Hyperventilation

• ANATOMY OR SYSTEM AFFECTED: Lungs, respiratory system

DEFINITION: Breathing at a faster rate than what is needed for metabolism, which results in the exhalation of carbon dioxide faster than it is produced.

Causes and Symptoms

Hyperventilation is rapid, deep, or quick shallow breathing, which can result in a dramatic decrease in carbon dioxide levels and an increase in the pH of the blood. While its purpose is to get more oxygen, hyperventilation can result in feeling breathless or dizzy and, in extreme cases, fainting.

As a person hyperventilates, their low carbon dioxide levels can narrow the blood vessels supplying the brain. This further results in a diminished blood supply to the brain, leading to lightheadedness and other symptoms. Many people who are hyperventilating do not realize this is occurring. As this condition persists and becomes more severe, it can result in loss of consciousness.

There are several possible causes or reasons for hyperventilation, including anxiety, panic attacks, depression, anger, overconsumption of caffeine, and agoraphobia—fear of open spaces. Hyperventilation can also be a symptom of an underlying disease process, such as an infection, bleeding, or heart and lung disorder, as well as a response to altitude exposure. Hyperventilation syndrome (HVS) can be manifested either acutely or chronically. Although the causes of hyperventilation syndrome are not completely known, there appear to be linkages with panic disorders. Approximately 50 percent of those who experience panic disorder also suffer from hyperventilation syndrome.

Chronic HVS can cause a variety of physical problems involving respiratory, cardiac, neurologic, or gastrointestinal (GI) systems. Aerophobia, a fear of fresh air, brings on GI problems such as flatulence, bloating, and belching. Besides rapid breathing, hyperventilation can cause a fast pulse, shortness of breath, chest pain or tightening, dry mouth (from mouth breathing), numbness around the lips and hands, and, in more severe cases, blurred vision, seizures, and loss of consciousness. The chest pain resembles typical angina, but does not usually respond to nitroglycerine. Changes in the patient’s electrocardiogram (ECG) are common, including ST-segment elevation or depression, T-wave inversion, or a prolonged QT interval. Patients with mitral valve prolapse are particularly susceptible to HVS. On occasion, hyperventilation can also be manifested with extreme agitation, tingling in the extremities, or painful hand and finger spasms. The chief characteristic of chronic HVS is multiple complaints without supporting physical evidence. Hence, classic hyperventilation is not readily apparent, but frequent sighing may be evidenced, along with chest wall tenderness, numbness, and tingling sensations. To rule out more serious conditions, physicians generally suggest arterial blood gases, toxicology screens, and chest X-rays.

Swimmers and deep-sea divers purposely use hyperventilation to enable prolonged breath-holding. However, this practice has caused many drownings because it can lead to delayed unconsciousness underwater and subsequent death.

Treatment and Therapy

Contrary to popular belief, breathing into a paper bag to slow down respiration and retain carbon dioxide is not a recommended treatment for hyperventilation. This is because of the potential life-threatening aggravation of a more serious medical problem, such as hypoxia, pneumothorax, pulmonary embolism, or a myocardial infarction—also known as a heart attack.

After life-threatening causes of hyperventilation are eliminated, the most successful treatment for hyperventilation is reassurance, discussion of how hyperventilation is causing the patient’s symptoms, and removal of the cause of the anxiety, if possible. Instructions from a respiratory therapist on proper abdominal diaphragmatic breathing are also helpful. A patient who faints should be placed flat on the floor with legs elevated.

Patients with hyperventilation syndrome often breathe primarily with the upper chest, leading to lung hyperinflation and a limited tidal volume that causes shortness of breath. Treatment focuses on diaphragmatic breathing retraining, in which patients are taught to exhale fully and use the diaphragm rather than the chest wall. This reduces lung hyperinflation, slows the respiratory rate, and gives patients a practical technique to manage symptoms and regain a sense of control during hyperventilation episodes. Because of its effectiveness, patients should be referred to qualified specialists—such as physiotherapists, respiratory therapists, or mental health professionals—for guidance and ongoing reinforcement of this technique.

Treatment for HVS may include medications such as benzodiazepines and selective serotonin reuptake inhibitors (SSRIs) to reduce episode frequency and severity. These drugs require long-term management and should be prescribed and monitored by a specialist, rather than used sporadically after an emergency department visit. While benzodiazepines can relieve stress and reset the body’s hyperventilation trigger, prolonged use should be carefully supervised. Additional interventions, including stress reduction therapy, beta blockers, and breathing retraining, have proven to be effective symptom management approaches. Once HVS is diagnosed, patients should be referred to qualified therapists or clinicians to implement these treatments as part of an ongoing care plan.

Prevention may also be an effective way to curtail hyperventilation syndrome. Activities such as breathing, physical exercise, meditation, and yoga may have positive results in forestalling future instances of hyperventilation.

Bibliography

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