How to Break a Panic Attack

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One problem that many Aspies face is Panic Attacks. There is a cluster of terms all interrelated to describe this human condition. They are called a major meltdown, a panic attack, anxiety attack, trauma attack, a panic disorder, and tonic immobility. The very deep ones can be quite debilitating.

According to the Internet: Panic attacks are sudden, intense surges of fear, panic, or anxiety. They are overwhelming, and they have physical as well as emotional symptoms. Many people with panic attacks may have difficulty breathing, sweat profusely, tremble, and feel their hearts pounding. Some people will also experience chest pain and a feeling of detachment from reality or themselves during a panic attack, so they may think they’re having a heart attack. Others have reported feeling like they are having a stroke. Panic attacks can be scary and may hit you quickly.

I am 72 years old and my heart is not what it use to be. Recently I have been diagnosed with a condition called supraventricular tachycardia, which is an arrhythmia that causes your heart to beat too quickly. This condition is very similar to a panic attack and the techniques to break this attack are similar to the techniques to break a panic attack.

Essentially my heart turns on a dime. I can have a normal heart rate of around 65 beats per minute (bpm) and a few seconds later I will be at 170 bpm. For me this is not a pounding heart rate but rather more like a little flutter of butterfly wings. I can also reverse this from 170 bpm back down to normal by applying mechanical techniques to break the rapid heart rate. So I started this thread to discuss these mechanical techniques. When Aspies experience a panic attack, often they try and find a quite place, a shelter from the storm. Some will use relaxation techniques and meditation until their bodies slowly come out of it. That is not what I am talking about. The mechanical techniques that worked for me (burping and box breathing) are very quick and effective.

It is my belief that if Aspies prone to this type of attack should learn these techniques, it will put them back in control and restore their sense of normality.

So let us talk about the techniques.

The first is Burping. Most times my episodes of supraventricular tachycardia would begin in the middle of the night. I would wake up and find my heart racing. I felt an urge to burp. So I let out a couple loud burps and my heart rate would return to normal. Then a minute later, my heart rate would jump up to 170 bpm. I would burp a few more times and it returned to normal. Another minute would go by and I was back up again. More burps and then my heart settled down to a normal rhythm for several hours. This technique was very natural and automatic. It is not something I learned or practiced. It just was my body reacting.

The second technique is called box breathing. I found this technique to be very useful. So I will describe this technique in detail and I recommend that those who are prone to panic attacks practice this technique until it becomes a second nature. And then whenever a panic attack strikes, just pull this out of your toolkit and execute it.

The first step is to sit down and close my eyes. I picture a square box. I start at one corner of the box and move my head and follow it up, across, down, and then across to the starting point. Now I add the timing. Three seconds on each side. I follow the edge of the box up counting to three, then across counting to three, then down counting to three and then across to the starting point counting to three. Now I add in the breathing. As I follow the line up, I take a deep breath, for 3 seconds. Then I follow the line across holding my breath for 3 seconds. Then I exhale for 3 seconds. Then I rest for 3 seconds, returning to my starting point. Now here is a really important point. It must be deep breathes. This is not nose breathing. Open your mouth wide and gulp in the air as you begin the box.

For me I have found that around three times around the box will break the rapid heart rate and return my body back to normal. The response is very quick.

There were a few other techniques that I tried but without much success. But you might give them a try and see if it breaks your panic. The first is a cough. Tilt you head to one side and cough several times hard. The second is called bearing down, it also goes by the name "Valsalva maneuver". The way to describe it is that you're bearing down, so you put your hand on your abdomen and push your abdomen muscles against your hands. The way the medics describe this as similar to putting abdominal pressure like you were going to pass a hard sh*t.

Off Topic #1

Although the primary purpose of this thread is to discuss techniques for hard braking a panic attack, I thought I would digress a little and discuss supraventricular tachycardia itself. Generally I noticed a pattern of when these episodes of racing heart would begin. IMHO the transition into REM sleep is the trigger. My heart would take off suddenly around 3 or 4 AM in the morning when I am in deep sleep. More specifically it was when I was entering REM sleep.

