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COPD and Panic Attacks

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This blog post was written by Ryan Rivera, www.calmclinic.com.

Panic attacks are a type of mental health disorder that can feel overwhelming. Most people associate the word “panic” with fear, but panic attacks are not necessarily a fear-related disorder. Indeed, while they can be triggered by fear, panic attacks may have no trigger at all, and the symptoms are almost entirely physical. They include:

  • Severe shortness of breath.
  • Racing heartbeat.
  • Chest pain and difficulty breathing.
  • Feeling faint, lightheaded, or dizzy.

People that have never experienced panic attacks before often describe the experience as “feeling as though they are dying.” Over-sensitivity to your own physical responses is one of the clear culprits. A little bit of anxiety or nervousness (which is common for those with panic disorders as they worry that they may get a panic attack) causes the person experiencing the panic attack to overact to the heart beat increasing, triggering another panic attack.

Panic attacks are difficult enough for those that have no other physical or mental health problems, leading to agoraphobia and the occasional hospitalization despite nothing being physically wrong. For those with COPD, panic attacks can be much worse, because when you have COPD, a panic attack – which, again, has no physical cause – can be misconstrued as a serious health complication. Worse is that, for safety, it would be dangerous for a doctor to assume that someone living with COPD is having a panic attack, so they may load those with COPD with medicines and treatments they otherwise don’t need, potentially exacerbating your health problems or, at the very least, causing considerable medical expenses.

The most important thing you can do to help with your panic attack management is to learn as much as you can about panic attacks, pay attention to your own panic attack symptoms, and make sure those around you understand that you suffer from panic disorder.

Panic attacks are difficult to cure, but they’re made worse by a complete lack of understanding both in and out of the medical field about what they are and what the experience of a panic attack is like. Many doctors still treat panic attacks like a medical disorder, when in reality they need mental health treatment. In addition, those that suffer from panic attacks often struggle to believe that something so severe could be caused by something mental, especially if you have COPD. But the more you and others understand panic disorder, the less you’ll be affected by the symptoms.

Similarly, learn to understand your own triggers and focus on the differences between your COPD and your panic attack problems. Your ability to tell the difference is an important part of limiting the panic attack symptoms and unnecessary medical visits. You should also consider all of the following:

Give yourself a task to complete when you have a panic attack. Panic attacks happen in cycles, and if you have a go-to task (like drinking water or counting to 20) that you do when you have a panic attack, you’ll be able to manage the attack better and worry less about the next one. Never reinforce it. Agoraphobia – or the fear of being outdoors – is a common side effect of panic attacks. Too many people fear leaving their home because they worry that they’ll get a panic attack if they do, and of course these panic attacks become self-fulfilling prophecies, thus reinforcing their fear. Instead, expect a panic attack. Wait for it, have a plan in place, and move on once it comes. Only by acknowledging that they’re coming can you learn to live with them.

Find a buddy/partner. Someone to call is always useful, especially if they understand both your COPD and your panic attacks. They’ll be there with you to talk you down from your anxiety/panic, and you know that if something goes seriously wrong you’ll have them on the phone with you to help. Panic attacks involve some of the most severe anxiety symptoms available, and are difficult enough for those in otherwise good health. If you have COPD, they can feel overwhelming. Learn as much as you can about panic disorders and coping strategies, because only if you learn to live with both can you enjoy the quality life that you deserve.

About the Author: Ryan Rivera used to suffer from unbearable panic attacks and agoraphobia, but learned to cope and can now live more comfortably out in the open. He writes about panic attacks and anxiety at www.calmclinic.com.

25 Comments



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  • Good advice.
    Reply
  • So glad to see this post -- such great tips. Anxiety is so common with COPD and there is no shame in seeking assistance for something that impacts your life in such a significant way (just as we do for breathing difficulties or pain). Just as with medication, what works for one person may not work for another, so it helps to talk to a professional and see what is the best fit for you. Glad to see too that the author is managing his anxiety and sharing his experience with others. Thanks for this!
    Reply
  • My wife has Stage IV Copd with an FEV1 of 16%. She has been having horrible numbers of full blown panic attacks. The psychiatrist has her on 2 anti depressants and increasing Ativan with very little success. An exacerbation stopped her first psychologist appointment to use cognitive behavior therapy.
    During the recovery phase after the initial day of the exacerbation, she was given a bipap overnight treatment while in the midst of a major panic attack. Within about 30 seconds the panic attack not only subsided, it ended completely.

