Post by Batch on Aug 20th, 2011 at 12:14pm
Hey Lobster,
Good question. The term hyperventilation means just that... ventilating the lungs as fully and completely as possible to the point where the exchange of oxygen and carbon dioxide (CO2) is more than needed. Taking rapid shallow breaths is not hyperventilating...
The most effective breathing technique to use in order to hyperventilate effectively when using oxygen therapy as an abortive for cluster headache involves breathing as deeply as possible at forced vital capacity tidal volumes.
Tidal volume is the lung volume representing the normal volume of air or oxygen displaced between normal inspiration and expiration when extra effort is not applied...
I'll explain... The critical part of the respiration cycle during this method of oxygen therapy is exhalation. You need to stand to give your diaphragm a full range of motion and lean against a wall (you will get dizzy and if you feel too dizzy, sit erect in an upright chair). Open your mouth and drop your jaw like saying the word "Haw" and exhale forcibly until it feels like there's no breath left to exhale... there is...
At that point do an abdominal crunch like doing sit-ups and hold the chest and abdominal squeeze until your exhaled breath makes a wheezing sound for a couple seconds. The crunch will squeeze out another half to a full liter of exhaled breath.
Then without delay, inhale rapidly until it feels like your lungs can't hold any more... then repeat the forced exhalation with a crunch. Repeat this sequence without hesitating between inhalation and exhalation and keep repeating it until the pain is completely gone.
Three things will happen when you use this breathing technique. The first thing is you'll start coughing... this is normal and the coughing will clear in 5 to 10 seconds. This is why you can take your time with the first 3 to 4 breaths using this procedure. When the coughing clears, you can start increase the respiration rate.
The second thing that will happen is you'll start to experience the symptoms of paresthesia after three to five respiration cycles using this breathing technique. The symptoms of paresthesia include a very slight tingling or prickling of the fingertips, lips, or back of the neck with no apparent long-term physical effect. You'll also experience a slight dizziness.
Strange as it may sound, the symptoms of paresthesia are your friend and they are the best indication you're breathing correctly for the fastest abort of your CH as possible. As you are using this breathing technique to voluntarily hyperventilate, the symptoms of paresthesia will clear in 10 to 15 seconds after you return to a normal respiration rate.
The third thing that will happen is you'll get tired. If you're executing this breathing technique properly, it's hard work... but well worth the effort.
The reason for using this breathing technique is simple. It's the most effective way to push your system into respiratory alkalosis as fast as possible. As the last volume of exhaled breath (the end tidal flow), contains the highest concentration of CO2, using this breathing technique will pump CO2 from your lungs through exhaled breath faster than your body generates it through normal metabolism.
Lowering CO2 levels with this breathing technique elevates your arterial pH making it more alkaline, hence the name respiratory alkalosis. This condition stimulates vasoconstriction of the arteries and capillaries in an around the trigeminal ganglion to start the abort process.
This is an important bio-mechanical step in the process of aborting a cluster headache as narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels counteracts the vasodilation associated with the cluster headache syndrome that's causing all the pain.
If you think about it, sumatriptan succinate (imitrex, imigran) or any of the other family of triptans do the same thing... only they carry some onerous side effects and costs a lot more per abort than oxygen...
When you combine this breathing technique with 100% oxygen, you cast off the 80% nitrogen in normal air you've been breathing (Nitrogen is inert and just taking up space) and you replace it with oxygen. This gives you the benefit of hyperoxia, a vasoconstrictor. You also get the benefits of respiratory alkalosis with reduced CO2 levels (a condition called [i[hypocapnia[/i] and an elevated arterial pH, both of which act as powerful vasoconstrictors.
For the final benefit of using this breathing technique with 100% oxygen... You get the Bohr effect... This is where blood hemoglobin has a greater affinity for oxygen when arterial pH is elevated above normal. When this happens, each molecule of hemoglobin is capable of loading more oxygen molecules than normal and this super oxygenates the blood flow to the brain further increasing the level of cerebral vasoconstriction... and that makes the abort come even faster.
