Sleep Apnea and Panic Attacks

The subject of panic attacks is often raised. The following is some information about the connection between sleep apnea and panic attacks:

Sleep apnea and panic attacks.

Mar-Apr 1991
Edlund MJ, McNamara ME, Millman RP., Department of Psychiatry, Rhode Island Hospital, Providence.

A survey of 301 sleep apnea patients demonstrated that obstructive sleep apnea may cause nocturnal panic attack symptoms. Sleep apnea should be considered in the differential diagnosis of nocturnal panic disorder.

PMID: 2022111 [PubMed - indexed for MEDLINE]

Nocturnal Panic Attacks: Anxiety Attacks at Night

link to web4health website info

Written by: Martin Winkler
First Version: 25 Aug 2003. Latest version 10 Nov 2006

What are the reasons for anxiety attacks at night? Is excessive dreaming the main reason for my panic attack at night?

About 50% of all patients with panic disorder have nocturnal panic attacks, but most of the events will be happening during daytime activities. Research shows that only 10.2% of all panic attacks happen at night, but patients might be more severely concerned about these events.

A significant number of patients are afraid of the nighttime and do expect a loss of control or severe somatic consequences like a heart attack, stroke or other irrational cause of death. Of course this is most unlikely!

We know that most panic attacks are NOT caused by dreams. Records of sleep polysomnographia show a maximum of panic attacks during early sleep phase (phase II), not during the REM-phases associated with dreams. This is a major difference to nightmares! Nightmares happen during the second half of the night, so we are often able to remember the content of these dreams.

Pavor nocturnus is a very specific type of sleeping disorder, more common among children. It is defined by a sudden avakening with crying, strong anxiety symptoms and vegetative symptoms like heart palpitations, short breathening and sweating. This type of sleeping problems occur during deep phases of sleep (phase IV).
Arousals caused by sleep apnea syndromes are usually not characterized by extreme anxiety symptoms. But this sleep disorder might have an effect on the origin of panic attacks, because sleep apnea has an impact on heart frequency and blood pressure. Chronic arousal of anxiety during night could be a kind of dysfunctional protection against apnea during night.

The exact causes for panic attacks at night are not known. Other possible causes include an increase of CO2-concentration (False Suffocation alarm hypothesis) or changes of the parasympathotonic system due to autonomic dysfunction.

So panic attacks at night will be mainly influenced by the events of the last day, consumption of alcohol or drugs and a general higher arousal due to the anxiety disorder of the client.

Nocturnal panic attacks.

Sept. 2002
Lopes FL, Nardi AE, Nascimento I, Valenca AM, Zin WA., Laboratory of Panic Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

The panic-respiration connection has been presented with increasing evidences in the literature. We report three panic disorder patients with nocturnal panic attacks with prominent respiratory symptoms, the overlapping of the symptoms with the sleep apnea syndrome and a change of the diurnal panic attacks, from spontaneous to situational pattern. The implication of these findings and awareness to the distinct core of the nocturnal panic attacks symptoms may help to differentiate them from sleep disorders and the search for specific treatment.

PMID: 12364936 [PubMed - indexed for MEDLINE]