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Treating Hyperventilation by Breathing Into a Paper Bag
When to seek emergency care.
When someone is hyperventilating on TV or in a movie, you often see them take out a brown paper bag and begin breathing into it. You may have even seen someone use the paper bag method in real life—maybe you've tried it yourself.
While a TV character might get relief from the symptoms of hyperventilation using the method, it doesn't always work in real life. It's possible that the trick can work in some cases of true hyperventilation, but it's not the ideal treatment.
Even more importantly, in some instances, it may be dangerous. If you think you're hyperventilating but are actually experiencing symptoms of a more serious medical condition, you may be putting your health—if not your life—at risk.
Hyperventilation syndrome is most often associated with panic disorders. When a person has a panic attack, the psychological condition can make them breathe too fast, which causes the body to lose carbon dioxide (CO2).
While it's true that CO2 is a metabolic byproduct in the air you exhale, you still need to a minimum amount in your bloodstream to maintain your body's pH balance. When you lose a significant amount of CO2 due to hyperventilation, the tissues in your body can start to malfunction.
The idea behind breathing into a paper bag or mask is that rebreathing exhaled air helps your body put CO2 back into your blood. While breathing into a paper bag to treat hyperventilation can work in theory, many healthcare providers (and patients) don't find it to be a particularly quick or effective method.
If you have frequent panic attacks and anxiety you may have a chronic case of hyperventilation. Your healthcare provider can help you find the best treatment and management strategies.
While there hasn't been enough research to definitively prove the paper bag method is harmful, there isn't any real evidence proving it helps, either.
Interestingly, what research has found is that there may be a link between high concentrations of CO2 and panic attacks—meaning artificially increasing CO2 in inhaled air (as is the case when you breathe into a paper bag) would be more likely to trigger feelings of panic in people with anxiety.
Using the paper bag method is most dangerous when someone has mistaken respiratory distress for hyperventilation when it is actually a symptom of a more serious medical condition.
Common symptoms of hyperventilation include tightness in the chest, shortness of breath, and dizziness—all of which may also occur during heart attacks.
If someone having a heart attack opts to use the paper bag method because they think they're hyperventilating, the decision may delay potentially life-saving medical intervention.
Furthermore, since breathing into a paper bag restricts how much fresh air a person can breathe in (which reduces blood oxygen levels) it may worsen the underlying medical condition. Heart attacks often occur due to reduced oxygen to the heart.
Symptoms of other serious conditions can also overlap with hyperventilation and may be worsened by using the paper bag method instead of seeking medical care.
Other conditions that may result in symptoms similar to hyperventilation include:
- Head injuries : A head injury can lead to changes in breathing. Without the presence of physical symptoms, a head injury can go undetected if hyperventilation is the only cause considered. Additional symptoms of a head injury include headache, confusion, and severe nausea.
- Lung disease : Lung conditions, such as chronic obstructive pulmonary disease ( COPD ) and asthma, can make breathing difficult. Additional symptoms, such as wheezing, cough, and chest pain distinguish these conditions from hyperventilation.
- Diabetic ketoacidosis : Diabetic ketoacidosis can cause hyperventilation. Additional symptoms include nausea, excessive thirst, and frequent urination. Go to the emergency room if you are throwing up for more than two hours, your breath smells fruity, you are confused and tired, and/or you're struggling to breathe.
- High altitude exposure : The low oxygen at high altitudes can lead to hyperventilation even in people without lung conditions. To avoid complications, assess and treat symptoms appropriately rather than attempting to use a paper bag when at high altitudes.
Treatment for hyperventilation aims to slow down and return breathing to a normal pattern. The preferred and safest treatment for a hyperventilation episode is to stay calm. People should be encouraged to practice breathing slowly and not too deeply.
Calming breathing exercises have been shown to be as effective, if not more so, as breathing into a paper bag to treat hyperventilation in people with anxiety disorders. These exercises also don't pose an additional health risk.
Researchers from Brunel University in the United Kingdom confirmed these findings when they sought to compare relaxation therapy versus breathing therapy for the management of hyperventilation. The study found a significant reduction in the frequency and severity of hyperventilation attacks in the group who used breathing exercises.
Breathing exercises are not your only options. Your healthcare provider will help find ways to treat the underlying causes of hyperventilation, which is the best way to prevent it from occurring.
