# Full of questions today...anyone have a panic attack on the bike?



## namaSSte (Jul 28, 2004)

Okay, I don't even know if its really a panic attack but its screwing me all up. For the last two years, I have really struggled with this issue while climbing but thus far, have had no medical opinion or treatment as its my last line of defense if all else fails (stupid logic, I'm just not a go to the doc kinda guy). In any case, a couple years ago (while mountain biking, I was on a difficult climb and pushing max HR when suddenly, I was sure I was a goner. Seriously did not think I'd get another breath in and I couldn't calm down. Fortunately my buddy was with me and really helped get me head right and I seemed to get things under control almost as fast as it came on. The problem is that its happened dozens of times since and always during huge exertions and typically climbing. I feel like I have plenty left in the tank but then I start to panic and its a struggle and unbelievably frustrating.

One thing I have started doing is backing off when I feel it coming on but that doesn't work terribly well when racing and makes me nuts since I know that physically, I can go with the guys who I am letting pass. Don't get me wrong, I still finish the climbs in the top 10 riders or so but its not without the price I know Ill pay to that demon that keeps trying to convince me I'm going to die (literally, that's how it feels and its scares the crap outta me).

Does this sound like panic, asthma, or maybe something else? I don't usually get this way, even in fast crits when at the front or sprinting (well, a little sometimes in a sprint but nothing like on a climb). 

Can anyone offer some constructive advice on this or do I need to get in and get checked out? FYI, I have never had a panic attack other than in this situation (exertion) and, to the best of my knowledge, I'm not asthmatic.

Someone, please help!


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## pretender (Sep 18, 2007)

Lots of things can trigger panic attacks, so it wouldn't surprise me if this was happening. It's like a big feedback loop: the climbing makes your heart race, which in turn makes you feel like you're dying, which in turn increases your heart rate and pulls blood from your extremities, etc etc etc.

Go to an MD to rule out a physiological cause. (Perhaps the MD would refer you to get an EKG, etc.)

I would also look for a psychologist with a background in mindfulness-based stress reduction (MBSR) and treating anxiety/panic.

Keep riding and racing, but pull back before you hit that red zone. Yes, you give up places, but it doesn't do you any good to flip out in the middle of a race.

You might find that MBSR has many benefits beyond helping this one specific issue.


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## namaSSte (Jul 28, 2004)

pretender said:


> Lots of things can trigger panic attacks, so it wouldn't surprise me if this was happening. It's like a big feedback loop: the climbing makes your heart race, which in turn makes you feel like you're dying, which in turn increases your heart rate and pulls blood from your extremities, etc etc etc.
> 
> Go to an MD to rule out a physiological cause. (Perhaps the MD would refer you to get an EKG, etc.)
> 
> ...


thanks much, I will definitely look into those suggestions, especially, the MBSR.


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## 4Crawler (Jul 13, 2011)

What are the symptoms, hard to breathe or a very rapid pulse? 

If rapid pulse, it might be something like lone atrial fibrilation. I've had that as a side effect of mitral valve prolapse all my life. Sometimes hits me while riding and I find with a HRM, I can sometimes find a certain heart rate that is a trigger point. I find that if stay above or below that rate, I am usually OK, but passing though that few BPM range I can sometimes feel the fluttering. 

I've been worked up at the doctor and as they put it, this is a condition you die with and not from (i.e. not life threatening). I did get some beta blockers to take a while back and I find those work well as a "pill in the pocket", take a pill when it hits and it'll restore normal operation in 15-30 minutes as you ride on slowly. I don't take the meds all the time as I find they lose their effectiveness after some weeks and also they really mess up your riding, your heart rate stays so low that your legs are on fire at any exertion level. Usually though it just takes a few minutes of sitting or lying down to cool off and relax a little and it'll pop back into normal rhythm.

But to diagnose this, they do need to have you on an EKG when it is happening and then they have various medications that are tried to rule out one or another cause and zero in on exactly what you have. None of the tests are painful or anything, but a couple of the meds give you a really strange feeling for a short time.


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## MR_GRUMPY (Aug 21, 2002)

I had one, last Saturday...............when I saw the start list of a Crit I was doing.

Holy F., This guy never does Master's races in my Catagory. He often does 1-2 races, and finishes well. 

My fears were well founded. After four laps, he jumped away, and rode the field off his wheel. I cracked like cheap glass.
I finished the race, got my wheels, did not pass go, or collect $200, but just went home with my tail between my legs.


