Hyperventilation: what you can do about it

Without even thinking about it, we do it on average about ten times a minute, or 14,000 times a day: breathing. It is one of the most wonderful and beautiful systems of our body. When you inhale you bring in much-needed oxygen, when you exhale you remove unnecessary carbon dioxide (CO2). Depending on your activities, the rhythm adapts; with exertion, breathing speeds up, while sleeping slows it down. This is completely effortless and automatic. At least, if the system works properly. Stress or anxiety can disrupt breathing, often without you realizing it. You then breathe too fast and sometimes too deeply. It’s called hyperventilation. Although it is physically harmless, people often find the physical complaints that they can experience very bad.

Fight or flight

If you worry a lot or are often anxious, your body is always ready. It doesn’t matter to the brain whether you are actually in a threatening situation or whether you are just thinking about it. The physical reaction, stress, is the same. That fight-or-flight reflex dates back to prehistoric times, when a threat, an attack from a wild animal or a fight with a rival tribe, often literally meant a matter of life or death. Today we are dealing with ‘dangers’ of a completely different order. Health problems, for example, or financial concerns; family troubles or bad news in the news. These problems are generally not life-threatening, especially in the here and now. But they often give rise to long-lasting fear and tension. When you are under stress, your body produces extra hormones, such as adrenaline and cortisol. These ensure, among other things, that your breathing and heart rhythm constantly go faster than necessary. The result: you feel as if you are running, while you are just sitting quietly on the couch. If that ‘overbreathing’ becomes very intense, you can have a hyperventilation attack. Hyperventilation can cause all kinds of annoying complaints. A feeling of tightness, but also sweating, dizziness, headache, nausea, tingling, dry mouth or chest pain. These symptoms often appear out of nowhere. At worst, people feel like they are dying or going crazy. A violent and frightening event. Incidentally, some diseases that affect the respiratory stimulus can also cause hyperventilation. Think of pulmonary embolism or chronic heart failure. But that is less common.

Avoidance is counterproductive

People who have had a panic attack with hyperventilation often try to avoid the situation in which that happened. Suppose it happens to them again! They are also very alert to symptoms that could herald a new attack. As understandable as it may be, that is counterproductive. You thus feed the fear, as it were, so that it only increases. Before you know it, you end up in a vicious circle. That is why it usually does not stop at one time. Moreover, there is a danger that your world will become smaller and smaller, because you dare less and less. Fortunately, anxiety and hyperventilation are usually easy to remedy. You can get started with it yourself, for example by doing breathing and relaxation exercises, as described on the following pages. Or you can seek professional help. The treatments can be roughly divided into two groups: psychotherapy and psychosomatic physiotherapy. With a psychologist (or psychiatrist) you mainly look for the underlying cause of the complaints and you learn to deal with anxiety and stress differently. A psychosomatic physical therapist is specialized in the treatment of physical complaints related to tension or stress. He or she will help you to regain control of your body. Psychological and social aspects are also discussed. Often the two professions work together. If necessary, the general practitioner (or psychiatrist) can prescribe medication to help reduce the anxiety.

Paper bag: don’t

The moment you go through a panic attack, it feels like everything is going wrong in your body. But hyperventilation can’t hurt; you don’t care about it. That knowledge alone can reassure you during an attack. Traditionally, you often hear that you should blow into a (paper) bag to supplement the possible shortage of carbon dioxide in the blood. However, it is now clear that this does little to nothing physically. So you might as well leave that out. Another thing you shouldn’t do during an attack is to walk away from the ‘frightening’ situation. Suppose that while shopping it turns out that you have forgotten your wallet. With a long line behind you, you start to hyperventilate at the checkout. In the stress, you leave your purchases and run outside. There is a good chance that the next time you have to go to the supermarket, you will be extra tense beforehand, possibly resulting in another attack. Or you don’t dare go there at all. Instead, try to calm yourself on the spot with breathing techniques during such an attack. In this way you teach your brain that the situation is not actually frightening and that the tight feeling will also pass.

Exercises for a panic attack

1. Exhale well

Fokje de Wit, psychosomatic physiotherapist: “Step one is to restore the normal breathing rhythm as quickly as possible. You do this by exhaling properly. This is easier if you exhale focused on a fff sound. If you have it to hand , you can hold a sheet of toilet paper or kitchen roll in front of your mouth. If it waves while you exhale, you know for sure that you are blowing the air out in a targeted manner.”

2. Count your breath

“Do you find it difficult to focus on your exhalation during a panic attack? Then count for a while. Make sure that you take a breather after each exhalation. For example: four counts in, two counts out, four counts pause.”

3. Distract yourself

“By diverting attention from the breath, you make it easier for your body to get back to its natural rhythm. For some people it helps to get moving and do some knee bends, for example. Others benefit from it.” read aloud.”

Exercises to help prevent hyperventilation

1. Map your breath

Fokje de Wit: “To prevent panic attacks, it is important to find out the cause of the stress or anxiety and to do something about it. You can also learn to regulate your breath. That starts with understanding how often you actually breathe. Take a white sheet of paper and a pen. Place your left hand on your stomach and place the pen on the paper with your right hand. , down on exhalation. Make sure that you breathe normally (and do not slow down on purpose, for example). After three minutes, count how many times you have breathed per minute. At rest, five to ten times is normal. Is your breath above that? Then you know that you breathe more than (physically) necessary. It is then useful to train yourself to breathe more calmly. Incidentally, you only speak of hyperventilation when at rest more than twenty breaths per minute.”

2. Let your body do the work

“People who breathe excessively work very hard unnoticed. They are actively sucking the air in. To become aware of this, lie down quietly with your hands loosely on your stomach. First observe how your breathing is. and where you feel the movement, for example only in your chest or also in your abdomen. Then you exhale audibly four times to a fff sound. After each exhalation, you wait for your body to inhale again, without making any effort. .That’s possible in
be difficult in the beginning. In that case you can first count: four counts in, six counts out. Then let your body do the work.”

3. Use a breath app

“You can optionally use a telephone or tablet app with breathing exercises as support. For example, the free NFP Breath app from the Dutch Association for Physiotherapy according to Psychosomatics. You can see on it by means of a red or green color when you enter and exhale.Note: build up the breathing training slowly.If you normally breathe fifteen times a minute, it is not wise to immediately start practicing with eight times.For example, start with twelve and gradually decrease the tempo. “

4. Create relaxation in your abdomen and pelvic area

“When you suffer from stress or panic, your breath is often high. Unnoticed you hold tension in your pelvic area and squeeze your abdomen, so that the breath cannot sink. To make more space there, do the following exercise Lie with your knees bent, keeping your feet on the floor.Then, at your own pace, let your knees fall alternately left and right together for a few minutes. Where in your body do you feel that movement? In your back, your neck, your head? Feel good afterwards. What is different now? Is your back flatter? Does your diaphragm feel heavier? If you repeat this exercise regularly, you will notice that your pelvis, abdomen and chest become more flexible and it becomes easier to breathe through.”

• Not breathing in a bag, but with an app. We tried these breath apps.
• www.hyperventilation.org, the website of the Dutch Hyperventilation Foundation, offers not only information but also experiences from patients.
• on www.defysiotherapeut.com Find a psychosomatic physiotherapist in your area.

Thanks to psychosomatic physiotherapist Fokje de Wit of Fysio de Tille in Kootstertille.

This article previously appeared in Plus Magazine June 2019. Not yet a Plus Magazine subscriber? Becoming a subscriber is done in no time!