Breathing, Hyperventilation, Carbon Dioxide and Panic

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How does a panic attack relate to how we are breathing and the level of carbon dioxide and oxygen in our blood, and what is the fundamental flaw in brain programming that makes some of us so vulnerable to panic attacks?

I was debriefing with a young woman who took too much of a new medication and ended up in the emergency room with what she thought was a Covid pneumonia causing extreme shortness of breath and chest pain but which turned out to be a panic attack.

Breathing and Oxygen and Carbon Dioxide Levels in the Body

A few facts to bear in mind:

  1. Our Lungs are Generally Very Good at Getting Oxygen. Usually (unless we are sick or old or have damaged our lungs in some way) our lungs are able to get all the oxygen we need from the air.
  2. Feeling “Short of Breath” Usually Reflects Low Carbon Dioxide More than Low Oxygen. When we feel short of breath this usually has nothing to do with the level of oxygen in our blood. This is why people who get Covid can wander around with a very low oxygen level in their blood without knowing it, until they get tested. Rather, feeling short of breath reflects low carbon dioxide, which occurs when we breathe rapidly. The initial sensation can best be termed “sighing dyspnea,” in which patients feel as if they are not getting enough air or oxygen or “as if I can’t fill my lungs with air.” 
  3. Sensitivity to Low Carbon Dioxide “Shortness of Breath” Leading to Faster Breathing Causes Panic Attacks. Some of us are especially sensitive to low carbon dioxide shortness of breath and tend to increase the rate of breathing more as a result. Rapid breathing leads to even lower carbon dioxide and this positive feedback loop is the flaw in brain programming that makes us have a panic attack

This is the sequence that my patient experienced. In her case, it was the medication that was making her breath faster. But then, as her breathing rate increased she felt “short of breath” and this, and the anxiety it generated, led her to breath even faster and in turn to lower her blood carbon dioxide far enough that she was experiencing many physical side effects that were very distressing.

A sudden drop in your blood CO2 level due to hyperventilation typically causes an array of symptoms, including lightheadedness, tingling in your arms and legs and around your mouth, foggy thinking, and possibly fainting.


Using a Paper Bag

This brings us to the seemingly crazy idea that is the one home cure that is most likely to help a person who is entering a panic attack. If you put a paper bag over your mouth you will now be breathing in air that has an extra dose of carbon dioxide (from the air that you breathed out) and a little bit less oxygen. The slight drop in oxygen won’t affect your blood level very much (because our bodies are so good at getting oxygen out of the air) but what it will do is counteract the low carbon dioxide which is driving the sense of being short of breath and which is in turn leading to the panic attack.

Slowing the Outward Breath

An alternative is to focus on breathing out long slow breaths. This also sends a signal directly to your limbic or emotional brain that things are OK. It directly reduces anxiety. But it also slows down breathing and that counteracts the low carbon dioxide.

Five Finger Breathing

This is an alternative breathing exercise you can try.

Step 1: Place the index finger of one hand on the outside of the pinky finger on your other hand. As you breathe in, trace up to the tip of your pinky, and as you breathe out, trace down the inside of your pinky.

Step 2: On your next inhale, trace up the outside of your ring finger, and on the exhale, trace down the inside of your ring finger.

Step 3: Inhale and trace up the outside of your middle finger; exhale and trace down the inside of your middle finger.

Step 4: Continue finger by finger until you’ve traced your entire hand.

Step 5: Reverse the process and trace from your thumb back to your pinky.

Five finger breathing is great, because it brings several of your senses together at the same time. You’re watching and feeling your fingers while you’re paying attention to your breath. This not only requires awareness of multiple senses (seeing and feeling) but an awareness of multiple locations in your body (your two fingers, your two hands and your lungs).

When you’re able to use up your RAM with multi-sensory and multi-location awareness, you can forget what you’re worrying about, even if it’s for a few moments. As you do this, you’re also calming your physiology down, so if those thoughts come back, they won’t be as convincing because they won’t have the same emotional tone. Without that arousal, they have less weight behind them and they’re easier to let go of or not react to.

Panic Attacks Feel Awful but They Don’t Hurt Our Health

The good news is that, despite feeling terrible and is if you are about to die or have a heart attack, the physical effects of panic attacks are not usually significant. In fact, I have worked with patients who regularly had 2 panic attacks a day, and do this for years, until they finally get treatment. And they did not have any adverse effects.

For More Information

Why Panic Attacks Cause Shortness of Breath