Studies Show Possible Link Between Sleep Apnea and Panic Disorder

By Admin

While there is a lot we do not know about panic disorder and its relationship to sleep disorders, studies continue to show strong correlations between the two types of conditions, suggesting a causal link that can make patients susceptible to both illnesses. According to the National Institute of Mental Health (NIMH), roughly 2 to 3 percent of Americans develop panic disorder, while up to 11 percent may experience an attack at some point in their lives. Sleep apnea, which is more prevalent at 3 to 7 percent for adult males, may be as high as 26 percent for those over 30. Together, these seemingly independent conditions can have comorbid relationships that are mutually exacerbating, potentially leading to increased symptoms or more progressive disorders. While researchers continue to explore the causal mechanisms involved, they do know that buildup of carbon dioxide from sleep-disordered breathing plays a role in panic and anxiety responses similar to the experience of suffocation. In the same way, nocturnal panic episodes can be closely related to sleep apnea events, with both disorders contributing to sleep disruption and possible stress and sleeplessness during the day. By increasing awareness and screenings for these common disorders, healthcare professionals can better assess the possible links and develop tailored treatment plans to focus on both conditions more proactively.

Panic Disorder: A Brief Introduction

Panic disorder is a type of anxiety disorder that involves panic attacks, an event characterized by sudden feelings of fear or terror when there is no immediate danger. Symptoms are very similar to a heart attack, usually starting with heart-rate increases or palpitations, followed by sweating, dizziness or light-headedness, sight problems, shortness of breath, shaking, numbness, and chills or flashes. Normally, these symptoms are accompanied by fearful thoughts and worries, but the events tend to pass after a few minutes. The experience is very much like a physiological fight-or-flight response without a clear or obvious cause.

While the direct cause of panic disorder is not yet known, researchers have identified potential causal factors in both external and internal events. External events, for example, may include environmental cues that trigger a fight-or-flight response without conscious awareness of a potential threat. The sound of car brakes, a stranger resembling a threatening individual from someone’s past, these types of cues can be subtle enough to ignore on a busy day, yet still trigger a response due to their associations with traumatic events from the past. With internal events, the same types of responses can be triggered by internal stimuli, and abnormal gas exchange from shallow breathing or carbon dioxide buildup is a common example.

Panic Disorder and Sleep Apnea

Anxiety and mood disorders are some of the most common comorbid conditions associated with sleep apnea, and panic disorder is one that may be on the rise in the post-Covid years to come. While search queries related to sleep problems and panic attacks have increased dramatically in the last two years, studies have revealed a strong link between sleep apnea and panic episodes occurring at night, and even during sleep. Together, these conditions can have extremely harmful outcomes for both physical and mental health, as the resulting sleeplessness can increase stress and fatigue during the day hours.

One study in particular, conducted at the University of Iowa, found that carbon dioxide increases can also increase brain acidity, leading to the release of proteins responsible for fear or anxiety responses. In other words, people can have panic episodes as a result of physiological changes in the body. Sleep apnea, a common cause of carbon dioxide buildup, is thus a potential risk factor for panic attacks, which can exacerbate existing sleep problems and possibly lead to further disorders in the long term. By treating both conditions at the same time, patients can do a lot for their sleep and peace of mind. This is why screening and early diagnosis is so important for the health, both immediate and long-term, of the patient.

Scientists have known for years that carbon dioxide can trigger responses in people with panic disorder or other related anxiety disorders, but it wasn't until this recent study in Iowa that researchers identified the specific physical process of how the gas causes a reaction. As the study points out, the disruption of gas exchange during breathing can have immediate consequences. This does not only occur during a complete cessation of breathing, such as an apnea event, but also during short or shallow breaths, which can cause the same kind of buildup over time.

Treatment Options

While panic disorder and sleep apnea each have their own set of treatment options, there are some approaches that overlap. Breathing, one of the body’s central functions, can be effectively altered or controlled at any time (including when unconscious using CPAP therapy). And surprisingly, breath exercises can be one of the most effective treatments for both panic disorder and sleep apnea. Slowed and/or controlled breathing, especially during moments of relaxation or meditation, can have powerful anti-anxiety effects that can last throughout the day and night. Relaxation therapy can have similar effects as well, often incorporating breathing exercises into the therapy as part of the treatment. For those with sleep apnea, this can be part of a mindful therapy routine that is performed each night before sleeping with CPAP. Another type of therapy, called cognitive behavioral therapy, is also useful in treating both disorders and is sometimes used as a supplementary treatment to help with any complications during primary treatments. For example, symptoms that persist after using CPAP or meditation may require more guidance from a trained therapist. Some medications can be helpful as well, particularly in cases where patients have severe conditions and need immediate relief.

In the case of both panic disorder and sleep apnea, underlying factors such as genetics, stress, or physiological makeup may contribute to the disorders as well as their symptoms and comorbidities. This is why consulting a primary care physician is always the first step to take. Even if a patient regularly meets with a physician or healthcare provider, concerns about new or undiagnosed symptoms should be brought to their attention as soon as possible. The key to treating multiple, related conditions is to assess them early and thoroughly. The sooner you learn about your treatment options, the more effective they will be at reducing your symptoms and improving your overall health.