Chapter 2: Patterns of Breathing Dysfunction in Hyperventilation Syndrome and Breathing Pattern Disorders

This is a chapter 2 summary of “Multidisciplinary Approaches to Breathing Pattern Disorders” by Leon Chaitow. The second edition will be coming out this December, and you can preorder it by clicking on the link or the photo below



This chapter’s goal is to cover both normal and abnormal breathing patterns. Often, breathing disorders can seem similar to serious disease when in reality the patient may not be getting an adequate breath. In fact, hyperventilation syndrome (HVS) and breathing pattern disorders (BPD) have the following incidence:

  • 10% of general medicine practice patients have HVS/BPD as their primary diagnosis.
  • Female:male is about 2:1 to 7:1; most commonly in the 15-55 year age group.
  • Acute HVS only makes up about 1% of cases.

Normal Breathing

The normal resting breathing rates equate to around 10-14 breaths per minute, which moves around 3-5 liters of air per minute through the airways.

Not so Normal Breathing

HVS/BPD can be defined as a pattern of overbreathing where the depth and rate are greater than the body’s metabolic needs. In some cases, such as during exercise and organic disease, hyperventilation is an appropriate response. It is when these causes are not found that we attempt to affect these breathing patterns.

There are a large number of symptoms that may coincide with HVS, but none are absolutely diagnostic. Oftentimes these symptoms are exaggerated when one has a hyperventilatory episode. I will break the signs and symptoms into the following categories:

  • Neurological
    • Headache
    • Numbness and tingling
    • Giddiness/dizziness
    • Ataxia and tremor
    • Blurred/tunnel vision
    • Anxiety and panic
    • Phobias
    • Irritability
    • Depersonalization
    • Detachment from reality
    • Impaired concentration, thinking, performance, and affect
    • Poor stamina
    • Disturbance of sleep/nightmares
    • hallucinations
  • Cardiovascular
    • Chest pains and angina
    • Palpitations and arrhythmias
    • Tachycardia
    • Lightheadedness and syncope
    • ECG changes
  • Respiratory
    • Breathlessness and inability to take a deep breath, often nocturnal
    • Sighing and yawning
    • Upper-chest breathing and use of accessory muscles in the neck
    • Chest wall tenderness
    • Two hand test; one on upper sternum and the other on upper abdomen – top hand moves more
    • Dry, unproductive cough and often clears the throat
    • Wheezing
  • Muscular
    • Aching and stiffness due to hypertonicity
    • Limb weakness
    • Cramps, carpopedal spasm and tetany
  • Gastrointestinal
    • Lower chest and epigastric discomfort
    • Esophageal reflux and heartburn
    • Upper abdominal distension
    • Dry mouth
    • Manneurism of air swallowing and belching
  • Skin
    • Sweating

This is a Test

There are several special/lab tests that one can look at to help determine breathing disorders. Listed below are some of the more prominent tests performed:

  • Peak expiratory flow rate (PEFR)
  • Chest x-ray
  • ECG.
  • Arterial blood gas
  • Think test – have the patient recall a painful experience in which they experienced their symptoms; if end-tidal CO2 drops 10 mmHG, then the patient likely has a HVS.
  • Breath holding time test – Those with HVS often have a hard time holding their breath no more than 10-12 seconds. 30 seconds is the dividing line between HVS and not.
  • Voluntary overbreathing to reproduce symptoms.

Other Breathing Issues

Hyperventilation can also occur as a secondary issue to other breathing dysfunctions. Two examples included obstructive and restrictive breathing disorders.  You may also see those who have been in chronic pain may be especially prone to HVS/BPDs.