Managing Hyperventilation

Symptoms of hyperventilation

Hyperventilation results in two broad categories of symptoms:

In the brain:

Blurred vision
 Feelings of unreality

In the body:

An increase in heartbeat to pump more blood around
Numbness and tingling in the hands and feet
Cold, clammy hands
Stiffness in the muscles
Muscle twitching or cramps
Irregular heartbeats

Hyperventilation can also be responsible for a number of overall effects:

The act of overbreathing is hard physical work, hence, the individual may often feel hot, flushed and sweaty.
Because it is hard work to overbreathe, prolonged periods of overbreathing will often result in tiredness and exhaustion.
People who overbreathe often tend to breathe from their chest rather than from their diaphragm. As the chest muscles are not made for breathing, these muscles tend to become tired and tense. Thus individuals can experience symptoms of chest tightness or even severe chest pains.
Another important point about hyperventilation is that hyperventilation is often not obvious to the observer or even to sufferers themselves. In many cases hyperventilation can be very subtle. This is especially true if the individual has been slightly overbreathing for a long period of time. Mild hyperventilation can cause an individual to remain in a state of perpetual apprehension and anxiety. In this case there can be a marked drop in carbon dioxide, but, because the body is able to compensate for this drop, symptoms may not be produced. This may account for why many sufferers report that "I don't feel as if I'm hyperventilating". However, because carbon dioxide levels are kept low, the body is less able to cope with further decreases and even a slight change of breathing (e.g., a sigh or yawn) can be enough to trigger symptoms.

The present section discusses the prevention and control of hyperventilation. The first step in preventing and controlling hyperventilation is to recognise how and when hyperventilation occurs.
Many people who panic show some signs of hyperventilation. Hyperventilation may act as the initial cue which causes an individual to panic. Alternatively, hyperventilation may also become the way in which the body reacts to a fearful situation (i.e., hyperventilation is part of the panic reaction). The following questionnaire can be used to assess whether hyperventilation is an important part of a particular individual's panic reaction.

Hyperventilation Questionnaire (Ref 1)
1. In general, do you often feel short of breath, as if you are not getting enough air? Yes / No
2. Do you sometimes feel as if you are suffocating? Yes / No
3. Do you experience chest pain, tingling, and prickling and numbness sensations? Yes / No
4. Do you sigh or yawn a lot or take in big gulps of air? Yes / No
5. When you are frightened, do you hold your breath or take very quick and shallow breaths? Yes / No

If the individual answered yes to any of the items in the questionnaire it is likely that hyperventilation plays a part in the panic reaction. It is easily possible, however, that the individual will not be aware of his or her breathing patterns. Therefore, it is important to examine the individual's breathing pattern.

One way to test whether individuals are breathing too fast is to get them to monitor their breathing. Ask them to count how many breaths they take in one minute (where breathing in and then out is counted as one breath). At rest the average person needs to take only 10-12 breaths per minute. If the individual's rate of breathing is greater than 10-12 breaths per minute then the individual may need to learn to reduce his or her breathing rate. It will also be useful to monitor breathing rates at other times, particularly during times of stress, anxiety or worry.

Managing hyperventilation
In order to reduce the symptoms of hyperventilation it will be necessary to increase and steady the level of carbon dioxide in the blood. One way of achieving increased levels of carbon dioxide is by breathing into a paper bag. This method is simple and effective, however, it may not always be convenient or socially appropriate to pull out a paper bag in a public place! Additionally, although breathing into a paper bag is useful during a panic attack, this method does nothing to prevent panic attacks from occurring. An alternative method which is less obvious to other people and which will help the individual reduce habitual overbreathing is the Slow breathing exercise (also detailed below).
If individuals follow this exercise as soon as they notice the first signs of overbreathing, the symptoms should subside within a minute or two and panic attacks will hopefully be avoided. The more frequently individuals practise this slow breathing exercise the better they will become at using slow breathing to prevent anxiety from escalating. Generally, individuals would be advised to practise this exercise at least 4 times each day, taking as much time on each occasion for the breathing routine to feel comfortable (this may take up to half an hour on early occasions). In addition, the individual would be advised to practise the exercise at any other time that he or she notices sensations of anxiety.

Slow Breathing Exercise

(To be practised regularly and at the first signs of anxiety or panic).
1. Hold your breath and count to 5 (do not take a deep breath).
2. When you get to 5, breathe out and say the word relax to yourself in a calm, soothing manner.
3. Breathe in and out slowly through your nose in a six second cycle. Breathe in for three seconds and out for three seconds. This will produce a breathing rate of 10 breaths per minute. Say the word relax to yourself every time you breathe out.
4. At the end of each minute (after 10 breaths) hold your breath again for 5 seconds and then continue breathing using the six second cycle.
5. Continue breathing in this way until all the symptoms of overbreathing have gone.
A small number of individuals report that they get symptoms of anxiety when they first start to use the breathing exercise. These symptoms are probably due to breathing a little too fast or becoming sensitive to breathing patterns when thinking about them. If individuals persevere on each occasion and continue the breathing exercise, the anxiety will eventually diminish.
It may be useful to demonstrate the slow breathing exercise for the individual and then ask the individual to have a turn at practising the exercise. Make sure the individual performs the slow breathing exercise correctly before leaving.
The slow breathing exercise (as well as a number of other useful techniques for managing anxiety) is demonstrated in a CD-ROM available from the publishers (see end papers).

1 Barlow, D.H. & Craske, M.G. (1989). Mastery of your Anxiety and Panic. University of Albany, State University of New York: Albany.