Hyperventilation refers to repeated episodes of excess breathing in response to anxiety or fear. It is one of the most commonly encountered diagnoses in general clinical medicine. Hyperventilation is also known as rapid, deep breathing or over-breathing. Healthy breathing occurs with a healthy balance between breathing in oxygen and breathing out carbon dioxide. In hyperventilation, this balance is disturbed by exhaling more than inhaling, resulting in rapidly decreased carbon dioxide levels in the body.

Low carbon dioxide levels result in narrowing blood vessels that supply blood to the brain. As a result, loss of consciousness can occur due to severe hyperventilation.

In a few cases, hyperventilation occurs very rarely. It happens only on occasion, panic response to fear or stress.

In other cases, this condition occurs due to emotional disorders such as depression, anxiety, or anger. When hyperventilation occurs frequently, then it is known as hyperventilation syndrome.

Hyperventilation has rapid physiological effects on pH levels and reduction in the level of CO2 in the body resulting in respiratory alkalosis (disturbance in the acid-base balance due to alveolar hyperventilation).

What Are the Common Causes of Hyperventilation?

The most common causes of hyperventilation are fear or panic attacks. Other factors include anxiety, stress and nervousness, and pulmonary and cardiac conditions.

Cardiac and Pulmonary Causes of Hyperventilation:

Asthma and allergies.
Myocardial infarction (heart attack).
Congestive heart failure (inability of the heart to pump blood).
Pneumonia.
Pulmonary embolism (blood clot in the lung).
Chronic obstructive lung disease (COPD includes chronic bronchitis and emphysema).
Bleeding.

Psychological Causes of Hyperventilation:

Hyperventilation is the symptom of psychological disturbances.

These include:

What Are the Risk Factors of Hyperventilation?

Several factors increase the risk of developing hyperventilation. Risk factors include:

Family history of anxiety.
Certain medications such as stimulants.
Stress.
Personal history of anxiety or panic attacks.

What Are the Steps Involved in Reducing the Risk of Hyperventilation?

Practicing relaxation techniques.
Engaging in routine physical activities.
Learning breathing techniques.
Gaining support from family and friends.

What Are the Symptoms of Hyperventilation?

The symptoms of hyperventilation can last from 20 to 30 minutes. The symptoms include:

Rapid or deep breathing for the first time.
Fever.
Pain.
Bleeding.
Pounding and racing heartbeat.
Numbness or tingling in the hands, feet, or around the mouth.
Chest tightness, fullness, pressure, tenderness, or pain.
Vertigo - problem with the balance.
Lightheadedness.
Frequent sighing or yawning.

What Is Hyperventilation Syndrome?

Sudden and regular are the two forms of hyperventilation syndrome. In its everyday form, over-breathing may be hard to detect. The sudden condition occurs rapidly and has more intense symptoms. People with this syndrome may experience stomach, nervous system, chest, and emotional complaints.

Chemical changes can happen with over-breathing. These chemical changes cause the carbon dioxide level in the blood to decrease. This low level of carbon dioxide reduces blood flow to the brain, resulting in following nervous and emotional symptoms like weakness, fainting, dizziness, confusion, agitation, and feeling unable to breathe.

Many different factors can cause chest symptoms with hyperventilation syndrome. Usually, breathing is in a relaxed manner. If a person over-breaths, the lungs become overinflated. Unknowingly, a person may use the chest muscles to expand the rib cage. This muscle strain feels like shortness of breath, and a person will have difficulty taking deep breaths. The chest muscles become tired. The lowered carbon dioxide levels in the blood can cause squeezing of airways, resulting in wheezing. The chest symptoms include chest pain or tenderness, wheezing, and shortness of breath.

What Are the Potential Complications of Hyperventilation?

Due to the imbalance in oxygen and carbon dioxide levels, the complications of hyperventilation can be very severe, resulting in life-threatening conditions. The complications are:

Loss of consciousness.
Panic attacks.
Inability to participate generally in activities.
Restlessness.

How to Diagnose Hyperventilation?

Blood tests to evaluate oxygen and carbon dioxide levels in the blood.
Computed tomography (CT) scan of the chest helps rule out any lung changes, mainly in case of infection.
Electrocardiogram (ECG) to check the electrical activity of the heart.
Ventilation or perfusion scan of lungs helps to measure breathing and lung circulation.
Chest X-ray helps diagnose some causes of hyperventilation, such as infections.
An arterial blood gas test measures the amount of oxygen and carbon dioxide in the blood. This test determines if hyperventilation has lowered carbon dioxide in the blood.

How to Treat Hyperventilation?

1) Primary Steps to Follow: The primary step is to stay calm in acute cases of hyperventilation. The goal is to increase the level of carbon dioxide in the body and slow the breathing rate. Patient education and behavior modification are necessary for treating hyperventilation and preventing recurrence.

2) Homecare: Following are the techniques to help treat acute hyperventilation:

Breathe through pursed lips.
Attempt to breathe into the belly rather than the chest.
By holding breath for 10 to 15 seconds at a time.
Try alternate nostril breathing - with mouth covered, close the right nostril and breathe in through the left, then alternatively by closing the left nostril and breathing through the right.

3) Acupuncture: Acupuncture is also an effective method for treating hyperventilation syndrome. It involves placing thin needles into areas of the body to help heal. In addition, it aids in reducing anxiety and treating the severity of hyperventilation.

4) Medication: Depending on the severity and the underlying conditions, medications are prescribed.

Anxiolytics are drugs used to treat anxiety.
Antidepressants help treat hyperventilation associated with stress.
Selective serotonin reuptake inhibitors (SSRI).
Benzodiazepines are helpful in the treatment of hyperventilation resulting from anxiety and panic attacks. Benzodiazepines are effective in reducing the stress that provokes hyperventilation.
Alprazolam helps in treating anxiety and management of panic attacks.
Lorazepam is a sedative hypnotic benzodiazepine group. Enhancing gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, depresses all central nervous system (CNS) levels, including the limbic area and reticular formation.
Diazepam depresses all levels of the central nervous system, possibly by increasing the activity of gamma-aminobutyric acid.
Clomipramine is one of the most important foods that help treat hyperventilation, panic attack, and anxiety.

Conclusion:

Hyperventilation is a treatable condition with treating underlying problems. An interprofessional team approach is necessary to gain positive outcomes. The prognosis of hyperventilation is generally reasonable. Treating underlying root causes and lifestyle modifications aids in the better prognosis and management of hyperventilation.