I have used o2 for ch abortion successfully. Now I have a hyperventilation (chest pain, hard to breath or breathing very shallow, headache, numbness, tingling, nausea, dizziness). Breathing to paper bag eases the symptoms.

So the question is. How to treat CH with o2 without Hyperventilation? Any suggestions how to stop hyperventilating? How long do I have to avoid O2?

I have a bad headache (not CH though) related to the Hyperventilation.

You can try setting your regular to 10, 12, or 15Lpm and just breathe regularly.  See if that will work for you, breathing in only the pure oxygen.  It may be an 8-10 minute span before it catches hold, reduces, and dissipates a hit, but is still a consistent abortive method for many.

thanks, it seems i still have to practise...but the main thing is that it works.

Hey Sagandra,

Sorry you're having problems with oxygen therapy at flow rates that support hyperventilation.  At least it's working...

In order to help I need a bit more info...  What flow rate are you using or do you use a demand valve?

What is your average abort time with this method of oxygen therapy? 

Most of the symptoms you've experienced are quite normal for this method of oxygen therapy...  They usually include coughing for the first 15 to 20 seconds until your lungs adapt to the dryness of the oxygen...  and Paresthesia - a very slight tingling or prickling of the fingertips, lips, back of the neck...

Dizziness and some numbness are also common... Even with the dizziness, I've not seen any reports of CH'ers passing while out using this method of oxygen therapy... 

I suspect it might be that you've never experienced these symptoms before...

Without any warning... or head-zup these symptoms are going to happen during this method of oxygen therapy, they can be a bit daunting and a little spooky at first... 

When you finally realize the symptoms of paresthesia are harmless and they're actually your friend as they indicate the abort will come much faster than at a flow rate of 15 liters/minute...  (like three to four times faster...) they become a lot less worrisome.

The symptoms you mentioned that don't sound quite right are the chest pains and nausea... 

Chest pain on inhalation triggering the need to breathe very shallow sound more like imitrex overuse...  If you're also taking imitrex... how much are you taking and for how many days?

The body also reacts to cluster headache pain in several ways and a high pain level cluster headache can trigger nausea in some CH'ers...  High level cluster headache pain can also trigger the need for a bowel movement... If that happens... go.

Finally, if you're using this method of oxygen therapy properly...  it's hard work!   

The body reaches respiratory alkalosis with some of the symptoms you described in one to two minutes after starting oxygen therapy at flow rates that support hyperventilaion... 

It usually takes less than a minute for the symptoms of paresthesia to dissipate after stopping this method of oxygen therapy and you start breathing room air at a normal respiration rate. 

Are you saying some of the symptoms you described are lasting longer than that after stopping this method of oxygen therapy?

Perhaps if we could talk, by phone or Skype, we might be able to work out some of these issues... 

I've coached hundreds of CH'ers through this method of oxygen therapy over the last five years. PM me with your phone number or give me a Skype call... I'll be happy to help.

Take care,

V/R, Batch

sagandra wrote on Sep 16^th, 2012 at 5:05pm:

I have used o2 for ch abortion successfully. Now I have a hyperventilation (chest pain, hard to breath or breathing very shallow, headache, numbness, tingling, nausea, dizziness). Breathing to paper bag eases the symptoms. So the question is. How to treat CH with o2 without Hyperventilation? Any suggestions how to stop hyperventilating? How long do I have to avoid O2? I have a bad headache (not CH though) related to the Hyperventilation.

It isn't clear from what you have written whether you are deliberately hyperventilating as part of your oxygen therapy strategy, or whether hyperventilation is occurring without deliberate intent whenever you use Oxygen.

As Batch has said hyperventilation while using oxygen seems to increase the benefit in many people. However if it is causing unpleasant symptoms for you then it would certainly be worth trying without it. In a well known study of the benefit of O2 in CH (Cohen et al) there was a 78% benefit rate for using O2 and it would seem this was without hyperventilation. So it may well be worth just using a reasonably high flow rate of O2 without hyperventilation and see if you gain benefit.

