My Two Major Panic-Anxiety Episodes

In this modern age of anxiety, it’s almost a given that you’ll have some anxiety over certain things, such as financial, health, relationship, or academic concerns. If you have a sleep-breathing disorder, it’s likely your stress and anxiety levels will be much higher. Any degree of sleep deprivation or inefficient sleep can heighten your nervous system, and make you over-react to situations that normally wouldn’t stress you out.

Looking back, I distinctly remember two episodes in my life, where I had some major panic attacks, beyond the typical life stresses or anxiety provoking states, such as death, relationship issues, or even job interviews.

I’ve always considered myself an introvert, but not shy. In high school, I was active in music (orchestra, symphonic band, and the jazz band), was captain of the track team, and was active in science research. I don’t remember having any problems giving presentations and speaking in public, but that changed once I got to medical school.

In the second year of medical school, I was sitting in a small psychiatry class, where each student had to interpret and critique an interview that was just observed. For some reason, as my turn came near, I could feel my heart pounding away, and broke out in a cold sweat. My heart was beating so fast and intensely, I though I was going to have a heart attack and die. Even my kidneys hurt. Fortunately, I said a few words about the interview, and didn’t die. This type of panic and anxiety persisted to some degree for the rest of the year. Fortunately, by my my third year clinical rotations, it problem went away completely.

The other situation that I remember was after a major highway car accident during residency. I was driving along with Henry Hudson Parkway at night in the express lane, and saw from the rear view mirror that there was a car that was zig-zagging from lane to lane. Within an instant, I saw that he was high beaming me on and off, and then he rammed into me while speeding over 100 miles per hour. My car got pushed onto the divider, turning almost 90 degrees, and I though I was going to flip over and die. Fortunately, my car slid back down and slid along the right side of the elevated highway for another few hundred feet. My car was totaled, and I was taken on a backboard to the ER at Columbia. I came away with only the shock of the experience, but for about a few months after this incident, whenever I saw a car change lanes into my lane behind me, I would have mild panic attacks.

Looking back at both incidents, I was in a period of time when I was majorly sleep deprived. During second year medical school, I was not getting enough sleep due to the various demands of all the courses. During residency, I was still taking first call, working about 100 to 120 hours per week. This is like having a short bout of PTSD, or post-traumatic stress disorder.

The point I wish to make here is that if you don’t sleep long enough, or if your sleep is inefficient (like with sleep apnea), then you’re more likely to suffer from anxiety or pain attacks. My examples are the more extreme conditions that can arise, but most people just get upset a bit quicker or over-react inappropriately in certain situations. This is why good, quality sleep should always be a top priority in your life.

Do you have any experiences where major sleep deprivation caused you to have increased anxiety or pain attacks?

Please note: I reserve the right to delete comments that are offensive or off-topic.

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8 thoughts on “My Two Major Panic-Anxiety Episodes

  1. this morning I woke up with a start realizing that my tongue retaining device was in my hand, and that I had just let myself sleep without protection during REM sleep and that I was going to have a bad day. I had so much anxiety about this that I was wide awake and unable to go back to sleep, and in a bad mood for hours (on top of the usual fog from what happened). but I knew that at some level the anxiety was probably because I had been struggling to breathe in my sleep, and my sympathetic nervous system was going to just need a lot of calming down.

    but what I realized was that a big part of my frustration was because I felt so out of control, and I started wondering if people with sleep breathing problems tend to be “control freaks” because they have this low grade subconscious sense of being out of control (of their ability to breathe). I know you have seen associations with SBD to anxiety and you comment in your book about OCD starting in early adulthood, but have you noticed a correlation with OCD type behavior? I realized this morning that my control-freak-ness started within a few years after I had orthodontia; I was NOT like this as a young child at all.

  2. Dr. Park. I have Apnea and use CPAP. Recently I have been waking up in a panic attack state with elevated blood pressure and heart rate. My girlfriend says that I am stopping breathing even with VPAP on. I am a cardiac patient with recent angioplasty and stent surgery, and am taking Plavix, metaprolol beta blocker @ 25mg BiD, and aspirin, this lowers my heart rate to 45bpm and BP to 120/80, and thins my blood, and makes me very tired during the day. Your thoughts please? And, should I have another sleep study to adjust the VPAP pressures upward now?

    Thank you.

    Jon

  3. Thank you so much for replying promptly, and taking the time to do so. On one of previous titration PSGs, the report stated ” 15.5 arousals most of which were spontaneous”. I’m using a dental appliance, but the throat is still closing. The dentist (specialist in sleep) intructed me to forward it another notch, but it hurts at this point, but hopefully I can gradually tolerate it. The other PSGs including this one did not mention “spontaneous” in the general report. No need to reply just thought I’d throw that in. Thank you so much Dr Park.

  4. Dr. Park,
    First of all, I’d like to say that I wish more doctors are like you to reach out for patients and get them understand their medical problems. I truly enjoy you teleseminars and articles.

    I have been suffering from sleep apnea for quite a few years and have been using CPAP for 2 years (only being diagnosed 2 years ago). CPAC does improve me sleep to some degree, but I do noticed that I have increasing episodes of panic attack and periods of anxiety. I have been given lorazopane and pexil on and off to deal with it in the past 2 years. SinceI have a very stressful job and I am a somewhat a perfectionist, I have always thought my sleep problems (insomia, apena) are cause by anxiety. Now hearing your experiences, I may have to think the other way around, that is sleep deprivation probably triggers my anxiety (sometimes quite severe). In order to understand this relationship better, may I ask you a question: In you clinical practice, do you see correlations between sleep apnea and anxiety? In other words, do most sleep apnea patients often report that they worry things a lot.

    Regardless which causes what, I really like what you said ” good, quality sleep should always be a top priority in your (our) life.”

  5. May,

    Thanks for your feedback. If you’ve been on CPAP for 2 years, it’s possible that your pressure needs to be re-calibrated. You should talk to your sleep doctor about this. The more I talk with patients and people over the internet, and the more I read the research studies, the more I’m convinced that sleep deprivation of any kind can aggravate anxiety issues. It’s only natural that heightened senses from chronic sleep deprivation can aggravate, if not bring on anxiety issues. Dr. Krakow and I talked a lot about anxiety and sleep in my November Expert Interview. If you haven’t listened to it, i strongly recommend that you download it. Good luck.

  6. Dr. Park,
    Thank you very much for your quick response. I did have another CPAP tatrition study recently and my doctor said the pressure needed remains the same which is 6, which is a kind of relief. (Is it true that the higher the pressure neede, the more severe is the apnea?) I also enjoyed listening to you interview with Krakow. I totally agreed with both of you that there is such a disconnection among most doctors in treating sleep disorders and psychological problems. They are indeed hands-in-hands, causing vicious cycle, at least in my own experiences.
    Thank you so much for taking the time to educate us, your “out” patients.

  7. May, it’s likely that your CPAP machine is preventing your apneas and hypopneas, but not your smaller partial obstructions and arousals, which can only be done by the technique that Dr. Krakow describes, where you completely normalize the nasal airflow tracings. Unfortunately, most sleep doctors may disagree with Dr. Krakow, stating that getting rid of apneas and hypopneas is good enough. In general, the lower the pressure, the lower the severity of sleep apnea, but when you get too low, you’re getting into upper airway resistance syndrome territory. This produces multiple micro-obstructions and arousals that are not treated with typical PAP therapy.