Panic attacks and anxiety are common conditions that you see often written about. Here’s an article published in Johns Hopkins Magazine from 1999 by a fellow alum, David Levine. He describes in vivid detail his first experiences with panic and anxiety as a college student at age 19. It’s remarkable how these episodes could be attributed instead to new onset apneas.
He quotes, ” The worst attacks struck at the end of dreamless naps. I woke up completely drenched, disoriented, my heart pounding.” His very first episode presented after waking up one morning with an impending sense of doom.
Repeated obstructions to breathing can set off a constant fight-or-flight response, which can carry over into the daytime. Waking up suddenly after suffering from a 20 to 30 second apnea can cause the typical nervous symptom reactions like your heart racking, sweating, and a feeling of doom. Medications like Valium can calm the edginess and anxiety, but never completely “cures” the problem. Eventually these episodes slowly subsided for Mr. Levine after years. Decades later, he’s diagnosed with obstructive sleep apnea (OSA) and is doing well using a mandibular advancement device.
Of course it’s hard to say if he had sleep apnea at the time of his first panic attack. My guess is no, since a handful of short obstructions and arousals may not be enough to qualify for a formal diagnosis of OSA.
It’s also no coincidence that most people with anxiety or panic attacks can’t sleep on their backs. Due to crowding of the upper airway from smaller jaws and crowding of the teeth, the tongue and voice box falls back due to gravity. Whenever deeper levels of sleep is reached, the throat muscles relax, and obstruction happens. If it lasts longer than 10 seconds, it’s an apnea. If it’s less than 10 seconds, it’s not counted in the final sleep apnea score. This is one major reason why people may stop breathing 20 to 30 times every hour and have an AHI score of 0. They are usually told they don’t have sleep apnea and that their fatigue and anxiety are due to other potential medical problems. This condition is called upper airway resistance syndrome, which I’ve talked about in detail.
It’s no wonder that patients with depression do better if you address sleep quality. Whether it’s from poor sleep hygiene or OSA, it’s important to address any potential sleep problems before medicating anxiety or panic attacks.
For those of you who are prone to panic, what’s the quality of your sleep?