Myth or fact

Breathe into a paper bag when you panic

Short answerNo

By GyroscopeUpdated November 14, 20264 sources

No. Breathing into a paper bag is old first-aid advice. It does put back some of the carbon dioxide you’ve blown off, but it also cuts the oxygen you breathe, and if the real cause is your heart or lungs it can be deadly. Slow, long out-breaths through pursed lips do the same job without the risk.

Why it seems true

The logic is neat. When you panic and breathe too fast, you blow off carbon dioxide, and low carbon dioxide causes the tingling, dizziness and racing heart that make panic worse. Breathe your own air back in from a bag and you breathe some of that carbon dioxide back in too. It’s been around long enough that a 1989 emergency medicine paper called it “traditional practice.”

The trouble is that the air in the bag gets worse with every breath. Rebreathing your own air is like reusing bathwater. It’s warmer each time, and there’s less clean water in it.

What happened when an emergency doctor tested it

In 1989, Callaham, an emergency physician at the University of California, San Francisco, wrote up what he’d seen. He reported three patients who died after being told to breathe into a paper bag. Each one had been treated as an anxious person hyperventilating. In fact, they were short of oxygen or their heart wasn’t getting enough blood.

That pushed him to test the bag on healthy people. Twenty volunteers, 14 men and 6 women with an average age of 36, breathed fast on purpose to blow off carbon dioxide. Then they kept breathing fast into a standard brown paper bag fitted with oxygen and carbon dioxide sensors.

• Oxygen fell, steadily. The oxygen they were breathing kept dropping for the whole three minutes. On average it fell by 26 mmHg at its lowest. In seven volunteers it was down 26 at three minutes, in four it was down 34, and in one it was down 42.
• Carbon dioxide came back up. Within 30 seconds it had risen to about 39 mmHg on average, though many volunteers never reached 40.

The bag did raise carbon dioxide, and it cost oxygen the whole time. The healthy volunteers got through it. In someone whose fast breathing comes from a heart problem or low oxygen, losing more oxygen is the last thing they need.

Why you can’t always tell

Fast breathing from panic and fast breathing from a medical emergency can feel the same from the inside. MedlinePlus lists the symptoms of overbreathing as feeling lightheaded or dizzy, feeling you can’t catch your breath, chest pain, a fast or pounding heartbeat, and tingling around the mouth and in the arms. Callaham’s three patients show how easily a heart or oxygen problem gets mistaken for anxiety.

That’s why MedlinePlus says that rapid breathing for the first time may be a medical emergency, and that you should get to an emergency room right away.

What to do instead

1. Sit down somewhere safe. If someone’s with you, ask them to stay and talk to you in a calm, quiet voice. MedlinePlus suggests reassurance like this.
2. Breathe in through your nose, a small breath. Don’t gulp.
3. Breathe out slowly through pursed lips, as if blowing out a candle. MedlinePlus recommends this pursed-lip breathing for overbreathing.
4. Make each breath out about twice as long as the breath in. Keep going for a few minutes.
5. Once you’re steadier, a few minutes of cyclic sighing or six a minute on the timer can help. Skip any pattern with holds while you’re panicky.

If this is your first time breathing this fast, or there’s chest pain, fainting or trouble breathing that doesn’t settle, call emergency services. Don’t wait to see if breathing exercises fix it.

Why slow breathing works better

A slow out-breath tackles the actual problem. You stop blowing off carbon dioxide faster than you make it, so the level drifts back to normal on its own, and every breath is still fresh air. Your heart slows a little on each long out-breath too.

There’s also evidence that it helps with the feeling itself. In the Stanford trial, five minutes of cyclic sighing, with its long out-breath, cut anxiety after each session by about twice as much as fast breathing did. For panic that keeps coming back, breathing is one tool. A doctor or therapist can help with the rest.