Effects of Panic Disorder and Anxiety Attacks on Sleep

Condition May Relate to Anxiety and Cause Nightmares

Panic attacks and anxiety can contribute to nightmares in sleep and insomnia
Panic attacks and anxiety can contribute to nightmares in sleep and insomnia. Getty Images

Anxiety is a common complaint that can affect your ability to function during the day. When the anxiety is associated with panic attacks, the consequences can be significant, especially when these attacks interrupt your sleep. What are the symptoms of panic attacks? What are the effects of panic disorder and panic attacks on sleep? How do these conditions relate to anxiety, nightmares, and insomnia?

How should panic attacks be treated? Consider the answers that may help put your worries to rest and allow you to get the sleep that you need.

The Symptoms of Panic Attacks

Anxiety is a common complaint that affects 18% of people in a given year. Insomnia, the most common sleep disorder, may occur in 1 out of 3 people. These two conditions often occur together and a panic disorder with frequent panic attacks may be disruptive to sleep. Post-traumatic stress disorder (PTSD) can also impact sleep.

Panic disorder typically develops in early adulthood, most often in the late teens or early twenties. It is more apt to afflict women. Approximately 2-3% of people are diagnosed with panic disorder, which is used to describe someone who has recurrent unexpected panic attacks lasting 1 month or longer. There may be anxiety about the potential for future attacks, avoidance of triggers (especially places or situations), and worry about underlying medical disorders.

But what are the characteristic symptoms of panic attacks?

Panic attacks consist of a sudden episode of severe anxiety, fear, or discomfort with associated physical symptoms, including:

  • Chest pain
  • Fast heart rate or palpitations
  • Sweating, hot flashes, or chills
  • Shortness of breath or choking
  • Lightheadedness or dizziness
  • Nausea or upset stomach
  • Numbness or tingling
  • Fear of dying, losing control, or going crazy
  • Trembling or shaking
  • Feelings of unreality or being detached from oneself (depersonalization)

The symptoms start abruptly, last only seconds to minutes, and typically reach a peak within 10 minutes. Panic attacks may occur during sleep and may be associated with nightmares.

Panic Attacks and the Effects on Sleep

Approximately two-thirds of people with panic disorder will have moderate to severe difficulties sleeping, most often complaining of insomnia. Insomnia is difficult falling asleep, staying asleep, or sleep that is not refreshing. Panic attacks that occur out of sleep can be an important contributor to this insomnia.

Nighttime panic attacks consist of an abrupt awakening from sleep, often associated with shortness of breath. This occurs out of deep slow-wave sleep (NREM sleep) and these panic attacks are not typically associated with dreams. Though it only occurs in half of people with panic disorder, it can be recurrent.

Unfortunately, panic attacks that disrupt sleep may lead to sleep deprivation and worsen anxiety and further panic attacks. When sleep is studied in people with panic disorder, the polysomnogram may show decreased sleep efficiency and less total sleep time.

People with panic attacks are often more likely to experience isolated sleep paralysis which may consist of an inability to move, anxiety, chest pressure, and hallucinations. It is described as "isolated" because if sleep paralysis occurs with other symptoms, it can lead to the diagnosis of narcolepsy.

Anxiety and depression often walk hand in hand. Therefore, it is important to recognize and treat any overlapping depression as this can also disrupt sleep.

Treatment of Panic Attacks

Panic attacks that disrupt sleep may improve with good sleep habits and the avoidance of caffeine. It is important to minimize sleep deprivation as this can worsen the underlying anxiety. Other medical causes of the symptoms described above should be investigated, which might involve checking your thyroid-stimulating hormone (TSH) to rule out hyperthyroidism.

There are a variety of medications that can effectively treat panic disorder. The most commonly used medications include selective serotonin reuptake inhibitors (SSRIs), such as: fluoxetine, sertraline, and paroxetine. In addition, benzodiazepine medications may help alleviate anxiety, including alprazolam and clonazepam. Other medications such as tricyclic antidepressants and monoamine oxidase inhibitors have been used in the past, but they are no longer considered first-line treatments.

Finally, cognitive behavioral therapy can be helpful without relying on the use of medications. This treatment involves challenging irrational thoughts about panic symptoms, reducing avoidance behavior, and learning to minimize fear about specific situations. It is often administered by a specially trained psychologist.

If you believe that you have panic attacks that are disruptive to your sleep, start by speaking with your primary care physician who may recommend an evaluation by a psychiatrist.

Sources:

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), American Psychiatric Press, 4th edition, 1994.

Kryger, MH et al. "Principles and Practice of Sleep Medicine." ExpertConsult, 5th edition, 2011, pp. 1473-1476.

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