Panic Attack or something else

travismcgee · Post by **travismcgee** » Mon Mar 16, 2009 11:06 am

Sorry forgot to log in.

Uncle_Bob · Post by **Uncle_Bob** » Mon Mar 16, 2009 11:54 am

I too have had panic attacks and general anxiety. I hated the fear of impending doom and very dark dark thoughts about what i could do to myself and my family. But that is in the past now.
I didn't do well on talk type therapy. The shrinks wanted to pin it on something bad that happened in my childhood, but nothing bad did happen.

I notice a reduction in anxiety with the CPAP treatment so i highly recommend keeping it up. Its OK to go 2-3 hours some nights. The aim would be to build up the hours over time, just try to relax and go with the flow regarding the CPAP.

As a side note i am almost anxiety free after a year and 100 sessions of neurofeedback training with QEEQ brain mapping.

Good luck.

MrSandman · Post by **MrSandman** » Mon Mar 16, 2009 5:41 pm

DreamStalker wrote:Maybe you really didn't have a panic attack ...

Just kidding.

Have you ever had your heart thoroughly checked out by a cardiologist?

You may be experiencing arrythmias of some sort. Long periods of undiagnosed OSA can lead to long periods of undiagosed severe nocturnal hypertension which can lead to an enlarged heart (left ventricular hypertrophy) or a cardiomyopothy and leaky arterial valves, which can cause various arrythmias and symptoms such as you described. I would get a referral to a cardiologist if you have never visited with one.

I had a couple of similar "panic attacks" though not as severe as blacking out or falling on my ass ... but a bit scary nonetheless. My PCP referred me to a cardio and I got checked out with a bunch of specialized tests ("nukeyuler" stress, calcium scoring, and sonar). Turns out I have the cardiomyopathy thingy that caused my arrythmias and I was put on a beta blocker which seems to have worked. The cardio doc told me that it may take a long while for my heart to get back to a normal size and beat even though I have my OSA and hypertension well treated ... or "faked out" as it were.

- touche ... No I have never been to a Cardio doc. I just got back from my doc and he says he thinks it was a panic attack and maybe hyperventilation caused me to pass out for a second. He says to see the shrink and get on a medicine and stay on it and if things are going good not to mess with the dose. He says this is my cross to bear as far as genetics and a genetic predisposition to how I handle stress and anxiety. It does seem to run in the males on my fathers side although I have had little contact with them since I was 5 I have heard about their nervous breakdowns and stuff. I wish I had their insite but I tried to contact my Dad and his twin brother and discuss this issue and they will not discuss it or are in de-nile.

I like my Dr. but I distrust doctors in general. But I did have a physical and ekg last year and things were fine except borderline cholesterol and triglycerides and high BP.

I did cut my dose of Lexapro in half to 10mg a month or so ago when I started to feel better on cpap.

I had just about convinced myself that all my problems were untreated sleep apnea. I don't like to think that I am "weak minded" . My Dr. aslo has a degree in psychology and he told me to get that Sh_T out of my mind. He said it is a chemical issue in the brain just like a diabetic has or any number of other disease people take pills for. Of course I have heard all of this before. He said I may need this medicine the rest of my life just like some people need BP meds or other.

MrSandman · Post by **MrSandman** » Mon Mar 16, 2009 5:45 pm

Uncle_Bob wrote:I too have had panic attacks and general anxiety. I hated the fear of impending doom and very dark dark thoughts about what i could do to myself and my family. But that is in the past now.
I didn't do well on talk type therapy. The shrinks wanted to pin it on something bad that happened in my childhood, but nothing bad did happen.

I notice a reduction in anxiety with the CPAP treatment so i highly recommend keeping it up. Its OK to go 2-3 hours some nights. The aim would be to build up the hours over time, just try to relax and go with the flow regarding the CPAP.

As a side note i am almost anxiety free after a year and 100 sessions of neurofeedback training with QEEQ brain mapping.

Good luck.

