Why Anxiety Feels Worse at Night (and what to do about it!)

 Ever wake up at 2am in panic mode? This episode is for you! Today I'm talking all about nighttime anxiety. How to recognize it, why it happens, and practical steps to move past it. Thanks for listening! 

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FREE Recovery Guide: https://the18minutes.com/ 

 TikTok: https://www.tiktok.com/@the18minutes

Instagram: https://www.instagram.com/the18minutes/

YouTube: https://www.youtube.com/@the18minutes

Email: amanda@the18minutes.com 

Transcript

SPEAKER_00 0:24

Welcome to the 18 Minutes Podcast. Happy Friday. One of my favorite things to do is go to an art museum. I love art. They're almost always in these beautiful old buildings, and they're just nice to be in. There's a local art museum to me, the Minneapolis Institute of Art, that is incredible. I frequent it somewhat regularly, and it has special meaning to me now because when I was agoraphobic, it was a place that I always wished I felt like I could go. And I it just wasn't on the table for me when I was at the worst points of my anxiety. I would imagine being able to go there and walk around by myself at my own pace and just like enjoy the experience, and it wasn't something I could do. I was just there a couple days ago because they do this gorgeous flower show every spring where artists, floral artists, create these floral art pieces, art pieces that are inspired by an art piece at the museum, and you get to see them side by side and talk to some of the artists. It's really, really cool, something they do every spring. And they have a party the night before it opens, and there's uh food and drink, live music, um, flowers everywhere. It's super gorgeous, really fun, and it's packed with people. So many people were at this party. And I cannot go to events like that now without getting a little bit emotional because I never thought that I would be able to experience things like that again. And now being able to participate in them since being recovered from panic disorder uh has made me more grateful for things like that. And so um I was thinking a lot about my anxiety journey while I was there because I had so much fun, I was so happy to be there, and there were so many elements to it that were not things that I could be around for literally years of my life, and it was so much fun. So that's why I'm here today doing what I'm doing, because I didn't know that living a full life was an option to me. And maybe you're in that place now. Maybe you hear my story or other people's stories, and you think that's really great. I'm so happy for you, but that's not something that I could ever do. And I want you to know that everyone who has recovered from an anxiety disorder has felt that way at some point. It feels permanent, and we feel when we're in those experiences like we're weak and incapable, and sometimes people even tell us that that's the case. I'm telling you, you have everything you need to recover from your disordered anxiety, even if it feels impossible for you. You don't have to live in fear for the rest of your life. Before I get into today's episode, please keep in mind that I'm not a therapist or a licensed medical professional. The information I share in this podcast is based on my own personal experience with disordered anxiety. It is not a replacement for therapy. So please take what's helpful to you, leave what isn't, and heed any advice that you get from your medical and mental health professionals. As I've mentioned, I have considered myself recovered from disordered anxiety for about six years now, but that doesn't mean that I never feel anxious. If you are a human, you are supposed to feel anxious sometimes. Lately, I have been waking up in the middle of the night about once a week and having serious anxiety out of nowhere, and sometimes experiencing what's called nocturnal panic attacks. And all that is is just waking up in the middle of the night, having a panic attack for seemingly no reason with no obvious trigger. Common symptoms of a nocturnal panic attack include shortness of breath, racing heart, chills, tingling or numbness in your fingers and toes, feeling like you're choking, chest pain, nausea, sweating, and trembling or shaking. Personally, I have been waking up with a super high heart rate, um, shortness of breath, and pretty intense um tremors and shakes. It happens the moment that I gain any sense of awareness, I'm already having these physical sensations and it's very disorienting. While I'm not afraid of these symptoms, like I said, I've been having them about once a week, and it's probably been three or four months now. Um, I don't want to feel this way in the middle of the night. It's not fun. So I researched for you and me both why this happens, what our brains and bodies are doing in the middle of the night that makes this so difficult, and what we can do about it. If you're enjoying this podcast, make sure to follow on whatever platform you're listening on to get updates about new episodes that come out every week. And let's get into it. So I've talked a lot recently about the amygdala and its role in the feelings of anxiety that we have. The amygdala is our primary