Breathing into a paper bag: does it work?

You've seen it in films. Someone panics, breathes too fast, and a friend hands them a brown paper bag. Breathing into a paper bag looks like the classic fix for a panic attack.

I would never breathe into a paper bag. I'd avoid it completely, because I believe you're not getting back the oxygen you need. Here's what actually helps.

Why people breathe into a paper bag

When panic hits, the breath gets fast and high in the chest. You feel like you can't get enough air, so you breathe even more.

But fast breathing doesn't give you more oxygen. It makes you breathe out too much carbon dioxide. That's what brings the dizziness, the tingling in the hands and face, the tight chest and the racing heart. Feeling all that, you breathe even faster, and the loop goes on.

The paper bag idea is old and logical: you breathe your own air back in, the air you breathe out contains more carbon dioxide, and that's supposed to bring the level back up.

Why I'd skip the bag

The air you breathe out still has some oxygen in it, but less than the air in the room. In a bag, you breathe that same air again and again, so each breath has less oxygen than the one before.

In 1989, emergency physician Michael Callaham reported three patients who were given the bag because it looked like hyperventilation, when the real problem was low oxygen or a heart problem. All three died. Those cases led him to test the bag on 20 healthy volunteers, and their oxygen levels kept falling the longer they breathed into it (Callaham, 1989).

A panic attack and a heart attack can look alike from the outside: chest tightness, short of breath, fear. If it's something else, taking oxygen away makes it worse. This is the biggest risk of the bag.

The bag also misses the point. When anxiety is making you breathe too fast, what helps is letting your breathing settle. And the bag may not even do its job: in Callaham's test, carbon dioxide only climbed to about normal, and for many people not even that, while oxygen kept dropping.

Try this now: slow the breath down, gently

This is only for when you know your fast breathing comes from anxiety, for example it feels like the panic you've had before and a doctor has already checked you. If there's chest pain, or the breathlessness is new or unexplained, don't practice. Get medical help first (see below).

You're not trying to take big, deep breaths. You're trying to breathe more gently: slower, softer, smaller.

1. Sit down if you can. Put one hand on your chest and one on your belly.
2. Close your mouth if you can, and breathe through your nose.
3. Breathe in softly, a small breath, into the belly. Let the belly move naturally, without forcing it or trying to keep your chest perfectly still.
4. Breathe out slowly, a little longer than the breath in. Imagine you're turning a fan down from high to low, one notch at a time.
5. Keep the breath quiet and easy.
6. Keep the breath gentle and comfortable. You don't need to hold it back or make yourself feel short of air. If following the breath makes you feel worse, open your eyes, look around the room, and go back to your natural breathing.

How long: a few minutes, until the tingling and dizziness ease. If they haven't eased after about 5 minutes, or they get worse, stop and get medical help. How often: whenever you notice yourself breathing fast. Practice it when you're calm too, with the 2-minute long exhale timer, so it's familiar when you need it.

A note from me: here's one number from my training. When you breathe normally, your blood is already about 96% full of oxygen. That's why "more air" was never the answer.

If you feel short of breath: don't force anything. Let the breath out be long and easy. The in-breath will come by itself. If the breathlessness gets worse instead of easing, stop and get help.

What people often get wrong about "deep breathing"

When we tell someone who's panicking to "take a deep breath", they often take a huge one, in through the mouth, chest up, shoulders up. That's more of the same fast breathing.

What helps is a slow breath, not a big one. The anxiety researcher Alicia Meuret puts it well: when people hyperventilate, they take in too much air, yet it feels like they can't get enough. She calls it almost a biological system error. Breathing less and slower is how you correct it, safely, from the inside.

FAQ

Does breathing into a paper bag help a panic attack?

It can bring carbon dioxide back up, but it also lowers the oxygen you breathe in, and it can be dangerous if the cause is actually a heart or lung problem. If anxiety is making you breathe too fast, gently slowing your breathing is a safer approach than a paper bag, as long as you know it's anxiety.

What should I do instead of breathing into a paper bag?

Slow your breathing down. Small, soft breaths in through the nose, and longer breaths out. Hand on your belly. If there's chest pain or the breathing doesn't ease, get medical help.

Why does hyperventilating make you dizzy?

Breathing too fast blows off too much carbon dioxide. That changes your blood chemistry for a while, which can cause dizziness, tingling and a tight chest. Slowing down lets it come back to normal.

Keep going

• Waking up with a panic feeling: what to do in the first minute.
• Long exhale breathing: practice it when you're calm.
• How to calm your nervous system in 2 minutes: before a meeting or a call.
• Free 10-minute practice for the evening.

Sources: M. Pistono, Breathe How You Want to Feel (overbreathing, carbon dioxide and the paper bag, p. 114) · J. Nestor, Breath (Alicia Meuret on hyperventilation) · Callaham, Annals of Emergency Medicine 1989 · Alessio's own view (he would never use the bag, because he believes you don't get back the oxygen you need).