man overwhelmed with sleep apnea and daytime panic attacks looking out the window

Sleep apnea and daytime panic attacks – How they’re linked and what you can do about it

By Jason Wooden, PhD | March 26, 2019

Panic attacks and sleep apnea both make daily life hard.  They can also play off of each other and make a bad situation worse. 

Panic attacks can hurt sleep while sleep apnea can increase your risk for day time panic attacks.  Good news if you’re dealing with sleep apnea and daytime panic attacks – there’s a lot you can do for both.

In this article, we’ll talk about:

  • What’s a panic attack
  • The link to poor sleep
  • How sleep apnea and daytime panic attacks are connected
  • What you can do about it

A) What’s a panic attack?

You’re on your way to meet up with friends and all of a sudden you get an overwhelming wave of fear for no reason at all…

Or maybe, you’re at work and suddenly your heart starts pounding, you can’t seem to get enough air, and you get that feeling that something really bad is about to happen…

If you or someone you know has experienced something like this, it might have been a panic attack.

People with panic attacks experience sudden periods of intense fear even when there is no real danger.  It may include heart palpitations, sweating, shortness of breath, and a feeling that something bad is going to happen.

The attacks may last for several minutes or longer.  If it happens repeatedly you may be dealing with an anxiety disorder known as panic disorder.

Some panic attack symptoms:

  • pounding heart
  • sweating
  • trembling
  • shortness of breath
  • feelings of choking
  • chest pain
  • nausea
  • dizziness
  • chills or hot flashes
  • numbness or tingling sensations
  • fear of losing control
  • fear of dying

Some Panic Attack Symptoms:

  • pounding heart
  • sweating
  • trembling
  • shortness of breath
  • feelings of choking
  • chest pain
  • nausea
  • dizziness
  • chills or hot flashes
  • numbness or tingling sensations
  • fear of losing control
  • fear of dying

Some Panic Attack Symptoms

  • pounding heart
  • sweating
  • trembling
  • shortness of breath
  • feelings of choking
  • chest pain
  • nausea
  • dizziness
  • chills or hot flashes
  • numbness or tingling sensations
  • fear of losing control
  • fear of dying

In the US, panic disorder affects over 6 million adults with women twice as likely to be affected as men.  In Europe, 3% of the population will have a panic attack in any given year.

Did you know that some pretty famous people have had panic attacks?  Emma Stone, Sarah Silverman, Stephen Colbert, Kirsten Stewart, and Kim Basinger all have dealt with bouts of irrational fear.

Dan Harris, co-anchor of ABC’s Nightline, famously had a panic attack on air.  Barbara Streisand was unable to perform in public for years until she worked through her attacks.

While the causes are poorly understood, panic attacks are believed to be the result of genetics, thought patterns, stress, and other environmental factors.

Panic attacks can make daily life hard.  They can affect relationships and lead to many other problems if left untreated, including links to other health conditions like sleep apnea.

B) Panic attacks linked to poor sleep and sleep apnea

Stress and anxiety are known to make it harder to fall asleep.  Not surprisingly, people with panic disorder often have sleep issues.

Night time panic attacks can make it harder to fall back to sleep.  They have also been linked to sleep apnea, a common sleep disorder that affects over 18 million adults in the US alone.

For people with sleep apnea, breathing stops or gets very shallow during sleep.  These breathing pauses may occur up to 30 times or more in some individuals and affect the supply of oxygen to the body.

As your body becomes oxygen deprived, your brain will arouse you out of deep restorative sleep into a lighter sleep.  When you wake up in the morning, you feel unrested and miserable.

Some of the symptoms of sleep apnea and night time panic attacks overlap.

Do you have sleep apnea?

  • Pauses in breathing while asleep
  • Choking, gasping, or snorting sounds
  • Loud snoring
  • Dry mouth or sore throat
  • Difficulty staying asleep
  • Waking up frequently to urinate
  • Morning headaches
  • Day time fatigue
  • Irritability or mood swings
  • Attention or memory problems

Learn more

Do you have sleep apnea?