threat detection mechanism. Nocturnal panic attacks typically happen between stages of sleep, and our amygdala incorrectly perceives some bodily sensations as dangerous. This perceived danger causes the amygdala to send a signal to our adrenal system, which then dumps adrenaline directly into our bloodstream, and we can feel that change within seconds. So when we wake up, we're already in the middle of the threat response. There's a piece of this that's really interesting to me because one of my symptoms is waking up and feeling like I can't breathe. I've got this shortness of breath and air hunger, and I immediately try to take in as many deep breaths as I can. One of the likely triggers to our oversensitized amygdala is a rise in CO2 levels in our bodies as our breathing rates slow down during sleep. People with panic disorder are often hypersensitive to changes in CO2 levels because of over-breathing patterns. So even when we're completely unaware during sleep, our amygdala has catalogued a rise in CO2 as dangerous. Learning this recently was such a light bulb moment for me because it helped me understand what's happening in my body, and it makes sense that I wake up feeling like I need to get a bunch of air because my amygdala is so good at keeping me safe. So, while not a fun experience, it makes perfect sense. And I'm actually now considering doing some CO2 sensitivity training. But if you struggle with respiratory anxiety symptoms, you can try things like breathing through a straw, breathing through a paper bag, or even exercising, which all increase CO2 levels and at the same time practice the principles of exposure and response prevention like acceptance, willingness, and you'll teach your amygdala that a rise in CO2 doesn't equal death. Side note, please talk to your doctor or therapist before starting any of your own treatments for anxiety. Okay, so back to us waking up in the middle of the night freaking out. I mentioned that this typically happens between stages of sleep, particularly stages two and three. Stage four is our REM sleep stage where our dreaming occurs. This is super important for understanding anxiety disorders in a larger context, because when we have panic disorder, generalized anxiety disorder, agoraphobia, OCD, we think sometimes, or hope maybe, that it's a cognitive issue that we can think our way back out of. If we just read enough books, Google enough symptoms, listen to enough podcasts, we will have a greater understanding of this issue and be able to relax. The fact that our threat response system is working while we're not conscious and detecting physical sensations that it perceives as threats that we cannot cognitively participate in a forward feedback loop tells us that anxiety disorders are primarily a physical problem, not a cognitive one. That's why exposure and response prevention works so well for treating these anxiety disorders. Because our brains have been trained through our behavior to categorize certain physical sensations as dangerous when we avoid experiencing those sensations out of fear. I was so incredibly excited to learn about this because I'm even more confident now that I can overcome this nighttime anxiety. I've always had more fear around my breathing and my heart rate than anything else. So now I know I probably just need to dig a little deeper on those things because what I didn't mention is that at that same stage shift in our sleep, our heart rate also decreases a little bit, and the amygdala perceives that as dangerous depending on how sensitized we are to that. And so doing some kind of CO2 training, exercising more, practicing more acceptance, I'm sure will help train my amygdala to stop waking me up in the middle of the night when it senses that rise in CO2 or a decrease in my heart rate. Another mechanism that can cause us to wake up in panic is our naturally rising cortisol levels. In the second half of sleep, our cortisol naturally starts to rise. And you might recognize cortisol as a stress hormone. For people with an overly sensitized nervous system, this rise in cortisol can be perceived as a threat. Cortisol also hits a peak about 30 to 45 minutes after waking up. In people with anxiety disorders, this peak can actually be exaggerated. You could have a steeper, faster spike in cortisol. So if you're someone who experiences anxiety in the morning, that could be why. If you're like me, you might find that everything is scarier and harder to deal with in the middle of the night. I've always been this way. I never thought about why this might be happening or if there's anything I could do about it until today. Turns out there is indeed a biological reason for this. When we enter the second half of our sleep cycle, often really early in the morning in the middle of the night, our cortisol is rising, and this increase changes how our perception works a little bit. First, it narrows our attention to threat relevant information. This is a survival mechanism, but when a real threat isn't present, it puts a spotlight on whatever worry content is available. Financial stress, worrying about your health, relationships, whatever it might be. Our brains are set up at this point in our daily hormone cycle to focus