    I have researched this phenomenon and while I find lots of evidence of increased CO2 levels causing increased acidosis of her blood and lots of studies showing increased acidosis causing panic attacks in both healthy people (add 5% CO2 to their air supply) as well in COPD patients.
    I can't find any info on using bipap as a treatment for COPD panic attacks.
    Does anyone have any info or better yet experience using a bipap machine to counter daytime panic attacks. I'm thinking a 5 or 10 minute bipap use should do the trick.
    Respiratory techs don't seem to think this is a good idea and panic attacks are not a pulmonologists concern. When you have a panic disorder its considered a mental issue for treatment by psychologists and psychiatrists. But they have little or no experience in pulmonary issues. I really need a pulmonary psychiatrist, but those don't seem to exist.
    Reply
    • I completely understand your dilemma and I'm so sorry that both of you are experiencing this. I have researched the respiratory journals and it looks like antidepressants are not helpful.
      And it only makes sense since the air hunger experienced and panic or anxiety it causes has a real cause. It's a bit like giving someone medication when they are drowning, but not pulling them out of the water.
      Of course there is purse lip breathing, but I'm sure you know about that. Regarding the bipap, I have heard of people using them intermitantly, and considering how well she responded to the bipap, I have no clue why the pulmo would not give it a try. I think if something is not harmful, why not try it for a better QOL.
      I think it is just awesome that you are not ready to stand by, but are looking for answers for her. You sound armed with knowledge and information, it sounds as if you need someone on your side to help your wife.
      I have used ativan, but they now make it worse, especially at night. They obviously interfere with my breathing and allows more co2 to build up. This is my own experience.


      Reply
    • Also I wanted to draw your attention to this sentence in the article :

      "Worse is that, for safety, it would be dangerous for a doctor to assume that someone living with COPD is having a panic attack, so they may load those with COPD with medicines and treatments they otherwise don’t need, potentially exacerbating your health problems or, at the very least, causing considerable medical expenses."

      I think it is important to realize that panic attacks in people without COPD can cause shortness of breath feelings, but in COPD it is the other way around. =If you take away the dyspnea, the panic stops.


      Reply
    • Jim, hopefully your wife's physchiatrist and Pulmonologist can work together to help her have an action plan on how to treat her symptoms promptly so they don't escalate into a full panic attack and can be gotten under control if she DOES get panic attacks.

      So glad that the bi-pap helps her. Maybe a refresher training on pursed lip and diaphragmatic breathing would also be useful. That is something we review frequently in our support groups and the patients find it very useful.
      Reply
  • I don't know if this is the right section to ask this but I'll take my chances anyway.
    Hi All, I just want to ask if you ever tried using cannabis for anxiety? I am 35 years old now and been battling anxiety and panic attacks for almost half of my life. I have read many articles about medical marijuana and how it can help you in terms of pain management, anxiety disorders and panic attacks, inflamation, even cancer and a lot more. Like this review on a certain strain called XJ-13 from http://www.ilovegrowingmarijuana.com/xj-13/. Cbd and thc are also new to me and I don't even smoke. If this is true I cant find any solid conclusive evidence that speaks to its efficacy. Any personal experience or testimonial would be highly appreciated. Thanks
    Reply
    • There is a lot of info on various components of using Marijuana for anxiety. The hallucinogenic compound THC is known to increase anxiety, panic attacks, and even paranoia.

      The anti-anxiety compounds, the cannabinoids, are available online. Google Charlottes Web. This extract is legal, contains the anti-anxiety cannabinoids, no THC and is available online in multiple formats. It may also be available locally. We bought some through a crossfit gym of all places.

      We tried it, but I believe our anxiety is caused by the CO2 buildup and it wasn't a solution for us. However, I urge you to give it a try. There is no downside to doing so.
      Reply
    • Finally, our Bipap machine comes tomorrow! And due to her low FEV1, no sleep study was required. We have very high expectations for it in reducing the panic attacks and hope we aren't disappointed.
      Reply
    • The 2017 Global Initiative for COPD is available online and on page 18, the following is included:

      "NPPV may improve hospitalization-free survival in selected patients after recent
      hospitalization, particularly in those with pronounced daytime persistent hypercapnia. In patients with both COPD and obstructive sleep apnea there are clear benefits associated with the use of continuous positive airway."

