The principle function of breathing occurs in the lungs, delivering oxygen from air to red blood cells and removal of carbon dioxide (by-product of body metabolism) from red blood cells to room air. Red blood cells deliver life-giving oxygen to all the cells of the body and blood carries waste carbon dioxide back to the lungs to be exhaled. Calm relaxed breathing is primarily abdominal, dependent on the diaphragm muscles to move air in and out of the lungs. When stressed, involuntary brainstem signals tighten one’s muscles including the diaphragm muscles, forcing one to depend on the muscles of the rib cage for movement of air into the lungs.

Why Do POTS Patients Develop Hyperventilation?

Those with POTS who struggle with severe headaches, concentration difficulties, lightheadedness, chest discomfort, chronic fatigue and/or forgetfulness are at higher risk for psychological stress and breathing difficulties. This arousal may not always be outwardly visible, but “inside a psychological storm may be raging.” When individuals are psychologically aroused, either related to fear or apprehension, breathing tends to temporarily become more rapid, shallow and noisy. To speed-up the rate of breathing air in, the muscles that lift the ribs work harder to create negative pressure (partial vacuum) that encourages movement of air into the upper lungs. This abnormally rapid shallow chest breathing is known as HYPERVENTILATION. Hyperventilation (rapid chest breathing) requires more energy than relaxed breathing and is less efficient. Rapid breathing, when not exercising, causes excessive blowing off of carbon dioxide and worsening of POTS-related symptoms. For hyperventilators the duration of inspiration becomes prolonged and the duration of expiration is shortened, instead of being equal as is normal. While unhealthy hyperventilation occurs more commonly in the general population than in POTS subjects, both are rarely recognized, even when present.

Clues to recognition of unhealthy hyperventilation include:

  • Rapid breathing (16 or more breaths per minute) (12 is normal)
  • Chest breathing (utilization of rib cage rather than diaphragm to move air in and out of lungs)
  • Chest pain (sprained rib cage muscles and joints)
  • Erratic breathing
  • Spasmodic gasping breaths
  • Pre-speaking air sucking
  • Frequent large sighs
  •  Sensation of breathlessness (feeling unable to obtain an adequate breath)
  • Sensation of “lump in throat”
  • Dizziness, faintness, light-headedness, weakness (due to blowing off excessive carbon dioxide)
  • Tingling, numbness, trembling, tremors (due to blowing off excessive carbon dioxide)
  • Apprehension, anxiety, phobia, panic
  • Palpitations, tachycardia

What to Do If Hyperventilation is Suspected?

Psychological-induced hyperventilation may be difficult to distinguish from hyperventilation induced by such medical conditions as heart, lung, brain, kidney and metabolic diseases like diabetes. Evaluation by a medical professional should be consulted to determine the cause of symptoms suggestive of hyperventilation.

When hyperventilation is finally recognized, Individuals are usually told, “You need to calm down, it’s all in your head,” without providing the necessary long-term skills to cope with unhealthy rapid shallow chest breathing. POWER over POTS – A family guide for managing POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME provides POTS hyperventilators with skills to learn healthy breathing and reduce anxiety.