[ note: update: In a recent post[2] I detail what I suspect generates the urge to breath at high rates as well as some potential solutions. The high rates generate the changes to the brain which likely result in the symptoms of PTS. Please also note that modified EERS[3] helps keep things calm at night. (added: Tue Sep 29 04:59:17 PDT 2015) ]

In late 2005 I was assaulted and robbed. I mean five extra holes in my body from a knife (near heart, kidney, gut, he had murdered and robbed before) and a forever changed orbit of my left eye. Two others the perpetrator had also assaulted and robbed attended with me the perpetrator’s sentencing.

In the following years near the anniversary of the attack panic drove me to the emergency room (ER) twice. Then the year following changing my blood pressure medicine from a beta blocker (slows the heart and lessens circulation) to an alpha blocker (reduces pressure by opening up circulation) along with careful use of exercise, eating, and pure niacin (the flushing effect improves mood I find) got me though the next couple of years without an ER visit.

In a following year as the time approached I was listening to a Doctor Park Sleep Apnea related web seminar and obtained some key information which made this and all proceeding seasons easier and also likely saved my life. The topic was Buteyko breathing which is a form of “eucapnic breathing”. As we breath we manage at least two blood gas issues. Everyone knows about oxygen and how important that is. But metabolism of oxygen produces carbon dioxide. Basically oxygen in and carbon dioxide out when we breath.

The presence of carbon dioxide in the blood at the correct levels is a rather critical matter. It has positive ions (H+) which are necessary to facilitate metabolism (see: Bohr effect[1]). It also is critical to control the circulation of blood. More carbon dioxide tends to produce more open circulation in general (vasodilation). Less carbon dioxide less circulation in general (vasoconstriction). So as you breath you want to facilitate a carbon dioxide exchange rate which results in not too much carbon dioxide in the blood (hypercapnia) nor too little carbon dioxide in the blood (hypocapnia) but the right amount of carbon dioxide in the blood (eucapnia).

One thing about Buteyko breathing bothered me. It seemed to have no real way to “not go too far” in terms of increasing carbon dioxide levels.. The “Nose Clearing Exercise” worked for me without holding my nose. Just getting more circulation and better metabolism going on in my airway was apparently enough to clear matters up no hands or extra head motion needed. It was also nice to feel the nice warm blood rushing back into my feet and to feel my heart rate going down. Indeed my “panic attacks” were times when I over breathed (hyperventilated) chronically. Eucapnic breathing became a very good tool to control the attacks!

As I thought about my heart rate going down I occurred to me that lowest heart rate with exertion held constant might make a very good indication of eucapnia (proper carbon dioxide levels). So on went my pulse/oximeter and finding the lowest heart rate controlling breathing while holding exertion constant became my task. Not a particular easy task. However in using my pulse/oximeter to do this I also noticed that the lowest heart rates were obtained along with the same SpO2 levels each time. SpO2 became a very useful guidepost. At about 100′ ASL 96% at desk or 97% while doing moderate exercise coincided with the lowest heart rates. Years later at 2500′ ASL (and in better shape) 95% at desk and 96% while doing moderate exercise became the guideposts for lowest heart rates.

My pulse/oximeter stayed on my wrist constantly for the next three months. I still think about proper breathing levels often each day and I do still use a pulse/oximeter to guide my breathing from time to time (mostly during exercise) but other physical things have become useful as guideposts:

1. A stuffy nose is usually the first indication that I am breathing too much. I have enjoyed several summers of “smelling the flowers” while in years past I would be booking it for the pharmacy. A very pleasant change indeed.

2. The “plumping” of the veins on the back of my hand has proven to be another easily accessible indicator. With the hands relaxed and basically at heart level plumping appears to indicate that I am breathing too much or too little. I do not see the veins when things are at proper levels.

3. A sneeze usually seems to indicate that I did not catch a stuffy nose in formation (changes in breathing level seem tied to emotional states, changes in air quality or temperature, and changes in lighting which can change quickly and without awareness). Now any sneezes are followed by thirty to forty seconds of no breathing if quiet or somewhat less time if active. I very very rarely sneeze twice anymore and sneeze much more rarely indeed.

4. Headaches are also very rare anymore. But a few minutes of eucapnic breathing levels would most always be all that was required to make them go away.

5. If I can hear my heart beat when I place my hand over my ear it usually means I am over breathing. If I am just a bit toward hypocapnic I will hear a “fush fush” sound. If a bit more and it is like someone knocking on wood. If I am near the point of getting dizzy or aura I will hear my heart sound like an engine knocking while holding my hand to my ear.

6. If my stomach is in a knot I have noticed that after several minutes of eucapnic levels of breathing are I will feel my stomach relax. Perhaps this is not so strange if you consider that the gut is often considered our “second brain” (enteric brain) along with the fact that the changes in circulation within the brain due to changes in carbon dioxide blood gas levels are profound (see: cerebrovascular CO2 reactivity)

7. Pain in my joints happens if I exercise while breathing too much. My personal trainer at the time (a Ph.D. Physiologist) confirmed arthritis in some of my joints (knees) and lots of movement does seem to keep this at bay. But if breathing is not controlled pain results while doing exercise but goes away when apparently eucapnic levels are restored using the pulse/oximeter as mentioned above.

8. While using CPAP especially near the anniversary of a traumatic attack I will sometimes wake up with a dry mouth. I am not a mouth breather. Simply – after eucapnic levels of breathing are restored (about 40 seconds after) – my mouth will become moist again. This is very consistent. My feet will also tend to be cold and will of course warm when levels become eucapnic. Sometimes there is a tendency for my legs to cramp which is also relieved as well. Sometimes I wonder if periodic leg movement and/or restless legs and similar maladies might be related to nighttime circulation issues. As I start the change (breath less) I will feel a strong air hunger which evaporates about fourty seconds later so perhaps the “illicit air hunger” is related to brain circulation issues!?

[1] http://en.wikipedia.org/wiki/Bohr_effect

[2] https://honesttocpap.wordpress.com/2015/09/20/neck-exercise-to-improve-the-cpap-experience/

[3] https://honesttocpap.wordpress.com/2014/09/28/now-using-modified-eers/