What is hyperventilation?
Hyperventilation (hyper - too much, ventilation - breathing) is a condition in which a person experiences abnormal, increased rate and depth of breathing, for a prolonged period. When they begin to breathe too fast and too deeply, they blow off carbon dioxide from the lungs and blood which results in chemical changes which cause a variety of symptoms but most distressing the feeling of acute anxiety.
Hyperventilation is accompanied by various symptoms including dizziness/light headedness, anxiety, feeling of suffocation, numbness or tingling in the toes or fingers, feeling of being detached from the body, heart palpitations, chest pains, dry mouth, clammy hands, difficulty swallowing, tremors, sweating, weakness and fatigue. People may also less commonly experience blurring of vision, headaches and sometimes become unconscious.
An attack of hyperventilation may last between 20 and 30 minutes during which time the patient normally seeks help from the nearest doctor or emergency department. Although scary, hyperventilation due to anxiety is seldom dangerous.
Hyperventilation is usually caused by anxiety or a panic attack, but can be experienced in association with other illnesses for example, severe stomach pains, heart failure, collapsed lung, severe bleeding, a central nervous system disorder, a diabetic emergency and poisons.
Hyperventilation can be prevented by avoiding situations that lead to anxiety. Avoiding stimulants like caffeine and cigarette smoke can also reduce the occurrence of hyperventilation. Regular exercise to relieve stress may also be helpful.
The important thing to recognize is that not all hyperventilation is anxiety related and therefore taking a good history is essential. If the patient has a history of anxiety or anxiety related hyperventilation the diagnosis is easier.
Hyperventilation can be pathological and associated with serious illness so a history of past systemic illness is important.
If you suspect the patient has a cause for hyperventilation other than anxiety, ensure that they get to the nearest Emergency Centre.
The treatment of anxiety related hyperventilation is fairly simple and usually very effective.
Coaching the patient gradually back to breathing normally is effective management once you have established their trust and confidence. Establish a rhythm of breathing by counting out loud and slowly reduce the rate. Once they realise that they are not seriously ill, that realisation will in itself mitigate the anxiety and relax them.
Hyperventilation causes a lower than normal carbon dioxide level in the blood and so "re-breathing" of air can help to restore the balance and improve symptoms. Breathing in and out of a brown paper bag (a bag) four or five times creates rebreathing and the desired effect. Allow the patient to rebreathe air only for short periods until symptoms improve.