Anxieties is characterised by the fear or worry that something bad will happen, normal anxiety occurs occasionally in response to situations that threaten our sense of security. This helps us avoid harm and remember not to put ourselves in the same potentially dangerous situation in the future. Anxiety is a normal stress response that has been conserved throughout human evolution and is evident in all other animals. When anxiety occurs inappropriately in response to normal everyday events, it can become a debilitating condition known as anxiety disorder. Anxiety disorders cause a person to be constantly “primed”, or “tense” in expectation of an impending threat to their physical or psychological well-being.
Symptoms of anxiety disorders are often chronic, and can include:
- Difficulty concentrating,
- tense muscles,
- sleep disturbances, and
- Trouble overcoming worries.
The conventional health care model typically attempts to alleviate anxiety with an array of psychoactive drugs that mimic or manipulate neurotransmitter signalling. For instance, medications for anxiety might either increase the recycling of existing neurotransmitters or bind directly to neurotransmitter receptors and block or activate them, artificially altering your mood. These psychoactive drugs fall short of addressing the underlying causes of anxiety – hormonal and metabolic imbalances which can emerge as our bodies attempt to adapt to chronic stress.
Recognizing and responding to underappreciated risk factors for anxiety disorders, such as elevated homocysteine and sex hormone imbalances, is an important aspect of any treatment regimen. Sadly, mainstream physicians often fail to address these subtleties. Anxiety is a multifaceted disorder, and must be addressed as such in order to achieve symptomatic relief. Nutrients such as omega-3 polyunsaturated fatty acids, magnesium, and adaptogenic herbs like rhodiola can synergize with healthy eating habits and stress management techniques to effectively optimize the body’s stress response mechanisms and support healthy neurological communication. Compounds like B-vitamins and amino acids can provide the raw materials the body needs to ensure proper neurotransmitter synthesis and signalling.
Nearly 15% of adults will experience an anxiety disorder in their lifetime. It’s interesting to note that depression and anxiety are very much interrelated. Women are twice as likely as men to suffer from generalized anxiety disorder. The latest statistics suggests that an imbalance in female hormone levels during and after menopause, during menstruation, and after pregnancy may be tied to the aetiology of anxiety.
Frequently Asked Questions
- 1Are there different types of anxiety in people with Sleep Disorders?
- 2In which Sleeping disorder do we find symptoms of Anxiety and depression?
- 3How Upper Airway Resistance Syndrome does commonly masquerades itself?
- 4What anxiety symptoms are related to Sleep Apnea?
- 5How does Sleep Apnea (UARS and OSA) cause anxiety?
- 6Can anxiety disorders aggravate Sleep Apnea?
- 7What treatments are available for Sleep Apnea Anxiety?
- 8What Integrative measures are recommended to treat anxiety?
- 9What natural therapies may help with anxiety?
- 10What can you do to control and prevent anxiety?
Anxiety is one of the most common mental problems associated with sleep disorders. It's not unusual that if you have anxiety disorder, you will also have sleep disturbances, like insomnia.
These are the most common anxiety disorders that can cause sleep disturbance:
- Generalized anxiety disorder (GAD):
GAD manifests symptoms of anxiety that are driven by worry, which last for at least 5 -6 months.
In this type of anxiety disorder, there are symptoms related to sleep apnea, such as fatigue, restlessness, irritability and poor concentration, but this doesn't mean that you have a link between sleep apnea and anxiety.
- Panic disorder:
The panic disorder manifests with symptoms such as chest pain, heart palpitations, tachycardia and fear of dying. A person with panic attacks is more likely to experience sleep apnea.
The symptoms are similar:
- severely impaired sleep
- frequent awakenings
- decreased sleep efficiency
- increased movement time
- fear of going to bed
Upper Airway resistance syndrome manifests itself in Depression and Anxiety.
One of the key differences between upper airway resistance syndrome and obstructive sleep apnea is that apneas (pauses in breathing) and hypopneas (decreases in breathing) are either absent or very low in patients with UARS. It is frequent that UARS is misinterpreted as chronic fatigue syndrome, fibromyalgia, or as psychiatric disorders, such as attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD)
- Chronic fatigue syndrome – severe, continued tiredness that is not relieved by rest and is not directly caused by other medical conditions.
