Fear of not being able to breathe: why it happens, and how to ease it

For some people, the most frightening part of anxiety isn’t a racing heart or a worried thought. It’s the fear that they won’t be able to breathe: that they’ll run out of air, suffocate or choke.

This fear is common, it makes sense, and it’s very treatable.

What the fear can look like

• worrying you won’t be able to get enough air
• panicking in tight or crowded spaces, like elevators, tunnels, planes or MRI scanners
• feeling trapped by face masks, scarves or tight collars
• avoiding exercise because getting out of breath feels scary
• fearing you’ll stop breathing in your sleep
• constantly checking your breathing, or taking big breaths to “test” it
• fear of choking when eating or swallowing

Why your brain is so sensitive to breathing

Breathing is about as important to survival as anything gets, so it makes sense that your brain watches over it closely. In 1993, the psychiatrist Donald Klein suggested that we have a built-in suffocation alarm, a system that detects signs we might not be getting enough air, like rising carbon dioxide, and triggers an urgent urge to escape.

His theory was that in some people prone to panic, this alarm is extra sensitive and can go off when there’s no real danger. That would help explain why breathlessness and a feeling of smothering are such common parts of panic attacks, and why the fear of not being able to breathe can feel so overwhelming.

How the fear keeps going

1. You notice a breathing sensation: a tight chest, a shallow breath, a stuffy mask.
2. You read it as danger: “I can’t breathe.”
3. Fear makes you breathe faster, and that fast breathing makes you feel more breathless.
4. You escape, take off the mask, or avoid the situation next time.
5. Relief comes, and your brain learns the situation really was dangerous.

Each loop makes the fear a little stronger, and the list of things you avoid a little longer.

What helps

In the moment

• Breathe out first, slowly. A long out-breath calms your body and eases the feeling of air hunger. In for 4, out for 6.
• Remind yourself: “I’m getting enough air. This is my alarm system, not real danger.”
• Don’t gulp air. Big breaths make the breathless feeling worse.
• Ground yourself through your senses: what can you see, hear and feel?

Over time

• Face it gradually. Make a list of situations you avoid, from easiest to hardest, and practise them step by step: a short time with a scarf around your neck, a few minutes in an elevator, a gentle jog. Each step teaches your brain you can cope.
• Practise slow breathing daily, so it’s familiar.
• Exercise gently. Getting a bit out of breath on purpose, in a safe way, shows your brain that breathlessness passes.
• Get support. Cognitive behavioural therapy (CBT) is very effective for panic, claustrophobia and health anxiety.

How Breatheasy can help

Breatheasy can help you practise calm breathing, and get through moments of fear. Its guided breathing exercises pulse your phone as you breathe in, so you can follow a gentle rhythm with your eyes closed, which is a good way to build confidence in your breathing. If the fear turns into panic, tap “I’m feeling anxious” and Luma walks you through it, step by step. Breatheasy is coming soon to iPhone and Android.

When to get help

See a doctor if you often feel short of breath, to rule out physical causes, and if fear of not being able to breathe is stopping you doing things. Our guide to anxiety and panic attacks and post on how to tell if shortness of breath is from anxiety are good next steps.

Call 911 if you’re truly struggling to breathe, can’t speak, or your lips or skin turn blue or grey.

Sources

• Klein, D. F. (1993). False suffocation alarms, spontaneous panics, and related conditions: an integrative hypothesis. Archives of General Psychiatry.
• Claustrophobia, NHS
• Panic disorder, NHS