Anxiety Attacks at Depth

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padiscubapro once bubbled...
Some of your symptoms are classic signs of high CO2.
From - eMedicine Consumer Journal, August 1 2001, Volume 2, Number 8

"Breathing nitrogen under pressure has an intoxicating effect. Most divers will begin to experience symptoms at depths greater than 100 feet, but symptoms may occur in as little as 33 feet of depth. Use of compressed air deeper than 120 feet is not recommended for this reason.

Symptoms are reversed with ascent. Factors that increase the risk of narcosis include cold, rapid descent, anxiety, alcohol, sedatives, fatigue, and carbon dioxide excess.

SIGNS AND SYMPTOMS

Symptoms include light-headedness, inattention, difficulty concentrating, poor judgment, anxiety, decreased coordination, hallucinations, and coma. The condition can lead to death."

from-eMedicine Consumer Jrnl, July 30 2001, Volume 2, Number 7

"Carbon dioxide build-up when diving is the result of inadequate ventilation. It is often caused by inadequate breathing, a tight wetsuit, overexertion, regulator malfunction, deep diving, and contamination of the air supply with exhaled gases. As a result, carbon dioxide levels in the blood can increase, causing shortness of breath and sedation.

SIGNS AND SYMPTOMS

Nausea, vomiting, dizziness, headache, rapid breathing, flushing . . . Severe cases progress to confusion, convulsions, and loss of consciousness."

With the greatest respect Uncle Pug and Padiscubapro, which set of symptoms more closely fits the bill?

While it may be that molecule-for-molecule carbon dioxide is more narcotic than nitrogen, as is oxygen, the narcotic effects of these gasses are never seen because the partial presures required to produce narcosis by these gasses are seldom, if ever, seen in life because they are not inert and have other toxic effects at far lower partial pressures.

For example, nitrogen often produces narcosis at 4 bar. Could you imagine the condition a diver would be in if his inspsired gas contained anything like this amount of oxygen or carbon dioxide?

In my considered opinion, if carbon dioxide did play a part it was to worsen the effects of nitrogen narcosis in this case.
:doctor:
 
Dr Paul Thomas once bubbled...
With the greatest respect Uncle Pug and Padiscubapro, which set of symptoms more closely fits the bill?
Looking back at what the ole mouthbreather said about his dive:
"the current caught me off guard and I had to fight to stay anywhere near the group and descent line until we reached the bottom.

By the time I hit bottom with "only" 1800 psi, I was winded and breathing HARD. I could feel my heart pounding. Then the sense of "impending doom" started....I felt like "This is too deep...I shouldn't be here...I don't have enough air to complete the dive...I have to abort...I can't abort I'm supposed to be helping the instructor and divemaster...I don't want to be the first to run low on air...I can't do this...Why am I breathing to fast? I've done this dive before? "Why is my heart pounding?" This is too deep, the boat is to high up. I might run out of air.etc. etc."


Why was he breathing so hard? Narcosis? Probably not.... I think that it is possible that he was experiencing the Dark side of mild narcosis... caused by anxiety.... caused by task overload, gas concerns, overworked muscles and CO2 retention.

As I said in another thread.... same song... just harmony.

Would relaxing and breathing deeply and normally at the same depth alleviate the symptoms of narcosis? Often that is all that is require to alleviate a dark narc. Why? :D
 
Uncle Pug once bubbled...
Why was he breathing so hard? Narcosis? Probably not.... I think that it is possible that he was experiencing the Dark side of mild narcosis... caused by anxiety.... caused by task overload, gas concerns, overworked muscles and CO2 retention.

Would relaxing and breathing deeply and normally at the same depth alleviate the symptoms of narcosis? Often that is all that is require to alleviate a dark narc. Why? :D

I fear we may be splitting hairs here Uncle Pug.

Carbon dioxide retention is a factor in narcosis and acute CNS oxygen toxicity but it does not produce narcosis by itself, any more than CO2 produces acute CNS toxicity by itself.

I have no doubt whatsoever that mouthbreather had high CO2 levels. He also had high levels of anxiety, both of which are well known to predispose to narcosis and as I said, the symptoms appear to fit. Let us not argue the point for no good purpose, please?

