The symptoms of Hyperventilation Syndrome (lightheaded, dizziness, facial and hand tingling, increasing anxiety and shortness of breath, etc.) usually come as a result of an Anxiety Attack or so-called Panic Attack. Unfortunately there is often additional secondary hyperventilation makes the anxiety problem even worse. This problem can be improved and corrected by controlled breathing, to reduce the excessive loss of carbon dioxide from the lungs and restore the internal chemical pH balance that triggers these symptoms.

However, Hyperventilation Syndrome can be much more subtle than the more obvious association with Panic Attacks. This situation requires long term breathing control techniques, and will not be directly addressed here.

We will show you in this project two breathing tricks using the BIS^tm prompting system without using the breathing biofeedback component how to control an ACUTE hyperventilation attack.

Those who are fortunate and have the appropriate respiratory transducers can also see their real time breathing patterns. This makes these techniques even more effective. Regardless, even without the respiratory biofeedback signal you will find this to be a powerful technique.

The secret to success is to have the patient breathe in an abnormal fashion, to permit easy focus on the abnormal pattern, and then use this abnormal breathing pattern to advantage. Again, these techniques are only to control ACUTE attacks.

This involves reducing the rapid and excessive breathing pattern of Hyperventilation Syndrome to a slow, and comfortably deep pattern. In so doing the excessive level of ventilation and Carbon Dioxide loss can be reduced, and the patient again resume control and feel comfortable.

The first technique is the Constant or Steady Breathing Pattern. This breathing pattern is abnormal because it is larger than normal (giving the patient a more satisfying breath and also more time to concentrate), and the inspiration and expiration times are identical (normally expiration is slightly longer). The inspired volume suggested will probably have to be adjusted to one that is comfortably deep.

The patient concentrates on slow, deliberate and steady inspiration and expiration, and paces themselves by counting "One Thousand and One, One Thousand and Two, etc. up to One Thousand and Five" and then immediately exhaling in a similar manner, counting all the while. While it is generally desirable to maintain a count of "Five," occasionally it is desirable to count up to 6 or 7, particularly in the early phase of controlling an acute attack. The breathing pattern is as noted below:
    ©  April 10, 2000

Note the Tidal Volume has been set to 2000 cc, and some patients are comfortable with even larger volumes, though most will use a smaller volume to be comfortable. Note the Respiratory Rate is set to 8 breaths per minute (to compensate for overventilation) and some patients require even lower rates. Note that the Tidal Volume and Rate may be dynamically adjusted, by either entering a new number or using the mouse pointer on the up and down arrows next to the appropriate indicators. Depending on the patient size and individual preferences, adjustments of the breath volume and breathing rate are required to find a comfortable balance.

The patient should watch the blinking yellow cursor on the program line and practice pacing their breathing in order to coordinate with the timing of the breathing pattern. They should be at full inspiration just as they count "One Thousand and Five," with inspiration ending exactly on "Five." The patient then immediately begins the exhalation phase, counting and finishing in a similar manner. This is visual biofeedback training to learn a slower breathing rate.

However, by asking the patient to sense the volume of air as it flows into their chest, you are providing another sensory biofeedback signal, which is an approximate but effective calibration of the patient to the volumetric signal of the visual prompting device.

Adjustment of the Tidal Volume and Rate to control acute symptoms requires certain settings. Normalized controlled breathing following resolution of the acute attack, to prevent a recurrence, requires obviously much different parameters.

Suggested normal breathing settings are Tidal Volume 500-800 cc, Respiratory Rate 8-10 breaths per minute, Inspiration Time 40% (therefore giving a desirable longer expiration time of 60%), Inspiration Hold 5%, and Expiration Hold 10%. Considerable experimentation to find appropriate settings may be required, but once defined they are then easily input at following sessions.

Note that you may coordinate inspiration with the [Esc] function key, which re-zeros the system. Simply have the patient exhale normally, tell them to inhale, and simultaneously press [Esc].

The second technique is the Pause Breathing Pattern. This technique is somewhat more difficult to master, but is generally the preferred method.

As with the Constant / Steady Breathing Pattern, the Tidal Volume, Inspiration / Expiration Times, and Respiratory Rate are identical. The patient counts in the same manner. In addition there is an Inspiration and Expiration Pause of 20%, with the patient saying "Pause" at the appropriate times.

This will cause a slightly accelerated inspiratory flow, that may be more satisfying to some patients. The Pause times are distinct areas to have the patient focus on stopping breathing, and enhances general focus and the process of learning to slow down the Respiratory Rate.

Occasionally, to emphasize the Pause phase, a longer Pause Time (e.g. 30 % to 40%) may be used temporarily. As this is excessively disruptive of normal breathing this should not be used as a regular pattern.

This breathing pattern is as follows:
    ©  April 10, 2000

Copies of their breathing prescriptions should be provided to the patient, preferably with annotations as to deficiencies and areas to be worked on. If the patient has a personal computer they may practice at home with the program itself.

Patients should practice preferably twice a day, but no longer than five minutes. During this time they should be relaxed, and concentrate on "put the breathing pattern in your head."

Should they have another Panic Attack or episode of Hyperventilation Syndrome they should calm themselves, relax, and try to visualize the desired breathing pattern in their mind, and to follow same while pacing their breathing by counting.

Return to HomePage