How Sleep Apnea Can Cause Anxiety And Panic Attacks
December 8, 2009
As we approach the most stressful time of the year, the one thing that we all forget to do is to remember to breathe. Literally. Tension and stress causes a nervous system reaction that causes you to take short, shallow breaths, leading to carbon dioxide (CO2) retention. Interestingly, a recent study showed that increased levels of carbon dioxide has been shown to affect areas in the brain that triggers fear and panic attacks.
This makes sense since if you’re chronically oxygen deprived from not breathing at night due to sleep apnea, you’re going to build up carbon dioxide, which can increase the acidity levels in the amygdala, which is the area of the brain that processes fear and behavior.
This biochemical reaction, along with generalized nervous system over-responsiveness that comes along with inefficient sleep, is a good reason for you to feel over-stressed, over-anxious, and on edge. I’ve also described a situation where your tongue suddenly collapses and obstructs your breathing, and you’ll wake up violently, in a state of panic, in a cold sweat, and with your heart racing. This happens much more commonly than you think.
This study makes me wonder what all the carbonated beverages are doing to us as a society.
What’s you’re take on this? Do you find yourself taking short, shallow breaths or even hold your breath when you’re stressed? Please enter your comments in the box below.
41 Responses to “How Sleep Apnea Can Cause Anxiety And Panic Attacks”
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What about adrenalin’s role in anxiety? I understand that when long apneas occur, the body produces excess adrenalin.
Roger,
Absolutely! An apnea by definition causes a sympathetic nervous system response. This study merely isolated carbon dioxide’s effect on the brain’s fear and anxiety centers. I’m sure there are thousands of other mechanisms or pathways that apneas can cause.
Thank you for the interesting article. I’ve always had anxiety – generalized anxiety disorder, obsessive compulsive behavior and panic attacks. After I was diagnosed with sleep apnea and started using a cpap machine they went away!!!! I wonder how many other people suffer anxiety caused by a sleep breathing disorder.
Marie, much more often than you think. There are even reports of severe PTSD going away completely after sleep apnea treatment.
My daughter has problems sleeping at night due to anxiety attacks. How can sheget rid of the attacks and is there something that she can take to control them
I have been having episodes of high blood pressure, severe headaches, fast pounding heart,and sweating over the last 14 months. Episodes used to be once a month and never last more than 20-30 minutes. I feel fine once the episode ends. My doctor had me do 3 24hr catechlolamine tests. All 3 tests were 5 times above normal for metanephrines. I am scheduled for MIBG scans on May 26-28 2010 to rule our Pheochromocytoma. I do have sleep apnea and stopped using my CPAP about 18months ago because it was causing me to wake up with the fast heart rate. I am starting to wonder if my symptoms are sleep apnea or if it's just a coincidence that these sporadic episodes of HBP, fast pounding heart rate could be Pheochromocytoma. Can sleep apnea cause an increase in your metanephrines? I felt my CPAP was ramped to high, and that was causing me to wake up every couple hours with the fast heart rate. My only symptom prior to being diagnosed with sleep apnea was the headaches. What is your take on all of this? thank you, Cindy
Cindy,
I’m not aware of any study that shows increased metanephrines from sleep apnea, but I wouldn’t be surprised if there is. You should go ahead and treat your possible pheo condition. However, if you have sleep apnea, it can cause similar symptoms, such as causing headaches, taking up with a fast heart rate, and sweating. It should be treated simultaneously. It’ll be interesting if you’re able to control your sleep apnea definitively—does it help your pheo-like symptoms. Good luck.
4 months ago I did A sleep apnea test but because Im very claustrophobic I didn’t do the CPAP.Soon as they but the CPAP mask on me I had A panic attack fear of suffocation.now in the last 10 days I went to the E/R five times.I now have anxiety attacks, shortness of breath, tremors and twitches,nervous breakdowns,pounding heart,insomnia and Im very depressed.The E/R Doctors told me I have sleep apnea and Im going to need A CPAP to sleep.what can I do Im still claustrophobic but I need it to live.what can I do.PLEASE CAN YOU HELP ME.Im very depressed .Thank You
Mr. Guzman,
There are other options for treating obstructive sleep apnea including oral appliances and surgery. Please check my Sleep Apnea Basics page on my homepage at http://doctorstevenpark.com.
