Why People Reach for the Paper Bag
The idea of breathing into a paper bag during a panic attack has been around for decades. You’ve probably seen it in a film or maybe tried it yourself— I hold my hands up, 20 years ago when I had panic disorder I tried it. I still remember being a teenager in school, watching a friend collapse during class with what we later understood to be a panic attack. The teacher dashed out and returned with the trusty brown paper bag. It felt like a caring, immediate response — and at the time, that’s what many people believed worked.
The logic sounds simple: when you hyperventilate, you breathe out too much carbon dioxide (CO?), which can cause dizziness, tingling, and a sense of losing control. By rebreathing into the bag, you’re meant to raise your CO? levels again and calm the body.
But I want to be very clear: using a paper bag to breathe during a panic attack is not recommended — and in some cases, it can be dangerous. I specialised in anxiety disorders and have had panic attacks myself, and keep up-to-date with research and recommendations and want to inform you why paper bags are not recommended, and more importantly, what to do instead.
What’s Actually Happening During a Panic Attack
Panic attacks aren’t simply a problem with carbon dioxide. They’re the result of a false alarm in the brain, triggering a full-body stress response:
- Lightheadedness
- Chest tightness
- Tingling in fingers or face
- Feeling disconnected or faint
Panic attacks are less about oxygen or carbon dioxide — and more about perception. Your brain has mistakenly flagged a threat, and your body responds accordingly. The most effective techniques shift your system from ‘threat mode’ back to ‘safety mode.’ That’s why breathwork, grounding, and vagus nerve activation work better than a paper bag. They send a signal to your body: you’re safe now.
So yes — your breathing is involved, but it’s part of a much wider nervous system loop.
Learn more about the physical symptoms of panic attacks here.
Panic Fact vs Fiction
Myth: You must raise CO? with a paper bag.
Truth: The key is not to raise CO? — it’s to calm the nervous system and stop the panic loop.
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Why Paper Bag Breathing Is No Longer Recommended
There was a time when breathing into a paper bag was the go-to response for hyperventilation during a panic attack. The idea was that rebreathing your exhaled air would restore balance by increasing carbon dioxide levels. But this method is no longer recommended — and for good reason.
A widely cited study by Callaham (1989) found that in some cases, paper bag breathing caused dangerous drops in oxygen levels, with several participants experiencing a fall in blood oxygen by as much as 34–42 mmHg in under three minutes. Even more concerning, the study was prompted by real-life cases in which this method led to death when applied to patients with undiagnosed heart or lung conditions.
That same caution is echoed in clinical guidance today. According to UCLA Health, while the theory behind paper bag breathing makes biochemical sense — helping to restore blood pH during hyperventilation — it’s not safe unless you’re absolutely certain that you’re having a panic attack and not something more serious. In fact, UCLA clinicians explicitly state:
“Unless you know beyond a shadow of a doubt that you’re hyperventilating due to an anxiety attack, leave the paper bag manoeuvre to the TV writers.”
I agree. Panic symptoms can mimic other medical conditions, including asthma, low oxygen (hypoxemia), and cardiac issues — and rebreathing could make those worse. It’s also not a long-term solution and can create a sense of dependency.
Paper bag breathing is what we might call a legacy intervention — it lingers from a time when anxiety was seen as a breathing problem rather than a full-body experience involving brain circuits, stress hormones, and learned fear.
The paper bag method was never designed for medical emergencies, yet people began using it in response to unexplained symptoms. This is where the danger lies.
What if it’s not anxiety?
Some heart attacks, asthma attacks, and blood sugar crashes present with dizziness, breathlessness, or tingling — just like panic.
And what if the issue is actually low oxygen, not low carbon dioxide?
Breathing into a paper bag depletes oxygen further. This can cause real harm, especially if you have an undiagnosed respiratory condition or if it wasn’t panic in the first place.
More importantly, paper bag breathing can be unsafe:
- It assumes the cause is anxiety — but rapid breathing can be a symptom of heart issues, asthma, or metabolic problems.
- In some people with panic disorder, even a small increase in CO? can trigger more panic, not less.
- If someone becomes lightheaded due to another medical condition, limiting their oxygen supply could cause harm.