It is important to note that the symptoms of hyperventilation will not do you any harm. Once you stop hyperventilating the symptoms will resolve, but it can take time. I have treated hundreds of patients who have had hyperventilation as a result of anxiety and it is clear they find the symptoms extremely unpleasant and fear of the symptoms often worsens their anxiety, hence leading to further hyperventilation. With severe hyperventilation from anxiety it can take some time for the syptoms to resolve after the hyperventilation has stopped. In some cases it can take a good 15 - 20 min.

The symptoms you have described are quite typical of hyperventilation (with the exception of headache). Tingling and numbness, especially around the face and in the fingers and hands are the most common. Muscle spasms can occur, most commonly affecting the fingers (feeling very stiff), but I have seen arms and even legs involved in bad cases.  Dizziness and feeling lightheaded or faint are also common.

Chest pain can occur, and often leads to increased anxiety as people think they are having a heart attack so get more anxious and hyperventilate even more. Typically people say they feel as if they can't breathe or that it is very hard to breathe, but in fact this is clearly not the case since they are getting more than enough air into their lungs!

it is worth noting that the symptoms aren't generally due to high oxygen levels, but rather low CO2 levels. Rapid or deep breathing results in the bodys normal CO2 being 'blown off' excessively which alters the acid-base balance of the blood and causes the symptoms. This however will not do you any harm and will correct itself when hypervetilation ceases. So don't be concerned that you are getting too much O2, or that you need to use less O2 when treating your CH.

As I said it is hard to know from what you have said whether your hyperventilation is deliberate as part of your O2 strategy (as often recommended) or whether you are for some reason becoming anxious either about using O2, or about the pain of the headache itself.   

I am also wondering if you are continuing to hyperventilate after your treatment has ceased. Sometimes people start breathing fast for good reason (eg exercise or asthma) and after that reason is no longer present they nevertheless continue to breathe too fast, and end up hyperventilating.

I would suspect that most people who use a deliberate hyperventilation strategy as part of their O2 use would only experience mild symptoms (a bit of tingling and maybe a bit dizzy) and that these symptoms would resolve quite quickly (within a couple of minutes). Personally I get very little in the way of symptoms at all. The fact that you are getting fairly strong symptoms suggests either you have a greater than average susceptibilty (we all have our differences), or that you have a strong anxiety component that is leading you to hyperventilate to a high extent.

G'Day BlueDevil,

Bonzer response...  You're my kind of paramedic!

Take care mate.

V/R, Batch

I have found that it is the pain that drives my hyperventilating, as the pain subsides I return to normal breathing, adjusting the O2 as necessary. And yes, the tingly feeling is your friend.

ttnolan wrote on Sep 18^th, 2012 at 7:53pm:

I have found that it is the pain that drives my hyperventilating, as the pain subsides I return to normal breathing, adjusting the O2 as necessary. And yes, the tingly feeling is your friend.

Yeah..pain in general frequently leads to rapid breathing, so quite feasible that CH would lead to a degree of hyperventilation.

BlueDevil wrote on Sep 19^th, 2012 at 6:23am:

Yeah..pain in general frequently leads to rapid breathing, so quite feasible that CH would lead to a degree of hyperventilation.

This adds a good awareness.  My post simply addressed only this question in her post:


sagandra wrote on Sep 16^th, 2012 at 5:05pm:

So the question is. How to treat CH with o2 without Hyperventilation?

You responded to this in the same fashion also.


BlueDevil wrote on Sep 18^th, 2012 at 12:24am:

...hyperventilation while using oxygen seems to increase the benefit in many people. However if it is causing unpleasant symptoms for you then it would certainly be worth trying without it. In a well known study of the benefit of O2 in CH (Cohen et al) there was a 78% benefit rate for using O2 and it would seem this was without hyperventilation. So it may well be worth just using a reasonably high flow rate of O2 without hyperventilation and see if you gain benefit.

