Capnometry and Heart Rate Variability (HRV)

One of the unique diagnostic and treatment tools used at The Health Equation is non-invasive capnometry and Heart Rate Variability (HRV) monitoring.

Capnometry is one way that is scientifically accurate in measuring CO2 levels, which also measures heart rate variability (HRV) and can be used to help breathing retraining, capnotraining. HRV is the variance between our heart rate at rest and at exertion. When at rest, when we breathe in, heart rate increases, and when we breathe out, heart rate decreases. This variance is HRV, specifically Breathing Heart Wave (BHW). There are other ways of calculating HRV but BHW makes the connection between breathing and the autonomic nervous system, therefore the good things is that we can be taught to manipulate it.  It is an excellent measurement of our autonomic nervous system response (the subconscious nervous system).

A low HRV is a predictor of all causes of death, and from a scale of 0 (not great) – 30 (good autonomic nervous system balance), the average person will range somewhere between 8 – 12. A low HRV will often combine with negative emotions and poor health, with the converse also holding true.HRV decreases with age. The role good breathing physiology plays in maximising HRV is not to be underestimated.

Breath and life are obviously intertwined, as are breath and thought.  It is by means of breath that we remain physically alive.  We are born with the inherent knowledge to breathe correctly through our diaphragm.  However, our own unique breathing patterns are influenced by many life events, especially during childhood.  Our emotions influence our breathing patterns and just as importantly, our breathing affects our emotions.

It is estimated that  70% of patients who consult The Health Equation do not breathe properly and most of them do not know it. At first this may seem strange, as breathing is a subconscious activity.  Unless we have an obvious breathing problem (asthma, lung disease etc) we do not usually notice our breathing.  You may notice, in other people or indeed yourselves, that we may sigh a lot, find it difficult to catch our breath or talk very fast, which are all signs of not breathing properly.

You will probably know that when we breathe in, we breathe in oxygen (O2) and when we breathe out, we breathe out carbon dioxide (CO2).  However, it is not as simple as that! Whilst the main aim of respiration is to get O2 into cells to help with energy production and the many cellular reactions that our bodies need to survive, this action is dependent on an adequate level of CO2 being present in our bodies.  Almost always, when people are not breathing properly, the issue is one of overbreathing (although this doe NOT necessarily mean breathing too fast).

The effect of this is to breathe out too much CO2 and so the levels of CO2 in our body drop (hypocapnia) and so reduce the level of O2 delivered to the cells of the body (hypoxia).

Ironically trying to breathe more O2 in DOES NOT necessarily help this situation.

Somebody, who is classically hyperventilating (deep and fast breathing), often with symptoms of breathlessness and panic, is breathing in lots of O2 but is actually expelling more CO2, then they should.  So the treatment for acute hyperventilation is to hold a brown paper bag over their mouth and nose, so that they re-breath their own breath (mostly CO2) and they return to normal because cellular O2 increases.  Whilst most of us do not classically hyperventilate, our pain, anxiety/panic, depression, insomnia, OCD, hyperactivity, asthma, gut problems, increased blood pressure etc can at least be partly caused by not breathing well.

Breathing Assessment

An initial assessment, lasting up to 1 hour and including a case history breathing questionnaire, clinical examination and assessment by capnography will allow the diagnostic consultant to ascertain if the patient is a good breather or indeed, more likely, that the patient has a breathing pattern disorder.  People who don’t breathe well fall into 2 groups; the first is intermittent over breathing, which tends to be triggered in certain situations, the second is chronic over breathing, which is generally a long established poor breathing pattern and often needs intensive breathing re-training with a capnometer.

If it is decided that biofeedback via the capnotrainer is necessary this usually involves at least 4, 45-minute combo-sessions, spaced weekly, which will include use of the capnotrainer and osteopathic manual treatment.

This often needs to be done in conjunction with some homework or personal capnotraining. Breathing re-education works very well with meditation, learning how to quieten the mind will often have a much faster effect.

Training in the use of Capnomety and Heart Rate Variability (HRV) by Mr. Gerry Gajadharsingh has opened my eyes to an unrecognized problem discussed in medicine.  As an ER (Emergency Room/Accident and Emergency) physician I am familiar with treating acute airway emergency, but now, with his training I am now more aware of chronic breathing issues and how they can affect a multitude of body systems.
Dr. Tiffany Keenan, New Brunswick, Canada, Emergency Room Physician