Waking Up in Panic

Teebs, you have my sympathy on this one, it's an issue I've been struggling with for a few years now.
I haven't yet found a way to 'make it stop', but I have found some ways to reduce the length of the panic attack after I wake up, perhaps my experience can help you.
Usually, if I wake up in a panic attack, I need to first remind myself where I am and find something familiar and solid to know that I am still okay and things haven't changed much since I went to sleep. (You may or may not find comforting, but I find comforting because if things haven't changed that probably means that nothing drastic or bad has happened)
The next thing I do is try to halt any anxious thoughts that might be buzzing about in my brain by distracting myself (Either I'll get up and take a shower, or I'll read a bit of a book, or sometimes it's just as simple as trying to actively think about something else -- anything that can keep my attention.)
After that I do some self-talk, reminding myself that what I'm feeling is just the chemicals in my body, an adrenal response that will  be over soon and I'll be fine, there's nothing I need to be worrying about right this minute, and if it's important I'm better off dealing with it while rational and calm so I don't need to worry.
If I'm still not very calm or it's taking a while to calm down, I might try to think actively about how I feel when I'm calm, to try to push myself towards that state. (It doesn't always do much, but sometimes it can help)

I do this in a cycle, and what I've found is that if I do it every time (even if I do it out of order) my brain knows I'm going to calm down soon, it anticipates the process the same way as you'd get hungry if you always ate at the same time of day, or with the same plate and you saw that plate, it's conditioning, and so using that I can calm down faster.
Though I do seem to have hit a bit of a hard limit of at least 5-10 minutes before it's mostly over and I'm only anxious not panicking, and can often get back to sleep. Really that's not all that bad considering I started off not sleeping for the rest of the night and even after the panic stopped I'd still feel very anxious.

Davit may have been onto something with the identifying of your triggers. I don't have those kinds of 'triggers' I don't think about anything worrying before I go to sleep (or I wouldn't sleep) and when I wake up in the middle of a panic attack, I don't always know why I'm feeling panicked and don't have any accompanying anxious thoughts, just the physical side of things, I call it chemical panic, or body panic. Those are the most common for me, and frustrating because I don't think I can prevent them.
But if you *do* have triggers, or specific thoughts that get to you when you first wake up with one, you should definitely work with what you have and try to prevent the panic before it wakes you up. If your sleeping brain doesn't hit any triggers, or if it can deal with them when it trips over them, you should have an easier time of it. Likewise, having a calm-down cycle that you follow can help over time.. It took about a year for mine to really start being effective so be patient with yourself.

Hope that helps
- Ivy

What is the next step?

Hey all,

I've joined here because I'm already familiar with using CBT and feel like I need a bit of a refresher. Especially for pushing anxiety boundaries and breaking out of the box I've let myself crawl into these last few years.
However, I am running into a few troubles unrelated to that, CBT is something I already apply in my daily life, and have for years, and it doesn't seem to help with all of my troubles. I have what I called body panic, or chemical panic, which is where I suddenly feel panicked but it's essentially only physical symptoms without any specific thoughts to accompany it, and I am often wondering and asking myself "why are you panicking? This is silly I have no reason to panic" and I have no answer.
Later upon examining the situation or thoughts I had (I have OCD thought obsessions, so I am very aware of my thoughts and practice mindfulness), I still can't think of any reason I was a panic attack (when I first started having them I would start thinking of all the things that made my anxious and could make myself worse trying to figure it out and stressing feeling like "there must be a reason", but I have since realized it's easier to just tell myself it's chemical and wait it out/try to calm down.)

Often I wake up to these, but they also happen randomly. I do also have triggers, but these no-trigger panic attacks are the most common for me, and I looked through the course but didn't see anything that covered coping with 'no trigger' panic attacks. They can be very disruptive, and sometimes if it lasts for quite some time I can start to feel very trapped or frustrated in an ambivalent sort of way combined with the panic, because I seem to have no control over how I feel, or when it ends. (Though I've developed a cycle of behaviours [non-compulsive FYI] which I can use to calm myself down, and when I wake up with one most of the time it works, but when they happen seemingly randomly when I'm awake waiting it out can take a lot longer.) If I get too frustrated I can unintentionally overwhelm myself and become incoherently panicky instead of still thoughtful, so I try not to let myself think about it and focus on calming down.

I also get anxiety in this sort of way, but much less commonly, as my anxiety mostly has triggers. (And so causes avoidance behaviours, where as my panic attacks feel unavoidable and uncontrollable)

Something worth noting, so that it's clear it is not in fact a 'hidden trigger': I don't spend much, if any, time worrying about if I'll have another panic attack and what that will be like, I've mostly accepted that I will and do my best not to worry or think about it. Dwelling on things you don't want to happen has never been helpful for me, so I try not to engage in that thought-pattern/behaviour.


What can I do? What is the next step in coping with these? Am I already doing all I can? I hope not but at least if I know that I don't have to feel like I'm not trying hard enough.

Thanks, and sorry for the length, I'm wordy...
 - Ivy

What is the next step?

Yo Davit,

Hm... Thank you for telling me about those. Though to be honest, I don't think I buy it (at least as you've explained it), and it doesn't make sense to me either.

Some elements of it (at least have you have explained it) are not possible: Thoughts are a mixture of electrical and chemical, and we can see it on things like CT scans, and even if we don't know everything we have a pretty good idea of what ideas are ridiculous and not possible. Thoughts don't, for instance, move faster than the speed of light; anyone saying "we can't see my version of the truth because it's happening *invisibly*" is probably selling pseudo science.
Invisible, intangible and untestable is the opposite of evidence. (That last category, untestable, makes it not capable of being part of science/known things.)

