How do I know if I'm actually short of breath, or if it's psychosomatic?
March 31, 2015 3:52 PM   Subscribe

Back in the 1990s I had a lot of actual health problems mixed with some stuff that was probably psychosomatic. I had bad allergies and many episodes of shortness of breath, but while the allergies were real my doctors never figured out what the shortness of breath was about. Now my allergies are acting up, and after weeks of me worrying the shortness of breath would come back too, here it is. How can you tell if you are experiencing actual, allergy-related shortness of breath, or just having a panic attack about the possibility?

Apologies for the Great Wall of Text, but this is a problem that kind of destroyed my life for a few years in the 1990s and I really, really don't want to deal with it again. Any information would be much appreciated.

Back in the 90s I used to have awful allergies, with sore throats, runny nose, plugged nose, earaches, sinus infections, dizzy spells, rashes, endless postnasal drip and a nasty, nagging cough. But by far the worst of it was the shortness of breath, this inescapable, terrifying feeling of suffocation that could last for days at a time. My doctors could see I was genuinely allergic, but when they would test my lung function I didn't show clear signs of asthma. One doctor told me that when they gave me the stuff that was supposed to induce shortness of breath for the tests, my lung function actually looked better. In hindsight I don't know how much of the shortness of breath was a real thing, but I do know my constant panic made it a lot worse and that at least some of the time I was probably so focused on every stupid breath that I basically gave myself psychosomatic asthma attacks.

My allergies improved by about 93 percent when I moved away from my crap-hole hometown, and I've now enjoyed many years of not being a hay fever zombie. Until a few weeks ago, when the weather went nuts and all the cars in the neighborhood got coated with a yellow film of pollen and I had a bad allergic episode that's only starting to fade now. The main symptom has been constant postnasal drip, leading to a bad cough. I've been taking drugs for it, including Nasacort, and they've helped. I seem to be mostly recovered, knock wood.

But last night, right when I was going to bed, I suddenly felt some shortness of breath. I hadn't been coughing much at all that day, and my instincts told me I was just imagining the feeling that I wasn't getting enough air. The feeling was gone when I woke up, but then this afternoon it came back a little. Ugh.

If you have asthma, or some other condition that causes real shortness of breath, how do you know the difference between that and just fixating on your breathing to the point where you start to feel like you're not getting enough air? Is there some aspect of it that lets you know that you are actually suffocating, and not just having a panic attack? Can you be short of breath without coughing, sneezing or having other allergic symptoms? Can an episode of legit shortness of breath go on and on for days or weeks, or is that more likely to be a psychological thing?
posted by Ursula Hitler to Health & Fitness (23 answers total) 5 users marked this as a favorite
You have asthma. Your doctor should have prescribed a rescue inhaler for you. Asthma comes and goes when it wants to. Ask for a prescription of Singulair if it continues and demand a rescue inhaler.

I was misdiagnosed as well. I spent years thinking that I was having a panic attack, even though I was calm. Now I take Singulair and those pesky feelings just don't happen anymore.

You can get a pulse oximeter on for $20. This can give you a little outside reassurance if you like.
posted by myselfasme at 4:20 PM on March 31, 2015 [2 favorites]

The short answer: see a doctor. (I am not one.)

Shortness of breath can indeed go on for days, and allergies can indeed cause that as can anxiety or any number of other things including but not limited to asthma. There isn't necessarily a good way to tell what the cause is just by how it feels, unless you've felt it before and identified the cause. For instance, a long-time asthma sufferer can probably recognize their own asthma attacks when they happen, but someone having one for the first time wouldn't necessarily know that that's what it was.

Talk to your doctor, and explicitly mention that you think it could be anxiety-induced, or allergy-induced, or some combination. He or she will probably recommend you a medication for one or both possible causes, and ask you to perform an experiment on yourself. If you are short of breath and take an antihistamine (for allergies) and your breathing returns to normal, then it's probably allergies. If that doesn't work but an anxiolytic (diazepam, clonazepam, etc.) does, then it's probably anxiety. Your doctor shouldn't have a problem prescribing you a small number (say, three) of doses of a good anxiolytic, and she or he should be able to recommend a good over-the-counter antihistamine. (Benadryl is still the standard and most broadly effective, though of course it makes most people drowsy.)

