Breathing Into a Paper Bag for Hyperventilation

When someone is hyperventilating on TV or in a movie, you often see them take out a brown paper bag and begin breathing into it. You may have even seen someone use the paper bag method in real life—maybe you've tried it yourself.

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While a TV character might get relief from the symptoms of hyperventilation using the method, it doesn't always work in real life. It's possible that the trick can work in some cases of true hyperventilation, but it's not the ideal treatment.

Even more importantly, in some instances, it may be dangerous. If you think you're hyperventilating but are actually experiencing symptoms of a more serious medical condition, you may be putting your health—if not your life—at risk.

Theory

Hyperventilation syndrome is most often associated with panic disorders. When a person has a panic attack, the psychological condition can make them breathe too fast, which causes the body to lose carbon dioxide (CO2).

While it's true that CO2 is a metabolic byproduct in the air you exhale, you still need to a minimum amount in your bloodstream to maintain your body's pH balance. When you lose a significant amount of CO2 due to hyperventilation, the tissues in your body can start to malfunction.

The idea behind breathing into a paper bag or mask is that rebreathing exhaled air helps your body put CO2 back into your blood. While breathing into a paper bag to treat hyperventilation can work in theory, many healthcare providers (and patients) don't find it to be a particularly quick or effective method.

If you have frequent panic attacks and anxiety you may have a chronic case of hyperventilation. Your healthcare provider can help you find the best treatment and management strategies.

Safety

While there hasn't been enough research to definitively prove the paper bag method is harmful, there isn't any real evidence proving it helps, either.

Interestingly, what research has found is that there may be a link between high concentrations of CO2 and panic attacks—meaning artificially increasing CO2 in inhaled air (as is the case when you breathe into a paper bag) would be more likely to trigger feelings of panic in people with anxiety.

Using the paper bag method is most dangerous when someone has mistaken respiratory distress for hyperventilation when it is actually a symptom of a more serious medical condition.

Common symptoms of hyperventilation include tightness in the chest, shortness of breath, and dizziness—all of which may also occur during heart attacks.

If someone having a heart attack opts to use the paper bag method because they think they're hyperventilating, the decision may delay potentially life-saving medical intervention.

Furthermore, since breathing into a paper bag restricts how much fresh air a person can breathe in (which reduces blood oxygen levels) it may worsen the underlying medical condition. Heart attacks often occur due to reduced oxygen to the heart.

Symptoms of other serious conditions can also overlap with hyperventilation and may be worsened by using the paper bag method instead of seeking medical care.

Other conditions that may result in symptoms similar to hyperventilation include:

• Head injuries: A head injury can lead to changes in breathing.
  Without the presence of physical symptoms, a head injury can go undetected if hyperventilation is the only cause considered. Additional symptoms of a head injury include headache, confusion, and severe nausea.
• Lung disease: Lung conditions, such as chronic obstructive pulmonary disease (COPD) and asthma, can make breathing difficult.
   Additional symptoms, such as wheezing, cough, and chest pain distinguish these conditions from hyperventilation.
• Diabetic ketoacidosis: Diabetic ketoacidosis can cause hyperventilation.
  Additional symptoms include nausea, excessive thirst, and frequent urination. Go to the emergency room if you are throwing up for more than two hours, your breath smells fruity, you are confused and tired, and/or you're struggling to breathe.
• High altitude exposure: The low oxygen at high altitudes can lead to hyperventilation even in people without lung conditions.
  To avoid complications, assess and treat symptoms appropriately rather than attempting to use a paper bag when at high altitudes.

Treatment

Treatment for hyperventilation aims to slow down and return breathing to a normal pattern. The preferred and safest treatment for a hyperventilation episode is to stay calm. People should be encouraged to practice breathing slowly and not too deeply.

Calming breathing exercises have been shown to be as effective, if not more so, as breathing into a paper bag to treat hyperventilation in people with anxiety disorders. These exercises also don't pose an additional health risk.

Researchers from Brunel University in the United Kingdom confirmed these findings when they sought to compare relaxation therapy versus breathing therapy for the management of hyperventilation. The study found a significant reduction in the frequency and severity of hyperventilation attacks in the group who used breathing exercises.

