Hyperventilation Syndrome - Treatment

Treatment of hyperventilation syndrome should be comprehensive. Correction of mental disorders is carried out using psychotherapeutic influence. Of great importance is the "reconstruction" of the internal picture of the disease, demonstration (this is easily done using hyperventilation provocations) to the patient of the connection between clinical manifestations and respiratory dysfunction. The impact on the neurophysiological and neurochemical bases of the mechanisms of hyperventilation syndrome is realized by prescribing psychotropic, vegetotropic drugs and drugs that reduce neuromuscular excitability.

As means of reducing neuromuscular excitability, drugs regulating calcium metabolism and magnesium metabolism are prescribed. The most commonly used are ergocalficerol (vitamin D2) at a dose of 20,000-40,000 IU per day enterally for 1-2 months, calcium gluconate, calcium chloride. Other calcium preparations (tachystin, AT-10) and preparations containing magnesium (magnesium lactate, potassium and magnesium aspartate, etc.) can also be used.

One of the leading methods, and in most cases the main method of therapy for both hyperventilation syndrome and psychogenic dyspnea and psychogenic (habitual) cough is the use of various techniques of respiratory "re-education" in order to form a normal, physiological breathing pattern. The use of the respiratory regulation techniques listed below is indicated not only for disorders of the respiratory system, but also in the presence of broader signs of instability of the mental and vegetative spheres, i.e., in various manifestations of psychovegetative syndrome.

The specialized literature reflects the experience accumulated over more than 2000 years of using the Indian system of hatha yoga and raja yoga. However, it is believed that for patients with hyperventilation syndrome and vegetative dysfunction, those strict and sometimes categorical recommendations on breathing that have been widely advertised recently, but do not always have sufficient physiological justification, are unjustified.

In this regard, we have outlined here the basic principles of breathing exercises, as well as the specific technique for performing them. In our opinion, the application of these principles allows for a combination of sufficient focus in the patient's breathing exercises with simultaneous flexibility in developing certain breathing skills. This also leads to the establishment of an adequate breathing pattern, taking into account not only the needs of the body, but also the optimal energy expenditure on breathing work.

The first principle of breathing exercises is an attempt to gradually include, and if possible even switch to diaphragmatic (abdominal) breathing. The effectiveness of the latter is due to the fact that diaphragmatic breathing causes a pronounced Hering-Breuer reflex (an "inhibitory" reflex associated with the inclusion of receptors for stretching in the lungs), leads to a decrease in the activity of the reticular formation of the brainstem, a decrease in the activity of the neocortex and stabilization of mental processes. In addition, it was found that in situations accompanied by negative emotions, chest breathing prevailed, and in those accompanied by positive emotions, diaphragmatic breathing prevailed.

The second principle that should be implemented when conducting breathing exercises is the formation of certain ratios between the duration of inhalation and exhalation - 1: 2, respectively. Such ratios are the most favorable and, apparently, correspond to a greater degree to a state of relaxation and peace. In our studies of the time parameters of breathing patterns, a clear tendency was found in patients with hyperventilation syndrome to shorten the exhalation phase, and such a tendency increased sharply when modeling negative emotional effects.

The third principle is an attempt to slow down and/or deepen breathing. Formation of a slow breathing pattern has a number of advantages in the sense that it optimizes the process of intrapulmonary diffusion.

Establishing a slow breathing pattern is certainly beneficial from the point of view of “destroying” the pathological hyperventilation, most often rapid, breathing pattern.

The fourth principle of breathing exercises for hyperventilation syndrome, which is of great importance for its success, is the use of a certain psychological regulation. In the pathological breathing pattern of patients, a close connection between the feeling of anxiety and increased breathing acts as a core formation. Any breathing exercises, especially at the initial stage of classes, are perceived by patients as a bodily feeling of anxiety, worry. Breathing exercises in themselves are ineffective if they concern only the physiological part of the breathing pattern. Therefore, the emergence of a new adequate breathing pattern should occur against the background of constant "absorption" of emotionally stable positively colored states during exercises.

Such stabilization of the mental sphere can be caused by both feedback mechanisms (as a result of the breathing exercises described above) and an increase in the level of subjective control over bodily functions - control, the feeling of which was lost during the manifestation of hyperventilation syndrome. Psychological stabilization is also facilitated by psychotherapeutic measures of various natures (including methods of autogenic training), as well as psychopharmacological agents.

Such complex effects in hyperventilation syndrome ultimately lead to mental and respiratory stabilization. Frequent breathing exercises, initially lasting several minutes and then quite long, tend to modify the pathological psychophysiological breathing pattern with the formation of a new one, which is gradually included in a wider complex of mechanisms of the patient's corrected behavior.

