Hyperventilation syndrome: treatment

Treatment of hyperventilation syndrome should be comprehensive. Correction of mental disorders is carried out with the help of psychotherapeutic treatment. Of great importance are the "reconstruction" of the internal picture of the disease, demonstration (this is easily done with the help of hyperventilation provocation) to the patient's connection of clinical manifestations with breathing dysfunction. The effect on the neurophysiological and neurochemical basis of the mechanisms of the hyperventilation syndrome is realized by the appointment of psychotropic, vegetotrophic agents and drugs that reduce neuromuscular excitability.

As agents that reduce neuromuscular excitability, prescribe drugs that regulate calcium metabolism, magnesium exchange. The most commonly used ergocalphicol (vitamin D2) at a dose of 20,000-40000 IU per day enterally for 1-2 months, calcium gluconate, calcium chloride. Other calcium preparations (tachystin, AT-10), as well as preparations containing magnesium (magnesium, potassium and magnesium aspartate, etc.) can be used.

One of the leading methods, and in most cases, the main method of therapy as a hyperventilation syndrome, and psychogenic dyspnoea and psychogenic (habitual) cough is the use of various methods of respiratory "re-education" in order to form a normal, physiological breathing pattern. The application of the following methods of respiratory regulation is shown not only in disorders of the respiratory system, but also in the presence of broader signs of instability in the psychic and vegetative spheres, i.e. With different manifestations of the psychovegetative syndrome.

Special literature reflects the experience gained over more than 2000 years of the Indian system of hatha yoga and raja yoga. However, it is considered that for patients with hyperventilation syndrome and autonomic dysfunction, those rigid and sometimes categorical recommendations on breathing that have recently been widely advertised, but do not always have sufficient physiological justification, are illegal.

In connection with this, we outlined here the basic principles of respiratory gymnastics, as well as the specific technique for carrying it out. Application of these principles allows, in our opinion, to combine sufficient focus in the patient's breathing exercises with simultaneous flexibility in the formation of certain breathing skills. This also leads to the establishment of an adequate pattern of breathing, taking into account not only the body's needs, but also the optimal energy costs for the work of breathing.

The first principle of respiratory gymnastics is an attempt to gradually switch on, and if possible even switch to diaphragmatic (abdominal) breathing. The effectiveness of the latter is due to the fact that diaphragmatic breathing causes a pronounced Hering-Breyer reflex ("inhibitory" reflex associated with the inclusion of receptors for stretching in the lungs), leads to a decrease in activity of the reticular formation of the brainstem, a decrease in the activity of the neocortex and the stabilization of mental processes. In addition, it was found that in situations accompanied by negative emotions, chest breathing prevailed, and accompanied by positive emotions, was diaphragmatic.

The second principle, which should be implemented in respiratory gymnastics, is the formation of certain relationships between the duration of inspiration and expiration, respectively 1: 2. Such relationships are most favorable and, apparently, correspond more to the state of relaxation, rest. In our studies of the temporal parameters of the respiratory patterns, a clear tendency was observed in patients with hyperventilation syndrome to shorten the exhalation phase, a trend that increased sharply in the modeling of negative emotional influences.

The third principle is an attempt to reduce and / or deepen breathing. The formation of a slow breathing pattern has several advantages in the sense that it optimizes the process of intrapulmonary diffusion.

The establishment of a slow pattern of breathing is clearly beneficial from the point of view of the "destruction" of the pathological hyperventilation, most often rapid, pattern of breathing.

The fourth principle of respiratory gymnastics in hyperventilation syndrome, which is of great importance in the success of its conduct, is the use of certain psychological regulation. In the pathological respiratory pattern that exists in patients as a nuclear entity, there is a close relationship between the sense of anxiety and the intensification of breathing. Any breathing exercises, especially at the initial stage of training, are perceived by patients as a bodily sensation of anxiety, anxiety. Respiratory exercises are in themselves ineffective if they concern only the physiological part of the pattern of breathing. Therefore, the birth of a new adequate pattern of breathing should occur against the background of a constant "absorption" into itself during the exercise of emotionally stable positively stained conditions.

Such stabilization of the psychic sphere can be caused both by feedback mechanisms (as a result of the breathing exercises described above), and by an increase in the level of subjective control over bodily functions - control, the sensation of which was lost in the manifestation of the hyperventilation syndrome. Psychological stabilization is also promoted by psychotherapeutic measures of various nature (including methods of autogenic training), as well as psychopharmacological means.

Such complex effects in the hyperventilation syndrome ultimately lead to mental and respiratory stabilization. Frequent breathing exercises, initially lasting several minutes, and subsequently quite long, tend, as a rule, to modify the pathological psychophysiological pattern of breathing with the formation of a new one, which is gradually included in a wider set of mechanisms for corrective behavior of the patient.

