Is your breathing too shallow? (Respiratory Depression/Hypoventilation) - Let's talk about this!

Have you ever felt like you were having a hard time breathing, or like you were really short of breath? Maybe you felt dizzy or tired. One possible reason behind these things is a decrease in breathing, which is what we medically call (Respiratory Depression) or (Hypoventilation) .

What is respiratory depression?

Simply put, respiratory depression ( or hypoventilation) is when your breathing rate becomes too slow, or you breathe too shallowly. When this happens, air exchange doesn't happen properly in your lungs. Think about it, when we breathe, oxygen in the fresh air goes into the blood through the tiny air sacs (alveoli) in our lungs. Also, carbon dioxide (CO2) , which is a waste product for our body, goes back into the lungs from the blood and is exhaled. This is what we call gas exchange .

Now, in the case of (Hypoventilation) , what happens is that because you are not breathing properly, that carbon dioxide (CO2) gas does not leave the body and accumulates in the blood. We call this (Hypercapnia) . Not only that, sometimes the lungs may not receive enough oxygen. Then the oxygen level in the blood decreases, which is called (Hypoxemia) . Do you understand?

What are the symptoms?

When you have shortness of breath (hypoventilation), you may experience symptoms like:

• Nausea and vomiting.
• Headache.
• Feeling tired, sleepy , or lethargic all the time.
• Disorientation, confusion , or a change in mental status.
• Heart rate increases.
• Dizziness.
• Breathing feels slow, shallow, or labored.
• Blue discoloration of the skin, lips, or fingernails (cyanosis) . This is a more serious sign.

What causes this?

The main causes of shortness of breath can be the misuse of certain medications, overdose , or an unexpected reaction to certain alcohol or drugs. Consider these things:

• Opioids: These are also called narcotics . Examples include morphine , tramadol, oxycodone (OxyContin®) , and fentanyl . Some people abuse these drugs.
• Benzodiazepines: These are medications that generally cause mental calm and help you sleep. Examples include lorazepam (Ativan®) , alprazolam (Xanax®) , and diazepam (Valium®) .
• Barbiturates: These medications are sometimes given for seizures or migraines .
• Illegal drugs: Things like heroin and gamma hydroxybutyrate (GHB) .
• Sleeping pills: Prescription medications such as zolpidem (Ambien®) .
• Anesthesia: It can also be caused by the medication given to make you sleepy before surgery.

In addition to these drugs and medications, other diseases and conditions can also cause hypoventilation :

• Obesity: This is called Obesity Hypoventilation Syndrome (OHS) . It means that breathing becomes difficult due to obesity.
• Conditions that cause breathing difficulties: For example, chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea .
• Conditions that reduce respiratory drive: For example , stroke and hypothyroidism .
• Conditions that affect the spine, nerves, or muscle control: Examples include muscular dystrophy, nerve or spinal cord disorders, multiple sclerosis (MS) , and amyotrophic lateral sclerosis (ALS) .
• Changes in the shape of the chest or spine: Conditions such as scoliosis ( curvature of the spine), ankylosing spondylitis, and flail chest .
• Toxins or poisoning: Things like tetanus , ciguatera toxicity, and botulism .

What things increase the risk?

The risk of shortness of breath may increase due to the following reasons:

• Misuse of medications such as opioids or benzodiazepines .
• If you have recently undergone surgery (due to anesthesia).
• If there are certain lung, muscle, and nervous system (brain and spinal cord) diseases, as we discussed above.

What complications can this cause?

If the level of carbon dioxide (CO2) in your blood becomes too high, it can cause dangerous, even life-threatening, complications. Take a look:

• Respiratory Acidosis: This means your blood is more acidic than it should be.
• Respiratory Failure: This is when your body's tissues do not get enough oxygen.
• Cardiac Arrest: The sudden stop of the heart.
• Coma.
• Pulmonary Hypertension: Increased pressure in the blood vessels connected to the lungs.

How do you diagnose this?

To diagnose respiratory depression , a doctor will first ask you about your symptoms, your medical history, and any medications you are taking. Then, they may order special blood tests to measure the amount of carbon dioxide (CO2) in your blood. They may also order other tests to find out exactly what is causing the hypoventilation .

