help with dyspnea

[juliemakela]

Dear Doctor,

I started to experience breathing difficulty in 1998.  It started out a few times a day I would yawn and try to gasp for air.  I saw a doctor and he found nothing.  Six year later, the problem remains, but has gotten WORSE.  I am yawning constantly - all day long, every minute - always.  I am deep yawning to get air - its terrible,  I saw a pulomonary doctor and he gave me chest x-ray, echo, PFT's, excercise, GERD.  He sees nothing wrong with my heart or lungs.  I had a heck of a time taking the PFT's.  Anyway, I am at my wits end - he can find no explaination. (unexplained dypsnea)  They put me on am inhaler and that didi not work.  He sent me to a Ear, nose, throat and he said he suspected VCD - heres the problem - its not working - my syptoms (symptoms) dont match up - heavy coughing, and periodic attacks - I keep telling them I dont have attacks - its a CONTINUAL, persisitent breathing problems.  I have been to 4 sessions and they are not helping me.  The deep yawning to try and get a breath is so awful.  It makes me lightheaded and anxious feeling.  I am so desperate for some relief - I feel helpless and like no one will ever be able to help me - sometimes I feel they think its in my head, believe me I wish, to me, I cannot breathe and the syptoms (symptoms) are very real and interfering with the quality of my life.  I want to have a child, but I am afraid that if I cannot breathe right, the baby will be greatly affected - is this true doctor? I need some advice on what I should do next - any suggestions or recommendations of a good pulmonary doctor here in Pittsburgh, PA?

[National Jewish]

This sounds like a type of dysfunctional breathing called hyperventilation.  This is not vocal cord dysfunction (VCD).  Hyperventilation can have many different causes including a variety of breathing problems.  Your thorough evaluation and extensive testing have shown that your lungs are fine.  Usually hyperventilation is related to a condition called panic disorder.  This unfortunately is a very bad name.  People who suffer from it do not always experience panic-type feelings.  In fact, we think that it is a disorder of the very deep part of your brain that controls your breathing.  This leads to frightening, but not harmful, “suffocation false alarms”.  In some people this triggers feelings of panic, but in others this just leads to intense feelings of “smothering” along with all the body symptoms, including gasping for air and lightheadedness.

The breathing exercises for hyperventilation are designed to have you breathe slowly, regularly, gently, and smoothly.  Always try to breathe in through your nose, if possible.  While you breathe out through your mouth, imagine that you are breathing out through a straw by “pursing” your lips.  Slow regular breathing is most important.  Also work at breathing using your diaphragm rather than your upper chest.  Diaphragmatic breathing is a technique that may help you move more air in and out of your lungs.  This helps decrease shortness of breath.  Here are the instructions:
· Breathe in slowly and deeply through your nose.
· While you breathe in, count 1, 2 and push your stomach out.
· Place your hand on your stomach so you can feel your stomach going out.  This promotes the use of your diaphragm and your lower breathing muscles.
· Breathe out slowly and deeply through your mouth.
· While you slowly breathe out all the way, count 1, 2, 3, 4 and let your stomach relax.  You can feel your stomach going in with your hand.
You often can get help with this type of breathing by taking an introductory yoga class or checking out a videotape on yoga that focuses on breathing and relaxation.

For some people with panic disorder as the cause of their hyperventilation, treatment with certain anti-depressant medicines can be helpful, even if they do not feel depressed.  The bottom line is that even though the cause of hyperventilation may technically be in your head, this is not an “all in your head” problem — you have a real problem based in altered physiological function.  Best of all, this is a problem that can be treated successfully, so do not hesitate to seek out good help.

You would do well to consult a pulmonologist with experience in this realm.  Another option is a psychiatrist with experience in the management of panic disorders.  To find these specialists please check at a university medical center in the Pittsburgh, PA area.  This is treatable.  There is no reason why you should not have a baby.

[AndyRRT]

This is very interesting. I'm not sure I can give you an exact answer, but perhaps we can give you some possibilities as to why you are yawning so much.

First lets discuss what a yawn is. There are many parts of the body that are in action when you yawn. First, your mouth opens and jaw drops, allowing as much air to be taken in as possible. When you inhale, the air taken in is filling your lungs. Your abdominal muscles flex and your diaphragm is pushed down. The air you breath in expands the lungs to capacity and then some of the air is blown back out.