This link is sooooo true I bet this is the MAIN cause of my anxiety and panic disorders. I have been battling with anxiety and panic attacks for 6 years. It is a degenerative condition that has progressed to the point now I live in a daily consistent panic attack. I do have some very real physical symptoms as well including strange pains that appear in my upper torso and constant eye floaters (the squiggly lines that pass through your vision).
Some days I wake up and feel great, I have no floaters, I can take on the work and have no panic. Others days are the complete opposite but the common thread is that they are tied together (Panic, Difficulty Concentrating, Edgy/Irritable, Eye floaters and weird pains).
I was diagnosed with Moderate OSA three years ago. I was given a CPAP machine but unfortunately for me it does not always work. My apneas are occurring somewhere in my throat that the air pressure concept can’t keep open. I went to an ENT this summer and had my tonsils and uvula removed as they were each the size of golf balls (ENT’s word not mine). Although this stopped my snoring it did not fix my OSA as my wife says now I sound like air is whistling in my throat when I sleep (she describes it as a silent snore). My panic attacks are so bad now that I can hardly function and I can guarantee it has to do with sleeping. You know you have a sleeping disorder when you are no longer tired anymore. This is a hard concept to explain but it is like your body is trying to fight though the constant tiredness so hard and for so long that your mind retrains itself to exist in this new state of awake’ness. The side effect of this “fighting though” the tiredness is the panic attack. Whatever chemical your brain is outputting to keep you alert is over stimulating the fight or flight reaction.
Here’s the rub – I would like to think that OSA can be fixed by losing weight, wearing a CPAP or other surgical procedures but I am just not sure. I just found out this summer that Percy Harvin an NFL football player who suffered from constant headaches was diagnosed with OSA. If a man of his extreme physical condition can suffer from OSA I am convinced this is more of a generic build flaw in some peoples months and throats than it is a condition that can be treated. I smoked for 10 years and I think this had some effect in acting as a catalyst to the chronic apneas. I quit cold turkey some time ago because of how sever the attacks were. Anyone who has smoked a pack or more per day knows how bad it is to quit yet because of how bad my panic was and how each cigarette compound the panic attacks by at least double I quit as simply as changing from bottled soda to caned soda. I read something on the web about CO2 levels and panic attacks and then OSA and CO2. I will say that this CO2 deal has to be spot on. OSA and cigarettes both modestly increasing CO2 levels are what trigger and cause my panic attacks.
Most recently I have joined a gym as I am 35lbs overweight and I think a large amount of that fat is in my neck. I hope (pray) that the combination of quitting smoking, losing weight, having tonsils/uvula removed and using a CPAP machine will cure my OSA thereby my panic attacks but I am not so sure as I have lost 15 so far, quit smoking, 6 months past surgery and it is worse than it has ever been. The more drastic OSA procedures are very expensive and my insurance does not cover them. I have read that OSA can return some years after these procedures as your mouth/throat can reform.
Mr. Harig,
Thanks for your input. Removing your tonsils and uvula alone won’t cure your sleep apnea, unless you address your tongue definitively, and not using minimally invasive techniques. But before considering further surgery (soft tissue or jaw surgery), did you do everything possible to make sure that you’re CPAP options are exhausted? Did you ever use data from the CPAP machine to see what your AHI is during CPAP use? Did you ever consider a dental device for your sleep apnea?
I am a 35yo slim healthy woman who’s recently been diagnosed with mild/moderate apnea. I was relieved as I’m active but feel like I’ve been fighting tiredness for years. I’m currently waiting for an oral appliance, which I opted for instead of CPAP (Dr suggested CPAP). About a year ago I began to have panic attacks. I put it down to a series of stressful life events but more and more I’m suspecting a link between the apnea and anxiety; or that apnea has made the anxiety worse. On the days when I wake up super exhausted, I’ve noticed I am much more prone to dizziness and panic. If I have a rare day when I wake up feeling less tired, I notice I have almost no symptoms.
I guess some of this could be self-fulfilling (ie I’m so tired, now I’ll be more anxious), but I’m hoping that with improved sleep, I get improved anxiety.
