Do you often feel like you can’t get a deep or satisfying breath? If so, you might be over-breathing. When this patten of over-breathing is persistent, the condition is called Hyperventilation Syndrome. It is a form of deep or rapid breathing in response to anxiety, fear, panic or stress. Interestingly, you might not be aware of your excessive breathing and instead you may feel you’re not getting enough breath. This is because the symptoms of hyperventilation are remarkably similar to those of oxygen deprivation. In reality, your body’s carbon dioxide levels decrease when you hyperventilate. Until your carbon dioxide levels returns to normal, the more you try to breathe deeper or faster, the more severe your symptoms will become. Number of symptoms can accompany such as tingling, dizziness, chest pain and palpitations.
What is Hyperventilation?
Hyperventilation is known as rapid or deep breathing. It is a condition involving excess breathing cycles which lowers carbon dioxide blood levels, and creates an increased blood pH. In other words, blood becomes too alkaline due to low carbon dioxide levels. This leads to Respiratory Alkalosis which is a condition resulting from high alkaline in blood. Alkalosis causes constriction of the small blood vessels that supply the brain. Reduced blood supply to the brain can cause a variety of symptoms, including light-headedness and tingling of the fingertips. Severe hyperventilation can cause transient loss of consciousness.
Hyperventilation is a cycle. Even though hyperventilation causes a lack of carbon dioxide, the symptoms of hyperventilation are nearly identical to what one would experience if they lacked oxygen. So, the person who is experiencing hyperventilation tries breathing even more rapidly and deeply, and by doing that they only worsen their condition.
What Causes Hyperventilation?
The causes of hyperventilation are: 1) organic and physiologic and, 2) psychogenic (emotional/habit). This condition most commonly results from anxiety, panic, nervousness, or stress.
Patients who are young and middle-aged are most affected. Among personality traits, neuroticism has the strongest association with hyperventilation. Anxiety and hyperventilation are highly correlated with each other. Anxiety encourages over-breathing and over-breathing encourages anxiety. Hyperventilation is also strongly correlated with depression, exhaustion, sleep disturbances and quality of life. People with Panic Disorder are found to have more hyperventilation than those with Generalised Anxiety Disorder and Social Phobia. Moreover, chronic hyperventilation can lead to panic disorder due to its compensatory mechanisms.
What is Hyperventilation Syndrome (HVS)?
Although hyperventilation is a rare response to fear or stress in most people, some people regularly experience it as a response to fear or anxiety, When hyperventilation is a frequent occurrence, it is known as Hyperventilation Syndrome.
Hyperventilation Syndrome is a pattern of breathing where you breathe more quickly and deeply than normal. Symptoms are manifold, ranging from sensations of breathlessness, dizziness, parenthesis, chest pains, generalised weakness, syncope, and several others. The clinical expression is a rich combination of respiratory, cardiac and neurological signs which can simulate various organic diseases.
There is an approximated HVS prevalence in the general adult population at 9.5%.
How is it diagnosed?
There are many diagnostic tools used for HVS such as the Nijmegen Questionnaire, voluntary hyperventilation test, gas exchange while exercising, gas exchange when transitioning from a seated position to a standing one. Since the mechanisms behind dysfunctional breathing (DB) and HVS are not fully understood, the diagnosis of DB/HVS is often made after the individual has been the subject of many studies across multiple medical disciplines until the organic causes are disproven. Also, the variety of symptoms in HVS makes the diagnosis quite challenging. The physical symptoms including weakness, chest pain, dry mouth, tingling, and dizziness frequently draw attention away from the underlying respiratory issue. HVS patients may develop a more subtle, persistent, and recurrent pattern of breathing, which makes the detection even more challenging.
What is Chronic Hyperventilation Syndrome?
The hyperventilation syndrome is usually easily recognized when it follows an acute form. It is often overlooked, however, when it follows a chronic and insidious course. Chronic hyperventilation syndrome is a commonly misdiagnosed condition. The condition is different from acute hyperventilation or panic attacks, where patients often recognise that they are stressed and hyperventilating. Chronic hyperventilation patients often complain of difficulty taking a full breath in. They sigh deeply and frequently and often have nonspecific somatic symptoms in the context of mood and anxiety disorders and emotional stress.
During long term hyperventilation, kidneys dump bicarbonate to maintain pH. This ensures a continued state of chronic hyperventilation. Chronic hyperventilation causes arterial blood vessels to constrict. This reduces blood flow to organs and systems including brain and heart.
How is Hyperventilation Syndrome Treated?
Most patients require treatment for underlying mood or anxiety disorders; such treatment includes cognitive therapy, stress reduction techniques, drugs (eg, anxiolytics, antidepressants, lithium), or a combination of these techniques. Breathing retraining and yoga are effective in reducing the intensity and the frequency of episodes of hyperventilation.
I believe that psychoeducation about hyperventilation can be quite an effective treatment method.
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