Magazine article Clinical Psychiatry News

25% with Panic Disorder Experience Nocturnal Attacks. (Leader Fear of Sensations Tied to Sleep)

Magazine article Clinical Psychiatry News

25% with Panic Disorder Experience Nocturnal Attacks. (Leader Fear of Sensations Tied to Sleep)

Article excerpt

ALBUQUERQUE -- One in four patients with panic disorder experience frequent nocturnal panic attacks, Michelle C. Craske, Ph.D., said at a psychiatric symposium sponsored by the University of New Mexico.

This phenomenon, in which an individual awakens from sleep in a full-blown state of panic, has until recently been little studied and poorly understood. But a series of clinical studies led Dr. Craske to hypothesize that nocturnal panic represents a learned fear of bodily sensations associated with sleep and sleeplike states.

This in turn led her to develop a 12-session course of cognitive-behavioral therapy specifically tailored to address these issues. Its recent success in a soon-to-be-published clinical trial (see accompanying story) lends validity to this conception of nocturnal panic as a version of panic disorder characterized by fearful associations with sleep, according to Dr. Craske, professor of psychology at the University of California, Los Angeles.

When nocturnal panic occurs frequently-and in a significant proportion of patients with panic disorder it occurs weekly or even several times nightly-it can be highly disruptive. Affected patients often become afraid to go to sleep. They may rearrange their lives and change jobs in an effort to stay awake at night and sleep during the day.

Nocturnal panic is a non-REM event. It's not seizure activity; indeed, it's not associated with any EEC abnormalities. Nor is nocturnal panic related to sleep apnea or other sleep disorders, It typically occurs about 90 minutes after falling asleep, when a patient is in late stage 2 or early stage 3 sleep. Nocturnal panic is not related to sleep terrors or nightmares, which occur during stage 4 sleep, the psychologist continued.

The symptoms associated with nocturnal panic are the same as those accompanying panic attacks during the day: tachycardia, shortness of breath, and fears of dying or going crazy Both nocturnal and daytime panic involve heightened sympathetic arousal under conditions of acute stress, with a flip-flop to parasympathetic dominance and low vagal tone under non-challenging conditions. …

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