What Causes An Sudden Dramatic Wakefulness While Sleeping With An Intense Sense Of Panic?

Posted on Mon, 16 Jul 2018

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Mon, 16 Jul 2018 Answered on

Wed, 14 Sep 2022 Last reviewed on

Question : 1. Lately when I go to sleep I wake up in a dramatic & intense sense of panic & it feels like I can't breathe & that I am suffocating. Then I return to sleep & it can happen again several times in the same sleep session. This happens to me a few times per week but not every night.
2. I do notice that I have these panic symptoms usually when I am psychologically overburdened & when I am under work stress or family stress.
3. I think that that these symptoms are panic related & not related to sleep apnea- but I need a professional opinion. Thank you very much.

Answered by Dr. Seikhoo Bishnoi (19 minutes later)

Brief Answer:
Please provide me more details

Detailed Answer:

Hello,

Please provide me more details about you. What is your weight and height? Any history of hypertension and diabetes? What kind of work you are doing? Do you have stress at work place?

Before reaching to a conclusion the sleep apnea should be ruled out. Other thing that should be ruled out is cardiac condition. Did you get your EKG done?

Thanks

Please provide me more details in follow up.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Seikhoo Bishnoi (23 hours later)

1. I am 5' 7" tall & I weigh 162 lbs

2. I do not have hypertension as by bp is usually less than 120/80 & my AC1 is 5.6; I am under the care of a cardiologist & have had my EKG done several times most recently about 6 months ago & things were ok;

3. I am a criminal trial lawyer; I do have tremendous stress at the work place; I also have a lot of family stress

4. A few years ago I was 172 lbs & my red blood cell count was high. I was diagnosed with sleep apnea. Back then & I would have the panic symptoms while sleeping on some occasions. Then a few months later I lost about 10 pounds and was retested. At the retest I used a specially firm pillow & slept on my side. Under these conditions I was not diagnosed with apnea.

5. Now these panic symptoms seem to have returned with some intensity. I do notice that I have these panic symptoms usually when I am psychologically overburdened & when I am under work stress or family stress.

6. That us what leads me to think that that these symptoms are panic related & not related to sleep apnea- but I need a professional opinion. Thank you very much.

Answered by Dr. Seikhoo Bishnoi (1 hour later)

Brief Answer:
This could be anxiety but other causes should be ruled out

Detailed Answer:

Hello,

Your BP is normal, you have no diabetes and EKG was normal so we can rule out cardiac causes easily. Your BMI too is normal so I don't think this is due to apnoea during sleep. You are 47 and at this age in obese individuals there is risk of apnea but your BMI is normal and all cardiac work up came normal so I don't think its related to apnea.

You are a lawyer and have stress at work. You mentioned that the incidences of such episodes increase when you are in stress which also favors anxiety as most probable cause of these symptoms. But in most individuals anxiety occurs more during day time and its very unlikely that isolated episodes occurs in night. Non refreshing sleep, multiple awakening can result in palpitations and this could mimic panic symptoms. We can provisionally put you in this but panic or anxiety alone as diagnosis is not sufficient. Sleep study is needed in order to confirm the cause.

Other option is to give a trial of low dose anti anxiety drug like Paroxetine which will help in improving the sleep too and will reduce the incidences of panic symptoms.

You can talk with a psychiatrist for this. Paroxetine is a safe drug and has no serious side effects if taken as per prescription.

Thanks.

Please let me know if you need more help.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar