How to tell if shortness of breath is from anxiety

Feeling short of breath can be unsettling, but before you let worry take over, let’s explore whether anxiety might be playing a role. This article explores:

• The concept of ideal breathing rate
• Indicators suggesting anxiety may be a trigger for shortness of breath
• Practical techniques for managing and easing such episodes
• Instances where immediate action may be necessary.

Understanding shortness of breath: What’s happening?

Shortness of breath, also known as dyspnoea, can feel like your breath is shallow or like you’re struggling to get enough air. Dyspnoea is a subjective feeling of discomfort when breathing that may differ in sensations and intensity. It might come on suddenly or gradually over time. Shortness of breath can stem from various reasons, not all of them severe.

Anxiety-induced shortness of breath can feel overwhelming, but understanding its mechanisms sheds light on why it happens. General Adaptation Syndrome explains how the body reacts to stress in three stages: alarm, resistance, and exhaustion. In the alarm stage, the body gears up for a “fight or flight or freeze” response, releasing stress hormones like adrenaline. This surge in hormones amps up your heart rate and triggers increased breathing to supply your muscles with more oxygen, preparing you to face a threat. As a result, your breathing may become shallow and rapid, causing that feeling of breathlessness. However, in the case of anxiety, there’s often no immediate physical danger but the mind and body don’t know that. They react the same whether the stressor is external or internal (psychological).

After the alarm stage, the body then tries to recover by reducing stress hormones and returning to normal. But if the stressful event continues for a long time the body will continue to produce and secrete more stress hormones. This leads to the resistance stage, where you may feel irritable and have trouble concentrating. If this stress persists even longer, you may reach the exhaustion stage, which is associated with fatigue, feeling burnt out, depression and anxiety.

Chronic stress can contribute to low-level inflammation in the body through the secretion of glucocorticoids, like cortisol, from the adrenal glands, as well as other pro-inflammatory chemicals. While these hormones initially help the body cope with stress, chronic exposure to high levels of glucocorticoids can dysregulate and suppress the immune system. This continuous activation of the immune system can result in a state of low-grade inflammation throughout the body, which has been linked to various chronic health conditions, including cardiovascular disease, high blood pressure, insulin resistance, and depression. Managing chronic stress and its effects on glucocorticoid secretion may be important for reducing inflammation and mitigating associated health risks.

If you are interested to learn more about the effect of diet on inflammation, check out our article: A guide to anti-inflammatory foods.

Exercise can be a powerful tool for managing stress and improving overall well-being—check out our article to find out more and see if there is an type of exercise that suits you best: Exercises for releasing stress in the body.

Some common physical conditions like asthma, chest infections, being overweight or smoking can cause breathlessness. Other more serious conditions like chronic obstructive pulmonary disease (COPD), heart failure or pneumonia may be a hidden cause. It’s therefore important to never self-diagnose breathing problems. Whether addressing underlying health issues or managing anxiety-related symptoms, consulting a GP ensures comprehensive care and support for optimal wellbeing.

Finding your ideal breathing rate: A breath of fresh air

For adults, the normal breath rate at rest usually falls between 12- 20 breaths per minute at rest. However, a 2017 review suggested that 6-10 breaths a minute may be optimal given the evidence supporting slower breathing and beneficial health outcomes, including lowering blood pressure and helping the body find a better sympathetic – parasympathetic balance. The parasympathetic nervous system is part of the autonomic nervous system that helps regulate involuntary bodily functions, often associated with rest, digestion, and relaxation.

A 2018 systematic review found that slow, paced breathing is linked to feelings of relaxation and well-being, whereas rapid breathing is frequently associated with anxiety and stress.

Breathing through the nose rather than the mouth helps to prevents over-breathing or hyperventilation; optimising oxygen exchange, stimulating the diaphragm and filtering out dust. Nasal breathing has also been shown to significantly reduce perceived breathlessness.

If you would like to learn more, check out our in-depth article on why nose breathing is best: the surprising benefits of nasal breathing.