One of the extremely effective methods of treating patients with hyperventilation syndrome is the use of biological feedback (BFB) techniques. The advantage of this method compared to breathing exercises is that the patient is able to control his actions; this significantly accelerates the process of forming a new breathing pattern and normalizing his condition. The BFB variant we used with coupled motor accompaniment (hand movement simultaneously with the breathing cycle) allows for a relatively short time (7-10 sessions) to significantly correct the respiratory function in hyperventilation syndrome.

In addition to the indicated treatment methods, pathogenetic or symptomatic therapy is prescribed depending on the indications.

Thus, the treatment of hyperventilation syndrome should be comprehensive, multidimensional, taking into account the leading links of pathogenesis.

We present specific technical methods for performing breathing exercises in patients with hyperventilation syndrome and other manifestations of autonomic dysfunction (autonomic paroxysms, neurogenic fainting, migraine and muscle-tonic cephalgia, cardialgia, abdominalgia, etc.).

Necessary conditions: there should be no noise in the room; the air temperature should be comfortable for the body. The room should be ventilated beforehand. Clothes should be loose and not restrict movement. If possible, you should exercise at the same time, preferably early in the morning or just before bedtime. Before exercising, you should empty your bladder and bowels. Exercise should be started 2-3 hours after eating; drinking a glass of water before the beginning of the exercise is allowed. It is forbidden to do breathing exercises after prolonged exposure to the sun or after heavy physical work: in these cases, exercises are only possible after 6-8 hours.

Contraindications to breathing exercises: severe diseases of the heart, blood vessels, lungs, abdominal organs; severe cerebral atherosclerosis, hypertension, blood diseases, mental (psychiatric), infectious, colds, menstruation, pregnancy. An important contraindication is glaucoma.

Technique of execution

1. Take a horizontal position on your back, close your eyes (if it is light, put a special bandage or towel on your eyes) and try to relax as much as possible mentally and physically for 5-7 minutes. You can use autogenic training techniques, causing a feeling of warmth and heaviness in your limbs.
2. Breathing begins with a normal full exhalation. Inhalation is done slowly, with the abdominal wall bulging outward (and not vice versa!). At this time, the lower part of the lungs is filled with air. The chest expands at the same time (the middle lobes of the lungs are filled with air). It is important to emphasize that the abdominal component should predominate in the duration of inhalation. Exhalation: first, the stomach slowly descends, and then the chest narrows. Exhalation, as well as inhalation, should be smooth and even.
3. During breathing, you should constantly make (to yourself) a light internal guttural sound, which is necessary to control the duration and regularity of breathing movements.
4. During the exercises, bring all breathing phases to approximately 90% of the maximum possible to avoid stretching the lung tissue.
5. It is necessary, especially in the initial periods (weeks, months) of training, to keep a constant mental count of the duration of each inhalation and exhalation. You can mark the number of completed breathing cycles by slightly bending your fingers.
6. Start with 4 s of inhalation and 8 s of exhalation; perform 10-15 cycles in this way, taking into account the above recommendations. If there is no shortness of breath, general tension, excitement, anxiety, dizziness, severe fatigue, then the duration of the breathing phases should not be reduced; if such sensations appear with the specified parameters, you should switch to the 3:6 mode. Subsequently, gradually increase the duration of inhalation and exhalation, observing their ratio of 1: 2. After the initial conditions have been selected (they can be 5-10 or 6-12 s), they must be adhered to for a month so that the body gets used to the new breathing exercise regime. The number of initial cycles should not exceed 20 per day. After a month, you can begin to add one breathing cycle every 3-5 days up to 40-50 cycles. Subsequently, after 1-2 months, you should gradually lengthen the time of one cycle, observing the specified ratios. The duration of the cycle increases at the rate of 1 sec for inhalation (and correspondingly 2 sec for exhalation) over 2 weeks. The longest duration of the cycle is one breath per 1.5 min (i.e. inhalation - 30 sec, exhalation - 60 sec). Further prolongation of the cycle time in patients with autonomic dysfunction and even in healthy people without training with a specialist is inappropriate. 7. If breathing exercises are performed correctly, there should be no palpitations, shortness of breath, yawning, dizziness, headache, numbness in the fingers and toes, or muscle tension. At the beginning of the exercises, some patients may feel heartbeats; this sensation passes with time. Correct performance of the exercises causes after a certain time a feeling of inner comfort and peace, drowsiness, a pleasant feeling of "immersion", etc.

When mastering breathing exercises, it is prohibited to consume tobacco, alcohol, and drugs that stimulate mental activity.

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