Often categorized as one of the sleep disorders commonly in babies and children, anxiety attacks or night terrors are nevertheless a known evil for many adults.
According to INSEE figures, nearly 20% of the French adult population will experience at least one nocturnal panic attack during their lifetime.
But how does this disturbing and intense phenomenon present itself? What are the symptoms and causes? How can nocturnal anxiety attacks be treated? What are the solutions to fight against?
We take a look at this sleep pathology in this article.
What Is A Nocturnal Anxiety Attack?
A nocturnal anxiety attack is a sudden outbreak, for no apparent reason, of an intense and uncontrollable panic attack in the middle of the night.
Although perfectly conscious of the excess of his fear and the excess of his reactions, the person is incapable of reasoning during the attack, which can last from a few minutes to several hours.
As a rule, the crisis leaves as it came, and remains a benign disease, even if it leaves a striking or even traumatic memory to the person who has been a victim of it and to their relatives.
Most of the time it is an isolated incident (the vast majority of patients will only experience one or two attacks in their life), but it can happen that anxiety attacks can be repeated, up to several times a day in the most serious cases.
It’s a sign of a more serious anxiety disorder that needs to be detected and treated (see treatments).
How Does An Attack Take Place?
Nocturnal anxiety attacks generally follow a pattern that could be represented in the form of a bell:
- A hidden phase where the anxiety settles and rises gradually. It is often before bedtime, cause by stress sometimes completely unconscious.
- A peak of anxiety that characterizes the beginning of the crisis itself: is at this moment that the symptoms appear brutally and intensely, whether they are physical or psychological. The patient then wakes up in a state of advanced stress.
- A phase of a gradual return to “calm”, during which the symptoms gradually fade away. This phase can last from a few minutes to a few hours. Note that during the night, this phase can be longer: in fact, the hormones produced by our body during the evening and during the night (melatonin among others) slow down our thinking and reasoning capacities.
- This phase is followed by a return to normalcy accompanied by intense physical and psychological fatigue.
Who Is Affected?
Anybody can have a nocturnal panic attack, doesn’t matter anyone’s sex, age, or mental stability (existence or not of psychiatric or somatic pathology).
It is estimated that 20% of French people will suffer from it at least once in their lives.
However, it has been observed that some people are more vulnerable than others to this neurosis:
- Women are more 1,5 to 2 times more inclined to know in their life at least an episode of night panic than men.
- Children and young people aged 15 to 20 are also more affected by this neurosis than adults.
- Anxious personalities are at greater risk. They are generally: very shy, very emotional, even hypersensitive, very indecisive: they have great difficulty in making decisions, are permanently psychologically tense, very perfectionist, in permanent demand of reassurance.
- People who have already had a nocturnal anxiety attack or whose close relative has experienced this disorder.
- People who are depressed and suffer from psychological disorders related to anxiety.
- People who have been sexually abused or who have been abused.
What Causes A Nocturnal Anxiety Attack?
It is important to know that a nocturnal panic attack is not automatically linked to a context of stress: it can take place in a calm situation of apparent well-being.
Nevertheless, some factors, both psychological and physical, can explain the appearance of a nocturnal panic attack.
Physical Causes.
Certain physical practices or disorders would tend to increase the risk of experiencing a nocturnal panic attack.
Sleep Apnea.
Sleep disorder like apnea is characterized by the interruption of the sleeper’s breathing regularity. Breathing pauses reduce the oxygen supply that the body needs during its recovery periods and tend to trigger the emission of the stress hormone.
If there is a large amount of it in the body, the anxiety attack may be enhanced.
Gastroesophageal Reflux.
People suffering from this type of reflux would be more affected by nocturnal panic attacks.
Absorption Of Exciting Substances Before Sleep.
Certain habits can also intensify the phenomenon, such as drinking coffee or alcohol before going to bed.
These substances disturb neuronal reactions and promote the release of stress hormones: factors that are conducive to the outbreak of an anxiety attack during sleep.
It should be noted that nitrogen dioxide or sodium lactate are also elements that can promote the triggering of a nocturnal panic attack.
Stopping Certain Medications Or Drugs Without Withdrawal.
Some treatments, such as antidepressants, or certain narcotics require a certain amount of time to be withdrawn before it is possible to stop using them.
Stopping them suddenly can cause a physical reaction that can lead to nocturnal panic attacks.
Psychic Factors.
The body may be part of the reason for a nighttime panic attack, but there are many factors related to the person’s mental health.
