panic attack after 300 dives

[DiverLaura]

I'm with Lynne here, it actually sounds pretty cut and dry like a CO2 retention event.

High CO2 will have a very vivid effect on the diver if left unchecked (AKA exertion continues) it can start with just a general sense of unease, to hearing your heart pounding, to feeling 'too warm', not being able to get control of your breathing, all the way to "get me the F*%$ out of here, i want to go home".

if you've experienced it, you can even logically _know_ whats going on, but all that does is give you something to hold on to that can prevent it from becoming a full blown oblivious to the world around you panic episode.

CO2 causes this much more often that divers realize or admit to.

My buddy Lamont and i are almost sure that its a High CO2 that contributes to what we refer to as a "Dark Narc" (that narcosis thats worse than plain narcosis and makes you wanna go home) most commonly caused by bombing your way down depth with effort (swimming, pulling arm and arm, fighting current on surface, etc...) or exertion once at the bottom.

The more aware you become of your "self" underwater, the more you will see/recognize the subtly different nuances of the physiology going on, on the inside. People can then recognize the tendrils of a CO2 loading issue coming on, wrapping its clammy fingers around your brain stem, and work on stopping the cycle (reduce effort, blow off some CO2, etc...)

here is an interesting non diving example that i relate in these discussions....

my real job is as a surgical tech, and one of the operations i've been a part of many many times is an awake carotid endarterectomy. To make sure the patient has adequate collateral flow from the other side, and isn't showering their brain with plaque or clots, some surgeons keep them awake and talk to them, and have them squeeze a rubber ducky during the critical part of the procedure. It sounds a bit barbaric, but the fancy gadgets designed to monitor this stuff have a delay, supposedly (as it was explained to me) if something is going bad, you can tell much faster when the squeaking stops or the patients starts slurring than waiting for it to show up on the monitor.

okay, so when we put a clamp on the carotid bulb to start the actual endarterectomy part, we actually put pressure on the carotid bodies, little chemo receptors near the bifurcation. When the clamp goes on, the patients will sometimes get super agitated and uneasy, "i can't breath" "the drapes are smothering me" "I don't feel right" "I'm dying". Nothing else has changed except for the stimulation of the receptors. If we release the clamp, or move it slightly, almost immediately the patient will settle down. (interestingly enough, one of my very first instructors referred to the carotid bodies and compression of them as to why some people just can't tolerate a snug drysuit neckseal)

The clamp is simulating a sudden increase in CO2 (the receptors don't know the difference). If someone can be perfectly fine with moderate sedation (as fine as you can be if you are on the OR table) one minute and whacked out the next, it seems to me quite logical that if we as divers drive up our retained CO2 rapidly (fighting current, gear, sucking through a straw or a ****ty reg) that we too will encounter some of those same feelings..

anyhow, sorry this was so long... and since i'm not a doctor and don't even play one on TV, its essentially worth what you paid for it... It is a theory based 20 years of diving/diving instruction, and 15 years in surgery watching the same things happen again and again and again....

 

[TSandM]

Very cool story, Laura! I think there is some good anecdotal evidence out of the rebreather community that CO2 toxicity can have almost a "threshold" effect, so that the diver thinks he's fine one moment and is incapacitated the next.

 

[drbill]

I've experienced panic attacks years ago and understand how debilitating they can be. I've never had a true panic attack while underwater though.

The closest I've come was after an OOA incident years back. My tank valve unexpectedly clogged at 80 ft and the CESA from that depth with "empty" lungs (I had just exhaled) was not the easiest thing I've ever done. For perhaps 50-75 dives after that, I always felt anxiety on descending, but was fine once at depth. It's been a few years so this is no longer a problem.

Hopefully your husband will not experienced such anxiety after the fact.

 

[lamont]

Yeah, once you start to struggle and build up CO2 underwater you need to stop and find a way to relax and get the CO2 out. If not, you'll start to circle the incident pit tighter and tighter, since the CO2 is going to lead to more anxiety, which will lead to more problems breathing which will lead to more CO2.

 

[lowviz]

Yeah, once you start to struggle and build up CO2 underwater you need to stop and find a way to relax and get the CO2 out. If not, you'll start to circle the incident pit tighter and tighter, since the CO2 is going to lead to more anxiety, which will lead to more problems breathing which will lead to more CO2.

What about starting a dive with an oxygen debt (lactic acid in the muscles)? Has anyone studied that? It appears to me that this could be directly related to the OP.

 

[formula1mb@aol.com]

Are there any recommendations for how long of a break to take to lower your CO2 levels after a long surface swim? Earlier this year, I went diving at deadman's reef in laguna, long 20 min surface swim and rough conditions and looking back now I think I may have had a mild panic attack due to CO2------after descending, I felt very uneasy and nervous and almost had the feeling like I wanted to bolt and get out of the water. Luckily after getting to the bottom though, I sat there for around a minute, relaxed and tried taking slow, deep breaths and felt much better.

Before descending, I did take a minute or two break before descending but might not have been enough. Is there a consensus on how long of a break you need to clear extra CO2 following a long swim or overexertion? 5 minutes? 10 minutes?

 

[ClarkKent]

Are there any recommendations for how long of a break to take to lower your CO2 levels after a long surface swim? Earlier this year, I went diving at deadman's reef in laguna, long 20 min surface swim and rough conditions and looking back now I think I may have had a mild panic attack due to CO2------after descending, I felt very uneasy and nervous and almost had the feeling like I wanted to bolt and get out of the water. Luckily after getting to the bottom though, I sat there for around a minute, relaxed and tried taking slow, deep breaths and felt much better.

