How Sleep Panic Attacks Are Different
Nocturnal or sleep panic attacks are far less common than daytime episodes. Researchers are not certain whether nighttime disturbances are caused by the same underlying disorder, or whether they actually represent a different set of problems and have different causes.
A panic attack that occurs during waking hours is considered a “cognitive” event, because while the cause of the attack may be unknown, the person is aware of what is happening and their awareness (fear and anxiety) actually triggers and intensifies the physical symptoms that define a panic attack—the shortness of breath, racing pulse, cold sweat and trembling, dizziness, nausea, etc. But a sleeping person lacks that conscious awareness and anxiety that usually sets off sleep panic attacks.
This unconsciousness of course makes it particularly difficult to analyze the cause of a nighttime panic attack. The most obvious guess might be that the panic is linked to nightmares. Scientific studies of sleep patterns says no, however, because nocturnal panic attacks usually occur during phase II of the sleep cycle and not during the REM-phase—when dreams and nightmares occur.
But while nightmares have largely been ruled out as a cause of nocturnal panic attacks, there are a number of other identified sleep disorders that might play a role in the attacks, such as gastric reflux, sleep apnea, laryngospasm, and sleep seizures.
Two of these disorders are quite common. People with gastric reflux disease, for instance, often wake up at night with a burning throat and a choking feeling, which in turn can create anxiety and palpitations…triggering a panic attack almost before the person is awake.
The other fairly common and well-known sleep disorder is sleep apnea—or more technically, “obstructive sleep apnea.” With sleep apnea, the person’s breathing actually stops momentarily, causing the blood to becomes oxygen-deprived. This triggers a rapid heartbeat and gasping and choking sensations that wake the person suddenly and are extremely similar to panic attack symptoms. Some people who don’t realize they have sleep apnea (and many don’t) may actually attribute their waking to a panic attack rather than to sleep apnea.
Laryngospasm is less familiar, but it basically involves an involuntary closing or contraction of the vocal chords, actually cutting off the sleeper’s breathing. Again the person awakes in alarm, struggling for breath but not knowing why. Recipe for a panic attack in a susceptible person. A person undergoing a temporal lobe seizure has symptoms that fill all the requirements for a panic attack: rapid heart rate, hyperventilation, sweating, a tingling feeling and dissociation.
All of these sleep disorders are caused by diagnosable physical conditions, unlike panic attacks, which are generally assumed to be psychological events. But if nocturnal panic attacks could really be determined to be caused by physiological factors, it raises the question whether at least some daytime panic attacks are also linked to something beside a mental malfunction.
For instance, one interesting discovery is that people who have panic attacks also have higher levels of carbon dioxide in their bodies at night than “normal” people. A panic attack can actually be induced in a person with panic disorder by having them inhale CO2. The theory is that when the brain perceives this higher level of carbon dioxide, it sets off something called a “false suffocation alarm,” causing the person to develop common panic attack symptoms, like hyperventilating.
Another more purely psychological explanation for nocturnal panic attacks is that they may be linked to a basic fear of “loss of vigilance.” People with this fear find it difficult and uncomfortable to relax, because they feel too vulnerable and unprotected. When they are in the deeply relaxed state of sleep or meditation, they can actually start to feel panic.
There are many theories and possibilities for what causes nocturnal panic attacks. But for those who do suffer from them, it is important to see a doctor to determine whether they might have a treatable medical condition—like sleep apnea or gastric reflux—which is causing those episodes.
