Sleep panic attacks: a micro-movement analysis

[Panic attacks during sleep]

Panic attack is a separate episode of fear or anxiety with the simultaneous development of typical autonomic and mental symptoms. Attack is a widespread phenomenon that makes up the central core of panic disorder and affects about 5% of the population. Up to 71% of patients suffering from attacks report panic episodes not only in wakefulness, but also during sleep. This review focuses on the distinctions of night panic attacks, the particular qualities of sleep disturbances associated with them, and methods of treating these conditions.

Sleep Disturbances in Patients With Psychiatric Illnesses

Sleep is essential not only for our physical well-being but also for our mental well-being. Researchers, however, have determined that specific alterations in sleep patterns do exist among patients with psychiatric illnesses. The causes of these abnormalities include both direct and indirect mechanisms. These abnormalities lead to declines in both cognitive function and quality of life. Management should include both nonpharmacological and pharmacological methods. This article will review the types of sleep abnormalities associated with schizophrenia, depression, bipolar disorder, and anxiety disorders and will additionally review treatment options available for each illness.

Anxiety and sleep problems: emerging concepts and theoretical treatment implications

The high prevalence and comorbidity of anxiety and sleep problems, especially insomnia, suggest an important underlying relationship between these disorders. In this article, we highlight two theoretical models explaining this co-occurrence, provide a brief update on the association between anxiety-insomnia and anxiety-cataplexy in general, and review more specifically sleep problems in generalized anxiety, post-traumatic stress disorder, and panic disorder. We also explore sleep paralysis as an anxiety-sleep event. Our goal with this examination of selective anxiety-sleep problems is to provide clues about diagnostic and treatment approaches and frame strategies for future research.

Sleep and anxiety disorders

Sleep disturbances commonly are associated with anxiety disorders, in particular generalized anxiety disorder, panic disorder, and posttraumatic stress disorder. Sleep loss may exacerbate and contribute to relapse of these conditions. Core features of panic disorder and posttraumatic stress disorder occur in relation to sleep (sleep panic attacks or re-experiencing nightmares). Investigation of sleep in anxiety disorders provides clues to mechanisms of arousal regulation relevant to insomnia and pathologic anxiety. Established treatments for anxiety disorders and insomnia have many overlapping components; however, optimal sequencing and integration of the approaches remain under-investigated.

[Sleep in psychiatric disorders]

Altered sleep patterns are prominent in the majority of psychiatric disorders. This article examines the psychiatric disorders that are most often associated to sleep dysfunction as it is related in clinical practice and describes the polysomnographic findings. Patient's main complaints are related to difficulty in initiating and maintaining sleep (initial or middle insomnia, respectively) and poor quality of sleep. Early awakening or terminal insomnia is most described in the depressive conditions. Hypersomnia may be the main symptom in some depressive disorders, as seasonal depression, depression with atypical features or depressive episodes in bipolar disorder. Polysomnographic evaluation shows, in general, a significative reduction in the efficiency and total time of sleep, in detriment to the amount of slow wave sleep. The reduction of rapid eye movement (REM) sleep latency is mainly described for the depression, but has also been reported in other psychiatric disorders.

Sleep complaints in panic disorder patients

Patients with anxiety disorders often report difficulty sleeping. The present study assesses the prevalence of sleep complaints in panic disorder (PD) patients, compares them with sleep complaints in a normal population, and investigates the role of comorbid depression and nocturnal panic attacks in sleep complaints in the PD patients. Seventy PD patients and 70 healthy controls were asked about their subjective sleep characteristics by means of the Sleep-Wake Experience List, which assesses sleep/arousal complaints over a 24-hour period. Sixty-seven percent of the PD patients reported sleep complaints, compared with 20% of the controls. Eighty-six percent of the depressed PD patients and 59% of the nondepressed had sleep difficulties; 77% of the PD patients with nocturnal panic attacks reported sleep complaints, versus 53% of the PD patients without nocturnal panic. It is concluded that PD patients demonstrate a higher prevalence of sleep complaints than normal controls; this can only partly be explained by comorbid depression, and cannot be explained by the presence of nocturnal panic attacks.