What kind of tests are done?

Tests such as these can be done to find the underlying cause of shortness of breath:

• Arterial Blood Gas Test: This checks the amount of oxygen, carbon dioxide, and acidity in the blood.
• Pulmonary Function Tests: These are tests that check how well your lungs are working.
• Pulse Oximetry: A device that measures the amount of oxygen in your blood by attaching a small clip to your finger. You may have seen this.
• Blood Tests: There are many other blood tests that can help diagnose this condition or its causes. Examples include a Complete Blood Count (CBC) , Basic Metabolic Panel (BMP) , Toxicology Screen (to check for substances such as drugs), Carbon Dioxide (CO2) blood test, and Thyroid Function Tests.
• Imaging: A doctor may order X-rays of your chest, CT scans (Computed Tomography scans) of your chest or head to look for other underlying conditions.
• Sleep Study / Polysomnography: This test helps detect conditions like sleep apnea and obesity hypoventilation syndrome .

How is it treated?

Treatment for shortness of breath depends on the cause and how severe the condition is. Healthcare providers may give you treatments such as:

• Noninvasive Ventilation: This involves using a machine that helps you breathe through a mask that fits over your face. For example, a Continuous Positive Airway Pressure (CPAP) machine or a Bilevel Positive Airway Pressure (BiPAP®) machine. You may have heard of these.
• Respiratory Stimulant Medications: Sometimes, if this condition is caused by an overdose or as a side effect of a medication, reversal agent medications can be given. For example, if this condition is caused by opioids , the effects can be reduced by giving a medicine called Naloxone/Narcan® .
• Oxygen Therapy: Oxygen can be given if necessary.
• Mechanical Ventilation: If the condition is very serious, a person may need to be sedated, put in a tube, and have a machine breathe.

What kind of situation can be expected going forward? (Outlook)

The prognosis for shortness of breath depends on the cause. An emergency, such as an opioid overdose, can be fatal if not treated quickly. However, if the condition is caused by sleep apnea, obesity-related obstructive sleep apnea syndrome ( OHS ) , or other long-term conditions, it will require ongoing treatment and will improve gradually.

Can it be prevented?

The best way to prevent shortness of breath is to take your medications exactly as prescribed and to manage any underlying medical conditions. Be sure to ask your doctor or pharmacist before taking two or more medications, especially opioids and benzodiazepines, that depress your concentration or make you sleepy. Also , be aware of the possible adverse reactions that can occur when these medications are taken with alcohol.

"Medicine is a friend if used correctly, but an enemy if used incorrectly."

When should I see a doctor?

Talk to your doctor in these cases:

• If you have any questions or doubts about a medical condition you have.
• If you have questions or doubts about a medication prescribed by a doctor.
• If you have symptoms of shortness of breath, especially if you have other medical conditions that increase your risk.

When should you go to an Emergency Treatment Unit (ETU) ?

If you have any of these serious symptoms , go to the nearest emergency room immediately:

• If you have seizures .
• If the mental state has changed and there is confusion .
• If you feel so sleepy that you can't stay awake.
• If you have disorientation about where you are and when you are.
• If you experience unusual fear or suspicion (paranoia) .
• If the skin, nails, or lips turn blue.

What questions should you ask the doctor?

It may be helpful to ask your doctor questions like these:

• "Why did this happen to me?"
• "What should I do to prevent something like this from happening in the future?"
• "What treatment options do I have?"

Finally, things to remember (Take-Home Message)

Respiratory depression is a serious condition in which carbon dioxide (CO2) builds up in your blood. But it can often be prevented. If you are taking medications that can cause respiratory depression, talk to your doctor to make sure you are taking them correctly and safely. If you have another medical condition that could cause this condition, ask your doctor about steps you can take to reduce your risk. He or she can talk to you about your concerns and create a plan to safely manage your condition and medications. Taking care of your health is the most important thing.

` Respiratory depression, hypoventilation, decreased breathing, carbon dioxide, oxygen, lung disease, drug abuse