Breathing exercises are not your only options. Your healthcare provider will help find ways to treat the underlying causes of hyperventilation, which is the best way to prevent it from occurring.

As hyperventilation is often related to psychological stress from fear, anxiety and panic attacks, some potential options for treatment include:

• Anti-anxiety medications
• Talk therapy and counseling
• Cognitive behavioral therapy

When to Seek Emergency Care

With or without hyperventilation, some symptoms could indicate a serious, life-threatening condition.

Symptoms You Shouldn't Ignore

If you experience any of these symptoms, seek medical attention immediately:

• Chest pain
• Blue lips, skin or fingers
• Fainting
• Confusion
• Fever

There are times when it will be difficult to determine if hyperventilation is the result of anxiety, stress, or a more serious health condition. As a general rule, if you are experiencing severe hyperventilation or experiencing it for the first time, it's best to seek medical care.

Why does breathing into a paper bag help?

Breathing into a paper bag is a technique that can help you regulate hyperventilation. It works by putting some of the lost carbon dioxide back into your lungs and body. This helps to balance oxygen flow in your body.

However, breathing into a paper bag must be done properly and may not work for everyone. Medical research on using it to help hyperventilation is divided on whether it really works.

Some case studies don’t recommend using this breathing technique.

Other medical review studies find that breathing into a paper bag can help some patients with hyperventilation.

How to do it

To use a paper bag to help you breathe when you’re hyperventilating, follow these steps:

• Hold a small paper bag (the kind used for lunches) over your mouth and nose.
• Take 6 to 12 normal breaths.
• Remove the bag from your mouth and nose.
• Take a few breaths.
• Repeat as needed.

Do’s and don’ts

• Don’t breathe into a paper bag for more than 12 breaths.
• Do remove the paper bag from your mouth and nose after 12 breaths.
• Do hold your own paper bag for breathing. If someone else holds it for you, they may not know when you’ve taken up to 12 breaths.

Does it have to be a paper bag?

Yes. Always use a small paper bag, not a plastic one. A plastic bag doesn’t work the same way and can be dangerous.

The thin plastic can get sucked into your mouth when you’re breathing in. This can be especially dangerous for smaller children and older adults.

Drawbacks

The paper bag technique won’t help an asthma attack and can even make it worse, because you may not get enough oxygen into your body.

Don’t use this breathing technique if you have any heart or lung conditions.

Also, breathing can be more difficult than normal if you’re at a high altitude. Breathing into a paper bag won’t help with elevation changes in breathing.

Only use the bag method if you’re sure you’re having an anxiety attack. Other causes of hyperventilating include an asthma attack, fever, or other illnesses.

You might have other anxiety symptoms like:

• shortness of breath
• feeling like you’re choking
• a pounding or racing heart
• heart palpitations (feeling your heart is stopping or missing a beat)
• dizziness
• nausea
• sweating
• racing thoughts
• feeling like you’re losing control
• thinking you might die
• aggressiveness

Other tips to calm you

Other remedies to help you calm down during an anxiety attack or when you’re hyperventilating include:

• deep belly breathing
• laying down on a sofa, bed, or floor
• putting your head down between your knees
• breathing through pursed lips, like you’re whistling
• breathing in and smelling an essential oil or a scent you like
• holding your breath for 10 to 15 seconds
• breathing slowly into your own cupped hands
• breathing through alternate nostrils (hold one nostril closed at a time)
• breathing in through your nose and out through your mouth
• jogging or walking briskly while breathing in through your nose and out through your mouth

When to talk with a doctor

Tell your healthcare provider or mental health professional if you have symptoms of an anxiety attack often or hyperventilate frequently.

Get urgent medical help if you:

• hyperventilate for longer than 30 minutes
• think you’ll faint or lose consciousness
• don’t feel better after trying home remedies during an anxiety or panic attack
• experience severe or frequent symptoms

The bottom line

Breathing into a paper bag may help you breathe better during an anxiety or panic attack. This breathing technique can help some people regulate hyperventilation. However, it may not work for everyone.

You can hyperventilate for many reasons, including some health conditions. You may need other medical treatments, including oxygen therapy and medications.

Call 911 if you hyperventilate for longer than 30 minutes or begin to lose consciousness. You may need urgent medical care.