If either one of them can fix it, then it's probably anxiety brought on by allergies! If it takes both together then maybe it's a combination of the two. If neither works, even together, then there's probably some other cause.

Your doctor may want to rule out some more serious conditions as well (always a good idea) and perhaps they will be able to figure something out by talking to you and/or looking at your vitals or other signs. But they will probably ask you to do the above experiment and report back to them. (If they don't suggest it, they may well endorse it if you suggest it yourself.) In any case it's something best done under the guidance of a doctor, as they can provide an expert's perspective on your observations of the results, plus you need one to prescribe you the anxiolytics.
posted by Anticipation Of A New Lover's Arrival, The at 4:21 PM on March 31, 2015

On non-preview, myselfasme has a point. You could always have been misdiagnosed as non-asthmatic while being asthmatic in reality. Yiu coyld definitely ask your doctor to prescribe an inhaler, and add that to the experiment. Despite the unusual delivery system, albuterol (the stuff in rescue inhalers) is a very safe drug when administered in metered doses.
posted by Anticipation Of A New Lover's Arrival, The at 4:25 PM on March 31, 2015 [1 favorite]

In hindsight I don't know how much of the shortness of breath was a real thing, but I do know my constant panic made it a lot worse and that at least some of the time I was probably so focused on every stupid breath that I basically gave myself psychosomatic asthma attacks.

Philosophically (TINMA), what does it matter. If you have asthma, you have asthma. So get it treated. What myselfasme said.

Personally, I resisted an asthma diagnosis for a long time, because of a prejudice that "asthma" sounded sort of pathetic, or sickly, or something. Maybe that's what you're feeling, maybe not.
posted by JimN2TAW at 4:28 PM on March 31, 2015

I have very mild, coughing-type asthma. I can tell I'm having an asthma attack if I try to exhale and empty my lungs as completely as possible, and it feels difficult to squeeze out all the breath, especially at the end. My asthma is not your asthma, YAMV.

But regardless of whether your shortness of breath is psychosomatic, it sounds like it comes around when your allergies are not being properly managed. In your place, I would see an allergist, mention the shortness of breath along with the other symptoms, and see what they say. It may be that addressing your allergies will solve the problem, and if so, you're all set.
posted by BrashTech at 4:37 PM on March 31, 2015

how do you know the difference between that and just fixating on your breathing to the point where you start to feel like you're not getting enough air?

To answer the question directly, asthma is a physiological reaction where the little bubbly alveoli go into spasm, constricting a person's exhale mostly. And for an asthmatic, just getting nervous about it, or worrying about dust, say, or looking at a pillow and hoping there are no feathers in it, or wondering how you're going to get up two flights of stairs, can definitely precipitate that reaction. On an anxious day. AOALA has very good advice here, investigate the options.
posted by glasseyes at 4:39 PM on March 31, 2015

Response by poster: Not to threadsit, but I felt like I should add some info: back in the 1990s I went to a big-deal allergy clinic in LA and had lots of tests and tried lots of different medications, over the course of a few years. I used an inhaler for many months, and IIRC they said my lung function actually declined slightly when I used it. When I would use the peak flow thing at home, my numbers were never in the danger zone. (Although I had some difficulty using the thing, and was never sure if I was doing it quite right.)

It's been so long I can't recall everything my doctors did or said, but I do know that absolutely nothing helped and after years of tests they said I didn't seem to have asthma. My doctors just kind of shrugged, and some of them suggested it could be psychosomatic and some of them wouldn't commit to that and said it was a mystery. Eventually the problem went away completely, and I was happy to stop thinking about it.

The reason why it would matter so much to me if it's psychosomatic, is because if it is I don't have to worry about an attack that will send me to the hospital (or kill me) and I can work on it as a purely psychological issue. If it's an actual physical problem, it's likely that all I could do would be to go back into more tests and misery and worry. Like I said, I lost years of my life to this crap.

This latest allergic episode is the worst I've had in years, but either it's passing by itself or the drugs are helping. I feel just about normal now, except for these weird little episodes of being way too aware of my breathing. I've got some huge stress in my life, and if I was going to have a psychosomatic meltdown now would be the time. (I'm already on happy pills and seeing a shrink.)