I hear you Bob. Intrusive unwanted thoughts aka OCD . I don't know what neurofeedback training is but I am seeing my shrink in the morning and I am going to get serious about getting some therapy to learn how to deal with some things better. I have always been an "overthinker" and negative thinker and worry wart. It sucks.

EDIT: I do not usually have a problem with the use of CPAP and it isn't the cause of the panic attack. I don't know what is. But since it happened while I was using cpap it made me kinda scared to hook up again. I did hook up again and sleep for about 5 hours this morning.

Mike

tattooyu · Post by **tattooyu** » Mon Mar 16, 2009 5:46 pm

Your anxiety may not be a permanent condition. Sure you may be predisposed to anxiety, like me, but the brain has a wonderful ability to remap/rewire itself when certain pathways are emphasized, i.e., the way you think about and perceive things. You should ask your shrink if he/she knows about or can use CBT (Cognitive Behavioral Therapy) for you. That, combined with meds--at least in the meantime to get by--should improve things greatly.

A lot of shrinks just want to stick you on a pill and forget the real underlying issues.

MrSandman · Post by **MrSandman** » Mon Mar 16, 2009 5:59 pm

LoQ wrote:Well, it could be a lot of things, I don't think we are going to be able to tell you what it is. You might be able to figure it out better than we can. For example, people go through alcohol withdrawal without telling anyone, and it can be very hard for a doctor to figure that out if he doesn't know that one piece of information.

Also, whatever you have, I would suggest that anxiety is just making it worse. You seem to have some emotions that are not helping you. Why the guilt/shame ("I hate to admit I have this panic issue")? If you were going through alcohol withdrawal, guilt might be understandable, but otherwise, it seems out of place.

I have a heart condition that sets off attacks similar to what you describe. My heart begins to race, and I feel like something very bad is about to happen, but I don't know exactly what. There is a feeling of absolute panic. And irrational thought. Lots of emotion, and it's hard to control my panic feeling, which makes me think I'm losing my mind.

But the truth is, this is 100% physiological. The panic response in the mind is the result of a chemical change in my brain generated by the mis-behaving heart.

In my case, the condition is harmless itself, though if I faint or fall or something, I could have an injury from that. But it sure seems at the time that I'm gonna die.

What I have learned to do is to tell myself during these attacks that it is not going to kill me, that I've lived through it before, and that I'll make it through this one. I try to slow my breathing down by taking deep breaths, which will slow my heart down. Take a deep breath, hold it for 4 seconds, and exhale slowly.

By allowing myself to hyperventilate and increasing the anxiety, all that does is increase adrenaline, which isn't going to help. Indeed, that will make it worse.

My advice to you is to find out what it really is. This is going to be hard, because often attacks like this are over by the time you get to the doctor. The doctor is going to need to see it in person.

You've had 2 in twenty years. Your anxiety over having another one is inappropriate, and it may be making it more likely that it's going to happen, not less. You are living with a false belief, that somehow by being vigilant you will be able to prevent another attack. Unless you are drinking, I don't think you can prevent it by vigilance.

In my case, I can lessen the likelihood of a panic attack by avoiding stimulants like caffeine. But at the end of the day, my heart has a defect. If it goes nuts, there isn't a whole lot I could have done to prevent it, assuming I have avoided caffeine and other stimulants. You can try that. You can also educate yourself. For example, perhaps you have a heart condition like mine. If you knew that for a fact, a lot of your unhelpful emotions should disappear based on believing fact. Heck, you could just tell yourself that it might be that (it might), and if so, there's not a whole lot you can do about it, other than avoiding alcohol/caffeine/pseudoephedrine/stimulants, and learning how to cope during the attack.

But I would suggest to you that your runaway thoughts about it are borne of ignorance and are not helpful to you. You are irrationally associating "going out of town" and "using CPAP" with the cause of these attacks, and I think those are both highly unlikely to be related. You don't really know what the cause is, you are just assuming it is whatever you were involved in at the time of the attack. If I were to use the same logic, I might think that using a computer causes my panic attacks. See how irrational that is? The truth is my heart was going to flip out while I was doing something....I can't just associate whatever I was doing with the cause.

