Can't Take a Deep Breath? How Anxiety Makes Your Breathing Feel Tight

Why can't you take a deep breath? Learn how the feeling that your lungs won't fill is linked to anxiety, when to see a doctor and what you can do.

You take a breath, but it seems to stop halfway. You try again, puffing out your chest and lifting your shoulders; still that satisfying "click" of a full breath does not come. You sigh again and again during the day, trying to complete your breath with a yawn. The people around you do not notice, but you have started counting every breath you take. The feeling that you can't take a deep breath is one of the most common and least understood bodily faces of anxiety. Many people fear there is something wrong with their lungs, heart or thyroid; when the tests come back clear, they become even more confused. In this article I explain where this feeling comes from, why it gets worse the harder you try, which symptoms always mean you should see a doctor, and ways of making peace with your breathing again.

What Is the Feeling That You Can't Take a Deep Breath?

This feeling usually stems not from a real lack of oxygen but from a sense that the breath is "not complete". People generally use expressions such as: "My lungs won't fill", "My breath gets stuck in my chest", "It's as if there isn't enough air", "I can't relax without yawning."

Most people with this complaint can talk, walk and climb stairs. In fact, from time to time, when they become absorbed in a task, they forget the feeling completely. Then it suddenly comes back to mind, and the breath starts to seem "incomplete" again. This detail is important: a feeling that increases when attention turns to the breath and decreases when attention goes elsewhere is very often closely linked to anxiety and the mechanism of attention.

Breathing is one of the most interesting systems in our body, because it runs by itself and yet we can also control it whenever we wish. We go through the day without noticing it. The moment we start to control it, however, its natural rhythm can be disrupted. Just as you can stumble when you start thinking about your steps while walking, constantly monitoring your breath can disrupt its flow.

Why Can't You Take a Deep Breath? Anxiety's Traces in Your Breathing

Breathing Too Much

When we are anxious, our breathing speeds up without our noticing and starts to come from the chest. This can lead to breathing in and out more than the body needs, in other words to a mild form of over-breathing. The level of carbon dioxide in the blood falls further than expected. Surprisingly, this can make a person feel that they are not getting enough air. As a result, the person tries to take in even more air, which increases the imbalance. Tingling in the hands and around the lips, mild dizziness and tightness in the chest can accompany this cycle.

Tension in the Chest and Shoulder Muscles

Under stress the shoulders rise, and the chest and abdominal muscles stiffen. It becomes harder for the main breathing muscle, called the diaphragm, to move freely. Breathing with a tense ribcage is like trying to take a deep breath inside a tight coat: there is enough air, but it feels as though the cage will not expand.

The Sighing and Yawning Cycle

During anxious periods, sighing and yawning become more frequent. A sigh gives brief relief, but the breaths that follow can feel even more "insufficient". The person tries again and again to catch a complete breath. This trying turns breathing into a test.

Attention Locking onto the Breath

Once you have thought "my breath is incomplete", the mind starts checking every breath. Each check disrupts the natural flow of breathing a little more and reinforces the feeling. In this way a bodily sensation settles at the centre of the anxiety.

Breathing is like a dancer who stumbles when watched; give it room and it finds its own steps.

When Should You See a Doctor?

Before concluding that the feeling of not being able to take a deep breath is linked to anxiety, medical causes need to be assessed. Asthma, allergic reactions, lung infections, anaemia, thyroid disorders, heart problems and stomach acid rising into the oesophagus can all cause complaints like this. A GP or a chest specialist can assess the situation, if necessary with lung function tests and blood tests.

In the following situations, call 112 (emergency services) or go to the nearest emergency department without delay:

• Breathlessness has started suddenly and severely
• There is blueness of the lips or fingernails
• You are so breathless that you cannot finish a sentence while speaking
• It comes with chest pain, fever, blood-stained phlegm or clouding of consciousness
• There are allergic signs such as wheezing or swelling of the face or lips

If these signs are absent and the medical assessment is clear, there is suitable ground for addressing the link between the breathing sensation and anxiety. It is also useful to ask your doctor which changes in the future would mean you should come back. That way, instead of starting a new hunt for tests with the question "Is it different this time?" every time you feel breathless, you have a clear criterion in hand. This criterion gives you solid ground to rely on while working with anxiety.

Moments in Daily Life When Breathing Feels Tight

The feeling that your breath is not enough is often stronger in particular conditions. Enclosed, stuffy offices, cramped company shuttles, crowded metrobuses, long meetings and difficult conversations are among the main settings. For some people the hardest time is the moment they lie down in bed; for others it is the minutes before leaving the house in the morning.

Let us say a thirty-five-year-old bank employee has been under intense pressure to hit targets for months since a new manager arrived at the branch. She notices that she sighs frequently during the day and tries to fill her breath by lifting her shoulders at her desk. When she goes home in the evening the feeling does not go away; before bed she opens the window as wide as it will go. The tests carried out by the chest specialist come back clear. In this example, breathing may be one way in which the pressure she does not voice finds expression in the body.

The economic uncertainty of recent years in Turkey, long working hours, long commutes and the state of alertness that followed the earthquakes can leave the body in a constant state of mild alarm. Complaints like these can show up not only in breathing but in different parts of the body too; if you are curious about how the body expresses stress, the article on psychosomatic symptoms can guide you.

This feeling also has a social side. Someone who keeps sighing in a meeting can give others the impression that they are bored or annoyed. A person who notices this tries to suppress their sighs, and now the breath feels even more restricted. Some people are embarrassed that their breathing can be heard; others become more worried because of warnings from those around them such as "There's something wrong with you, go and see a doctor."

