Hyperventilation

and Carola Felchner, science journalist

Marian Grosser studied human medicine in Munich. In addition, the doctor, who was interested in many things, dared to make some exciting detours: studying philosophy and art history, working on the radio and, finally, also for a Netdoctor.

More about the experts

Carola Felchner is a freelance writer in the medical department and a certified training and nutrition advisor. She worked for various specialist magazines and online portals before becoming a freelance journalist in 2015. Before starting her internship, she studied translation and interpreting in Kempten and Munich.

More about the experts All content is checked by medical journalists.

Doctors speak of hyperventilation when someone breathes excessively quickly and deeply. In the film, hyperventilation is a popular means of showing people under severe psychological stress: those affected suddenly begin to puff frantically, turn pale, and finally someone rushes up with a plastic bag into which the afflicted should breathe out and breathe in. In fact, acute hyperventilation can occur under great psychological tension. The symptom can also be chronic. And the psyche is not always to blame. Read everything important about "hyperventilation" and why the plastic bag is definitely justified in many cases.

Brief 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 area, cold hands and feet, cramping hands, "constricted" throat, dizziness, drowsiness, visual disturbances, feeling of pressure in the heart area
• Causes: e.g. intense tension, depressive states, pain, inflammation of the brain or tumors, stroke, traumatic brain injury, poisoning, infections, severe diarrhea, metabolic disorders
• When to the doctor in general, but especially with chronic hyperventilation
• Therapy: depends on the cause
• First aid: breathe into the diaphragm, breathe in a plastic or paper bag, do relaxation exercises

Hyperventilation: description

Hyperventilation describes excessive ("hyper") ventilation of the lungs. That sounds strange at first, but it can happen when breathing accelerates and deepens at the same time.

The lungs are responsible for the vital gas exchange of the blood. It supplies it with fresh oxygen and in return the carbon dioxide (CO2) produced by cellular respiration is exhaled through the lungs. With hyperventilating, breathing becomes faster, but at the same time the breaths become deeper. Since the blood is almost 100 percent saturated with oxygen during normal breathing, the body is no longer supplied with additional oxygen through hyperventilating. The concentration of CO2 in the blood is getting lower and lower, the so-called partial pressure of carbon dioxide (CO2) in the lungs and in the blood circulating there decreases. This shifts the pH value of the blood into the alkaline (basic) range:

Under normal circumstances, the resulting CO2 dissolves in the blood and is there bound as carbonic acid. As the name suggests, this has an acidic effect on the pH value in the blood. When the CO2 and thus the carbonic acid content decrease, the blood becomes alkaline: the pH value of the blood rises (it should actually be around 7.4). The resulting condition is called "respiratory alkalosis". In fact, a decreasing CO2 partial pressure automatically reduces breathing activity via an unconscious reflex; in 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 be a disadvantage. This is also the case in the case of hyperventilation with regard to cerebral blood flow:

If there is an increased concentration of CO2 in the blood, this is usually associated with a decreased oxygen content. Special receptors on the paired carotid artery and the aorta (main artery) are able to measure the CO2 level in the blood and report to the brain where the signal is being processed. If the CO2 concentration is high, the brain concludes that the oxygen content is low and therefore causes the blood vessels in the brain to widen so that it is better supplied with blood and thus receives more oxygen. The mechanism itself makes sense because it ensures an adequate supply of oxygen to the thinking organ, even if less oxygen is dissolved in the blood.

Conversely, however, the problem arises that the blood supply vessels are made narrower as soon as the CO2 content in the blood drops, which is the case with hyperventilation. Especially in the case of chronic hyperventilating, this can lead to a slight undersupply of the brain and thus to symptoms such as dizziness, drowsiness and visual disturbances.

Hyperventilation: symptoms

Hyperventilation, which is primarily of psychological 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
• Racing heart
• Tremble
• Visual disturbances
• shortness of breath
• Chest tightness
• sudden dry cough

In the case of psychologically conditioned 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.

Real hyperventilation must be differentiated from accelerated breathing, with which the body tries to compensate for an insufficient supply of oxygen or an excessive attack of CO2. More on this in the chapter: "Hyperventilation: Causes and Possible Diseases".

Tetany from hyperventilation

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

Due to the alkalization of the blood as described, some proteins in the blood give off protons (positively charged ions). The now negatively charged proteins can in turn "intercept" the doubly positive calcium ions (Ca2 +), which swim freely in the blood, and thus cause a relative calcium deficiency. This means that the total calcium content in the body is not reduced, but the free calcium ions, which are important for many physiological tasks, are reduced. As a result, muscle cramps can occur, which often first appear in the hand (“paw position”) or around the mouth (“carp mouth”).

Hyperventilation: you can do it yourself

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

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

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

Relaxation exercises: Those who frequently suffer from stressful situations should learn relaxation techniques (progressive muscle relaxation, autogenic training, etc.). With these techniques, dealing with acute stressful situations can be more successful.

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 of hyperventilation. In many cases, the psyche plays a trick on those affected. Sometimes the deeper, faster breathing also has physical (physical) reasons.

Psychological causes

Common triggers of psychogenic hyperventilation are:

• strong tension
• Nervousness, excitement
• fury
• Anxiety or panic attacks
• depressed states

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

Physical causes

Physical disorders that can trigger hyperventilation include:

• Inflammation of the brain (encephalitis): In addition to many other symptoms such as fever, headache, paralysis, visual disturbances, etc., it can also trigger hyperventilation (due to a disruption of the respiratory center).
• Brain tumors: Similar to encephalitis, they can also sometimes speed up and deepen breathing.
• 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. In contrast to pure hyperventilation, however, this is an attempt by the body to prevent over-acidification of the blood caused by a different cause by lowering the carbon dioxide content - for example in:

• Poisoning
• severe infections or blood poisoning (sepsis)
• extreme diarrhea
• severe metabolic imbalances such as derailed diabetes mellitus or metabolic syndrome

Another type of “not real” hyperventilation, which can show symptoms similar to these, is intensive breathing in response to a general lack of oxygen in the tissue. This can, for example, be the result of a weak heart (heart failure) or occur in connection with a pulmonary embolism and other lung diseases with gas exchange disorders. People who go to high altitudes without sufficient time to adapt can also begin to hyperventilate.

Hyperventilation: when do you need to see a doctor?

With physical causes, hyperventilation is often chronic and can lead to other symptoms, such as

• Air swallowing with subsequent flatulence
• frequent urination
• Heart problems and a tendency to cramp due to an absolute lack of calcium
• severe headache

In any case, a visit to the doctor is advisable.

Psychogenic hyperventilation, on the other hand, is usually acute, and the symptoms quickly subside as soon as the person concerned calms down a little and breathes normally again. Nevertheless, a visit to a doctor is advisable here, as hyperventilation (especially if it occurs more frequently) can severely impair you and the exact trigger should be clarified. If necessary, a psychologist can also be called in.

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 can be carried out, such as a physical examination with listening (auscultation) of the lungs or a blood gas analysis (for example, this enables statements to be made about the pH value and the concentration of O2 and CO2 as well as free calcium in the blood).

Hyperventilation: treatment

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

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.

Tags:  laboratory values Diseases magazine