Nocturnal panic attacks

I'm awaiting my sleep study but am feeling more & more confident that I may not have sleep apnea. I had a question about night panic attacks. I have anxiety disorder and when I was at my worst, I would wake up in the night with my heart racing and in the midst of a huge panic attack. I know what they feel like and I know it can be quite common to have them at night as your mind races while you are asleep. Since getting my anxiety under control, I rarely have them in the middle of the night, in fact, it's been a very long time. I do sometimes have "mini" attacks right as I am drifting off to sleep (which is what prompted me to pursue a sleep study) but now that I am reading about anxiety, I see that a lot of people get these same attacks right as they are falling asleep from their anxiety. I never wake up gasping for air, it is more of a sensation of right as I am falling asleep, I feel like I "fall" and my heart maybe skips a beat or beats a little faster. Feels like a panic attack, but goes away within a second or two.

With sleep apnea, I thought that you mostly stopped breathing when you were in a deep sleep. So I am wondering if my mini attacks (which are rare and I believe caused by anxiety as they become more prevalent in anxious times or when switching anxiety medication) could even be a cause for concern of sleep apnea since I am having them as I drift off to sleep.

I'm still going to go through with the sleep study but I am curious if anyone knows much about this. I don't have panic attacks in the middle of the night, but more like a (rare) mini attack right as I am drifting off to sleep. Has anyone else experienced anything similar?

beth0277 wrote:With sleep apnea, I thought that you mostly stopped breathing when you were in a deep sleep.

Yes, no, and maybe. Some people have them in deep sleep. Some people have them as they fall asleep. Each pattern is different.

There are many sensations that one can experience in a transitional mental state (very similar to hypnosis), like when you are falling asleep. The mind can in such instances interpret otherwise harmless and well-known events as threatening. When I was very young I started experiencing such events when I'd try to go asleep laying on my back, and even on my sides. So I learned to sleep on my stomach. (Now I'm convinced that those were caused because my body knew that in such positions I could not breathe right.) The same would happen to me today, if I tried any other sleeping position. I also occasionally (very rarely) experience true panic attacks for no apparent reason (although, there is always a reason in our unconsciousness): I'd wake up feeling something is not right, disoriented, only to realize there is no reason for alarm (this is different from having a nightmare). I also sometimes have panic attacks related to my CPAP equipment (e.g., that I can't get enough air through it), but you don''t use that.

Just remember: there is no "normal" and "abnormal", people are different and their minds and bodies function in their own way. As long as you are feeling happy, it is all that matters; so if you stop being bothered by those events, you wouldn't need to do anything about them. But it's good you're doing a sleep study, just so you know if sleep apnea might be involved.

McSleepy

archangle wrote:

beth0277 wrote:With sleep apnea, I thought that you mostly stopped breathing when you were in a deep sleep.

Yes, no, and maybe. Some people have them in deep sleep. Some people have them as they fall asleep. Each pattern is different.

And I have most of mine during REM. Each of us are a snowflake, sometimes similar but yet always unique.

I'm actually not bothered by the events at all. They happen rarely and I know what it feels like so as quickly as I notice it, I calm right down and I'm fine. They were only brought up because my therapist asked if I was still experiencing my panic attacks and I said that I hadn't had a "real" one in a while but that I started having little "mini" attacks right upon falling asleep from time to time and she is the one who mentioned the possibility of sleep apnea, but made it very clear that she didn't know much of anything about the condition.

I guess I am not confident that I even need the sleep study, but will go through with it, of course. I had a period last summer of a month or so of heavy snoring but that stopped when I treated my acid reflux. I am never tired during the day and my husband hasn't noticed any strange breathing patterns in my sleep. I have morning headaches but I have for as long as I can remember and they usually only "flair up" when I am going through a period of high anxiety. I don't know, I will certainly get the study but I don't know that I fit the characteristics of someone who has sleep apnea, symptom wise.

I should mention that I experience panic attacks during the day as well, which of course can't be related to sleep patterns. They are worse when my anxiety is not under control but when I am in a very anxious state, I have them during the day and at night.

Sleep doc told me that changes in heart rate while asleep is common to all people, and for that alone is not considered to be a sign of anything wrong.

However; In the 1990's the medical community suggested that night time panic attacks, and some daytime-awake panic attacks are a manifestation of a true heart problem, which can be diagnosed and treated. Further such heart problems can be in very young people, who otherwise seem health. Also, if you do not know, a resting EKG is sometimes helpful in Diagnosing heart problems, but I would feel sure, (as I have had Open Heart surgery) that a doc would say that a resting EKG does not disprove a heart problem.

Personally I am very concerned with many of the US's recent war veterans who were exposed extreme explosions (from IDE's) which can cause heart damage in someone who is otherwise healthy. Plus of course, many have multiple concussions which will damage their ability to think, and lead to . . .

Then the waking up with a rapidly beating heart is also a sign of PTSD.

If you are also waking up in a sweat, it might be related to Diabetes, or -far less likely, Cancer.