I remember most of my life, some people don't have a lot of recall for their childhoods, or they had un-dealt-with issues, where as I, have been in and out of treatment for depression and anxiety learning and refreshing my learning for coping skills since I first started having issues at 7. (Since I'm in my mid twenties, that's just under two decades. Most of my life.) So even if memory does influence my every action, I have troubles believing that there is anything to remember I wouldn't have dealt with at the time, yeah know what I mean?
I make a habit of challenging my experiences and conception of things, and when I do have a negative experience that is situational I remind myself that it is in the past and doesn't need any of my active concern, I should learn from it not relive it.
Learning these skills so young is actually what I attribute to my being even as healthy mentally as I am, sure I still have issues, but I have been preventing cycles of negative self-talk or background anxiety from running wild for years now. I stop them when I catch myself doing them, sometimes as quickly as they start to happen. It's a habit at this point, and also something I practice actively when I need to; it can still be a struggle some-days, I am ever mindful and making an effort to keep myself out of those kinds of unhelpful thought patterns and stress causing worry cycles.

The first hypothesis I don't mind really, because if there really isn't anything I can do about, that's okay, it's not fun, but at least it would mean that it's not something I'm doing or not doing.
My psychiatrist will hopefully find me a drug (or set of drugs) that can help, though so far I've had rare poor responses and allergic reactions to everything I've tried, but I'll keep trying til I run out of options and just have to cope.

Thank you for replying though Davit, the explanation is helpful.

(I'll make a separate post for replying to Vincenza, thank you both for your responses. It's good to be heard)

What is the next step?

Hello Vinchenza,

Thank you for the welcome. Yes, it's very good to see a community of people trying to help each other through experience, that aspect was definitely one of the things that attracted me to this program. It's good to not be alone, I mean I knew I wasn't, but it's good to actually be able to read what other people who are going through similar things say, their take on issues.

Yes, that part of it, the fact that the "subconscious" can affect every day life, I agree with. That's why it's important to stop negative self talk, and also to make sure you catch behaviours and thought patterns (even the ones that you are only peripherally aware of doing/acting upon) that are unhealthy for you. Those thoughts patterns however are something you should be able to notice of affect in some way, maybe I misunderstood, but it seemed like the way Davit explained it these would be un-noticeable things and that I don't trust to be true. It has been my experience that at some point you can catch a memory or thought patterns and  thus can change them.
It's something I noticed a difference with quite a bit when I went through a course focused on OCD, they did something that later seemed to me to be related to "Dialectical behaviour therapy" (which is meant to be used in tandem with CBT - I've picked up a book DBT recently to review) which when it is in reference to OCD has a lot to do with 'mindfulness' (awareness of self-talk and thoughts).
But I don't think that's the issue with my 'chemical/body panic attacks'. Because actively doing positive self-talks helps when I have anxiety caused by not being mindful enough, but it doesn't seem to have an effect on the frequency or intensity of these panic attacks. (I thought that might be what was causing them at first too, but due to non-effect of skills that help with those sorts of thing I've mostly ruled it out as a likely cause. I wasn't quick about that either, I tried for a year.)
When memories or thoughts are affecting you 

As to 'crawling in a box'... Well, I've had a lot of situational anxiety and depression these last few years (three people I loved died, my mother's codependent behaviour has spiralled out of control staying with a partner who is a substance abuser and has driven them both to living on the streets, and my significant other had a mental break down because of pressure at his work) and when I couldn't cope in other ways because the situations were over-whelming, I would remove myself from the things that were extraneous effort to maintain and caused me anxiety. Sometimes the only way to cope with the immediate is to pull back and work on expanding outwards again when you can cope with the immediate/internal.
I didn't know until I came here that my extreme anxiety about being alone was actually a form of agoraphobia, for me has been a very key thing, I have never enjoyed going out by myself but I dealt with it by having somewhere specific to go, when things started going poorly in my life pushing myself to go anywhere alone was only with a lot of difficulties, and I had only even been okay with it for limited times, and I moved into a state of never wanting to be alone with some alone situations being worse than others. I've pushed past that a bit, I can be at home alone now, and I've gone back to being able to walk to the store by myself if I have a specific list, or waiting for someone after being dropped off, but I still don't go anywhere alone at this point unless I'm either going to meet someone else or I have a specific task I am getting done.
I've never thought it was logical or okay, and wouldn't let myself stay at the worst point (and clearly I still want to work forward, since I am here reviewing so I can be ready for that push) but it has been my experience that for some things the discomfort never ceases (being alone, calling people, working on projects that I didn't decide the parameters for, showing people that work on projects or assignments, meeting new people, or going new places that someone else chose) you just learn to live with it, and at the worst point all my negative emotions were magnified and I just couldn't deal with or live with it or I had to retract for a bit.
Only at my worst points was I completely unable to act despite my emotions (which was when I was in the worst parts of the grieving process) I push myself most times. But sometimes you feel like you aren't okay and just have to crawl into box for a bit, and when you're okay just being in that box, you can start climbing out again and live outside it.

It is quite possible that these situation have had a significant effect on my panic attacks, however that would mostly mean that it would just be a time thing before they subside. As I deal with the situations and the situations improve (or I get used to them, as is the case for someone being gone, or someone behaving in a way that you find severely unhealthy and can't change for them.) they might eventually lessen, which is quite okay with me, but it's still not comfortable in the mean time. I want to know as much about what is happening to me and what I can do about it, as possible. The more I know about why something is happening, the better I am equipped to help myself.
The only other trouble is because of the timing of these events, they have comprised and compromised the vast majority of my adult life so far, so pushing into the working world is going to be a serious problem in and of itself just due to lack of experience. Which is a situation anxiety I have yet to really come to, but know is on the horizon.

Thanks for your reply, I hope my responses are clear. (It's good to be able to talk about it openly and honestly.)