Managing Panic Attacks and Autonomic Nervous System Disorders

How to Adjust After Experiencing Autonomic Nervous System Dysregulation and Panic Attacks

Dear Doctor,
I hope you can help me (I hope you can read through this lengthy message).
Since childhood, I have experienced sudden awakenings during sleep, feeling as if the objects around me were distorting and that the walls and items were expanding.
In those moments, I would struggle to breathe and feel extremely panicked.
However, this stopped happening as I grew older, until two years ago when I began to experience sudden awakenings accompanied by rapid heartbeat, a sensation of my heart pounding in my chest, numbness, trembling, and panic, leading me to feel as if I was going to die.
After examinations, the doctor diagnosed me with mitral valve prolapse, which was causing palpitations and arrhythmias.
However, the doctor mentioned that this type of arrhythmia is not pathological, and that I could manage it through medication and psychological adjustment.
I went from experiencing severe panic attacks that prevented me from working to being able to return to my job now.
However, I must take half a tablet of medication (Xanax 10) in the morning and evening to alleviate anxiety or reduce the fear of panic attacks.
As for my heartbeat, I am now less afraid of the sensation of it pounding.
Previously, during severe episodes, any activity that would slightly increase my heart rate (like stress or exercise) would trigger memories of past attacks, leading me into extreme fear and even mild episodes (rapid heartbeat and the sensation of my heart pounding).
Since November of last year, I have not experienced sudden episodes of rapid heartbeat or intense heart pounding, but sometimes I encounter situations that feel similar to an impending attack, such as watching a tense movie where my heart rate increases and I might feel palpitations.
In those moments, I quickly take half a tablet of medication to ease my anxiety, and I notice that the feeling of an impending attack disappears immediately after taking the medication.
This observation leads me to believe that the psychological aspect is likely the primary issue; as long as I take the medication, my anxiety dissipates, and I can avoid an attack.
Of course, I still have some peculiar physical symptoms, such as tinnitus and dizziness, which, although not constant, do occur from time to time.
I would like to ask you, from your perspective, do you think this is related to autonomic nervous system dysfunction and panic disorder? How can I adjust to face the increased heart rate and palpitations during stressful situations or exercise without associating them with an impending attack, viewing them instead as normal heartbeats? After all, I do not want to rely on medication for the rest of my life, but a pharmacist I know mentioned that he is aware of others who have taken medication for several years before being able to stop...
Sincerely,

yuayua, 20~29 year old female. Ask Date: 2020/08/16

Dr. He Dongjin reply Cardiology

Hello, regarding issues with autonomic nervous system dysregulation and panic disorder, I suggest discussing it with a mental health specialist.
The medication "Xinkang Le" (心康樂) is a low-dose option that can be taken as needed without any issues.
I believe that using some simple medications can help resolve the problem, and it shouldn't be necessary to think about taking medication for a lifetime.
There may come a day when you won't need to take medication anymore; this is not a chronic illness, and it's not like morphine, which you can't stop once you start.
Don't overthink it or complicate things; there's no need to worry.
I pray for your peace and well-being.
Changhua Hospital cares about you.

Reply Date: 2020/08/16

More Info

Managing panic attacks and autonomic nervous system disorders can be quite challenging, especially when symptoms manifest in various ways, as you've described. Your experiences of sudden awakenings, feelings of distortion in your surroundings, and intense panic attacks are not uncommon among individuals dealing with anxiety disorders and autonomic nervous system dysregulation.

From your description, it seems that you have a history of panic attacks that have evolved over time. The initial episodes of waking up in a state of confusion and fear, followed by more pronounced panic attacks characterized by rapid heartbeat, numbness, and trembling, suggest a significant interplay between psychological and physiological factors. The diagnosis of mitral valve prolapse (MVP) you received is relevant, as it can sometimes contribute to palpitations and anxiety, although it is often benign and not the primary cause of panic attacks.

Panic attacks are often linked to the body's fight-or-flight response, which is regulated by the autonomic nervous system (ANS). When faced with stress or perceived danger, the body releases adrenaline, leading to symptoms such as increased heart rate, rapid breathing, and heightened alertness. In individuals with anxiety disorders, this response can become exaggerated, leading to panic attacks even in non-threatening situations.

Your observation that medication helps alleviate your symptoms is significant. It indicates that your anxiety may have a strong psychological component, and pharmacological treatment can be effective in managing these symptoms. However, relying solely on medication may not be ideal for everyone, and many individuals seek to develop coping strategies to manage their anxiety without long-term medication use.

Here are some strategies you might consider to help manage your symptoms:
1. Cognitive Behavioral Therapy (CBT): This form of therapy is effective for anxiety and panic disorders. It focuses on identifying and changing negative thought patterns and behaviors that contribute to anxiety. CBT can help you reframe your thoughts about your body's responses during stressful situations, making them feel less threatening.

2. Mindfulness and Relaxation Techniques: Practices such as mindfulness meditation, deep breathing exercises, and progressive muscle relaxation can help calm your nervous system and reduce anxiety. These techniques can also help you become more aware of your body's sensations without immediately associating them with panic.

3. Gradual Exposure: If certain situations trigger your anxiety, gradual exposure to these situations in a controlled manner can help desensitize your response. Start with less anxiety-provoking scenarios and gradually work your way up to more challenging situations.

4. Physical Activity: Regular exercise can help reduce anxiety and improve overall well-being. It can also help regulate your heart rate and improve your body's response to stress.

5. Healthy Lifestyle Choices: Maintaining a balanced diet, getting adequate sleep, and avoiding stimulants (like caffeine) can help stabilize your mood and reduce anxiety symptoms.

6. Support Groups: Connecting with others who experience similar challenges can provide emotional support and practical strategies for managing anxiety.

7. Medication Management: If you find that medication is necessary, work closely with your healthcare provider to find the right balance. Some individuals may benefit from a combination of medication and therapy, while others may eventually taper off medication as they develop coping strategies.

It's essential to communicate openly with your healthcare provider about your symptoms and concerns. They can help you determine the best course of action, whether that involves adjusting your medication, referring you to a therapist, or exploring other treatment options.

In conclusion, your symptoms appear to be consistent with panic disorder and autonomic nervous system dysregulation. While medication can be an effective tool in managing your symptoms, incorporating therapeutic strategies and lifestyle changes can empower you to cope with anxiety more effectively. Remember, recovery is a journey, and it's okay to seek help along the way.

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