Hypothesis Postural orthostatic tachycardia syndrome: A respiratory disorder? Stewart et al 2021

As we all know, a subset of patients have disordered breathing which has been a fertile ground for proliferation of psych theories and interventions.

This hypothesis paper addresses what it thinks are the causes of hyperventilation from a different angle. Key section:

Fig. 2. Putative mechanisms leading to development of POTS phenotype. HDBR head down bed rest; TBI traumatic brain injury; IOH initial orthostatic hypotension; CIH chronic intermittent hypoxia; SNA sympathetic nerve activity; CNS central nervous system.

https://www.sciencedirect.com/science/article/pii/S266594412100002X

 

POTS coincided with abnormal breathing for me.

Difficulty holding breath due to the intense discomfort. Rapid breathing with little pause.

The most abnormal thing was a tendency to experience a sudden discharge of nerves at certain points of the breathing cycle, in particular at the moment when one switches from exhaling to inhaling. This would also often cause an abnormal heart beat due to the discharge affecting the heart rythm. Breathing-wise it felt like a moment of paralysis, which produced a small surge of fear. I sometimes also felt the need to consciously help with breathing because automatic breathing seemed to have these difficulties working properly. At night I would sometimes wake up with air hunger and taking a sudden big breath in, presumably because the automatic breathing had become too shallow.

At the peak of dysfunction, hypnic jerks were also extremely strong and often lifted my chest off the bed due to their force.

My interpretation is that automatic breathing wasn't working properly due to some kind of damage to the nervous system and this set off these unpleasant compensatory mechanisms, that doctors would misinterpret as anxiety.

 

Since developing ME/CFS and POTS, I can't hold my breath for even 5 seconds without huge discomfort.