During the night, you cycle through two types of sleep: non-rapid eye movement (non-REM) sleep and rapid eye movement (REM) sleep. Your brain and body act differently during these different phases.

When you enter REM sleep, brain activity increases again, meaning sleep is not as deep. The activity levels are like when you’re awake. That’s why REM sleep is the stage where you’ll have intense dreams. At the same time, major muscles that you normally control (such as arms and legs) can’t move. In effect, they become temporarily paralyzed.

Besides increased brain activity and muscle relaxation, your body goes through a series of changes during REM sleep. These changes include:
* Faster breathing.
* Increased heart rate and blood pressure.
* Penile erections.
* Rapid eye movement.

So one of the problems or dilemmas that I faced was "Should I try and stay awake to avoid supraventricular tachycardia, or go into deep sleep and wake up at 170 bpm heart racing without the ability to control it."

Motion to sticky.

Jimmy posted this just when I needed it. Thank you!

I do something similar to the box breathing, I learned it as square breathing, but instead of a three count, you use a four count for the inhaling, holding, exhaling, holding, then repeat. I also keep my eyes open and follow a window or the ceiling or a table, anything with four corners. It works wonders for getting both my breathing and heart rate in check. I've only ever had the physical symptoms of panic attacks (I am dx'd with GAD though) so heart rate and breathing are what I need to get under control when I start to get out of whack.

Next time my heart rate goes through the roof, I am so gonna try burping. I find that both amusing and delightful. And if I'm lucky, I'll find it effective too.

I've had some luck with citrus fruit too. But I only do that if I'm still feeling off after my heart rate and breathing have returned to normal. I'll grab an orange, hold it, feel it, smell it, essentially engage in mindfulness using the fruit as an 'anchor to reality'. Mindfulness can be sometimes overwhelming to me if I'm in a tense place already, so having the orange to try to pour all my focus into helps give me a solid focal point v/s being hyper aware of all the noises in my house, for example. I find it rather calming.

I have had this all my life and never knew there was a word for it. Really, you guys can burp whenever you want to and however many times you want to? I have never been able to do that unless I swallow air first. amazing the things you learn on a forum. I don't find much similarity between tachycardia incidents and panic attacks because the heart flutter rates don't alarm me, but with panic attacks I am in full stampede mode. I do use slow breathing with the heart thing. I reported this to doctors for the first half of my life and was always told that the chest pains and the heart fluttering,rapid pulse was all psychosomatic ( stereotypical thinking in those days, women were not believed to ever have heart problems, especially not young ones, I was simply being hysterical). I love coming here and learning all the stuff you guys teach me!

Off Topic #2

I thought I would digress a little and discuss my encounter with supraventricular tachycardia. I had experienced this condition on-and-off for several months now and generally could break it mechanically. But the last month it became solid, all the time condition. It probably put a severe strain on my heart. So I began the process of getting a referral to see a cardiologist.

It was an interesting story. I went to my General Practitioner (GP) to make him aware of my fast heart rate problem and to seek a referral to see a cardiologist. They refused to see me because I had a cough and sent me to another clinic to get COVID tested. At that clinic they took my fast heartbeat seriously and hooked me up to an EKG. They then told me I needed to go to the Emergency Room immediately in the small county hospital across the street. In the hospital emergency room they gave me a rapid COVID test. Then they administered a chemical to slow down my heart.

They injected me with a large amount of Adenosine. I was surrounded by around a half a dozen nurses, doctors and orderlies when they did this. It is a very rare procedure. Several of the medical staff mentioned even though they had worked in ER of many years this was the first time they saw this procedure. So what was it like to be injected with adenosine. Well, I would describe it as being on a football field and being tackled by a 300 pound lineman. It knocked the wind out of me. I suspect this was a major strain on the heart.

Next they decided to send me to the main hospital a 150 miles away. So I spent two hours in an ambulance. My COVID test came back negative, but the cardiologist decided that the rapid test produced too many false negatives and in his opinion I probably had COVID. [Better safe than sorry.] At the hospital I was placed in the COVID ward. This was a wing of the hospital that was negative pressure. I was administered a second COVID test which was sent to an outside lab for analysis. This was a very accurate test.

