Dr Emile Kraepelin made the connection between disordered breathing and manic depressive insanity attacks over 100+ years ago. It would be a good idea to revisit his hypothesis. 

The early pioneers of breathing biology found that the range of breathing rates at rest was very wide; from as low as 3 breaths per minute to as high as 28+ breaths per minute at rest.  Adults are not aware of their breathing rates or depth- this is regulated by the brain stem and by the periphery.  People with hidden damage to any part of the motor apparatus which moves air in and out of the body may succumb to exacerbations of metabolic issues due to their inadequate ventilatory response to respiratory challenges brought on by the stress of physical illness, blood loss or injury.   

It is easy to revisit Kraepelin’s hypothesis, you simply need to count involuntary breathing rate at rest when awake in young adults [first episode-unmedicated] at rest to see if ventilatory rate is fixed too low or too high at rest when awake.    Depth is supposed to compensate for abnormal frequency but is limited to what is allowed by the nervous system.   Scientists do not understand this yet. Because they do not study the mechanical complex motor of ventilation when awake at rest …in illness or in health.

Respiratory rate awake at rest has never been studied since Dr Kraepelin.  The patients will not be aware of their disordered daytime breathing at rest or the consequences when experiencing respiratory challenges of illness.

Disordered breathing [with normal lungs] is known to lead to problems with retention of carbon dioxide in the blood and in the brain.  A continuum of  of mental confusion is the result.

Chronically fixed disordered breathing at rest when awake would explain the lengthy attacks of depressive insanity for example. Chronically fixed disordered breathing will present problems for the body in addressing the internal chemical metabolic problems involved with the stress of physical illness. Metabolic problems [pH, PCO2] will cause hypercapnia and mental confusion. In people with normal lungs pulse oximeter may be normal.HCO3 may also be normal.   Only obtaining minute ventilation measurements will tell you how much air a person is moving in and out of the body awake and at rest.  Lung doctors, physiologists and respiratory physiologists have never measured this in many decades and so do even not know what they do not know.

The early pioneers of breathing biology found that the range of breathing rates at rest was very wide; from as low as 3 breaths per minute to as high as 28+ breaths per minute at rest.  Adults are not aware of their breathing rates or depth- this is regulated by the brain stem and by the periphery.  People with hidden damage to any part of the motor apparatus which moves air in and out of the body may succumb to exacerbations of metabolic issues due to their inadequate ventilatory response to respiratory challenges brought on by the stress of physical illness, blood loss or injury.   

Disordered breathing is a area of medicine which is relatively new and there are a lot of syndromes we have not yet discovered.
Disordered breathing increases the risk of respiratory failure, especially respiratory pump failure which can be insidious and difficult for any doctor to recognize; the symptoms are often nonspecific.
Kraepelin identified the physical signs of bipolar depression in thousands of his patients. When these patients were in their stage of the reversible syndrome, their vital signs were abnormal and the pattern was unmistakably clear, and concerning.
Activation of the sympathetic nervous system [high B.P.and H.R.] , great anguish and distress and internal dysphoric arousal, lethargy, loss of weight, mental and locomotor slowing and ………inability to raise the breathing rate in response to the stress of physical illness, as is supposed to be the case with sympathetic arousal.You do not have to be a genius to see that this will cause many problems affecting the heart, the brain, the liver, the ability to eat, to sleep, to move, to think and every other organ system.This is disturbing to the patient, very disturbing-especially in a young adult in their prime- and especially since the patient is not aware of their disordered breathing but they are very much overwhelmed by the distress and anguish it causes.  It is also disturbing to the doctor because the anguish is palpaple, yet the doctor will not be able to put their finger on the problem because of the neglect of measuring vital signs, which are vital for a reason!! Startin with respiratory rate at rest when awake! and blood pressure and heart rate and body temperature.  And looking at the pattern they display.
In mania, disordered breathing is even more disordered and chaotic and the physical signs begin to resemble those of the “Cushing reflex” maybe due to increasing intracranial pressure; [the patient complains that there is an immense pressure in their head for a very good reason, I think].   Patients in Kraepelin’s time used to occasionally drop dead despite their youth or fall into a mild respiratory failure [depressed insanity] or quiet delirium….which must be protective against death if not madness.
But psychiatrists are not good at recognizing chronic medical emergencies and do not explore the existence or effects of grossly disordered involuntary and unconscious ventilatory mechanical problems, hypercapnia or possible mild respiratory failure. [it is unbearable despite not being immediately lethal] . It seems that doctors have forgotten that physical illness is a physical stressor which will cause the autonomic nervous system to react as such.   Not being able to raise your breathing rate under such circumstances is not ideal, I think.
Please expand your medical knowledge and look at what I have learnt from the existence of my colleague and friend Paula.  She has a breathing rate of 3 breaths per minute at rest when healthy…..but it does not rise during physical illness.  Like Kraepelin reported in thousands of similar patients.
Please look at our blog on “Mind and Loss of Mind” and our ideas regarding undetected disordered breathing [in health and in illness]  which increases the risk of a correctible [in our view] dementias- if caught early.  We need to know when disordered breathing due to injuries affecting the movement of air in and out of the body, are the cause of altered consciousness.

https://ofsoundmind.life

Paula has disordered breathing. [and it is not sleep apnea].No one knows.She doesn’t know- we found out by accident a few decades ago.[at a first aid class for ordinary citizens].She has had major attacks of depressive insanity,  now that her baseline mental and physical status has been restored, she remembers what is felt like.
What she reports is very similar to what Kraepelin reports in his study on Manic Depressive Insanity.
Chapter 1 of Manic depressive insanity defines this syndrome as a remitting [spontaneously-in the days before medication] and relapsing. Attacks spontaneously lift, restoring normal mental status. Chapter 3 of Manic depressive insanity, Bodily Signs, identifies disorder breathing as the most likely culprit.   There ARE physical signs. We just do not measure them and the patient does not know of them.
Scientists do not understand this kind of disordered breathing yet.It is hard to know about stuff you have not discovered yet….[oops Kraepelin discovered it and understood the implications but his findings have been forgotten.]
I can assure you that future treatments of manic depressive illness will not include psychotherapy or antipsychotics.  They may include non invasive breathing support, bronchodilators , antibiotics and at home breathing machines and who knows what more once we understand madness and how it is related to the motor complex act of breathing and ventilation [breathing] apart from the lungs.
SSRI’s , well they are unpredictable but over time possibly effective…because they affect control of breathing and basically all body systems.    But they are too slow…and have too many side effects.
Better treatments exist already in the 21st century, ….
Please read our blog.Please share our ideas.
Respiratory physiologists have yet to study this phenomena.This is not a lung problem-lung function is normal or these patients would not survive.
This hypothesis explains the cardiovascular issues and the [reversible] dementia and cognitive impairment.
Reversible dementia is delirium-  the locomotor types are quiet silent delirium, mixed delirium, and wild delirium [combative, restlessness,  euphoric, manic, psychotic- there are many manifestations].   Kind of sounds similar to the natural course of manic depressive insanity described by Dr Kraepelin…….
To know Paula’s birth history read our blog.
To know about Jerry’s story, read the blog.
To know Anna’s story, read the blog.
To find latest pubmed, Nature, Science research papers on mitochondria, acidosis, hypercapnia, altered mental status and respiratory physiology….keep reading our blog.

Please read our blog.Please share our ideas.

Let me know what you think…..and remember our blog is ongoing  and we are not professionals or not even great writers or scientists or storytellers.Kraepelin was an awful writer but he was an astute scientist and a polymath to boot.