The feeling of panic suddenly creeps in. You know you’re about to experience shortness of breath. The more you try to avoid it, the more anxiety ensues. Living with anxiety, and the moments of breathlessness that come with it, can be debilitating and sometimes scary.

What Is Air Hunger?

Heather Ann Voyer knows this all too well. In her mid-20s, she was diagnosed with anxiety. Over the past 20 years since her diagnosis, she has experienced panic attacks that come with rapid heartbeat, intrusive and circular thoughts, tightened muscles that lead to headaches and muscle pain, uncontrolled crying, hyperventilating, and distressed breathing. 

This inability to breathe properly is referred to as “air hunger,” a sensation that Kim Nowak, LCSW, clinical therapist at Chicago Counseling Center, has personally experienced. She became a therapist after years of her own struggles with anxiety. Her first panic attack occurred during a doctor’s visit in 2010.

“During the panic attack, I experienced difficulty breathing, followed by light headedness likely caused by shallow breathing, and it was the scariest of all the symptoms,” says Nowak. “As is common with people who have had a panic attack, I became scared of having future ones and the first symptom to set in would usually be feeling like I couldn’t catch my breath.”

Jeffrey R. Strawn, MD, psychiatrist and professor at the University of Cincinnati Health, says some of his patients describe air hunger as a sensation of “suffocating,” even though they are not physically exerting themselves or do not have a medical condition like COPD or asthma that impairs breathing. 

“Some have described it as like ‘breathing through a straw’ or they may feel their chest becoming tight,” he says. 

Why Does Air Hunger Happen?

Air hunger in anxiety and panic is closely tied to the body’s autonomic nervous system, which is the system that drives the fight-or-flight response. During panic attacks, the sympathetic nervous system becomes activated and may change breathing patterns, increase heart rate, and prepare the body for “fight or flight” responses, describes Strawn.

He points to a concept that is well studied in anxiety disorders, including panic disorder, called interoception, which refers to a person’s awareness of their internal bodily sensations like heartbeat, respiration, and gastrointestinal activity. Interoception can become dysregulated with anxiety disorders.

“In these cases, the brain may misinterpret normal physiological sensations as dangerous,” says Strawn. “This heightened sensitivity may cause individuals to overreact to normal benign changes in breathing or heart rate, which can in turn, trigger or worsen panic.” 

What to Do When You’re Air Hungry

When you experience air hunger during anxiety or panic, your instinct is often to breathe harder. However, Strawn says doing so can actually make the symptoms worse. Instead, he suggests slowing your breath and engaging the parasympathetic (calming) system. 

“A simple technique is paced breathing, where the individual breathes in through the nose for four counts, holds for four, and exhales through the mouth for six to eight counts,” he says. 

Nowak also finds breathing techniques helpful. 

In 2018, the FDA cleared a breathing-regulation device for panic attacks, which guides users through paced breathing to activate the parasympathetic nervous system. 

While experiencing air hunger, Nowak says it’s also important to pay to attention to your thoughts “because if you are catastrophizing, this is dangerous and is not likely to improve.” 

Once a doctor has confirmed that your difficulty breathing is caused by anxiety, Nowak says reframing catastrophizing thoughts from “I can’t breathe” to more helpful ones like “This is how I breathe when I’m anxious, it doesn’t and won’t last forever and isn’t dangerous, just uncomfortable” can be powerful and calming.

Nowak uses cognitive behavioral therapy (CBT) to help her clients with anxiety and panic. She says CBT is helpful for learning how to manage air hunger. The therapy teaches coping skills so that when a person is in a “crisis” state, they know how to reframe their thoughts and change their relationship to the anxiety. 

This approach has helped her personally, too. “I had to get to some acceptance and stop struggling against the anxiety. A thought that helped me—after countless doctor visits to assure this wasn’t asthma or something physical—was simply ‘this is the way I breathe when I’m anxious,’” she says. 

Grounding techniques like holding a cold object or naming things in the environment can also shift attention away from bodily sensations, adds Strawn. 

Can Medication Help Prevent Air Hunger?

Strawn says there is a long history of researchers trying to understand ways in which respiratory symptoms are associated with certain types of anxiety disorders. 

“More than 30 years ago, researchers in the UK found that patients with panic disorder often fall into two distinct groups: those with prominent respiratory symptoms and those without,” he says. 

The group with more respiratory symptoms has more spontaneous panic attacks and responded better to antidepressants, whereas those with fewer respiratory symptoms tended to have situational panic attacks and responded more to a group of medications called benzodiazepines.

“This suggests important differences in underlying biology of a disorder like panic disorder,” says Strawn. “We’ve also learned that people with panic disorder are especially sensitive to inhaled carbon dioxide.” 

Research shows that breathing carbon dioxide triggers panic in those with panic disorder, but not in people with some other types of anxiety or in healthy individuals, even when the sensation of breathlessness is matched.

Finding the Right Medication

Part of Voyer’s journey is figuring out which medications work best to help her manage anxiety and panic, especially to prevent symptoms. 

“I have tried medications aplenty. At one point, I did the GeneSight test and found out a missing enzyme was responsible for so many meds not working,” she says. “In spite of this information, I still struggle quite a bit.” 

She turns to her psychiatrist and general practitioner for guidance on the most effective medication regimen to manage her anxiety. She also sought help from Intensified Outpatient Therapy programs. 

“Coping skills are important to learn [but] difficult to implement unless you practice them outside of an anxiety attack,” says Voyer. “Counseling and meditation for me is critical. Having lifelines is crucial. Having a Crisis Plan in place is helpful—it is on my phone, and a printout is posted inside my kitchen cabinet for my family’s reference.”

Takeaway

Anxiety and panic can bring about many symptoms, including air hunger, which is difficulty breathing. While this symptom can be scary, understanding why it occurs, and learning ways to manage it, can help you cope.