Nocturnal panic attack

A panic attack usually lasts from 5 to 30 minutes, with the symptoms peaking at about 10 minutes, but attacks have been reported to last for hours. A person must have at least 4 of the 13 symptoms listed in Table 9—6 for an episode to be classified as a panic attack. Panic attacks may occur during sleep, in which case they are known as nocturnal panic attacks. These attacks may wake the person from sleep but are otherwise similar in symptoms to daytime panic attacks. A majority of patients with panic disorder will experience nocturnal panic, but only a few patients describe having the majority of their panic attacks at night. 

CBT is an effective treatment for panic disorder, and has shown long-term efficacy [ 115]. CBT for panic disorder usually aims at preventing panic attacks and avoidance behaviors. However, there is a lack of data on the effect of CBT on nocturnal panic attacks. Sleep hygiene education and other CBT to reduce sleep-related worries and anxiety can be applied to avoid elevation of anxiety associated with sleep and to avoid maladaptive sleep-related behaviors that may further exacerbate sleep problems. 

A 47-year-old woman with an 8-year history of nocturnal panic attacks and a recent history of major depression had a poor response to SSRIs and instead took a 0.1% tincture of St. John s wort. After 10 days she noted racing and distorted thoughts, increased irritability, hostility, aggressive behavior, and a reduced need for sleep. After discontinuing the herbal treatment, her symptoms resolved within 2 days. 

Anxiety disorders may cause patients to complain about their sleep, cither because there is a reduction in sleep continuity or because normal periods of nocturnal waking arc somehow less well tolerated. Nocturnal panic attacks can make patients fearful of going off lo sleep... 

Nocturnal panic attacks may be distinguished from night terrors by the fact that the patient will wake fully before panic symptoms have reached a peak and is fully aware. 

Anxiety can be defined as a sense of apprehensive expectation. In reasonable amounts and at appropriate times, anxiety is helpful (e.g., anxiety before an examination may cause a student to initiate an appropriate study plan). Too much anxiety, however, can be deleterious. Anxiety can be considered pathological when it is either completely inappropriate to the situation or is in excess of what the situation normally should call for. An example of the former is nocturnal panic attacks—episodes of extreme anxiety that arise out of one of the most physiologically quiet times of the day, stage lll/IV sleep (64). An example of the latter is specific phobias—for example, an irrational fear to venture outside of one s home. 

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