**Respiratory Drive and the Mind

This is a mess………….get help…………

Paula and I think that respiratory drive is the key to homeostasis [of the blood and of body fluids. . Paula and I think that respiratory drive is the key to the function of the organs, especially that of the brain and consciousness [meaning arousal -alertness, wakefulness- and cognition].

What is respiratory drive? It is basically the drive to breathe in and to breathe out. And the brain stem has the neurons that direct this drive. And as long as you are alive, the brain stem is at work and signalling the respiratory skeletal muscles to breath in and out unconsciously and involuntarily. The rate of breathing in and breathing out will depend on may things, including pressures in the lungs and thoracic cavity, signals sent to the respiratory skeletons muscles and signals returning to the brain sampling PCO2 of the blood. The rate of breathing in and breathing out will depend on the muscles of breathing doing all of the work , and there are many of these are skeletal muscles in the neck, the torso, as well as the diaphragm muscle. The action of the heart muscle and blood thickness, blood substates, blood circulation, venous return and blood gases all play a role.

And let us mention all the feedback sensors to maintain communication about all the proper chemistry of all the gases and fluids being exchanged every minute;

The Thoracic Neural Receptors: Mechanoreceptors found in the airways, trachea, lung, and pulmonary vessels provide sensory information to the respiratory center in the brain with regards to lung volume, airway stretch, and vascular congestion. There are two primary types of thoracic sensors: slow adapting stretch spindles and rapid adapting irritant receptors. The former conveys only volume information while the latter additionally responds to irritative chemical triggers such as harmful foreign agents and dust. Both types of mechanoreceptors transmit information to the respiratory center via cranial nerve X (the Vagus Nerve) to increase the rate of breathing, volume of breathing, or to stimulate cough. A notable example is the Pulmonary stretch reflex, also called Herring-Breuer reflex, which prevents the lungs from over-inflating by sending inhibitory impulses to the inspiration center. Another type of receptors worth mentioning is the juxta-capillary receptors that respond to vascular congestion and interstitial edema in the lungs by sending signals to the brain to increase the breathing rate.

The Peripheral chemoreceptors : the peripheral chemoreceptors include the carotid and aortic bodies. The carotid bodies are located at the bifurcation of the common carotid arteries and send information to the respiratory center via cranial nerve IX, the glossopharyngeal nerve. The aortic bodies are situated within the aortic arch, and send information to the brain via cranial nerve X, the vagus nerve. Physiology, Respiratory Drive StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Joshua E. Brinkman; Fadi Toro; Sandeep Sharma.

These parts of the body are not protected by the skull or the spinal cord and can be damaged, at birth or at any time throughout life.

And the brain must figure stuff out despite this. But keeping a stable internal environment will become more difficult, with peripheral damage.

It is complex, for sure, but there are ways tease out the details.

Let us take Paula as an example Paula seems to have respiratory drive, we think, during her attacks of bipolar depression and during full health. She has the drive to inhale and to exhale. And it is automatic. She is not aware of it, she just breathes. Her breathing is different from others because she seems to have no other way to breath. It is natural for her. This is why neither she or anyone else is aware that her breathing rate is depressed at all times [as an adult]. Something else is amiss. Her tidal volume has been measured [in health] and is

Results: are………

. In fact her lung function is very fine for her age and points to completely healthy lungs. So this is not a lung problem even though a pulmonary function lab usually will help to measure tidal volume. Tidal volume at rest is a general biological measurement which tells us something about the mechanics and feedback mechanisms that are affecting the breathing rate.

Doctors do not measure respiratory rate at rest and do not measure tidal volume. This means That they never obtain minute ventilation. This was dumb and I will tell you why.

If the range of breathing rates at rest is wide, as has been reported in the classic early 20th century literature, then the range of air needed to be alive and have a functional mind [as in being able to work and take care of oneself], is extremely variable.

Produce my results:

The average rate of breathing is 12 breathes per minute at rest . Assuming a normal tidal volume of .5 L, this means that the person is exchanging 6 Litres per minute at rest.

.

What does this mean? I do not think anyone has really thought about it.

Do people at the extremes have the same flexibility in reacting to increases in PCO2 as people in the more normal range?