- Fibromyalgia – it’s a common syndrome in which a person has long-term, body-wide pain and tenderness in the joints, muscles, tendons, and other soft tissues. Studies shows that the vast majority of fibromyalgia suffers have undiagnosed UARS. When UARS is properly managed, fibromyalgia pain can dramatically decrease.
- Migraine – a common type of headache that may occur with symptoms such as nausea, vomiting, or sensitivity to light.
- Depression – described as feeling sad, blue, unhappy, miserable, or down in the dumps. When children don’t get enough sleep they get hyper and cranky. When adults don’t get enough sleep over a prolonged period of time, depression can easily set in. Sadly, mental health professionals rarely evaluate their patients for difficulty breathing during sleep.
- rapid and irregular heart beat (palpitations),
- sensation of asphyxiation or choking (with or without CPAP mask),
- feelings of suffocation (mostly when sleeping with CPAP mask),
- chest pain,
- dizziness, weaknesses and likely to lose consciousness,
- loss of personal identity (depersonalization),
- having fear of going crazy or losing control,
- fear of dying, which is a common trigger of anxiety in patients with sleep apnea,
- Sudden brief sensation of heat and cold.
- Injury in specific brain locations caused by untreated sleep apnea.
- People with sensibility for anxiety have increased risk of having future panic attacks.
- Negative thoughts can cause fear, the precursor of anxiety in apnea patients with anxiety sensitivity.
- Stop breathing during sleep - knowing that you stop breathing for tens of seconds is a scary thought.
Thoughts about dying in sleep - I can’t sleep at night thinking about my death! - This is the most powerful precursor for anxiety and panic attacks symptoms in sleep apnea patients.
- Thoughts about CPAP side effects, such as asphyxiation during sleep, chest pain while using CPAP, claustrophobia from CPAP mask, power failure while sleeping with CPAP mask, etc.
- Sleep Apnea and Nocturnal Panic Attacks Sleep apnea can cause nocturnal panic attacks. Clinicians also encountered parasomnias, delirium, personality change and violent outbursts in some OSA patients. Many sleep apnea patients have dreams during a breathing pause while sleeping.
Developing fear wearing the CPAP mask can determine the patient to avoid using the CPAP consistently. In this situation, sleep apnea will worsen in time, causing many complications.
Anxiety or depression can contribute to insomnia and specifically UARS. Being very tired, but without the possibility to sleep, will make your body even weaker than before. The panic attacks or nightmares, when you stop breathing, can affect your mood of the following day. The recurrent anxiety attacks can lead to the fear of having another panic attack. This fear of anxiety can be a risk factor for panic disorder. Having anxiety will negatively affect your treatment for sleep apnea, causing insomnia symptoms and other anxiety feelings in the future. Breaking this cycle is possible through having a good night’s sleep - sleeping without having apnea episodes. This means using the CPAP all night, without throwing the mask away during sleep, or without having leaks. With a good night’s sleep, a patient with sleep apnea can eliminate the anxiety symptoms.
CPAP (continuous positive airway pressure) treatment is the most effective way for healthy sleep in apnea patients, but it's also a tough choice for a patient who also has anxiety. Those patients with UARS(Upper Airway resistant syndrome) will possibly need a brace for their treatment if they do not tolerate a CPAP and experience more anxiety from it.
1. Anxiety & Hormones: Anxiety disorders affect twice as many women as men. Further, women experience more anxiety when they are pregnant, postpartum (after giving birth), premenstrual and menopausal than at other times in life. Large quantities of DHEA, estrogen, progesterone, and testosterone receptors are found in the brain. These hormones affect the brain in a number of ways, including regulation of mood. The drop in estrogen during menopause, associated with reduced serotonin production, has a negative impact on mood and cognitive function. Progesterone plays a role in anxiety. BHRT involves supplementation (usually) with either transdermal (topical) or oral preparations of hormones obtained from a compounding pharmacy. BHRT differs from conventional synthetic hormone replacement therapy (HRT) in that it relies on the use of natural hormones whose molecular structure exactly matches those of the hormones produced within the human body.
