Resetting the respiratory center

In the article about the respiratory center we saw that it is adaptive. This means that the respiratory center can adjust itself to other acidity levels in the blood. The respiratory center for people with chronic hyperventilation has become hypersensitive to the increase of these acidity levels.

The Dutch neurologist Ph. D. Snitslaar

The Dutch neurologist Ph. D. Snitslaar lived – when he was still young – with his parents on a tropical island. He spent some time as a ‘skin diver’ under water. Initially he could stay under water for a maximum of 30 to 60 seconds. This could be increased to 200 to 250 seconds over the course of several months. Striking was the fact that the usual stuffiness eventually did not occur or hardly at all.

A Greek sponge fisherman, who had practiced his profession in the Bahamas, also told Ph. D. Snitslaar that he and his colleagues had this experience when they were still looking for sponges without diving equipment.

Years later – as a medical student – he learned how to deal with cases of chronic far-reaching ventilatory hypoxemia + hypercapnia. It turned out that treatment with extra oxygen in these cases must take place with much consultation. This is because the respiratory center in the brain has become less susceptible to CO₂. It is mainly the reduced pO₂ that provides the incentive to breathe under these pathological conditions. Apparently, the respiratory center had failed to respond to elevated carbon dioxide levels with an enlarged respiratory stimulus.

Three incidents – during his practice as a neurologist – made Snitslaar think back to the experiences above. These incidents are described in briefly form below.

The hyperventilating girl of 16 years

A 16-year-old girl ended up in the First Aid Department of a metropolitan hospital because of an impressive hyperventilation attack. Phobic fears and frequent severe hyperventilation had plagued her for years. The alarmed young doctor on duty gave her an amount of diazepam by intravenous means. A spontaneous passing respiratory arrest followed and resulted in a strong hypoventilation. That is the opposite of hyperventilation, an extremely slow breathing frequency. This hypoventilation lasted a few minutes. In subsequent checks, the patient turned out to be completely free of hyperventilation and phobic fears. Which was not explainable at that time.

The heroin addict

The second example involved a 45-year-old man who had been addicted to heroin for 20 years. This man had been very anxious and hyperventilating for years. He was admitted to the surgical department of a general hospital for an acute condition and treated surgically. Following the admission and surgery, a heroin-abstinence syndrome developed after a few days. That is why the medical staff began administering Methadone according to a certain schedule.

Shortly after the first administration – following the visit time – they found the patient comatosed and with apnea (= respiratory arrest) in his bed. It turned out that his helpful wife, in addition to the prescribed Methadone, had given him heroin during the afternoon visit. This led to his respiratory arrest. Breathing started again through appropriate measures.

The laboratory research revealed an extreme acidosis (= acidification). It took a lot of effort and time to correct the acidosis. In the months of recovery following the event, the patient’s phobic fears, the need for heroin and the hyperventilation attacks had mysteriously vanished.

The phobic woman

The third case concerned a 34-year-old woman. She suffered from conversion symptoms, severe phobic fears and severe hyperventilation attacks. Once a week – for about 45 to 60 minutes each time – she was treated with ‘Brevital’. These are short – medically induced – sleep sessions. Nothing explained why this woman gradually lost the long-standing and persistent therapy-resistant symptoms in the course of about 3 months. She could fully participate in the daily life activities again. However, the doctors noticed her low breathing frequency and depth during the sessions.

The relationship between chronic hyperventilation and the respiratory center established

Ph. D. Snitslaar correlated the connection between the following:

• The underwater experiences from his early years.
• The warnings and explanations of his teachers regarding oxygen administration to patients with chronic severe ventilatory hypercapnia / hypoxemia.
• The briefly described incidents with the three patients who were found to be cured of long-standing phobic fears and severe hyperventilation.

Ph. D. Snitslaar correlated these facts. This gave him the idea that it could be possible to reset the respiratory center’s sensitivity for carbon dioxide. It could be made less sensitive for this substance in a relatively simple way. The assumption was that this then could then be a physiological, direct and effective treatment of the syndrome of chronic hyperventilation. He considered a number of possibilities. For practical and safety reasons, he eventually developed the HyperVen therapy.

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