Question and Answer Forum

Anxiety and Panic Attacks as They Relate to CFS and Sleep

By David S. Bell, MD, FAAP

Published in Lyndonville News, January 2000

Question: What are your feelings about anxiety and panic attacks? Currently my biggest issue is panic attacks that get worse after taking a nap or lying down.

Answer: This question brings up several interesting and important issues. In general, anxiety and panic is a sensation that is mediated by the adrenal hormone adrenaline, and is an important part of the fight or flight mechanism. In an emergency, the body secretes adrenaline and extra reserves are mobilized. Unfortunately, especially for persons with CFS, these extra reserves cause increased fatigue.

One crisis that may occur is sleep apnea. In this condition, the person has difficulty breathing or spots breathing during sleep, and choking to death is considered an emergency. Thus the person with sleep apnea can wake with a panic attack due to the adrenaline secreted. Sleep apnea may be due to mechanical obstruction like snoring or large tonsils, but can also occur with diseases of the brain. This is called "central" sleep apnea, and can occur in CFS. The mechanical obstruction can be treated by sleep centers, frequently by a machine that delivers positive pressure, and if "obstructive" sleep apnea is the cause of a person's fatigue, it is well treated this way. The central sleep apnea seen in CFS does not respond to the positive pressure machine, although it can eliminate the panic attacks.

A second part of this question is interesting. Some persons feel increased fatigue and malaise after sleeping. They prefer tiredness to the state of being after falling asleep. The mechanism of this is unknown. The relationship between panic and chronic fatigue is important. If CFS is due to inadequate blood flow to the brain, one of the body mechanisms to counteract this is to secrete more adrenaline to improve blood flow to the brain. Unfortunately this will cause panic. In this proposed mechanism, panic is the result of the underlying process of CFS rather than fatigue being the result of emotional issues such as anxiety or panic.

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