Is Waking Up at Night a Sign of Panic Disorder?

Waking up in the middle of the night can be a symptom of a panic attack?

I am currently 23 years old, and I have had a profound fear of death since childhood, a deep-seated anxiety and dread.
My condition has fluctuated over time; however, recently, I have been waking up suddenly in the middle of the night, feeling half-awake and half-asleep, and suddenly experiencing the terrifying reality of death.
Does this qualify as a panic disorder? I am currently taking Mirtazapine (30 mg per day) for anxiety, but my condition does not seem to be improving.
Should I ask my psychiatrist at my next follow-up appointment if I can schedule an appointment with a psychologist for potential new improvements?

Chen Sir, 20~29 year old female. Ask Date: 2019/10/04

Dr. Huang Xiaoxian reply Psychiatry

Dear Mr.
Chen, thank you for your question.
It sounds like you are experiencing concerns and fears about death, as well as sudden panic, which are somewhat similar to symptoms of panic disorder.
This falls under the category of anxiety disorders.
Generally, the treatment for anxiety disorders involves medication and psychotherapy.
If the frequency and intensity of your episodes are increasing, it is advisable to discuss this with your treating physician to adjust your treatment.
Wishing you all the best!

Reply Date: 2019/10/04

More Info

Waking up at night can indeed be a sign of panic disorder, especially when it is accompanied by feelings of fear, anxiety, and a sense of impending doom. In your case, it seems that your fear of death has been a long-standing issue, and the recent episodes of waking up at night feeling half-awake and overwhelmed by thoughts of mortality could indicate that your anxiety is manifesting in a more acute form.
Panic disorder is characterized by recurrent and unexpected panic attacks, which are sudden surges of intense fear or discomfort that peak within minutes. Symptoms can include palpitations, sweating, trembling, shortness of breath, feelings of choking, chest pain, nausea, dizziness, chills, or heat sensations, numbness, and a fear of losing control or dying. The experience of waking up in a panic state, especially if it feels like you are caught between sleep and wakefulness, aligns with these symptoms.

Your current treatment with Mirtazapine (known as 瀰鬱停) is aimed at managing anxiety and depressive symptoms. However, if you find that your symptoms are not improving, it is crucial to communicate this to your psychiatrist during your next appointment. They may consider adjusting your medication or exploring additional therapeutic options.
Cognitive Behavioral Therapy (CBT) is particularly effective for anxiety disorders, including panic disorder. It helps individuals identify and challenge negative thought patterns and beliefs that contribute to their anxiety. It may also provide you with coping strategies to manage your fear of death and the associated panic attacks.
Moreover, it is essential to consider the impact of your lifestyle on your anxiety levels. Factors such as sleep hygiene, diet, exercise, and stress management techniques can significantly influence your mental health. Establishing a regular sleep schedule, creating a calming bedtime routine, and avoiding stimulants like caffeine in the evening can help improve your sleep quality and reduce nighttime awakenings.

In summary, waking up at night feeling anxious and fearful can be a symptom of panic disorder, particularly in the context of your longstanding fear of death. It is advisable to discuss your experiences with your psychiatrist and consider a referral to a psychologist for therapy. This comprehensive approach can help you better manage your anxiety and improve your overall well-being. Remember, seeking help is a sign of strength, and there are effective treatments available to support you through this challenging time.

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