One of the most effective methods for treating patients with hyperventilation syndrome is the use of biofeedback (BF) techniques. The advantage of this method in comparison with respiratory gymnastics is that the patient is able to control his actions; this greatly accelerates the process of formation of a new respiratory pattern and the normalization of its state. The applied variant of BF with conjugate motor support (movement of the hand simultaneously with the breathing cycle) allows for a relatively short time (7-10 sessions) to significantly correct the respiratory function in the hyperventilation syndrome.

In addition to these methods of treatment, depending on the indications prescribed pathogenetic or symptomatic therapy.

Thus, treatment of hyperventilation syndrome should be complex, multidimensional, taking into account the leading links of pathogenesis.

We give specific technical methods for conducting respiratory gymnastics in patients with hyperventilation syndrome and other manifestations of autonomic dysfunction (vegetative paroxysms, neurogenic syncope, cephalgia migraine and muscle-tonic, cardialgia, abdominalgia, etc.).

Prerequisites: there should be no noise in the room; air temperature - comfortable for the body. Preliminary premise air. Clothes free, not constraining movements. Engage, if possible, at the same time, preferably in the early morning or just before bedtime. Before the exercises, it is necessary to empty the bladder and intestine. We start the exercises 2-3 hours after eating; Before the start of the training, a glass of water is allowed. Do not breathe exercises after a long stay in the sun or after heavy physical work: in these cases, only 6-8 hours are possible.

Contraindications to carrying out breathing exercises: severe diseases of the heart, blood vessels, lungs, abdominal organs; severe cerebral atherosclerosis, hypertension, blood diseases, mental (psychiatric), infectious, colds, menstruation, pregnancy. An important contraindication is glaucoma.

Technique of execution

1. Take a horizontal position on the back, close your eyes (if it's light, then put a special bandage or towel on your eyes) and within 5-7 minutes try to relax as much as possible mentally and physically. In this case, you can use the techniques of autogenic training, causing a sense of warmth and heaviness in the limbs.
2. Breathing begins with a normal full exhalation. The breath is made slowly, while the ventral wall protrudes outward (and not vice versa!). At this time, the air is filled with the lower part of the lungs. The thorax is simultaneously widened (medium air lobes fill the air). It is important to emphasize that for the duration of inspiration the abdominal component should predominate. Exhale: first slowly the stomach falls, and then the thorax narrows. Exhale, as well as inhalation, should be smooth and smooth.
3. During breathing, a light inner laryngeal sound, necessary for controlling the duration and regularity of respiratory movements, should be continuously published (for oneself).
4. During the exercise, all phases of breathing are brought to about 90% of the maximum possible to avoid stretching the lung tissue.
5. It is necessary, especially in the initial periods (weeks, months) of occupations, to keep a constant account in the mind of the duration of each inhalation and exhalation. You can mark the number of performed breathing cycles by lightly bending your fingers.
6. Begin with 4 breaths and 8 with an exhalation; thus to carry out 10-15 cycles in the light of the above recommendations. If there is no shortness of breath, general stress, agitation, anxiety, dizziness, severe fatigue, then it is not necessary to reduce the duration of the respiratory phases; If, at the specified parameters, such sensations appear, you should switch to the 3: 6 mode. Then gradually increase the duration of inspiration and expiration, observing their ratio of 1: 2. After the baseline conditions are selected (they may be 5-10 or 6-12 seconds), it is necessary to adhere to them within a month, so that the body gets used to the new regime breathing exercises. The number of initial cycles should be no more than 20 per day. In a month, you can start to add one breathing cycle every 3-5 days to 40-50 cycles. In the subsequent, after 1-2 months, gradually it is necessary to extend the time of one cycle, observing the indicated relationships. The duration of the cycle is increased at a rate of 1 second for inspiration (and 2 seconds for exhalation, respectively) for 2 weeks. The longest cycle is one breath in 1.5 minutes (ie, the inspiration is 30 seconds, the exhalation is 60 seconds). Further elongation of the cycle time in patients with autonomic dysfunction and even in healthy without training with a specialist is inexpedient. 7. With proper holding of breathing exercises, there should be no heart beat, shortness of breath, yawning, dizziness, headache, numbness in the fingers and toes, muscle tension. At the beginning of the session, a number of patients may experience heart beats; Over time, this feeling goes away. Correct execution of exercises causes after a certain time a feeling of inner comfort and rest, a nap, a pleasant sensation of "immersion", etc.

With the development of breathing exercises, it is forbidden to take tobacco, alcohol and drugs that stimulate mental activity.

[1], [2], [3], [4], [5], [6], [7], [8]