The Stress Resilient Mind Blog
What Causes Chronic Hypverventilation & What You Can Do About It
PART 4: What You Can Do
This article is the fourth and final part of a series exploring the questions of what might be causing chronic and resistant over-breathing or hyperventilation (showing up as stubbornly low carbon dioxide readings from a capnometer) and secondly what we might do to address such problems. The articles are aimed primarily at people experiencing such issues, but I hope they'll be relevant to health practitioners too.
In part 1 I gave an introduction to the topic. Then in part 2 I presented some important background physiology relevant to breathing regulation, specifically acid-alkali (or acid-base) balance and regulation. This gave us the basis for exploring in some depth, in part 3, two possible causal accounts for persistent hyperventilation or over-breathing. Summarising these two narratives:
- The first is that chronic hyperventilation is truly a breathing dysregulation: over-breathing, probably related to stress, has become a persistent pattern and the bicarbonate buffering system has been forced to compensate in order to bring the blood pH back to balance. Breathing regulation and bicarbonate buffering aren't working together, but in a sense against each other. The result is a non-optimal state of functioning.
- The second account says the problem is not really a breathing issue at all. The regulatory systems are working to counter an underlying problem of a different nature. Problems with cellular energy production have lead to excessive lactic acid, and over-breathing is an adaptive response to this.
In this article we get to the important topic of what you can do about the problem of chronic over-breathing.
I have to confess I don't have great news for you if you are struggling with chronic hyperventilation. I don't have a simple solution, or even a clear story. But hopefully I can point you in the right direction.
An obvious starting point is to work out which of the two causal accounts outlined applies in your case. Even here I can't offer much clarifty because the truth might be a mixture of the two - they are more like poles on a spectrum than dichotomous alternatives. Stress can not only directly trigger over-breathing but (at least when chronic) it can adversely affect mitochoncrial function, according to many experts such as Dr Frank Shallenberger (mentioned in an earlier article). Moreover, problem over-breathing caused initially by stress may gradually lead to more and more mitochondrial dysregulation as time goes on.
That said, there are some things you can do that might give you an indication.
1. Have a good go at breathing retraining using capnometry biofeedback
If stress is the primary cause for chronic over-breathing, then addressing the sources of stress, combined with breathing retraining (ideally assisted by capnometry biofeedback) should be a viable solution. My Stress Resilient Mind Programme aims to do both these things. (I should make clear I'm talking about psychological stress here - there are also physical causes of stress such as being over-weight.) At least you should be able to achieve temporary gains, in terms rises in the capnometer's measurement of end-tidal carbon dioxide. It's common for clients to achieve this in one session, only to be starting again from the same low baseline in the next session. In this case it may just take a lot of practice.
But when a client can't make any significant shifts in the CO2 reading at all, in spite of trying a number of different approaches, I tend to think something else (of a more organic nature) may be at play.
2. Measure your urine (& saliva) pH
Another thing you can do to work out which causal account (most closely) fits the bill for you is measure your urine pH. Urine pH does NOT tell you how acidic or alkaline your body is, or any of your body compartments are. It only tells you how hard your body is working to maintain healthy balance.
It's simple, cheap and easy to measure urine pH. You can buy a pack of test paper strips online, e.g. from amazon or ebay. Search on "pH testing strips" - I'd advise buying ones that are specifically for urine or saliva - they have a narrower range (about 5 to 9) and are thus more sensitive. You simply pee on the paper, then compare the colour to the reference chart.
According to the book "Complete Practitioner's Guide to Take-Home Testing" by Dicken Weatherby and Scott Ferguson, a normal or healthy range is about pH 6.4 to 6.8 (so slightly acidic). It does vary at different times of day - the first morning reading tends to be more acidic. Ideally you'd take quite a few readings over several days, and take an average (excluding the first morning ones).
If your measurement is more acidic than this range, (i.e. pH < 6.4) it suggests your kidneys are working quite hard to maintain balance. It may be that your body is producing quite a bit of lactic acid - so possibly pointing to a metabolic issue. Bear in mind that you will produce lactic acid in intense exercise - and it could also be that your gut flora rather than your own cells is producing the acid - so don't be tempted to over-egg this result. Weatherby and Ferguson suggest it might also be caused by carbohydrate and fat maldigestion. For that matter, the nature of your diet has a bearing too.