We do have an answer for Paula, but not for the others. We have answers for Paula because we measured her breathing rate during times of great illness and great emotion [massive fear and distress] and found that her breathing rate did not increase as it should. It stayed at 3 breaths per minute, even under duress. This suggests that the feedback system that usually would increase breathing rate in times of greater need or greater emotion, is not working. We measured her breathing rate while moving and during exercise and found that it did rise but very sluggishly. Something is wrong. We have no idea what, but her drive to breath is very strong; she simply is not able to raise her breathing rate in a normal way.

Any one can figure out how much air one needs to move in and out of the lungs and the circulation [of blood and other bodily fluids] by simply multiplying the respiratory rate at at rest by the normal average tidal volume at rest. This is called minute ventilation. And the measurement of minute ventilation will attest to the unbelievable variety of nature to be alive and to be able to function independently. And we need to understand what is normal before we can understand what undermines organ function and that of the mind. The inability to change one’s breathing rate accordingly when ill or when moving or when very fearful will result in problems with acid base of the blood in the body or in the brain or both, no one knows. No one has ever thought of broken connections complicating the feedback necessary to adjust breathing rate for homeostasis [pH, thermoregulation PCO2].

Until Kraepelin. Until Paula. And most likely many others.

And acid base problems and hypercapnia will cause mental disturbance . And fixed respiratory rate problems will cause fixed patterns of mental disturbance such as what we see in bipolar depression, chronic quiet delirium, mixed states, chronic mania and chronic hyperactive delirium.

Because of some broken connections, some mechanic al problem, requiring some support to “resuscitate” homeostasis and a normal blood environment.

The “Hard Problem”as most consciousness thinkers call it, is less philosophical and more mechanical and physical that is realized. We have made mental processes more complicated due to our tendency to assume that basic physics and chemistry and biology need some kind of voodoo to work.

Part of the answer is in front of our faces but it is not necessarily sexy and does not necessarily require fancy specialists or fancy tools to grasp. And the answer will not be found in studying the smallest molecules because they will act in accordance with the larger pattern of physical forces which we understand as the basic physiological functions of minute ventilation [respiratory rate at rest is good but we need tidal volume at rest to understand the whole picture.], blood pressure, heart rate [and basic heart function [presence of arrhythmia’s, murmurs and such] and most importantly thermodynamics and body temperature. These work as a team and the patterns adopted by this team will explain many questions about health, illness, consciousness level, and higher level cognitive functions.

It is so cool and has never been examined since scientists in the early 20 th century , including people like Krapelin and J.S. Haldane and …..Hemholtz and Claude Bernard and Wundt , these are the kind of scientists we need today: Hermann von Helmholtz: A 19th Century Renaissance Man Barry R. Masters “Hermann von Helmholtz was many things to many people: physicist, teacher, medical doctor, aesthete and more. He drew on his extensive knowledge of many fields to invent the ophthalmoscope—a device that revolutionized ophthalmology—when he was just 29 years old“.

to be continued [as I collect that thought]

And Paula is a proxy for the thousands of bipolar depressed patients Kraepelin observed. Because Kraepelin alluded to the thousands of bipolar depressed patients with the same limited depressed mechanical pattern of the ventilatory part of breathing.

to be continued…

Respiratory drive and spontaneous breathing rate at rest changes throughout physical and hormonal development. We can track this by measuring respiratory rate at rest per minute [which is very reproducible as it is set by the autonomic nervous system and the brain stem unconsciously and seamlessly]. We are not aware of our own or anyone else’s breathing rates. We take it quiet for granted that our mechanical and neural motor act of breathing is fine. There are some circumstances when we are unaware that the system is unable to respond to chemical challenges like abnormal pH or abnormal PCO2 of the blood. Abnormal patterns of altered mental status, mood and locomotor activity can result and we won’t know why. And that is scary. If the pattern of breathing rate is stable yet insufficient for stable organ function, then the pattern of mental disturbance will be stable as well; as in the case of spontaneously depressed breathing at rest and depressed mood, dulled thinking and depressed locomotor activity and speed. Because the neural/motor apparatus pushing air in and out of our lungs can become fixed and broken. This what happened to Paula. She had no idea. She still doesn’t feel it. Only measuring her resting respiratory rate tells us that her breathing is broken, despite her normal lungs.

