People breathe into paper bags to treat hyperventilation, but doctors no longer recommend it because it can lower oxygen levels.
Old advice
Breathing into a paper bag was used to treat hyperventilation by raising CO2.
Why it’s discouraged
It can cause dangerously low oxygen, especially if the cause is a heart or lung problem.
Better
Slow breathing: in for 4 seconds, out for 6.
Panic attack
Sit down, relax your shoulders and breathe slowly.
See a doctor
If it keeps happening.
Emergency
Chest pain or fainting. Call 911.
Evidence against the practice
Breathing into a paper bag was once advised for hyperventilation, on the idea of raising carbon dioxide. This is no longer recommended because it can cause low oxygen (hypoxia), particularly if the symptoms stem from a heart attack, asthma or pulmonary embolism rather than a panic attack. Deaths have been reported.
- A 1989 report in the Archives of Internal Medicine described cases where rebreathing worsened hypoxia in people with heart or lung disease.
- The American Red Cross and the AHA no longer teach paper bag breathing.
- Panic attacks peak within 10 minutes and are not dangerous in themselves.
Better options
Slow diaphragmatic breathing (inhale 4 seconds, exhale 6 seconds), grounding techniques such as naming five things you see, and sitting down help. Seek emergency care for chest pain, shortness of breath that does not settle, fainting or if it’s a first attack. Therapy such as CBT and medications like SSRIs treat panic disorder, which affects about 2 to 3 percent of adults in a year.
Evidence against the practice
Breathing into a paper bag was once advised for hyperventilation to raise carbon dioxide levels. It can be dangerous if the cause is a heart attack, asthma or pulmonary embolism, since it lowers oxygen. Medical guidelines no longer recommend it, and deaths have been reported.
Better options
Slow breathing through the nose, pursed lip breathing and counting to 4 on inhale and 6 on exhale help panic episodes. Call emergency services for chest pain, severe breathlessness or blue lips.
Physiology of hyperventilation
In hyperventilation, breathing out too much CO2 causes respiratory alkalosis, leading to tingling, dizziness and chest tightness. Rebreathing from a bag raises CO2 but also lowers oxygen. Case reports show cases of hypoxia and death when the bag was used by people with heart attack or asthma. A 1989 study showed that oxygen saturation could fall in cardiac patients.
Evidence based methods
Teach slow nose breathing, with exhale longer than inhale, and use grounding techniques. Cognitive behavioral therapy treats panic disorder, which affects about 2.7 percent of US adults per year. If you have chest pain, blue lips or breathlessness that does not settle, call emergency services.
Based on data from the American Lung Association and the National Institute of Mental Health