As for relaxing and breathing deeply and normally at the same depth alleviating the symptoms of narcosis this is obviously because it does two things. Relaxation and anxiety are the opposite ends of the same spectrum and anxiety predisposes to narcosis, while efficient ventilation reduces the pp Co2 which also predisposes to narcosis.

Anxiety is a feature of nitrogen narcosis but is not recognised as a feature of CO2 retention. On the other hand anxiety may be characterised by HYPERVENTILATION which, in fact, is characterised by low CO2 levels!

I am not really sure that CO2 retention is such a major problem with modern scuba gear at normal recreational depths because modern regulators are now so efficient.
 
Doc,

Many times severe narcosis and CO2 buildup go hand in hand, one can cause the other. Everytime I have seen a CO2 problem, narcosis signs were present also, but I cant say the same the other way around narcos may bring on CO2 but its not a given. Its doesn't take much CO2 to confuse a person and the deeper you go the less thats needed.. 10% co2 at the surface can cause unconsciousness, to get that same PCO2 at depth requires much less.. With my CCR classes I do a CO2 excercise(its required), many people momentarily pass out, they all have this attitude they see it and think they can handle it.. next thing... lights out... and wonder what happened.. its something they don't easily forget..

The reason Why I suspect its a CO2 problem is because I had something similiar happen to me diving my rebreather a while back.. I was only at 170 or 180 on AIr in truk and all of a sudden I felt this impending doom, and all kinds of other worse possible outcomes.. I quickly ascended to a more reasonable depth and nothing changed... I did a full loop flush and within a few deep breaths all was gone.. I have been diving a long time and have never experienced the FEAR that was running through my mind for no real reason.. I have gotten into a few life threatening situations (for instance deep inside a wreck with total silt out (bubble percolating to ceiling created zero viz) and line broken - and I still maintained my calm) I then realized I had water in the loop so my scrubber was not working optimally and I was working bit.. I did a normal ascent and completed my deco flushing the loop every once in a while for good measure..
 
N-narcosis, CO2 buildup...those can be the primary causes or simply contributing factors to your anxiety.

I had been diving for over 20 years before I felt my first bit of "high anxiety" on a dive. Neither of those factors were contributary.

Oddly enough, I was in less than 5 feet of water, collecting stone crabs for data collection as part of a research project. For some reason, my mask kept flooding. No big deal, usually. The vis was zero, but there were no other contributing factors I can think of right now (well, lots of drunk powerboaters were around, as I was diving on the edge of a channel under a bridge over the Memorial Day holiday---but I dont' think they were worrying me that much....).

Anyway, I suddenly felt overwhelmingly anxious. I couldn't breathe, I couldn't figure out what I was doing and I didn't want to be there anymore. I forced myself to slowly surface (not much more than "standing up"). No one knew what happened but it made me angry as much as anything. "What the hell happened? " was all I could wonder. I had hundreds and hundreds of dives and considered myself "panic proof" (hey, TOO much confidence is a bad thing).

I tried to "explore the feeling", to see if I could figure out what set me off and what I could do if it happened again. I deliberately removed my mask and spent most of the rest of the day without it or with it mostly flooded (couldn't see anyway). I continued to collect the crabs by feel and with my eyes exposed to that nasty water, but I couldn't replicate what happened. The feeling didn't return and I simply ended the day irritated with myself.

Then, a year or two later, the feeling came back on a dive at Stetson Bank. I made a free ascent in a current and found myself exhausted and breathing hard near the bottom. There was nothing to "hang to", so I couldn't just stop and "take a rest". It was very uncomfortable--I couldn't "catch" my breath and I found my movements were suddenly jerky and ill coordinated. All I could feel was the need "not to be here, right now" and a sense of helplessness.

I even worked on breath control, trying to slow down and deepen my breathing, but it didn't help. My inhalations were very stop-start ( I had to "force" deep breaths, because I wanted only to breathe shallow,but my inhalations were sorta staccato). My attempts to exhale deeply seemed equally ineffective. Gradually, I calmed down and I finished the dive normally and without incident by closing my eyes and thinking "pleasant' thoughts.

From that moment on, for the next two or three years, I would hope to make a "whole trip" without having one of the those "this ain't fun, what am I doing here?" dives. I wasn't so lucky. On trip, after trip, I would have 5 good dives and then, bang, one bad one.