Even if it is sometimes difficult to identify them, there are many factors that people recurred to psychological vectors in the matter.
The Existence Of A Stressful Context.
Whether it is linked to a professional situation (redundancy, harassment), a family situation (divorce), or a personal situation (bereavement, illness), stress is an important risk factor when it comes to anxiety attacks.
The more the person evolves reinforcing his anxiety, the more he will have the risk of experiencing nocturnal anxiety.
The Existence Of A Childhood Trauma.
Toddlers are sometimes not emotionally and psychologically mature enough to integrate and overcome the serious traumas they may face.
Even when accompanied, children who have been raped, abandoned, or abused may simply repress their emotions and memories. These memories may surface years later, causing the traumatized adult to experience the same feelings they had at the time of the shock.
Similarly, people with post-traumatic stress disorder are more likely to experience a panic attack than those without.
Finally, to an extent, a child who has not lived well with the stage of separation from his parents could see this anxiety reappear as an adult, through night-time panic attacks.
The Existence Of Phobias.
This exaggerated fear without any real rational basis is a trigger for nocturnal anxiety attacks.
Whether it is the fear of public transportation, airplanes, or crowds… People who suffer from these phobias are suddenly confronted with them in their sleep, but their subconscious being unable to process and overcome the fear, they wake up terrified.
Depression and obsessive-compulsive disorders (OCD) are also factors that aggravate the regularity of the appearance of nocturnal anxiety attacks.
Symptoms.
The nocturnal anxiety attack is accompanied by a certain number of physical manifestations and psychological disorders, some of which can be impressive. Let’s take a look at the symptoms that may occur during a panic attack.
Physical Symptoms.
An anxiety attack is often accompanied by numerous physical signs, although the identification of the former as the cause of the latter can sometimes be delayed.
These unpleasant symptoms appear without warning and are sometimes of such intensity that patients have the need to go to the emergency room for additional tests.
Although it may seem unnecessary since the symptoms of an anxiety attack will gradually fade away on their own, it is important to consult a doctor for two reasons:
- Make sure that the symptoms are not related to a more serious illness: heart attack, asthma attack, etc.
- Consult a doctor who will have a reassuring diagnostic that will be able to stop the vicious circle that can set in during an attack (worrying symptoms reinforcing the anxiety that is already present), and will allow you to regain calm more quickly.
Even if they vary greatly from one person to another, here is a non-exhaustive list of the most common symptoms:
- heart palpitations, making it seem like a heart attack.
- increased heart rate (tachycardia).
- breathing difficulties with a feeling of suffocation, respiratory blockage.
- hyperventilation.
- chest pain or discomfort, feelings of tightness.
- muscle tremors or twitching.
- malaise, dizziness, lightheadedness.
- itching.
- blurred vision.
- ringing or buzzing in the ears (tinnitus).
- lower abdominal pain, abdominal discomfort.
- nausea, vomiting, diarrhea.
- sweating, chills, hot flashes.
Psychic Disorders.
When a person is a victim of an anxiety attack, the physical symptoms are followed by psychological symptoms.
Here are those most often reported :
- The belief that the worst is about to happen: often generated by the body pains felt, the sensation of imminent death insidiously reinforces the physical symptoms, making the patient enter a vicious circle.
- One is afraid to choke because one feels respiratory discomfort which causes even more respiratory difficulties.
- One is afraid of losing consciousness when one’s head is spinning, which feeds the confusion.
- We are afraid of having a heart attack when we have palpitations which accelerate, even more, the cardiac rhythm.
- A feeling of absolute powerless and loss of control, the brutality of the appearance of physical manifestations takes the patients totally unprepare. What can they do in the face of the violence of an unforeseen danger? The patients tell us that they thought they were losing their mind in the most serious cases of panic attacks, a form of dissociation of the personality and loss of anchorage, in reality, can be felt faced with these psychic manifestations, the reactions can be diametrically opposed.
When some people scream and are in a state of extreme agitation, others remain calm, as if dazed and paralyzed, or become evasive, trying to hide from the rest of the world the physical and moral ordeal they are undergoing.
The Consequences On Daily Life.
If the anxiety attack is punctual and isolated, it has no repercussions in your everyday life other than recovering physically (the night having been shortened), and psychologically from a strange and trying experience.
But when the episodes return regularly, the consequences on the life of the patients can be otherwise more difficult:
- Socially: people prefer to remain in a safe place and dread contact with the outside world with fear of having a seizure in front of strangers for example, provoking a situation that would trigger a seizure.
