4am Panic Attack Any Experiences And Does Sleeping Flat or Raised Help?

[Machair]

After a good few years of being relatively stable I have been getting worse recently, and last night it all came to a head with a 4 am panic attack that woke me up from sleep. Anyone else have these? I normally wake up hot most days with a headache and it gradually goes with a large glass of fluid and then intensive morning hydration, but today it was a full blown panic state that I haven't had for a few years. I think it is my fault as I have been paying less attention to the illness and had 3 late nights last week.

I am wondering if I should be sleeping flat as I know this also causes fluid loss in the night? Any experiences with 4am panic and do you sleep flat or raised?

[Pistol]

Hello @Machair - I know what it is like to go through this , and how frustrating it is to experience after years of being relatively unaffected! --- When I go through a stressful time or have several nights of not sleeping well I have to take something or else I have the same thing happen to me. For me these panic attack-like episodes are usually caused by increased levels of adrenaline. At night our adrenaline is supposed to drop after about 3 hours of sleep, in order to allow for REM sleep. But with dysautonomia this may not happen, and stress or any change in daily routine can be the culprit. What helps for me is several things: 

- I rest more during the day but also do targeted exercise, meaning I rest and then go for a walk etc, instead of doing chores and getting my exercise from running around doing things. 

- I stop all electronics 2 hours before bedtime, and I avoid any liquid that may make me get up to pee. 

- Weighted blankets do wonders for adrenaline levels, and they help to let you sleep through the night. 

- I take 0.5 mg Lorazepam for sleep on nights I know I will have trouble. I DO NOT take them daily. Melatonin is also a supplement many people like to take for sleep. 

- Some people benefit from raising the foot OR the head of the bed, I do not. I need to sleep flat.

These are things that have helped me overcome my sleeping problems. Another thought - I do not know your age but I experienced these attacks frequently when I went through menopause. 

[Machair]

Thank you so much Pistol for your very helpful reply which is appreciated so much.

Yes menopause may be the issue, I only recently went through this so I think it could partly be the culprit.

Do you avoid any foods or drinks that make it worse? Do you have any advice for eating during the day?

I had been thinking about getting a weighted blanket so will do so now.

I agree about the daily routine affecting sleep- I am sure it is the build up of adrenaline. I know because when I go on air travel or long car journeys this triggers bad nights. Usually though I recognise them and try to do the right thing.

 

[Pistol]

Hi again @Machair - regarding food or drinks: of course avoid anything caffeinated and alcohol. I also have to stop drinking tea after 5 pm or I will be up peeing! 

Food wise what I do is avoid large meals and snack all day. POTS used to cause a lot of GI problems for me and I had to relearn my whole eating routine. I learned that large meals will trigger symptoms, especially carbs. So I eat smaller snacks every 2 hours, and this has really done wonders for my dysautonomia. An example for a day of eating for me is: 6 am coffee, toast and cheese, 8 am banana, 10 am tea and cereal bar, noon protein and vegetable, 2 pm yoghurt, 5 pm dinner ( low carb ). After that I stop eating. I do drink a lot of gingerale during the day but I do not tolerate water ( it nauseates me ). Since I cannot drink enough in order to ensure proper hydration ( due to my stomach issues I can only either eat or drink, not both, and this has caused excessive weight loss in the past ) I get IV fluid infusions several times a week and this has drastically improved my POTS symptoms. 

I hope this is helpful. If you are suspecting menopause to be the culprit I would definitely discuss this with your GYN. Some POTS patients do well with HRT. 

[Machair]

Thank you so much for this it is incredibly helpful. I think I am going to quit the 3 meals and try your regime because I am so symptomatic after meals generally. I think it is the thing I have never tried and also there is certainly an increase in symptoms after meals containing 2 courses.

I might look at HRT but I have had two ops for fibroids and polyps so with the recent stress of those in the last few months I am reluctant to add oestrogen.I had late menopause at 59 too so was lucky there.Two GA for 2 procedures wasn't fun and it wasn't good for POTS either!

I hope you are doing well yourself and thank you for all your help.xx

[Pistol]

11 minutes ago, Machair said:

I think it is the thing I have never tried and also there is certainly an increase in symptoms after meals containing 2 courses.

What I do when I cook is I cook the normal 3 meals for my family but I will spread the courses out for myself. So if I serve a salad to them with a meal I will have the salad 2 hours before the meal and just eat the meat and veggie at meal time. If I do desert I save it for later and only eat the meal. This worlk out well, because they do not have to watch how much they eat, so its the same mount of prep. Also - I LOVE pasta and bread but I use them sparingly for myself. They are the main culprits in postprandial problems in dysautonomia patients. So if I have pasta or bread its very little. 

Feel free to PM me anytime if you want to talk more! Best wishes !

[bizbiz]

Hi Machair,

Sorry to hear you are experiencing episodes of early morning panic.

What you describe sounds similar to what I experience when in a flare. Wake, (sometimes multiple times a night) feeling short of breath and panicky, followed by uncontrollable shaking. Usually lasts ten to fifteen minutes. 

These episodes gradually disappear as I slowly get better. I don't experience them at all if I'm not in a flare (which could be years of feeling pretty normal and not POTSY).

In the past, I've always slept with the bed flat, however with this last flare I found that raising the head of the bed helped with the severity of the night time episodes. I'm not sure what the recommended height is, but we've only raised ours a couple of inches and it seems to be enough. I also found that I was more likely to experience one if I slept flat on my back, as opposed to sleeping on my side.

Also, along with keeping well hydrated, switching from table salt added to my water to salt/potassium tablets has made a huge difference. Lack of sleep will also exacerbate my symptoms.

I hope you start feeling better soon.