I would be pretty sure that a doc would not suggest testing for things other than Sleep Apnea, until after he has scored your Sleep Apnea tests. A lot of information can be gleaned from a properly done and scored Sleep Apnea study than might seem possible to a un-trained person. Proceeding with eliminating possible causes (with a trusted test) one possible issue at a time, sounds like a good course of action. If you are rich, then let some doc check you into a hospital for a battery of scans, tests and such that will help to make the hospital better off. Obviously they need the money.

I have found that often doctors ignore the symptoms which I try to explain to them as being important to me, and my having a quality of life. Instead they love to treat some things as they; Know how, like hypertension. Docs have a lot of statistics saying this issue or the other is really important, like diabetes, high cholesterol, Etc. They hesitate to suggest tests where the patient will complain about the cost, the time needed to do the test, and how embarrassing or uncomfortable the test is. Plus we all now want a solution to a health problem like what I call the antibiotic solution. Take this inexpensive pill for ten days and the problem will be gone. Limited cost, limited inconvenience, complete cure with no further medical intervention needed.

My experience is that Docs often want to deal with only one issue in a single visit. If he is looking at treating you for hypertension, then he will only cursorily deal with another issue. Doc will expect that you will come back to speak with him about other symptoms. This is the effect of the insurance industry which says a doc must see as many patients in a work day as possible. Docs deal with what seems to require emergency care (where he probably sends you to the ER or somewhere else). AND, whatever you made the appointment to speak with him about (or he will let his agenda of treating some issues hijack the visit.)

If you are not satisfied with how a doc can explain the symptom, which clearly is interrupting to your life, and not his, then you must be pro-active in seeking an understanding of your health issue, hopefully with an effective treatment. To me, it is a matter of either letting the doc follow his list of what to treat in what order, or saying, "Damn it doc, this is important. so work on this."

As I receive Medicare, it is not a good idea to piss off a doc who is up to his whatever with Medicare patients which he can barely make money on (he moonlights in hospital ER). I think a lot of docs would just as soon a Medicare patient go somewhere else or just shrivel up. I am always careful to be polite and thank my doc for a good effort when it leads to (I feel) he has done all that can be done for my symptom.

beth0277 wrote:I'm actually not bothered by the events at all. They happen rarely and I know what it feels like so as quickly as I notice it, I calm right down and I'm fine. They were only brought up because my therapist asked if I was still experiencing my panic attacks and I said that I hadn't had a "real" one in a while but that I started having little "mini" attacks right upon falling asleep from time to time and she is the one who mentioned the possibility of sleep apnea, but made it very clear that she didn't know much of anything about the condition.

I guess I am not confident that I even need the sleep study, but will go through with it, of course. I had a period last summer of a month or so of heavy snoring but that stopped when I treated my acid reflux. I am never tired during the day and my husband hasn't noticed any strange breathing patterns in my sleep. I have morning headaches but I have for as long as I can remember and they usually only "flair up" when I am going through a period of high anxiety. I don't know, I will certainly get the study but I don't know that I fit the characteristics of someone who has sleep apnea, symptom wise.

You may not be bothered by them but your body is sure going through trauma due to them.
There are really no characteristics of someone who has sleep apnea - there are only some symptoms that some people have. And you have them.

beth0277 wrote:I guess I am not confident that I even need the sleep study, but will go through with it, of course.

Good. Doctors tend to see a "moment in time snapshot" when they normally do tests, like blood draws, or whack you with a rubber hammer. In a sleep study you will be watched in a lot of detail for an extended period of time, tho it is only for 1 night in a strange circumstance. But they will see your heart rhythms, your brainwaves, your breathing, your movements, and maybe see a "panic attack". They can not only rule in, or out, sleep apnea, but they may see other things that indicate alternate causes.

I make a list, on paper, of my symptoms and/or "maladies" (I have 9 now) and take them to the doctor and read them off and ask, "What do these indicate to you?", not offering any suggestions myself unless the Dr. is baffled (him being baffled seems to happen a lot though). I would say one subset of my maladies are correlated, grouped with each other with a common cause; sleep apnea. Others are independent... a disc in my back, or maybe peripheral neuropathy. Make sure you mention the acid reflux and the panic attacks, and anything else you sense, as together they may have a common cause. The Dr. may want to monitor some things to see what is going on.

In my case, we treat the obvious (blood pressure, apnea) and then see what is left. Wa La! Some other things start peeking their head out at us after we clear away the "apnea brush".

My wife has conditions that really baffle doctors, even the best in the world, and in part they don't do the right tests, under the right conditions, to figure out why. We are our own best advocates, so we press on for causes and treatments for her.

I've had full work ups of my heart, so I know there is no issue there. I have panic & anxiety disorders, so while I know that panic attacks can be signs of sleep apnea, I am more likely to peg them to my anxiety disorder since I had never had a single one until I went through a traumatic experience. I also don't wake up in sweats ever, but I have had work ups for diabetes and pretty much everything else under the sun.

