Treatment of chronic hyperventilation

This article was written by Ph. D. B. Snitslaar, neurologist, in the 80’s associated with the Phobias project of the Department of Personality Studies of the sub faculty of Psychology at the University of Amsterdam. Later he was employed by the Common Medical Service, Research and Development department, Research section. Although many medical terms are used in this article, it can still provide good background information. Even if you are not a medical doctor and are interested in more accurate information about chronic hyperventilation syndrome, the medical articles on this site may be of interest to you.

Many cases of chronic hyperventilation are not or insufficiently recognized. Treatment of the chronic hyperventilation syndrome, for example, only focuses on the phobic symptoms with which the patient registers. Depending on the specific skills and beliefs (or lack of them) of the therapist, he or she will apply certain medical treatment, talking therapy or behavioral therapy.

Treatment with medication

Treatment of chronic hyperventilation with drugs usually involves the prescription of anxiolytics from the benzodiazepine group. Of this, the success is variable and often ultimately insufficient. In some patients, imipramine (Trofanil) has an unexpectedly favorable effect, even in relatively low doses (eg 3 times daily 10 mg). The panic attacks occur considerably less frequently and less violently: often after 3-7 days of treatment.

Hyperdynamic-beta-adrenergic state 

Where in patients the hyperdynamic-beta-adrenergic state exists in the context of the syndrome of chronic hyperventilation, a substance such as Inderal appears unequivocally active.

Treatment of chronic hyperventilation with psychotherapy

The result of psychotherapy is limited in our experience and often disappointing. Lege artis performed behavioural therapy seems to benefit the most patients with phobic symptoms. What actually brings about the beneficial effect here is not yet clear. The continuous anticipatory preoccupation for the occurrence of panic / anxiety attacks in the phobic situations can be reduced. As a result, the ventilation level of the person concerned can gradually be brought below a critical threshold value. The development of a respiratory alkalosis is then less easy. This will also break the hyperventilation ->anxiety ->hyperventilation relationship.

Adequate explanation to the patient

Furthermore, adequate explanation to the patient about the phenomena plays a role are of great importance. This significantly improves the treatment of chronic hyperventilation. The doctor should never trivialize the severity of the condition. Through the explanation one gives the sufferer in a certain sense a hold. He or she understands a little more about cause and effect relationships. This reduces the feeling of ‘what could happen’ to the passive and powerless patient.

Re-education of the wrong breathing habits

Several authors have pointed out the beneficial effect of re-education of patients with regard to their wrong breathing habits. Think, for example, of unlearning the frequent deep sighing. Adequate instruction and guidance by an expert physiotherapist may induce the patient to release his (breath-inducing) thoracic breathing in favor of the diaphragmatic (abdominal) breathing type.

Re-education of the respiratory center

The author of this article has positive experience with the re-education of the respiratory center. By learning the respiratory center through disciplined exercises over the course of several months to accept the higher CO₂ levels as normal. As a result, the patient loses his or her excessive sensitivity to CO₂ again. As a result, he or she is less likely to hyperventilate. In addition, the body will also build up HCO₃ buffer again. This leads to a less easy occurrence of the symptoms of respiratory alkalosis. The panic / anxiety states vanish. Also in phobic situations. The anticipatory avoidance behavior is given the opportunity to extinguish. For a detailed explanation of this, see the article on HyperVen therapy.

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