Q. Sometimes, at night, usually when I go to bed on the early side, I can wake up with a full blown panic attack--short of breath, feeling unreal, and knowing that this is the big one. It is so scary and sometimes I think I will not make it through one more. Are these nighttime attacks common? Also, my chest and neck seem to be red and flushed all the time. Is this normal?

A. We can't diagnose, but from the sound of your letter it does appear as if you are having nocturnal panic attacks. There is no doubt they can feel very violent. They are very common in people who have spontaneous panic attacks and some people do go onto develop Panic Disorder as a result of the fear of them.

It is very important for you to have had a full medical check up to ensure there is no physical cause for the attacks. Once you have been diagnosed as having nocturnal attacks, it then becomes a matter of learning to manage them. There is research which suggests (and with which we agree with 100%) that the nocturnal attacks happen on the change of consciousness--as we either move into sleep, known as the hypnogognic state, or as we move from REM sleep to deep sleep or deep sleep back to REM. The attacks are not associated with dreams or nightmares, but happens, as we said, on the change of consciousness. One research study (again, with which we agree) says it is the magnitude of the change in consciousness which can create the symptoms.

People who develop this type of attack usually have a history of Dissociation. That is, they have the ability to self-induce various trance states, though they may not be aware of their ability to do this.

We do understand what the experience is like, because we also experience them ourselves. Although the attacks can feel like the 'Big One', the one which we feel it is going to cause 'massive' physical problems. They don't. Personally, we have now learned that when we wake up from them to say to ourselves, 'ok I'm having an attack,' and simply turn over and go back to sleep!

They can manifest in many different ways and it is very common for people to have a red face and/or neck as a result. The secret is to lose the fear of them.

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