If you're the other way, (urine too alkaline, > 6.8) it suggests your body is dumping out bicarbonate. This may be an indicator of a true (stress related) over-breathing problem. But don't judge it by this alone.
If you do buy test strips it's easy to also measure your saliva pH. Do this away from food and drink. Ideally the reading should be slightly alkaline, pH 7.1 to 7.4. Over-breathing caused by stress will tend to more alkaline saliva. Again, there are many other factors that have a bearing so don't over-interpret this result.
3. Functional Medicine Testing
Functional Medicine (FM) is a new paradigm of healthcare that is becoming increasingly popular especially in America. FM views health in terms of a spectrum from optimal through to outright disease. Many of today's health problems aren't necessarily outright disease but are the result of loss of functioning in the body's systems, e.g. your digestive system. Diseases like diabetes (type 2) are best seen as extreme points on a spectrum of dysfunction or dysregulation. The FM practitioner aims to assess (measure) the level of functioning in body systems and identify the weak points, which are the places where you can make the most difference. In other words, FM practitioners aim to identify causal factors, and then address these, rather than simply trying to suppress symptoms as mainstream medicine so often does. Causal factors are individual and often multiple, meaning that the whole FM process needs to be individualised. Therapy aims to improve functioning by addressing causal factors, typically via nutrition and lifestyle interventions.
There are various lab tests you can do to measure the status of your mitochondrial energy production, or more accurately the factors which adversely affect mitochondrial functioning. Dr Shallenberger gives a list of possible causal factors. I list some of these below, in the section on what to do about impaired cellular energy production, but let me say here I don't expect you to understand everything on the list. The point is, ideally you would find an experienced practitioner to guide you. Listing lab tests is beyond the scope of this article but some of the links I give in the further information section below may be helpful.
What You Can Do About Chronic Over-breathing
Chronic over-breathing to which the body has adapted via action of the bicarbonate buffer system, may leave you somewhat deficient in bicarbonate. Therefore an obvious thing you might try is to make good the deficit by supplementing bicarbonate.
You can for example buy (food-grade) sodium bicarbonate (also known as baking soda). Baking soda powder can easily be dissolved in water, but does taste pretty unpleasant (not unlike salt water). However you can also buy capsules, which are going to be more expensive but less unpleasant to consume. For example see this bicarbonate product from BioCare (made here in the UK).
Please don't take this as a recommendation to supplement bicarbonate - that should only be done by a qualified practitioner on the basis of a personal assessment. But of course you're free to experiment - I'm not aware that you could cause any significant problems for yourself, as long as you take it well away from meals.
If you do experiment with bicarbonate, timing is critically important. Bicarbonate reacts with stomach acid (to produce carbon dioxide which you then typically belch up). Besides not getting the benefits of absorbing bicarbonate, you don't want to neutralise your stomach acid, as it's there for the purpose of digesting protein you've eaten. That means you should take bicarbonate well away from meals, especially protein-rich meals, so that there'll be little or no stomach acid present. A good time is first thing on a morning or even during the night - see my comments below on mouth-breathing.
I've also heard that the bicarbonate buffer adaptation to over-breathing causes loss of both potassium and magnesium in urine. It's possible to be deficient in either of these, particularly magnesium as it's difficult to get enough from even a relatively healthy diet. Magnesium deficiency is associated with anxiety and panic, so there may be an important link here - a chain reaction of worsening problems. Again I'm not recommending but pointing out options - do take responsibility.
I've been told that dehydration can contribute to over-breathing, or at least make it more difficult to correct via biofeedback-assisted breathing training. I'm not really sure why this might be, but I can say that in my own experience of finding myself with slightly dysregulated breathing (which tends to happen sometimes at night), it seems to help me if I down a couple of glasses of water. I recommend my clients do this too, if I'm struggling to make progress.
Mouth Breathing & Over-breathing In Your Sleep
It's quite common for my clients to report waking up in the early hours feeling short of breath, and in some cases having panic attacks on waking. I've experienced this shortness of breath on waking myself. It seems that a degree of hyperventilation has developed during sleep. Why would this happen?
One common trigger seems to be mouth breathing. If you wake up with a significantly dry mouth, chances are you've been mouth breathing. Mouth breathing might sound innocuous enough, but it's actually a far from ideal way to breathe. It's significantly more likely that your breathing will become dysregulated if you mouth-breathe. If you do mouth-breathe, I recommend you take steps to correct the problem.