Now for the $64,000 question... as asked by Sir Laurence Olivier in the 1976 film classic Marathon Man, as he drills holes Dustin Hoffman's teeth without anesthesia... Is it safe?
The simple answer is yes... very safe.
Some of you may have read that hyperventilating like this can cause localized ischemia (areas of restricted blood flow or supply) in the brain. It turns out this is true. However, as the blood entering the brain while using this breathing technique with 100% oxygen is super oxygenated, the actual oxygen perfusion within the brain tissues is actually increased above that achieved while breathing 100% oxygen at normal respiration rates with normal CO2 levels.
I've attached the results of a fascinating study by B.F. Matta et al. titled: "The influence of arterial oxygenation on cerebral venous oxygen saturation during hyperventilation that explains all this in detail. I'll give you the bottom line conclusions if you don't want to wade through the entire article... You'll have to pick through technical jargon, but I think you'll get the big picture...
"It is likely that hypocapnia, even at PaCO2 of 30 mmHg, results in cerebral vasoconstriction that exceeds any vasoconstrictive effect of normobaric hyperoxia.
We conclude that hyperoxia during acute hyperventilation in the anaesthetized patient improves oxygen delivery to the brain as measured by increased cerebral venous oxygen content and saturation."
You'll need an oxygen demand valve or an oxygen regulator capable of delivering oxygen at a minimum flow rate of 25 liters/minute or higher and an O2PTIMASK™ with the 3-Liter reservoir bag to get the full benefit of using this breathing technique. Both methods work equally well and each has its advantage.
If you're stuck with an oxygen regulator that can only deliver a max flow rate of 15 liters/minute, you've got two options while you're waiting for the high flow regulator…
Use the above breathing technique, but alternate the procedure by breathing air for two breaths to one breath of 100% oxygen and keep repeating this sequence.
This procedure won't be as effective as breathing 100% oxygen with every breath, but you'll still achieve hypocapnia and the level of hyperoxia will be sufficient to achieve an abort faster than breathing the 100% oxygen with every breath at a flow rate of 15 liters/minute. It will also give the reservoir bag time to fill while you're breathing air.
If you're feeling adventuresome, you can always try the other alternative and build yourself a redneck reservoir bag out of a clean 40 gallon trash bag or 55 gallon drum liner. You can find the directions for building one of these Rube Goldberg lash-ups at either of the following links:
START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to
or 
END PRINTPAGE See reply #25
START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to or END PRINTPAGE
See reply #16,
This contraption works surprisingly well and I've used one on several occasions… It also has the least inhalation resistance of any breathing device I've used.
Once you get used to this breathing technique, you'll find like many of us that a flow rate of 40 liters works best as it's sustainable without getting too pooped out and it results in the fastest aborts possible.
Now I know there are some of you that have been told never to do this as you'll pass out and stop breathing... To this I say after more than five years using this breathing technique… I can't tell you how many times I've prayed to pass out while using this breathing technique to abort a cluster headache... just to get away from the pain of the heavy hitters... As much as I wanted it to happen... it never did.
Even if you did pass out and stop breathing, (again, this has never happened to me in over five years using this breathing technique), when the arterial CO2 levels build back up to the triggering point, you'll start breathing again with a snort. Sound familiar... Like sleep apnea? Remember, it's arterial CO2 levels that control the respiration rate... not oxygen levels.
One last thing some of you may notice after you've used this breathing technique for a few weeks while hyperventilating on 100% oxygen to beat down the beast... your lung functions improve.
I used a spirometer to calibrate my tidal volumes while developing this method of oxygen therapy. What I noticed after a few weeks of using this method of oxygen therapy was the maximum tidal volume I could achieve, actually increased.
There's a simple reason for this... Working the diaphragm and the intercostal muscles between and over the ribs that expand and contract the chest cavity during this method of oxygen therapy, causes them to tone up and they start working more efficiently.
With all that said, practice this breathing technique with room air and try to remember the sensations of paresthesia so you'll know what to do when you use it for real with 100% oxygen on your next cluster headache. Hope this helps.
