On this page you can read the general description of the Chronic Hyperventilation Syndrome and also see the extensive list of symptoms that people - who suffer from CHS - experience. There is also a page with information on how to diagnose CHS.
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The respiratory center in the brain triggers the respiratory muscles in the thorax and abdomen. The frequency is determined by the acidity level of the blood. The acidity level rises and falls due to the amount of carbon dioxide (CO2) in the blood. CO2 is a waste product of the burning process in our organs and muscles. A part of it stays in the blood and the rest is exhaled through the lungs.When the activity of the body increases, for example by increasing the activitiy of the body (like sports), the burning process also increases and more CO2 enters the blood. The acidity level rises, the respiratory center increases it's activity and the result is a higher breathing frequency. This supports more oxygen to be taken up through the lungs into the blood, which is needed for the increased burning process. When we are at rest, the burning process decreases and the amount of CO2 in the blood lowers. This causes the acidity level to lower and the respiratory center reacts with a reduced breathing frequency.
When the breathing frequency is higher then is actually needed, a situation develops which is called a CO2-shortage: respiratory alkalosis, in common language: hyperventilation (see causes). Everybody hyperventilates if the circumstances are right; it is a normal reaction of the body to danger or excitement: the body is being prepared for action, like fleeing or fighting (so more oxygen is needed). The temporary loss of CO2-is compensated by CO2 buffers in the bodily fluids. More then a little dizziness or tingling sensations are all you might notice. As soon as the cause of the hyperventilation is gone, the buffers are replenished.
In situations of maintained stress or anxiety a person keeps hyperventilating and a situation can develop where the CO2 buffers are depleted. The blood becomes alkaline (the opposite of acid). In this condition two specific effects can be noted: 1. the blood vessels narrow; 2. the red blood cells are unable to release their oxygen properly to the surrounding tissue. The blood vessels can narrow so extreme, the blood supply to the brain can be decreased by a mere 30 to 40%! This leads to an oxygen shortage in the brain, causing an impact in the main functions: blurry vision, sounds appear as coming from the distance, lack of concentration, inability to think clearly, a sense of loosing consciousness. The alkaline blood starts to cause a variety of symptoms.
The problem escalates if the alkaline condition is maintained too long. The respiratory center starts to react as if the reduced acidity level of the blood is the normal situation! Now even with a small increase of the CO2-level, the respiratory center increases it's activity resulting in a breathing frequency that is too high for the acidity level in the blood! The body stays in an alkaline condition and maintains the hyperventilation automatically! The condition has become chronic. The only way to reverse this is to "force" the respiratory center to accept a higher acidity level again (see treatment).
The changing pH-level (acidity) in the body has a number of unwanted effects. It has an impact on the autonomous nervous system (see description) and the red blood cells are unable to release their oxygen to the surrounding tissues. On top of that the cells in the body start to produce lactic acid in an attempt to restore the pH-level in the blood. All these changes cause muscle ache, an altered metabolism, exhaustion, depression, a raised release of histamines and subsequent allergic reactions, elevated pulse, panic en closeness. The processes in the body start to change due to the alkaline environment.
Just like other disorders, not every patient shows the same amount or intensity of the symptoms. But the following list of effects are usually present without exception:
These symptoms often come up in certain situations and cause subsequent phobic fears. Some patients wake up in the middle of the night and others experience them when sitting quietly in front of the television after a hard days work. The majority of people experience these symptoms when they are standing in a queue in the supermarket, in a full bus or in a train, in elevators, tunnels or busy cinemas or theatres.
The physician can, besides determining the patients symptoms, perform a variety of tests to determine whether hyperventilation is the cause. Unfortunately most physicians are not aware that these tests can be used for diagnosing the hyperventilation syndrome. Typical tests are blood work, urine test, Electromyography (EMG), Electroencephalography (EEG) en Capnographical tests see test results).
People that report in to their physician with some kind of phobic fear, often appear to be suffering from chronic hyperventilation. Most people that suffer from hyperventilation have one or more phobic fears. Sometimes they have extreme hypochondriac fears (fear of have some sort of terrible disease). These fears manifest themselves usually directly after the first big hyperventilation attack.
Usually the patients are not able to clearly present the doctor their symptoms, they show nervous behavior, and are clearly struggling to tell their doctor what's wrong with them. This is probably due to the impact of hyperventilation on the functions of the central brain. (see description). Doctors usually also lack insight in the background of the patients psycho-social situation. The unusually alarmed patients on the one hand, and the "not being able to find anything" on the other hand, makes it virtually impossible for the doctor to come up with the right diagnosis. The doctor might want to make assure the patient by telling him "there is nothing wrong", or "it is probably nerves", or "a little bit of strain". The patient often feels being accused of affectation and bothering the physician for "nothing real". Some patients even feel accused by their doctor of being lazy or trying to get a social benefit. But the patients concerns regarding the illness increases, which causes an even bigger demand on the medical facilities. The physician will be strengthened in his believe that this patient might be faking an illness. A long, frustrating road lies ahead for both doctor and patient.
A person trained in detecting the typical symptoms of hyperventilation, can spot a patient with this illness quickly. A well known method is to have the patient breath less then 12 times per minute. With people that suffer from hyperventilation this usually is already enough to bring up the symptoms. The relationship between the symptoms and their breathing is then established. An other method is to try and hold the breath as long as possible. People suffering from hyperventilation usually can only hold their breath for a very short time, usually significantly less then 1 minute.