At Night and While Falling Asleep

For some people this feeling is most noticeable when they lie down in bed. When the activities of the day come to an end, attention turns to the body; even hearing your own breath in a quiet room can be enough to start monitoring it. The natural slowing and irregularity of breathing as you drift off to sleep can also trigger the worry "Will my breathing stop?" In this situation a person may try to keep themselves awake even when sleepy, or try sleeping propped up on a pile of pillows. If there is snoring, breathing stopping during sleep or waking as if choking, this needs to be assessed separately by a doctor. If these signs are absent, it helps to know that changes in breathing on the way into sleep are natural, and to try step by step to stop controlling your breath in bed.

How Can You Cope When You Can't Take a Deep Breath?

The suggestions below are for people who have had a medical assessment and whose complaint is thought to be linked to anxiety. The aim here is not to find "the right breath", but to loosen the relationship you have with your breathing.

1. Notice your "test breaths". For a few days, note how many times during the day you try to take a deep breath to check whether your breath is filling up. Most people are surprised to see how high this number is. Awareness is the first step towards change.
2. Breathe more slowly, not more. Instead of trying to fill your breath, take a quiet, calm breath in through your nose and then let the out-breath lengthen a little. The aim is softness, not depth. Breathing through the nose rather than the mouth helps to reduce over-breathing.
3. Allow the feeling of incompleteness. When the feeling "my breath isn't filling up" comes, try waiting for a few minutes without trying to fix it. Very often the feeling recedes on its own when left alone. This is a way of telling your body, "This feeling is not dangerous."
4. Drop your shoulders. Several times a day, check whether your shoulders have crept up towards your ears. Consciously lowering your shoulders and relaxing your jaw makes room for the ribcage.
5. Move. Activities such as brisk walking, swimming or light jogging are situations in which breathing naturally deepens and speeds up. This experience shows your body again that your breathing system actually works well. Start by following your doctor's recommendations.
6. Move your attention outwards. Turning to a conversation, a jigsaw, cooking, or listening to the sounds around you while you walk leaves your breathing to itself.

If you would like to read in detail about what different techniques are for when working with the breath, you can take a look at the article on breathing exercises for anxiety. One point needs care, however: breathing exercises can sometimes turn into a tool for controlling the breath even more. If your anxiety rises while you are doing an exercise, it may be more helpful to take a break for a while and turn your attention elsewhere.

When Should You Seek Professional Support?

If your medical assessment was clear but one of the following describes you, talking to a mental health professional may be useful:

• Checking your breathing occupies your mind throughout the day
• You avoid enclosed spaces, crowds or public transport because of worry about your breathing
• The feeling of breathlessness is turning into panic attacks
• You are afraid that your breathing will stop as you fall asleep
• Despite going to the doctor repeatedly and getting clear results every time, you cannot feel reassured

These signs do not amount to a diagnosis on their own; but they may show that anxiety has settled in the body and that support may be needed. If the symptoms are intense, an assessment by a psychiatrist can also be part of the process.

How Is Anxiety About Not Being Able to Take a Deep Breath Approached in Therapy?

Cognitive Behavioural Therapy (CBT) is one of the research-supported approaches for working with the anxiety that accompanies bodily sensations. For anxiety about breathing, the therapy process usually includes the following elements:

Information. The relationship between over-breathing, muscle tension and attention is discussed together. Once the person understands the answer to the question "Why does it get worse the harder I try?", a significant part of the fear begins to dissolve.

Mapping the cycle. In which situations the feeling starts, which thoughts follow, and what the person does are examined in detail. Behaviours such as test breaths, opening windows, constant yawning or avoidance are made visible.

Facing the sensation. With the therapist, breathing-related sensations are produced in a controlled way; for example, breathing through a thin straw for a short time, or breathing quickly in and out. The person learns through experience that the feeling they fear is temporary and harmless. This work is planned with the doctor's approval and at the person's own pace.

Letting go of safety behaviours. Habits such as constantly opening windows, carrying sprays or particular objects, or avoiding crowded settings are reduced step by step.

Working with the underlying stress. The breath is often the first signal of a load being carried. Pressure at work, relationship problems, the division of responsibilities in the family or the belief "I must always be strong" can be discussed in therapy. A schema-focused perspective can help in understanding which experiences shaped these beliefs.

You can find more information about how the bodily symptoms of anxiety are worked with on the anxiety and panic page.

Frequently Asked Questions

Can a constant need to yawn be caused by anxiety?

Yes, during anxious periods a frequent need to yawn and sigh in order to complete a breath is common. That said, severe sleep deprivation and some medical conditions can also increase yawning. If the need to yawn has started recently and comes with marked tiredness, it is a good idea to consult a doctor.

Should I check myself with a pulse oximeter?

Unless your doctor has specifically asked you to, measuring your oxygen frequently at home usually feeds anxiety. Each measurement brings brief relief but makes the need to check grow. It is healthier to clarify with your doctor in which situations you should take a measurement.

Could this feeling be a sign of asthma?

Asthma can also cause breathlessness; but asthma usually involves wheezing, coughing and attacks that appear with particular triggers. Telling them apart requires an assessment by a chest specialist and, if necessary, breathing tests. Knowing that asthma and anxiety can exist together, and that each can be addressed in its own right, can make it easier to ask for support when you need it.

Can breathlessness that started after Covid be anxiety?

In the period after Covid, breathlessness can stem both from lung-related causes and from the anxiety left behind by the illness. That is why an assessment by a chest specialist is needed first. If, after medical causes have been ruled out, intense attention to and fear about breathing still remain, this anxiety can be worked with in its own right.

• #shortness of breath
• #anxiety
• #hyperventilation
• #psychosomatic symptoms

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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