The term “panic attack” refers to a sudden, unreasonable attack of anxiety or fear, lasting from 10 minutes to an hour. It is accompanied by vegetative symptoms: when falling asleep, for example, it throws you out of sleep, while the pulse quickens, chills or dizziness appear.

The problem is quite widespread, since at least 5% of the population are familiar with such sensations. Most of them are young or middle-aged residents of megacities. Nocturnal panic attacks require treatment, as they can lead to insomnia, mental, somatic disorders.

Why do they arise

PA as an independent disease has been studied for about 40 years, but the exact reasons for this phenomenon have not yet been established. At the moment, it has only been possible to determine the factors contributing to a panic attack: 

• Psychogenic – stressful situations or events, strong impressions, conflicts.
• Biological – hormonal imbalance caused by the peculiarities of the menstrual cycle and pregnancy in women, the intake of hormones. Endocrine diseases are not included here.
• Physiogenic – drug use, alcohol intoxication, physical stress, acclimatization, excessive insolation. Drugs such as Prednisolone, Cholecystokinin, or Bemegrid can also trigger panic anxiety syndrome.

Persons with a certain set of personality characteristics are susceptible to seizures. In men, this is anxiety, suspiciousness, concern for the state of health; in women – drama, the need for the attention of others, demonstrativeness. Heredity is also important: the presence of this disease in parents increases the risk of its development in a child. 

Symptoms

PA in the waking state begins with causeless anxiety, to which other clinical signs join within 5 minutes. With nocturnal attacks, a person in a dream or at the time of falling asleep suddenly wakes up sharply, while experiencing fear.

The panic attack does not depend on the dream, since nightmares are dreamed in another phase of sleep. Upon awakening, one or more characteristic symptoms of dysfunction of the autonomic nervous system appear:

• difficulty breathing, choking, shortness of breath, “lump” in the throat;
• wavy alternation of chills and fever, sweating, paresthesia;
• tachycardia, pain like heart attacks, heart sinking;
• dizziness, a feeling of unreality, distortion of the perception of sounds, images, one’s own “I”; 
• reactions of the gastrointestinal tract in the form of nausea, vomiting, dyspepsia.

The exact causes are unknown, but the mechanism for triggering and developing an attack is well understood. The production of adrenaline, dopamine and norepinephrine suddenly increases, respectively, the vessels narrow, and the pressure rises. Against this background, clinical symptoms of panic attack appear. At the same time, noradrenergic neurons in the brain and chemoreceptors are activated, increasing the feeling of fear.

Insomnia and nocturnal panic attacks are linked: after one attack, there is a fear of sleep, difficulty falling asleep. This is how the restrictive behavior characteristic of the PA is manifested. Fearing a repetition of unpleasant sensations, a person avoids the situation in which they first appeared.

When exactly does a nocturnal attack occur? Most often, patients complain that they start to panic while falling asleep. Before falling asleep completely, a person experiences severe fear, at the same time a rapid heartbeat is felt. A panic attack can develop after sleep has begun. In this case, awakening occurs due to apnea or tachycardia, and the panic itself intensifies later.    

Treatment

It is imperative to treat panic attacks that occur at night during sleep, as they can provoke chronic insomnia. You need to seek help from a neurologist and a psychotherapist, who will select the optimal scheme. The main method of treatment is psychotherapy, the task of which is to find out the probable causes of pathology and establish control over fear. The psychotherapist, using various methods, explains that panic attacks are a simple neurosis that is not dangerous to health, and also teaches us how to cope with them.  

The most effective way to stop an attack is to breathe deeply. If you feel a strong heartbeat, take a deep breath right away. Holding your breath for at least a minute, exhale smoothly, repeat the exercise several times. The muscles of the body on exhalation should be relaxed as much as possible. This technique allows you to prevent the development of an attack at the very beginning. To reduce the likelihood of nocturnal panic attacks, do not indulge in unpleasant thoughts before bed. 

If non-drug methods of therapy do not give an effect, drugs are prescribed. Tablets and treatment regimens are selected strictly individually, the result is systematically monitored. The most commonly used drugs are benzodiazepines, which act quickly but can be addictive.  

Inhibitors of serotonin uptake are safer, but at the beginning of the course of therapy they cause side reactions ( insomnia , anxiety, irritability). And antidepressants such as amitriptyline increase symptoms in the first 2 weeks. The minimum course of drug treatment is six months.