As hyperventilation is often related to psychological stress from fear, anxiety and panic attacks, some potential options for treatment include:
- Anti-anxiety medications
- Talk therapy and counseling
- Cognitive behavioral therapy
With or without hyperventilation, some symptoms could indicate a serious, life-threatening condition.
Symptoms You Shouldn't Ignore
If you experience any of these symptoms, seek medical attention immediately:
- Blue lips, skin or fingers
There are times when it will be difficult to determine if hyperventilation is the result of anxiety, stress, or a more serious health condition. As a general rule, if you are experiencing severe hyperventilation or experiencing it for the first time, it's best to seek medical care.
Schwartzstein RM, Richards J, Edlow JA, Roy-Byrne PP. Hyperventilation syndrome .
Gerez M, Sada A. Tello A. Amygdalar hyperactivity, a fear-related link between panic disorder and mesiotemporal epilepsy . Clin EEG Neurosci . 2011;42(1):29-39. doi:10.1177/155005941104200108
Lechtzin N. Hyperventilation syndrome . Merck Manual Professional Version.
American Heart Association. About heart attacks .
Whited L, Graham DD. Abnormal respirations . StatPearls.
MedlinePlus. Hyperventilation .
West JB. High-altitude medicine . Am J Respir Crit Care Med . 2012;186(12):1229-1237. doi:10.1164/rccm.201207-1323CI:1229-37
Jones M, Harvey A, Marston L, O'connell NE. Breathing exercises for dysfunctional breathing/hyperventilation syndrome in adults . Cochrane Database Syst Rev . 2013;(5):CD009041. doi:10.1002/14651858.CD009041.pub2
By Rod Brouhard, EMT-P Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients.
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How do paper bags help with panic attacks?
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How Stuff Works: Breathing into a Bag for Panic Attacks
- Posted on: August 7, 2013
By William Schroeder
Have you ever wondered why people are told to breathe into a bag when they have panic attacks ? When people panic, they tend to take in too much Oxygen. When we are over oxygenated, our body changes, but part of the focus is on the PH level changes that happen which create more anxiety. The increase in O2 and not enough Co2, people will often report symptoms of dizziness, shortness of breath, distorted vision, and tingling sensations around their extremities.
The trick is to reverse the acidity at these key junctures of the brain. Breathing into a paper bag helps to reverse this cycle as it ‘recycles’ the carbon dioxide that we have released and limits the amount of fresh oxygen that we can take in. Breathing exercises can also be practiced to produce a similar effect. In a recent conversation with Dr. Scott Elkin , he discussed how it is also helpful for tension headaches and demonstrated its effectiveness with some breathing exercises to help a team member.
For further information, read about anxiety counseling , or make a counseling appointment so we can be of help to rule out other potential causes. You can also find more information on how to deal with panic attacks here .
Photo by Nine Köpfer on Unsplash
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3 Steps to Coping with a Panic Attack
How to reduce fear and let go of the struggle without getting stuck.
Posted July 16, 2020 | Reviewed by Matt Huston
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Many years ago, just after getting certified as a scuba diver, I was under 90 feet of water and needed to clear my mask. As I lifted the bottom of the mask to blow out the water, I suddenly felt an intense rush of fear, could not catch my breath, felt lightheaded, and had an urgent need to escape. Problem was that being 90 feet underwater meant that I could not just shoot up out of the water—I would need to go up slowly, or I could damage my lungs. Thankfully, I knew there was one thing that would help me deal with the panic—pause my breath for a little while, just long enough for my suddenly depleted carbon dioxide levels to rise, and for the oxygen to get back to my brain so I could think straight.
If you’ve ever had a panic attack, you know the feeling of being overwhelmed, feeling lightheaded, short of breath, your heart pounding, not being able to form a coherent thought, feeling tingly and nauseous. You may have worried that you were dying or having a heart attack or going crazy. The good news is that none of that was true. Panic attacks are very scary, but otherwise harmless. The reason you experience all those unpleasant physical sensations is primarily due to a breathing dysregulation that happens when you panic—overbreathing, also commonly known as hyperventilation.
My previous post on breathing explains exactly what happens when you overbreathe. To summarize here briefly, overbreathing happens when you breathe out too much carbon dioxide. This results in lack of carbon dioxide in your blood, which prevents oxygen from being released from your bloodstream and reaching your brain, muscles, and other organs. Lack of oxygen is the reason why you experience lightheadedness, shortness of breath, tingly fingers or toes, difficulty thinking clearly, nausea or other stomach discomfort, feelings of agitation and unreality.
