Interesting. First, tell your friend, if he's on ST, that he can feel free to PM me about this. I've written much about my personal issues with panic and have seen patients (professionally) with more serious issues like psvt/paf/SIPE. My own troubles have always started with being an AOS, of course, and simply always feeling constricted with what was recommended as a 'normal fitting' wetsuit. I bought a Helix full and Helix sleeveless in 2012, after teaching myself to swim in late 2011 and wanting to try triathlon. Got into a master's swim group and that and lots of video got me from a BOP (almost dead last in my first triathlon, a HIM) to front MOP in my first IM (my second triathlon, for the record). I had a panic attack/anxiety/constriction issue about every other race over the next several years. And for the record, I have no cardiac or significant pulmonary issues but I'd say that I have some form of 'water anxiety/panic disorder' for sure at this point. I did make many, many rookie mistakes along the way like: not practicing in open water, not putting on the wetsuit multiple times prior to races, not putting on the wetsuit correctly, not using bodyglide...etc...

Now, older athletes certainly need to worry about ischemic heart disease and arrhythmia (as do younger pts) as causing issues in the water, and shortness of breath is often an atypical warning symptom of heart disease, but RARELY does this occur in the water. It is usually something else-panic/anxiety, asthma, wetsuit too small or not put on correctly but occasionally is something bad like SIPE, paf, psvt or other serious cardiac issues. If it happens repeatedly, a proper evaluation with a cardiologist is certainly in order from a risk/reward standpoint, IMO. Swimming induced tachycardia is not uncommon. Monitors of various types for various times can help.

I've personally always had issues putting my face in the water and being comfortable with it. I have marginal swim technique, even after years of this, yet I've improved enough to place in my AG at some races. Even earned an 'elite' spot in our local sprint this year. When I went out with the faster swimmers in that group, I had my usual breakdown mentally after acquiring a few kicks to the chest and being swum over and gotten the wind knocked out of me. Yes, I was hanging on a kayak. A little panic and it's hard to catch your breath. I was on that kayak for what seemed like an eternity and that wrecked my race that day-almost DNF'd. I felt constricted after the kick, had started breathing too fast and was stacking my breaths not getting all of my air out and started to feel panicky. Not a great race and it sounds eerily similar to your friend's experience.

I'm not a bad swimmer at this point. I did casco bay swim/run last year and swam 5 miles in the ocean with a partner, including a mile stretch by ourselves, in 58 degree water. I can swim. But swimming around people and getting nudged messes with my mind. Having a wetsuit on makes it worse.

In my last sprint race, I had just lava shorts and my chest was free. The water was warm enough and I had NO problems. First in my AG. I've ordered an oversized ROKA wetsuit and just got it today, and swam without any constriction issues. Haven't yet tried it in a race, but for the record, I love the way the ROKA suit seems to not constrict as much. The neck seems lower than on my Helix too. I'm 5'8'' and 155 pounds and have a ML. (I almost bought a L)

sizing chart
https://www.roka.com/...372195137#size-chart

For me, it's always important to get a good swim warm up in. I now know that I need 10+ minutes before I start to feel more comfortable in the wetsuit. I also know that I must start slow and relaxed, preferably on the outer edge and get into a rhythm until I feel at ease enough to change my stroke rate and become a more aggressive swimmer. I usually do this by counting down from 100 or whatever the number of strokes needed to hit the first buoy, which I'll count in my warmup.


So, IMO, part of it is the mind and part of it is the feeling of being squished in the neoprene and being uncomfortable and needing to get 'warmed up' both physically and mentally. For others, there may be an underlying arrhythmia, heart disease, lung disease panic/anxiety or something else contributing.

A qualified professional can help. Tell your friend to consider it and wish him good luck from me.

Dale