Lung function and respiratory drive are two different things. And the scientific investigation of respiratory drive is only beginning. Respiratory drive is a physiological motor process involving the brain and the periphery, neurons in the central nervous system and the peripheral nervous system. Smooth muscle and skeletal muscle are involved. Internal physiological processes are involved, such as heat loss processes, heat retention processes, pH balance of the blood and PCO2 and PO2 of the blood. All in a coordinated manner to keep internal chemistry and pressure of the body within the narrow range for staying alive, never mind the issue of maintaining intact conditions in the blood, skull and brain for higher mental processes.

Children have faster respiratory rates than adults,7 and the “normal” respiratory rate can vary significantly by age. The normal ranges of respiratory rates for children of different ages include:

  • Newborn: 30-60 breaths per minute
  • Infant (1 to 12 months): 30-60 breaths per minute
  • Toddler (1-2 years): 24-40 breaths per minute
  • Preschooler (3-5 years): 22-34 breaths per minute
  • School-age child (6-12 years): 18-30 breaths per minute
  • Adolescent (13-17 years): 12-16 breaths per minute

Periodic Breathing in Children 

Infants usually have a much faster respiratory rate than older children,7 and can also exhibit a phenomenon referred to as periodic breathing. With periodic breathing a child’s average respiratory rate may vary widely; she may have periods during which she breathes slower than normal followed by a few minutes of breathing much faster than normal.

The importance of periodic breathing is that while it can be frightening as a parent it is usually quite normal unless your child has other symptoms suggestive of an underlying medical condition.

Normal Rates in Adults 

As with children, the respiratory rate should be measured when a person is at rest and has not just engaged in vigorous activity. In general, respiratory rates are slightly faster in women than men.8

The average respiratory rate in a healthy adult is between 12 and 18 breaths per minute.

Periodic Breathing in Adults 

In contrast to periodic breathing in children, another type of periodic breathing called Cheyne-Stokes breathing may be found in adults and is not normal.9 It may be caused by congestive heart failure, carbon monoxide poisoning, a low sodium level in the blood (hyponatremia), high altitude, or in the final stages of dying.

Elderly 

Normal respiratory rates in elderly people tend to be higher than those of younger adults, especially among older adults who are in long-term care facilities.10

Decreased Respiratory Rate or Respiratory Depression is rarely mentioned except in the critically ill hospitalized population in the I.C.U.’s hooked up to machines showing their vitals, or in people taking respiratory depressants such as opioids. Depth of breathing in respiratory depressed breathing rates are not well understood. The rate of breathing considered to be problematic is a breathing rate at or below 8 breaths per minute at rest.

Paula has a breathing rate at rest of 3 breaths per minute, as long as she is sitting at rest [eg. reading a book. ] We decided to obtain her tidal volume, since doctors assumed that her breaths were 3 or 4 times deeper than normal.This turned out to be incorrect. Paula’s tidal volume is .5Litres, which is normal. It means that Paula’s lungs are functioning normally. the amount of air circulated per minute at rest though….too be continued…..

Increased Respiratory Rate 

In adults, the cut-off for an elevated respiratory rate is usually considered a rate over 20 breaths per minute, with a rate of over 24 breaths per minute indicating a very serious condition (when it is related to a physical condition rather than a psychological condition such as a panic attack). [and Paula and I think that panic attacks are due to unknown problems involving respiratory drive. [see past blogs on research suggesting that there are higher levels of carbon dioxide in the blood of people prone to panic attacks.]

The respiratory rate is a very important vital sign. One study found that an elevated respiratory rate was a better determinant of people who were stable versus unstable than heart rate or blood pressure. What Is a Normal Respiratory Rate? By Lynne Eldridge, MD  Medically reviewed by Doru Paul, MD on July 14, 2020https://a8cf79cc8238cdd3cc5f439fac8ffa75.safeframe.googlesyndication.com/safeframe/1-0-37/html/container.html

Although respiratory rate is thought of as an issue involving lung health, it is a completely different thing, Lung health may be completely normal, as it is during physical growth, Yet respiratory rate and respiratory drive change as a person grows taller, as hormonal development occurs and as the person reaches physical maturity.

And, interestingly enough, as breathing rate declines in early adulthood, higher cognitive functions develop. It is really cool, when you think of it this way.

Respiratory rate, pattern and depth at rest are connected to peak organ function and to cognitive ability and to level of arousal [alertness].

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s