      The point I'm making is Bipap therapy is justifiable for reduced hospitalizations and reduced mortality. So if you don't have one and panic attacks are in your picture, consider asking your pulmonologist for one.
      Reply
  • I am going to be blunt about this article. This article reads like a DSM article. COPD panic is not related at all to any DSM diagnosis and in fact dragging that into a serious disease like COPD is dangerous. I have experienced this first hand and it is making getting proper treatment for COPD very difficult. If someone is drowning, no amount of drugs or therapy will help. If you disconnected the "alarm receptor" in the brain that responds to not getting air, people would die.
    Do people who cannot breathe suffer anxiety or panic? Yes, but there are no treatments that are safe and is so reflected in thoracic journals. The reason is that it is not the same anxiety and panic that non copd people experience. It is a completely normal reaction and a life saving one, or is supposed to be, coming from receptors between lungs and the brain. Does Ryan Rivera have severe dyspnea from COPD?
    Reply
    • Eves, Thank you for your comment. I believe you take a one-sided view of COPD panic and may be missing the point of the discussion. I tried to point out (and I guess I failed) that my wife has severe panic and the max dose of two anti-depressants and daily Ativan failed to give her any relief. Cannabinoids failed to help her as well.
      I'm sure you can understand how hard I might search for something that might give her relief. If it was throwing softballs over a rooftop, I would try that.
      You are right about COPD panic not having a DSM diagnosis code and I find major fault with that. There should be a DSM code for it. All the literature I have read says COPD panic happens in the majority of COPD cases so why isn't there a code for it.
      My wife is a referred to as a CO2 retainer. I have also seen studies where just a 5% CO2 mixture with 95% regular air invokes panic in normal healthy people. So dyspnea is an ongoing issue and it does precipitate panic in her. I have first hand seen relief from a bipap machine.
      Thankfully the research (and now the 2017 GOLD report) into non-invasive positive pressure ventilation (specifically bipap) in COPD patients now suggests it improves mortality and reduces exacerbations resulting in less hospital time. While that's great for those important things, a side benefit will be to hopefully reduce panic in COPD sufferers. My issue is that will be a happy coincidence though as you say there is no DSM code for the anxiety and panic. There is a disconnect between the pulmonologist and the psychiatrist. There is no one addressing her panic as a function of her COPD. The psychiatrist is treating her as he would for a non-COPD patient and the pulmonologist isn't treating her anxiety and panic at all. Since anxiety and panic is so so common, shouldn't there be better coordination? Wouldn't a DSM be appropriate? There should be no doubts about my opinion. As a final note, during my wife's last exacerbation, two respiratory therapists recommended she consider marijuana for her anxiety. You know that's not in any DSM and neither is tossing a softball over the roof.
      So not only do I believe COPD panic should be on every pulmonolgists' radar, I believe your suggestion that its dangerous to talk about it is irresponsible.
      Reply
  • Hi Jim Ragsdale.
    You see, both of us agree, kind of. I'm saying there should be no DSM diagnosis. The reason that COPD'ers panic is air hunger. So it is not a 'mental illness'. And should not be treated with the meds you use for the 'normal' population and as was proven to you and research, those meds do not work. NIV can often work because it is dealing with the very real physical component of disease. People who have panic in a non disease state obviously might benefit from meds or CBT, but they would never benefit from a Bipap.

    I watched my dad at end of life with panic, it was no fun. There was nothing for him at that stage. What would be abnormal is if someone felt no panic when suffocating. Although that would be a god-send.


    Reply

    • I understand where you are coming from now. You are looking at it based on the last days where nothing will help. You have an insight I have yet to experience though I know it is coming.

