Sleep Disorders: Anxiety, Cramps, and Panic Attacks

Q: Sleep Disorders: Anxiety, Cramps, and Panic Attacks

Hello Ah-Hsien： The symptoms you experience while sleeping are somewhat similar to those of sleep terror disorder. <br>Symptoms include sudden awakening, screaming, increased heart rate and breathing, and cold sweats. <br>The causes can include stress, excessive fatigue, lack of

At night, there is a pressure to curl up my whole body and scream?

Hello Dr.
Lin: I have been struggling with insomnia for over 30 years.
I am aware that it is due to generalized anxiety, primarily stemming from my father, who was placed in a nursing home two years ago.
He is now on regular psychiatric medication and no longer disrupts my life, so my source of stress has been alleviated.
However, three years ago, I experienced cramping and spasms in my hands and feet while trying to sleep at night.
A psychiatrist diagnosed me with panic disorder and prescribed me one tablet of Duzhe'an (10 mg) to take at night, which improved my condition after a few days, and I have been on this medication ever since.
Two months ago, due to persistent poor sleep quality, my doctor suggested gradually increasing the dosage to two tablets.
However, I experienced the same symptoms again, which was very distressing, with my hands and feet wanting to cramp together, making me feel like screaming.
Consequently, I made some changes: 1.
I reduced my medication to 1.5 tablets, 2.
I sleep with a small light on, and 3.
I exercise daily and walk 10,000 steps.
Initially, there was some improvement, but for the past two weeks, I have been experiencing the same issues.
I find it difficult to fall asleep initially, and after about an hour, I wake up feeling very stressed, which leads to insomnia.
I am beginning to wonder if there might be another underlying condition.
The psychiatrist is also puzzled! Please provide your guidance, Dr.
Lin.
Thank you.

A-Hsien, 50~59 year old female. Ask Date: 2020/11/16

Dr. Lin Mianzhang reply Psychiatry

Hello Ah-Hsien: The symptoms you experience while sleeping are somewhat similar to those of sleep terror disorder.
Symptoms include sudden awakening, screaming, increased heart rate and breathing, and cold sweats.
The causes can include stress, excessive fatigue, lack of sleep, and withdrawal from alcohol or central nervous system depressants.
If this is the case, the focus of treatment should be on reducing stress, ensuring adequate sleep, and gradually tapering off alcohol or medications.
Of course, there are other sleep disorders that need to be considered in the differential diagnosis, such as nightmare disorder and REM sleep behavior disorder.
To confirm the diagnosis, further sleep studies may be necessary.
I recommend starting with the aforementioned strategies to reduce stress, ensure sufficient sleep, and gradually taper off alcohol or medications.
If symptoms persist, consider undergoing a sleep study for further evaluation.
Wishing you a speedy recovery!

Reply Date: 2020/11/16

More Info

Dear Patient,
Thank you for sharing your experience regarding your long-standing sleep issues and the associated anxiety and panic symptoms. It sounds like you've been through quite a journey with your sleep disorders, and it's commendable that you are actively seeking solutions. Let's delve into the complexities of sleep disorders, particularly in the context of anxiety, cramps, and panic attacks.

Sleep disorders can manifest in various forms, and they often intertwine with mental health conditions such as anxiety and panic disorders. In your case, the history of generalized anxiety and the recent exacerbation of symptoms, including cramps and the feeling of your limbs wanting to curl up, suggest a multifaceted issue that may require a comprehensive approach to treatment.

Firstly, it’s important to recognize that anxiety can significantly impact sleep quality. Individuals with anxiety disorders often experience heightened arousal, making it difficult to relax and fall asleep. This can lead to a cycle where the fear of not being able to sleep creates additional anxiety, further complicating the situation. The symptoms you describe, such as waking up after a short period of sleep and feeling an overwhelming sense of pressure, are common among those with anxiety-related sleep disturbances.

The cramps and sensations in your limbs could be attributed to several factors. One possibility is that they are related to anxiety itself, as stress can lead to muscle tension and spasms. Additionally, certain medications, including those used to treat anxiety and panic disorders, can have side effects that impact muscle function and sleep patterns. Since you mentioned that you have been adjusting your medication dosage, it’s crucial to communicate these changes and symptoms with your psychiatrist. They may need to reassess your treatment plan to ensure that it aligns with your current needs.

Your proactive steps, such as reducing your medication to 1.5 tablets, sleeping with a small light on, and incorporating daily exercise, are commendable. Regular physical activity is known to improve sleep quality and reduce anxiety. However, it’s essential to ensure that your exercise routine is not too close to bedtime, as vigorous activity can sometimes have a stimulating effect.

In addition to these lifestyle changes, consider implementing a structured sleep hygiene routine. This includes:
1. Consistent Sleep Schedule: Try to go to bed and wake up at the same time every day, even on weekends. This helps regulate your body’s internal clock.

2. Relaxation Techniques: Engage in relaxation practices before bed, such as deep breathing exercises, progressive muscle relaxation, or mindfulness meditation. These can help calm your mind and prepare your body for sleep.

3. Limit Stimulants: Avoid caffeine and nicotine, especially in the hours leading up to bedtime. These substances can interfere with your ability to fall asleep and stay asleep.

4. Create a Comfortable Sleep Environment: Ensure your bedroom is conducive to sleep—dark, quiet, and cool. Consider using earplugs or a white noise machine if noise is an issue.

5. Limit Screen Time: Reduce exposure to screens (phones, computers, TVs) at least an hour before bed, as the blue light emitted can disrupt your natural sleep-wake cycle.

6. Dietary Considerations: Avoid heavy meals close to bedtime, and consider a light snack if you’re hungry. Foods rich in magnesium, such as nuts and leafy greens, may help with muscle relaxation.

If your symptoms persist despite these changes, it may be beneficial to consult with a sleep specialist. They can conduct a thorough evaluation, which may include a sleep study, to determine if there are underlying sleep disorders such as sleep apnea or restless leg syndrome contributing to your symptoms.

Lastly, it’s essential to maintain open communication with your psychiatrist regarding your medication and any side effects you experience. Adjusting medication can be a delicate process, and your healthcare provider can help you find the right balance to manage both your anxiety and sleep issues effectively.

In conclusion, your situation is complex, and it may take time to find the right combination of strategies to improve your sleep quality. Be patient with yourself as you navigate this journey, and remember that seeking help is a sign of strength. I wish you the best in your pursuit of restful sleep and improved well-being.

Warm regards,
Dr. Lin

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