- Physically: anxiety attacks create chronic affections, the patients “somatizing” in a way (persistent cough, respiratory problems, digestive knots, hiccups, heart problems, libido disorders, nervous system disorders, headaches, ulcers…), not to mention the physical exhaustion that results from them.
- Morally: anxiety attacks are rarely immediately identified as the cause of the physical problems. Also, patients can remain for months without understanding what is happening to them, and sink into depression, be overcome by dark thoughts, be tempted to end their lives (or even to take action: it should be noted that 20% of patients attempt suicide) or to “relieve” their malaise by falling into various addictions (alcohol, drugs, gambling…).
- Emotionally: people prone to repeated panic attacks can be overcome by what is called anticipatory anxiety, i.e. the permanent fear that a new crisis will occur.
Treatments.
In spite of the not very encouraging picture (difficulty of diagnosis, late diagnosis), treatments are possible as soon as the problem is identified.
Information For Both The Patient And The Family.
Much less well known than insomnia, nocturnal anxiety disorders, once diagnosed, must be the subject of sustained education for the patient and his or her family.
By understanding the mechanisms that lead to an anxiety attack, the patient is better able to deal with it and to accept it in his or her daily life. Similarly, training the people around them to provide adequate care and to adopt reassuring gestures that can calm people suffering from night terrors.
Medication.
Even if they are not enough, medications such as antidepressants and, to a lesser extent, anxiolytics (because of their side effects – memory impairment, confusion, risk of dependence, and withdrawal syndrome, which are more important), can provide occasional relief to patients, as they often space out the attacks.
In France, it is set to prescribe one of the following drugs as first-line treatment:
- Selective Serotonin Reuptake Inhibitors (SSRIs): Deroxat®, Paxil®, Seroplex®, Lexapro®, Seropram®, Celexa®.
- Tricyclic Antidepressants: Anafranil®.
- Venlafaxine: Effexor®.
They actually allow the patient to regain a certain level of calm, enabling him to implement basic therapy and to seek the source of his anxiety.
On the other hand, treatments aimed at reducing pain related to physical symptoms may be prescribed by the patient’s doctor (e.g. heartburn medication).
In any case, these medications must be under the strict supervision of a physician, who will be the only one to determine the appropriate duration and discharge protocol of the treatments.
Therapies To Combat Nocturnal Anxiety Attacks.
Different therapies can then be put in place to help the patient understand the deep mechanisms explaining his anxiety.
Behavioral And Cognitive Therapy.
Cognitive and behavioral therapy, or CBT, is the most commonly used psychotherapeutic treatment for night terrors. It focuses on uncovering the unconscious actions and negative thoughts that lead the patient to suffer an anxiety attack in the middle of the night.
It aims at demystifying panic attacks, identifying the warning signs, and finding the mechanisms to reduce the crisis before it occurs.
The patient is accompanied during this process by a therapist, who organizes weekly group or individual sessions, from 10 to 25 sessions depending on the patient, and who guides patients through practical exercises.
When conducted by a serious and competent professional, CBT has a 70-90% positive outcome
CBT does not seek to find the “root of the problem” but only to provide practical tools to stop the mechanisms leading to the crisis.
Analytical Psychotherapy.
Psychoanalysis can be useful as a complement to CBT, in that it can explore the underlying reasons for the patient’s anxiety.
Naturotherapy.
Aimed at treating anxiety in a natural way, naturotherapy relies on natural exercises and the use of plants (phytotherapy via essential oils, such as chamomile, ylang-ylang, and bitter orange).
Again, the goal is not to bring to light the psycho-emotional conflicts that constitute the breeding ground for anxiety, but rather to detect the warning signs of a crisis and to provide the patient to react before it is too late.
Hypnosis.
Hypnosis allows us to bring to light the most unconscious reasons for nocturnal anxiety attacks.
Although it is an unconventional discipline, it achieves satisfactory results much faster than psychoanalysis, which has the same goal.
The 18 Techniques To Get Rid Of Nocturnal Anxiety Attacks.
Treating nocturnal panic attacks is not an easy task. But some solutions are effective in countering the arrival of an attack, or, when it is there, to minimize its effects and its duration.
Choose A Relaxation Method.
Yoga, meditation, sophrology, reiki… There is no lack of methods to relax and they are very useful to reduce stress and anxiety.
So, if you are prone to panic attacks, don’t hesitate to try several until you find the relaxation technique that suits you best.
Focus On Reflexology.
Another method, halfway between relaxation and massage: reflexology. This discipline aims to rebalance the body and mind by stimulating certain areas of the body through touch.