It’s been mindblowing to learn that panic and sleep COULD be linked. I thought perhaps stress/anxiety was why I was so tired, but the apnea may actually causing the anxiety?
Fingers crossed that with my soon-to-arrive positional sleeper and oral appliance I get a decent sleep and maybe a break from anxiety too.
Steven,
Any suggestions on mouth appliances?
I was diagnosed with anxiety about 10 years before I was diagnosed with Sleep Apnea. I followed a lot of methods to tone down the Generalized Anxiety Disorder (which was caused in large part by work stress) – meditation, exercise, therapy and drugs. I still take Celexa daily for controlling my anxiety.
I don’t know if I had apnea that long before it was diagnosed or not, but I’ve had that under control for the past 4 years. So good on both fronts.
Unfortunately, I have a bronchial infection & was given Combivent for it – which is adrenalin. So have had some serious hours-long anxiety/panic attacks again. I did NOT miss them.
I was hospitalized in September 2010 for an insect bite that turned into cellulitis and required iv and oral antibiotics. I had an anaphylactic reaction to the antibiotics that were being used to treat me and the allergic reaction was life threatening. After the allergic reaction was stopped and the infection was treated I was released from the hospital. Since that time I have had recurrent symptoms of numbness in my tongue and throat, dizziness, blurred vision and gasping/gulping for air. My blood pressure is also higher (140/80) now and before my hospitalization it had been 115/60 on a consistent basis. The symptons come and go at sporadic times and can last for minutes, hours or days. I have seen doctors specializing in endocrinology, infectious disease and psychiatry as well as my personal physician. The doctors all agree there is some physiological cause for my symptons that is causing anxiety. Since a culture of the insect bite was never taken I have been told it is nearly impossible to find the exact cause of the origin illness. My husband noticed that since my release from the hospital I wake up at night gasping for air and shoot straight up in bed. This only started occuring after my release from the hospital in September. He believes I have sleep apnea. Is it possible the illness is causing anxiety which is in turn causing sleep apnea? I am at my wits end. I went from being in excellent health to days where I can barely function. I am frustrated with all the doctors appointments I have been to with no specific diagnosis, treatment or cure. I have been told that this will get better in time. It has been over 6 months and I cannot possibly imagine continue to live with these symptoms. What should my next step in seeking treatment and what type of doctor would you recommed. I greatly anticipate your suggestions!
Natalie,
It’s more likely that you were always predisposed to sleep apnea anatomically, but the sequence of events after the insect bite tipped you over the edge. If does sound like you have sleep breathing problems, so you should see a sleep medicine doctor. Hopefully, once your sleep quality improves, your symptoms will improve significantly.
i have had anxiety and depression for 6 years now. i am 32 years old. i have been having strange thinngs happening in my sleep. i will be dreaming that something or someone is choking me and i will try to speak but cannot and then i wake up abruptly. i recently had a dream where i was singing and all of a sudden i didnt have enough breath to get out the words and i woke up with a physical feeling like i would have died if i hadnt forced myself to wake up and breathe… very scary. i do have acid reflux. i feel horrible during the day, no energy,terrible anxiety. my problem is i have no insurance and cannot afford a sleep study. does this sound like sleep apnea. i would so appreciate any suggestions or help in this matter..
i am a ministers wife and i am in desperate need of help. i feel like i am losing the battle with this. i am so overwhelmed by all the things that i need to do and want to do but i have no energy to do them. i am scared to death!!!!
Karen,
Sorry to hear about your situation. It can be frustrating and difficult to suffer from this condition and not be able to afford the very expensive tests. The treatments can be expensive as well. Sometimes starting with the basics can help, before going on to formal diagnosis and treatment. Make sure you’re able to breathe through your nose. Try nasal saline and/or breathe right strips. Take care of any allergies if you have any. Don’t eat or drink alcohol within 3-4 hours of bedtime. Don’t sleep on your back. Practice deep-breathing exercises during the day (restorative yoga is a good option). There are a number of tongue exercises that can help. Even acupuncture is found to help somewhat. There are also inexpensive screening options for sleep apnea. Oral appliances can also help. These can be over $1000 and work very well, but sometimes, over-the-counter boil-and-bite mandibular advancement devices (under $100) can also help. One model is called Somnoguard Classic. Hope this helps.
