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sue1234

Standing Co2 Clue To Why We Get Lightheaded??

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I read this article today:

http://www.ncbi.nlm.nih.gov/pubmed/22156614

At first, I was thinking "oh gosh, now they'll all think we have POTS because we panic". But, then I thought that we ALL know better, that this person didn't panic in the sense of a "psych" issue. The person "panicked" because the brain was not getting enough oxygen, and the adrenaline kicked in--a pure and simple body response to a metabolic crisis.

So, then I was thinking about Rama's post from a few days ago about cerebral hypoperfusion. This could explain it. Low CO2 causes vasoconstriction.

I guess the take away from this article is, it always comes back to keeping the brain perfused. If we breathed in a bag, I guess we could keep the CO2 levels up. That would keep the vasodilation going in the brain. But, would it compromise our standing ability at all? Would it help our standing ability at all? Any thoughts?

I have definitely noticed that, in general, since POTS began I seem to breathe slower all the time. My breathing had changed that much that I actually noticed it. I have no clue why. When I'm sitting real close to my husband, it seems he is hyperventilating compared to me, but he is just breathing like a normal person. So, why would I be breathing slower with my condition, even sitting?

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Hi Sue

I have actually noticed changes to my breathing pattern also since getting POTS....mine varies though....sometimes it seems so slow I feel like I have to remind myself to breathe....other times I notice I am breathing much more shallow than I used to ....I take alot more deep breaths out of no where and for no reason.......oddly enough though when given oxygen in hospital it almost makes me feel worse....sometimes I think thats because my body doesnt know what to do with all the extra oxygen :P

Bren

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Bren, I totally know what you mean! I seem to breathe shallower, also, and also seem to take those random deep breaths.

I actually only breathe through my nose. When I try and breathe through my mouth, I feel like I am getting too much air, if that makes any sense. Kind of like you said about when you get oxygen, our bodies don't know what to do with it.

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I have the same breathing patterns Bren describes. And, when I take one of those deep breathes, it gives me an adrenaline rush. I can feel the adrenaline wash through my arms within 1-2 seconds of the exhale.

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This is a good point. When I first started exhibiting symptoms 4 years ago, i realized I was holding my breath all the time. After trying not to breathe whenever i would.get a spell it would.go away. Now though, that doesn't work. However the past few weeks I keep catching myself sleeping with my head under the covers which is.something I had never done.before.

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Sue....thats interesting I have a hard time breathing through my mouth also.....like its too much air at once and the lungs/system isnt used to it.....I also have a deviated septum and suffer chronic congestion....I think over the years my body has gotten used to a lesser amount of oxygen

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I actually have it where I am asleep and wake up suddenly and take a deep breath because I think I wasnt breathing...not sure if it is connected, but its scary! I think I stop breathing in my sleep.

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We have actually had this subject come up before. If you do a search on carbon dioxide - there's some pretting interesting threads about it. It makes sense that we could have too much and then it causes us to hyperventilate in order to expel the carbon dioxide and get in more oxygen. Could be a connection to the way we breathe (or don't breathe, in this case). In our sleep it could be related to brain dysfunction that regulates our breathing - called central sleep apenea. I have both kinds of apenea and it does affect your O2 levels and the way you breathe. Carbon dioxide also affects the way the veins dilate and/or constrict.

Issie

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I've been told that 30% of those with dysautonomia have sleep apnea, so when I was diagnosed, my doctor sent me to get a sleep study, and sure enough, I had it. I had many episodes, where I would wake up gasping. My husband had to poke me on several occasions, so I would start breathing again, when I was sleeping on my back, especially. I slept like this for too many years and was exhausted. I had two nights of sleep studies, and on the first night, I had 91 arousals during my test, 64 hypopneas and 15 apneas. My O2 concentrations where pretty good, actually, and most people with this disorder have Obstructive Apnea instead of Central Sleep Apnea, except those with Multiple Systems Atrophy, which is progressive. I now sleep with a Cpap (Continuous Positive Airway Pressure) machine, and I am finally getting the sleep I need. My heart palpatations would constantly wake me up in the middle of the night, because of my Mitral Valve Prolapse. I would become tachycardic in a supine position, too. Now I'm on a beta blocker, and that doesn't happen as often as it used to, and I am finally getting my much needed sleep. I am on clonazepam, as well. That also relaxes me to rest easy:o)

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I had a sleep study and it didn't show any apnea. It did show that I don't sleep well, though, but I think that is due to too much adrenaline from low glucose in the night. I think there is something where when there is a metabolic acidosis or alkalosis, the respiratory system kicks in the change the pH. I know it works both ways, too, that the metabolic system will alter the pH for the respiratory system. I haven't studied all that in 25 years, so definitely don't remember much about it. Who knows, maybe my hypoglycemia has chronically altered my pH system. I know some of the meds for diabetes can cause a met. acidosis or alkalosis, so maybe hypos do alter it all.

