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How to Tell If Your Shortness of Breath Is Anxiety or a Medical Emergency

It’s a tough call to make when you’re gasping for air, but there are some definite clues to look out for

There are few things scarier than experiencing shortness of breath out-of-nowhere. It was enough to freak out even hardened mob boss Tony Soprano and send him to the hospital. And when it comes to a symptom so often associated with life-threatening heart and lung problems, many people assume the feeling is an emergency. But what if that shortness of breath is all in your head, no matter how much it feels like it’s in your chest?

This kind of mix-up happens frequently, psychiatrist Gail Saltz explains. “The most common confusion arises over panic attacks, which cause shortness of breath, but also can cause palpitations, a feeling like you could be dying or having a heart attack,” Saltz tells me. By the time she sees patients who have obvious anxiety and panic disorders, many of them have already made expensive trips to the ER to rule out something physical. 

Among the more effective ways to distinguish between a panic attack and a life-threatening event is to focus on your breath. That’s because with anxiety, “it’s not that you have any issue with your lungs or trachea in terms of breathing, it’s that norepinephrine is being released throughout the brain and body,” Saltz says. This is the fight-or-flight response at work because we think we’re in danger, and when we’re in that mode, we do everything faster, including breathing more rapidly. “The faster breathing gives us the perception of being short of breath,” Saltz continues. 

While Stephanie Stathas, a licensed professional counselor specializing in anxiety, agrees, she also points out that many people don’t understand the cyclical nature of how stress affects breathing: The shortness of breath impacts the nervous system, which in turn makes it harder to breathe, which can then make you pretty damn confident you’re going to hyperventilate. “To target the confusion a person may feel, proper psychoeducation is needed, as well as reassurance by an individual’s primary-care physician that the anxiety and shortness of breath aren’t related to a medical issue,” Stathas notes. 

Luckily, there are a few ways to determine if breathing issues are rooted in anxiety when you’re seemingly trapped in the moment. So before you freak out further, ask yourself the following questions… 

What Are Your Other Symptoms?

When people go into fight-or-flight mode, they don’t just lose their breath. “There will be other symptoms like a racing heart, feeling jittery or nauseous, sweating and thinking thoughts like, ‘I’m going crazy,’ or ‘I’m going to die,’” Saltz says. If those things are happening as well, then it’s likely anxiety. “But if you have a sudden, unexplained episode of shortness of breath” without other issues, Saltz warns “it could be a medical issue; so I’d say the first time it’s important to urgently be examined to rule out a medical emergency.” 

Are You Having Chest Pains?

Minor symptoms like nausea are probably anxiety, but if you feel pain or discomfort in your chest, Stathas says you may “have a blockage affecting your breathing such as food or another object.” There’s also a good chance you’re experiencing something other than anxiety if “you cough up blood, have a fever or chills or have a history of bronchitis, pneumonia, chronic asthma or another respiratory condition.” Discomfort in your chest could indicate a heart attack as well. 

The point is, when shortness of breath is combined with chest pain, deep breathing isn’t a solution and you need to see a doctor.

How Are You Doing Emotionally?

After checking in on physical symptoms, it’s time to check in on your feelings. “Negative emotions tend to activate our nervous system in a way that causes shortness of breath,” clinical psychologist Andrea Naranjo tells me. “Think about how you breathe when you’re surprised, angry, frightened or anxious.”

As a result, job loss, breakups or other traumatic events can cause you to lose your breath, “which tells our brain that something isn’t right, which puts us in a vicious cycle of anxiety and difficulty catching our breath,” Naranjo says. 

Men in particular appear to be at an increased risk for anxiety after a breakup, a recent study found. In general, people can temporarily develop something known as “broken heart syndrome” following an emotionally stressful situation, which typically resolves itself but symptoms include shortness of breath. So, if something is going on in your life that’s emotionally taxing, that could explain where your breath went. If not, then there may be reason to panic, outside of a panic attack, of course.

When Was The Last Time You Saw a Doctor?

The most precise way to rule out if something else is going on is by going to the doctor. Naranjo often recommends “people get a physical to rule out any breathing issues, especially if they have a medical history that includes asthma.” In addition to asthma, it’s important to take inventory of other habits like smoking or drinking. 

The point is, instead of waiting until your anxiety and breathing get out of control enough to send you to the ER, taking a more proactive approach to your physical health can give you better peace of mind when anxiety hits and shortness of breath kicks in. 

Have You Tried Mindfulness?

Since anxiety and breathing are so closely intertwined, if you can bring your anxiety down with mindfulness practices like the grounding method, light exercise or even sucking a lemon, then you should be able to catch your breath. Likewise, if you can get your breath under control with exercises like boxed breathing, the parasympathetic nervous system should be able to override the sympathetic nervous system, which is what triggers the fight-or-flight response. This is why breath work is so often prescribed to produce a sense of calm, and alleviate anxiety.

In particular, Naranjo recommends her clients who struggle with anxiety do diaphramic breathing for three minutes, three times a day. “To practice diaphragmatic deep breathing, one should take a long deep breath in, hold it and then exhale. It’s important to exhale longer than inhale,” Naranjo explains. “Again, if you think about strong negative emotions, we tend to breathe-in as quickly as possible and feel that we cannot get enough air into our lungs.” 

Meanwhile, Stathas suggests “learning how to challenge irrational thoughts using cognitive behavioral therapy techniques, progressive muscle relaxation, guided imagery, journaling and Eye Movement Desensitization and Reprocessing, or EMDR therapy.

They might all be pretty different in execution, but their aim is one in the same — giving you the time (and tools) you need to catch your breath.