Not getting enough restful sleep can trigger anxiety. Stress and anxiety can also interfere with sleep and cause you to stay awake at night. It can be a frustrating cycle when the stressors of the day and future worries cause you stay up at night. Take some time to wind down before bed such as utilizing some of the above relaxation and meditation strategies. Also, instead of letting your mind continuously race at night, try putting your thoughts, worries, and plans for the next day on paper before bed. This will ease your anxiety about forgetting something you need to accomplish in the future and allow you to relax and rest.

Because involuntary panic attacks can be caused by other medical conditions, such as mitral valve prolapse, thyroid problems, hyperglycemia, side effects from certain types of medications, recreational drug use (such as marijuana), stimulants, etc., it’s best to discuss your panic attacks and symptoms with your doctor to rule out any medical cause.
There are several different anxiety-related disorders. Some symptoms overlap across many of these disorders, and others are more specific to a single disorder. In general, however, all anxiety-related disorders feature worry, nervousness, or fear that is ongoing, excessive, and has negative effects on a person's ability to function. It can be tricky to decide when anxiety is typical or linked to a disorder, which is why diagnoses should be made by licensed professionals, such as psychologists or psychiatrists.
While the use of drugs in treating panic attacks can be very successful, it is generally recommended that people also be in some form of therapy, such as cognitive behavioral therapy. Drug treatments are usually used throughout the duration of panic attack symptoms, and discontinued after the patient has been free of symptoms for at least six months. It is usually safest to withdraw from these drugs gradually while undergoing therapy.[14] While drug treatment seems promising for children and adolescents, they are at an increased risk of suicide while taking these medications and their well-being should be monitored closely.[59]
Genetics and family history (e.g., parental anxiety) may predispose an individual for an increased risk of an anxiety disorder, but generally external stimuli will trigger its onset or exacerbation.[57] Genetic differences account for about 43% of variance in panic disorder and 28% in generalized anxiety disorder.[58] Although single genes are neither necessary nor sufficient for anxiety by themselves, several gene polymorphisms have been found to correlate with anxiety: PLXNA2, SERT, CRH, COMT and BDNF.[59][60][61] Several of these genes influence neurotransmitters (such as serotonin and norepinephrine) and hormones (such as cortisol) which are implicated in anxiety. The epigenetic signature of at least one of these genes BDNF has also been associated with anxiety and specific patterns of neural activity.[62]
Most treatment providers for anxiety-related disorders can be found in hospitals, clinics, private or group practices. Some also operate in schools (licensed mental health counselors, clinical social workers, or psychiatric nurses ). There is also the growing field of telehealth in which mental health workers provide their services through an internet video service, streaming media, video conferencing or wireless communication. Telehealth is particularly useful for patients that live in remote rural locations that are far from institutions that provide mental health services. Mental health providers that work in telehealth can only provide services to patients currently located in the state in which the provider is licensed.
Although beta-blockers are most often used to treat high blood pressure, they can also be used to help relieve the physical symptoms of anxiety, such as rapid heartbeat, shaking, trembling, and blushing. These medications, when taken for a short period of time, can help people keep physical symptoms under control. They can also be used “as needed” to reduce acute anxiety, including as a preventive intervention for some predictable forms of performance anxieties.

“I thought I would be smart, take care of myself, and not go out as much,” Sideman says. He managed to find ways to build his business without leaving his home office. After he had a panic attack on a freeway, he decided to avoid driving on the freeway — a tough stand to take in Los Angeles. He kept withdrawing from activities to try to avoid panic attacks, but that never solved the problem, he says, and after two and a half years, he realized the attacks were getting worse.
Panic attacks (or anxiety attacks - the terms are interchangeable) are intense episodes of fear which are so powerful that they trick you into fearing that you are dying, going crazy, about to faint, or losing control of yourself in some vital way. The symptoms of a panic attack feel so powerful and threatening that they convince you that you're in terrible danger.
I was 34 before I knew anxiety was real. I had lived my life with these feelings, never knowing that everyone else wasn’t experiencing the same thing. I was 35 when I reached out to a friend, who is a nurse practitioner, to ask about my symptoms. That is when I began taking medication. I am on the lowest dose of anxiety medication and I have been taking it for six months. It has changed my life.

Panic attack symptoms and heart attack symptoms can seem similar because their signs and symptoms can be similar. Most medical professionals, however, can quickly tell the difference between their symptoms as heart attacks have distinct symptoms that aren’t panic attack like. If you are unsure of which is panic attack symptoms and which is heart attack symptoms, seek immediate medical advice. If the doctor believes your symptoms are those of a panic attack, you can feel confident his or her diagnosis is correct. Therefore, there is no need to worry about a heart attack.
A panic attack is an abrupt surge of intense fear or discomfort that reaches a peak within minutes, and during which time a variety of psychological and physical symptoms occur. These symptoms include rapid heart rate, sweating, shaking, shortness of breath, hot flashes, and lightheadedness—as well as a sense of impending doom, chills, nausea, abdominal pain, chest pain, headache, and numbness or tingling.

Obsessive-compulsive Disorder (OCD): In OCD, a person becomes trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome. Such rituals as counting, prolonged handwashing, and repeatedly checking for danger may occupy much of the person’s time and interfere with other activities. Like panic disorder, OCD can be treated effectively with medication and/or psychotherapy.


Selective serotonin reuptake inhibitors, or SSRIs, work in the brain via a chemical messenger called serotonin. SSRIs commonly prescribed for panic disorder include Fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa). SSRIs are also used to treat panic disorder when it occurs in combination with obsessive-compulsive disorder, social phobia, or depression. SSRI's tend to have fewer side effects than other antidepressants. Patients may initially experience nausea, drowsiness, diarrhea, or sexual side effects when they first take SSRIs, but over time, symptoms subside. An adjustment in dosage or a switch to another SSRI may also correct the problem. Clients should discuss all side effects or concerns with their doctor so that any needed changes in medication can be made.

