Hyperventilation

Hyperventilation is when you move more air through your chest than your body needs. It may be caused by breathing faster than normal (more than 15 breaths a minute), mouth breathing, sighing or yawning frequently.

Your lungs exchange the oxygen in air you breathe in for the carbon-dioxide your body makes. The air you breathe out then has more carbon dioxide gas in it. People who over-breathe (hyperventilate) lose too much carbon dioxide. This causes changes in your body, including to nerve cells, and blood flow to your heart and brain.

Most people know what it feels like to over-breathe for a short time when you’re stressed or frightened, and that’s very easy to spot.

When hyperventilation is chronic (ongoing) or recurrent and comes with symptoms in your body, or anxiety, it is known as hyperventilation syndrome. The normal pattern of breathing often changes from abdominal breathing to upper chest breathing, often through your mouth. This leads to changes in upper chest and neck muscles, which in turn causes pain, tension and headaches. Natural anxiety over symptoms leads to further over-breathing, creating a vicious circle. This new breathing pattern becomes a major stress all by itself. You might not notice you are over breathing. Instead you might notice lots of different symptoms, and you and your healthcare provider might wonder if you have a serious disease.

Hyperventilation syndrome is one of a group of breathing problems called dysfunctional breathing disorders or breathing pattern disorders. 

Hyperventilation can be your body’s way of signalling distress. There are physical, emotional and environmental triggers:

• Anxiety disorder and panic disorder. Many people have both hyperventilation and anxiety. It's not known if one causes the other.
• Depression, bereavement, fear or pain.
• Asthma – a change in breathing patterns separate to the asthma itself.
• Fever.
• Drugs.
• Some vocal cord problems.
• Medical problems of the heart, lungs or kidneys.

Acute hyperventialtion

• Breathlessness – you might feel like you can’t get enough air, or that you're choking or suffocating.
• Dizziness or light-headedness.
• Chest pain or tightness.
• Tingling, often fingers on both sides and sometimes your toes or around your mouth.
• Palpitations – a feeling of your heart racing or pounding.
• Weakness.
• Muscle twitching and cramps in your hands and feet.
• Ringing in your ears.
• Sweating.
• A sense of impending doom – that something terrible is going to happen.
• Anxiety and panic.

These can last for minutes to an hour. Some people faint, but episodes generally get better leaving behind no problems.

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Hyperventilation syndrome

If you have have hyperventilation syndrome you may not be aware of over-breathing. Instead you may notice:

• a feeling of being generally tired and unwell
• neck pain
• headache
• dry mouth
• burping or bloated tummy.

If you are experiencing the symptoms of hyperventilation talk to your healthcare provider. Because some of the symptoms can be caused by serious disease, it’s important to see your GP or nurse practitioner as they may need to rule out other illnesses. They may refer you to a specialist respiratory physiotherapist for further assessment and to help work out possible triggers.

During an episode

The most important treatment is to understand that the feeling of not being able to breathe is a feeling, it's not a sign that you will truly stop breathing or that there is something seriously wrong.

If there's a trigger, or something causing stress, remove it if possible.

Some people find a breathing exercise helps during an episode. Here's an example:

• While lying or sitting, put one hand on your tummy, the other on your chest.
• Notice which one moves the most. This will almost always be the hand on your chest.
• Change your breathing so that the hand on your tummy moves more and the hand on the chest hardly moves at all. It takes practice to get the hang of this.
• Breathe in slowly over 4 seconds, pause for a few seconds, and then breathe out over a period of 8 seconds.
• After 5 to 10 breathing cycles, you should start to feel calmer and notice your breathing improves.

You can find some videos on breathing exercises on the anxiety page.

You might have seen advice to breathe into a brown paper bag. It's best NOT to do this as it's not safe for some causes of hyperventilation.

After an episode

Look for ways to reduce stress. If you have anxiety, that should be treated.

A respiratory physiotherapist can teach breathing pattern retraining and specific ways to relax. You can ask your healthcare provider about a referral, but note that this often needs to be paid for privately.

A structured treatment plan often includes:

• breathing retraining
• upper respiratory health assessment
• postural and upper chest musculoskeletal balancing
• stress recognition
• physical coping strategies
• sleep hygiene
• a graduated fitness regimen/lifestyle appraisal.

It takes up to 6–8 weeks to change your breathing back to normal. For some people, it may take longer. You'll need to work hard at practicing your breathing.

As you learn to breathe well and restore balanced carbon dioxide and oxygen levels, the unpleasant symptoms which come with over-breathing will ease. You can enjoy life again!