1. Risk of Hypoxemia
Rebreathing your own air reduces oxygen levels. For some people, especially those with asthma, heart issues, or undiagnosed medical problems, this can lower oxygen dangerously — a condition called hypoxemia — and mimic or worsen the symptoms of a panic attack.
2. Panic Attacks Aren’t Always About CO?
While overbreathing plays a role, panic isn’t always caused by a CO? drop. It’s more about how the brain and body interpret signals — and misfire.
In fact, recent research shows that people with panic disorder often have increased CO? sensitivity — meaning even small increases can trigger panic, not relieve it. (Biological Psychiatry, 2020)
3. Not Safe for All
The paper bag method assumes that the cause is anxiety. But what if it’s a cardiac arrhythmia? Or asthma? Or a vasovagal episode? In these cases, a paper bag could delay proper treatment.
4. No Strong Evidence It Works
Despite its persistence in popular culture, no high-quality studies support paper bag breathing as a safe, effective treatment for panic attacks.
So Why Does It Seem to Help Some People?
Sometimes, it’s the ritual of the paper bag that soothes people — not the breathing itself. Doing something structured, being cared for, or simply the passage of time can all create the illusion that the bag was the cure.
In clinical practice, I often see people improve because they feel seen, safe, or in control — not because their CO? changed.
What’s a Safer Way to Recover from Hyperventilation?
The real solution is to help your breathing return to baseline — and that starts with your nervous system.
1. Slow, paced breathing
Try this: Breathe in for a count of 4, out for a count of 6. Slowing the out-breath supports your vagus nerve, which helps signal to your body that it’s safe.
2. Ground your senses
Notice the weight of your body in the chair. Touch something cool or textured. Name five things you can see. Grounding yourself in your environment helps break the fear loop.
3. Reassure yourself
Panic attacks feel dangerous, but they are not harmful. Knowing this can help you ride the wave without feeding it.
You can also read my article on guided relaxation for more structured help calming your system.
f you’re unsure whether you’re hyperventilating or experiencing something else (like low blood sugar, asthma, or even a cardiac issue), it’s safer to avoid anything that restricts your breathing. Instead, try slowing your exhale or using box breathing.
The Real Question: Why Is Your Breathing Dysregulated?
Panic isn’t just “in your head.” It’s a full-body stress response.
When you’ve had multiple panic attacks, your nervous system starts to anticipate them, and your breathing patterns can change long before the attack even starts. This is called anticipatory anxiety, and it sets the stage for chronic hyperventilation and fear.
This is why I don’t just help you “calm down” — I help you retrain your nervous system.
? Learn how your emotional memory can trigger panic attacks — and how we begin to unlearn those triggers.
It Might Not Even Be Panic…
This part’s important. Some people are told they have anxiety or panic disorder, but they’re actually suffering from something else.
I was.
In my case, my panic attacks at night were actually due to sleep apnea. I’d wake up gasping for air, heart racing — textbook panic — but the root cause was my breathing stopping during sleep.
It wasn’t until I had a sleep study and started treatment that everything changed. You can read more in:
- Why Is My Anxiety Worse at Night?
- Nocturnal Panic Attacks
- The Role of Sleep in Panic Disorder
- The Connection Between Panic Attacks and Sleep Apnea
And if you haven’t already, make sure you’ve ruled out the common medical conditions that mimic panic attacks.
Clinical Insight
In my work as a psychologist, I’ve never seen paper bag breathing offer lasting relief. It’s a short-term fix at best — and a risky one at worst. What does help is learning how to interrupt the panic loop before it starts: retraining the way your body responds to false alarms, and restoring safety from the inside out.
What You Can Do Instead
If you struggle with panic, especially out of the blue or at night, here’s what I recommend:
- Learn how panic works (not just how it feels).
- Regulate your breathing with long outbreaths, not paper bags.
- Start exposure therapy to retrain fear patterns. (Guide here)
- Rewire the connection between symptoms and fear using CBT and neuroscience-based tools to stop panic attacks.
Final Thoughts
If someone’s breathing is out of control, don’t reach for the paper bag. First, find out what’s causing it. If in doubt, always get medical help — especially if it’s the first time.
And if it is anxiety or panic, you don’t need a paper bag — you need a plan.
Next steps:Panic Attack Counselling (hub) · CBT for Panic Attacks · How to Stop Panic Attacks · Exposure therapy for panic