Next time you have an attack, try reminding yourself that you lived through this before and it's not going to kill you. Also try taking a very deep breath, holding it, then exhaling very slowly. This WILL slow your heart down if you do it enough times. Get a pulse-meter of some sort and try it right now. You'll see that you can slow your heartrate down with slow breathing. Practice now so you'll be skilled at it when you need it. The great thing about this technique is that you can do this anywhere, anytime, and no tools needed.

Thanks for the reply. I have had several ekg or is it ecg and tests for chemicals that would say I had a heart attack and everything comes back fine. I meant that I feel "weak or inadequate or a failure" for not being able to control this myself. I have had many incidents of social type phobia where I had to escape crowds or situations and had a similar feeling of panic although mild.

Mike

MrSandman · Post by **MrSandman** » Mon Mar 16, 2009 6:11 pm

tattooyu wrote:Your anxiety may not be a permanent condition. Sure you may be predisposed to anxiety, like me, but the brain has a wonderful ability to remap/rewire itself when certain pathways are emphasized, i.e., the way you think about and perceive things. You should ask your shrink if he/she knows about or can use CBT (Cognitive Behavioral Therapy) for you. That, combined with meds--at least in the meantime to get by--should improve things greatly.

A lot of shrinks just want to stick you on a pill and forget the real underlying issues.

My shrink is a young likeable guy always in a hurry-you know the type-15 minute visit and time to go. I call him a pill pusher because he is usually open to anything I ask. Do you want to try a different medicine-no problem. So you think you want to try no medicine ok lets taper off and see how you do. Do you want to try a medicine for anxiety-no problem. You are tired all the time do you want to try this new drug called provigil-no problem. I asked him if he really thought that with treating my sleep apnea I could maybe get off all the drugs and he said with a smile that no he thought I would be back on medication.

I plan to ask about therapy tomorrow-cbt type... I do have and have had a lot on my mind for years.

To the person that mentioned drinking a few times or quitting drinking. In 20 years I have drank a total of a few bottles of wine(those in the last year) and got wasted on vodka once several years ago. I do not drink often and almost never. I was out of town with a friend when I got drunk on the vodka at a party and he almost called an ambulance because he said he thought I died because I stopped breathing for so long. I wasn't using cpap at the time and even though I knew I had apnea I didn't use cpap for years. I am a light weight and don't like the out of control feeling I get from booze. I like to be in control of myself.

Mike

MrSandman · Post by **MrSandman** » Mon Mar 16, 2009 6:21 pm

Guest wrote:Mr Sandman, I am currently being treated for anxiety and panic attacks, although since I've found the right doctor I haven't had one in almost two years. I do still have a fair amount of anxiety and this is how it started. About two years ago I woke up in the middle of the night, this is prior to being diagnosed w/OSA, in a complete state of incomprehensible fear. I was gasping for air, heart racing, tight chest and feeling like I was going to die. To this day I do not know what triggered it but from that night forward my anxiety was so intense, especially at night, that my chest physically hurt. After several doctors prescribing sleep meds, I was up to 3mg of Lunesta + 3mg of Xanax a night and it would still take me 4 hours to fall asleep and then I would only sleep for about 90 minutes, I went back to my GP and asked if I could be tested for sleep apnea. That is how that was diagnosed but I was still having tremendous anxiety and panic episodes (I also went through 3 anti-depressants, all SSRIs). I was also diagnosed with hypothyroidism during this time.

My panic attacks were similar to what you are describing and if you compare the symptoms of having a heart attack you would swear that that is what is happening to you. All in all I made 3 trips to the ER over the span of about 1 year and every time my heart and everything else they checked were fine. I never experienced the dizziness; it was always shortness of breath, rapid heart beat, tightness in the chest and an overwhelming sense of doom (if that makes sense). Since you mentioned thyroid, my panic attacks seemed to coincide with a high TSH level. I am not saying they were the cause, it was just an observation that I became aware of.

