Leading Integrated Healthcare

Breathing Pattern Disorder, Hyperventilation, Overbreathing


Breathing Pattern Disorder (BPD) is a combination of individual symptoms which, on their own, may all be attributed to other causes, but collectively, may make up a breathing pattern disorder. These symptoms are all actually due to low levels of CO2 (carbon dioxide), as opposed to the common misconception that the cause is insufficient intake oxygen.

BPD is diagnosed using physical assessment, a validated questionnaire (the Nijmegen) and a machine that measures respiratory CO2 levels (a Capnometer). Symptoms of Breathing Pattern Disorders can cause fatigue, abdominal bloating, brain fog, muscular aches and pains, pins and needles in arms and hands, feeling of anxiety, palpitations, muscular fatigue, and headaches. They can also cause sighing or yawning, gasping for air during speech, a feeling that breathing is unnatural or difficult, breath holding and clenching of the teeth.

Hyperventilation Syndrome (HVS) is a disorder that often presents with chest pain and a tingling sensation of the fingertips (paresthesia) and around the mouth, as well as deep and labored breathing (causing hyperventilation), although chronic but subtle hyperventilation can cause these symptoms too. Hypocapnia is a deficiency of carbon dioxide in the blood, resulting from hyperventilation and eventually leading to alkalosis.

People who over-breathe often complain of symptoms that include

  • Light headedess
  • Head neck and upper body aching/pain
  • Giddiness/Dizziness
  • Anxiety
  • Shortness of breath
  • Heart palpitations
  • Numbness
  • Chest pains
  • Dry mouth
  • Clammy hands
  • Difficulty swallowing
  • Tremors
  • Sweating
  • Weakness
  • Fatigue


Breathing re-training is usually helpful for people who

  • Feel depressed
  • Feel exhausted
  • Feel tense or achy
  • Have difficulty sleeping
  • Have difficulty concentrating
  • Feel agitated or anxious

Breathing Pattern Disorders influence health due to

  • Altered blood pH, creating respiratory alkalosis
  • Increased sympathetic arousal, altered neuronal function (including motor control)
  • Sense of apprehension, anxiety, affecting balance (and possibly panic)
  • Depleted Ca and Mg ions, enhancing sensitization, encouraging spasm, reducing pain thresholds
  • Smooth muscle cell constriction, leading to vasoconstriction (and possibly altering fascial tone)
  • Smooth muscle constriction can also lead to colon spasm and pseudo-angina
  • Reduced oxygen release to cells, tissues, brain (Bohr effect) – encourages ischemia, ‘brain-fog’, fatigue & pain
  • Evolution of myofascial trigger points
  • Biomechanical overuse stresses that compromise core stability and posture, and cause pain


Dr Kaplan: Provocative Therapy

In December 2012, as result of a stress at work, I suffered from severe anxiety, fear, panic attacks, tachycardia and insomnia.These symptoms became increasingly severe and were associated with low self-esteem and loss of self-confidence. I consulted my GP who prescribed Citalopram and beta blockers for the tachycardia. The antidepressant did not suit me and I felt worse. I was then referred to Dr Brian Kaplan, to be treated with the ‘Provocative Therapy’. This treatment adapted by Dr Kaplan, is based on the principle that the therapist ask questions covering all aspects of the patient’s life, by exaggerating the meanings of it. During the 1 hour session, the patient experiences a strong reaction, triggered by the ‘Provocative’ input of the therapist. Initially, there is an increased fear with regression to the childhood, associated to strong emotions and sorrow, which may precipitate sobbing. Subsequently, this state is followed by a phase of self-analysis which is more constructive. The ‘provocation’ breaks the pattern of the patient’s own feelings of hopelessness and discomfort. In fact, there is an opening of the self-image and a critical strong desire for change, in response to the provocation, which can be at times, outrageous. I underwent 9 weekly sessions during which I progressively became free from fear. The anxiety and panic attacks reduced significantly and I started to know what I want from my life and became more positive and optimistic. At the end of the 9 weeks, I acquired my self-confidence and self – esteem together with a new approach in my life which initially appeared to me broken and rather useless. The 9 sessions – in my opinion – were sufficient to resolve the initial acute state with anxiety and I felt a person full of interest and happier.  It is more than one year since I started the ‘provocative therapy’ with Dr Kaplan and I have not had any relapse to the original symptoms and discomfort. I strongly recommend this this therapy as a novelty; this is medication- free and can produce resolution of the acute psychological/mental conditions, quicker than the conventional therapies. In order to be successful, it is crucial that the patient collaborates and has complete trust in the therapist. The scientific process of such a treatment is not yet known and /or clarified. However, a number of recent studies in Neurophysiology and Psychiatry have shown the importance of hexogen and endogen stimuli, which can triggers and induce changes in the brain in response to the external inputs, acting via the hypothalamic/endocrine axes. It can be suggested that some of these mechanisms may be involved in the therapeutic process of the Provocative Therapy, but a lot of work needs to be in hand.