Is ME/CFS/SEID linked to disordered breathing/overbreathing/hyperventilation?
Dr Peter Litchfield, a breathing expert notes that “Overbreathing can be a dangerous behaviour immediately triggering and/or exacerbating a wide variety of serious physical and mental symptoms, complaints, and deficits in health and human performance.”
So does overbreathing or hyperventilation play a part in ME/CFS/SEID?
1) Hyperventilation symptoms are very like those of ME/CFS/SEID
“Hyperventilation syndrome (HVS) can show itself in different ways. Most people with HVS will experience some, or many, of the following symptoms:
Respiratory: breathlessness tightness around the chest fast breathing frequent sighing
Tetanic: tingling (e.g. in fingers, arms, mouth) muscle stiffness trembling in hands
Cerebral: dizziness blurred vision faintness headaches
Cardiac: palpitations tachycardia (rapid heart beat)
Temperature: cold hands or feet shivering warm feeling in the head Gastrointestinal: sickness abdominal pain
General: tension anxiety fatigue and lethargy insomnia”
(this information was taken from my local Derbyshire NHS Community Health info on Hyperventilation Syndrome, and it is great that they recognise it).
Any and every system in the body can be affected. Here is a more detailed list, not everyone has the same symptoms, genetics also plays a part.
2) Hyperventilation depletes the tissues of oxygen
a. Low levels of CO2 stop release of oxygen from the blood
Short of breath? Breathe less! Says Dr Myhill, well known CFS expert.
“Many patients, particularly asthma patients, but also CFS patients, have a sensation that they are not getting enough oxygen to their tissues. Their response to this is to breathe more deeply. However blood cannot become more than 100% saturated with oxygen. All that happens is that more carbon dioxide is washed out of the blood. This makes oxygen cling more fiercely to haemoglobin in red blood cells and therefore oxygen delivery to the tissues is made worse! Paradoxically, to improve oxygen supply to the tissues you have to breathe less! Breathing less increases carbon dioxide levels and improves oxygen delivery.”
b) Low levels of CO2 reduce blood flow to the brain
Dr Medows researches orthostasis (feel worse when standing) and ME/CFS “Some of those with ME/CFS and orthostasis (feel worse when standing) also experience very rapid, deep breathing during an orthostatic challenge, like trying to catch your breath after strenuous exercise. This hyperventilation, in turn, leads to reduced carbon dioxide (CO2) levels, or affecting the pH of the body. And, guess what? One of the most powerful modulators of brain blood flow happens to be CO2. The lower the CO2, the lower the cerebral blood flow.”
Dr. Medow’s hypothesis: that the reduced cerebral blood flow and brain fog occurs, at least in part, because of impaired control mechanisms for regulating C02 and/or blood pressure.
3) Learning to breathe less can help ME/CFS/SEID symptoms
Breathing normalization by re-education can help; you can find some success stories here.
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How hyperventilation harms: part 3 hyperventilation can unbalance the blood gases and reduce transfer of oxygen from the blood to the organs and tissues that need it.
Breathing air into and out of the lungs supplies us with oxygen and gets rid of excess CO2. Air entering the lungs is oxygen rich, and the blood supply, as it passes through the lungs, picks up oxygen easily and carries it round the body attached to haemoglobin molecules in red blood cells. You can buy quiet cheaply a handy device (a pulse oximeter) that you stick your finger into and it can actually measure how much oxygen is carried on your haemoglobin (I don’t suggest you rush to buy one, results can be hard to interpret, see below). Normal oxygen saturation levels (sats) are usually considered to be between 96- 99%; people with lung damage might struggle to achieve that. However, a plentiful supply of oxygen circulating in your bloodstream and a 99% oxygen reading is not always an indicator that your body and its organs are well oxygenated. There is another step to consider; the blood has to carry the oxygen round the body to where it is needed most and that will be where there is low oxygen – for example in an actively contracting muscle -and then the blood has to release the oxygen from the haemoglobin so it can be utilised where it is needed. An active muscle will be rapidly metabolising and will require more oxygen, and will produce more CO2. The higher local levels of CO2 and the lowered local pH are important triggers that help to release oxygen from the haemoglobin so it can be used exactly where needed. This is known as the Bohr Effect and has been described in physiology text books for a century.
The more you breathe, the less oxygen you get.
Unfortunately, hyperventilation (breathing more than you need for the activity you are doing) can cause loss of too much CO2 from the body (hypocapnia). There is only a tiny amount in the air we breathe, so to maintain a healthy level in our bodies, we have to retain and accumulate CO2 by breathing correctly. Breathe too much and CO2 levels can become too low, and alter the whole body biochemisty.
When CO2 levels are too low, oxygen is not released efficiently from the blood to where it is needed. (Picture by V Lunn Rockcliffe)
One thing that can happen with lowered CO2 is that oxygen is no longer efficiently released from the haemoglobin in circulating red blood cells in the blood supply. Instead of the oxygen being released in the body where there is high metabolic activity, and high CO2, the oxygen sticks tightly to the haemoglobin and continues to circulate in the bloodstream, where it really can’t do any good. It is easy to see that aching muscles and brain fog and a host of symptoms could be related to low oxygenation caused by hyperventilation and unbalanced blood gases. It is very common for people to say “breathe deeply” “take big breaths for more oxygen”. In fact it is easy to get enough oxygen, air is about 21% oxygen and the cells of the body only need about 2%. Much more likely deep breathing will flush out too much CO2, air only has 0.04% and the cells of the body need about 6%. So by trying to breathe deeply for more oxygen, you can do the opposite and starve your body of oxygen. The more you breathe, the less oxygen you get.
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How hyperventilation harms: part 2 hyperventilation can narrow the blood vessels and reduce blood and oxygen supply.
Chronic hyperventilation unbalances the blood gases; one of the important changes can be low body carbon dioxide (CO2) or hypocapnia. CO2 is not just a waste gas; you need a certain amount for healthy body function. 
Part 1 focused on low CO2 and tightening of the airways and how hyperventilation, or over-breathing, can cause respiratory issues.
In part 2 we turn the spotlight on blood vessels and circulation: hyperventilation-induced hypocapnia can lead not only to the airways narrowing but also constricts certain blood vessels and affects the blood supply to many organs, leading to diverse symptoms from IBS to brain fog to cold hands and palpitations (fuller list of hyperventilation related symptoms). One example of reduced blood flow/low O2 supply is shown in the figure of a brain scanned before and after just one minute of voluntary hyperventilation. The reduction in cerebral blood flow can lead in turn to poor oxygen (O2) supply to the brain, and may contribute to brain fog, poor concentration and anxiety. Continue Reading
How hyperventilation harms: part 1 hyperventilation can narrow the airways.
People who have asthma and other respiratory problems (blocked nose, sinusitis, cough etc) tend to breathe a lot more than normal (yes it is possible to breathe too much!)
Over breathing or hyperventilation is breathing more than the body’s requirement at any given time, so if you are seated quietly, but breathing as much as you would need for walking, that is hyperventilation. So you can breathe too many breaths per minute, or too much air per breath, or both. The blood gases can then get out of balance; one of the important changes can be low body carbon dioxide (CO2) or hypocapnia.Continue Reading
