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Hyperventilation: cause and treatment

by Josephine Andrews
Published: Last Updated on 367 views

Doctors speak of hyperventilation when someone breathes excessively fast and deeply. In films, hyperventilation is a popular way of showing people under severe psychological stress: those affected suddenly begin to pant frantically, turn pale, and finally someone rushes over with a plastic bag into which the sufferer is supposed to breathe out and breathe in. In fact, under great mental stress, acute hyperventilation can occur. However, the symptom can also occur chronically. And it’s not always the fault of the psyche. Read everything you need to know about “hyperventilation” and why the plastic bag is justified in many cases.

quick overview

  • What is hyperventilation? excessive ventilation of the lungs with accelerated and at the same time deepened breathing
  • Symptoms : Tingling in the fingertips, feet and mouth, cold hands and feet, cramping hands, “constricted” throat, dizziness, lightheadedness, blurred vision, feeling of pressure in the heart area
  • Causes : eg strong tension, depressive states, pain, brain inflammation or tumours, stroke, craniocerebral trauma, poisoning, infections, severe diarrhea, metabolic imbalances
  • When to the doctor? in general, but especially in chronic hyperventilation
  • Therapy : depends on the cause
  • First aid : breathe into the diaphragm, breathe into a plastic or paper bag, do relaxation exercises

Hyperventilation: description

Hyperventilation describes excessive (“hyper”) ventilation (“ventilation”) of the lungs. This may sound strange at first, but it can happen when breathing accelerates and deepens at the same time .

The lungs are responsible for the vital exchange of gases in the blood. It supplies it with fresh oxygen and in return the carbon dioxide (CO 2 ) produced by cell respiration is exhaled through the lungs. When you hyperventilate, your breathing gets faster, but at the same time your breaths get deeper. Since the blood is already almost 100 percent saturated with oxygen during normal breathing, the body does not receive any additional oxygen through hyperventilation. However, the concentration of CO 2 in the blood is getting lower and lower, the so-called partial pressure of carbon dioxide (CO 2 ) in the lungs and in the blood circulating there decreases. This shifts the pHof the blood in the alkaline (basic) range:

Under normal circumstances, the resulting CO 2 dissolves in the blood and is bound there as carbonic acid. As the name suggests, this has an acidifying effect on the pH value in the blood. When the CO 2 decreases and with it the carbonic acid content, the blood becomes alkaline: the pH value of the blood increases (actually it should be around 7.4). This condition is called ” respiratory alkalosis” . In fact, a decreasing CO 2 partial pressure automatically causes a reduction in breathing activity via an unconscious reflex; with hyperventilation, however, this control loop is broken.

Hyperventilation has nothing to do with the normal acceleration of breathing during physical exertion.

Hyperventilation and the brain

The human body is equipped with a number of protective functions and reflex mechanisms that are usually very useful and serve well. Under certain circumstances, however, such a reflex mechanism can also become a disadvantage. This is also the case in the case of hyperventilation with regard to cerebral blood flow:

If there is an increased CO 2 concentration in the blood, this is usually accompanied by a reduced oxygen content. Special receptors on the paired carotid artery and the aorta (main artery) are able to measure the level of CO 2 in the blood and report it to the brain , where the signal is processed. When the CO 2 concentration is high, the brain assumes that the oxygen level is low and therefore causes the blood vessels to dilateexpand in the brain so that it is better supplied with blood and thus receives more oxygen. The mechanism itself makes sense because it ensures that the thinking organ is adequately supplied with oxygen, even if there is less oxygen dissolved in the blood.

Conversely, however, the problem arises that the blood-supplying cerebral vessels are narrowed as soon as the CO 2 content in the blood drops, which is the case with hyperventilation. This can lead to a slight undersupply of the brain, especially in the case of chronic hyperventilation, and thus to symptoms such as dizziness, drowsiness and visual disturbances .

Hyperventilation: Symptoms

Hyperventilation that is primarily psychological in origin must be distinguished from that which has a tangible physical cause.

The psychologically induced hyperventilation occurs with typical symptoms. This includes:

  • Dizziness,
  • Tingling in fingertips, feet and mouth area
  • tachycardia
  • Tremble
  • visual disturbances
  • shortness of breath
  • tightness in the chest
  • sudden dry cough

In the case of psychologically induced hyperventilation, however, these phenomena have no physical cause, but are mostly a reaction of the psyche to strong emotional states.

In contrast, somatogenic (physically induced) hyperventilation takes place on a different level – for example, because something in the brain is not working properly. But dramatic changes in metabolism can also be to blame.

True hyperventilation is to be distinguished from accelerated breathing, which the body uses to try to compensate for a lack of oxygen or an excessive burst of CO 2 . More on this in the chapter: “Hyperventilation: causes and possible diseases”.

Tetany from hyperventilation

A consequence of hyperventilation can be the so-called tetany. One speaks of tetany when there is neuromuscular hyperexcitability due to a lack of free calcium in the blood. Such a (relative) calcium deficiency can develop in those affected as a result of hyperventilation and thus lead to persistent muscle cramps , but also abnormal sensations such as numbness or tingling on the skin . But what does hyperventilation have to do with calcium deficiency?