Is anxiety the culprit? Let’s connect the dots

Anxiety often shows up in physical ways and may manifest as headaches, nausea, needing to use the toilet more frequently, sexual dysfunction and shortness of breath. Breathlessness accompanied by feelings of anxiety, like racing thoughts, dry mouth, sweating, trembling, or feeling on edge, may indicate that anxiety might be at play. If you experience any of these symptoms it’s advisable to discuss them with your GP to identify the cause.

For more information, our article on what is anxiety? can help guide you on common/ rare symptoms, diagnosis, treatment and techniques to help manage anxiety.

If someone you know has (or you suspect has) anxiety, our guide on how to help someone with anxiety may help you support them.

Managing anxiety and controlling breathing rate can significantly ease shortness of breath if anxiety is the root cause. There are different techniques and you may find some work for you more than others. Some you may consider trying:

Deep breathing exercises- There are many different evidence-based breathing techniques that can support anxiety management. A few include:

– Diaphragmatic breathing: A randomised controlled trial found that following diaphagmatic breathing twice a day for 8 weeks showed a statistically significant reduction in self-reported anxiety scores, heart rate and breathing rate.
– Pranayama (yogic breathing): A systematic review looking at 10 papers on yogic breathing consistently found improvement in anxiety across many different groups of people, as well as improved quality of life reports.
–Alternate nostril breathing (ANB): ANB has been shown to help shift the body towards using the parasympathetic nervous system. A pilot trial looking at ANB before public speaking showed a trend towards lower anxiety in the test group. They concluded that ANB may have calming effects in acute stressful situations.
–Pursed-lip breathing: This technique involves breathing in through the nose and then slowly out through pursed lips (as if blowing out candles on a birthday cake). This style of breathing has been shown to ease shortness of breath and may help regain control of breathing rate.

Progressive muscle relaxation: This technique involves actively tensing or clenching different muscle groups, slowly relaxing them and repeating the process again to release tension. This techniques has been shown in numerous study to reduce feelings of stress and anxiety among different cohorts.

Cognitive-behavioral therapy (CBT): Working with a CBT therapist can help to reformulate negative thoughts and develop coping strategies. CBT has been found to be a highly effective treatment for anxiety and stress-related disorders.

Lifestyle adjustments: A systematic review, looking at multicomponent lifestyle medicine interventions (including studies that implemented at least 2 of the following lifestyle factors: exercise, sleep, nutrition, and stress management), found that lifestyle modification had a small, but significant, effect on anxiety.

Recognising when to pay attention: Red flags

There are certain signs that should prompt you to seek help quickly.

If you experience any of the following symptoms:

• Severe difficulty breathing, such as gasping, choking, or inability to speak
• Tightness or heaviness in your chest
• Pain that radiates to your arms, back, neck, or jaw
• Noticeable changes in lip or skin color, like turning very pale, blue, or grey (for individuals with brown or black skin, check the palms of your hands for easier detection)
• Sudden confusion

Call 999 or head directly to the nearest A&E department for immediate assistance. 

The NHS advised a scheduled visit with your GP if:

• Your shortness of breath worsens during routine activities or while lying down.
• You have associated episodes of feeling light headed/dizzy.
• You experience palpitations.
• You experience breathlessness accompanied by swollen ankles.
• Persistent coughing continues for three weeks or more.

Getting medical advice ensures any potential issues are addressed promptly: seeking professional help is never a waste of anyone’s time.

The take-away message

While shortness of breath can be alarming, understanding its connection to anxiety opens doors to effective management. By embracing gentle techniques and seeking support, you may be better equipped to navigate through anxiety-related breathlessness and reclaim a sense of peace and wellbeing. If uncertainty lingers or symptoms persist, you may want to consider reaching out for professional assistance.

For more practical breathing exercises and to keep and manage your personal health records, download the free Evergreen Life app today.

Reviewed by:

Anna Keeble MA BA Head of Content and Wellbeing Expert

Dr Claire Marie Thomas MRCGP DFSRH DTMH DipNLP MBChB BMedSci Medical Expert

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