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Nocturnal Panic Attacks: When Night & Fear Combine

Panic attacks are already immensely stressful events. During a panic attack, you feel like everything is going wrong at once. You experience powerful physical sensations that often mimic heart attacks and more serious illnesses, and you find yourself left with considerable anxiety and fear that leaves you completely drained and fearing the next attack.

When you have panic attacks at night, also known as nocturnal panic attacks, you often wake up in the middle of the night in a deep sweat, barely comprehensible, believing something horrible is happening. It's a terrifying experience – arguably worse than a daytime panic attack – and unlike regular panic attacks, you can't even see it coming.

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An Uncontrollable Fear

Panic attacks are not the only way to qualify for panic disorder. It's also possible to simply fear panic attacks to such a degree that they control your life. Often that fear actually causes panic attacks, which leads to more fear, and a vicious cycle that is all controlling.

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Despite the stress of living with panic attacks, in many ways it can be worse to be suddenly awoken with a panic attack, because when that happens you may not even have seen it coming. It can become incredibly difficult to go back to sleep, and in some cases you may start to fear sleeping – worried that you'll get a panic attack again.

Causes of Nocturnal Anxiety Attacks

Because panic attacks can have many different types of triggers, nocturnal panic attacks may also have many different types of triggers. It may be possible to have a night panic attack with no cause at all.

But unlike daytime panic attacks, nighttime panic attacks do appear to have a range of possible causes. The most likely causes of nocturnal panic attacks include:

Obstructive Sleep Apnea

Obstructive sleep apnea appears to be one of the most likely culprits. It is a type of sleep apnea that occurs when the upper airway gets obstructed, usually with a person's fat and tissues as a result of relaxation in the muscles of the throat.

Obstructive sleep apnea blocks the airway to the point where your body actually stops breathing for as long as 30 seconds or more. This causes what's known as hypoventilation – the opposite of hyperventilation, which is a common cause of panic attacks – which leads to stress on the heart and many symptoms that mimic heart disease.

While most people with obstructive sleep apnea wake up and go back to sleep often without realizing it, some people become so attuned to their body that they notice each and every symptom and wake up in a complete panic. They start hyperventilating (because they are breathing in too quickly in order to regain their breath) and a panic attack occurs.

Obstructive sleep apnea may also be caused by obesity hypoventilation syndrome, and tends to occur more often in those with excess fat around the head and neck.

Gastroesophageal Reflux Disease (GERD)

GERD, also known as "acid reflux disease," may also be a cause of night attacks. Many people suffering from GERD experience symptoms that mimic more serious health issues, including chest pains and pressure, labored breathing, hyperventilation, and sometimes even headaches and night sweats. These can all cause you to wake up in a panic, and trigger a serious panic attack.

GERD doesn't always cause these symptoms at night, and often people can sleep through them, but severe GERD can still lead to very serious panic attacks, especially in the evening.

Hyperventilation Disorder

Hyperventilation disorder is a chronic problem that affects a large number of those with panic attacks. In many cases, the hyperventilation is inflicted by anxiety and stress, so when a person's sleeping they become less likely to hyperventilate. But some people simply have developed extremely poor breathing habits, leading to hyperventilation.

Hyperventilation is responsible for many of the symptoms of a panic attack, and often causes panic attacks as well. So it stands to reason that those that manage to hyperventilate in their sleep may be more prone to waking up with panic attacks.

Frequent Nightmares

Those that have frequent nightmares may also set themselves up for nighttime panic attacks. Most likely, the nightmare causes the individual to hyperventilate in their sleep, because their mind thinks they have severe anxiety. But in some cases the nightmare itself may be sufficiently frightening that when the person wakes up they're already in the process of a panic attack.

Combatting Night Fears

It can be very hard to deal with nocturnal panic attacks on your own, because the sheer shock of these attacks makes them much harder to control. Some people with daily panic attacks learn tricks to stop their panic attacks from becoming too severe, but when you're asleep, much of what you do is beyond your control.

But that's not to say there isn't hope. For example:

  • Exercise and Lose Weight – When your panic attacks are caused by something like obstructive sleep apnea, weight control is a very important. Losing weight doesn't always cause the sleep apnea problem, but it does for many, and can drastically cut down on your hypoventilation. Usually those with nighttime panic attacks still have daytime panic attacks, so a solution for both will still be required, but the ability to avoid the night attacks triggers will be a tremendous help.
  • Acid Tablets/GERD Treatments – Similarly, if your symptoms are likely caused by GERD, talking to your doctor about acid reflux treatments is important. There are some over the counter ones that can be used for a short time, but you'll still want to discuss it with your doctor because many over the counter acid reducers stop working if you use them for too long.
  • Other GERD/Apnea Treatments – For GERD and sleep apnea that is severe, there are countless treatment options available. None of these are designed for panic attacks, but if you relieve the trigger you'll become more likely to prevent the attacks in the future.
  • Panic Cheat Sheet – Near your bed, you should also have something that will help you regain control when you wake up in a panic – a panic cheat sheet, if you will. By grabbing this sheet every time you wake up in a panic, you can remind yourself what you're dealing with and how to make sure it doesn't get out of control. Create a list of reminders, such as "it's just the sleep apnea..." and "try taking slow, deliberate breaths" and "don't forget to go back to sleep." During panic attacks, it's easy to forget those things that are important for controlling the extent of the attack, so a sheet nearby your bed can be a big help.

These do nothing to affect your ability to stop your overall panic attacks (although exercise may be beneficial), but treating these issues can go a long way towards preventing night attacks, and are important for your overall quality of life as well.

Panic Attack Treatments

You will need to address your nighttime panic attack triggers first, especially if an underlying health problem – such as GERD – is causing them. Unfortunately, because you can't "talk yourself down" from having a panic attack if you wake up already having one, this is one of the few anxiety problems where treating a medical cause first is most important.

But once you've treated or ruled out any of those causes of night panic, you'll still need to address your anxiety. Learning better breathing habits and coping mechanisms is important, but the only true way to end anxiety altogether is to commit to a long term and effective treatment strategy.

I strongly recommend that you take my anxiety test now. I made it to catalog your symptoms and provide you with information about the disorder you likely struggle with and what you can do to treat it.

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References

Ley R. Panic attacks during sleep: a hyperventilation-probability model. J Behav Ther Exp Psychiatry. 1988 Sep;19(3):181-92.

Lopes, Fabiana L., et al. Nocturnal panic attacks. Arquivos de neuro-psiquiatria 60.3B (2002): 717-720.

Craske, Michelle G., and Jennie CI Tsao. Assessment and treatment of nocturnal panic attacks. Sleep Medicine Reviews 9.3 (2005): 173-184.

Sarísoy, Gökhan, et al. Panic disorder with nocturnal panic attacks: symptoms and comorbidities. European Psychiatry 23.3 (2008): 195.

 

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