      I'm talking about a different time. It's the time from first diagnosis and ending before the morphine. The bipap is still able to blow off CO2 in her case.
      So for that middle time in end stage COPD, no one seems to want to do anything for her panic. Its like, "oh you poor dear, you have anxiety and panic. Ok, next."
      I don't accept that and its so frustrating when I see her suffer with no way short of extra ativan to help her. It will have taken us two months of her suffering to get the machine. IF there was a DSM that says to give them a bipap for the anxiety and panic, I would be satisfied.
      While anxiety and panic aren't considered life threatening, it has turned my wife into an agoraphobic withdrawing from family and friends and life in general. I so desperately want to help her enjoy with time she has left.
      So, yes I disagree with you. I believe there should be a DSM for COPD panic prior to the morphine.
      Reply
  • Jim I agree, there should be something and if DSM said BIPAP, then I think they would have moved forward and understood the disease.
    I was given anxiety meds for dyspnea. They worked at first and I still take them when I am desperate. But it is well known that these meds are to be used short term for the 'normal' anxious folks, because they will increase anxiety eventually. That is why people need bigger doses. And to come of them (for non diseased folks) is a nightmare because their anxiety has increased.
    I now find I cannot use them at night because obviously they make my bad situation worse....cause me to fall asleep more solid, yet awake with more panic due to not waking up in time to clear my airways. It is also a breathing suppressor so it would make sense that panic might ensue not just to the dyspnea, but also to the breathing suppression. The reason we get these meds is because they have nothing else for destroyed lungs that don't breathe well. And obviously it's not a good med if it suppresses the breathing. Morphine has worked so well for some folks, but they are SO scared of opiates, when in reality anxiety meds are not benign meds.
    Don't be scared of morphine, because I know one forum member who has used it for years. And I think that is wonderful. It does have drawbacks, constipation, and might not work for everyone, but I don't see why it could not be used alongside a Bipap. I mean it's about QOL. It's all about that for the patient and family.

    See Jim, I think we are thinking along the same lines, despite our interpretations.....although I am not fond and never will be of the dsm. But this is about copd and it's real physical consequences. The fear responses that we are 'labeling' as anxiety, is very real, but not to be confused with the kind of anxiety we feel when we have other issues.

    Reply
    • And Jim, I agree, one should not wait two months to get suggestions on different things to try and as soon as possible. If it extends a QOL, one should be given to try whatever might help. PLB only goes so far.
      I guess a bipap can actually do harm if not used for the right patient? An RRT could enlighten me on this. But I read it somewhere. I asked my pulmo about a bipap, but he did not even discuss it. So I guess that means no.
      Reply
    • Lol another comment JIM.. I just read where the bipap is coming. I'm so excited for you. It might be a bugger to get used to, but I hope and pray it all works out and gives her MUCH better days.
      Reply
    • We have had to push our pulmonologist for one. The literature is fairly recent on the benefit. It seems all the research prior to a few years ago was with low pressures and the new research showing benefit was with high pressures. It is now part of the 2017 GOLD standards of COPD treatment though. You might want to revisit the issue with your pulmonologist.
      There is a reason they are by prescription. Too much I understand can put you in hyper-oxygen resulting in alkadosis(?) or maybe it was too little CO2. I forget. It has to be adjusted and titrated to the best prescription for you. A respiratory therapist has to come to the house to set it up.
      An interesting result they found was with overnight use of bipap for COPD. There was discussion of a "carry over" benefit during the day when not in use. I can't imagine how that would work, but the research said it did.

      If you are interested, google this paper:
      Non-Invasive positive pressure ventilation for the treatment of severe stable chronic obstructive pulmonary disease: a prospective, multicentre, randomized controlled clinical trial.
      Reply
  • Thanks Jim. You know, I am so happy and so impressed that you are such a HUGE part of your wife's care. It makes such a big difference to have someone that is genuinely researching and advocating and supporting. I'm not complaining as I have a great guy, but he's not the type to be interested. So many kudos to you.

    I tested very high on my abg for alkalosis, but that can be a compensation move for preventing co2 build-up, so i have no clue. All I know that when an RRt looked at the results she said she's never seen such numbers.
    I do know that an abg will be different from moment to moment.
    Even right after waking the numbers will be different than a few minutes before while in sleep. The body is constantly fighting to keep that homeostasis going.

