A few months ago, I had my first full-blown panic attack in almost two decades. The pattern was the same: I fall into a black, dreamless sleep and wake up less than an hour later. There are reasonable explanations for the return of my panic—the isolation of the pandemic, the accumulation of life’s stressors, or my favorite: the attack was a one-off. These facile reasons vie to pass for comfort. But for the most part, my panic disorder has been successfully treated with medication all these years.

Maybe what I’m experiencing is breath gone awry. The rise and fall of my chest from short, shallow intakes of oxygen. I swear my chest will pry open at any moment. I wake up and my nerves are so taut that I think this state of hyper-vigilance will last forever. My jagged breathing will kick off more panic and confusion. And then this departure: Did I have a heart attack? Did I die?

More than one therapist has told me that deeply inhaling is calming, steadying. I don’t discount that it can work for others. I wish it worked for me. I take that drag of air—refresh, refresh, refresh. I’m desperately seeking transformation. I want to breathe deeply enough to swipe right, then left, and clear away the anxiety. I envision a blind, whiting erasure. Clarity. A catch and release of breath.

Breathe in, breathe out—it’s constant. A person draws breath more than 25,000 times a day. So much breath—it’s dizzying. Breathing is an involuntary bodily function. You barely notice that you’re doing something so vital. The few times I tried yoga, the instructor said to breathe in through my nose and out through my mouth. I jumbled her instructions until I was panting.

Here is my downfall: I am a mouth breather. Heavy, loud, sometimes labored. When my husband points this out, I know he’s worried. But I hardly know I’m breathing this way; it’s simply how I exist. I do some reading on breathing and learn that when air enters the lungs, it is called “inspirational.” I love the double entendre. Breath stirs as it oxygenates the body. When air is released from the lungs, it is called “expiration.” I don’t like that double entendre. I feel as if I’ve died a little bit between breaths.

When I was 6 years old, my mother had a bout of pleurisy that inflamed the two thick layers of tissue separating her lungs from her chest wall. It hurt her to breathe. It scared me to see how thin her breathing had become. Her illness stole some of her 25,000 breaths. “I’m suffocating,” my mother croaked. At the same time, I had penicillin-resistant strep throat, and we shared a sick bed. I asked my mother if we were going to die. It was the first time I felt dread and panic. It was the first time I understood death as something that could happen to my mother and me.

I do more research on breathing as if this will rope me back from panic’s stratosphere. The diaphragm contracts during inspiration. The external muscles elevate the ribs and the sternum. A therapist once made a recording for me in which he instructed to regulate my breathing. He called it a relaxation tape. “Fill your diaphragm with breath,” he said in an even and soothing voice. I make a mental note that what goes in must come out. I don’t parse the logic of that observation; I don’t acknowledge that it’s not necessarily true.

Expiration is less voluntary. The diaphragm returns to its resting position, and the external muscles relax enough to depress the ribs and sternum. If all goes right, I know that I will live through the panic attack. I will live to see daybreak even though my mind is hopped up on adrenalin. The lungs inflate, then the lungs deflate. And yet, my breath sabotages me.

“Think of it as a balloon,” the same therapist tells me. “You breathe, so oxygen enters your bloodstream to circulate to the brain and vital organs.” I doubt myself. I’m too jumpy to engage in such a smooth, physiological operation. He goes on to tell me that I expel carbon dioxide when I exhale. It’s a waste product the body produces. But here’s the rub: If I don’t exhale completely, some carbon dioxide remains in the body, and I may yawn or become fatigued.

Here’s what I learn from my insomniac research: If carbon dioxide remains in the body, it affects the nervous system and cardiac functioning. This is the kind of information that trips my body into high alert. My heart is beating so loudly that my vision blurs. Bam, bam, bam—I can’t hear, so I can’t see. A panic-inducing episode, if ever there was one.

Anxiety is attributable to an inciting incident. Panic is the hunter that attacks out of nowhere during the blue-black night. Here is my own cobbled physiology lesson: A river of adrenaline pollutes my oxygen intake. My breath, uneven as Morse code, terrorizes me. The clonazepam brings my heart rate down. I roll into the mantra that “I will live, I will live.” The medicine will work. I will work. Panic is the aggressor, but I will win back my life with that medicine.

I go back to sleep. I am well until the next time.

Find resources for Mental Health Awareness Month at The Blue Dove Foundation.

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