  • Pauses in breathing while asleep
  • Choking, gasping, or snorting sounds
  • Loud snoring
  • Dry mouth or sore throat
  • Difficulty staying asleep
  • Waking up frequently to urinate
  • Morning headaches
  • Day time fatigue
  • Irritability or mood swings
  • Attention or memory problems

Learn more

Do you have sleep apnea?

  • Pauses in breathing while asleep
  • Choking, gasping, or snorting sounds
  • Loud snoring
  • Dry mouth or sore throat
  • Difficulty staying asleep
  • Waking up frequently to urinate
  • Morning headaches
  • Day time fatigue
  • Irritability or mood swings
  • Attention or memory problems

Learn more

C) What’s the link between sleep apnea and daytime panic attacks?

While people with sleep apnea often experience mood swings and depression, the connection between sleep apnea and daytime panic attacks is not well understood.

Studies have found that sleep apnea patients do have a higher risk for panic disorder.

So, how could breathing interruptions at night lead to panic attacks during day?

Keep in mind the lapses in breathing may be up to 30 times an hour for some people.

One theory is that when your breathing is interrupted, the brain receives a panic signal to wake you up enough to resume breathing.  When repeated throughout the night, it can set off a constant fight-or-flight response which carries over into daytime.

A 2009 study of sleep apnea patients with anxiety symptoms found changes in brain areas involved with regulating emotions.

Another study looked at other things that could happen when you have sleep apnea episodes at night.  They found that as oxygen is deprived the build up in carbon dioxide can affect the area in the brain that triggers fear and panic attacks.

man overwhelmed with sleep apnea and daytime panic attacks sitting on couch

D) What should I do?

Panic attacks and panic disorder can make daily life hard. Sleep apnea can leave you feeling exhausted and miserable throughout the day.

By now, it should be obvious that they’re really bad together as they can play off of each other.

And let’s not forget that untreated sleep apnea can lead to other serious problems besides depression and mood swings.  It’s also been linked to high blood pressure, heart disease, stroke, and diabetes.

Panic attacks can wreck your sleep and keep you from getting the rest you need to get better.  Ignoring your sleep apnea can make it harder to manage panic attacks.

I think you get the idea – it’s really important to get help for BOTH your sleep apnea and your panic attacks.

E) What can I do for sleep apnea?

We’ve talked about the connection between sleep apnea and daytime panic attacks, so let’s make sure you’re doing everything you can do to tackle your sleep apnea.

Today, it’s a very treatable condition.  Sadly, most people with sleep apnea go undiagnosed and don’t get properly treated.

Here’s what you can do:

Get properly diagnosed – A sleep specialist can make sure you’re taking the right steps.  They’ll check for other things that may be hurting your sleep or contributing to your sleep apnea.  They can also help you try out different treatments and work with insurers to get them covered.

Lifestyle changes – For mild obstructive sleep apnea, changes in daily activities might be enough to help, including getting regular sleep and avoiding substances like alcohol that can relax your throat too much.

Change your sleep position – Switching to your side may help keep your throat open if you have obstructive sleep apnea.

Lose weight – Weight loss can help improve symptoms for some patients.

Get properly treatedCPAP (continuous positive airway pressure) is currently the gold standard for treatment, although some people find the mask and blowing air uncomfortable.  Don’t let this stop you, they’re now plenty of alternatives you can try besides oral appliances and surgery.

Learn more about sleep apnea treatment

More about the latest CPAP alternatives

F) What can I do for panic attacks?

Today, anxiety disorders are treatable, so there’s lots you can do.

Unfortunately, too many people don’t get help.

In fact, anxiety disorders affect 40 million adults in the US alone, yet only a third of people suffering receive treatment according to the Anxiety and Depression Association of America.

Here are some of the things you can do:

Find a therapist – A type of counseling known as cognitive behavioral therapy (CBT) can teach you different ways of thinking, behaving, and reacting to the feelings that come with a panic attack.  Learn more

Medications – They’re many different types of medications used to treat anxiety disorders such as panic disorder: selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), beta-blockers, and benzodiazepines.  Be sure to talk with your doctor about possible side effects.  Learn more

Lifestyle changes – Avoid substances such as alcohol, caffeine, and illicit drugs that can trigger or worsen panic anxiety.