    Part of my problem is that my oxy is at 97-99, then the second I fall asleep, the machine beeps at 89. It takes such a small amount of time. I can feel my brain actually going through the wake up phase, it's scary. So I just try to go back to sleep again and do the cycle lol. I do have oxy prescribed by my GP, my pulmo was another no.
    So I get desperate and put on a low flow to see if it's better.
    I obviously have more things going on and after going bugeyed researching, I think it looks a lot like Paroxymal nocturnal dyspnea, which of course seems to be a precursor to greater things to come.
    Reply
    • Since I last talked with you, the wife ended up in the ER and now the ICU with a mild exacerbation. Her CO2 was 70, which is bad of a non-COPD patient. It wasn't far off her usual level. However her pH was pushing down to almost 7.0 so they put her on their bipap and the numbers improved quickly. Once they got her up to the ICU, she had another panic attack, they put her on the bipap and it went away. They will keep her on bipap at night and only during the day when she has a panic attack. This should be just a few days unlike the intubation and 3 weeks back in February.
      I've never heard of PND before. I assume you have left ventricle issues? It irritates me your pulmo wasn't more accomodating. You mentioned you "put on low flow" which I think you mean O2 low flow? I didn't hear you mention a CPAP or Bipap. I would think a CPAP would at least be appropriate in your circumstance to just keep the airways open.
      I do know they have cautioned me about not turning up the O2 concentrator past her 2L/min setting. They told me she could get too much O2 and it would cause alkalosis.
      During the wifes last exacerbation in February, she ended it with about a 10 day stay in a Long Term Acute Care (LTAC) hospital. They focus on weaning people off respirators. They titrated the amount of O2 she needed by starting at 5L/min, taking blood gases and then sequentially dropping her O2 flow and taking abg each time. The lowest they could go was her original 2L/min without dropping her O2 sat rates. My point is you might be better served by making sure you need that O2 and talking with the pulmo about a home ventilator, not a bipap or cpap. With you PND, you might need some help in initiating the breathes during sleep. I get the feeling there is a disconnect for you while asleep. If the ventilator can initiate those breathes, you might find you short term issue solved. (They can hook the ventilator up to your cpap/bipap mask. It doesnt have to inlcude a tube into your wind pipe.) I may be peeing in the wind here, but those are just my thoughts. And yes, I have stayed in a Holiday Inn.


      Reply
  • Jim, I'm sorry to hear your wife is not well, but glad that she is being looked after and the bipap is doing it's job.
    As far as PND, I have not been diagnosed with that, it is my own stabbing in the dark, looking for reasons and answers.
    I had heart tests over a year ago, and if new problems arise, they just go by the old tests and don't see that things can change.
    Thank you for all your thoughts. We seem to have to do our own investigating into what the problems could be, and what answers there might be.

    I hope your wife improves greatly and soon so she can relax and start to feel better. I will keep good thoughts flowing your way.
    Reply
  • I try to stay grounded and focus on coping strategies and it works slightly for me at times, however I always have this black cloud feeling that I'm going to drop dead! I speak to some of my customers and neighbors and they all tell me early 50s are a rough time for some people! I hope it gets better?
    Reply
    • Try to remember FDR's statement ( oops - you're too young. So I'll write it here ) -
      "There is nothing to fear but fear itself". I know that sounds like I don't get it - but honestly, I do. And I care. I'm 66 years old with COPD. I use a bipap, and oxygen at night. I fully intend to be around for at least the next 11,( and hopefully more) years to see my youngest grandchild graduate from high school. When I was your age, I remember fearing my own mortality, but as time passed and I saw that the fear was making my symptoms worse, I slowly let those fears go. There is no denying that our COPD is a very serious disease, but if we take good care of ourselves, are honest with our doctors, do what we need to do to maintain and keep our disease at bay - there is nothing to fear.
      So do what you need to do, whatever your docs say - do it, if it's not working for you - tell your doc, if that doesn't help - research and find out what does, then find a doc that is better suited to your needs - if you need to slow down, make it happen - if you need to bring in psychiatrist and/ or psychologist, do so. Whatever makes your symptoms the mildest they can be, will help to get you through this difficult time is an absolute must. When you've done all of that, you will find yourself at age 66 wondering what you were so worried about. 😉
      Reply
  • I wish everyone put as much effort into finding the root cause of a problem, then researching it and finding an individual, practical solution. Having read the article and all of the comments thus far, I must say that your responses are an education all COPDers should read and take to heart. Thank you all !
    Reply

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