Hyperventilation - makes you feel as if you can't get your breath
At last I am beginning to understand hyperventilation. It has never made sense to me until now after reading about Buteyko's ideas. Please see Wikipedia article on Konstantin Buteyko
I have never understood why humans evolved such an inefficient system of breathing. We inhale most of our recently exhaled air, which to me seemed a nonsense: it is much more efficient to have a one way flow of air over a surface, like fish do with water over gills. However, there is a good reason. Life evolved over millions of years in an atmosphere rich in carbon dioxide, the waste gas of respiration. Carbon dioxide became essential for normal cell metabolism because cells used carbon dioxide to maintain their optimal pH (acidity). When levels of carbon dioxide in the atmosphere fell, cells had to develop a mechanism for artificially bathing themselves in the right level of carbon dioxide for their efficient metabolism. And so lungs evolved.
Lungs are necessary to keep carbon dioxide levels high in inhaled air and therefore in the blood. The blood is very efficient at gathering oxygen and all arterial blood is 100% saturated with oxygen. But here comes the crunch! Oxygen is only readily released from red blood cells to supply oxygen to the tissues in the presence of high levels of carbon dioxide. So what does this mean in practice?
Short of breath? Breathe less!
Many patients, particularly asthma patients, but also CFS patients, have a sensation that they are not getting enough oxygen to their tissues. Their response to this is to breathe more deeply. However blood cannot become more than 100% saturated with oxygen. All that happens is that more carbon dioxide is washed out of the blood. This makes oxygen cling more fiercely to haemoglobin in red blood cells and therefore oxygen delivery to the tissues is made worse! Paradoxically, to improve oxygen supply to the tissues you have to breathe less! Breathing less increases carbon dioxide levels and improves oxygen delivery.
Lowering carbon dioxide levels in the blood has other dire effects. It upsets the acidity of the blood and causes what is known in medical jargon as a respiratory alkalosis. This causes all sorts of awful symptoms such as panic attacks, pain, fatigue, feeling spaced out and dizzy, brain fag, brain fog and so on.
[Historical Note : Brain fag syndrome (BFS) was described by RH Prince in 1960. It was first discovered in Nigeria, describing high school and university students with symptoms including somatic, sleep-related and cognitive complaints, head and neck pains, difficulty in concentrating and retaining information, and eye pain.]
Again, taking the evolutionary approach, humans used to live a far more active existence. Because we are now so sedentary, we do not need the oxygen supply our lungs have evolved to deliver. We do not produce enough of the waste gas carbon dioxide either. The system is under used and so there is an in-built tendency to breathe too much. This is worsened by stimulants such as excitement (sitting in front of an exciting film, but not using any oxygen up), caffeine, computer games and so on.
Hyperventilation is probably extremely common and we could all benefit from breathing less. We have simply got into bad habits and have to re-learn how to breathe.
Asthma is how the body tries to prevent you from hyperventilating. The airways constrict to try to reduce gaseous exchange to allow carbon dioxide to be retained. Breathing harder, or deep breathing makes asthma worse. Inhalers to open up the airway, whilst relieving the airway constriction in the short term, in the long term worsen hyperventilation and therefore the cause of asthma.
Typical symptoms of hyperventilation
Vivid dreams or nightmares; tingling and numbness of hands, feet, and area around mouth; yawning or sighing; sensation of needing to take a deep breath; panic attacks; feeling of being spaced out, faint or dizzy, episodes of weakness and exhaustion; muscle spasms, twitching, cramp, aching.
Diagnosis of Hyperventilation
If you are asthmatic then the answer is a definite yes. All asthmatics hyperventilate (it is only in the very extreme forms of asthma that oxygen levels in the blood fall).
Many CFS symptoms are the same as those from hyperventilation. Buteyko suggests you test yourself with his controlled pause: Sit comfortably in an upright chair, breathe in normally and out holding your nose after the out breath. Count the seconds using a watch until you feel you have to breathe in again. The number of seconds counted gives your control pause. The ideal pause is 60 seconds, but a pause of 40-60 denotes good health. (Editor's note: 60 seconds seems too long! I can't do this, but perhaps I need retraining!) A control pause of 30 (according to Buteyko) means you are breathing enough for 2 people and suggests mild asthma. A control pause of 15 seconds indicates you are breathing for 4 people: this is serious hyperventilation. A control pause of 10 seconds denotes severe asthma. Like I said before, his controlled pauses seem like a long time to me and I can't do 60 seconds!
The other method to check for hyperventilation is to do a forced test of over breathing. Sit and breathe deeply through your mouth, as if you are running. Within 30-40 seconds you will develop unpleasant symptoms which may include dizziness, palpitations, cough or wheeze. If your troublesome symptoms are flared, this suggests hyperventilation may be the cause.
