What is hyperventilation?
Hyperventilation, or over -breathing, is a condition in which you breathe too quickly or deeply. Usually, hyperventilation occurs with anxiety. Overbreathing can cause imbalances in the levels of oxygen and carbon dioxide in your blood. These imbalances can make you feel breathless, dizzy, light-headed, confused or weak.
Hyperventilation is rapid or deep breathing that can occur with anxiety or panic. When you breathe, you inhale oxygen and exhale carbon dioxide. Excessive breathing leads to low levels of carbon dioxide in your blood. This causes many of the symptoms you may feel if you hyperventilate.
Feeling very anxious or having a panic attack is the usual reason that you may hyperventilate. However, rapid breathing may be a symptom of a disease, such as:
- Heart or lung disorder
Your doctor will determine the cause of your hyperventilation. Rapid breathing may be a medical emergency -- unless you have experienced this before and have been reassured by your doctor that your hyperventilation can be self treated. Often, panic and hyperventilation become a vicious cycle. Panic leads to rapid breathing, and breathing rapidly can make you feel panicked.
If you frequently overbreathe, you may have hyperventilation syndrome that is triggered by emotions of stress, anxiety, depression, or anger. Occasional hyperventilation from panic is generally related to a specific fear or phobia, such as a fear of heights, dying, or closed-in spaces (claustrophobia).
If you have hyperventilation syndrome, you might not be aware you are breathing fast. However, you will be aware of having many of the other symptoms, including:
- Chest pain
- Dry mouth
- Muscle spasms in hands and feet
- Numbness and tingling in the arms or around the mouth
- Shortness of breath
- Sleep disturbances
- Anxiety and nervousness
- Cardiac disease, such as congestive heart failure or heart attack
- Drugs (such as an aspirin overdose)
- Infection such as pneumonia or sepsis
- Ketoacidosis and similar medical conditions
- Lung disease such as asthma, chronic obstructive pulmonary disease (COPD), or pulmonary embolism
- Panic attack
- Severe pain
- Situations where there is a psychological advantage in having a sudden, dramatic illness (for example, somatization disorder)
- Stimulant use
The first step that should be taken is to treat the underlying cause.
If hypoxia is present supplemental oxygen may be useful. If it is due to anxiety as the cause of hyperventilation syndrome, benzodiazepines may be useful. Hyperventilation is most often caused by stress, anxiety or panic. It may also result from medical conditions, such as asthma, bleeding, a pulmonary (lung) condition, a cardiac (heart) condition, diabetic ketoacidosis (life-threatening complication of diabetes), or an infection. The side effects of certain drugs or medications can also trigger hyperventilation. Along with rapid breathing, other symptoms of hyperventilation may include abdominal bloating, chest pain, difficulty sleeping, dry mouth, muscle spasms, numbness, or tingling.
Hyperventilation can happen to anyone. Usually, adults breathe at eight to sixteen breaths per minute. A breathing rate exceeding sixteen breaths per minute is characteristic of either hyperventilation or tachypnea (rapid shallow breathing). While tachypnea and hyperventilation are sometimes considered to be the same, hyperventilation is usually related to stress or anxiety.
How is hyperventilation treated?
Treatment for hyperventilation is aimed at increasing carbon dioxide levels in the blood, usually by adjusting your breathing rate. Seeking reassurance from nearby people or reducing stress may help you cope with anxiety or panic. You can also increase carbon dioxide levels and decrease your oxygen levels by pursing your lips or breathing through a single nostril or breathing into a paper bag. Long-term care for hyperventilation includes psychiatric help, breathing exercises, relaxation techniques, and physical exercise. In serious cases, medication may be prescribed to treat hyperventilation.
Hyperventilation is treated by increasing the amount of carbon dioxide in the blood. This can usually be accomplished by changing breathing patterns. In serious cases, medication may be required to treat hyperventilation. Psychological counseling is beneficial to patients with anxiety or panic disorders that lead to hyperventilation
Current thinking suggests that the syndrome might better be termed behavioral breathlessness or psychogenic dyspnea with hyperventilation as a consequence rather than as a cause of the condition. It is also recognized that some patients may be physiologically at risk of developing psychogenic dyspnea.
Symptoms of hyperventilation syndrome and panic disorder overlap considerably, although the two conditions remain distinct. Approximately fifty percent of patients with panic disorder and sixty percent of patients with agoraphobia manifest hyperventilation as part of their symptomatology, whereas only twenty five percent of patients with hyperventilation syndrome manifest panic disorder.
Your doctor will look for other medical illnesses before diagnosing hyperventilation syndrome.
If your doctor has explained that you hyperventilate from anxiety, stress, or panic, there are steps you can take at home. You, your friends, and family can learn techniques to stop you from hyperventilating when it happens and to prevent future attacks.
If you start hyperventilating, the goal is to raise the carbon dioxide level in your blood, which will put an end to most of your symptoms. There are several ways to do this:
Get reassurance from a friend or family member to help relax your breathing. Words like "you are doing fine," "you are not having a heart attack," and "you are not going to die" are very helpful. It is extremely important that the person helping you remain calm and deliver these messages with a soft, relaxed tone.
To increase your carbon dioxide, you need to take in less oxygen. To accomplish this, you can breathe through pursed lips (as if you are blowing out a candle) or you can cover your mouth and one nostril, and breathe through the other nostril. Or breath into a brown paper bag.
