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Can Anxiety Cause Shortness Of Breath, Tension And Stiffness In Shoulder Blades?

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Posted on Thu, 28 Apr 2016
Question: This is XXXX, XXX XXXXXXX for this account. Since my account is blocked, I chose to set a second in motion. Nothing out of the ordinary since we last spoke. Fact I have fallen back a bit with Anxious Thinking. The thoughts have always ended up dwelling on how much air I can get in my lungs or the shortness of breath because I cant get enough.
Knowing that all Doctors have basically said same diagnosis, I have to give in to that answer but what is it that my GAD/Panic/Anxiety/Stress is capable of doing physically to my respiratory system or the function of taking a breath that doesnt feel labored, unfinished, unsatisfying with getting oxygen balance.
The thoughts of Lung damage or COPD (Emphysema) lend themselves to the thoughts of Air Trapping/Gas Trapping(not sure which is the accurate phrase) keeping limited space for a breath or taking a breath. I have had to take a Xanax Sunday, Monday, and Tuesday to keep calm under these thoughts. You have explained quite a bit in prior chats regarding the effects of Panic but what exactly is causing the breathing to feel a. limited. b. labored. c. unsatisfying such as a breath does not feel like i am getting but stale air. I woke in the middle of the night and began thinking thoughts. I noticed while laying there that my back shoulder blades are stiff and sore, i figure that has to be two issues, tension and breathing incorrectly as I try to cope with the breathing.
doctor
Answered by Dr. Alexander H. Sheppe (3 hours later)
Brief Answer:
Private Consultation

Detailed Answer:
Hello XXXXXXX welcome back!

Would you mind sending me your email? You can also contact me at YYYY@YYYY , I think this will help us facilitate our therapy on this site more conveniently.

You are correct indeed in identifying anxiety and panic as the cause of these very real physical symptoms. I'd like us to just take a moment to identify this as progress! When we first started talking, you were more or less entirely convinced that there was something very wrong with your lungs themselves. It seems now that you are more convinced that your lungs themselves are okay. This is a step in the right direction.

I want to reiterate a very important point: anxiety and panic cause very REAL and VERY uncomfortable physical sensations. However, this does not mean that you are actually in any danger. For example: when someone on Halloween steps out from behind a doorway and yells BOO and you weren't expecting it, you experience a rush of feelings -- tightness in the chest, panic, shortness of breath, the feeling that you need to run. These are all very real sensations -- but you aren't in any real danger (unless it's a real werewolf). Your brain is interpreting information as DANGER which is OUT OF PROPORTION to reality.

When you experience anxiety and panic, it is more drawn out that a simple one-off scare or BOO -- your brain is more overactive than this throughout the day. It is causing your chest to feel tight, even though your lungs are oxygenating your blood just fine. It causes you to focus in on terrible possibilities -- even though these have no chance of being real or actually coming to pass (emphysema, inability to breathe, passing out, dying). By training yourself to RECOGNIZE these sensations as illogical, you're using the rational part of your brain to overcome the emotional/primitive part of your brain. This is what therapy does. Medication helps too, by bathing the brain's fear center (amygdala) in serotonin.

Over time, you will come to focus less and less on your breathing. At some point, you'll look back and think, Why was I so worried by lungs weren't working right? My hands still have circulation, my brain is still working, my muscles are moving, I'm getting plenty of oxygen! But right now we're still working on training you mind to ignore these false red flags your brain is throwing at you.

Does this make sense? Thoughts, concerns?

And please don't forget to email me, or post your email in your reply!

Dr. Sheppe


Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Alexander H. Sheppe (13 hours later)
Not sure what is the underlying causes but again I woke during the night and had a panic attack that kept me up. Still wound up as I write this. Not sure if it's the Zoloft or what. Again I know what all the Drs and you say but it must be something imbedded solidly to make my breathing not short of breath but to how much I can get in before the body stops expanding. I notice that I am not expanding in upper chest is this from stress.

