The two topics of the title of this module are frequently closely linked, and to understand one topic you must understand the other.

Hyperventilation is simply overbreathing, and the constellation of symptoms this may produce is called the Hyperventilation Syndrome. These symptoms may be acute and sudden, the Acute Hyperventilation Syndrome, or they may be chronic and quite subtle, the so-called Chronic Hyperventilation Syndrome. Typically Panic Attacks (or Anxiety Attacks) are associated with the Acute Hyperventilation Syndrome, though subtle Chronic Hyperventilation Syndrome complaints may provide a background of anxiety symptoms that set the stage for developing Panic Attacks with even more hyperventilation problems being produced.

The lungs have two basic functions. The first is to take in oxygen containing air. Oxygen is a fundamental source of energy, necessary for the metabolic function of all cells in the body. The second is the removal from the body of Carbon Dioxide ("CO2"), which is an end-product of metabolism, i.e. a waste product that must be removed. The rate of CO2 removal is normally exquisitely balanced by lung breathing control mechanisms, depending on general levels activity and other factors, so that not too much, and not too little CO2 is eliminated. Hyperventilation Syndrome occurs when breathing is over-active, and this overbreathing eliminates too much CO2, thus causing the CO2 level in the body to fall lower than it should. And this has immediate consequences in terms of maintaining the all important internal body pH, a measure of how acidic or alkaline the body environment is.

An excessively low CO2 level therefore has widespread consequences, and one of the important ones is so-called vasoconstriction, i.e. spasm or constriction, of the arteries carrying blood to the brain, thus reducing the blood flow to the brain. This causes a reduction of vital oxygen delivery to the brain.

But there is another important consequence of reduced blood flow to the brain, and that is a reduction of the supply of the sugar Glucose. The two main metabolic fuels for the brain are Oxygen and Glucose, and there are essentially no reserve supplies of Oxygen and Glucose stored in the brain. Therefore, any interruption of blood flow to the brain has almost immediate consequences. And these consequences can be catastrophic. For example, with an acute heart attack with sudden total cessation of blood flow, brain death begins in about only five minutes. This of course would not happen with breathing abnormalities, but reduced blood flow induced by hyperventilation can indeed have significant consequences.

This picture is a Brain Scan, looking at the brain from above, using the Magnetic Resonance Imaging technique to study brain Glucose metabolism using isotope glucose.

The reddish-brown, yellow and light blue areas in the left scan, in the patient breathing normally, indicate normal active glucose metabolism.

The right scan is the same subject, after a brief period of hyperventilation. From the color scale, it is clear that glucose metabolism is now markedly reduced.

This glucose reduction has resulted from the reduced blood flow to the brain, which would also indicate a marked parallel reduction in the oxygen supply to the brain.




Can there be any doubt that hyperventilation may cause acute brain dysfunction, and therefore many brain related symptoms? However, and it must be emphasized, despite the alarming overbreathing changes noted, they are not permanent, and even severe overbreathing does not cause permanent brain damage.

Typical hyperventilation complaints are those of being light-headed, or feeling somewhat disoriented, or dizzy or feeling faint, and occasionally actual fainting may occur. Frequently there is a sense of "Air Hunger," a smothering sensation mimicking true physiologic shortness of breath. And frequently there is a feeling of anxiety, which may escalate into a full-blown Panic Attack. These are direct manifestations of brain dysfunction. And there may be additional peripheral symptoms, such as a numbness or tingling about the face and around the mouth, or tingling in the fingers, and occasionally even some muscular spasm of the fingers. There may be a sense of pressure of tightness in the chest, leading to fears of a heart attack. And there may be a vague feeling of overall weakness and fatigue.

It is no wonder that these symptoms during an acute attack may be very alarming. Fortunately the diagnosis of this problem is relatively easy, if witnessed by a physician or psychologist. However, many physicians and psychologists do not have particular skills in treating Hyperventilation Syndrome, or the mimicking component of Anxiety or Panic Attacks. A referral to a consultant with the appropriate skills would be indicated.

With lesser degrees of chronic symptoms, correct diagnosis can be, and frequently is, a significantly difficult problem. Persistent subtle varieties of these symptoms may lead to concerns about possible underlying serious illness, such as heart disease or cancer. These symptoms frequently lead to multiple physician visits, and many tests and consultations, all with negative results, and an unsatisfied and frustrated patient with no answers to their ongoing symptoms. Here the advice of a physician or psychologist with specific training in this problem is very important. And that individual should have equipment, or have ready access to equipment, that can measure the so-called "End Tidal CO2 (ETCO2)." This is an indirect measurement of the blood level of CO2, easily done by sampling air from your nose or mouth, and is critically important in diagnosing the subtler types of chronic overventilation.

