The four most commonly reported symptoms of panic are rapid heart beat, sweating, dizziness and shortness of breath. People who suffer with shortness of breath often go to great and frequently unpopular lengths, to ensure a supply of fresh air is available. They may, for example, drive with the window down in all weathers. They may insist that windows are always open in the house, or their place of work. The perception of such people as 'fresh air freaks' is a price many are prepared to accept in order to mask the real reason behind their need.
Over-breathing (hyperventilation) is as much a cause as it is a feature of panic. Typically this occurs in the form of rapid and fairly shallow breathing which of itself can quickly lead to dizziness and/or light headedness, plus other symptoms like tingling in fingers, a sense of pressure in and around the chest and a red face. Little wonder these symptoms are frequently viewed as a heart attack both by the victim and sometimes by onlookers.
Assuming a heart attack has been ruled out the person may be referred for psychological assessment. As part of the assessment process the person may be asked to undertake a hyperventilation test. This will not be conducted if the person has a medical background of epilepsy, high or low blood pressure, cardiovascular disease or asthma. The test will also be omitted if the person is pregnant. If conducted, the test will help the therapist determine whether hyperventilation is a key cause of panic.
During the procedure the therapist asks the patient to breathe in a rapid and shallow fashion for up to two minutes. Often the test is preceded by some form of anxiety assessment; this is usually a scale of 0-10 or 0-100 where the upper figure represents absolute fear or terror. Following the test the patient re-rates their anxiety. Typically the second rating reveals a higher level of anxiety and the patient reports very similar sensations to their previous experience of panic.
Some people are prone to repeated hyperventilation and two groups of people appear most affected. The first of these are asthma sufferers (previous and current) and the second are people who, for whatever reason, have a fear of suffocation. The conventional wisdom of asking the person to breathe into a paper bag is based on the reasoning that carbon dioxide is too low as a result of over-breathing. In reality this technique is rarely if ever taught now. One reason is that people in a state of panic are rarely capable of breathing into a bag and secondly there are some medical concerns as to whether the technique is actually counter-productive, particularly if confused with an asthma attack. In practice it is far more common for the person affected to be taught how to regulate their breathing. After a short time most people find they are able to follow the exercises without distress and they are encouraged to practice daily.