If you are hyperventilating then your blood and therefore your urine becomes alkali. This can be tested for with litmus paper - I can send you some if you order. Indeed many people with CFS tend to have acidic urine because they are constantly switching into anaerobic metabolism with the production of lactic acid. Hyperventiliation may be the body's response to try to restore normal blood pH. Please see Litmus paper test.
Treatment of Hyperventilation
For those patients who do not have a chronic fatigue syndrome, physical exercise is extremely helpful. Take up some sort of physical activity, such as running, swimming or cycling on a daily basis to reduce your hyperventilation. Singing is also very helpful and the breathing exercises for singing are very much like those for hyperventilation, particularly breath control. The third possibility is to take up a wind instrument such as a trumpet, which again teaches breathing control and which can be helpful for hyperventilation.
The following principles apply both to non-CFS and CFS patients.
Firstly you must always breathe through your nose. This increases the amount of air which is exhaled and immediately re-inhaled and is therefore relatively rich in carbon dioxide. Mouth breathers must make a conscious effort to close their mouths always, if necessary tape your lips closed at night.
Secondly, breathe less deeply and more slowly. Initially this brings a feeling of wanting to breathe more, but this must be ignored. It is a bit like having an irritating itch and not being allowed to scratch it. Some anti-hyperventilation techniques ask you to practice breathing using your diaphragm instead of your chest. I don't see the logic of this because whether you use your diaphragm or your chest muscles, air will still be drawn into the lungs. Buteyko is similarly unconcerned about diaphragmatic breathing, so in this we agree! The results of reducing your rate of breathing are felt very quickly (within a few minutes) with good positive feedback to encourage you to continue! But improvement may continue over weeks, so keep at it!
Thirdly, if you catch yourself sighing, yawning or taking a deep breath, hold your breath for a few seconds, breathe out very slowly, then start breathing slowly and shallowly again.
There is another mystery which may also be explained by hyperventilation. Virtually all of my CFS patients are magnesium deficient. Why? The body's response to a respiratory alkalosis is to pee out bicarbonate. Bicarbonate is a negatively charged ion and cannot leave without a positively charged ion. Guess which positively charged ion goes out with it? Spot on, magnesium! Magnesium deficiency may well be another indicator of hyperventilation. Taking magnesium carbonate may be very helpful (suggest 2-4 grams daily).
Further information can be obtained from The Buteyko Breathing Association via their website or contact your local teacher for more information. A list of Buteyko teachers is displayed on their website. Recommended reading includes "Freedom from Asthma, Buteyko's Revolutionary Treatment" (Amazon Link for "Freedom from Asthma, Buteyko's Revolutionary Treatment") and "The Carbon Dioxide Syndrome" by Jennifer and Russell Stark (Amazon Link for The Carbon Dioxide Syndrome)
It is interesting to speculate about the relationship between asthma and hyperventilation and fatigue. In my experience it is unusual to see fatigue and asthma in the same patient at the same time, although with CFS patients there is sometimes a past history of asthma. Perhaps the local reaction to hyperventilation is asthma (by constricting the airways to reduce gaseous exchange) and the systemic reaction is fatigue (through reducing blood supply, to try to increase carbon dioxide retention in the blood in an attempt to improve local oxygen delivery). Perhaps treatment of asthma by using bronchodilaters (blue inhalers), whilst relieving the local airways obstruction and wheeze actually then allow the systemic symptoms to become a problem? This is speculation! But it squares with clinical observation.
Further information from Physiotherapy for Hyperventilation
Test for Hyperventilation
John McLaren Howard has now developed a test for hyperventilation at Acumen. This measures levels of red cell carbonic anhydrase. Please see Carbonic anhydrase studies in red blood cells. In chronic hyperventilation this becomes depleted and the ratio between the activity and the protein gives a good indication of whether or not hyperventilation is a problem. This test tells us how much effort we have to put in to correcting this and essentially there is a two-pronged approach - firstly biochemical and secondly physical.
- Wikipedia article on Konstantin Buteyko
- The Buteyko Breathing Association
- ButeykoWorks website
- Buteyko Breathing Centre
- Amazon Link for "Freedom from Asthma, Buteyko's Revolutionary Treatment"
- Amazon Link for The Carbon Dioxide Syndrome
- Physiotherapy for Hyperventilation
There have been many studies of the Buteyko method. Here is a selection of studies, together with their broad conclusions:
"BBT is a safe and efficacious asthma management technique. BBT has clinical and potential pharmaco-economic benefits that merit further study."
- A randomised controlled trial of the Buteyko technique as an adjunct to conventional management of asthma.
"The Buteyko technique, an established and widely recognised intervention, or an intensive programme delivered by a chest physiotherapist appear to provide additional benefit for adult patients with asthma who are being treated with inhaled corticosteroid."
"We conclude that the BBT may be effective in improving the quality of life and reducing the intake of inhaled reliever medication in patients with asthma. These results warrant further investigation."
"The trial results showed benefits to using Buteyko breathing in both asthma and dysfunctional breathing"
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