Take care,
V/R, Batch
Good question. The term hyperventilation means just that... ventilating the lungs as fully and completely as possible to the point where the exchange of oxygen and carbon dioxide (CO2) is more than needed. Taking rapid shallow breaths is not hyperventilating...
The most effective breathing technique to use in order to hyperventilate effectively when using oxygen therapy as an abortive for cluster headache involves breathing as deeply as possible at forced vital capacity tidal volumes.
Tidal volume is the lung volume representing the normal volume of air or oxygen displaced between normal inspiration and expiration when extra effort is not applied...
I'll explain... The critical part of the respiration cycle during this method of oxygen therapy is exhalation. You need to stand to give your diaphragm a full range of motion and lean against a wall (you will get dizzy and if you feel too dizzy, sit erect in an upright chair). Open your mouth and drop your jaw like saying the word "Haw" and exhale forcibly until it feels like there's no breath left to exhale... there is...
At that point do an abdominal crunch like doing sit-ups and hold the chest and abdominal squeeze until your exhaled breath makes a wheezing sound for a couple seconds. The crunch will squeeze out another half to a full liter of exhaled breath.
Then without delay, inhale rapidly until it feels like your lungs can't hold any more... then repeat the forced exhalation with a crunch. Repeat this sequence without hesitating between inhalation and exhalation and keep repeating it until the pain is completely gone.
Three things will happen when you use this breathing technique. The first thing is you'll start coughing... this is normal and the coughing will clear in 5 to 10 seconds. This is why you can take your time with the first 3 to 4 breaths using this procedure. When the coughing clears, you can start increase the respiration rate.
The second thing that will happen is you'll start to experience the symptoms of paresthesia after three to five respiration cycles using this breathing technique. The symptoms of paresthesia include a very slight tingling or prickling of the fingertips, lips, or back of the neck with no apparent long-term physical effect. You'll also experience a slight dizziness.
Strange as it may sound, the symptoms of paresthesia are your friend and they are the best indication you're breathing correctly for the fastest abort of your CH as possible. As you are using this breathing technique to voluntarily hyperventilate, the symptoms of paresthesia will clear in 10 to 15 seconds after you return to a normal respiration rate.
The third thing that will happen is you'll get tired. If you're executing this breathing technique properly, it's hard work... but well worth the effort.
The reason for using this breathing technique is simple. It's the most effective way to push your system into respiratory alkalosis as fast as possible. As the last volume of exhaled breath (the end tidal flow), contains the highest concentration of CO2, using this breathing technique will pump CO2 from your lungs through exhaled breath faster than your body generates it through normal metabolism.
Lowering CO2 levels with this breathing technique elevates your arterial pH making it more alkaline, hence the name respiratory alkalosis. This condition stimulates vasoconstriction of the arteries and capillaries in an around the trigeminal ganglion to start the abort process.
This is an important bio-mechanical step in the process of aborting a cluster headache as narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels counteracts the vasodilation associated with the cluster headache syndrome that's causing all the pain.
If you think about it, sumatriptan succinate (imitrex, imigran) or any of the other family of triptans do the same thing... only they carry some onerous side effects and costs a lot more per abort than oxygen...
When you combine this breathing technique with 100% oxygen, you cast off the 80% nitrogen in normal air you've been breathing (Nitrogen is inert and just taking up space) and you replace it with oxygen. This gives you the benefit of hyperoxia, a vasoconstrictor. You also get the benefits of respiratory alkalosis with reduced CO2 levels (a condition called [i[hypocapnia[/i] and an elevated arterial pH, both of which act as powerful vasoconstrictors.
For the final benefit of using this breathing technique with 100% oxygen... You get the Bohr effect... This is where blood hemoglobin has a greater affinity for oxygen when arterial pH is elevated above normal. When this happens, each molecule of hemoglobin is capable of loading more oxygen molecules than normal and this super oxygenates the blood flow to the brain further increasing the level of cerebral vasoconstriction... and that makes the abort come even faster.
