False Suffocation Alarms, Spontaneous Panics, and Related Conditions

Abstract

A carbon dioxide hypersensitivity theory of panic has been posited. We hypothesize more broadly that a physiologic misinterpretation by a suffocation monitor misfires an evolved suffocation alarm system. This produces sudden respiratory distress followed swiftly by a brief hyperventilation, panic, and the urge to flee. Carbon dioxide hypersensitivity is seen as due to the deranged suffocation alarm monitor. If other indicators of potential suffocation provoke panic this theoretical extension is supported. We broadly pursue this theory by examining Ondine's curse as the physiologic and pharmacologic converse of panic disorder, splitting panic in terms of symptomatology and challenge studies, reevaluating the role of hyperventilation, and reinterpreting the contagiousness of sighing and yawning, as well as mass hysteria. Further, the phenomena of panic during relaxation and sleep, late luteal phase dysphoric disorder, pregnancy, childbirth, pulmonary disease, separation anxiety, and treatment are used to test and illuminate the suffocation false alarm theory.

Respiratory Responses to Intravenous Infusion of Sodium Lactate in Male and Female Wistar Rats

“…Previous reports suggest a premenstrual exacerbation of panic disorder (Basoglu et al 2000;Breier et al 1986;Cameron et al 1988;Cook et al 1990;Klein 1993; however, see also Stein et al 1989), that panic disorder may improve during pregnancy (Hertzberg and Wahlbeck 1999;Klein et al 1994;Villeponteaux et al 1992), and that patients with premenstrual dysphoria experience panic attacks when exposed to lactate (Facchinetti et al 1992;Sandberg et al 1993, see also Yonkers 1997. Given the possible influence of female sex steroids on the respiratory effect of lactate, in the first experiment using female rats (experiment 2), the animals were gonadectomized before being tested in order to avoid the possible influence of estrus cyclicity.…”

“…In the present study, the effect of sodium lactate on respiratory rate and tidal volume in freely moving, unrestrained male and female rats of the Wistar strain was explored. Given the previous reports suggesting that spontaneous panic attacks are menstrual cycle-dependent (Basoglu et al 2000;Breier et al 1986;Cameron et al 1988;Cook et al 1990;Klein 1993), that panic disorder may improve during pregnancy (Hertzberg and Wahlbeck 1999;Klein et al 1994;Villeponteaux et al 1992), and that patients with premenstrual dysphoria experience panic attacks when exposed to lactate (Facchinetti et al 1992;Sandberg et al 1993), we also investigated if possible effects of lactate on respiration are estrus cycle-dependent. …”

“…Panic attacks are almost always associated with hyperventilation and respiratory discomfort, such as shortness of breath; it has thus been suggested that lactate-induced as well as spontaneous panic attacks may be due to an activation of a hyperresponsive suffocation alarm system involving activation of central or peripheral chemoreceptors (Klein 1993). Supporting this concept, an anxiety-provoking effect similar to that of lactate has been observed after inhalation of CO 2 in panic disorder subjects and in women with premenstrual dysphoria (Gorman et al , 1988aGriez et al 1987;Harrison et al 1989;Kent et al 2001;Papp et al 1997;Perna et al 1994;Woods et al 1986).…”

Feedback of end-tidal pCO2 as a therapeutic approach for panic disorder

“…Klein's suffocation alarm hypothesis (Klein, 1993), for example, suggests that both panic attacks and the consistent respiratory abnormalities seen in panic patients may be due to hypersensitive, medullary carbon dioxide (CO 2 ) detectors. Among the cross sectional findings supporting this hypothesis are increased variability in tidal volume and minute ventilation (Abelson et al, 2001;Gorman et al, 1988;Caldirola et al, 2004), exaggerated lactate responses to room air hyperventilation (Dager et al, 1995), and hypersensivity to inhaled carbon dioxide (Gorman et al, 2004) in PD patients compared to controls.…”

“…However, this study was designed to test primarily overall effects of the BRT intervention; thus, any interpretation of our findings in terms of mechanisms therefore is speculative. Repeated elevation of pCO 2 during homework sessions may have desensitized a hypersensitive suffocation alarm system (Klein, 1993), reducing panic vulnerability. Such desensitization could increase tolerance for incidental increases of arterial pCO 2 during daily life and result in fewer compensatory hyperventilatory episodes.…”