Over the long term, there are several important steps to help you stop overbreathing:
- If you have been diagnosed with anxiety or panic, see a psychologist or psychiatrist to help you understand and treat your condition.
- Learn breathing exercises that help you relax and breathe from your diaphragm and abdomen, rather than your chest wall.
- Practice relaxation techniques regularly, such as progressive muscle relaxation or meditation.
- Exercise regularly.
If these methods alone are not preventing your overbreathing, your doctor may recommend a beta blocker medication.
When to Contact a Medical Professional
Call your health care provider if:
- You are experiencing rapid breathing for the first time. (This is a medical emergency and you should be taken to the emergency room right away.)
- You are in pain, have a fever, or notice any bleeding.
- Your hyperventilation continues or gets worse, even with home treatment.
- You also have other symptoms.
What to Expect at Your Office Visit
Your doctor will perform a careful physical examination.
To get your medical history, your doctor will ask questions about your symptoms, such as:
- Do you feel short of breath?
- What other symptoms do you have when you are breathing rapidly (any bleeding or dizziness)?
- Do these symptoms start at any other time (when excercising or walking)?
- Do you have any medical conditions (high blood pressure, diabetes, high cholesterol)?
- What medications do you take?
- What is happening in your life in general? Is this a particularly stressful time?
- Do you feel anxious or stressed, especially before you start breathing rapidly?
- Are you in pain? What does the pain feel like? How intense is the pain? Where is the pain?
- The doctor will assess how rapidly you are breathing at the time of the visit. If you are not breathing quickly, the physician may try to induce hyperventilation by instructing you to breathe a certain way.
While you hyperventilate, the doctor will ask how you feel and watch how you breathe -- including what muscles you are using in your chest wall and surrounding areas.
Tests that may be performed include:
- Blood tests for the oxygen and carbon dioxide levels in your blood
- Chest CT scan
- Ventilation/perfusion scan of your lungs?
- X-rays of the chest
Cannabinoids Treat Hyperventilation Syndrome
THCV is found in largest quantities in Cannabis sativa subsp. indica strains. Some varieties that produce propyl cannabinoids in significant amounts, over five percent of total cannabinoids, have been found in plants from South Africa, Nigeria, Afghanistan, India, Pakistan and Nepal with THCV as high as (53.69%) of total cannabinoids. They usually have moderate to high levels of both THC and Cannabidiol (CBD) and hence have a complex cannabinoid chemistry representing some of the world's most exotic cannabis varieties.
It has been shown to be a CB1 receptor antagonist, i.e. blocks the effects of THC. In 2007 GW Pharmaceuticals announced that THCV is safe in humans in a clinical trial and it will continue to develop THCV as a potential cannabinoid treatment for type 2 diabetes and related metabolic disorders, similar to the CB1 receptor antagonist rimonabant.
First, transmission of the excitatory neurotransmitter glutamate causes an influx of calcium ions into the post-synaptic neuron. Through a mechanism not fully understood, the presence of post-synaptic calcium induces the production of endocannabinoids in the post-synaptic neuron. These endocannabinoids (such as anandamide, are released into the synaptic cleft, where binding occurs at cannabinoid receptors present on pre-synaptic neurons, where they modulate neurotransmission.
Cannabivarin, aka cannabivarol or CBV, is a non-psychoactive cannabinoid found in minor amounts in the hemp plant Cannabis sativa. It is an analog of cannabinol (CBN) with the sidechain shortened by two CH2 groups. CBV is an oxidation product of tetrahydrocannabivarin (THCV, THV). THCV a potential cannabinoid treatment for:
Excessive breathing (hyperventilation), respiratory failure, hyperventilation syndrome.
Medical marijuana relieves stress and anxiety which are symptoms of hyperventilation. Medical marijuana relieves depression which is another symptom of hyperventilation. Medical marijuana clears aggression. Medical marijuana cools emotional upset and mood swings. Medical marijuana stops muscle spasms. Medical marijuana eliminates sleep disturbances.
Recommendation: Whole plant extracts (Indica x hybrid)
Taken under the tongue for immediate relief.
Duffin J, Phillipson EA. Hypoventilation and hyperventilation syndromes. In: Mason RJ, Broaddus CV, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 78.
Winter AO, Purcell TB. Somatoform disorders. In: Marx JA, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 111.
1. Gardner W (April 2000). "Orthostatic increase of respiratory gas exchange in hyperventilation syndrome". Thorax 55 (4): 257–9. doi:10.1136/thorax.55.4.257. PMC 1745726. PMID 10722762.
2. yourdictionary.com > hyperventilation Citing: The American Heritage® Dictionary of the English Language, 4th edition Copyright 2010
3. Kenneth Baillie and Alistair Simpson. "Hyperventilation calculator". Apex (Altitude Physiology EXpeditions). http://www.altitude.org/oxygen_levels.php. Retrieved 2006-08-10.- Online interactive oxygen delivery calculator that mimics hyperventilation
4. Sauty, A; Prosper, M (2008-11-19). "[The hyperventilation syndrome].". Revue medicale suisse 4 (180): 2500, 2502–5. PMID 19127893.
^ Stocchetti N, Maas AI, Chieregato A, van der Plas AA (2005). "Hyperventilation in head injury: a review". Chest 127 (5): 1812–27. doi:10.1378/chest.127.5.1812. PMID 15888864 References
1. Martin, Elizabeth A (ed.) (2003). Oxford concise medical dictionary (6th ed. w. corrections & new cover). Oxford University Press. p. 334. ISBN 10:0-19-860753-9