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What Causes Chronic Persistent Hyperventilation & What You Can Do About It - Part 1

In my work teaching stress resilience skills to clients, I commonly encounter over-breathing or hyperventilation. It's not something surprising to me – over-breathing seems to be a reflex-like part of the stress response. While the stress response is (in theory, at least) adaptive, over-breathing can have quite strong negative impacts on brain performance and emotional well-being.

Sometimes over-breathing is a relatively short-term, context-specific response. Classic panic attacks typically involve acute and extreme hyperventilation. But often hyperventilation is chronic, or in other words an ingrained habit which the body has adapted to. It can also be quite mild. In that case you might have no awareness that you are in fact over-breathing.

As part of my Stress Resilient Mind Programme I teach clients optimal breathing skills, and it very often proves dramatically beneficial in calming down anxiety. But not always. Sometimes the breathing remains stubbornly dysregulated, as reflected in persistently low carbon dioxide readings measured by the capnometer, which is the biofeedback device I use to train optimal breathing. Another pattern I've noticed is that can achieve improvements in breathing but not lasting change - at the next session they are back at square one.

I've noticed this scenario (of persistent low CO2, or hypocapnia) seems to be particularly likely in clients who are more generally unwell, besides being stressed, for example in those complaining of chronic fatigue.

What could be going on in this client population, to cause them to get stuck at chronically low CO2 levels, and what might we do about it?

I wrote a series of articles to address these two questions.

My thought has been that there's something going on that is more organically rooted (rather than “merely” psychological or stress-related). For that reason, we're going to delve more deeply into the science of breathing regulation. things do get a little technical at times, but I'll try to keep things as simple as possible, and I'll give regular summaries. Along the way, we'll venture into cellular energy production (energy metabolism) and even into the body's regulation of acid-alkali balance, or acid-base balance, which is a notoriously complex topic.

My account is based on (my understanding of) established and mainstream physiology, though I do get speculative at times. Knowing general principles of physiology is one thing but trying to work out what's happening for any given individual is another. So I'll try to make clear when I'm speculating.

Let me be clear and open from the outset - when it comes to the question of what you can do about chronic persistent hyperventilation, I can't offer too much in the way of hope. I don't think there are any easy answers. But I do have something to say about what you might do, and that will come in part four. We need to start with an understanding of causal factors, as far as we can.

Two Initial Hypotheses

In answer to the first question of what might cause chronic over-breathing, as evidenced by stubbornly low carbon dioxide levels, I'm going to present two possible causal accounts. Both are plausible and might be at play in any given individual. If we can determine which one applies, then this might open up possibilities for solutions. In practice things usually aren't clear-cut and the truth might be some combination of both accounts.

Hypothesis 1: Stress is the Primary Cause

The first account, in summary, is this: stress is the original cause of over-breathing. Perhaps because the stress is persistent in nature, over-breathing becomes ingrained. In the slightly longer term, the body is forced to adapt to the new level of CO2, but this adaptation, while necessary, has negative consequences, turning the over-breathing into an entrenched problem.

Hypnothesis 2: Non-optimal Energy Metabolism is the Primary Cause

The second account goes like this:

An underlying problem with cellular energy production interferes with the body's acid-alkali balance. The increased breathing is actually a compensation that returns the body to balance, but in a far-from-ideal way. Over-breathing is not the problem at all but an adaptive response, that masks a deeper problem.

Coming Up In This Series

The rest of this article sequence is going to be a fuller exploration of these two accounts, and of how to know which one applies to you, assuming you have this pattern of persistently low carbon dioxide as measured by the capnometer.

We'll also begin to look at what you might do about it, in either case.

In part 2 we'll cover the basics of acid-alkali physiology. It's a complex topic but I'll simplify it as much as I can so that you get a sense of the important elements from a practical point of view.

Just a word of warning here. When it comes to acid-alkali balance in the body there's quite a bit of dubious content out there on the internet, so be very careful with what you read. In the end notes I'll give some references that I trust.

With this grounding in acid-alkali physiology, we'll be in a position to go more fully into the two possible causal accounts of why carbon dioxide in the breath can be consistently low. This is what we'll do in part 3. And that will entail a look at cellular energy production.

Then in the final article we'll turn to the question of how to know which of the two causal accounts applies in you, should you have chronically low carbon dioxide, and then perhaps more importantly, what you can do about it.

We'll investigate how to measure the acid-alkali balance in the body, or at least how to get an idea of what can be measured, because the truth is, it's very difficult to directly measure pH in any of the three body compartments – but you can get clues about what might be going on.

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