Who knows, really. I will get the sleep study and go from there. I wish things were more black & white, but unfortunately most of the time in regards to health, there is a large gray area!

Oh, and someone mentioned PTSD, which I have also been diagnosed with. I know that can cause panic attacks as well.

Re. " I'm still going to go through with the sleep study but I am curious if anyone knows much about this. I don't have panic attacks in the middle of the night, but more like a (rare) mini attack right as I am drifting off to sleep. Has anyone else experienced anything similar? "

Beth, yes, I've had them too; falling asleep, in the middle of the night, and as I arise. They come and go, diminish over time and, in my case, are relatively infrequent now. The first time I had a nocturnal anxiety attack was soon after my leg was broken in a few places in a skiing accident. That first time was the most alarming. Like you, now that I'm familiar with what they are, while they aren't 'fun,' they aren't nearly so alarming.

Although I've had onset sleep delay (can't get to sleep very quickly) since childhood and had my share of nightmares as a child, and of course still have sleep issues including sleep apnea, I feel quite sure the onset of my anxiety attacks was far more related to the trauma of my leg fractures than to sleep apnea.

Still, like others who've replied to your post, I'm glad you're going ahead with the sleep lab tests. I've been on CPAP for only two months now and am amazed at how effective the therapy is in dramatically reducing the apneas, both obstructive (due to muscular induced narrowed or collapsed trachea/airway) and central (brain induced breathing cessations). I'm much more alert and much sooner after arising than before. You have reason to be confident in being checked out in a sleep lab.

Also, adapting to using the CPAP devices, the mask and air-blower unit, turned out to be no big deal. I didn't have to go through a "period of denial" that I have sleep apnea, nor was I reluctant to follow instructions and give the equipment a try. So I hope you'll relax a bit and have a good experience during your first lab test. All the wires on me and I felt no discomfort or any other sensations from them at all. They let you watch tv and/or read, etc. until you feel sleepy enought to fall asleep on your own. As I am already prescribed to use sleeping pills when needed, they have no problem with me doing that either. My sleeping habits and patern were such that I only got about two hours of sleep in my first lab test, but it was enough for them to get the live data they needed to perform a good diagnosis (which in my case was severe sleep apnea and included both obstructive and central apneas.) Depending on the results they may, as they did with me, ask you to return for a second lab test, a "CPAP titration" test, which is a fancy way of saying that they use the time you're asleep to calibrate what settings you would begin with on a CPAP machine to start your therapy.

Please note, I'm not a doc, but this wonderful website, along with other research I've done, has helped bring me up to speed fairly quickly. Come back here often, Beth. It's very helpful and you get to ask questions here and receive rapid responses from some very knowlegeable and experienced folks. Good luck to you.

Papit

I had night sweats and heart racing so bad that I would wake up scared to death like someone was in the house. I was told
it was during deep sleep and during a episode of stopped breathing. Your body goes into panic. Everyone is different but this
is what alerted my doctor as I don't snore not even during sleep study. I was afraid to go to sleep also because I would have
nightmares as soon as I went on cpap all has stopped unless I start mouth breathing.

Hi Beth0277.

A number of the patients in my clinical practice have similar experiences of nocturnal anxiety. Although you are right in that people can experience anxiety attacks when falling asleep, in a lot of cases the events you describe may be more physical in origin. Of the past six people who have presented in my practice with nocturnal anxiety, I have referred all of them to a nearby pulmonology practice for a sleep study and five have been diagnosed with OSA. I'm not trying to minimize your experience, but I do want to encourage you to follow through with the study.

One of the other things to remember is this: OSA, as is the case with most disorders exists on a continuum, from mild to severe. (Even mild OSA can be quite serious, though.) I've noticed on our website that the more severe cases seem to stand out almost like they're marked with a highlighter.

When I had my sleep study, I had an AHI of 8. This may seem like a pretty boring number compared to some of the ones you see on the forum. However, I have benefited tremendously from CPAP treatment. So, even if are just over the diagnostic threshold, get started on CPAP and see if it helps your other issues.

I hope everything works out well for you.

beth0277 wrote:I should mention that I experience panic attacks during the day as well, which of course can't be related to sleep patterns. They are worse when my anxiety is not under control but when I am in a very anxious state, I have them during the day and at night.

Maybe if apnea episodes (basically being strangled in your sleep) might increase the incidence of panic attacks during the day. Maybe there are stress hormones or something electrical hanging around in the brain for hours. Once you get panicked, the results don't necessarily go away right away.

I wouldn't be surprised if some people have apneas or other sleep problems when falling asleep even if they get good therapy for the rest of the night. It might not even be worth raising the pressure to eliminate them, if the duration and severity of the events isn't too bad.

You can also get a false apneas recorded by your CPAP while you're awake or on the edge of falling asleep. Your conscious or semi conscious mind is holding your breath, swallowing, whatever, stopping your breathing for a while but it doesn't cause stress or O2 problems.