What are possible causes of sudden breathlessness at night in an otherwise young and healthy individual?

Doctor's Answer

Nighttime shortness of breath can be due to anxiety or a panic attack. Feeling anxious can trigger a fight-or-flight response in your body and cause a panic attack. You may struggle to take breaths, feel faint and become nauseous during a panic attack.

A panic attack is the abrupt onset of intense fear or discomfort that reaches a peak within minutes and includes at least four of the following symptoms:

  • palpitations
  • pounding heart
  • or accelerated heart rate; sweating
  • trembling or shaking
  • sensations of shortness of breath or smothering
  • feelings of choking
  • chest pain or discomfort
  • nausea or abdominal distress
  • feeling dizzy or unsteady
  • light-headed or faint
  • chills or heat sensations
  • paresthesia (numbness or tingling sensations)
  • derealization (feelings of unreality) or depersonalization (being detached from oneself)
  • fear of losing control or “going crazy”
  • fear of dying

Some people experience what is referred to as limited-symptom panic attacks, which are similar to full-blown panic attacks but consist of fewer than four symptoms.

Although anxiety is often accompanied by physical symptoms, such as a racing heart or knots in your stomach, what differentiates a panic attack from other anxiety symptoms is the intensity and duration of the symptoms. Panic attacks typically reach their peak level of intensity in 10 minutes or less and then begin to subside. Due to the intensity of the symptoms and their tendency to mimic those of heart disease, thyroid problems, breathing disorders and other illnesses, people with panic disorder often make many visits to emergency rooms or doctors' offices, convinced that they have a life-threatening issue.

Panic attacks can occur unexpectedly during a calm state or in an anxious state. Although panic attacks are a defining characteristic of panic disorder, it is not uncommon for individuals to experience panic attacks in the context of other psychological disorders. If the attacks occur at night, the possibility of post-traumatic stress disorder needs to be considered as well as many people do feel anxious when they have nightmares that are somewhat related to the traumatic incident.

Panic attacks are extremely unpleasant and can be very frightening. As a result, people who experience repeated panic attacks often become very worried about having another attack and may make changes to their lifestyle so as to avoid having panic attacks. For example, avoiding exercise so as to keep their heart rate low, or avoiding certain places.

Breathing exercises, avoidance of triggers and talking to a mental health professional may help you relieve feelings of anxiety and avoid panic attacks.

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