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## Creakyknees (Sep 21, 2003)

MR_GRUMPY said:


> I had one, last Saturday...............when I saw the start list of a Crit I was doing.
> 
> Holy F., This guy never does Master's races in my Catagory. He often does 1-2 races, and finishes well.
> 
> ...


yeah, welcome to every friggin weekend down here.


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## WeakSister (Oct 30, 2009)

You are definitley having a panic attack. I can think of two triggers that may or may not be relevant to your situation. 1) Caffeine -- some racers double-down on caffeine before races, which combined with the adrenaline and anxiety of racing, can cause negative reactions. 2) Breathing plays a huge part in your mental/emotional state, particularly in stressful situations. Controlled deep-breathing is good --- rapid, shallow breathing is bad. It's a given that you are breathing very heavily during a hard climb, but next time really try concentrating on good, deep, controlled breathes.


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## namaSSte (Jul 28, 2004)

WeakSister said:


> You are definitley having a panic attack. I can think of two triggers that may or may not be relevant to your situation. 1) Caffeine -- some racers double-down on caffeine before races, which combined with the adrenaline and anxiety of racing, can cause negative reactions. 2) Breathing plays a huge part in your mental/emotional state, particularly in stressful situations. Controlled deep-breathing is good --- rapid, shallow breathing is bad. It's a given that you are breathing very heavily during a hard climb, but next time really try concentrating on good, deep, controlled breathes.


Thanks for that. I've tried recently to belly breathe on climbs and it does help. I tend to think you're assessment is correct since I really don't think there's a physiological problem and the only time this ever happens is when on the bike and when climbing really hard. Truth be told, I start ruminating on it before the climb even starts and its almost like a self fulfilling prophecy or something.


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## namaSSte (Jul 28, 2004)

4Crawler said:


> What are the symptoms, hard to breathe or a very rapid pulse?


seems that its exclusively a breathing issue in my case. I feel like lung capacity is there as I can hold my breathe underwater for well over a minute and never feel in distress at other times on the bike (even under hard efforts).


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## 4Crawler (Jul 13, 2011)

namaSSte said:


> seems that its exclusively a breathing issue in my case. I feel like lung capacity is there as I can hold my breathe underwater for well over a minute and never feel in distress at other times on the bike (even under hard efforts).


One thing I find that helps is to synchronize my breathing with my pedal strokes (or when hiking with my foot steps). Depending on the cadence and level of effort, I may end up breathing in on each left stroke and out on each right stroke, for example. And also add a bit of pressure breathing, by restricting your lips and then increase the pressure as you exhale. I use this all the time at higher elevations, like above 10,000' while hiking. And while biking, it helps be from getting into oxygen debt, by only pedaling as fast as I can breathe. And it also gives you something to focus on (breathing) that is easier to do (than pedaling). And if you are breathing in sync with one leg down stroke all the time, switch that up from time to time to the other leg to even things out a bit.


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## namaSSte (Jul 28, 2004)

4Crawler said:


> One thing I find that helps is to synchronize my breathing with my pedal strokes (or when hiking with my foot steps). Depending on the cadence and level of effort, I may end up breathing in on each left stroke and out on each right stroke, for example. And also add a bit of pressure breathing, by restricting your lips and then increase the pressure as you exhale. I use this all the time at higher elevations, like above 10,000' while hiking. And while biking, it helps be from getting into oxygen debt, by only pedaling as fast as I can breathe. And it also gives you something to focus on (breathing) that is easier to do (than pedaling). And if you are breathing in sync with one leg down stroke all the time, switch that up from time to time to the other leg to even things out a bit.


that's really practical advice and some I can try out as early as tonight. thanks. I'll let you know how it works by taking on a few climbs nearby and being mindful.


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## 4Crawler (Jul 13, 2011)

If you are doing it right, you'll almost sound like an old steam engine chugging up the hill. But you can tone it down a bit if riding in a group if you get too many strange looks


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## WeakSister (Oct 30, 2009)

Mentally focusing on breathing will have a calming effect, so you can get physical & psycho benefits. Try to do positive visualization in your mind, like imagine youself strongly topping the hill, instead of ruminating.