Now for the $64,000 question... as asked by Sir Laurence Olivier in the 1976 film classic Marathon Man, as he drills holes Dustin Hoffman's teeth without anesthesia... Is it safe?
The simple answer is yes... very safe.
Some of you may have read that hyperventilating like this can cause localized ischemia (areas of restricted blood flow or supply) in the brain. It turns out this is true. However, as the blood entering the brain while using this breathing technique with 100% oxygen is super oxygenated, the actual oxygen perfusion within the brain tissues is actually increased above that achieved while breathing 100% oxygen at normal respiration rates with normal CO2 levels.
I've attached the results of a fascinating study by B.F. Matta et al. titled: "The influence of arterial oxygenation on cerebral venous oxygen saturation during hyperventilation that explains all this in detail. I'll give you the bottom line conclusions if you don't want to wade through the entire article... You'll have to pick through technical jargon, but I think you'll get the big picture...
"It is likely that hypocapnia, even at PaCO2 of 30 mmHg, results in cerebral vasoconstriction that exceeds any vasoconstrictive effect of normobaric hyperoxia.
We conclude that hyperoxia during acute hyperventilation in the anaesthetized patient improves oxygen delivery to the brain as measured by increased cerebral venous oxygen content and saturation."
You'll need an oxygen demand valve or an oxygen regulator capable of delivering oxygen at a minimum flow rate of 25 liters/minute or higher and an O2PTIMASK™ with the 3-Liter reservoir bag to get the full benefit of using this breathing technique. Both methods work equally well and each has its advantage.
If you're stuck with an oxygen regulator that can only deliver a max flow rate of 15 liters/minute, you've got two options while you're waiting for the high flow regulator…
Use the above breathing technique, but alternate the procedure by breathing air for two breaths to one breath of 100% oxygen and keep repeating this sequence.
This procedure won't be as effective as breathing 100% oxygen with every breath, but you'll still achieve hypocapnia and the level of hyperoxia will be sufficient to achieve an abort faster than breathing the 100% oxygen with every breath at a flow rate of 15 liters/minute. It will also give the reservoir bag time to fill while you're breathing air.
If you're feeling adventuresome, you can always try the other alternative and build yourself a redneck reservoir bag out of a clean 40 gallon trash bag or 55 gallon drum liner. You can find the directions for building one of these Rube Goldberg lash-ups at either of the following links:
START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to
or END PRINTPAGE See reply #25START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to
or END PRINTPAGESee reply #16,
This contraption works surprisingly well and I've used one on several occasions… It also has the least inhalation resistance of any breathing device I've used.
Once you get used to this breathing technique, you'll find like many of us that a flow rate of 40 liters works best as it's sustainable without getting too pooped out and it results in the fastest aborts possible.
Now I know there are some of you that have been told never to do this as you'll pass out and stop breathing... To this I say after more than five years using this breathing technique… I can't tell you how many times I've prayed to pass out while using this breathing technique to abort a cluster headache... just to get away from the pain of the heavy hitters... As much as I wanted it to happen... it never did.
Even if you did pass out and stop breathing, (again, this has never happened to me in over five years using this breathing technique), when the arterial CO2 levels build back up to the triggering point, you'll start breathing again with a snort. Sound familiar... Like sleep apnea? Remember, it's arterial CO2 levels that control the respiration rate... not oxygen levels.
One last thing some of you may notice after you've used this breathing technique for a few weeks while hyperventilating on 100% oxygen to beat down the beast... your lung functions improve.
I used a spirometer to calibrate my tidal volumes while developing this method of oxygen therapy. What I noticed after a few weeks of using this method of oxygen therapy was the maximum tidal volume I could achieve, actually increased.
There's a simple reason for this... Working the diaphragm and the intercostal muscles between and over the ribs that expand and contract the chest cavity during this method of oxygen therapy, causes them to tone up and they start working more efficiently.
With all that said, practice this breathing technique with room air and try to remember the sensations of paresthesia so you'll know what to do when you use it for real with 100% oxygen on your next cluster headache. Hope this helps.
Take care,
V/R, Batch