People might experience panic attacks for a number of reasons. Sometimes panic attacks are a result of panic disorder, a condition where the person experiences great fear of the physiological sensations of the panic attack itself, the so-called fear of fear. The person may be afraid that these sensations mean that she or he is having a heart attack, dying, or going crazy. The fear of the sensations remains even when the person is reasonably sure they are not going to die or go crazy.
People might also experience panic attacks when they are exposed to an object or situation they are afraid of (a phobia ), such as dogs if one is afraid of dogs, or being on an airplane or having your blood taken. For some people, panic attacks happen in social situations when they are afraid of being judged or coming across as stupid. Panic attacks can also happen for people who have experienced traumatic events, particularly when they are somehow reminded of these events. Finally, panic attacks can happen in completely unexpected situations when a person experiences fear even if they would not expect to be afraid (like me in the scuba diving situation).
No matter the reason for your panic attack, it is an intensely unpleasant experience. Most people struggle to stop the panic attack the moment they feel one coming on. Unfortunately, it is that struggle that is likely to exacerbate and prolong the panic attack. This happens for two reasons. One, the struggle exacerbates the already strong fight-or-flight or fear response that comes with the panic attack, revving up your nervous system , and producing even stronger sensations of fear. Two, the struggle to catch your breath, usually through taking big deep breaths, makes you breathe out even more carbon dioxide and further decreases the amount of oxygen available to your brain and body. The more carbon dioxide you breathe out with those big deep breaths, the less oxygen is being released from your bloodstream, and the more lightheaded, foggy, tingly, nauseous, and scared you feel.
If you experience panic attacks, you’ve probably read a lot of advice about how to get through them. You’ve probably heard the advice not to fight with the panic, but rather allow it to happen while mindfully being present with the sensations. This is great advice, except that when you are in the middle of intense fear and panic, it may be difficult to convince yourself to allow the experience and to be present with it. You might have read about some multi-step processes for dealing with panic. The problem is that the brain fog that comes with panic makes it very difficult to think of all the steps that you are supposed to take.
I suggest using this simple three-step approach which will address both of these problems and allow you to respond to the panic attack in a healthier way without getting stuck. Use these steps if you find yourself having a panic attack: H old, B reathe, O bserve. If you are feeling anxious, but not panicky, follow the breathing instructions from my previous post .
1. Hold : As you find yourself in the arising panic, pause your breath for about 10 seconds—slowly count to 10. That’s it. No need to think of complicated steps, just remember to pause your breath.
If you pause after the inhalation, count to 10 and then exhale slowly. If you pause after the exhalation, count to 10 and then take in a small inhalation and exhale as slowly as you can. Then pause and count to 10 again. Repeat 5-6 times, or until you start feeling more clearheaded and less overwhelmed.
Pausing your breath allows your carbon dioxide levels to rise and more oxygen to be released from your bloodstream to your brain and body. With each pause, your carbon dioxide levels rise a bit more, bringing more oxygen to your brain, and reducing the intensity of suffering.
2. Breathe : As your breathing stabilizes, continue breathing low and slow :
- Shift your breath from your chest to the belly.
- Take a normal size comfortable breath in, as if you are smelling a flower (no need for a deep breath).
- Exhale as slowly as you comfortably can, either through the nose or through pursed lips, as if you are blowing out a candle.
- Do not rush to the next inhalation. Let your body inhale for you when it’s ready. And let your next inhalation again be a normal-size comfortable one, followed by a long, slow, complete exhalation.
- Continue breathing low and slow for a few minutes and into the third step.
3. Observe : As the intensity of distress subsides, you will likely find yourself more willing to mindfully attend to your present experience and allow whatever sensations you become aware of to stay without trying to push them away. Just observe. It might help you to structure your observation around your senses: what do you see, what do you hear, what do you touch, what do you smell, what do you taste? This exercise will allow you to accept whatever is happening in your awareness without a struggle. Panic will subside on its own.
