| By :
Peter Rubel
Most panic attacks occur in the daytime. Infrequently, they occur in bed. Studies show they do not occur in the dreaming portion of sleep, so they are not the same as nightmares. But they do make getting to sleep difficult as one fears another attack at night. Panic attacks at night may be triggered by some emotional stress or crisis such as loss or potential loss of a loved one, by a physical condition such as mitral valve prolapse or asthma, or even by a benign and normal muscular jerking as we fall asleep (called a hypnic jerk). Knowing the cause of our panic is not harmful helps calm one down. But worrying over some potential crisis such as the possibility of another panic attack at night tends to give one a case of insomnia. One's goals naturally are thus both to stop the panic attacks and to get to sleep. I. Getting to sleep The first time one's panic occurs when sleeping, one is usually least prepared to handle it. If it never occurs again, or rarely, one may have little reason to improve sleep habits. In any event, poor sleep quantity and quality is not uncommon among panic attack sufferers, and improving sleep can thus contribute in the fight to stop panic attacks. Self-conscious preparation for sleep can include not eating after 8 PM and going to bed before 11 PM. Caffeine, nicotine, alcohol, and sugar should be avoided. Caffeine may even be hidden in soft drinks one may think has none. Physical exercise, especially a little while before bedtime, may help one feel more tired. Get the sleeping quarters as quiet and dark as possible. Even light shining through the eyelids from a clock radio can reduce sleep quality. Relaxation techniques may be exercised immediately before bed. There are many such techniques. Among them may be Yoga or stretching, listening to music or reading (provided the effect on the individual is calming), and using visualization or the imagination in an enjoyable, calming way. If one has trouble getting to sleep or getting back to sleep, worrying about not being able to sleep or anger at oneself for inability to sleep tends to prolong the insomnia. Also worth noting is that many people with panic attacks also have depression. People with depression may sleep too much rather than too little, though moods that influence longer sleep seem opposite to moods that keep one awake too much. And people with too much fat in the neck area or who have sleep apnea or who have a late term pregnancy may have physical conditions which inhibit good breathing and increase carbon dioxide in the brain. Too much carbon dioxide in the brain is known to cause panic. Physical solutions to such problems are available, in some cases such as sleep posture. After exercising good habits in preparation for sleep, one may still have a sleep panic attack. What then? First, if worry or anger about the insomnia prolongs the insomnia, accepting the insomnia tends to calm one a bit. Certain treatments for panic attack will also help, although not all are best practiced when in bed. One discipline that can be exercised in bed is replacing worrying thoughts as much as possible with enjoyable ones. The herb Skullcap and the amino acid tryptophan (found in the meat of Turkey) are known to help one feel drowsy when used in moderation, although be sure to consult a doctor before taking such substances especially if one is taking some prescription drug or is pregnant. II. Panic attacks treatments If necessary, one may turn on a light and record one's worrying thoughts. Long term, a journal of emotions can be a part of therapy for anxiety, and writing down (or voice recording) the thoughts may help one feel more in control. Second, in a panic attack, deep and deliberately slowed breathing tends to reduce the anxiety sensations that hyperventilation adds to panic attack symptoms. Hyperventilation is typical in panic attacks; it tends to increase a surplus of carbon dioxide in the brain rather than reduce it, contrary to what one might expect. Third, distracting one's anxiety-producing thoughts with thoughts of things for which one is sincerely grateful has a calming influence. In the daytime and between attacks, other actions and exercises may be necessary. One may need to change jobs, make decisions about one's financial affairs, improve one's physical health, alter the terms of a relationship, or otherwise handle various stresses. Often in addition, panic attacks take on a life of their own, requiring therapy or treatments targeted at a reducing a heightened state of anxiety in the limbic portion of the brain. These may be chemical or behavioral remedies or both.
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