Hi everyone. Some of you relate to having nocturnal panic attacks. Here's an exposure plan to help you.
Perhaps as many as two-thirds of people with panic disorder have experienced at least one nocturnal panic attack in which they wake up from sleep with the symptom of a panic attack. Treating and doing exposure work for nocturnal panic attacks is a little bit tricky and you may have to modify the Panic Program a bit to suit your needs. The following are a few things you might try.
- Try to learn as much as you can about nocturnal panic. Craske and Rowe wrote a good paper in 1997 entitled "Nocturnal Panic" in a journal called Clinical Psychology: Science and Practice.
- Practice some kind of relaxation exercise just before you go to bed. Try box breathing and progressive muscle relaxation. Both are described in later sessions of The Panic Program. You might include listening to some relaxing music. There was an interesting post in the relaxation forum a few days ago pointing to a website where you can download relaxation music.
- Familiarize yourself with the basics of sleep hygiene. The basics are described in a later session of The Panic Program
- You might want to consider doing exposure work in which you expose yourself to states of relaxation. You can start by sitting in a chair and "doing nothing" and progress to something like box breathing, progressive muscle relaxation, then perhaps yoga or tai chi. Sometimes nocturnal panic seems to go with a fear of being in a relaxed state.
You may have some fears (thoughts) related to sleep and/or relaxation that you may be able to challenge. For example, fears related to "losing control." If you sit in a chair and "do nothing" for half an hour, what is your physical experience? What thoughts come to mind? Can you challenge them?
You may be able to start to identify and challenge the thoughts you have when you wake up in a panic. This may be quite a challenge, as your experience may be that by the time you wake up it is "too late." However, with time you may be able to identify and challenge the thoughts that you have when you wake up and break the panic cycle. Use thought records to challenge your fears, whatever they are.
- You may want to try interoceptive exposure work in which
