Posted by QA on April 13, 2003 at 16:32:40:

In Reply to: Unusual Case posted by QA on April 13, 2003 at 15:08:36:

The patient has sleep onset insomnia as he is now fearful to initiate sleep in case of these attacks
palpitations and feelings of fear go with a picture of nocturnal panic attacks due to a general anxiety disorder: GAD
to further evaluate- we need a detailed history of his day time levels of anxiety and whether he has had similar episodes in wake. He should be closely questioned pertaining to GERD symptoms which can cause nocturnal water brash and laryngospasm which might feel like throat closure and be very terrifying. With GERD I would expect the examiner to offer you a history of nocturnal cough or wheeze or a PMH of refractory asthma.
other causes to be considered include OSAS- we have no bed partner and the patient is certainly in a demographic population sees a lot of OSAS. Don't forget patients can have more than one diagnosis- some of his awakenings may indeed be apnea which are frightening and could be followed with a physiologic recovery tachycardia that I suppose a patient could be aware of. The apnea related awakenings are usually accompanied with a loud rescue breath and limb flailing but would be potentially frightening and could predispose to underlying GAD related nocturnal panic attacks

other rare problems include Sleep Choking Syndrome- see ICSD- unknown etiology.freq awakenings with nocturnal awakenings and intense feeling of inability to breathe. near nightly occurrence and feeling of impending death. No stridor. The bed partner if present does not seen any impaired resps. Tachycardia is common.
SCS is more likely to be seen in those with underlying OCD of GAD disorders. More common in young female. seen in early to mid adulthood. not seen in kids. An anxiety disorder may result!
differential
OSAS
Sleep related abnormal swallowing - look this up guys
Sleep terrors
GAD related (general anxiety disorder) panic disorders Sleep related laryngospasm

review the ICSD

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