Obviously I was hoping a bunch of people would say that asthma shows these clear signs and if I don't have those, this can't be asthma. But unfortunately it sounds like I've ended up back in the same old crap-bog of ambiguity I thought I'd escaped from in 1999.
posted by Ursula Hitler at 4:49 PM on March 31, 2015

Some conditions are not psychosomatic. Some are somatopsychic -- in other words, they are physical conditions which have known psychological side effects because of what they do to the body chemistry. For example, low blood sugar is known to promote nightmares by flooding your system with epinephrine (adrenaline) when your blood sugar drops too low during the night. This makes your heart race in your sleep and very frequently causes bad dreams. The most common bad dreams associated with low blood sugar are dreams of running from something (presumably because the brain is trying to make sense of the heart racing and that is a logical explanation).

I treat allergies with non-drug things like (nutritional) adrenal support and thyroid support. In my experience, allergies cause anxiety-like physical symptoms and put stress on the adrenals. A former registered nurse -- the person who clued me that adrenal support was a useful non-drug means to treat my allergies -- once told me that when the adrenals are constantly stressed, it eventually stresses the thyroid.

Thus, it is possible that what you are experiencing is psychological symptoms rooted in the biological reaction to weeks and weeks of exposure to allergens -- it is possible that you are at a point where the thyroid is being stressed because of weeks and weeks of adrenal stress.

My oldest son and I have the same genetic disorder. It has significant impact on lung function and we are both sensitive as hell to things like pollen. He knows a lot more science than I do and he frequently looks up weird little factoids for me and does the research piece when we are trying to sort out what the fuck is going on now and how to cope with it. He read up once on what pollen does to the body and he talked about how it acidifies the airways. Acidifying the airways tends to promote inflammation of the tissues which can make you feel like you are suffocating.

So I will suggest that it might help to wash out your sinuses with saline solution (to help get rid of any pollen residue faster) and even to nebulize hypertonic saline (or if you live near the coast, go to the beach and try to walk out as far as you can on a pier or similar to put you out in dense salty air above the ocean). If you already own a nebulizer, you could ask for a prescription for hypertonic saline for your lung issues. It is not terribly expensive and is not actually a drug. It is just sterile salt water. It is most commonly prescribed for cystic fibrosis patients, but it wouldn't hurt to ask. (You can also make your own, but it is supposed to be sterile, so some folks really freak out at that suggestion.)

The other thing that comes to mind is that when I used to take lots of medication, being on multiple drugs for a long period of time eventually had impacts beyond the usual day-to-day relatively superficial side effects and the fact that it was multiple drugs seemed to compound things in ways doctors could not really predict. Being on a drug cocktail for weeks or months just did things to my body beyond what normally happened from taking two or three drugs for a week or two after going to the ER or taking one OTC drug as needed for something or similar behavior. My body began reacting weirdly to things that had not been a problem before and I developed new allergies that I had not had before. Those new allergies eventually improved after I got off the drug cocktail, but it took years and years.
posted by Michele in California at 5:22 PM on March 31, 2015

I can induce enough lung irritation to have me coughing for at least a day or two and totally miserable just by pretending to cough a few times. Once went on for a couple weeks. (That mayyy have been karma for trying to pretend to be sick to get out of a social thing.) It seems possible that when you get really fixated on it, you end up breathing more heavily or something to compensate, and that results in just enough irritation to make it worse. Basically, it could be more than "psychosomatic" and still respond well to dealing with the anxiety--or it could be substantially aggravated by the anxiety and still be worth getting an inhaler. Asthma as a diagnosis is weird in that while it seems like it should be objective, there actually seem to be a lot of varying standards for what counts. I know a fair number of people with symptoms that are just borderline enough that some have been diagnosed and others have had doctors reject the notion. The label probably matters less than finding medication and stuff that helps.
posted by Sequence at 5:25 PM on March 31, 2015

I don't want to minimize the possibility of asthma--of course it exists, and of course there's a huge symptom overlap with panic, and of course plenty of people have both asthma and anxiety. But what you're talking about, a brief sense of shortness of breath characterized by awareness of breathing, sounds so much like a symptom of anxiety, especially given your prior negative test results and lack of efficacy of medication, and especially-especially if allergies have heightened your awareness of your respiratory system even more, that it makes sense to see it through that lens first. I mean, you can always go back and reevaluate and see another doc or whatever if it gets worse.