Unfortunately, there are major hurdles in allowing people with sleep-breathing problems to get treated, even if you do have insurance. This reminds me to do some more research on how you can take care of sleep apnea if you have no insurance. I’ll probably either write an article about it or do a teleseminar.
when i was a child i broke my nose on monkey bars. i do have one nostril that is ubstructed . i cant breathe well through that side. throughout the day i will feel like something is shoved in my nostrils making it hard to breathe. i have had my heart checked, my lungs checked and they say nothing is wrong. the only thing i have been diagnosed with is diabetes. does what i described earlier about the dreams sound like sleep apnea? i understand if yoyu are not able to tell me that, but i thought i would ask. i literally cannot go on like this. the physical symptoms, the fatigue, the anxiety are just to much for me to deal with anymore.. its driving me crazy and i feel like i need professional help. i feel like if i KNEW what was wrong i could deal better but the not knowing and wondering is Hell on earth…
Karen, I think what your anxiety and exhaustion may stem from is actual over-breathing. When you can’t breathe thorough your nose, you end up breathing through your mouth. The problem with this is because there is nothing inhibiting our breathing we tend to over-breath without realizing it. Really try to slow your breathing down and take smaller breathes. DO NOT fill up your whole chest. This can lead to shortness of breath very quickly because our body interprets that wrong. Give this a try and see how you feel after a couple a few weeks. This may be way off the mark but think its worth a try.
going on about 5 months now, i have been struggling off and on (way more on then off), with shortness of breath on a daily, regular basis. around 2 months ago i sought the help of a pulminary doctor. I have since had a lung funtion test, ashma test, cat scan, x-rays, and sleep study’s done. I have recently found out that i have sleep apnea and possibly narcolepsy. All other test’s have come back negative.still, the doctor cannot figure out what is causeing these breathing symptom’s all day, everyday. there will be little spirt’s from time to time where i feel much better, compared to usual, and can breath better (still not normal),but there short lived and it returns to troubled breathing, and has really disrupted my whole life. ive tryed inhalor’s and breathing treatments to no avail. Could it be that the sleep apnea is causeing me to have this breathing problem? Or could it be sumthing that has stemmed from the sleep apnea, such as sumthing with the heart? im just now beginging to be treated with CPAP machaine so i dont know if it will fix this long, ongoing issue. Hopefully you can give me sum suggestion’s and other routes to go with this issue..Thank you
(added to above question)….with my shortness of breath, it seems if i make myself yawn, time and time again im able to get a good deep breath more times then not…im 27 years old, not to obese, could probably lose 20 lb’s..just never feel like i can get a good deep breath when wanted and always, constantly short of breath..active or just sitting around..thanks for the help
I am from nigeria.i found your post very helpful.i have been having anxiety attacks about two year ago,but i got tired of it and decided to put a stop to it.i didnt know the cause so i decided to google the cause of my heart palpitation and found out it was anxiety disorder.i didnt want to go to the clinic at first because i thought breathing excercise could cure it but it helped but it didnt go,but it helped.so i went to the hospital and i was diagnosed with anxiety disorder and was prescribed with tryptizol the anxiety went away after two weeks(as my psychiatry lecturer taught us)but now after two weeks it has resurfaced and i cant concentrate and i’m in first year in medical school.i think it should be sleep apnoea because when i sleep on my side it gets better the next morning but sometimes i end up rolling on my back.pls help.i think it has to do with the accumulated co2 diffussing the blood brain barrier and ionizing to H+, now increasing my heart rate to compensate for d hypoxia and hypercapnia.pls what can i do,i cant concentrate in classes and my exams re nearing.pls help!!!any help would be appreciated.thank you sir.
Ahmed,
Whether or not it’s sleep apnea, you’re still having obstructions with abrupt awakenings. This is also why it’s better when you’re on your back. It’s important to follow my basic recommendations first, before diagnosing and treating more formally.
1. don’t eat or drink alcohol within 3-4 hours of bedtime
2. use Breathe Rite strips or any other type of nostril dilators
3. take care of any allergies or nasal congestion
4. try using one of the simple over the counter boil and bite devices for snoring
5. do breathing exercises all the time.
