Why Worry: 'When I go to sleep, I feel like my heart stops...please help'

Sometimes, when I am tired, I have to sleep by pressing my belly to help my breath normal, then I can sleep. I don't know what this situation is called.

I went to a clinic for a check-up, they did all tests and told me this is panic attack.

I hope you understand my feelings, could you suggest some help?

Thank you and regards, 
Noman ul haq

Answered by Dr Sreekumar V. Nair, MBBS, M.D. Psychiatry, NMC Specialist Hospital, Dubai.

Dear Noman Ul Haq,

Let me assure you that what you are going through is not a serious illness. You have already done all the necessary tests to rule out any physical illness. And the doctors have made the diagnosis of 'panic attack'. They are right.

Now, what is 'panic attack'. This is how American Psychiatric Association describes it: A panic attack is a period of intense fear or discomfort that strikes suddenly, often in familiar places, where there is seemingly nothing threatening an individual.

But when the attack comes, it feels as if there is a real threat, and the body reacts accordingly. The discomfort and sense of danger the attack brings is so intense that people with panic disorder often believe they are having a heart attack or other life-threatening illness.

Following are the symptoms of panic attacks:

All the above symptoms may not be there, any four is enough to call it panic attack.

If you look at each of the symptoms separately, they can happen without any illness. For example, shortness of breath and rapid or pounding heart beat can happen if we run for some distance or climb a few flights of stairs.

As mentioned above, these symptoms can be body’s reaction to any threat. That means it is protective and alerts us that there is some threat.

The difference in panic attack is that there is no real threat here, it is on a perceived threat or stress.

Let’s look at the mechanism of how it happens

Triggers could be any stressful situation, cumulative effect of trivial stress, perceived threat, even a nightmare, some medications (like those used in cough and cold, asthma), alcohol, tobacco...

But in most cases a trigger may not be evident.

The mind misinterprets it as a sign of some threat or illness. This causes the release of stress hormone. This stress hormone release brings out all of the symptoms.

The occurrence of the symptoms reinforces the mind’s interpretation that there is something seriously wrong. This increases the stress hormone release and more symptoms. Thus it becomes a vicious cycle.

This can lead to the person anticipating an attack and always being worried about it. The person might start avoiding place or situations where the attack had happened, for the fear of it happening again. The person might restrict his activities and remain in a comfort zone, for fear of not getting help if a panic attack happens.

So, how do we deal with this

First and foremost is to understand that panic attacks are absolutely harmless. Nothing happens to you even if it comes repeatedly.

So, keep telling this to your mind and try to convince it.

Learn to relax. Simple deep breathing exercises and relaxation exercises do the job well. Here you are learning to relax your body. And the dictum is that "There cannot be a tensed mind in a relaxed body". This is the principle used in Yoga too.

Good cardio exercises help in the release of Endorphins, which is natural Morphine like substance produced in our body. This makes you physically fit and the mind also becomes positive.

Sometimes these alone may not be enough to manage the panic, because it also has a biology behind it, which is related to neurochemicals like Serotonin.

So, the help of a mental health professional may also be needed.

Treatment options

Two main treatment options are available for people with panic disorder medication and cognitive behavioral therapy. Both of these treatments have good success rates and are equally effective and can be chosen based on a patient’s preference.

Cognitive-Behavioral Therapy consists of five fundamentals:

Learning: In this first stage, the therapist explains the illness, teaches the patient to identify the symptoms, and outlines the treatment plan.

Monitoring: Patients keep a diary to monitor panic attacks and record anxiety-inducing situations.

Breathing: The therapist teaches breathing relaxation techniques to combat the physical reactions of a panic attack.

Rethinking: The therapist helps the patient change his or her interpretation of physical symptoms from catastrophic to realistic.

Exposing: The therapist helps the patient encounter situations that evoke frightening physical sensations at levels of gradually increasing intensity.

Medical treatments of panic disorder often include antidepressants, benzodiazepines, and other types of medications that have been shown to be successful in treating panic disorder.

With appropriate psychiatric treatment, people who experience panic disorder can recover and return to normal life activities.

If you have questions that you would like answered by a mental health professional in the UAE, please write in to readers@gulfnews.com. Also, please let us know if you'd rather stay anonymous.

Disclaimer: This blog is a conversation and is not an alternative for treatment. The recommendations and suggestions offered by our panel of doctors are their own and Gulf News will not take any responsibility for the advice they provide.