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## namaSSte (Jul 28, 2004)

Damn, did two days of hill workouts over the weekend and while I fought off a full panic attack, I was right at that edge on almost every climb. Granted, I intentionally pushed it to try some of the breathing techniques discussed but it still felt like hell to fight off the impending doom that was lurking in my head. In the end, I found that simply using deep, controlled breathes with smaller intake and more forceful output was the best approach. I also noticed that backing off, even .5mph sometimes allowed me to keep from going over that edge. I couldn't time my breathing with pedal strokes as I tend to spin up climbs rather than push big gears ala Uhlrich. 

I may ask the wife and kids for a HRM for father's day and start using that to manage my heart rate (and hopefully breathing) in addition to the above. I don't know, right now I'm just really frustrated that I know I can go faster up climbs but this issue is holding me back. Even worse, I can't stand the feeling I have when I do pierce that envelope and hit panic mode.


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## tazunemono (Jun 5, 2013)

Found this old thread, thought I'd reply since I had what I would describe as a "panic attack" on the bike yesterday. I had a stressful day, and I was going to blow off some steam by attempting KOM on a Strava segment (1/2 mile 7% avg. grade hill climb, with sections of 20%) and before heading out, I downed a double macchiato. I warmed up like normal, then proceeded to crush the climb. I was doing great, but near the top the world started to close in on me. It was a bright, sunny day but I felt like I was in a tunnel, drowning in the air. I was in control of the bike, but I felt like I was dying. It's hard to describe the feeling. I felt like I was dying, and couldn't get any oxygen (hence the drowning feeling) ... I felt like it was the end and this made it so much worse and triggered a massive wave of anxiety. I just kept the bike upright and softly pedaling until the feeling passed (a really long minute or so). I checked my heart rate monitor and I ramped up to 168bpm (max is 182) so I wasn't spiked. I used to get panic attacks really bad and was prescribed Xanax and Klonopin, but I thought I had made it past them (haven't had to take any for a long time). Anyways, just thought I'd share. I did get KOM by 3 seconds.


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## woodys737 (Dec 31, 2005)

Those that report having them on his thread are climbing and at or near their maximum. Not trying to be snarky, but it reads more like good ol' over exertion. Funny things happen when you push it way too hard and can't get enough oxygen. It's "painful" and if you really go deep you can get a bit of tunnel vision and/or seeing stars, and generally feeling pretty spent (aka dying).

I'd expect a panic attack, if it were to occur, at the start line, off the bike, sitting quietly etc...jmo and have not experienced one.


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## tazunemono (Jun 5, 2013)

This was different from overexertion. I'm used to doing above-threshold work, and as I said, my HR really didn't get that high. I've had my heart rate up way higher (crit sprint finish, crit crashes both hit 180 bpm) I think the combination of caffeine and overexertion triggered the panic attack (a sudden, intense rush of anxiety, like you're trapped in a tiny box, no hope, no way out, can't breathe, a sense of un-reality and dread like you're going to die, etc.). Panic attacks are not the same as feeling exhausted from overexertion, but some symptoms overlap. Luckily, I know what my panic attacks are like and I know I just have to maintain calm and ride 'em out.


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## AdamM (Jul 9, 2008)

It does appear to be a panic attack. The good news is that they are fairly easily treated with meds and/or cognitive behavioral therapy these days, so there's no reason at all to let it effect your life negatively. Think about seeing your gp and letting him/her know what's going on - I'm sure they deal with similar situations quite often.


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## Creakyknees (Sep 21, 2003)

Joking aside, it is possible to exceed the boundaries of your body's performance ability... you may call it a panic attack but in any case, at the extremes of efforts, any underlying problems that would be dormant in a less... active... person, can come to the surface and cause real damage, yes even death. 

If you're having nearly pass-out level problems... pulse / breathing not responding to intense efforts the way your buddies do... go see a doc and get a real stress test. 

One of my best buds, former cat 1, been cycling all his life, discovered he'd developed a heart arrythmia problem. It can happen to anyone.


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## looigi (Nov 24, 2010)

Creakyknees, I agree that's is possible for physiological effects to mimic a panic attack, but from the descriptions of the posters, it certainly sounds like panic attacks to me, even though they're brought on or triggered by high levels of exertion. Panic attacks can be triggered by many things: claustrophobia, agoraphobia, acrophobia, arachnophobia, etc... It's not exhaustion or physical discomfort of running out of breath, but an inappropriate and excessive fear response that is beyond direct control of the person experiencing it.


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