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Hyperventilation: *The* Anxiety Attack Symptom

Daniel Sher, MA, Clin Psychology
Hyperventilation: *The* Anxiety Attack Symptom

Out of nowhere, your heart rate starts to speed up. You feel weak and lightheaded and you feel like you can't take a deep enough breath. Suddenly your chest starts to hurt and your mind is racing. You feel like everything around you is crashing down – you feel like this might be it. All of the sudden you have one final moment of extreme terror…

… then gradually it starts to melt away.

You may know that what you experienced was a panic attack, and anxiety attacks often lead to intense physical symptoms. What you may not realize is that those physical symptoms were caused largely by hyperventilation, which is one of the responses that your body has during a panic attack. 

Introduction to Hyperventilation

While anxiety is to blame for hyperventilation, hyperventilation is to blame for many of the other distressing symptoms associated with anxiety. Hyperventilation can cause so many problems that some doctors label it its own disorder, known as "hyperventilation syndrome."

It's most common in those with panic and anxiety attacks but may affect anyone that suffers from anxiety.

Hyperventilation literally translates to "over-breathing." Contrary to popular belief – and contrary to the way it makes you feel – it is not the act of getting too little air. Instead, hyperventilation is the act of exhaling carbon dioxide too quickly, causing too much oxygen to enter the lungs and an imbalance of the two within the bloodstream. Hyperventilation can occur in many different ways:

One of the main issues with hyperventilation is that you start to feel as if you’re struggling with shortness of breath. In other words, your body feels as though it's not getting enough oxygen, when the problem is actually quite the opposite.

So the reaction that most people have to hyperventilation is to unintentionally hyperventilate even more. They try to breathe in too much air too quickly because they feel like they're not getting enough air, but this just causes the situation to get worse. 

Hyperventilation and Hyperventilation Syndrome

Hyperventilation is caused by anxiety, but hyperventilation can also end up warranting its own diagnosis: "hyperventilation syndrome." Hyperventilation syndrome is when you tend to hyperventilate even without anxiety present because your body has learned to breathe incorrectly, often as a result of excess stress or anxiety. 

Although it is possible to have one without the other, the two often have links:

That's why hyperventilation is such an important thing to understand for those with anxiety. It's not only the cause of many of the worst anxiety symptoms – it also may become its own disorder that requires your attention.

Symptoms of Hyperventilation

Hyperventilation is not dangerous. But it causes symptoms that mimic severe disorders. Hyperventilation causes carbon dioxide levels in your bloodstream to drop. This imbalance causes your blood vessels to constrict. All of this leads to a host of problems that those with anxiety attacks will find very familiar, including:

On their own, these symptoms would already cause significant discomfort. When combined with anxiety, these symptoms often lead to severe anxiety attacks, health fears, and more.

How to Tell if You Hyperventilate

There's no surefire test for hyperventilation as it relates to anxiety, since it tends to come and go. But you can start to determine if you’re prone to hyperventilating based on its symptoms:

If it sounds like you’re hyperventilating, it does help to visit a doctor. That way you can rule out heart or lung problems. If you've been to a doctor and ruled out any other health issues, it is possible that your hyperventilation is due to anxiety.

If you have anxiety attacks, there is a good chance you're hyperventilating frequently. And if you have anxiety and you've ruled out other health problems, hyperventilation is very likely to be the cause of your symptoms.

What to Do to Prevent Hyperventilation

Hyperventilation is often caused by anxiety. On the other hand, hyperventilation itself can also cause or worsen existing anxiety. This means that if you can stop hyperventilating, you can potentially reduce the severity of your panic attacks and perhaps prevent them altogether.

Most people don't realize they're hyperventilating until the process has already started, so it may be difficult to fully control all anxiety attacks and prevent all instances of hyperventilation. Furthermore, the more you think about your breathing, the more at risk you are for hyperventilation because your mind may interfere with your automatically programmed breathing rhythms. Therefore, it's not always in your best interests to spend too much time thinking about your breath. 

You also need to make sure that you're able to accept what hyperventilation actually is – a non-dangerous breathing style that is going to cause you some discomfort, but ultimately will not cause you any harm from a medical perspective. In other words, it can be helpful to remember that the worst thing that can happen is that you’ll feel discomfort. 

This acceptance is necessary because if you continually convince yourself that you’re going to have a heart attack, you're going to have a hard time using the strategies outlined below. Talk to your doctor first to make sure that your heart is in the clear - this will likely reassure you and help you to establish in your mind that your panic attacks are not as dangerous as they feel. 

The following are effective ways to prevent hyperventilation:

Doing this will help your body balance its carbon dioxide levels again and should prevent you from further hyperventilating. The trick is to regulate the rhythm of your breathing: keep it slow and steady. 

Even if you get enough carbon dioxide back into your bloodstream, it can take a while for your bodily and breathing rhythms to go back to normal, which is why the tips above will not always prevent panic attacks or their symptoms. But if you can reduce the extent of your hyperventilation you'll find that you fear it less, and that is important for overcoming anxiety in the future.

About Paper Bag Breathing - a Warning

In the past, it was believed that when you hyperventilate, you need to try to breathe into a paper bag. But is this recommended?

Studies of paper bag breathing are mixed, but there is some sound logic to the idea. Typically when we breathe in, we take in extra Co2 that we just expelled. This is important for maintaining the right balance. Breathing into a bag may conceivably improve the levels of carbon dioxide in your body, helping you overcome hyperventilation faster. 

But rebreathing into a paper bag is not recommended. Deaths have occurred in patients with acute myocardial infarction (MI), pneumothorax, and pulmonary embolism (PE) who were initially misdiagnosed with HVS and treated with paper bag rebreathing. Therefore, it’s best to proceed with caution and check with a licensed health professional before using the paper bag method. 

Breathing Retraining

Doctors also recommend that you retrain your body how to breathe. Anxiety often alters your natural breathing patterns, so even if you're feeling calm and happy, you may still be prone to hyperventilation, which ultimately may increase your anxiety and stress, possibly causing further anxiety problems.

There is no clear, scientifically validated way to retrain your body to breathe better, but most experts recommend the following:

Of course, the most powerful way to control your hyperventilation is to address your underlying anxiety. That's why no matter which of the abovementioned exercises you decide to perform, you should try to partner these with more general anxiety reduction or prevention strategies.

Article Resources
  1. Gorman, Jack M. Response to hyperventilation in a group of patients with panic disorder. The American journal of psychiatry (1984).
  2. Rapee, Ronald M. Differential response to hyperventilation in panic disorder and generalized anxiety disorder. Journal of Abnormal Psychology 95.1 (1986): 24.
  3. Holt, Phoebe E., and Gavin Andrews. Hyperventilation and anxiety in panic disorder, social phobia, GAD and normal controls. Behaviour Research and Therapy 27.4 (1989): 453-460.
  4. Rice, Raymond L. Symptom patterns of the hyperventilation syndrome. The American journal of medicine 8.6 (1950): 691-700.
  5. Varvogli, Liza, and Christina Darviri. "Stress Management Techniques: evidence-based procedures that reduce stress and promote health." Health Science Journal 5.2 (2011): 74.
  6. Kirkwood, Graham, et al. "Yoga for anxiety: a systematic review of the research evidence." British journal of sports medicine 39.12 (2005): 884-891.
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