I might have one great "yeehaw" dive in rough conditions, but during the next dive, even in dead calm, clear water, I might feel that old "Lord, this isn't fun" feeling return. I could fight it off, somtimes by closing my eyes, or holding onto a line for a moment or two, or sometimes just by "drifting" a bit in the current. I never had a full blown panic attack, but it sure wasn't fun.

For a year or so, I even felt uncomfortable on free dives and sometimes, just while swimming at the beach.

Finally, the feelings went away and I was able to dive freely and comfortably again, no matter what the conditions.

What changed? Some of it was related to stresses in "my dirt life" (land) that I learned to deal with effectively (job, sick child, that kind of stuff), some from a loss of diving skills. There was no epiphany, no sudden cathartic moment when I was "okay" and a good diver again, I simply went at it the old fashioned way: through practice, practice, practice. Gradually, over a period of a year, I regained my diving "composure".

Two years ago, I began swimming every day, even in the winter, if I could. I got where I could swim "laps" back on forth on a single breathold (My pool is moderately big, a little more than 45' in length)....

I am now to the point I can swim 4 of these laps U/W without much ado. I then started "towing" my 8 yr. old on my back on these laps, sans fins or mask for me. He simply taps me twice on my shoulder and I bring him up shallow where he releases . I then finish my swim on the same breath.

Why? That built confidence in my ability to free ascend at depth. For reinforcement, I also took to making more free dives on my trips, to the point I could easily go down quite deep and return without anxiety. Free diving was a skill I had mastered many years ago, but had lost.

Slowly, I started ENJOYING the dives again, instead of just enduring them (BTW, why didn't I just quit diving? Because I REMEMBERED how fun diving was, and I wanted that feeling back...)

For added scuba practice, I took to tossing my tank into the deep end of the pool (10') with only the regulator attached. The rest of the gear, I would spread randomly around the pool. Then I jump in and gear up without surfacing, saving the mask for last.

On other pool sessions, I would impulsively flood my mask, or dismount and remount my gear without surfacing.

On dives, I took to "not worrying" about my SAC so much. I used to have the best SAC of any diver in any group I went on. But, after those few "anxiety" experiences my SAC went up, way up. That made it worse, because, like you, I worried about running low on air too soon and ruining things for my buddy or the group. The more I worried, the more friggin' air I breathed.

After I stopped worrying about SAC, darn if it didn't go up and up, nearly to where it was when I was 18.

I am working hard to get back in shape, after getting really fat (a big part of my problem). When my son first got sick, I gained 70lbs, mostly by eating "his" hospital food for most of the two years he was in treatment. I was a sedentary and bloated 270lb fat guy.

These days, I work out four of five times a week in the gym and I ride my bike on the weekends. I still weigh 240lbs, but I'm losing weight slowly and comfortably and I'm in very good shape.

On any given week, I ride my bike 20 miles three times , and take one 45 mile single ride on the weekends. All this, including some century rides, I do all this, btw, on a mountain bike with knobbies (Hey, still too fat for my Peugeot).

I lift weights and work cardio every day (rotating groups). I am as strong at 45 as I was when I played HS football and I feel as well as I did then, too.

Next month I riding in a 100K bike ride as part of my qualification for a 4400 mile ride next year. I still need to lose some serious weight, but I will get there, no problem.

As for diving? I still display caution and try not to ovedue it on dives. I use the granny line whenever possible and I try hard not to get winded--even a little bit. In a bad current, if at all possible, I go hand over hand.

If I have to free swim, and if I do get tired and find myself breathing heavily, I just "let go" and breathe as deeply and freely as I feel the need. I don't try to "hold back", because this can cause CO2 buildup, triggering panic as your cues for breathing are fooled into thinking you don't have enough air when you do.


Mostly though, through practice, I overcame a loss of skills and confidence that had accrued over many years of intermittent diving. Through excercise I gained the reserved I needed to handle tough conditions.

As for you? Assuming you are in good shape, then IMHO, your experience level was likely not where it should have been for the level of responsibility you were assigned. You might have been nearly there, but close isn't good enough. A few more deeper dives, in a current, even setting lines, but without students to worry about might have been all you needed to get you to where you could handle "one more task" without overloading. You were trying to do too much and "worrying" about too much.