If this doesn’t work, then you’ll need a sleep study. Your options then include CPAP, formal oral appliances, surgery, or orthodontic jaw expansion.
Good luck!
Thank you for this article, it has helped me with the sudden onset of panic attackes.
This was very en lighting information. I have not been tested for sleep apnea, but all of my siblings have it and I seem to have some of the same symptoms. Some days I feel so exhausted when I wake up. It’s like I have ran 5 miles not stop and I need to get some rest. My husband wakes me up during the night to tell me to roll over on my side or stomach because I snore, and if he does not wake me up, I am awakened by simply choking.
My anxieties arise when I am on the freeway and I do not have to be driving. After hearing so many other testimonies I am going to consider get the sleep apnea test to see if that is part of my problem.
Yvette,
Sounds like a great plan. Good luck.
I too have sleep apnea which would also trigger panic attack. I was divorced and single for 13 years and remarried 3 years ago which has literally been a God send. After being married only a short time my wife asked me if I would have a sleep study performed. Not to mention that respect my wife’s opinion, she also happens to be a registered nurse & registered respiratory Therapyst. She know I was suffering from severe sleep apena. She set it up with a coleage to have the sleep study. I was qquickly diagnosed and sent home with a cpap. I now sleep wonderful and never intentially go to sleep without my cpap on. I have had only one panic attack in the Last three years since using the cpap, and the one panic attack that I did suffer was from falling asleep on the couch shortly after eating when I did not have the cpap on. Thank God for my wife and for CPAP , i just can’t explain in the quality of life living without sleep apnea and panic attacks. P.S When i did suffer the lazt panic attack, I put on my cpap while standing up and just normal breathing the panic attack soon passed, I truly hope this is of help to anyone that might be suffering from similar conditions. Mike
I was diagnosed with sleep apnea a few years ago. I recently have been having anxiety attacks and I have been very paranoid. I’m curious if my sleep apnea has something to do with that..?
I was diagnosed with OSA approximately 3 years ago and was treated with CPAP, which unfortunately didn’t produce any positive results in my quality of sleep. I too have chronic anxiety and morning fatigue which I believe is directly related to the poor quality of sleep as a result of OSA. About 2 years ago, I was seen by an orthodontist for a consultation for braces due to a cross-bite (note: I had previously had braces when I was a teen). One of the first questions he asked me was whether I had OSA. After he explained to me that my jaw structure is characteristic of someone with OSA, I met with an oral surgeon for an evaluation. Since then, I have been working closely with my oral surgeon, orthodontist, and dentist as I prepare for MMA with genioglossus advancement in approximately 1-2 months. I’ve read that this procedure has a >90% success rate in eliminating OSA, but am curious, Dr. Park, what your thoughts are on how successful this procedure truly is and whether patients who’ve had it have seen a reduction in anxiety-related symptoms as well as improvement in their quality of sleep.
Richard,
The MMA is a highly successful procedure (~90) but not without risks. When performed by an experienced surgeon, complications should be minimal. There are mixed opinions on obstructive sleep apnea and anxiety, but my feeling is that anything that helps you to sleep better can help with anxiety symptoms. Good luck.
I wake up violently @ night and i fell like im having a major heart attack. It’s truly a horrible sensation to wake up with every night. Ive woke up several nights from choking in my sleep. I suffer from bad anxiety a lot and panic attacks.
Mr. Alcantar,
It’s likely you’re having obstructions that are causing you to wake up violently. These episodes may not last long enough to be called apneas, but either way, it should be treated like OSA. You should consider seeing a sleep doctor about this.
Dr. Park,
Thanks for the response and your confidence in the procedure. Just to give you a quick update, I am scheduled for the MMA with genioglossus advancement on March 7th. I will do my best to provide you an update on the status of my sleep apnea and the quality of my sleep post-operatively. It may be a few months, but I will let you know.
I have trouble getting over the climax of a yawn for quite some time now. It feels as though I am choking. Sometimes I feel like take very shallow breaths and I wake up just before i fall asleep. There are also days when I wake up feeling like I have not slept at all. I have allergic sinusitis. Are they related? What do you think?