It is important to address the factors that cause hormonal imbalances in the first place. These include blood sugar dysregulation, oxidative stress, inflammation, and other disruptions in metabolic function leading to chronic stress, a condition that frequently results in both hormonal imbalances and anxiety disorders. In addition to managing hormonal imbalances, it is important to examine the relationship between the stress hormone cortisol and DHEA (a building block for the sex steroid hormones). During times of prolonged stress, a greater proportion of cortisol is made compared to DHEA, with a high cortisol to DHEA ratio being a marker associated with anxiety disorder. DHEA counteracts some of the negative impact of cortisol in the body. Clinical studies have found DHEA supplementation to be particularly helpful in relieving anxiety in both schizophrenics and females with low hormone levels. It is important to note that all the major sex hormones are interrelated. People with anxiety may benefit from comprehensive hormone testing, and if necessary, a program of bio-identical hormone replacement. Book a consultation with our Health Renewal doctors for Anxiety.
2. Lifestyle Changes
Smoking, alcohol and caffeine consumption, lack of exercise and an increased Body Mass Index (BMI) can all have a negative impact on the degree to which aging individuals experience anxiety.
Getting enough sleep and exercise, maintaining a healthy body weight, and moderating caffeine consumption on the other hand are recommended for reducing anxiety. Music and massage therapy appear to be particularly helpful in reducing anxiety associated with postoperative stress and treatment for cancer. A nutritious diet is central to controlling anxiety. When it is not always possible to have a well-balanced diet, nutritional supplementation can be an important lifestyle factor in the fight against anxiety.
3. Book yourself for a sleep study and find out if this might be the reason for your anxiety.
The following nutrients may help balance brain chemistry naturally:
- Amino Acids:
An amino acid from the diet or another chemical is already present in the brain. Enzymes are then used to convert the amino acid into the needed brain chemical.
- L-tryptophan, 5-HTP.
Insufficient intakes are associated with increased symptoms of anxiety. Supplementation with L-tryptophan or 5-hydroxytryptophan (5-HTP) has been shown to elevate brain serotonin levels and enhance both mood and one’s sense of well-being. Vitamin B6, magnesium, and vitamin C, nutrients already taken by most health-conscious people are cofactors that facilitate the conversion of tryptophan to serotonin in the brain. There are no reported adverse effects, but pregnant women and individuals taking MAOIs should avoid high doses.
An L-lysine deficiency has been shown to increase stress-induced anxiety. When presented with a stressful situation, supplementation with L-lysine reduced anxiety in human subjects.
Theanine, an amino acid found in green tea, produces a calming effect on the brain. Theanine easily crosses the blood-brain barrier. It increases the production of GABA and dopamine and protects the cells of the hippocampus, the seat of learning and memory in the brain from damage.
- S-Adenosylmethionine (SAM-e).
SAM-e occurs naturally in the body. It is concentrated in the liver and brain and is a major methyl donor in the synthesis of hormones, nucleic acids, proteins, phospholipids, and catecholamine neurotransmitters such as dopamine and serotonin. SAMe facilitates glutathione usage and maintains acetylcholine levels, helping to preserve cognitive function while aging and possibly attenuating neurodegeneration.
Magnesium deficiency has been linked to anxiety disorders in several clinical studies. When taken for one month in combination with a multivitamin, zinc and calcium, magnesium dramatically decreased symptoms of distress and anxiety. Further, supplementation with magnesium and vitamin B6 effectively reduced premenstrual-related anxiety.
Selenium has been shown to reduce anxiety. Selenium supplementation reduces anxiety in elderly hospitalized patients, cancer patients undergoing chemotherapy, and HIV patients receiving Highly Active Antiretroviral Therapy (HAART). In a selenium deficiency state, thyroid hormone synthesis may deteriorate, and can lead to poor mood and many other negative conditions.
- Fatty Acids
Omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are necessary for proper brain function. Omega-3 fatty acids have been shown to have a variety of health benefits, most recently being improved mood and reduced anxiety.
