Hyperventilation Syndrome - Treatment

Treatment

While traditional intervention for an acute episode has been to have the patient breathe into a paper bag, causing rebreathing and restoration of CO₂ levels, this is not advised or taught. When patients hyperventilate, they change their blood chemistry toward alkalosis. In alkalosis, hemoglobin binds more securely to the oxygen ('alkalotic O₂ clamping', also called the 'Bohr effect'), so the patient's cells become relatively hypoxic. Restricting inspired oxygen worsens this hypoxia and is detrimental to the patient. If attempting to calm the patient does not work within a few minutes, and the patient's condition is deteriorating, the hyperventilation may be caused by a medical condition (some of which are life threatening such as head injuries or drug overdose).

The same benefits can be obtained more safely from deliberately slowing down the breathing rate by counting or looking at the second hand on a watch. This is sometimes referred to as "7-11 breathing", because a gentle inhalation is stretched out to take 7 seconds (or counts), and the exhalation is slowed to take 11 seconds. This in-/exhalation ratio can be safely decreased to 4-12 or even 4-20 and more, as the O₂ content of the blood will easily sustain normal cell function for several minutes) at rest when normal blood acidity has been restored.

Most patients benefit from carefully, deliberately slowing down their breathing twice a day for five minutes at a time. The goal is to reduce breathing to no more than five breaths per minute. This helps retrain their habits and convince them that faster breathing is unnecessary.

The original traditional treatment of breathing into a paper bag to control psychologically based hyperventilation syndrome (which is now almost universally known and often shown in movies and TV dramas) was invented by New York City physician (later radiologist), Alexander Winter, M.D., based on his experiences in the U.S. Army Medical Corps during World War II and published in the Journal of the American Medical Association in 1951.

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