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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.

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.

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.

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.

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

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.

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

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

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

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. ........