Why Panic Attacks Cause Shortness of Breath and Hyperventilation

During a panic attack or sudden anxiety episode, the fight-or-flight response is activated, which can lead to an intense cascade of uncomfortable symptoms, including shortness of breath and hyperventilation. Whether you have had a single panic attack or have been diagnosed with panic disorder, experiencing shortness of breath can feel incredibly unsettling and frightening.

A better understanding of shortness of breath and its link to panic attacks and anxiety may help you or a loved one find appropriate resources, support, and strategies that aim to reduce and/or eliminate symptoms.

Breathing Characteristics of a Panic Attack

Shortness of breath and hyperventilation are intimately connected. When you feel shortness of breath, you may breathe faster, which can lead to hyperventilation—and, in turn, hyperventilation can trigger or worsen shortness of breath. You may also experience other symptoms of a panic attack or panic disorder during this time.

Shortness of breath. When experiencing a change in your breathing pattern during a panic attack, you may experience dyspnea or shortness of breath. You may feel as if:

• You are gasping for air (known as "air hunger")
• Your breathing feels shallow and restricted; you have to force yourself to take a deep breath
• You feel as if you are choking or being suffocated
• You may feel restriction or tightness in your chest

Hyperventilation. In addition to experiencing shortness of breath, you might experience over-breathing or hyperventilation, which can have the following effects:

• Your breathing pace is quicker than usual, and it is challenging to slow down
• Rapid breathing decreases the carbon dioxide in your blood
• You may feel confused and out of it
• You may experience symptoms of faintness, nausea, numbness or tingling, and dry mouth

What Causes Shortness of Breath

Breathing can be a good marker for an individual's internal state, so it makes sense that if an individual is experiencing panic, anxiety, and/or high levels of stress, their breathing will reflect that.

According to research, changes in breathing patterns can increase anxiety, trigger a panic attack, and intensify a panic attack that has already begun. Scientific study has also made the following connections:

• Genetics and hormones. Shortness of breath in the context of panic attacks and panic disorder have a genetic and/or hormonal component.
• Survival response. Shortness of breath is linked to the body's fight-or-flight response as the body attempts to take in more oxygen and prepares to defend itself.

Can Anxiety Cause Shortness of Breath?

Yes, anxiety can both cause and exacerbate shortness of breath. Symptoms of anxiety can include feeling short of breath, air hungry, and a smothering feeling. In turn, feeling short of breath can also increase your anxiety due to the uncomfortable and frightening symptoms. In terms of panic attacks, shortness of breath may occur before the onset of a panic attack or increase during one.

Treatment

If you or a loved one are experiencing panic attacks, know that there are many treatment options available. Because the root cause of panic attacks and panic disorder will vary from individual to individual, it's best to be evaluated by your doctor or mental health professional to determine the underlying cause. You may have to try multiple treatment options or combinations to figure out which one is the best fit.

Medication

Medication may be effective for some individuals in treating panic attacks and panic disorder. Medication may help reduce overall anxiety, decrease the frequency and intensity of panic attacks, and reduce the anxiety associated with panic attacks. Medication options that have proven efficacy in treating panic attacks and panic disorder in some individuals include:

• Tranylcypromine (Parnate)
• Paroxetine (Paxil)
• Clonazepam (Klonopin)
• Alprazolam (Xanax)
• Escitalopram (Lexipro)

Psychotherapy

Anxiety-focused psychotherapy may be used in conjunction with medication or on its own. Which route someone opts to try in terms of treatment may depend on the intensity and frequency of their symptoms as well as their personal preferences. Psychotherapy may address triggers for anxiety as well as the impact panic attacks have had on your personal life.

Therapeutic styles used to treat panic attacks and panic disorder include:

• Cognitive behavioral therapy
• Dialectical behavior therapy
• Exposure therapy
• Rational emotive behavior therapy
• Psychodynamic psychoanalysis

Coping with Shortness of Breath

Experiencing shortness of breath during a panic attack can feel stressful, isolating, and scary. Because panic attacks can begin without a known trigger, it's important to have a tool kit of techniques to stop or manage a panic attack. If you are having difficulty with daily activities or are having thoughts of harming yourself or others, it's important to connect with a professional immediately.

• During the start of a panic attack, recite a mantra to yourself that you can repeat (for example: "This will pass" or "I'm going to be okay").
• Practice a relaxation technique when you are not having a panic attack. Practicing while you are in a more relaxed state may help you feel better prepared to use your strategy when you feel a panic attack beginning.
• Begin practicing mindfulness meditation to help you gain better insight into your thoughts in a non-judgmental way.
• Track your symptoms with a panic attack diary to better understand your unique panic attack experience.
• During a panic attack, try to reconnect to your body and surroundings by doing an exercise of threes. Count three things you see around you, three things you feel, three things you can hear, and three things you can smell.
• Try breathing in a paper bag. This re-breathing of your exhaled air brings balance back to the oxygen and carbon dioxide in your bloodstream, helping you feel normal again.
• After a panic attack, call a supportive friend or loved one to talk through your experience.
• Consider calling your therapist or doctor if this particular panic attack was especially intense or if the frequency of your panic attacks is increasing.

Final Thoughts

Although panic attacks can feel terrifying at the moment, especially when your breathing is impacted, keep in mind that a panic attack is not life-threatening. However, chronic high levels of stress and anxiety can be very detrimental to your overall health and well-being, so you must prioritize seeking appropriate treatment for your panic attacks and connect with your doctor regarding any breathing-related issues.