Trouble breathing at OW swim start

I can't be the only person with this issue.  About 2 minutes into an open water start I experience extreme difficulty breathing.  I go into extreme anxiety/panic to the point that I have to stop and tread water to calm down.  This has been occurring more frequently in the pool as well even to a point where I have to get out for the day.  Most of the time it will go away after 10 minutes depending on how persistent I am but I feel there is a relative level of danger when this is occurring.   It doesn't matter what the water temp is, it will happen in a race even after I'm warmed up, pre-workout/caffeine made it worse (don't take it anymore), and I am almost guaranteed it will happen in an OW race.  I am an experienced swimmer of 40 years, competitive my entire life, and this just started in 2014.  I was out of the water from 2016- December 22.   

At this point I don't know what to do.  My primary care shrugs his shoulders like an idiot and says "well don't swim".   This can't be sipe because it goes away while I am still swimming and I definitely wouldn't be able to forge through this many occurrences.   It's beyond frustrating. I swam an OW race last weekend that lasted 1hr 40 min.  From 6 minutes to 16 minutes I fought this to a point that I was feeling on the edge of a medical emergency.  16 minutes!!  I completely removed myself from any chance of competing, I can't make that time up.  The anxiety surrounding it was so bad I even put my life in order and had everything set up for my family in case something happened.  

What are others experiencing with this?  How do we get over it? Swimming is my only outlet so I need to find a solution.  

  • I’m surprised your primary care doctor didn’t refer you to a psychiatrist/psychologist.


  • He prescribed me an SSRI and klonopin...  I won't take either.  He recommended I seek out cardio/pulmonary doc but that's it.  I can't get into one for that is actually taking new patients for 8-10 weeks.  

  • It just doesn’t seem like a medical issue…since you are breathing normally before…and then after the 10 minutes as you mentioned. Nevertheless, you should make an appointment with pulmonary and get on the standby waiting list. And again…I would ask about psych. 
  • Cmonster,

    Since this is somewhat similar to the issue you posted about a while back - "stagnant in the water" - the first thing that occurred to me is exercise induced-asthma or a variant on that theme in which your airways constrict.  Since it dissipates after 15-20 minutes, lower exertion during the first 15-20 minutes may be necessary until your body reaches "stasis."  I know this will take you "out of competing" and that will be frustrating.

    I have had to reduce my warm-up intensity for the first 20 minutes.  Feel like I am floating and I hate it, but the alternative feeling was worse.  After that, my breathing is better.  Easily something you can experiment with.

    I would ask your PCP for a referral a pulmonologist .

    Good luck

  • As a psychiatrist I see many people referred to me for panic disorder. It could be that, that's a very common problem. The fact however that it occurs after you've already started exercising and have gotten your heart rate up is not consistent with typical panic disorder. Exercise induced asthma is certainly a possibility, I also wonder if it's not related to the other problems  you are having with your exercise ability. I think seeing a cardiologist is probably is a good idea. It could be some sort of arrhythmia or something. Having an irregular heartbeat certainly can seem very much like a panic attack. There are several other possible physiological causes for your symptoms. I assume your primary care doctor got a complete lab workup. Did you get an EKG? An EKG is a snapshot and if it doesn't show anything a stress test may be more useful. I shouldn't speculate more without seeing you. I will endorse your not taking Klonopin as it is not really recommended for panic (which again, I am not convinced is the problem.) 

  • Thanks, Ive dealt with non-sports related panic and depression and it was ALL caused by alcohol.  I don't drink at all anymore but I a very familiar with the level of anxiety that I would experience with an "episode".  Klonopin would actually stop it but who the F wants any of that right?  This anxiety has been going on before that was ever an issue.  I am calling it anxiety because I have no other explanation.   EKG and nuclear stress test did not show anything abnormal but it may be time to repeat the tests.  It always comes on at the same time and the fact that I can eventually come back from it is what's confusing.  It only happens in the water and not while biking or running.  I haven't swam since Saturday but I am curious if I will experience it tonight in the pool.  Side note- Albuterol does not seem to lessen the onset.