I am a 41-year-old woman with an anxiety disorder, and I suffer from chronic acute depression. I am currently taking Effexor and Ativan once per day at bedtime. The first week in December I had a fibroid adenoma removed from my right breast.
My current concern is a constant tingling sensation around my mouth and chin, from my elbows to the tips of my fingers, and infrequently from my thighs to the tips of my toes. I am also in the beginning stages of menopause — night sweats, hot flashes, dizzy spells, and an inability to concentrate (although, thank God, not ALL the time). With this background information, can you tell me the possible cause of this tingling? It began three days ago with my mouth, and has not stopped. I also feel flushed and disoriented. Any input you can give me before I consult my physician would be sincerely appreciated.
Tingling is a symptom called paraesthesia. All of us have felt this occasionally when our foot has fallen asleep due to being in some unusual position which puts pressure on the nerves. Having an arm or leg fall asleep is not a symptom of poor circulation as is commonly thought, but is due to pressure interfering with the proper functioning of a nerve. The paraesthesias occur when we have relieved the pressure, and the foot is beginning to regain normal sensation. It consists of a disagreable tingling sensation that some people say feels like ants crawling under the skin.
Tingling around the mouth and in the fingers and toes is a special kind of paraesthesia commonly associated with anxiety. It is caused by increased depth and frequency of breathing, which may come on suddenly, or may be a chronic or long-term problem. Since today’s writer has been experiencing this symptom for several days, apparently without its getting better or worse, I would say that she is chronically overbreathing. Often the person is completely unaware of breathing more heavily than normal.
Overbreathing blows off carbon dioxide (CO2) from the blood. We all normally produce CO2 constantly as a by-product of our metabolism. The CO2 level in the blood is the most important factor stimulating the respiration in healthy people, and when we try to hold our breath for very long, the terrible need to breathe is caused by CO2 building up in our blood. The level of oxygen is actually less important in stimulating breathing in normal people. The prolonged heavy breathing that we do after intense physical activity is caused by the need to blow off the CO2 produced by that activity. As the level of CO2 returns to normal, our breathing returns to normal as well.
Under certain circumstances, the respiratory center in our brains becomes overstimulated and no longer responds automatically to the CO2 level. This can happen in anxiety, with fever, pregnancy and some other conditions. The center fails to regulate breathing to keep the CO2 level normal, and it therefore falls, which actually makes the blood become more alkaline. (Blood is normally slightly alkaline). This is called respiratory alkalosis, alkalosis meaning more alkaline, and respiratory indicating that the cause is overbreathing. Alkalosis increases the excitability of nerves, and this produces the symptoms described by our writer. Paresthesia around the mouth and in the fingers and toes are usually the first sign of respiratory alkalosis. If it becomes more severe, cramping of the hands and feet may occur, and confusion may also be noticed.
There is a simple test that our writer can do to determine if overbreathing is the cause of her symptoms. That is to breathe for five to ten minutes into a paper bag held over the mouth and nose. This forces the person to re-breathe the CO2 that they have blown off, thereby bringing the CO2 level in the blood back towards normal. If overbreathing is the cause of the paresthesias, they should promptly go away.
Obviously our writer cannot go around breathing into a bag all the time, so she needs to talk to her doctor about her anxiety and explore whatever in her life may be increasing it to produce this overbreathing. However, the bag rebreathing is something that she can safely use whenever the symptom becomes too annoying, until the underlying anxiety is treated.