I find it necessary to open this piece with the disclaimer that I am not a medical professional and none of the information to follow is meant to diagnose or treat any condition. Instead I write from the perspective of someone who, from time to time, has experienced the distinct sensation of choking to death and being unable to breathe. A couple of therapists of mine have called this experience a “panic attack,” though I’ve also read that the closure of the airway I’ve experienced can also be called a laryngospasm.
The first time I had a laryngospasm I thought I was dying. The simplest way I can think of to describe it is to imagine feeling like your throat is closing up. I compare it to being choked, but from within. Something inside my throat had tightened up and wouldn’t let go. I couldn’t breathe. I’m not talking about hyperventilation; I’m talking about not being able to bring air into my lungs because of a blockage in my throat not caused by food or a foreign object.
I later learned that this occurred because my vocal chords were spasming, making it possible for me to breathe out, but not possible for me to easily breathe in. It’s difficult to say whether the panic preceded the constriction of my throat, or whether the constriction caused me to panic, but I’m inclined to believe the latter. After all, the sudden onset of the inability to breathe is more likely than not to cause panic, whether or not one happens to experience anxiety.
I had my first laryngospasm in New York City, while surrounded by friends. We had been smoking marijuana. While inhaling the smoke deeply, my throat closed up. The episode frightened everyone in the room, me most of all. “You had a panic attack,” a friend said, casually explaining that I might want to go to a doctor for anti-anxiety medications. The evening continued as if nothing had happened.
Marijuana may have been the trigger of my first laryngospasm, but in the years since, long after I’ve largely sworn off smoking, I’ve had these spasms after drinking water too quickly, when experiencing post-nasal drip, in certain social situations, and most disturbingly of all, I have had these attacks occur while I was sound asleep, finding myself unable to breathe upon waking, the rudest of all rude awakenings.
These attacks last for less than a minute, though the feeling of imminent death, along with the inability to breathe is one of the most terrifying experiences I’ve ever had.
Friends and family have watched me have these episodes, and they have also been frightened. My father thought I might have been having an asthma attack. My boyfriend said he thought I was sleepwalking or at least in an altered state, and possibly about to pass out from my effort to breathe.
Over the years, I have found ways to handle the episodes, mostly by remaining calm, exhaling slowly, and reminding myself that I was having a panic attack and that I was not about to die. Trying to breathe only makes the spasm worse, and ironically, the solution to resolving the spasms is holding one’s breath or breathing out slowly, which is counterintuitive when you feel like you’re choking. In the midst of a laryngospasm, your panic will make you want to force air into your lungs.
I have spoken to my therapists about the episodes and they have said they were likely panic attacks, but I believe there isn’t much out there in the way of medical literature to help people who experience this frightening variety of asphyxiation.
Hyperventilation, which is typically associated with panic attacks, occurs when you breathe so rapidly that you over-oxygenate your body. Laryngospasms result in the literal closure of the throat and spasm of the vocal chords. Unlike hyperventilation, during a laryngospasm, the throat closes up almost entirely, leaving a person literally wheezing, unable to get air into their lungs no matter how hard they try.
Laryngospasms can indeed be caused by anxiety, but they can also be caused by acid reflux, postnasal drip, vocal cord dysfunction, and other medical conditions.
Causes of laryngospasms vary and the treatment is largely context-dependent. According to the book Complications in Head and Neck Surgery, laryngospasms can occur in children (and more rarely, adults) when they are administered anesthesia or when a ventilator is removed, and anesthesiologists must be trained to treat this “protective reflex, which may lead to either partial or complete airway obstruction.” Anesthesiologists are trained to listen for a high-pitched sound “produced upon inspiration.” If not treated immediately in this context, laryngospasm can lead to “cardiac collapse, and death.”
Dr. Phil Jones, a physician and associate professor at the University of Western Ontario notes in his blog that “post-extubation laryngospasm is a serious problem, because unless it is treated successfully, it is quickly followed by “bad things” including… negative pressure pulmonary edema.” All of this terrifies me. Especially given that Dr. Jones notes that “in a young healthy patient breathing actively against a closed glottis, it [being negative pressure pulmonary edema] can develop within a few breaths.”
As more people recover from serious COVID-19, I wonder whether reports of this condition will grow in number. An article published in the Orlando Sentinel notes that the condition can arise after a person experiences a severe cold.
