Is It Anxiety? Five Other Reasons Underlying Shortness Of Breath
If you’ve ever experienced shortness of breath due to anxiety, you know how uncomfortable and concerning it can be. Identifying the cause of shortness of breath can be crucial for effectively addressing it.
Shortness of breath, also known as dyspnea, may make it feel like your heart rate has spiked, your chest is tight and you’re having heart palpitations against your rib cage or upper chest, like your body's working overtime to take in more oxygen.
In some cases, a person may experience shortness of breath due to anxiety, but this isn’t always the case. In fact, there are several physical and mental health conditions that can cause an individual to struggle to breathe properly. In this article, we'll discuss how symptoms of anxiety disorders may affect your breathing, explore five other potential causes of shortness of breath, and offer tips that could help you breathe easier.
The connection between shortness of breath and anxiety
Anxiety can produce many potential physical symptoms, including nausea, gastrointestinal distress, rapid heartbeat, and, in some cases, shortness of breath, among others. This is because anxiety sets off your body’s sympathetic nervous system, which is responsible for the fight-or-flight response. Two components of this response include an increased heart rate and more rapid breathing, both of which are intended to help facilitate the exchange of oxygen and prepare the individual to run or fight.
Anxiety disorders
Occasionally and temporarily feeling anxious is a normal part of life, often due to transient worries about health, money, work, relationships, and other day-to-day concerns. However, when anxiety becomes more frequent or severe or begins to significantly impact daily life and functioning, it may indicate the presence of an anxiety disorder.
There are several types of anxiety disorders, such as generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobias. All of these have the potential to lead to shortness of breath in some people.
One possible reason is that anxiety may make it harder for a person to perceive their breathing patterns, so they may not realize that they’re engaging in shallow breathing. This can lead to a troubling cycle in which they start to experience anxiety due to rapid breathing, causing them to breathe faster, which can then lead to further anxiety. The unpredictability of when a dyspnea episode might arise could also increase anxiety and further fuel trouble breathing.
Five additional potential causes of dyspnea besides
Shortness of breath can be one of any number of common symptoms of several other mental and physical health conditions besides anxiety. The following are just a few examples.
1. Anemia
Anemia can develop when an individual produces an unusually low number of healthy red blood cells, which means their body doesn’t get enough oxygen-rich blood. This can cause shortness of breath as well as dizziness, headaches, irregular heartbeat, fatigue, and weakness.
2. Heart attack
Heart attacks occur when part of the heart doesn’t receive enough blood, often due to a blocked artery. Shortness of breath is a common symptom of heart attacks, along with chest pain, sweating, nausea, lightheadedness, and a pounding or racing heart.
Heart attacks are sometimes confused with panic attacks, which have a related but slightly different set of symptoms. For instance, someone experiencing a panic attack will often feel pain in the chest only. In comparison, heart attacks tend to cause pain that radiates to the arms, jaw, neck, and other areas of the body. Heart attacks may also cause more intense chest pressure and an achy or burning sensation, like heartburn, whereas people with panic attacks might feel a stabbing pain in the chest only.
3. High blood pressure
Breathlessness can also occur because of pulmonary hypertension, also known as high blood pressure. With pulmonary hypertension, the right side of the heart struggles to push blood through the lungs, preventing it from reaching the left side of the heart and body. When this happens, individuals often find themselves struggling to catch their breath on a regular basis, even after mild or no physical activity.
4. COVID-19
Trouble breathing is one of the most common byproducts of infection with the COVID-19 virus. In people with COVID-19, inflammation of the lungs may reduce oxygen in the blood, which can lead to dyspnea. Other studies suggest that the disease might also encourage the formation of blood clots. If these clots form in the tiny air sacs in the lungs, they can cause people to feel short of breath.
Shortness of breath usually subsides once the COVID-19 infection has cleared, though some people may experience this and/or other signs of “long COVID” for weeks, months, or even years.
5. Chronic lung diseases
Some chronic conditions that affect the lungs include asthma, pulmonary fibrosis, pulmonary hypertension, and chronic obstructive pulmonary disease (COPD). Some of these conditions are linked to lifestyle or environmental factors—such as smoking or working in an environment with high air pollution—and are therefore considered preventable. In other cases, the development of such a condition may be influenced by genetics. As an example, asthma runs in families but can also be affected by weather, air temperature, and some medications.
Tips for improving shortness of breath
Whether your shortness of breath is from anxiety or another health condition, there are several science-backed strategies that may help you calm your body and catch your breath. Depending on the cause of your shortness of breath, some of the below techniques may work better than others for long- or short-term relief. Consulting a healthcare professional can help you determine which strategies or treatments may help you breathe better and is recommended as a first course of action for dyspnea.