on danger. And so it makes it much harder to turn our focus away from it. So the same thing that could pop in and out of your mind at 2 p.m. could be a hyperfixation at 2 a.m. The prefrontal cortex, which we've talked about, helps us rationalize our perception and it weighs probability with catastrophic thinking. We need to be fully awake for this part of our brain to work at its full capacity. So that makes nighttime anxiety difficult to overcome. And high or rising cortisol levels actually has a suppressive effect on the prefrontal cortex. So with the prefrontal cortex suppressed and cortisol activating our nervous system, the amygdala has all the room it needs to be the primary voice in the middle of the night. If our amygdalas had an actual voice, there would be zero nuance, only certainty. So that's why in the middle of the night, when you wake up, your heart is racing, you're short of breath, your mind immediately goes to, I'm in danger, this is a problem, it's real this time, no question. The thoughts aren't surfacing because they're more true at this time of day. It's because our bodies are designed to function this way. So, what can we actually do about this? As you know, I'm a huge proponent of exposure and response prevention. Preventing this nocturnal panic cycle is primarily about desensitizing our fight or flight responses to bodily sensations. The best thing you can do for nighttime anxiety and nocturnal panic attacks is to practice exposure and acceptance during the day. Doing exposures specifically related to breathing, heart rate, even dizziness will teach your amygdala that changes in these bodily sensations do not equal danger. Then, when these things change during sleep and you're not cognitively aware to be able to do anything about it, it's okay because your amygdala will be in a new, healthy, balanced pattern when it comes to physical sensations. One of my first ever exposures was walking up and down the stairs in my house a couple times to get my heart rate up, my breathing rate up, and then I would fold the laundry, work on a project, do whatever I needed to do that day without reacting to the sensations, even though I was afraid of them. Allowing ourselves to feel anxiety and feel fear without running from it or fighting it is how we get our fight or flight systems back into a regulated state where we don't get sent into a panic spiral every time we feel our heart rate increase a little bit. Other than exposure practice, there are some behavioral changes you can make to help ease nighttime anxiety. I want to make my stance on this very clear because these behaviors can be used as a means of avoiding sensations. And if you are still afraid of bodily sensations, then changing these habits won't work for you. I strongly believe, and even more so after today's episode, that anxiety disorders are a physical problem that we can overcome through physical behavioral changes in how we react to fear. So that being said, keeping a consistent sleep schedule and getting direct sunlight into our eyes 30 to 60 minutes after waking up can help regulate cortisol levels throughout the day and make nighttime anxiety a little less hard to deal with. So that being said, keeping a consistent sleep schedule and getting morning sunlight 30 to 60 minutes after waking up can help regulate our cortisol cycles, which can make nighttime anxiety easier to deal with. Another thing we can do to help ease nighttime anxiety is to keep the hours before bedtime calm and peaceful. Not using screens, not having difficult conversations, not exercising, all of these things can help keep our cortisol levels where they need to be and help us relax before bed. When you do wake up in the middle of the night having a panic attack, the best thing you can do is practice not engaging with the thoughts. You can notice them, remind yourself that this is an overactive amygdala issue, and practice being willing to feel anxiety even in the middle of the night. This will teach your amygdala that this situation is not dangerous and doesn't warrant that adrenaline surge. Using calming techniques at this time could actually reinforce it as dangerous to your fight or flight system. I want to encourage you to use techniques like belly breathing, meditation, unclenching your jaw, muscle relaxation before you're in a situation where you're experiencing intense anxiety. That way, your amygdala doesn't then associate those behaviors as a means of safety from something dangerous. Okay, so that was a lot of science-y information. I hope that was helpful to you. The big takeaway I want you to leave with is that nocturnal panic and anxiety does not mean there's anything wrong with you. Nighttime anxiety is the result of a very predictable bodily mechanism and you are not broken. Even more, it's something that you can overcome. You are stronger and more capable than you think. If you have comments or questions about today's episode, I would love to hear from you. You can send me an email at amanda at the 18minutes.com or send me a message on any of my social channels. And be sure to follow the podcast to get notified when a new episode comes out. Thank you so much for being here today, and we'll see you next time.