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I think we all have different mechanisms at work that cause less oxygen in the brain. Some have pooling, others have low blood volume, some have EDS. I am not sure that keeping up CO2 levels would necessarily help - seems like more of a symptom than a cause. I do hold my breath too.

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They have msot likely misinterpreted what is occuring in this patient. In some POTS patients there is unusual chemoreceptor activity which results in reflex deep breathing which pushes them into hypocapnia. Dr Stewart and Medows have done a fair bit of work on this.

Panic type feelings occur in lots of cardiac conditions and often relate to the body attempting to utilise adrenaline to correct abnormal circulatory control. It doesnt usually help much and the subsequent hyperventilation can cause hypocapnia which itself can induce anxiety as well. it also leads to hypoxia.

http://www.ncbi.nlm.nih.gov/pubmed/16565300

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Oh, I agree Rama that they ultimately missed the point of the panic. What strikes me in the study you listed is 50% of the POTS patients did NOT have hypocapnia, yet 100% of the POTS patients had splanchnic pooling, which would lead to all having reduced thoracic volume. I feel that my body acts just like the hypocapnia patients, as I end up with the peripheral vasoconstriction.

So, what makes 50%(roughly, according to their study) of us end up with hypocapnia? From everything I've read, every POTS patient is getting less brain perfusion, yet half don't react. Now I'm real curious.

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I have always felt like my slower breathing (really all the changes in my breathing patterns) is my body's response to trying to regulate my heart rate and therefore my blood oxygen levels. I suspect there are multiple chemical reactions that are off in us that we are consciously and unconsciously compensating for all the time with POTS. I think of the breathing as just another counter-maneuver.

I also was dx'ed with mild sleep apnea and they wanted me to use a CPAP machine but it made me so nauseous, dizzy, adren. surgy, tachy in the first 15-20 minutes of having it on that I didn't keep it on. I tried for several nights and it was no good. Similar to Bren's comment, it seemed like it was too much air at one time even on the lowest setting.

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Yeah, the cpap is very annyoing and sometimes I just CAN'T wear it. I've had it for about 2 years now and am still fighting with it. I've had about 6 different kinds of headgear and settled on the nasal pillow ones by OPUS 360, as the most comfortable. Allot of the toleration is what the headgear is. I have claustaphobia and this one didn't make it as bad. It will initially give you surges of panic to start with. I have to lie in bed and get settled and relaxed and then put it on. The doctor - who also wears one - says he sits in bed and reads with it on before he tries to go to sleep and gets his body used to having it on and then tries to go to sleep. In one sense, I think it does cause the tachy thing worse when your awake - but, when you finally do go to sleep - it really helps the oxygen levels and it allows your partner to sleep with you in silience. LOL Most partners of people with apenea want them to wear it - my hubby would stay awake at night worrying that I wouldn't take another breath and he'd wake me up to breathe. Neither of us was getting sleep. It takes allot of determination to use it.

Issie

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I believe that sudden "deep breath" that so many of us experience is referred to as "breath hunger" in the medical community. It's been a frequent and very annoying symptom I've had over the last few years. I've also had all of the symptoms others have already described above. Haven't had a sleep study though. Have tried breathing into a paper bag to try to stop the hyperventilating that was occurring at times but it's not helped.

I keep hoping they'll figure something out related to this because it sure is involved somehow. My lung function always tests fine. I've had O2 help my symptoms once but never again.

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There's different opinions as to whether for us it's good to breathe into a paper bag. That causes you to uptake more CO2 and it may be instead of it being too low - it could be too high and we hyperventilate to expel the CO2 - thus taking up more O2. Just a possible flip - possibility. If you breathe into a paper bag, you re-breathe CO2 instead of O2.

Issie

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That makes sense Issie. Seems to be more likely in my case too. I found I had to remove the paper bag because it was making me worse, not better. I tried it out of desperation before I was diagnosed. I think, in retrospect, that I probably was severely hypotensive before I started hyperventilating but wasn't able to sort out symptoms at the time. Just knew the end result was hyperventilation and I was trying desperately to find anything to help the symptoms.

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I have had my carbon dioxide levels checked a few times ( always blood drawing). Every time, my Co2 has either been too low out of range, or just within the range. I was told by my old crappy doctor that it didn't mean anything, but of course now i realize it's a symptom of whatever causes the NCS.

I also have trouble breathing sometimes. Usually when I'm sitting I breathe really slowly. When standing of course I feel out of breath. Sometimes when I'm trying to sleep, if something startles me and I get an adrenaline rush, for hours afterward it will cause me to stop breathing every time I go to fall asleep. I guess it's a form of anxiety, or the effects of the anxiety even after the actual nervousness is gone.

ramakentesh, what you are saying sounds a lot like what happens to me actually

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