Breathing exercises
Breathing exercises may help facilitate oxygen exchange and help lower your blood pressure and heart rate so that you can relax. Pursed-lip breathing, for instance, is a common form of breathwork that requires less energy than a normal breathing pattern and can help calm your body when you experience dyspnea.
The basic steps for this technique include inhaling slowly through your nose for two counts, then pursing your lips before you exhale slowly for four counts. The practice may improve blood oxygenation and encourage slow, deliberate breaths.
Box breathing is another exercise that may enable more regular respiration. To practice box breathing, breathe in for four counts, hold your breath for four, breathe out for four, and hold your breath again for four before starting again. Repeat this process three to four times. Breathing exercises like these are versatile methods of addressing dyspnea that you can perform almost anywhere as needed. Remember to check with your doctor before engaging in breathing exercises like these if you have a lung condition.
Mindfulness meditation
Mindfulness is an ancient spiritual practice that originated in Asia and is now widely used around the world. It involves paying attention to the present moment and accepting current feelings and sensations without judgment. Mindfulness practices may help you slow down, relax, and reduce stress—and one of the primary components of mindfulness is breathwork.
If you’re experiencing shortness of breath from anxiety or another cause, you might take a mindful moment to focus on taking deep breaths and acknowledging the physical and emotional sensations you’re experiencing. It may help to sit comfortably or lie on a flat surface and try to relax your body as you do so. It’s not always easy to remain present and mindful of your emotions, but with practice, you may gradually learn to quiet your mind more easily and relax.
Self-care
Self-care generally refers to actions that help nourish the body and mind, and it can include a wide variety of activities—many of which research suggests may help you breathe easier. Some self-care activities that could help with dyspnea may include:
Drinking plenty of water, which may help with respiratory muscle strength
Exercising, which can increase lung health
Eating nutritious foods, which research suggests may help prevent asthma or improve asthma symptoms
Getting enough rest regularly, as peer-reviewed studies suggest that sleep deprivation may decrease “inspiratory endurance” and increase the intensity of dyspnea
Engaging in certain types of yoga, which may help improve respiratory function
Receive acupuncture, which could help control dyspnea by triggering the release of certain neurochemicals
Address anxiety in therapy
Again, it’s recommended that you talk to your doctor if you’re experiencing breathing problems. If they suggest they’re related to anxiety, meeting with a therapist may be a helpful resource in learning to cope with this symptom. A qualified counselor may help you learn to shift distorted thoughts that may be contributing to any anxiety-related breathing problems and can teach you effective strategies for coping with anxious feelings.
In-person therapy is not the only option for those who want to receive this kind of care. Through an online therapy platform like BetterHelp, you can engage with a licensed therapist virtually instead if you find it more convenient to attend sessions from the comfort of home. Research suggests that online therapy can be as effective as in-person therapy in many cases.
Takeaway
Read more below for answers to questions commonly asked about shortness of breath.
How do I know if anxiety is causing shortness of breath?
To recognize when your shortness of breath is caused by anxiety instead of other factors, you may need to consider your current circumstances and what you’ve been doing. Panic attacks often appear with little warning and tend to go away after 20-30 minutes. An anxiety attack could result from situations involving severe social or emotional stress.
In contrast, heart attacks frequently result from physical exertion, and they rarely occur “out of the blue”. They typically involve chest pain that starts at a mild level and gradually increases in severity. This pain may also radiate out to the arms, back, or jaw.
You may also be able to identify the cause by taking note of other anxiety symptoms such as:
- Dry mouth
- Muscle tension
- Trembling limbs
- Restlessness
- Pounding heart
These symptoms are unlikely to be present in many other serious conditions that can cause shortness of breath, such as pulmonary disease.
However, some physical symptoms of anxiety may overlap with those of cardiac arrest or arrhythmia. For instance, chills, sweating, and nausea can all be indications of either a heart problem or anxiety. If you’re an older adult or have any reason to believe you might be at risk for a heart attack, you may need to seek emergency medical attention if you’re not sure why you’re feeling short of breath.
Consciously controlling your breathing patterns may help you manage anxiety and overcome the shortness of breath caused by a panic attack. Mental health experts have identified several breathing techniques that can be useful for anxiety, including:
- Diaphragmatic breathing: Breathe slowly through your nose, imagining your lungs filling from the bottom to the top and allowing your stomach to expand and contract. Trying to breathe in for a count of 2-3 and out for a count of 3-4 may help.