For now, though, when you experience this...what happens if you hold your breath a while? Does it calm down? Feel worse? On a prior therapist's advice, I do this a lot to remind myself I'm hyperventilating, when I'm anxious. I feel the breath symptoms coming on (eek, it's Ondine's curse!)--I hold my breath, my CO2 evens out, my fingers stop tingling, and I can get back to things.

Have you talked to your shrink about it? Not just about the symptom itself, but about the dread of going back through the whole gamut of medical tests and ambiguity and fear, and what it's like to have that hanging over you, having to anticipate something that will bring your life to an utter halt for a while? Wait, I shouldn't phrase that as a question. Do talk to your shrink.
posted by mittens at 6:37 PM on March 31, 2015 [1 favorite]

Get a rescue inhaler. The technology has improved SO MUCH since the 90s, and they can give you something that will not kill you if you use it a few times with a panic attack, and will definitively answer the question if it is asthma.

I know so many people who have exercise-induced asthma* and carry inhalers for it, it's a relatively cheap and easy way to give you some reassurance.

*And anxiety, and thought the asthma was anxiety, or a normal aspect of exercise, or both. Really common problem.
posted by Lyn Never at 6:39 PM on March 31, 2015 [1 favorite]

I just wanted to point out that in your post you basically say I had allergies and I felt like I couldn't breathe. Then I had many years of no allergies (and you did not report that you had panic attacks during that time). Then lately I've had allergies and I feel like I can't breathe.

To me, that doesn't sound like someone who is suddenly getting panic attacks that look like allergies, it sounds like someone who has allergies and whose body quite naturally feels anxious when it's harder to breathe. I am just going on your post and obviously I am just someone on the 'net.

I would pursue the allergy & breathing angle.

For pollen-type allergies one of the biggest game-changers for our family has been to buy 8 pillowcases and swap them out every day, just before bedtime, and then wash them on hot on the weekend and keep them in a closed basket.
posted by warriorqueen at 6:42 PM on March 31, 2015 [1 favorite]

Have you ever been evaluated for GERD and other reflux conditions? Some of them can cause asthmatic symptoms from aspirated stomach acids.
posted by poffin boffin at 7:37 PM on March 31, 2015 [3 favorites]

Right after I married I got severe shortness of breath, then it magically went away. Turns out it went away when I replaced a wedding gift of a down and chicken feather comforter, with a quallofil one, no feathers. I discovered what it had been when I threw myself down on the guest bed, where the original comforter went. It was sudden drastic shortness of breath. So I threw the feathers out of the house, pillows, down jackets, and the comforter. It all went away along with the shortness of breath. Then when I went to work at a hospital the "asthma" came back, I was nearly medicated to death for it, when I discovered the trigger was the TB test I had to have every year. I opted out of that and the asthma went away. So find the worst triggers, keep your bed made, shower before you get in it, so for at least eight hours a day, you are without physical allergens. Good luck. I have provental inhalers here and there, I have not used in years. I need them for hiking at altitude, not much more.
posted by Oyéah at 9:14 PM on March 31, 2015

It's usually not very difficult to tell asthma from anxiety/panic related shortness of breath, from a medical perspective.
- The vast majority of asthma attacks present with wheezing. There are a small number of people who have the ability to make themselves sound wheezy on purpose, but this usually sounds like stridor, a wheeze that comes from the upper airway and can be heard without a stethoscope, rather than the lower airway, audible via stethoscope wheeze which people cannot think themselves into having. Some people have 'cough variant asthma' but they cough instead of wheezing. So, wheezing is the hallmark of asthma. Asthma attacks are frequently (but not always) triggered by pets, dust, upper respiratory infections, cold, or exercise. Albuterol makes shortness of breath caused by asthma feel markedly better very quickly after using it.
- People having panic attacks feel "like they're going to die." Those very specific words are almost universally used by people having panic attacks. Intriguingly, I have never had a dying person tell me they feel like they're about to die. People having panic attacks generally do not cough or wheeze. They may feel worse after albuterol, because it speeds up their heart rate and makes them feel more jittery. Panic attacks are often (but not always) triggered by a stressful situation. Benzodiazepines make panic attacks feel markedly better very quickly after getting them.