The room was nice and the people were nice. They had just experienced a major surge of cases over the previous 2 months which filled up this wing. Now they were down to the 30% capacity. The problem with a COVID ward is that you are essentially sealed in. Hospitals have millions of dollars of very specialized equipment to diagnose and treat patients. But in a COVID ward, none of this is available. They can't take you to the equipment without potentially contaminating the entire hospital. So you sit and wait until you recover from COVID or die. I was in the COVID wing for two days until my second COVID test came back negative. Then I was moved to the main part of the hospital. One of the problems I was dealing with was a case of bacterial pneumonia.

During my stay in the COVID wing I experienced two episodes of supraventricular tachycardia. Each time they broke it with adenosine. During one of these episodes they had me connected to an EKG which showed a blaze of electrical impulses targeting the heart.

So IMHO mechanical breaking of high heart rate is a far better way to go then chemical breaking.

One of the other techniques they had me try for mechanically breaking a fast heart rate was blowing through a straw hard. It didn't work for me, but it might work for you.

i don't know anything about this tachicardia of yours. but i can talk about panic attacks.

when i have a panic attack my heart starts racing, i sweat a lot, i tremble, i find it hard to take full breaths as my breathing gets faster and faster. my first instinct is to keep gasping for air, but that's counterproductive, and will only prolong the panic attack.

what i do, is i sit down with my shoulders perpendicular to the ground, and i take deep breaths for as long as my desperate need for air, stops. then i only tremble for a couple minutes, my hearts still keeps beating fast, but all those symptoms slowly fade and i return to a state of calm.

it takes me usually half an hour, or even more to get to that peaceful state, it's not a slow process, but i'ts the only way to stop a panic attack for me. after that, if i can i sleep or i do something that i enjoy.

I went and visited with my General Practitioner (GP) today and we discussed manual techniques for slowing elevated heart rate. He mention a type of neck massage. So when I got home I looked it up on the Internet and found the following article:

Vagal maneuvers are ways to treat a fast heart rate of more than 100 beats per minute that starts in the upper chambers of your heart, the atria. Doctors call this type of heartbeat supraventricular tachycardia, or SVT.

SVThappens when electrical signals in your heart's atria get out of sync. This interferes with signals from the sinoatrial (SA) node, your heart's natural pacemaker. Early beats in the atria speed up your heart rate.

How do vagal maneuvers work? Simply put, they affect the vagus nerve, a long nerve that runs from your brain to your belly. It sends signals to the atrioventricular node, a cluster of cells at the bottom of your heart’s upper right chamber that helps control your heartbeat. Think of it as an electrical relay station. It takes signals from the sinoatrial node and slows them down before passing them along to the lower chambers. The result: A slower heart rate.

These simple steps can slow your heart down right away.
Types of Vagal Maneuvers

1. Valsalva maneuver. Hold your nose, close your mouth, and try to blow the air out. This creates pressure in your chest that may activate the vagus nerve. Sitting or squatting may help. Try it for 10 seconds.
2. Cough. You need to cough hard to generate pressure in your chest and stimulate the vagus nerve. Children with tachycardia may not be able to cough hard enough to get a response from the vagus nerve.
3. Gag. You can try it with a finger. Your doctor might use a tongue depressor.
4. Hold your knees against your chest: Do it for a minute. This may work best for babies and children.
5. Cold water treatment. You might hear this called the diving reflex. You may need to put a plastic bag of ice on your face for 15 seconds. Or you can immerse your face in icy cold water for several seconds. It might also work to step into a cold shower or a cold bath.
6. Carotid sinus massage: Only a doctor should perform this one: Lie down and stick out your chin. The doctor will put pressure on your carotid sinus, a bundle of nerves surrounding the carotid artery in your neck just below your jaw. You’ll be monitored during the procedure.

Source: Vagal Maneuvers to Slow Heart Rate