How have I eliminated the panic attacks? I went to see a psychiatrist and she prescribed Remeron (15mg 2 hours before bed), however I still experience the anxiety at night so I also take 2mg of Clonazepam as well. I see that you wrote you were taking an anti-depressant during one of your attacks. I don't know which one but I will guess it was one of the Selective Serotonin Reuptake Inhibitors, please correct me if I am wrong. Remeron primarily blocks the reuptake of norepinephrine and to a small degree serotonin. So its pharmological action on brain neurotransmitters is quite different than the standard serotonin reuptake inhibitors. Which include, Celexa, Lexapro, Prozac, and Zoloft. I couldn't tolerate any of these types of compounds. They actually made me feel more anxious. Remeron has helped a lot but my sleep routine is still very fragmented, sleep for 3-4 hours wake up sometimes fall right back to sleep and then wake up 1-2 hours later (this is with CPAP). A lot of times I take 1-2mg of Xanax to get back to sleep. My work schedule is more average than yours, work days try to sleep nights. I know a lot of people are reluctant to endorse meds as the only recourse but sometimes it is. I have tried diaghphramatic breathing as well as relaxation CDs to minimize my anxiety at night but they do not help me.

Sorry for the long read but I hope there is some useful information in what I've written. I am not a doctor just an average guy relating some life experiences that are similar to what you are going through. Good luck.

Cheers

Travis

I really appreciate the long thread. I can relate to your post in a way more than others. Yes I have been on SSRis for almost 20 years of one kind or another. I have never tried Xanax. My schedule changes often. I am usually days or 2nd shift but switched to overnight shift two weeks ago and I like the shift but the idea of sleeping during the day makes me anxious feeling and I don't think I can continue it.. My TSH on physicals has always been normal including late last year. I have never taken 2mg of clonazepam.

Mike

roster · Post by **roster** » Tue Mar 17, 2009 8:26 am

MrSandman wrote: .........

I had just about convinced myself that all my problems were untreated sleep apnea. I don't like to think that I am "weak minded" . My Dr. aslo has a degree in psychology and he told me to get that Sh_T out of my mind. He said it is a chemical issue in the brain just like a diabetic has or any number of other disease people take pills for. Of course I have heard all of this before. He said I may need this medicine the rest of my life just like some people need BP meds or other.

Mike,

I am just getting around to read parts of this thread. Really busy this week, so pardon me if I overlooked something important in the thread. But I do want to make a (partially informed) comment.

You seem to be taking good steps to improve your mental and physical health. I do not want to dissuade you from the path you have taken. However, I am skeptical of the doc's comments about a "chemical issue in the brain". The fact that he has a degree in psychology makes me more skeptical. They don't teach s@#$ about sleep apnea in psychology curriculums.

If you would tell me that the doc is well-studied on sleep apnea and has read all the recent studies about the damage it does, especially to the brain, I would feel more confident with him. But then if he were so well-studied, would he be telling you it is a "chemical issue"?

I wish science would hurry up and catch up with what Snoredog was saying.

Regards,

Rooster

LoQ · Post by **LoQ** » Tue Mar 17, 2009 9:31 am

MrSandman wrote:Thanks for the reply. I have had several ekg or is it ecg and tests for chemicals that would say I had a heart attack and everything comes back fine. I meant that I feel "weak or inadequate or a failure" for not being able to control this myself. I have had many incidents of social type phobia where I had to escape crowds or situations and had a similar feeling of panic although mild.

Mike

But the kind of heart problem I'm talking about is not a heart attack. It is an electrical miswiring. An ekg/ecg (either is correct) won't find it unless my heart is misfiring when the ekg is done. The chemical tests are for a traditional heart attack, which is not what I'm talking about.

If you had something like that, there is no way you could control it through "strength of mind" or whatever it is you think should work. That would be like a Type I diabetic saying they should be able to control their blood glucose without insulin if they just toughen up enough.

I get a wierd kind of feeling when I am in crowds, too. I have had to stop going to the state fair because of it. I'm not sure what it is, but it is uncomfortable. Now you've got me wondering if it's increased adrenaline. Could be, I guess.

From what I can see, I don't think you have any reason to feel bad about yourself over this. It sounds like whatever your problem is, it is not because of a failure on your part in any way.