Hope you will follow up with your doctor ASAP, and hope your symptoms improve!
posted by treehorn+bunny at 11:55 PM on March 31, 2015 [4 favorites]

Allergies - specifically, hayfever can cause shortness of breath. I don't see any reason to look further than that. I had shortness of breath for 2 weeks before seeing a doctor, did the whole peak flow thing and it was just hayfever. It got better when the weather got better. Anti-histamines helped a little too. I hadn't been taking them because I wasn't sneezing, coughing or having itchy eyes - just the shortness of breath
posted by missmagenta at 3:56 AM on April 1, 2015

I've got the mild mostly-cough asthma. I didn't grow up with it, and I thought that always made it harder for me to know if it was in my head or if I really was having breathing trouble. You're not alone in having this sort of confusion.

The peak flow meter helped me to know if it was time to take my rescue inhaler. But what really helped was aggressively treating my allergies- I take two different antihistamines (ceterizine and fexofenadine), as well as a decongestant (pseudoephedrine). I did not find the steroid nasal spray helped-- one gave me migraine aura (fortunately no pain but the shimmery thingies were still scary), and another actually seemed to make my breathing worse.

Of course, as mentioned above, best way to treat allergies is to figure out what you're allergic to and get rid of it entirely. For me this is mostly dust and cats (so I don't live with cats, or carpets, all of my bedding is washable on high heat and gets washed frequently, and I use a dust mop to get dust off the floor at least twice/week). But for you it might be a certain kind of pollen-- allergy tests may or may not help you identify what it is. In this case, live somewhere that doesn't have the pollen, or if you can't, limit your outdoor exposure during its season, shower immediately after being outside, and replace clothing immediately too. I actually got a pollen mask which made me feel better (and I frankly don't give a damn if it was in my head or not, I felt better and that was worth it to me. I also dont' really mind looking like a goofball though).
posted by nat at 12:23 PM on April 1, 2015

Response by poster: Thanks for the advice, everybody. For various reasons I'm going to treat this like a mental problem, for now. I'm doing better today, and so far this feels more like a panic thing. But if it comes back and/or gets worse, I'll talk to my doctor about it.
posted by Ursula Hitler at 2:33 PM on April 1, 2015

I frequently had similar symptoms and was confused and distressed. Turns out the culprit was GERD, often symptomless (who knew!). Inhaling acidic fumes from the reflux is responsible for my shortness of breath .
posted by i_mean_come_on_now at 3:42 PM on April 1, 2015 [2 favorites]

Response by poster: Minor update, just in case anybody chances across this old thread: in this case, it turned out I had pneumonia. That was very surprising to learn. It really just felt like a persistent allergic thing, with a ton of postnasal drip.

I'm assuming the pneumonia was causing the shortness of breath. I don't know that for sure, but it seems likely.
posted by Ursula Hitler at 3:55 AM on May 8, 2015 [2 favorites]

Holy crap! I'm glad you got it checked out!
posted by mittens at 4:08 PM on May 8, 2015

Well, that'd do it! Classic example of why medical advice on the internet is so unreliable; not one of us even suggested pneumonia, but your doctor nailed it! Pneumonia will totally cause persistent shortness of breath. I'm glad you got it sorted!
posted by Anticipation Of A New Lover's Arrival, The at 8:25 PM on May 8, 2015

Response by poster: I only found out because I had a PET scan as part of my ongoing post-cancer monitoring. I'd been examined by a doctor who had no clue it was pneumonia, but then they did the PET scan and apparently my lungs lit up in such a way that they knew that's what it was.

Apparently you can have pneumonia and it can just feel like a bad hay fever attack, and then it can just get better by itself. Who knew?
posted by Ursula Hitler at 12:58 AM on May 9, 2015 [1 favorite]

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