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Hyperventilation: Causes, Mechanisms, and Therapy

Updated: Sep 9



Hyperventilation is an unphysiological, deepened, and accelerated breathing pattern that leads to a reduction in the carbon dioxide content in the lung alveoli and blood. It can occur both acutely and chronically.


This text was created as a final presentation for the "Medical Basics" training course. I note that I have no medical training, and despite careful research, this text does not claim to be fully accurate. It must not be used for diagnosis or therapy.


Causes of Hyperventilation

Hyperventilation can be triggered by various factors, including:

  • Lung diseases

  • Traumatic brain injury

  • Stroke

  • Stress and anxiety


Mechanism

The depth and frequency of our breathing are unconsciously regulated by the autonomic nervous system. This regulation is based on measuring the carbon dioxide (CO2) level in the blood, not the oxygen level. If this regulation is disrupted by one of the causes mentioned above, a person breathes more than necessary. As a result, excessive CO2 is exhaled, and the body’s CO2 level decreases.


Role of CO2

Carbon dioxide is often considered a waste product, yet it plays a central role in regulating breathing. The mechanism is complex:

For example, when a muscle requires more energy for its work, the carbon dioxide present in the muscle “orders” more oxygen through the autonomic nervous system. It is, so to speak, a delivery on demand. In the lungs, oxygen is bound to hemoglobin and transported to the muscle via the bloodstream. There, CO2 acts as a “divorce lawyer,” separating the O2 molecule from hemoglobin. If too much CO2 is exhaled due to rapid, deep breathing, there is insufficient CO2 to release the oxygen. Consequently, oxygen does not reach the muscle, impairing oxygen supply.


Symptoms of Hyperventilation

  • Increased breathing frequency: This leads to the constriction of blood vessels, which can cause dizziness or panic sensations.

  • Tetany: A decrease in blood CO2 levels increases the pH value (the blood becomes alkaline), leading to hypocalcemia (reduced calcium levels). This makes muscles excitable, resulting in cramps known as tetany (“claw hand” position of the hands, “pointed foot” position of the feet).

  • Limbic system response: The limbic system in the brain interprets the altered pH value as a life-threatening condition, triggering anxiety.


Therapy

For physiologically caused hyperventilation

The underlying cause (e.g., lung disease or trauma) must be addressed.


For psychogenic hyperventilation

  • Calm the patient.

  • Promote rebreathing, e.g., using a plastic bag. The exhaled air contains little oxygen but sufficient CO2. Re-inhaling this air can restore the CO2 level in the blood and rebalance the system.


For chronic hyperventilation

  • Consciously breathe through the nose with the mouth closed.

  • Learn to breathe slower and less.

  • Learn to exhale fully.

  • Strengthen respiratory muscles (diaphragm, intercostal muscles) through breathing exercises.

  • Intentionally stress the body through controlled hyperventilation.


Hyperventilation as Therapy

All breathing methods that induce hyperventilation (e.g., Holotropic Breathing, Tummo Breathing, the derived Wim Hof Method, Kapalabhati Breathing, or other breathwork techniques) fundamentally place the body in a hyperventilation state. The constricted blood vessels in the brain and the limbic system’s response put the body under stress. This can lead to altered states of consciousness, which are the desired outcome in some breathwork methods. Other methods assume that moderately inducing hyperventilation stress enhances the body’s resilience.



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