Chapter 29 - Sleep panic arousals

Summary

Sleep panic arousals (SPA) are characterized by full awakening from sleep with panic anxiety, myriad somatic symptoms and secondary fear-associated cognitions. SPA almost occurs during the first half of the sleep period, usually within 3 hours of sleep onset. Patients with panic disorder have abnormalities in respiratory physiological indices including higher respiratory frequency, tidal volume, minute ventilation and sigh breaths and decreased end tidal CO2 (PETCO2) levels. Night sweats may be associated with full arousals accompanied by anxiety that usually focuses on embarrassment and concerns about the underlying causes of the sweating. Medical disorders which may present with anxiety like symptoms during sleep such as nocturnal asthma, nocturnal gastroesophageal reflux, nocturnal angina, paroxysmal nocturnal dyspnea, thyroid disease, hypoglycemia, chronic obstructive pulmonary disease, arrhythmias and other cardiac conditions, hypoparathyroidism, and pheochromocytoma should be ruled out with a comprehensive clinical examination and/or additional laboratory tests.