Panic disorders range in prevalence between 1% and 3% of the general population. Approximately 6–14% of young adults report at least one spontaneous panic attack.51,52 Most of these events occur during the day, but as many as 2.5% of the attacks may occur exclusively as nighttime events. Two-thirds of patients with panic attacks have had one or more events at night.

Polysomnographic data demonstrate that panic attacks can occur at sleep onset or during stage 2 or slow-wave sleep, but the hallmark is that the event occurs after awakening. On polysomnography, patients have an abrupt arousal from sleep, followed by52–55:

• tachycardia
• tachypnea
• diaphoresis
• tremulousness
• feelings of impending doom
• clear memory of the events

Further systematic monitoring may be required to distinguish nocturnal panic attacks from other etiologies:

• other parasomnias
• nightmares
• gastroesophageal reflux
• REM sleep sinus arrest
• sleep-related laryngospasm
• paroxysmal nocturnal dyspnea
• nocturnal asthma
• seizures

Adapted from: Malow, BA, and Vaughn BV. Sleep disorders and epilepsy. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;255–267.
With permission from Elsevier (www.elsevier.com).
Reviewed and revised April 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.