Practice some more, particularly some more in dark, dirty water or in a currents, similar to the conditions where you felt uncomfortable the first times, and you might be surprised at how quickly you regain your confidence with a little "exposure".


Don't worry. Few admit it, but most divers have felt anxiety on a dive or dives (more than 50% according to DAN, report having suffered similar feelings on at least one dive in their experience).


Ricky...I ain't got no anxiety no mo'.......
 
Let's get off of narcosis and CO2 retention, and look at anxiety as an everyday psychological problem. If DAN says 50+% of divers suffer this, it's probably more like 70-80%. Even "nervousness" is a mild form of anxiety.

Like rockhound, I had an anxiety attack in 6' of water. I was working in a shallow exhibit at an aquarium, using a hookah rig, drysuit, and no bc. It was one of my first dives as a volunteer there. I was nervous to begin with, didn't want to look stupid, and dropped in, already breathing hard. 10-15 minutes into it, and I just couldn't shake off the "I don't like this" feeling. I stood up, spit out the reg, and clung to the top of the window, thinking, "What on earth is wrong with me?" One of the staff saw me, came over, and asked, "Are you OK?" I told her I just needed a moment. She waited with me, I said I was fine, and went back to work. No more problems, that day.

When a person gets stressed, multiple factors can stack up, deepening the level of anxiety until a "fight or flee" response kicks in. This is normal. We all deal with these situations in our own ways. I think that most of us try to talk ourselves down, calm ourselves. When this happens underwater, you are experiencing a *problem*. What are you supposed to do when a diving problem happens? Stop, breathe, try to solve it. Can't? Bail.

To me, my state of mind immediately before the dive sort of dictates how the dive is gonna go. This is not an exact thing, just an indicator of whether or not I need to "get my mind right" before I go in. If I need to, I deal with this before I gear up.

Any diver that tells me they never had some kind of anxious episode on a dive has also never peed in their wetsuit.

Joe
 
I had a bit of an episode on one dive. It was a dive that had been played up by others (even on scubaboard) as something more than it is. I remember feeling slightly nervous about it ahead of the dive thinking why have so many died on this wreck but there was no real reason for feeling nervous about it - i felt good that day, the weather was nice, calm seas and everything just seemed to be quite ok. I had done dives as deep or deeper, as cold or colder and as dark or darker before without incident. I was with my main buddy who i have absolute confidence in and no other factors seemed to be making this any different than any other dive i've done.

We got down the line and initially had a bit of a time finding the line from the block that actually led to the wreck but found it and then found the wreck. We did a circle of the wreck and even though it was around 110 ish ft to the bottom, we stayed well into the 80-90 foot zone as we could see things quite well. Every so often it would pop into my mind "why were people dying on this dive". About 20 feet or so from the line back to the mooring block and then back up the acsent line, I started breathing fairly heavily and found that I initially couldnt get it under control. There was absolutely no reason for this. It was a nice relaxing dive and we weren't working hard against a current or anything like that. There was plenty of air left and this wasnt a concern but my mind was racing and I felt for a bit that my regulator wasn't giving me enough air I was breathing so hard. Anyways, this went on for a maybe 30 seconds and i kept thinking to myself - i've done this before, i've been on more challenging dives and this ones almost over, try to slow down. I actually contemplated for an instant aborting and doing an accent right there but then my breathing started slowing down and things seemed to be getting back under control. The whole time we're continuing to the line and then did a nice slow accent and that was the whole show. We had lots of air left and did an extra long safety stop just to play around on the line. One thing i did do was close my eyes and this seemed to take me a bit out of the situation for a second and let me concentrate without thinking i was where i was. This seemed to help a bit.

Its funny how your mind can play tricks on you like that. I attribute that 100% to the anxiety i must have been feeling due to the things i've heard about that wreck. There was also a death on a wreck close by the weekend before and we were on the boat that that happened from which may have been subconsciously on my mind.

I hope it never comes back but I think having gone through it once may let me realize that I can get through it again.

steve
 
Uncle Pug once bubbled...
It is futile to argue with someone who is agreeing with you. :D

That common language getting in the way again!

:)
 

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