Oh gad is a constant worry. Because it is constant, can that worry keep the effects of it constant if your wound up and then you make note or focus on it.
doctor
Answered by Dr. Alexander H. Sheppe (15 hours later)
Brief Answer:
Private Followup

Detailed Answer:
Hi XXXXXXX

I'm sorry you had a panic attack. Let me give you my thoughts.

Now that you are starting Zoloft, a common but temporary side effect is actually an INCREASE in anxiety while your body is adjusting to the medication. This effect typically lasts a couple weeks or less, and is related to the brain adjusting its serotonin receptors in response to the medication. Typically after this adjustment period, we can begin to judge more accurately your response to the medication and its effects on lessening your anxiety/panic. So, this is not entirely unexpected while you are getting used to this new medication. Give it some time.

I want to again stress that your mind focusing on your chest's apparent inability to expand fully is anxiety and not a problem with your lungs. Your lungs are expanding perfectly enough, oxygenating your body well. This sensation of not feeling your lungs expand fully is a common one I hear during panic attacks. When you notice your mind focusing on your lungs, try to distract yourself with music, TV, or some other way, and try to remind yourself that this is anxiety and not a medical problem with your lungs.

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Alexander H. Sheppe (8 hours later)
So the side effects of Zoloft is increased anxiety? I take it at 6 am, I wake at 3 am at that time I lay there attempting to go back to sleep. Then I test my breathing. Test is to see how long I can keep an inhale going both nasal breath and mouth breath. I once could count to 10 - 14, now I get 4-6 occasionally 8-10. These are while laying on back. Standing is less.

When I wake, how much anxiety is there and is that what is affecting my breathing

While showering, I decided to quit trying to count my breathing and focus on relaxing. I will hope that once relaxed, it goes away.

I woke at 2 from step kid complaining about his asthma. Had an anxious moment. Took a Xanax and went back to sleep.

I will put together a series of thoughts of stresses and email to the other email account. Saves time writing on iPad.
doctor
Answered by Dr. Alexander H. Sheppe (11 hours later)
Brief Answer:
Private Followup

Detailed Answer:
Yes, a common but temporary side effect is actually an INCREASE in anxiety while your body is adjusting to the medication. This effect typically lasts a couple weeks or less, and is related to the brain adjusting its serotonin receptors in response to the medication. After that time we would expect your anxiety to begin improving, or if it doesn't, to start raising the dose higher (can eventually go as high as 200mg).

You describe a lot of anxiety in the early morning when you wake up. This practice of counting your breaths is totally and completely an anxious behavior. It reflects a concern in your mind that there is something wrong with your lungs, so you need to test your breathing to reassure yourself. But counting your breaths or monitoring your breaths closely isn't an accurate way of measuring lung function -- PFTs are, and remember, yours are normal.

Your practice of taking a shower to distract your self is a very good thing. I would encourage that whenever you are tempted to start monitoring or count your breathing, catch this pattern and stop it by doing something that relaxes you -- listen to music, play music, take a shower, light candles, watch a show/movie, something to break this cycle that your mind has gotten used to.

I would actually suggest switching from Xanax to a different benzodiazepine. Xanax is very short-acting and often leads to rebound panic and anxiety, which is bad. You might benefit from a longer-acting benzo like Ativan or Klonopin (I prefer Klonopin). Maybe mention this to your doctor next time you see them.

Look forward to hearing more from you,

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Alexander H. Sheppe (1 hour later)
I was considering changing Xanax out

Until I move out, I am in a small house with little option to play or listen to music or watch a good movie unless the house is empty

Some new thoughts came to mind today regarding certain physical sensations. I first noticed this sensation back in 2013 after a major ice storm came through and I got all stressed about the damage and clean up. In that event, I noticed that every so often my breathing was limited to how much I could get in and then it had an unpleasant sensation after. I assumed it was an area of lungs that had a amount of trapped air and that was the stopping point. This wasn't constant to each breath but every x number say 10. I quit noticing it it until a number of months later when another stressful moment occurred. I have been thinking about your comments on the start of Zoloft and wonder if this and all the other symptoms are related to the onset of new meds.
This morning I woke at 2 but went back to sleep from 3-5:30. No Xanax today. I am focusing on not focusing on my breathing, I am focusing on telling myself that it's only anxiety that is the root and will go away. The day was improved but still uncomfortable. Tonight I had a limited breathing event where after it had a unpleasant follow up sensation