But there was another question.


sagandra wrote on Sep 16^th, 2012 at 5:05pm:

Any suggestions how to stop hyperventilating?

This brings into being your further inquiry.


BlueDevil wrote on Sep 18^th, 2012 at 12:24am:

It isn't clear from what you have written whether you are deliberately hyperventilating as part of your oxygen therapy strategy, or whether hyperventilation is occurring without deliberate intent whenever you use Oxygen.

BlueDevil wrote on Sep 18^th, 2012 at 12:24am:

...it is hard to know from what you have said whether your hyperventilation is deliberate as part of your O2 strategy (as often recommended) or whether you are for some reason becoming anxious either about using O2, or about the pain of the headache itself.

Your post goes on very well in this respect as to the after-effects experienced.




BlueDevil wrote on Sep 18^th, 2012 at 12:24am:

I am also wondering if you are continuing to hyperventilate after your treatment has ceased. Sometimes people start breathing fast for good reason (eg exercise or asthma) and after that reason is no longer present they nevertheless continue to breathe too fast, and end up hyperventilating. ... The fact that you are getting fairly strong symptoms suggests either you have a greater than average susceptibilty (we all have our differences), or that you have a strong anxiety component that is leading you to hyperventilate to a high extent.

Good wondering and thanks for the info.   :)

Is this a anything of a possible clue or too little to speculate? 


Quote:

Breathing to paper bag eases the symptoms.

It all sheds light on this question, also a bit intriguing.


sagandra wrote on Sep 16^th, 2012 at 5:05pm:

How long do I have to avoid O2?

Avoiding sounds difficult.  It can be tried at 10-15Lpm if hyperventilating has been deliberate, but basically if it can be done without hyperventilating would be something to try for two possible reasons it seems, encompassing your first post in this thread.


BlueDevil wrote on Sep 19^th, 2012 at 6:23am:

Yeah..pain in general frequently leads to rapid breathing, so quite feasible that CH would lead to a degree of hyperventilation.

Quote:

Is this a anything of a possible clue or too little to speculate?  [quote]Breathing to paper bag eases the symptoms.

[/quote]

Breathing into a paper bag bag results in rebreathing of CO2, thereby increasing the CO2 levels in the body. This helps to alleviate the symptoms of hyperventilation by restoring the normal balance of CO2 in the body.

HOWEVER, rebreathing with a paper bag went out many years ago as a first aid measure for treating hyperventilation. The main reason behind this was that lay people may misdiagnose a serious respiratory condition as hyperventilation and treat it with a paper bag rather than oxygen. Rebreathing into a paper bag will significantly lower oxygen levels since you are basically using up all the oxygen but not replacing it. The extent to which this happens will depend on how closely the bag is sealed to the face (I have seen someone become quite blue from lack of oxygen when rebreathing from a tightly sealed bag). As you could imagine if someone had rapid breathing due to a clot in the lungs (pulmonary embolus), for example, and they were treated with a paper bag it would make their condition worse, and could have dire consequences. Even in someone who is genuinely hyperventilating (ie no other medical cause) it is not desirable to lower you O2 levels by rebreathing. Also, in some cases, having a bag stuck over the face may just increase the patients anxiety and make they hyperventilate more!

To return to the case of the original poster though, it is quite possible that using a paper bag will speed up recovery a little, but the best means of recovery is simply to get the breathing under control and let nature restore the bodies balance. Once the breathing has slowed to a normal rate the symptoms will disappear of their own accord. With regard to Sagandra though it should be noted that using a paper bag will lower oxygen levels when in fact the whole point of breathing oxygen in the first place is to elevate levels. Personaly I would prefer to keep the O2 levels in my sytem as high as possible after finishing on the O2, rather than using a procedure that may lower them below normal.