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Save your own life underwater!

How to deal with panic attacks while diving (and not only)

by Ivo Kalushev,, ATI Cave Exploration Team 

Dealing with Panic Underwater

Photo: TSgt Samuel Bendet


I want to share something with the diving community, which I think is very important and might actually save lives. I do not have anything original here, but I have been giving this advice to divers and non-divers over the past couple of years and since it seems to work every time and I get 100% positive feedback, I have some confidence that this is something worth sharing.

We have an often reoccurring problem in diving, both open water and overhead, and this is the possibility of panic underwater. Active panic, passive panic, weird panic, you name it. Everyone does it differently. There are many articles written on that subject. Especially in cave diving, when we study accident analysis (and we should!) there is this puzzling and reemerging pattern of fatal accidents which involve people who are later found with gas in their tanks. Most of these cases are later ‘diagnosed’ as heart attacks. This may very well be the final outcome, but from my own experience and from the experience of many fellow dive instructors, what is actually the cause of death may be a panic episode of some sort. In fact, in the overhead environment, a fully developed panic episode means almost certain death.

I think that many cave divers have experienced in certain situations a state of chaotic thinking which threatens to spin out of control. I certainly have. The more experienced we are, the better we can deal with this problem, but it is there, as a potential life threat. It is actually assumed that no one is exempt from this, no matter how skilled and experienced. And it has no doubt caused many deaths underwater, both directly and indirectly. There seems to be however a very simple technique you can do to stop this from developing, and it works every time. Read on.

Now, we seem to think that a ‘panic’ attack has a psychological trigger. After all, that is what the name suggests – ‘panic’ means fear i.e. we fear something, and we finally freak out. Wrong! It doesn’t really happen like that, although fear can be a factor. A panic attack which begins as a sudden anxiety accompanied by insistent, troubling and chaotic thoughts seems to have an entirely physiological immediate trigger, and the simplest one at that – a change in your breathing pattern, which leads to CO2 buildup in your body. I am stating nothing new here, I am just putting the pieces together. Bear with me, I’ll explain.

When we cave dive we use a horizontal trim. Our body is designed to rest while in horizontal position, and our breathing becomes shallower. Of course we adapt to that underwater and learn to stay alert, but we can not entirely overcome the tendency to breath shallow while, essentially, laying down. It is a bodily mechanism. If we keep the same rhythm and are not afraid (which also triggers shallow breathing), we are fine. However when we abruptly change the level of exertion – we start to swim after scootering, we start to fight a current or we just realize we have become lost and start a cycle of shallow breathing out of anxiety – the body can not get rid of the accumulated CO2 and a CO2 buildup happens automatically. As we know, it is not O2 deficiency which triggers the breathing impulse, it is actually an excess of CO2. So, what happens next is still more accelerated shallow breathing, accompanied by the feeling that you can not get enough air. That is actually not true – you do get enough gas, what you can not do is get rid of the CO2. In fact, by breathing shallow you are building up more of it and soon the body will shut off rational thinking and will revert entirely to instinct in order to survive. The bad news is – we do not have instincts for underwater. Our hardware wiring is to run in a dangerous situation. This, sadly, translates to drowning while diving.

As a CO2 buildup brings anxiety and chaotic thinking, people make the mistake to think that it is a mind issue. Most of us completely fail to realize that it is in fact an entirely physiological process. You accelerate your movement to get out of whatever is happening, and this builds up still more CO2. If you go on, in about a minute you will lose control.

As anyone who has done serious pranayama knows, breathing patterns in the human body are stable, they do not change easily. When faced with CO2 buildup emergency, the body does not change the already established shallow breathing pattern by itself, it just accelerates it, making the matter worse. In order to change the breathing pattern from shallow to deep, you have to know how to do it, and do that consciously, and you have to do it before you lose the ability to do rational things. You have a very short window of opportunity to reverse the process.

What you should do

What you should learn to do yourself, and what you should teach others to do at the first sign of anxiety and chaotic thinking is the following:

1. Stop all movement immediately and recognize that you are having a physiological issue, NOT a psychological issue! Freeze your body in a static position. This greatly diminishes the production of CO2 .

2. Exhale with as much force as you can, completely, two times. Concentrate only on exhaling, two times. This reverses the impulse to inhale and sends the right signal to your body.

3. Inhale, as fully as you can, hold the breath as low as possible, and create as much pressure as you can in the lower abdomen. Make your belly stick out as much as possible, like a basketball. Feel the strain, and HOLD as long as possible.

4. Exhale forcefully and completely, and repeat point 3 one more time, while still staying completely still.

That’s it. You will be surprised that immediately following these four simple steps, all your doomsday thoughts will vanish in thin air, you will feel completely comfortable and you will find yourself wondering how can all this be possible.

What we actually do is flush the CO2 from the body, and then change the breathing pattern with a very simple pranayama exercise, called “vase breath” (Kumbhaka). No need to explain where this is coming from, but it is a way for reprogramming the breathing pattern, among other things.

When you know this technique you will learn to recognize the very first signs of anxiety – both underwater and out of the water, and apply it immediately. If you are a cave diver, this will allow you to attempt things you didn’t dare to touch, with confidence and relaxation. If you are just a normal person suffering from panic attacks this will help you regain your life. Also – stay fit. A fit person is less likely to switch to a shallow breathing pattern. Try it for yourselves and please spread the word, as this is really important.

I wish you all happy and safe diving!