Aerobic exercise – Light to moderate aerobic exercise has been shown to help with anxiety.  Learn more

Relaxation exercises – Deep breathing, mindfulness meditation, and muscle relaxation techniques have been used to help with panic attacks.  

     Learn more:
     Deep breathing
     Mindfulness meditation
     Muscle relaxation

Natural remedies – Herbal supplements that contain kava have been found to be helpful for some people with mild to moderate panic disorder.  Learn more

Get regular sleep – Quality sleep on a regular basis can help recharge the brain and improve your daytime mood.  That’s why its really important to get your sleep apnea treated, practice good sleep hygiene, and deal with any other sleep issues you may have.  More about sleep hygiene

Sleep apnea and panic attacks are treatable.  Take action today so you can sleep better at night, wake up feeling more refreshed, and take on the day with more confidence

Is CPAP giving you panic attacks?

Some people find the mask uncomfortable and may have panic attacks when first starting CPAP therapy.

Some things to try:

  • Practice wearing your mask for brief periods while watching TV
  • Do breathing exercises to help your body realize it can still breathe through the mask
  • Turn on your CPAP & practice feeling how your body reacts to the air pressure
  • Make sure you’re relaxed before bedtime
  • Wear the mask for a couple hours then a little longer each night
  • Ask your doctor about the “ramp” mode
  • Try a different mask

Is CPAP giving you panic attacks?

Some people find the mask uncomfortable and may have panic attacks when first starting CPAP therapy.

Some things to try:

  • Practice wearing your mask for brief periods while watching TV
  • Do breathing exercises to help your body realize it can still breathe through the mask
  • Turn on your CPAP & practice feeling how your body reacts to the air pressure
  • Make sure you’re relaxed before bedtime
  • Wear the mask for a couple hours then a little longer each night
  • Ask your doctor about the “ramp” mode
  • Try a different mask

 

Is CPAP giving you panic attacks?

Some people find the mask uncomfortable and may have panic attacks when first starting CPAP therapy.

Some things to try:

  • Practice wearing your mask for brief periods while watching TV
  • Do breathing exercises to help your body realize it can still breathe through the mask
  • Turn on your CPAP & practice feeling how your body reacts to the air pressure
  • Make sure you’re relaxed before bedtime
  • Wear the mask for a couple hours then a little longer each night
  • Ask your doctor about the “ramp” mode
  • Try a different mask

Summary: sleep apnea and daytime panic attacks

  • Panic attacks can hurt sleep
  • Sleep apnea can increase your risk for daytime panic attacks
  • They can play off of each other
  • It’s important to get both treated
  • There’s lots you can do to for both

Sources:

1. “Panic Disorder: When Fear Overwhelms”, National Institute of Mental Health website.

2. “Facts & Statistics”, Anxiety and Depression Association of American website.

3. American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 214–217, ISBN 978-0890425558.

4. “What are causes and risk factors for panic attacks?”, MedicineNet website.

5. Sleep apnea and panic attacks. Comprehensive Psychiatry 1991, 32(2):130-132

6. Comorbid depression in obstructive sleep apnea: an under-recognized association. Sleep Breath. 2016, 20(2):447-56.

7. Sleep Apnea and Risk of Panic Disorder. Ann Fam Med. 2015, 13(4):325-30.

8. “How Sleep Apnea Can Cause Stress and Panic Attacks”, Alaska Sleep Clinic website.

9. Neural alterations associated with anxiety symptoms in obstructive sleep apnea syndrome. Depress Anxiety. 2009, 26(5):480-91.

10. The Amygdala is a Chemosensor that Detects Carbon Dioxide and Acidosis to Elicit Fear Behavior. Cell. 2009, 139(5):1012–1021.

11. Obstructive sleep apnea: current perspectives. Nat Sci Sleep. 2018, 10: 21–34.

 

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