache (feeling ‘beaten up’ or as if ‘been in a fight’)
- Tense jaw muscles (may cause headache)
- Muscle tremors
- Muscle twitching
- Tightness around eyes/mouth
Throat
- Globus (sensation of pressure or lump in throat or at root of neck)
- Sensation of restricted throat
- Difficulty swallowing
Gastrointestinal System
- Excessive belching, swallowing air
- Discomfort/tension/sinking feeling/distress just below tip of breast-bone
- Distended stomach
- During attacks of other symptoms: urgent/uncontrolled bowel movement
Urinary Tract
- Frequent need to pass urine
- Discomfort at neck of bladder
- Severe urge to pass urine/incontinence, when accompanied by any of the other symptoms in this table
Reproductive System
- Orgasm during cult activities (‘unusual’ sexual practices)
- Premature ejaculation
- Sex provoking prolonged exhaustion
- Sex improving all symptoms for a few hours
Interpretation
Less than 15: Unlikely to overbreathe
15-20: Symptoms may be caused by hyperventilation
Tests
There are no laboratory tests to detect hyperventilation, though patients subject to it may have chronically low serum phosphorus and this is well worth checking. The only real way to diagnose it for certain is for the patient deliberately to overbreathe by way of a test. This should be done with the patient lying down and preferably accompanied by someone who understands his or her condition.
The overbreathing needs to be kept up for several minutes; the patient should be quite tired as a result. If the familiar group of symptoms appear, the diagnosis is obvious.
Treatment
Drug treatment is quite inappropriate.
The real answer lies in retraining the patient to breathe correctly. Help from an expert physiotherapist is invaluable but beware: many physiotherapists make the problem worse by teaching the patient how to breathe deeply and efficiently, which is fine for someone with asthma but the exact opposite of that is wanted here.
The important point is to breathe abdominally; that means to make your stomach rise and fall as you inhale and exhale. The usual tendency is thoracic breathing, which means your chest goes up and down. That's what you use if you've held your breath under water for two minutes, to get large amounts of air into your lungs fast! It's not how you want to breathe normally. You will have to practise this, doing it right for several minutes a day, until it becomes a habit.
During severe panic attacks the old trick of breathing into a paper bag is as valid as ever. Or, if the patient can be reasoned with, get him or her to breathe out, count for six long seconds then breathe in slowly, out again, hold for six more seconds, and so on. It should be possible to slow the respiration down to about ten breaths per minute or less.
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