Panic Disorder and Insomnia, Nocturnal Panic Attacks

Panic disorder is a condition primarily characterized by symptoms of sudden, overwhelming fear. This acute fear is referred to as a panic attack. Symptoms of a panic attack include various autonomic nervous system manifestations such as dizziness, shortness of breath, palpitations, trembling, chest tightness, paresthesia, chills, hot flashes, indigestion, and excessive sweating.

The manifestations of symptoms can be very diverse. Once a panic attack is experienced, individuals may develop anxiety that these symptoms might recur, leading to persistent feelings of unease. This state is called anticipatory anxiety. Anticipatory anxiety, in turn, can raise the overall anxiety level, potentially leading to a vicious cycle of increased frequency and intensity of panic attacks.

Diverse Symptoms of Panic Disorder

In addition to physical symptoms, emotional symptoms may also be present. For instance, thoughts like "I might die" or difficulty controlling the situation, and an overwhelming sense of dread, like "I might go crazy," may appear. Other symptoms like derealization and depersonalization can also manifest. Derealization refers to a lack of reality, feeling as if floating or being in a dream. Depersonalization also describes an abnormal cognitive state where one feels detached from oneself.

Diagnosis of Panic Disorder?

1. Recurrent unexpected panic attacks.
2. Persistent worry about additional panic attacks.
3. Fear of losing control or dying.
4. Behavioral changes associated with these symptoms. For instance, avoiding places where panic attacks have occurred, such as elevators or airplanes.
5. The symptoms must not be attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

Associated Symptoms of Panic Disorder

Panic disorder can be accompanied by various associated symptoms. A prominent example is changes in sleep patterns, such as insomnia. Other co-occurring issues may include depression, agoraphobia, social phobia, alcohol addiction, and problems related to medication like sleeping pills or tranquilizers.

It can appear alongside various other conditions, and if one has been suffering from neuropsychiatric issues for a long time, the effects of psychotropic medication may also be present, requiring careful observation. Evaluation of sleep status is also important for determining the prognosis of symptoms. However, since the factors affecting sleep status are highly complex, it is not easy to identify the specific cause of sleep disturbance.

When Panic Attacks are Severe at Night

Specifically, when panic attacks occur during sleep at night, it is called a nocturnal panic attack. Approximately 70% of patients diagnosed with panic disorder are reported to experience nocturnal panic attacks, and about half of them suffer from these symptoms very frequently. Experiencing nocturnal panic attacks negatively impacts the quantity and quality of sleep.

Poor sleep quality leads to a general decline in overall condition. This can further exacerbate panic disorder symptoms. Therefore, therapeutically, it is very important to improve nocturnal sleep quality.

The Body's Danger Alarm

Generally, panic symptoms are considered a sudden malfunction of physical and physiological responses that would naturally occur as a reaction to fear. It can be likened to a fire alarm malfunctioning and going off due to the smell of grilling meat.

The body reacts sensitively even to minor stressors, leading to a sudden surge of anxiety, agitation, and other responses. In the case of nocturnal panic attacks, breathing, heart rate, and muscle activity differ during sleep compared to when awake. These changes may act as triggers for nocturnal panic attacks.

After experiencing one or two nocturnal panic attacks, individuals may become so afraid of sleeping that they try to avoid it altogether.

Sleep Status is Important

If sleep itself is avoided in this way, the overall biological rhythm collapses. Deteriorating condition disrupts the balance of daily life, and anxiety and panic symptoms fall into a vicious cycle. Treatment is often quite challenging because it requires gradually reducing the frequency and intensity of panic attacks while simultaneously restoring the quality and quantity of sleep.

In cases of severe nocturnal panic attacks, stronger sleeping pills or anxiolytics may be prescribed. It is not uncommon to see patients who have concerns about such medications. Nocturnal panic attacks remain a topic that requires much more research.

Panic Disorder Treatment

For panic disorder symptoms, pharmacotherapy, including sleeping pills, antidepressants, and tranquilizers, is often considered. When symptoms are not well controlled, increasingly stronger medications may be used. At this point, issues such as dependence and tolerance to tranquilizers can become problematic.

It is generally known that dependence can develop when medication is taken for more than 3 to 6 months. Since it becomes increasingly difficult to reduce medication after long-term use, a very cautious approach is required when deciding on pharmacotherapy. In this context, we increasingly see cases where individuals consider traditional Korean medicine treatments in the early stages of panic disorder.

Traditional Korean Medicine Treatment for Panic Disorder

In traditional Korean medicine treatment for panic disorder, various therapeutic options are considered. Various treatments are utilized with the aim of relaxing body tension, alleviating anxiety, and reducing stress. You can receive help through various treatments such as acupuncture, herbal medicine, pharmacopuncture, Chuna manual therapy, and myofascial release therapy.

Additionally, breathing exercises help alleviate states of bodily tension and anxiety. Because breathing has a very unique aspect in that it influences the autonomic nervous system yet can be consciously controlled by us, especially when there are neuropsychiatric problems, various benefits can be gained through breath control.

Today, we discussed panic disorder.