Nighttime Anxiety: Symptoms and Seeking Relief

Fear of the night?

Three weeks ago in the evening, after taking a Chinese herbal supplement called "Snake Pill" and drinking a cup of coffee, I experienced severe difficulty breathing and rapid heartbeat that night, preventing me from sleeping at all.
After an electrocardiogram and blood tests, the doctor indicated that my heart and thyroid were normal.
The doctor prescribed me two medications for one month: (1) a blue sedative to be taken once in the morning and once at night, and (2) an orange calming pill to be taken only at night, which induces drowsiness about half an hour after ingestion.
To this day, I still feel a rapid heartbeat, irritability, occasional chills, occasional heat intolerance, diarrhea (three to four times a day), poor appetite, and frequent thirst.
I also have a significant fear of nighttime; every evening, my hands tense up due to anxiety, and only after taking a shower does this uneasy feeling begin to subside.
However, after nightfall, I worry about insomnia, which leads to feelings of depression.
To prevent insomnia, I exercise in the park every evening (walking and jogging 4-5 laps, each lap about 1000 meters), intentionally increasing my fatigue.
When trying to fall asleep, I notice that my body feels hot; is this a normal phenomenon, and can it continue? I have never smoked or consumed alcohol, and my daily routine is normal, but due to a busy work schedule, I have no weekends or holidays.
I have taken the "Snake Pill" before without any discomfort, and coffee is an essential beverage for me every day.
Doctor, what condition might I be facing? What tests can confirm it? Is it possible that my symptoms are due to heatstroke? When my family helps me with "Gua Sha" or uses a "cupping" technique to draw out heat, I feel much more relaxed.
Could this practice have any side effects?

Alon, 30~39 year old female. Ask Date: 2000/11/20

Dr. Li Junren reply Psychiatry

Your issue actually stems from developing a fear of sleep, which causes anxiety whenever you encounter sleep-related situations.
In short, what prevents you from falling asleep is the "fear of insomnia." The following suggestions may be helpful for you:
1.
Avoid any stimulants before bedtime, such as coffee, tea, and vigorous exercise.
2.
Engage in relaxing activities before sleep, such as taking a bath, getting a massage, or listening to soft music.
You can also learn advanced relaxation techniques from the book "Overcoming Your Anxiety" (Health Publishing).
3.
Do not go to bed unless you feel sleepy; instead, engage in dull or relaxing activities.
(Even if you find yourself wide awake at three or four in the morning, tell yourself, "Just accept it; I can't sleep, so I'll find something to do.") This is crucial for overcoming your fear of sleep.
It may be challenging for the first few days, but this is key to your success.
4.
Wake up at the same time every day, regardless of what time you went to bed the previous night.
5.
Do not take naps during the day.
You may find it difficult in the afternoon, but if you stick to this routine, your sleep should gradually stabilize within about a week.
If you still experience issues, consider discussing your situation with a psychiatrist, who can provide tailored strategies for your condition.

Reply Date: 2000/11/20

More Info

Nighttime anxiety is a complex issue that can stem from various factors, including physiological responses to substances, psychological stressors, and lifestyle habits. Based on your description, it seems that your anxiety and physical symptoms have significantly impacted your quality of life, particularly during the nighttime hours.

Firstly, it is essential to understand that the symptoms you are experiencing—rapid heartbeat, difficulty breathing, gastrointestinal disturbances, and heightened anxiety—can be linked to several underlying causes. The fact that these symptoms began after taking a specific supplement (the "snake pill") and consuming coffee suggests that there may be a connection between these substances and your current state of anxiety. Both caffeine and certain herbal supplements can stimulate the nervous system, potentially leading to increased heart rate and anxiety, especially in sensitive individuals.

Your medical evaluations, including an electrocardiogram (ECG) and blood tests, have indicated that your heart and thyroid function are normal. This is reassuring, as it rules out some serious conditions. However, the ongoing symptoms you describe—such as feeling hot or cold, experiencing gastrointestinal issues, and having difficulty sleeping—may indicate a heightened state of anxiety or even a panic disorder. The physical sensations you experience, particularly the feeling of heat and rapid heartbeat, are common in anxiety disorders and can be exacerbated by stress and lifestyle factors.

The medications prescribed to you—a sedative and a calming agent—are commonly used to help manage anxiety and promote sleep. However, it is crucial to monitor how these medications affect you, especially since you are still experiencing significant anxiety and physical symptoms. If the medications do not seem to alleviate your symptoms, or if they cause adverse effects, it would be wise to consult your healthcare provider for a reassessment of your treatment plan.

Your routine of exercising in the evenings is a positive step toward managing anxiety. Physical activity can help reduce stress and improve sleep quality. However, it is also essential to establish a calming nighttime routine that allows your body and mind to wind down. This could include practices such as meditation, deep breathing exercises, or gentle yoga before bed. Limiting caffeine intake, especially in the hours leading up to bedtime, may also help reduce anxiety and improve sleep.

Regarding your concerns about the "snake pill" and the traditional practices of "gua sha" or cupping, it is essential to approach these with caution. While some individuals report feeling better after such treatments, they may not address the underlying causes of anxiety. Additionally, the efficacy and safety of herbal supplements can vary widely, and some may interact with medications or exacerbate anxiety symptoms. Always consult with a healthcare professional before continuing or starting any new treatment.

In summary, your symptoms suggest a significant level of anxiety that may be compounded by lifestyle factors and possibly the effects of the substances you have consumed. It is crucial to continue working with your healthcare provider to explore these symptoms further, consider adjustments to your treatment plan, and develop effective coping strategies for managing anxiety, particularly at night. If your symptoms persist or worsen, seeking a referral to a mental health specialist may provide additional support and resources tailored to your needs.

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