Pick an object that you can see somewhere in front of you and note everything you notice about that object—from its color and size to any patterns it may have, where you might have seen others like it, or what something completely opposite to the object would look like. You can do this in your head or speak your observational aloud to yourself or a friend.


The avoidance behaviors associated with agoraphobia can greatly restrict a person’s life. People with agoraphobia often develop groups of feared situations that are related. For example, many people with agoraphobia become extremely upset and uncomfortable in areas where there are many people in a confined space. This fear may limit them from standing in line at a store, going to a movie theater, or traveling on an airplane. Other commonly feared situations for people with agoraphobia include forms of travel, being alone, and open spaces. These fears may result in an inability to even leave their homes.
The last strategy — learning what triggers your anxiety — is important. Sometimes you can take small steps to conquer your anxiety instead of letting the trigger conquer you. For example, if meeting new people causes you high anxiety, consider going with a friend to meet the new neighbors. Once you do this with ease, you can move forward and meet people on your own. All the pent-up fear and anxiety attacks will start to resolve as you become accustomed to reaching out in your community.
For example, once you notice you are scaring yourself with anxious thinking, you can change your thinking to calming thoughts, which will stop stress responses and their physiological, psychological, and emotional effects. As you calm yourself down, your body will follow by stopping the flow of stress hormones. As stress hormones are used up or expelled, the sensations, symptoms, and feelings of panic will subside…in time.
Pick an object that you can see somewhere in front of you and note everything you notice about that object—from its color and size to any patterns it may have, where you might have seen others like it, or what something completely opposite to the object would look like. You can do this in your head or speak your observational aloud to yourself or a friend.
When you have an attack, your breath is too short and shallow, meaning it worsens further symptoms.  Once you feel the panic – stand up and start doing some simple stretching. If you manage to squeeze in a yawn, that will help you tame the attack even faster.  Stretching and yawning instantly helps you relieve muscle tension and interrupt the vicious cycle that is just about to roll in full strength.
Desperate for help, he reached out to the Anxiety and Depression Association of America, which sent him a list of therapists experienced in treating panic attacks and anxiety. “This is how I got better," Sideman says. "I found a therapist who understood what panic disorder was, understood agoraphobia, and knew cognitive behavioral therapy, which I had not known about.” He also started practicing meditation.
It is 3:00 in the morning. I wake up from a dead sleep, sit straight up, and immediately know something is wrong. I am sweating, nauseous, and feel as if someone has dumped a bucket of ice water onto my chest. I feel it spill down my abdomen and through my arms and legs. My chest feels as though a giant’s hand is squeezing it with the intention of taking my life.
Research upon adolescents who as infants had been highly apprehensive, vigilant, and fearful finds that their nucleus accumbens is more sensitive than that in other people when deciding to make an action that determined whether they received a reward.[56] This suggests a link between circuits responsible for fear and also reward in anxious people. As researchers note, "a sense of 'responsibility', or self-agency, in a context of uncertainty (probabilistic outcomes) drives the neural system underlying appetitive motivation (i.e., nucleus accumbens) more strongly in temperamentally inhibited than noninhibited adolescents".[56]
Great questions. Unfortunately, there is usually no clear cut answer – and like many mental health disorders – it is likely caused by a combination of genetic, behavioral, and developmental factors. Anatomically speaking, Generalized Anxiety Disorder is most closely related to a disruption in the functional connectivity of the amygdala – the “emotional control center” of the brain – and how it processes feelings of fear and anxiety. Genetics also play a role in Generalized Anxiety Disorder. If you have a family member that also suffers from this disorder, your chances of suffering from it are increased, especially in the presence of a life stressor. Interestingly, long-term substance abuse also increases your chances of Generalized Anxiety Disorder, as the use of benzodiazepines can worsen your anxiety levels, as can excessive alcohol use. Tobacco use and caffeine are also both associated with increased levels of anxiety.
Another important prevention strategy for anxiety is to incorporate exercise into your daily activities. Exercise has been shown to decrease stress hormones that influence anxiety and also improve overall mood. Exercise can also help you disengage from worry and stress and focus on the current task of exercising. Exercises such as light jogging or brisk walking that can be incorporated into your daily activities can help reduce the impact of anxiety when it occurs.
^ Leicht, Gregor; Mulert, Christoph; Eser, Daniela; Sämann, Philipp G.; Ertl, Matthias; Laenger, Anna; Karch, Susanne; Pogarell, Oliver; Meindl, Thomas; Czisch, Michael; Rupprecht, Rainer (2013). "Benzodiazepines Counteract Rostral Anterior Cingulate Cortex Activation Induced by Cholecystokinin-Tetrapeptide in Humans". Biological Psychiatry. 73 (4): 337–44. doi:10.1016/j.biopsych.2012.09.004. PMID 23059050.

Fortunately, panic disorder is a treatable condition. Psychotherapy and medications have both been used, either singly or in combination, for successful treatment of panic disorder. If medication is necessary, your doctor may prescribe anti-anxiety medications, certain antidepressants or sometimes certain anticonvulsant drugs that also have anti-anxiety properties, or a class of heart medications known as beta-blockers to help prevent or control the episodes in panic disorder.
Says Clyman: "You might start to consider your emotions as changing experiences that are always fluctuating. When we feel distressed, it can seem like the distress is going to go on and on forever until we emotionally combust. But instead, emotions act more like a wave, at times increasing and becoming more intense. But inevitably they'll reach a plateau, subsiding and finally passing."
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