The plan I have for going forward will be tough but I must try. I want to constantly assure myself that each time I sense something that it's just the body coming down from the extended long over stimulated body. I need to find a yoga place to begin slow activity. No biking or heavy exercise until I'm calmed down. Best start soon if I want to ride bike by end of summer

So yes things are recurring and some are ceasing with change. As long as the problematic sensation of taking a breath is just mental
doctor
Answered by Dr. Alexander H. Sheppe (11 minutes later)
Brief Answer:
Private Followup

Detailed Answer:
I don't think this is all related to new meds -- remember, your were experiencing anxiety and a major focus on your breathing well before the medication change -- but I just want to reassure you that it takes time for these medications to work, and they can even contribute to anxiety initially, so don't get discouraged and stick with it, because Zoloft is a great medicine and can do the trick for you.

You mention yoga, which I think is a fantastic idea. Let me also suggest going on YouTube and looking for some things to help you relax when you start panicking or focusing on your breathing in an anxious state. There are lots of guided meditation and progressive muscle relaxation videos that many people find helpful. There are also ASMR videos which some people find highly relaxing. Even if you can't listen to or play much music right now, popping on some headphones or earbuds and listening to this type of YouTube content can really help you distract yourself.

It looks like we've come to the end of this thread. For the next thread, let's brainstorm some more ways we can help your thinking break out of this anxious pattern.

Dr. Sheppe
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Prasad
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Dr. Alexander H. Sheppe

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Practicing since :2014

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Can Anxiety Cause Shortness Of Breath, Tension And Stiffness In Shoulder Blades?

Brief Answer: Private Consultation Detailed Answer: Hello XXXXXXX welcome back! Would you mind sending me your email? You can also contact me at YYYY@YYYY , I think this will help us facilitate our therapy on this site more conveniently. You are correct indeed in identifying anxiety and panic as the cause of these very real physical symptoms. I'd like us to just take a moment to identify this as progress! When we first started talking, you were more or less entirely convinced that there was something very wrong with your lungs themselves. It seems now that you are more convinced that your lungs themselves are okay. This is a step in the right direction. I want to reiterate a very important point: anxiety and panic cause very REAL and VERY uncomfortable physical sensations. However, this does not mean that you are actually in any danger. For example: when someone on Halloween steps out from behind a doorway and yells BOO and you weren't expecting it, you experience a rush of feelings -- tightness in the chest, panic, shortness of breath, the feeling that you need to run. These are all very real sensations -- but you aren't in any real danger (unless it's a real werewolf). Your brain is interpreting information as DANGER which is OUT OF PROPORTION to reality. When you experience anxiety and panic, it is more drawn out that a simple one-off scare or BOO -- your brain is more overactive than this throughout the day. It is causing your chest to feel tight, even though your lungs are oxygenating your blood just fine. It causes you to focus in on terrible possibilities -- even though these have no chance of being real or actually coming to pass (emphysema, inability to breathe, passing out, dying). By training yourself to RECOGNIZE these sensations as illogical, you're using the rational part of your brain to overcome the emotional/primitive part of your brain. This is what therapy does. Medication helps too, by bathing the brain's fear center (amygdala) in serotonin. Over time, you will come to focus less and less on your breathing. At some point, you'll look back and think, Why was I so worried by lungs weren't working right? My hands still have circulation, my brain is still working, my muscles are moving, I'm getting plenty of oxygen! But right now we're still working on training you mind to ignore these false red flags your brain is throwing at you. Does this make sense? Thoughts, concerns? And please don't forget to email me, or post your email in your reply! Dr. Sheppe