I am not sure if laryngospasms outside of the anesthetic context can cause these serious complications (though my horrific experience with laryngospasms makes me fear the worst), but Dr. Jones explains that the laryngospasms can be stopped without medication by applying pressure to the “laryngospasm notch,” the soft tissue located somewhere below the ear, where the mandible bone gives way to soft tissue. A YouTube video demonstrates this as the “Larsen Maneuver.”
The fact that there seems to be a ready mechanical treatment for laryngospasms shocks me that this treatment isn’t more readily discussed.
Dr. Jones’s solution seems to agree with other anecdotal treatments for laryngospasms. The Seattle Times published a letter by a woman who experienced laryngospasms explaining that by rubbing soap on the base of her neck, she was able to stop the spasms. The woman explains that she now wears a chain around her neck on which she hangs a pouch containing the magical soap. I have my doubts about the soap, but wonder whether it’s the mechanical action of rubbing the area that results in the positive effect, something similar to the Larsen Maneuver video above.
I’m not a medical professional and my own solutions to my throat constriction has come from trial and error. My solutions include staying calm, reminding myself that the vocal cord spasms will pass, breathing out slowly (highly counterintuitive in the midst of an attack) and sometimes leaving the room where the spasm initially occurred. I don’t doubt that my particular laryngospasms are related to anxiety given my family history of mental illness and my own history of anxiety.
We often classify anxiety as a psychological phenomenon with psychological symptoms characterized by avoidance behaviors, social withdrawal, depression, trouble sleeping, panic attacks, and more. But anxiety also has a very real physical component. A person experiencing anxiety, a panic attack, or a laryngospasm triggered by anxiety or sleep is experiencing something physiological. This may manifest in increased heart rate, sweating, trembling, hyperventilation, or, in my case, the laryngospasm.
I had a laryngospasm a few days ago. I woke up unable to breathe. I ran out of the bedroom, unable to calm myself, unable to remember I needed to breathe out slowly. I struggled to draw in air through my constricted vocal chords. I eventually collapsed on the couch, still wheezing, my body covered in sweat, my muscles trembling from the strain. My boyfriend held me and somehow, the force of his arms wrapped around me was able draw me up from the panic of not being able to breathe, allowing me to calm down, and exhale.
But the effects of the attack still linger. My throat still hurts. My vocal chords are sore. I feel like I have strep throat, but know I’m injured. I’m exhausted. I feel like I’ve had a physically demanding day (which for me would either involve surfing or hiking all day), but I haven’t really moved from my bed in days. I know all this pain is the physical manifestation of my throat closing up on me. I’ve gone to doctors and they ask me if I want to get on antianxiety medications and refer me to therapy, but I know how to manage my anxiety, a condition I’ve been dealing with my whole life.
Anxiety is one thing, choking to death because your vocal chords are having a Charlie horse is another matter entirely. Anyone would panic.
I taught my boyfriend how to do the Larsen Maneuver. I now know where to touch my neck when the next laryngospasm happens. I’m deeply curious about whether it will work, and I’ll report back here after I try it.
I suspect that there are many others out there like me, who live in fear about when the next attack might occur and who worry if they’ll be able to breathe again.
What gives me comfort is that every time these attacks have happened, the spasms have stopped. Sometimes they last only for a few seconds, sometimes for longer, but eventually, my throat opens up and I can breathe again.
Anxiety disorders and mental illness remain a mystery even to the doctors who study these conditions. Medical treatments for anxiety work sporadically, or well for some and not at all for others. I have found that daily meditation, time in the ocean, avoidance of substances, time set aside for reading and writing, and social interaction helps me cope.
The laryngospasm reflex is a protective mechanism of the vagus nerve (the nerve responsible for various functions, including heart rate, mouth movement, the movement of the vocal chords, and the nervous system). The spasm’s function is to prevent a person from aspirating food or liquid. I suspect that marijuana use may be connected to laryngospasms, but I also suspect that, in my case, anxiety may also play a role.
As marijuana becomes legal across the country, I wonder whether this condition will occur more frequently. As more people recover from severe COVID-19, I wonder whether they too might experience this frightening condition. While sleep-related laryngospasm is identified as a sleep disorder, the European Respiratory Journal says there isn’t much in the way of peer reviewed literature about this condition.
Either way, I’m putting all this out there because I don’t think I’m the only one waking up unable to breathe, or who experiences this type of unique panic attack.
About the Writer
Janice Greenwood is a writer, surfer, and poet. She holds an M.F.A. in poetry and creative writing from Columbia University.