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How can my panic attacks be cured?

Q: I am a 57 years old man suffering from anxiety / panic attacks when I go to sleep. At times the anxiety attacks happen within a short time of lying down in bed. At other times, I get up after a few hours of sleep with a panic attack. This lasts for about an hour after which I manage to fall asleep. I feel distressful and extremely uncomfortable. Even though I feel very sleepy, I am unable to fall asleep. I take half a tablet of 0.25 mg of Alprax which works sometimes. Can I take a medicine on SOS basis for instant relief? What should I do to get permanent relief from these attacks? I do not get any panic / anxiety attacks during the day. The doctor prescribed Prothieden about 3 months back but discontinued this medication as it did not help me. Please advise.

A:Thanks for communicating your concerns. You have mentioned anxiety attacks at night, after falling asleep. You might be suffering from night terror. One also needs to understand the backdrop (incl any significant stress) in which these symptoms are emerging. The management should be based on careful assessment of your symptoms, careful history, physical and neuropsychiatric evaluation. Have you been through a sleep EEG as yet? You may also find some benefit from following sleep hygiene tips (incl. avoiding use of tea/coffee particularly after evening hours; avoiding alcohol and smoking). You have mentioned use of alprazolam (benzodiazepine). Although short term use of benzodiazepines may be of some relief, long term use should be avoided due to risk of dependence; and please remember that such medicines should not be taken without proper psychiatric guidance. Yes, there are medicines that may help you and may I suggest that you consult a psychiatrist for a detailed assessment and management incl. stress management.

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