Treating Hyperventilation Syndrome with a Paper Bag

Can you treat hyperventilation syndrome by breathing into a paper bag?

girl breathing into a paper bag
Breathing into a paper bag is not the right way to treat hyperventilation.

The answer to the paper bag question is like many of the answers I give here; it is a solid maybe as far as whether paper bags work to help with anxiety-related hyperventilation. As far as whether you should use them to treat hyperventilation, the answer is definitely no—unless your doctor tells you to do so.

Hyperventilation syndrome is usually associated with panic disorders. It is a psychological or emotional condition that causes victims to breathe too much. Breathing too deep and too fast causes the body to lose carbon dioxide (CO2), the byproduct of metabolism in our exhaled air. While CO2 is a byproduct, we still need a minimum amount in the bloodstream to maintain the proper pH balance in our bodies.

When we lose a significant amount of CO2, some body tissues start to malfunction. First, numbness develops in certain areas -- typically the lips, fingers and toes. After a while, the muscles of the hands and feet begin to cramp.

The Paper Bag Myth

Paper bags have been used for years to treat hyperventilation syndrome. The idea is that rebreathing the air we exhale makes us inhale more CO2 and helps us to quickly add the CO2 back into our bloodstreams. It works. Breathing into a paper bag has been shown to increase CO2 levels in the blood, although not as quickly or as effectively as many doctors previously thought. In one study, patients who thought they were getting something similar to the paper bag treatment did nearly as well as the real paper bag group.

The problem with paper bags is not that true hyperventilation syndrome patients are at risk from the treatment. On the contrary, while it hasn't been shown to really help hyperventilation syndrome patients, it hasn't been shown to hurt them, either. What paper bags do hurt are the dangerous medical conditions that look like hyperventilation. Heart attacks and asthma are most commonly confused with hyperventilation syndrome.

Breathing into a paper bag restricts the fresh air you are able to get. Without fresh air, too little oxygen is in the air you're inhaling. So, breathing into a paper bag dangerously lowers the amount of oxygen in your bloodstream. There have been several documented cases of heart attack patients incorrectly thinking they had hyperventilation syndrome and fatally worsening their heart attacks by breathing into a paper bag.

To make matters worse, several studies now show a link between high concentrations of CO2 and panic attacks, which means that artificially increasing CO2 in inhaled air is likely to trigger more feelings of panic in patients who suffer from anxiety.

The best treatment of hyperventilation syndrome is to stay calm and practice breathing slowly and not too deeply. Calmness and breathing exercises have just as much success as paper bag breathing, and no one is going to die from staying calm.

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Article Sources
  • Callaham, M. "Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients." Annals of Emergency Medicine. Jun 1989 PMID: 2499228
  • van den Hout, M.A., et al."Rebreathing to cope with hyperventilation: experimental tests of the paper bag method." Journal of Behavioral Medicine. Jun 1988 PMID: 3139884
  • Ohi, M., et al."Oxygen desaturation following voluntary hyperventilation in normal subjects." American Journal of Respiratory and Critical Care Medicine. Mar 1994 PMID: 8118644
  • Griez, Eric J., et al. "Carbon Dioxide Inhalation Induces Dose-Dependent and Age-Related Negative Affectivity." PLoS ONE. 3 Oct 2007 PMID: 17912364