Worried about 10 hour flight!

[oscar1]

Next week I'm going on holiday. Its the first time I will have flown since I first started to suffer with anxiety 7 years ago. I get travel anxiety but can usually distract myself with puzzle books, music or talking to friends. My problem is I'm going to Texas and the flight is 10 hours. Im worried I won't be able to distract myself for that long and eventually it will build up and ill have a panic attack. Ive been given some diazepam by my doctor but only want to take them if I actually really really need to, and obviously they will have films and shows to watch on the plane. But its such a long time to be in one place and not be able to get out. Does anyone have any tips? Or just general words of encouragement would be appreciated. Thanks.

[panic_down_under]

Firstly, try and get a seat as near to the front of the aircraft as your ticket class allows so you get the freshest available air. CO2 is a potent anxiety inducer. It is used by researchers to provoke panic attacks. It can trigger PAs even those without the disorder if the CO2 concentration is high enough. And keep your fluid levels up, but not with alcohol, as dehydration is another anxiety trigger. The air is very dry at 35,000 ft.

Some claim that centre seats are best for those with anxiety so they can't see how far you are from the ground, but I think those next to the window are preferable as the view provides another distraction. IME, few people are actually frightened by the height. It is mostly about being trapped.

If you haven't taken diazepam before I suggest you try a dose now to see how it affects you. Some become very sedated which is a risk in the event of an emergency. Depending on the airline you might even be denied boarding if you're judged to be too sedated. It takes about 1.5-2 hours for diazepam to reach peak plasma levels so if you decide to take it before takeoff then do so a couple of hours before. Don't drive yourself to the airport if you do. And do not drink alcohol for at least 24 hours after taking diazepam.

Finally, the most hazardous parts of the journey are the drives to and from the airports, not the flight between them. Statistically, sitting in an office chair is far riskier than in an airline seat.

[Citydeer]

Hey Oscar, I was so worried about this too in the past few months, having recently gone though a period of almost daily panic attacks leading up to 12 hour flight from Heathrow to Johannesburg. I was so sure I would get a panic attack on the flight. I didn't. My fear of the flight was far worse than the experience of the flight itself! (which i feel like is pretty common with most anxiety fears - the things we fear are never as bad as we imagine) really, even if a panic attack does occur, it will pass and you will realise you are still safe. I'm sure you'll be OK though!

I agree with Panic Down Under's comment about if you do decide to take the diazepam, do a trial before the flight so you get used to the sensation and know what to expect. I have found it helpful with flights in the past. And yes make sure to hydrate before the flight and during, and to avoid alcohol! I wouldn't personally worry about the CO2 levels, cabin altitude is pressurised to be kept around 1500m - there is still plenty of oxygen at this level! Effects of altitude don't normally start to be felt until around 2600m and even then they are only minor symptoms like headaches. I spent last month at a location of 3800m altitude and didn't noticed any change in my anxiety levels.

Good luck!

[panic_down_under]

I wouldn't personally worry about the CO2 levels, cabin altitude is pressurised to be kept around 1500m - there is still plenty of oxygen at this level!

The problem isn't how much oxygen there is, but how much CO2. It can trigger panic attacks even when introduced in oxygen enriched air. For example one study used 65% O2, albeit with a high CO2 ratio (see also Pena G, 1994). And it takes just a small increase in CO2 levels to trigger panic attacks in some. Most studies are conducted using only 5% CO2.

The sensitivity isn't to the CO2 itself, but to the slight increase in brain acidity it causes, particularly in the brainstem. Lactic acid infusions are used in panic challenge tests for the same reason.

The back of planes tend to have the highest CO2 levels. One study (PDF) recorded a maximum 4,902 ppm on a TWA flight, more than 12 times the average air content. I suspect they would have recorded even higher reading on planes run by some low cost airlines.

[Citydeer]

Oh I see. just seems like another thing to worry about for nervous flyers if they end up not being able to get a good seat :-/

[panic_down_under]

Oh I see. just seems like another thing to worry about for nervous flyers if they end up not being able to get a good seat :-/

I'm not suggesting CO2 levels in planes will trigger panic attacks for everyone with PD, but it is something to be aware of. Sitting as far forward as possible is a good idea, so is selecting bigger carriers and I understand in newer aircraft models ventilation has been taken out of airline control so they can't increase the percentage of recycled air to reduce fuel costs.

But keeping well hydrated is probably more important.

BTW-when I used to fly a lot I tended not to follow my own advice and usually asked for a seat right at the back on long haul flights as I often got the row to myself. Because of lung disease issues long flights are too much of a chore now.