- Pursed-lip breathing: Push out your lips as though you’re whistling. Inhale through your nose, then exhale through your lips as though you’re trying to blow up a balloon. It’s often best if the exhale is noticeably longer than the inhale. This should usually be done for only 5-10 repetitions, and you can stop if you feel dizzy.
- Humming breath: Keeping your spine straight and upright, breathe in slowly through the nose. Then make a gentle humming noise with your lips closed as you slowly release the breath.
These exercises may be even more effective if you focus your awareness on the physical sensations involved. This can serve as an exercise in mindfulness, which research suggests can help reduce anxiety.
In most cases, shortness of breath resulting from anxiety occurs in short, discrete episodes such as panic attacks. This symptom usually goes away in under an hour. If you’re experiencing chronic, persistent shortness of breath, you may need to talk with a doctor to determine whether there’s a physical cause.
It’s unusual for anxiety to cause shortness of breath that persists over long periods. If you’ve been having difficulty breathing for multiple days, it’s likely a good idea to seek medical attention as soon as possible. Your symptoms might indicate the presence of a serious pulmonary disorder.
In some cases, the sensations of fear and worry involved in anxiety may interrupt your normal breathing rhythm. You might find yourself holding your breath without realizing it, then suddenly exhaling when you notice what’s happening. This may be an instinctive fear response that evolved to help humans remain still to hide in the presence of predators.
Experiments suggest that the sympathetic nervous system, which activates the “fight or flight response”, may be more sensitive and more strongly reactive in people with anxiety disorders. It may be easier for small stressors to trigger fear reflexes, including involuntary breath-holding.
While this disruption of breathing may be stressful and could affect long-term health, it doesn’t usually pose an immediate danger. The body’s autonomic responses should trigger breathing automatically when someone has been holding their breath for too long.
Although breathing exercises can often help reduce anxiety, simply trying to force yourself to inhale more deeply can sometimes be counterproductive. For some individuals, an excessive focus on their breath may trigger anxiety instead of relieving it. It could reinforce their mental perception that something is wrong with them and exaggerate their worries about their health and well-being.
Deep and fast breathing, also known as hyperventilation, may also have the unwanted effect of stimulating your sympathetic nervous system. This may aggravate anxious feelings. It may be better to focus on inhaling and exhaling slowly, gently, and deliberately rather than simply taking deep breaths.
In some cases, severe anxiety or panic attacks may contribute to tightness or pain in the chest. This can cause some people to believe they’re experiencing a heart attack. One recent study found that anxiety was responsible for 30-40% of cases in which patients came to emergency rooms when not experiencing cardiac distress.
Many studies have found evidence that certain controlled breathing can help reduce the frequency and severity of panic attacks. These can include simple techniques such as diaphragmatic breathing along with techniques derived from meditative or mind-body practices like mindfulness and yoga. Other potentially effective methods involve using biofeedback, in which participants can observe real-time measurements of stress symptoms like their heart rates, enabling them to see the effects as they adjust their breathing.
Controlled breathing may help reduce the physical and psychological symptoms of stress in several important ways. One is by activating the parasympathetic nervous system. These neurons, glands, and hormones helps to decrease the body’s fear response and promote a calmer state. By increasing activity within the parasympathetic nervous system, breathing exercises may directly decrease bodily sensations and mental perceptions of stress.
Many attentive breathing methods may also function as sensory grounding techniques or meditative practices. Learning to focus and control your attention in this way may improve your ability to release anxious thoughts and feelings, helping to decrease the psychological anxiety symptoms. Some studies even suggest that meditation and breathing practice could be as effective at reducing anxiety as medications like selective serotonin reuptake inhibitors (SSRIs).
Over time, consistently using calming breathing techniques may decrease stress hormones (such as cortisol) within the bloodstream. This can play an important role in preventing the long-term negative health effects associated with stress.
Regular physical exercise has been shown to help reduce many different mental health conditions, including anxiety. This may be due to a combination of physiological and mental effects. Establishing a regular exercise practice could improve confidence, discipline, and self-esteem. Meanwhile, bodily changes such as improved blood circulation and higher concentrations of endorphins might enhance an individual’s ability to control their emotions and achieve calm.
Exercise is only one of several “lifestyle interventions” that appear to decrease anxiety by promoting better overall health. Other strategies that may help include:
- Maintaining a healthy sleep schedule
- Eating a healthy diet
- Spending time outdoors in natural settings
- Strengthening social ties
- Reducing alcohol, tobacco, and caffeine use
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