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I have generalized anxiety disorder with panic attacks that

I treat and keep managed...
I have generalized anxiety disorder with panic attacks that I treat and keep managed with BCT, exercise, eating a well balanced diet, and breathing exercises. For the most part this works well. This past month has been pretty stressful and it sort of reached its peak of stress a week and half ago increasing my anxiety, causing panic attacks. This was due to personal stress, work stress, and also my time of the month. My anxiety during the day has started to come back down but my sleep is still off. I am waking multiple times a night and I start off feeling okay then I start to feel like my body is warming up. This has happened to me before in times of stress. Even though I feel good during the day now is there a reason my sleep is still bad? I get nervous because poor sleep will eventually affect my daytime mood as well. Last night I feel like I woke up every hour for a few minutes sometimes a bit longer. Is sleep the last to return to normal?
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Answered in 31 minutes by:
11/20/2017
TherapistMarryAnn
Category: Mental Health
Satisfied Customers: 5,878
Experience: Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
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Hello, I'd like to help you with your questions.

Anxiety can show itself in many ways and often the way it does show up doesn't make sense. For example, you can be feeling fine then suddenly experience a panic attack. Or you have spent months recovering then feel you take two steps back when symptoms flare up. Waking up at night can be one of those ways anxiety shows itself even if most of your day you feel relatively in control and even anxiety free.

In your experience, it sounds like the anxiety is showing up while you sleep, which is a common problem for people with anxiety. Because we tend to relax at night and let go of ourselves in the form of giving in to sleep, anxiety can increase because you may feel out of control while you sleep. When we are awake, we can feel in more control than when we sleep because with anxiety, we tend to be on guard and more aware during the day. But at night, in order to sleep, we need to give up that control. As a result, people with anxiety can wake up suddenly or have a panic attack at night because the mind is trained all day to be on guard that something is wrong. But at night, we are not conscious enough to maintain that guard against fear, so it comes through while we sleep. You may not even be aware that your mind is still on guard at night. It is not uncommon for people with anxiety to not realize how tense they really are even if they feel relaxed most of the time.

The fact that you feel warmer at night could be related to the anxiety. You may be experiencing a slight rise in blood pressure due to anxiety or you might be having a physical reaction to your stress. It is a good idea to check in with your doctor, if you have not already, just to rule out a physical problem such as hormonal surge or the onset of a virus. Most likely, though, you are probably feeling your body warming up due to anxiety.

What you can do to address the wakefulness at night is to establish a routine. If you do not have one already, a routine can act as a way to "shut down" your thoughts and body to be ready for sleep. Also, you may want to practice progressive relaxation before you go to sleep. Here is a link to help you:

http://www.guidetopsychology.com/pmr.htm

By practicing at night before sleep, you can more easily keep yourself relaxed if you do wake up.

Try writing down your thoughts and concerns from the day before you go into your bedroom to sleep. Sometimes expressing your thoughts, concerns and fears helps them from staying with you and waking you up at night.

Be sure to sleep in a cooler room in order to help with the increase in bodily warmth. It may also help you achieve a deeper sleep if you are in a cooler room.

If you do wake up during the night, practice the relaxation techniques you learn as well as taking deep breaths. Also, find a thought that you can repeat to yourself when you do wake up, such as "I'm okay right now. I can relax and sleep anytime I want to. This will pass and I will be fine." or something along those lines. If you have a way to sooth yourself, you may find it easier to go back to sleep quickly or even stay partially asleep.

Find something to bring to bed with you that comforts you. No matter your age, you may find a soft stuffed animal or blanket comforting. Or a soothing recording on a phone or ipad (just be careful of the light from these devices since they can wake you up further). Whatever you feel you can use to anchor yourself and comfort you until you sleep again.

It may take some time to learn to relax enough to sleep all the way through the night. But if you try these techniques, it may help. Also, talk with your therapist and doctor about your situation. Sometimes support can make a huge difference in helping you relax and know you are okay.

I hope this has helped you,

MaryAnn

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Customer reply replied 25 days ago
If it is my blood pressure should I be concerned it is going too high? Or am I just feeling the warmth bc I go from being relaxed to stressed? I could easily take my BP while it is happening to see. Normally unless of course I am in a doc's office my BP is around 110/78-80.

It sounds like you have a normal blood pressure. But when you are anxious, your blood pressure can rise a small amount, just like it does in any other situation where you increase physical exertion. Feeling warm is a common anxiety symptom. Some people experience sweating, some just feel warm all over, similar to when you have a slight fever, are in a warm environment like a hot shower or even when you feel embarrassed. Most of the time, it is not dangerous but just a normal reaction your body has to the increase in stress. If it helps to ease your mind, see your doctor to rule out physical problems. But in my experience, a majority of time feeling warm all over is a symptom of anxiety.

MaryAnn

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Customer reply replied 25 days ago
One last question I am going for my physical in beginning of January. What blood tests other than the routine CBC, chemistry panel should I get? He usually checks those two panels plus my thyroid. Last time I had him check my D and magnesium. D was low and magnesium was 2.2.

If your doctor is not aware of your anxiety diagnosis, then it is good to let him/her know and ask if there are any tests that would show physical problems that mimic anxiety. Thyroid is certainly one of those conditions as are metabolic conditions (you may need a complete workup by an endocrinologist to tell you that information) and any heart condition such as mitral valve prolapse. Checking your heart is a part of your physical workup, but you can specifically ask your doctor for extra tests to rule out any potential problems as well.

MaryAnn

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Customer reply replied 25 days ago
I have had an echo/stress and did a holter. All normal.

Okay, then that can be ruled out. If your doctor is aware of your anxiety diagnosis, it is likely he or she has paid attention to ruling out any physical cause but it doesn't hurt to ask and be sure. Your therapist should have also made requesting you get a complete physical part of your initial evaluation, just to be sure. You don't want to be treating anxiety on an emotional basis if there is any physical cause.

MaryAnn

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Customer reply replied 25 days ago
Well it is probably important to know that my anxiety is focused around hypochondria to physicals and extra tests are something I keep on top of. My issue right now is even though I have experienced these sleep issues with feelings like I am heating up after I awake I am always afraid I am ignoring something physical. Like maybe this time it is heart related and something has changed, etc. It is a constant fight between rationalizing it is just anxiety vs. this is now a real medical thing. Make sense?

Yes that makes sense. And your fears are very common with anxiety. Many people go to see their doctor when they first experience anxiety symptoms, thinking that there is a physical cause. If you are staying on top of your physical health, there is no reason to consider that as part of your anxiety diagnosis. And it sounds like you are doing a great job making sure you are dealing with anxiety and not something physical.

MaryAnn

TherapistMarryAnn
Category: Mental Health
Satisfied Customers: 5,878
Experience: Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
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Customer reply replied 25 days ago
Thank you. I just hate these times when you feel like you are going backwards. I just hope it does not last long I would like to enjoy the holidays.

You're welcome! I completely understand how you feel. But you have come this far and that is a very positive sign that you can recover from anxiety. Try some of the techniques we talked about. You may find something that helps you sleep. And continue to reach out. Support makes a big difference.

Take care,

MaryAnn

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