Symptom control may be achieved by slowing your rate of breathing, and if you are using large, gasping breaths, by reducing the size of your breath.

The timing of your breathing can be done anywhere, by breathing in and slowly and deliberately counting to yourself "One thousand and one; One thousand and two; One thousand and three; One thousand and four; One thousand and five." At the end of "One thousand and five" you should be at your full inspiration breath. Then, while breathing out, repeat the counting process from One thousand and one all the way down to One thousand and five at end expiration.

Note that the times of breathing in and out are identical with this method. This is actually an unnatural breathing pattern, and is a trick to have you further focus on your breathing counting.

The Breathing Trainer may be used to advantage with learning to count and control properly. Set the Tidal Volume to about 1000cc, the Respiratory Rate to about 10 or 11 (with a range of about 8 to 12 breaths per minute maximum), and leave the default times of inspiration and expiration as they are at 50% each. If you are uncertain how to adjust the settings on the Breathing Trainer, and how to trigger the screen to coordinate with your natural breathing, refer to the general instructions at: Go to Breathing Trainer operating instructions.

This is the breathing pattern you will see.
On the left is a breathe in, Inspiration line, and on the right a breathe out, Expiration line.

Note on the Inspiration line there is a cross. This is a moving cursor that moves precisely from the beginning to the end of inspiration, and likewise on expiration. It is your guide to learning to pace and time your breathing.

You must learn to start counting exactly at the beginning of the Inspiration line, and then breathe in a constant and steady manner so that when you reach the end of "One thousand and five" you will be exactly at the top of inspiration. Then, do the same type of counting for the Expiration line.

You may wish to make some adjustments to the breathing rate, but don't go greater than 12 breaths per minute.

It is important that you learn the feeling within your chest and lungs with this breathing prescription. Then, if you know that feeling, you should be able to quite accurately reproduce this breathing pattern by feeling how you breathe, in conjunction with your breathing counting.

When you are comfortable with this initial breathing pattern there is a further refinement you can make to your breathing control. This involves a slight pause, or breath holding time, at the end of inspiration and the end of expiration. This will give you better focus points, and slow your breathing even further.

This breathing pattern looks like this.

Here the Inspiration and Expiration pause is set to 10%. To emphasize the pause times they may temporarily be set to 20%.

Note the cursor is now on the Expiration line.

When counting "One thousand and five" the five should be at the beginning of the pauses, to make a distinct breath hold.

And a further teaching from the Yoga masters. Inspiration is a time for action, for being positive, and for doing things. Here is when you most want to concentrate on your breathing timing and being aware of your breathing. Expiration is a time for calmness and relaxation. And particularly during the Expiration Pause time, you should be focused, and totally and completely calm and relaxed. You may wish to experiment with prolonging the expiration pause time to further this experience.

It is emphasized, these two breathing patterns are to be used only to correct an Acute Hyperventilation Attack or Panic Attack, or to interrupt a developing attack, before it progresses into a more serious attack. Once you have controlled your breathing and your symptoms are subsiding, it is now time to switch to a normal breathing pattern.

This normal breathing pattern should be practiced when you are calm and feeling well. You should be able to relax and feel comfortable with this breathing prescription. Some adjustments may be needed to suit your individual needs, and when you sense optimal comfort with a particular breathing pattern, be sure you practice that pattern, and be able to feel that breathing sensation within you chest and lungs, so you can reproduce it at any time. If you feel you are starting to lose control, then switch back to your therapeutic control breathing pattern.

Here are some suggested settings for an average sized adult. Most important is maintaining a slower breathing rate. Note however, even with a slow breathing rate it is still possible to hyperventilate and blow off excess CO2 if you take unusually large breaths.
Tidal Volume -- 800 - 1000 cc
Breathing Rate -- 9 - 10 per minute (range 8 to maximum 12 breaths per minute)
Inspiration Time -- 40% (therefore Expiration Time will be set to 60%)
Inspiration Breath Pause -- 4%
Expiration Breath Pause -- 8%

And here is what that normal Breathing Prescription looks like.

Practice and feel it.

Feel it and do it, anywhere and any time.

And when you are breathing out, be relaxed and calm.

Be the master who controls your breathing, and controls the symptoms that bother you.

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