- Nutraceuticals and Herbs
Botanical herbs have been shown to manage many psychiatric disorders, including anxiety. The quality, composition, conditions for growth & extraction processes of herbal products can vary a lot; care should be taken in choosing an herbal remedy. The following herbs either have anti-anxiety effects or target key molecular sites associated with neurotransmitters in the central nervous system:
Ginkgo biloba binds to and activates the GABA receptor, and like a benzodiazepine, reduces anxiety in patients with generalized anxiety disorders without side effects.
Valerian (Valeriana officiaonalis). Components of valerian root have been shown in laboratory studies to bind to GABA receptors, increase the release of GABA, and decrease its reuptake. Valerian root extracts have also been shown to activate glutamic acid decarboxylase, an enzyme involved in the synthesis of GABA
- Lemon balm (Melissa officinalis).
Lemon balm is a member of the mint family, sometimes used as a culinary herb and flavouring agent. The plant also has several anti-anxiety actions. Lemon balm contains compounds that strongly suppress the breakdown of GABA, which may prolong the anti-anxiety effects of the neurotransmitter.
Rhodiola rosea is a known adaptogen, an herb that helps improve one’s resistance to stress. It has also shown promise in alleviating anxiety disorder.
- Ashwagandha (Withania somnifera).
Ashwagandha, or Indian ginseng, has long been used by Ayurvedic practitioners as a rejuvenating tonic. The herb has anti-inflammatory, antitumor, anti-stress, antioxidant, immunomodulatory, and rejuvenating properties. It has also been shown to reduce anxiety.
GABA is the chief inhibiting, or calming neurotransmitter in the brain, functioning as a brake on the neural circuitry during stress. Low GABA levels are associated with restlessness, anxiety, insomnia and a poor mood. The use of GABA as a dietary supplement relieves stress, anxiety, and increases the production of alpha brain waves (associated with relaxation.
- N-Acetyl Cysteine (NAC)
Shows promise for alleviating mood disorders through a variety of mechanisms. It acts as a precursor to glutathione, a potent cellular antioxidant that may help ease neuronal oxidative stress. This might lessen the excitatory transmission triggered by glutamate.
- Vitamin D.
There are receptors for vitamin D throughout the brain, and data indicates that lower vitamin D signalling leads to increased anxious behaviour. There is a considerable association between low vitamin D levels and depression, but the connection with anxiety is less clear.
Our bodies are truly elegant in their design. Glutamate accelerates brain activity (excitatory), while GABA puts the brakes on (inhibitory). Together, they keep the brain working along at just the right pace—not too fast, not too slow. If you have developed anxiety, then the balance of these two chemicals has been thrown off. As a result, the brain’s activity level is turned up too high, at least in some areas.
The importance of early management of any condition cannot be overstated. Once certain conditions set in and damage to organs occurs, complete recovery may be difficult to attain. Best results for prevention and longevity is early detection of a possible problem combined with conventional treatments, nutritional supplements and a healthy diet and lifestyle.
- Control Your Breathing
- Severe anxiety symptoms are often linked to poor breathing habits.
- Take more controlled, slower, shallower breaths
- Effective anxiety reduction is often about distraction, since your mind can be your worst enemy when you have severe anxiety symptoms.
- Try Some Aerobic exercise
- exercise has numerous advantages for controlling your anxiety symptoms:
- Exercise burns away stress hormones that create anxiety symptoms.
- Exercise tires your muscles, reducing excess energy and tension.
- Exercise releases endorphins, which improve overall mood.
- Exercise forces healthier breathing.
- Exercise is a healthy distraction.
- Aerobic activity, like light jogging or even fast walking, can be extremely effective at reducing the severity of your anxiety symptoms, as well as your anxiety itself.
- Find What Relaxes You
- Learn How to Trick Your Anxious Thinking
- Listen to Good Mood Music
- Every little thing matters. That's why even if it sounds like it won't make a tremendous difference, listening to your favourite music can have a powerful effect on your anxiety.
- Make Love: It's not a myth. Sexual intercourse can be incredibly calming. It is a distracting physical activity that releases endorphins and helps you feel more relaxed and less tense.
- Living in Today
- Those with anxiety often start to focus too much on how they feel and their worries about the future. Each day becomes trying to live with anxiety instead of trying to live in general.