You might be wondering whether you should breathe into a paper bag when you are having a panic attack. The short answer is No. Here’s why. Breathing into the paper bag does help raise your carbon dioxide levels and increase oxygen release, which is why you so frequently see people do this in the movies and on TV. However, when you breathe into and out of the paper bag, you don’t know how much carbon dioxide you are actually getting. If you’ve been breathing into and out of the paper bag for a while, the concentration of carbon dioxide may be higher than necessary and oxygen may be in short supply. In addition, you would have to actually have the paper bag with you. Pausing your breath for 10 seconds, on the other hand, will not deprive you of oxygen, and does not require carrying around any props.
Inna Khazan, Ph.D., BCB, is a clinical psychologist who teaches at Harvard Medical School.
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Mind-Blowing Reasons Why Breathing Into A Paper Bag Is Helpful for Anxiety Attacks
What does it mean to breathe into a paper bag ?
Hyperventilation can be controlled by breathing into a paper bag . This works by returning some carbon dioxide to your lungs. This balances oxygen flow.
But, it is important to do so correctly and the bag should not be used for every person. It is not known whether hyperventilation can be helped by it. Medical research has been divided about its effectiveness.
This breathing technique is not recommended in all cases.
Another medical review study found that some patients suffering from hyperventilation can breathe into a paper bag.
How to do it
- Hold a small paper bag (the kind used for lunches) over your mouth and nose.
- Take 6 to 12 normal breaths.
- Remove the bag from your mouth and nose.
- Take a few breaths.
- Repeat as needed.
Do’s and don’ts
- Don’t breathe into a paper bag for more than 12 breaths.
- Do remove the paper bag from your mouth and nose after 12 breaths.
- Do hold your own paper bag for breathing. If someone else holds it for you, they may not know when you’ve taken up to 12 breaths.
Do you need to use a paper bag?
Yes. Use a small, paper bag and not a large plastic one. Plastic bags are dangerous and don't work in the same way.
When you breathe in, the thin plastic can get trapped in your mouth. This can be particularly dangerous for older adults and children who are smaller.
The bottom line
When you feel panic attacks or anxiety, it may be easier to breathe through a bag of paper.
Hyperventilation may occur for many reasons.
Hyperventilation can last for over 30 minutes or cause consciousness to drop.
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Does Breathing Into a Paper Bag While Hyperventilating Actually Help?
By ellen gutoskey | feb 23, 2022.
Start hyperventilating in a public place and a good Samaritan might just empty the contents of their brown-bag lunch and hand you the bag. According to conventional wisdom (not to mention countless TV shows and movies), breathing into a paper bag is a great way to curb hyperventilation.
So why do we do it—and, more importantly, does it actually work?
What causes a person to hyperventilate?
When you hyperventilate , often during an anxiety or panic attack , you’re breathing so quickly and/or so deeply that you upset the ratio of oxygen to carbon dioxide in your bloodstream: too much oxygen, not enough carbon dioxide. As UCLA Health explains , the influx of oxygen can increase the blood’s pH level to the point that you develop a condition known as respiratory alkalosis , which can cause dizziness, tremors, and other adverse effects. Humans exhale carbon dioxide, so the idea behind the paper bag trick is that you’ll be inhaling the carbon dioxide you’ve just emitted—thus restoring your blood’s pH balance and alleviating those symptoms.
Does breathing into a paper bag work?
Though some people might find success with the paper bag method, there’s a general lack of scientific evidence supporting its effectiveness. Furthermore, it can be dangerous to try if your breathing issues are caused by something other than anxiety—particularly if they're the result of heart or lung conditions. If you’re experiencing shortness of breath because of asthma or hypoxemia (low oxygen in your blood), for instance, limiting your oxygen intake can make things worse, not better. As Verywell Health reports , certain heart attack symptoms—shortness of breath, chest tightness, etc.—are sometimes mistaken for hyperventilation symptoms. If you’re experiencing a heart attack, you also shouldn’t restrict your oxygen intake.
Because the paper bag method might do more harm than good, some experts recommend not trying it at all. And even those who do suggest it as a possible hyperventilation remedy advise an abundance of caution. According to University of Michigan Health , you should only take six to 12 breaths into a paper bag before removing it, and you shouldn’t let someone else hold the bag for you. And if you have “any heart or lung problems”—including coronary artery disease, asthma, and chronic obstructive pulmonary disease—or if you’ve ever had a stroke, a pulmonary embolism, or deep vein thrombosis, avoid the paper bag method completely.
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