According to Jérôme Palazzolo, author of Stop à l’anxiété sans médicaments (Leduc.s éditions), to reduce anxiety.
- Take the tip of your right thumb between your index finger and your left thumb.
- Apply pressure on the nail for about 30 seconds.
- We change hands: with the thumb and the index finger of the right hand, we press the nail of the left thumb for 30 seconds.
To lower the nervous tension, we must press on the point representing the secretion of adrenalin:
- You put your left hand on a flat surface, palm up.
- We press just above the thumb, on the fleshy part for a few minutes.
- Alternate hands.
We (Re)Learn To Breathe.
When you feel anxiety coming in, one of your first reflexes is to check your breathing and regulate it. Because the shorter and more jerky your breathing is, the greater your chances of having a panic attack. On the other hand, the better you breathe, the more likely you are to get over the crisis quickly.
The Combat Breathing Technique.
Appeared in the columns of the Reader’s digest and taken up by Jérôme Palazzolo, author of Stop à l’anxiété sans médicaments (Leduc.s éditions), the technique of the “tactical breathing” or “square breathing” consists in calming the acceleration that our breathing generally undergoes when the anxiety rages, in other words, called the hyperventilation.
Indeed, in case of stress, breathing becomes superficial: it does not allow the lungs to capture oxygen correctly.
As a result, our body becomes saturated with carbon dioxide and reacts: this is where the sweaty hands come from, and the terribly painful abdominal contractions, the heart racing.
Also, to find a regular and deep breathing rhythm, we adopt the following method:
- on four beats, we inhale air slowly and through the nose.
- on four beats, we block our breathing.
- on four beats, we exhale energetically through the mouth.
- on four beats, we block our breathing.
- at each step, we try to visualize the number we are counting.
The Technique Of Alternating Breathing.
Another tactic suggested by the naturopath Céline Touati: the alternation of the breathing, whose goal is of course to calm anxiety; but also to regain energy.
Concretely:
- We put our right thumb on the right edge of our nose.
- Put your right ring finger on the left side of your nose.
- We inhale deeply through the right nostril, blocking the passage of air in the left nostril.
- We exhale energetically through the left nostril, blocking the passage of air in the right nostril.
- At each alternation, we block the breathing for a few seconds (at least 4).
- We apply this solution for a few minutes before finding his calm.
The Technique Of Abdominal Breathing.
In the same way, when we are anxious and hyperventilate, the air remains blocked in the upper part of the lungs.
To regain ventral breathing it will allow oxygenating better on one hand, because you can breathe deeper, but also compress the diaphragm, which will naturally go up and exert light pressure on the heart.
The latter will then slow down, allowing the anxious person to regain his senses.
In fact, Jérôme Palazzolo, author of Stop à l’anxiété sans médicaments (Leduc.s éditions), advises :
- One positions oneself sitting, the quite right back.
- Place your hands on your abdomen, one at chest level, the other at stomach level.
- We inflate the belly with each inspiration (by the nose) while trying to leave the thorax immobile.
- We dig the belly with each expiration (by the mouth), while always trying to leave the thorax immobile.
- When you have understood the technique, you rest your hands on your knees and continue the exercise until the signs of anxiety disappear.
We Practice Self-Massage.
Stimulating the sense of touch can be a great help in calming anxiety, according to the results of a study conducted by Audun Irgens, Toril Dammen, Tor Erik Nysæter, and Asle Hoffart, because it refers to soothing caresses.
Stimulating The Thymus Gland.
The thymus, otherwise known as the “happiness point”, is located in the upper chest, under the neck, between the sternum and the base of the collarbones.
To free oneself from the stress that is becoming a little too invasive:
- Put your index, middle, and ring fingers on the level of the thymus.
- We call his energy by tapping on this place for about fifteen seconds.
- Don’t forget to smile!
The Stimulation Of The Solar Plexus.
In the same vein, where you are prone to anxiety attacks, get into the habit of massaging your solar plexus, two to three times a day.
If possible with a formula of massage recommended by Céline Touati:
- On a base of vegetable oil of sweet almond.
- We pour a drop of essential oil of tropical basil.
- A drop of whole ylang-ylang.
We Visualize Our Fears And We Face Them.
Sometimes, instead of avoiding your fears, it is better to face them. Here are a few visualization techniques to help you cope with your anxiety attacks.
The Superhero Technique.
To boost testosterone levels, the hormone responsible for mood regulation, pharmacist Ngub Nding recommends posing like a superhero:
- Stand upright.