I need to know what i can take before i start the sleep Apnea test so i can tolorate the test with out having a panic attack when i have to ware the cpap machine have failed in the past
This has been the most help for me!!!!!!! I have seen many doctors and have been having problems with Sleep Apnea for a year now. Nobody likes to think that anxiety could be the culprit. But it is a dirty double bladed sword! You have to manage your anxiety in order to sleep.
With restless sleep from anxiety and burst of adrenaline from sleep apnea……….plays tricks on your mind. You can feel anxiety, but sleep apnea is always in your mind.
Manage your stress, meditate, and dedicate a solid 7-9hrs each night…….build barriers to reinforce this and do not deviate from it. I own my business but with my health condition…….I have no choice. Know your limitations! Managing your life is living.
I have bad anxiety attacks also. I also have apnea but quit using the machine and now anxiety attacks are much more frequent. My doctor said I quit breathing 177 times during my sleep study. I find myself gasping for air, heart beating through my chest and racing thoughts. I’m going back to my CPAP machine to see if it will scale back or eliminate the panic attcks. Seems to me if you’re not breathing you brain would go into fight or flight mode thinking your being choked out.
Anyone experience this? I expected I had sleep apnea, heavy snoring, daytime tiredness, could also fall asleep in seconds and go immediately into deep dreams…then I started waking up in middle night with heart beating fast, feeling I could breathe. Went to ENT doctor and prescribed a sleep test. Went for sleep test, tossed and turned during the first part of the test (without a mask, to see if I met protocol for 2nd part of test with mask), fell asleep finally for only 30 minutes, woke up in panic, had to rip off all the electrodes and get out of the room. Literally couldn’t stop moving, walked around the building for hours. Turned out I stopped breathing 37 times in 30 minutes, diagnosed with severe OSA. Went another week, woke up in middle night, in panic again, and once again had to keep walking/staying in motion. Felt like I couldn’t breathe and I stayed up all night walking around my neighborhood, couldn’t stop moving. Ended up in ER next two days, felt hot, and felt like I was suffocating. Almost had to strap me to bed in ER since I wanted to get up and keep in motion. Next got sent to behaviour center for group therapy/CBT. Prescribed Ativan/lorenzapram which finally settled me down and I could stop walking. This went on and off for next few months. Had surgery to fix deviated septum, did fine in surgery, but in the recovery room they taped gauze over my nose which impeded my breathing, and the anxiety/panic started, first with feeling of body warming up (I had to rip the hospital slippers/socks off), then the pacing/walking mode started again. Went on for 3 days, literally walked around my neighborhood 24/7 for 3 days, and then it stopped instantly with a wave of calmness. Went to a computer class several weeks later, all of sudden room started warming up, I pulled off all my layers of shirts, but had to leave. Couldn’t sit in place and had to get moving/walking. This time it only lasted for the morning. That was a year and half ago, haven’t had another attack since (knock on wood). I did get the CPA way back and use it 100% of time. Nasal surgery also opened up my breathing/nasal passageways. And I went on heavy exercise cycling program. Probably a combination of things appear to have solved the issues.
But…anyone else ever have the feeling that they couldn’t stay in place and had to get up and keep moving? Literally pacing back and forth in the house, then outside, I must have walked about 25 miles a day (for real!). I felt like the bus in the movie Speed — that couldn’t slow down below 50!
I’ve seen mention of restlessness in limbs, but this was way beyond that. I think if they had strapped me to the table I would have ripped/burst the straps to flee and get moving.
I was in the hospital and noticed that I was having breathing problems at night. I also have asthma, but fortunately one of the nurses was willing to give me oxygen and I noticed that I felt much bettter and less anxious. That got me to thinking, so I asked my doctor if he could order an overnight pulse oximetry test…these are much easier and less expensive than sleep studies; you can ask your local oxygen company how they charge if you’re not insured, but otherwise most insurance covers this test. You just clip a sensor on your finger overnight and then they examine the data. This is a pretty easy way to get an idea if you have sleep apnea episodes and if your oxygen saturation is below a certain level, most insurance will cover an oxygen concentrator. Something to consider for those who can’t do the sleep study for whatever reasons….Good luck!