As a result of the alkalization of the blood described, some proteins in the blood give off protons (positively charged ions). The now negatively charged proteins can in turn “catch” the doubly positive calcium ions (Ca 2+ ) that swim freely in the blood and thus cause a relative calcium deficiency . This means that although the calcium content in the body is not reduced overall, the free calcium ions, which are important for many physiological tasks, are reduced. As a result, muscle cramps can occur, which often first appear on the hand ( “paw position” ) or around the mouth ( “carp mouth” ).

Hyperventilation: You can do this yourself

In the case of psychogenic hyperventilation (e.g. severe stage fright or other stressful situations) you can do a lot yourself to normalize breathing again:

Breathe into the diaphragm: If you suddenly start to hyperventilate, you should try to breathe with your diaphragm and not with your chest. It can help to place one hand on your stomach and concentrate on pushing your hand with your stomach while breathing in and out, or “pushing the air out of your stomach” with your hand. People who hyperventilate more often in certain situations and know this can already use this breathing exercise before such a situation arises in order to avoid hyperventilation in advance.

Use a bag: If this has happened and tetany with muscle cramps or a tingling sensation has set in, a simple plastic or paper bag can help. If the person breathes in and out of the bag for a period of time, carbon dioxide builds up in the blood and the blood pH can gradually return to normal in the exhaled air. Even the doctor does nothing else in an acute case with a patient.

Relaxation exercises: Those who frequently suffer from stressful situations should learn relaxation techniques ( progressive muscle relaxation , autogenic training , etc.). These techniques make it easier to cope with acute stressful situations.

Consult a specialist: Sometimes a psychosomatic therapy with a psychologist makes sense, i.e. a treatment that deals with the interactions between body and soul.

Hyperventilation: causes and possible diseases

In principle, there are several possible causes for hyperventilation. In many cases, the psyche plays tricks on those affected. Sometimes the deepened, accelerated breathing also has physical (physical) reasons.

psychological causes

Common triggers of psychogenic hyperventilation are:

  • strong tension
  • nervousness, excitement
  • Fury
  • Anxiety or panic attacks
  • depressive states

Patients suffering from this psychogenic hyperventilation syndrome often complain about other psychosomatic complaints such as gastrointestinal problems, palpitations and insomnia.

physical causes

Disorders on a physical level that can trigger hyperventilation are:

  • Inflammation of the brain (encephalitis): In addition to many other symptoms such as fever, headache, paralysis, blurred vision, etc., it can also trigger hyperventilation (due to a disruption in the respiratory center).
  • Brain tumors : Similar to encephalitis, they can also sometimes make breathing faster and deeper.
  • Stroke : In some cases, hyperventilation is the result.
  • Traumatic brain injury : Hyperventilation can also occur here.

In addition to these triggers that directly affect the brain, serious metabolic disorders are occasionally the cause of excessively increased breathing. Unlike pure hyperventilation, however, this is the body’s attempt to prevent blood acidification caused by other factors by lowering the carbon dioxide content – ​​for example, in the case of:

Another type of “non-true” hyperventilation, but one that can present symptoms similar to this one, is intense breathing in response to generalized tissue starvation . This can, for example, be the result of cardiac insufficiency (cardiac insufficiency) or occur in connection with a pulmonary embolism and other lung diseases with gas exchange disorders. People who venture to high altitudes without sufficient time to acclimatize may also begin to hyperventilate.

Hyperventilation: When do you need to see a doctor?

In the case of physical causes, hyperventilation often runs chronically and can thus lead to other symptoms, such as

  • Swallowing air with subsequent flatulence
  • frequent urge to urinate
  • Heart problems and a tendency to cramps due to an absolute calcium deficiency
  • severe headache

In any case, a doctor’s visit is advisable.

Psychogenic hyperventilation, on the other hand, is usually acute and the symptoms quickly subside once the person has calmed down and is breathing normally again. Nevertheless, a doctor’s visit is also advisable here, since hyperventilation (especially if it occurs frequently) can have a strong impact and the exact trigger should be clarified. If necessary, a psychologist can also be consulted.

Hyperventilation: what does the doctor do?

Based on the medical history (anamnesis), the doctor can get an idea of ​​how often, in what form and in what context hyperventilation occurs or whether it is permanent. If necessary, further examinations follow, such as a physical examination with listening ( auscultation ) of the lungs or a blood gas analysis (allows, for example, statements to be made about the pH value and the concentration of O 2 and CO 2 as well as free calcium in the blood).

Hyperventilation: Treatment

In the case of physically induced hyperventilation, the actual cause is treated first . In addition, the consequences of the hyperventilation that has often existed for a long time must be treated carefully: For example, in the case of an absolute calcium deficiency, the electrolyte must be carefully replaced artificially.

In the case of psychogenic hyperventilation, it is important to first calm the patient down and make it clear to him that the current problem will not have any lasting physical consequences. When breathing returns to normal, the symptoms of hyperventilation quickly disappear.

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