- You stand up straight.
- Spread your feet a little more than shoulder-width apart.
- Put your hands on your hips, elbows apart.
- Raise your arms above your head in a victory position.
- Stare at a point in the distance, slightly above the horizon.
- Hold this pose for two minutes.
The Spontaneous Writing Technique.
This technique allows you to get rid of negative elements that could have triggered an anxiety attack and empty your mind before going to bed.
This technique is simple:
- A quarter of an hour before going to bed, you sit down at a desk, a table, and you write without a filter.
- The important thing is not to think about what you are writing: even if it doesn’t make sense, it doesn’t matter, it’s your unconscious expressing itself.
- When we have nothing more to write, we tear up the sheet and we put it in the trash without rereading it.
- We come back to our desk and we write down an event or a positive feeling that has brightened our day.
- We carefully reread this happy element, then we tear up and throw away the sheet.
- We can now go to bed with a clear mind.
The Atomatic Thoughts Technique.
This technique consists of visualizing the thoughts that assail us when we are the victim of an anxiety attack to better rationalize and deconstruct them.
In his book Stop à l’anxiété sans médicaments (Leduc.s éditions), Jérôme Palazzolo explains that if you think you are having a heart attack when your breathing becomes distressed, you can compare this situation to shortness of breath caused by an effort of some kind (taking the stairs, for example).
Ritualize Your Bedtime.
Small evening rituals are important at any age. Also, to fall asleep as serenely as possible and to avoid a night-time anxiety attack, you can:
- Put yourself under warm water before going to bed.
- Eat a healthy, light meal.
- Read a few pages of your favorite book.
- Listen to classical music.
- Avoid checking your phone, your emails … at least one hour before going to bed.
- Tidy up your home or your room.
This list is not exhaustive, it is advisable to find what makes us feel good and to apply it each evening.
We Bet On Essential Oils.
Just like the sense of touch, the sense of smell is a sense that can be mobilized to reduce the occurrence of nighttime panic attacks.
The Power Of Lavender.
According to a recent Japanese study conducted by scientists from the University of Kagoshima (Japan), lavender in inhalation would have anxiolytic virtues as powerful as Valium.
We do not hesitate to use this plant, whose essential oil is easily found in pharmacies:
- Thanks to a diffuser of essential oils or in a bowl of boiling water (3 to 5 drops).
- In the washing machine (3 drops in the compartment intended for the laundry) to perfume the linen and diffuse the odor in the house.
- In massage in the neck (3 drops).
The Effectiveness Of Bach Flowers.
In the same way, on the advice of Céline Touati, one can use Rescue (or Bach Flowers), a floral elixir worked by Dr. Edward Bach in England at the beginning of the 20th century:
- Swallow four drops directly four times a day as a preventive measure.
- Swallow four drops every 10 minutes when the anxiety attack is there until the symptoms subside.
Diverting One’s Attention.
Another technique is to divert your mind to a specific point of your body or to another occupation.
Focusing On The Feet.
Amélia Lobbé, author of Vaincre l’anxiété et les crises d’angoisse (Leduc.s éditions), recommends focusing on your feet when you feel anxious or when an anxiety attack begins.
- Standing we look fixedly at our feet.
- We become aware that they fix us on the ground.
- We fix our attention on the different pressure points of our feet on the ground.
The Technique Of “Time Passing”.
Another technique of diversion of the spirit, the technique of the watch. When we have an anxiety attack, we fix our attention on the second hand of our watch or a clock.
This technique allows you to keep in touch with the time that really passes during an anxiety attack, to put its duration into perspective, and above all to focus your attention on something other than the physical and psychological manifestations of the attack.
Avoiding The Triggers.
When we know the aggravating factors of our anxiety attacks, we carefully avoid putting ourselves in a vulnerable situation if we already feel feverish.
For example, we turn off the phone at least one hour before going to bed in order to avoid any heated discussions, or any disruptive element (professional email). We also avoid social networks, which can have a deleterious effect.
We Surround Ourselves With Our Caring Loved Ones.
If a crisis occurs at night, do not hesitate to wake up our loved ones if necessary and explain to them that their presence helps get through the crisis.
Conclusion.
Their symptoms, nocturnal anxiety attacks are benign in themselves, but can seriously ruin the lives of those who suffer them at regular intervals.
Difficult to identify and diagnose, anxiety attacks can however be overcome with adequate treatments (medication and therapies), but also with related solutions, such as relaxation, breathing management, the use of essential oils, visualization, etc.