Before descending, I did take a minute or two break before descending but might not have been enough. Is there a consensus on how long of a break you need to clear extra CO2 following a long swim or overexertion? 5 minutes? 10 minutes?

How long? When your breathing returns to normal, is easy and stays easy. Your drive to breathe is based on the levels of CO2 in your body and not the amount of O2 (At very low levels of O2 this changes)

A side note When we exercise the amount of O2 we take in is 21% (obviously not Nitrox) and we exhale approximately 16-17% O2 mean we only use 5-7% depending on what book you read, however the amount of exhaled CO2 dramatically increases on exertion. The lack of oxygen to the tissues is usually a result of a situation where the cardiovascular system cannot keep up with the demand of the body. This can lead to lactic acid build up which also results in higher CO2 levels (Bicarb buffer system).

Although this certainly sounds like an anxiety related issue from perhaps a combination of disorientation, exertion and the "Dark Narc" if your husband has never had an experience like this you MUST look outside the box.

Anxiety is a diagnosis of exclusion, meaning when everything else is ruled out then we consider anxiety.

Often people who suffer serious acute medical conditions present with symptoms of anxiety and nothing else, these symptoms are a result of something and not simply anxiety.

Not saying anything is wrong but anxiety is always the last place to look.

 

[rongoodman]

I remember a very similar event a couple of years back during a rescue course, trying to push a rather large instructor to shore while breathing on a snorkle. After I settled down I went back and completed the exercise without incident using my regulator.

 

[funrecdiver]

As someone mentioned earlier in an excellent post, the underlying issue is not (necessarily) CO2 retention from overwork as much as not having a dive plan where divers are not over exerting and wasting energy and air (air, nitrox, etc). For example, as mentioned in another post, it is not a good idea to have a recreational dive plan where you begin your dive swimming against strong current, especially when you are required to reach a relatively small point (a buoy attached to a descent line).

There is a shipwreck dive in our corner of the seas where strong currents are very likely on most days except slack days at neap tides/times. Spring tides can be ripping and very challenging, even to divers who dive nearly every day. To get to the descent line to the wreck on these ripping days, (only experienced) divers exit the boat up current and then drift/rip toward the buoy and then dump their air as they get closer to the buoy, grabbing the descent line as they rip through the water. They then hold in position (after descending a bit to make room for their buddy team if necessary) on the line, waiting for their team / buddy to get into position (on the line).

If any buddy or team member misses the line, the team surfaces and drifts with their buddy, as a team. The buddy team sticks together. If one person misses the line, the group/team drifts together and waits for the boat to come pick them up. They, they try it again, as a team.

Hence, the "art of diving" is often to minimize the use of energy and maximize the use of dive planning (techniques) to do our best to insure that divers are not fighting against current (just because the current is there). It is not easy to "stop and rest" when a diver is over-exerted from swimming up current to a dive position where their team is (like a descent line); because if they stop (with nothing to hold on to!), the strong current will move them further and further very rapidly away from the target. Hence, when a dive team starts a dive with a flawed plan that each diver must swim against strong current to a descent line (for example), perhaps as hard as they can, the underlying problem is the plan, not the divers. Of course, we "forum junkies" were not there on the boat, but it sounds like the DM was not experienced in planning how to exit a boat and get to a (descent) line in strong currents.

As others have said better than funrecdiver me, the diver of this thread did not necessarily panic, they simply were over exerted and out-of-breath swimming against strong current (with the added issue of breathing using SCUBA). We can get out-of-breath and tired jogging in the park, working in the yard, romping in the bedroom, or playing any sports. The difference in recreational diving is that we plan our dives to optimize our air consumption and minimize our expended energy in the framework of our dive objectives, or so I have been taught.

Someone with 5,000 ++ dives and in the best of physical health (not me!) can get in the same situation if they are over-exerting themselves. Age may , or may not, play a factor. People in their 50s can be fitter than people in their 20s (easily), based on lifestyle, overall health and other factors. Anyone who is swimming a long way against current that is pushing them away from a required position or target could get in a very challenging (and perhaps dangerous) situation.

Not to be repeating (sorry, I think I am!); divers must think and plan dives, including entry and exit, so they minimize physical exertion, optimize air consumption, and have a fun recreational dive within their dive fitness, skill and confidence level (of all team members, buddies).

Recently, four of us did a ripping rising 50cm drift dive where we were enjoying acrobatics in the current. Two of us got ahead of the other two, the visibility was only 2-4 meters, so we held onto a rock and waited for the other two divers to pass, where we then released from the rock and joined them (it was like skydiving underwater) as the two "dark objects" approached from the abyss. We then drifted as a team in ripping current to 23 meters deep, well past the reef and where our boat was anchored for us drift divers. Based on our air consumption, we turned up current, back to the bay where the boat was anchored, and we conserved energy by crawling on the sandy bottom against the ripping current, up to 6 meters from 23 meters, where the boat was anchored. None of us were low on air, and we were thrilled with such a dive. If we did not crawl on the sandy bottom against ripping current, slowly and breathing with ease, I am sure at least one of us (me!), would have not enjoyed the dive, as I don't like swimming against ripping current. However, with proper planning, air consumption management, and some techniques for swimming against strong currents (change from a fish to a crab on the bottom and pull along the bottom on rocks to assist), even dives in strong current can be fun and thrilling (and you don't need to spend a lot of time on treadmills either!)

In closing, I should thank the person who taught me how to morph into a crawling crab when being a swimming fish is not the best creature to be, when swimming against strong, ripping current! Thank you Travis!

 

[bowlofpetunias]

Great thread.. thanks for contributing to my education everyone!