LoQ · Post by **LoQ** » Tue Mar 17, 2009 9:36 am

tattooyu wrote:LoQ, do you happen to have MVP (Mitral Valve Prolapse)?

No. MVP is very common and will cause similar symptoms. My problem is electrical and is also very common. There are a number of variations of these kinds of heart conditions. Many of them are quite benign, though when you are having a heart-induced panic attack, they sure as heck don't feel benign. I don't think anyone should feel inadequate in any way because they have one of these conditions. I think the feeling of not being able to control your emotions is very disconcerting, and people feel like they should be able to do that better. But with what is going on inside the brain, it's really not a matter of will as much as it is chemical.

LoQ · Post by **LoQ** » Tue Mar 17, 2009 9:44 am

rooster wrote:I am skeptical of the doc's comments about a "chemical issue in the brain".

Not so fast. It really depends upon what is causing the panic. In my case, it IS a chemical issue in the brain, caused by a heart that is miswired, having nothing whatsoever to do with sleep apnea. Everyone in my family has a miswired heart. None of them other than me have any symptoms, even, of sleep apnea.

I don't think we can know what Sandman's problem is. Doctors, like us and everyone else, tend to see the problem as being whatever they are familiar with. That may contribute to doctors diagnosing people with something other than SDB when SDB is what they really have. Similarly, it may be why we want to attribute all of our problems to SDB.

dieselgal · Post by **dieselgal** » Tue Mar 17, 2009 10:21 am

Mr. Sandman,
It is obvious by reading your posts that you are depressed and down about a condition that you feel you can' t control. That is the first thing you need help getting over. You can control this, you just need help figuring out the cause and triggers.
I thing LoQ is right about the heart testing. I was 45 years old before someone told me I had Mitral Valve Prolapse. After further testing they found it wasn't MVP but I do have that electrical misfiring. In my case it is diagnosed as supraventricular tachycardia . If your interested you can look this up here http://www.medicinenet.com/paroxysmal_s ... rticle.htm
This causes my heart to triple time just out of the blue and may be a part of other issues I sometimes suffer with. There is a fairly easy procedure which should fix this right up for me and I am really considering having that done. For the time being I am on medication that helps control it. This may not be part of your issue but it is a good idea to rule something like that out.
I also don't like the idea of someone telling you to drug up everyday and just live with it. This can be handled without drugs in many cases and with minimal drugs in a lot of cases.
You are not a weak or ignorant person just because you have these issues. You are who you are. That won't change but you can make the best of what you have to work with. I consider myself to be a smart savvy individual with a lot to offer and my panic doesn't make me any less worthwhile. Your's doesn't either.
You will get lots of advice here and much of it is well worth studying. I think you should look at this like a detective and track down information and tiny tidbits that will help you solve your problem!

Uncle_Bob · Post by **Uncle_Bob** » Tue Mar 17, 2009 2:45 pm

I hear you Bob. Intrusive unwanted thoughts aka OCD . I don't know what neurofeedback training is but I am seeing my shrink in the morning and I am going to get serious about getting some therapy to learn how to deal with some things better. I have always been an "overthinker" and negative thinker and worry wart. It sucks.

EDIT: I do not usually have a problem with the use of CPAP and it isn't the cause of the panic attack. I don't know what is. But since it happened while I was using cpap it made me kinda scared to hook up again. I did hook up again and sleep for about 5 hours this morning.

Mike[/quote]

Find more here http://www.eeginfo.com/
Process is basically rewarding good brain behavior to encourage new neuro pathways to form

roster · Post by **roster** » Tue Mar 17, 2009 2:50 pm

LoQ wrote:....... In my case, it IS a chemical issue in the brain, caused by a heart that is miswired, having nothing whatsoever to do with sleep apnea. ........

Just curious, which chemicals are out of whack?

BTW, everyone seems to really want to avoid being called weak, character deficient, etc. You are giving me a complex. Despite all my failings, I am one of God's children like you. We character deficient people have to live with ourselves so please don't make it rougher.

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