Wednesday, March 05, 2014

H Is for Hyperventilating

Here's another fun part of having panic disorder: hyperventilation syndrome.

Last summer, I went through several weeks where I thought I was becoming diabetic. I didn't mention it because it kind of scared the hell out of me, and rather than fret about it, I wanted to make sure to get regular exercise and eat better, just in case.

I started having chest pains and paresthesia--that tingling sensation you get in your fingertips. I was really worried that I was going to go into shock or have a heart attack or something. This is when I was still uninsured and reluctant to go to the emergency room or see my doctor, which is a whole other blog post in itself. But it turns out that worry was actually making the symptoms much worse, because what was really happening was hyperventilation syndrome.

It's something that can happen to people who have panic disorder. Back when I was first diagnosed with panic disorder, I was stunned; in the weeks following, I began to really, truly think about it, and I realized that I was panicked most of the time. And it wasn't just the big things, like the way snow can trigger panic in me, or loneliness, or frustration. But even the thought of having to leave the house or whether I had forgotten to pay a bill or whether there was anything to eat in the house caused mass waves of panic to flow through my body. I was always panicking, I'd just gotten so used to it that I stopped being aware of it and started letting it dictate my behavior.

Now, added to all of that is my weight problem and my sleep apnea. I sleep with a CPAP machine that keeps me from choking to death in the middle of the night. At some point, however, stress and panic started making me hyperventilate, so I sometimes have this problem where I'll wake up and immediately be anxious and start hyperventilating. The key to this is to find ways to deliberately slow down your breathing, but it's hard to slow down your breathing when you're wearing a mask that is shooting a steady stream of air up your nose so that your throat doesn't close in the middle of the night and suffocate you. Usually I just end up getting out of bed early and exercising (to get out the anxious energy) and trying to control my breathing.

What happens when you're experiencing hyperventilation syndrome is that you feel like you're not getting enough air and you start to breathe heavier and more rapidly. But you're still not getting enough air, because actually your blood oxygenation is normal, but your blood vessels are constricting because you're not getting enough carbon dioxide--which reduces the effective delivery of oxygen to your vital organs--because you're breathing too rapidly. It feels like you're drowning. So you breathe more rapidly, and then you can start to raise the blood pH, which makes the symptoms worse, which makes you breathe more rapidly, and then on and on. And that seems like it would cause a panic attack, except in my case it's already happening because of a panic attack, which just makes every part of it seem more desperate and hopeless.

It's not a heart attack, except it feels like one and, ironically, could actually give you a heart attack. It can also cause dizziness (check), fainting (not yet), perception problems (check; my eyes hurt a lot sometimes and my vision gets very blurry), and even disruptions or permanent changes in your nervous system.

And it happens all the time. Even right now, as I sit here writing this, I'm feeling a few of the symptoms and my head is hurting.

So, how do you treat it? No one really knows. SSRIs can apparently reduce their severity and frequency; there are other drugs that can apparently help your body's response to panic. I am, as ever, reluctant to take drugs like that, especially considering my last two antidepressant experiences, both of which led to a dramatic raising of my already-high blood pressure and compulsive thoughts of suicide.

A lot of it still comes down to breath control. You have to use a method to slow your breathing down; counting usually works for me, breathing in for 4 seconds, holding for 2, and exhaling for 6. Often, it calms me down but it makes me very sleepy.

That thing in my mouth in the picture is something I made to help with my breathing. Another way I can slow my breathing is to simply take in less air, so I rolled up a receipt, taped it together, and I breathe through it like a little straw.

I wish that panic disorder was as simple as just being really scared sometimes. That's bad enough, but the physiological responses to it can be baffling, confusing, scary, and hard to deal with. Too often people dismiss it as mere overreacting; how many of you with real anxiety problems have been told you're just "too sensitive"?

In reality, a person with panic disorder can experience severe behavioral changes for a month or more, often exacerbated by worrying about the implications of panic attacks and the fear of having another one. They can't be predicted, and that alone is enough to cause anxiety when you know how severe panic attacks can be. I spoke weeks ago about about having an anxiety attack so severe that I couldn't eat for 24 hours and was constantly suffering extreme gastrointestinal issues. It was most severe in the first day, but the effects continued for several more, and some of the effects still haven't gone away. That's what your body can do to you. Panic disorder and anxiety can make you feel like you have no control over the way your body responds, and that only creates more panic and anxiety, and sometimes people just give up.

Here's a fun example of what anxiety does for you: I once woke up during an operation when I was 8 years old, because the epinephrine in the anesthesia created an adrenalin rush that woke me up and caused a panic attack. Nothing like being an 8 year-old and getting yelled at by your dentist for freaking out while he cuts into your gums to pull down a permanent tooth that wasn't breaking through. If you have a child, please, please don't ever yell at them or make them feel ashamed of being afraid. They're not doing it to make you angry.

That's another part of the fun of all this: being able to remember, more clearly than anything else that's ever happened, every moment in my life when I was panicked and made to feel ashamed or ridiculous or like I was just "too sensitive," and how being made to feel those things built the operating schema that I was a failure at everything and where that's gotten me in life, because until I started therapy, I didn't even know consciously what it was that was holding me back. And I'm worried that I'm going to spend so much of the rest of my life attempting to get control of it.

ABC Wednesday


Leslie: said...

At first, I thought it was a cigarette so I appreciate the explanation. My daughter has occasional panic attacks, but then she has bipolar 2, taking several meds to try to keep her level. Best of luck treating yours. I'm just wondering - is that why people breathe into a paper bag when they start to hyperventilate?

abcw team

Cal's Canadian Cave of Coolness said...

I appreciate it very much when you talk about your various health issues. I suffer from panic disorder too and PTSD from the time I was shot at while working on a native reserve and I have just gotten back into teaching GED adults. It's great when I get here but it's so stressful on the days when I am not working. It's good to know I am not alone.

Nydia said...

Poignant post and helpful for those suffering with the same issue. I occasionalky hyperventilate during the night when I'm too worried about something, it's an unpleasant and scary experience, so I can relate to this detail. (((hugs)))

Roger Owen Green said...

I actually have that finger tingling stuff occasionally, and chest pain, but not on the left side. I KNOW it's stress, due to some stuff at home, involving the daughter, that's wearing me down. (See my blog, March 26.)

as always, I appreciate your honesty, and wish you well.

SamuraiFrog said...

Leslie: That's where it comes from, but generally that's not recommended anymore. The symptoms are too close to those of a heart attack. Breathing into a paper bag restores your carbon dioxide levels, which is good if you're hyperventilating out of stress and panic, but BAD if you're having a heart attack.

Cal: I've found your foray into adult education very inspiring.

Nydia: Thank you, I appreciate that. It's something I've only recently figured out, and it was scary up until then. Well, scarier. It's still scary.

Roger: The first time I ever had a panic attack, back around 2003 (I think), I didn't even know what panic attacks were and thought I was having a heart attack. I had no idea. In 2007, I did go to the ER for the same reason. It was so severe that when they hooked me up to the monitors and said my heart was fine, for several minutes I actually thought I was dead.