It has been said that a yawn is caused by being fatigued, drowsy or bored. Scientists are discovering that there is more to yawning than what most people think. Not much is known about why we yawn or if it serves any useful function, and very little research has been done on the subject. One of the most common theories about why we yawn is what we consider the Physiological Theory -- Our bodies induce yawning to drawn in more oxygen or remove a build-up of carbon dioxide. This theory helps explain why we yawn in groups. Larger groups produce more carbon dioxide, which means our bodies would act to draw in more oxygen and get rid of the excess carbon dioxide.

Have you had a sleep study? You could possibly have Sleep Apnea. If you dont have restful sleep at night, during the day your body may be telling you that its over tired, has too much carbondioxide, and wants MORE SLEEP.

Yawning is also suspected to be triggered by our brains by means of the frenic nerve. The frenic nerve is what triggers our diaphragm to flex causing inspiration. Perhaps you could seek a neurologist to get more answers as well.

Goodluck...

-Andy, RRT, CPFT

[AndyRRT]

I tend to disagree with NJC's scenario. Hyperventilation syndrome studies have shown that more than 80% of of the cases have shown some type of neurological disorder and/or link to panic attacks. Because of HVS's symptoms, there are long term cardiac side effects. You have made it clear that your doctors have not found any problems with both your pulmonary or cardiac systems. ECG changes are common in patients with HVS. Abnormalities may include prolonged QT interval, ST depression or elevation, and T-wave inversion.

Speak to your doctor about this, and possibly get a consult for a neuro exam.

[Doublestar]

I have had constant shortness of breathe on and off for years.  I actually have been really good for the past 4 years or more and recently had a major change in my life and I am back to having the shortness of breath on a daily basis. It is very annoying and is exhausting but my doctors say it is chronic anxiety. I too have to keep yawning to catch my breath.. Has anyone else been told their breathing problem was anxiety?

[juliemakela]

This is regards to the comment made by doublestar.  I understand where you are coming from doublestar.  When I first was seen by a pulmonologist, he looked at my heart and lungs and that was it.  He said it was anxiety.  Let me tell you something. I wish I could say that it was, because then I could treat it.  I think saying to patients "it is anxiety" is an easy way out of trying to figure out some pretty complicated symptoms.  To the patient, these breathing problems are real and they threaten my every day quality of life - I feel the physical symptoms in my breathing and my chest.  Yes, we are all human - there will be days in our lives that we are more stressed out than others, but to place sole blame on having anxiety is un-ethical.  AS, with telling a patient it's all because you are a "sress-case", the doctor may very well be missing something (a potentially serious illness with your body that could effect you years down the road) - thats what I worry about.  I knew a woman who has had similar breathing/yawning problems and the doctor said that it was "anxiety" - well, she did not accept that and decided to have more specialized tests done and she found out there was something wrong with her larynx.  She had surgey and it much better.  Here are my recommendations (as a person who has suffered with this problem since 1998 and I am only 32 years old):
1.  Practice yoga or breathing techniques DAILY
2.  Practice the pursed lip and diaphramic breathing techniques daily.
3.  Excercise the cadiovascular system with walking, etc.
4.  Loose any excess weight.
5.  See a good pulmonologist for a second opinion.
6.  See a neurologist to see if there are any problems there.
Good Luck to you, I know what you are goign thru
Love,
Julie Makela

[abdullah]

i agree with the concept of possible sleep-realated breathing disorder, the value of level 1 sleep study with you is to evaluate the possiblity of laryngeal myoclonus, which spasm of laryngeal muscles, and the other value to role out obstructive sleep apnea disorder or any other sleep-related problems but namely the above mentioned.

[orangephone]

To juliemakela

I was sad to see you wish you had an anxiety diagnosis.  Although it may seem easier to have a diagnosis for anything rather that cope with mystery symptoms, I would not wish anxiety on anyone.  I am a chronic anxiety sufferer and would not wish it on my worst enemy!  I wish you good health.

I came to this site as I have anxiety and keep yawning.  I am unsure whether to suppress yawns or not.  Any ideas?

[djelloul]

A related discussion, Dyspnea and Yawning was started.