Of course the obvious reason people mouth-breathe is that their nasal passages have become blocked or stuffy. You can try cleaning out your nasal passages, ideally using a suitable product such as "NeilMed Sinus Rinse" or "Xclear nasal spray" (try googling these or searching on ebay / amazon etc.) However to really make progress you might need to address the underlying causes (e.g. allergies, or even food sensitivities). You might need to search out a FM practitioner.
I've personally suffered from a stuffy nose pretty much all my adult life (in part due to allergies), and I do at times wake up with a dry mouth, in the early hours. Furthermore I do feel short of breath at these times. I've experimented with supplementing bicarbonate, and would say it seems to help. Sometimes I've found it very relaxing.
What You Can Do About Mitochondrial Dysfunction & Impaired Cellular Energy Production
Clearly in this case you'll need to take steps to improve cellular energy production. How? Well, it depends on what's causing the impairment. As per the Functional Medicine approach mentioned above, you need to identify the causal factors, or as many of them as possible, and then address them. What are the causes of mitochondrial dysregulation? In Dr Shallenberger's video material already refered to, he discusses this question - I list some of the factors below.
Causal Factors for Mitochondrial Dysregulation
- Toxicity e.g. heavy metals which we all ingest in trace amounts from food, water, even the air we breathe.
- Infections (which can be hidden and chronic)
- Nutritional deficiencies (e.g. magnesium and B vitamins are key in cellular energy production)
- Poor fitness
- Inability to break down fat stored in the body (into fatty acids which can then be used in cellular energy production). e.g. high levels of the hormone insulin can suppress this process of lipolysis.
- Ischemia and hypoxia - impaired supply of blood and oxygen to particular organs
- Methylation deficits
- Chronic systemic inflammation (actually while researching this article I learned that one of the diagnostic criteria for Systemic Inflammatory Response Syndrome (SIRS) is fast breathing and low carbon dioxide.
(At the end of this article I give links to some of Dr Shallenberger's YouTube material, for further reference.)
Of course every case is going to be different. Not all the factors listed will be at play in any individual - rather, some will be more prominent than others. So there's clearly not going to be a one-size-fits-all action plan for mitochondrial function, except to find a FM practioner who will help you identify the points where you as an individual can get the most leverage. The process typically involves lab testing and other assessments of functioning, plus a plan of diet, nutrition and lifestyle change.
Clearly the process isn't going to be cheap. I give a few comments on how to find a FM practioner in the further information section below. Here in the UK, FM isn't available on the NHS, to my knowledge, at the time of writing, and in other countries health insurance doesn't necessarily cover it.
Further Information & References
Most of the references I give here are about mitochondrial health.
- "Bursting With Energy" by Dr Frank Shallenberger - explains his anti-aging medicine approach and his testing methods.
- "Head Strong" by Dave Asprey. Asprey is probably the world's best known biohacker, and this book offers a wide ranging view of how to achieve optimal brain performance. Mitochondrial health is one of the foundational themes running through the whole book.
- "Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis Second Edition: it's mitochondria, not hypchondria" by Dr Sarah Myhill. Dr Myhill is a UK-based GP who specialises in treating chronic fatigue. This book gives quite a bit of technical information, including on how she tests for mitochondrial dysfunction.
- "Mitochondria and the Future of Medicine: The Key to Understanding Disease, Chronic Illness, Aging, and Life Itself" by Lee Know. This is a general book on mitochondria and why they are so relevant to health and well-being. See also the video interview with Dr Know below.
In the other articles I've referred to Dr Shallenberger's series - here is the first of four.
The following is an interview with author Lee Know by Ari whitten, who has an excellent podcast on the theme of energy.
This video is a fairly technical presentation of Dr Myhill's work, aimed at practitioners. It's not the most up-to-date, her book may be a better option now.
How To Find A Functional Medicine Practitioner
FM is best established in the US, so it's easier there. Here are a couple of registers you might check out.
Institute of Functional Medicine Find A Practitioner - the IFM is perhaps the foremost teaching organisation, for doctors at least.
Kresser Institute - Chris Kresser is a well-known practitioner of FM who I personally hold in very high regard. His Kreser Academy trains FM practioners and also health coaches.
British Association for Nutritional Therapists (BANT) - here in the UK there don't seem to be a lot of doctors offering the FM approach but many nutritional therapists are trained in FM and could be a cheaper option.
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