The man who doesn’t dare to sleep – night panic attacks [Case Study] Xiaojuan, who has been envied by her friends for having a good husband, has a difficult story to tell. Her husband contracted a strange disease three months ago and became afraid to sleep at night, especially when Xiaojuan was on duty and could not go home, her husband was sleepless at night. For this matter, Xiaojuan had tried to ask the unit leader several times whether she could not be on duty, but in the end, she always found it difficult to talk about the reason and gave up. Hongwu, a psychiatrist at the Shanghai Mental Health Center Xiaojuan’s husband is a construction supervising engineer who is funny and humorous, but he is particularly rigorous and diligent in his work, so he has achieved a lot in a few years. One night, three months ago, Xiaojuan’s husband suddenly woke up from sleep, feeling like he was dying because he was holding his breath in his chest and had difficulty breathing. At that time, they just thought it was a nightmare, so they didn’t pay much attention to it. But in the three months since then, Xiaojuan’s husband has been in a similar situation many times, and has gone to the hospital several times. Although the doctor has repeatedly told him that there is nothing wrong with his body, Xiaojuan’s husband has become particularly nervous and is slowly becoming afraid to sleep. Especially when Xiaojuan is not at home, he often stays up all night, afraid that once he has a “heart attack” at night, no one will save him. The reason why Xiaojuan’s husband suddenly got this strange disease? The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things. Why does this “heart attack” always occur at night? It could be what people call “nightmares”, like those often seen in movies and dramas? The doctor suggested that the couple come to the hospital’s sleep center and underwent a polysomnogram and other tests. The doctor told Xiaojuan and her husband that the problem should have nothing to do with dreams. Because Xiaojuan’s husband’s “heart attack” occurred in non-REM sleep, while dreaming usually occurs in REM sleep. Although, Xiaojuan’s husband did wake up suddenly from sleep like a “nightmare”, showing fear and dread, accompanied by an increase in heart rhythm and respiratory rate. However, the “nightmare” awakening occurred after the nightmare, and he could clearly recall the content of the dream after waking up. However, Xiaojuan’s husband did not remember whether he had a dream or not after he woke up. Therefore, it is obvious that this is not a “nightmare”. Since the nightmare occurred during the non-REM period, could it be the “sleep terrors” mentioned earlier in the book? Although the polysomnogram shows that both of them occur in the non-REM phase, and both of them have similar symptoms such as awakening from sleep, fear, rapid heartbeat, difficulty in breathing, sweating, and a sense of near death. However, in the case of “sleep terrors”, the consciousness is usually blurred and disorientation may be present, with no recall the next day. In contrast, Xiaojuan’s husband could clearly recall the experience during the attack. Let’s turn our attention to Xiaojuan’s husband again. What was it that prompted this man, who seemed very strong to outsiders, to fear the very natural physical need to sleep? It turns out that six months ago Xiaojuan’s father-in-law died of a sudden heart attack. The family was devastated by this incident, but Xiaojuan’s husband, the eldest son in the family, acted unusually strong. But according to Juan’s careful observation, her husband was particularly prone to stress and anxiety in the past six months, paying particular attention to his health, and he loved to run to the hospital if he was slightly unwell. Here, we seem to have found a clue. Xiaojuan’s husband may be suffering from a psychological disorder, to be precise, called “panic attacks”. Xiaojuan’s husband admitted that after his father’s death, he was really concerned about his health, and he also felt that he became particularly nervous. But why would she have a panic attack at bedtime when it is clearly the most relaxing time of the night? In fact, after worrying about physical symptoms many times, the fear of physical symptoms will appear “automatically”, and the excessive fear of death will lead to an increased sensitivity to subtle changes in the body, which will be associated with death. If one is overly sensitive to the changes in breathing and heart rate that occur during sleep, it is not difficult to understand why panic attacks occur. How did Xiaojuan’s husband’s condition develop over the past three months? How did he develop from an occasional panic experience to “afraid to sleep”? First, the first sleep panic attack; second, the conditioned fear of sleep; second, the conscious postponement of sleep or prolonged intermittent sleep deprivation, sleep deprivation or relaxation that further exacerbates wakefulness and sleep panic attacks; and finally, increased fear and avoidance behavior. Of course, the person may not feel that he or she is bothered by sleep fears, but may postpone bedtime with various excuses, such as too much work, not being sleepy, wanting to watch TV, etc. Some patients also have a friend or spouse watch them sleep, hoping that someone will be present when a sleep panic attack occurs. Having figured out the ins and outs, let’s go back to the title of this chapter – the man who is afraid to sleep. Xiaojuan’s husband had actually been sleeping poorly for the past six months. However, this unusual experience over the past three months has made Xiaojuan’s husband so exhausted that his fear of having another seizure developed into fear and avoidance of sleeping, and eventually became “afraid to sleep”, especially when no one was home and he stayed up all night. However, it is this chronic sleep deprivation that exacerbates the sleep disturbance and panic disorder episodes. Although most patients with panic disorder have panic attacks during the day, nocturnal panic attacks are a fairly common phenomenon. Approximately 44% to 71% of patients with panic disorder report experiencing at least one nocturnal panic attack, 18% to 45% have frequent or regular attacks, and about 10% of patients have panic attacks that occur at night, and patients are more concerned about panic attacks that occur at night. According to the literature, nocturnal panic attacks have been reported to have more severe insomnia than daytime attackers. Many patients become afraid to sleep, fearful of sleeping, or even simply do not sleep because of the anxiety and avoidance behaviors that precede the attack that follow the experience of a nocturnal panic attack. The fear of sleeping and not sleeping, in turn, will aggravate the night panic attacks, thus forming a vicious circle. In addition, people with nocturnal panic attacks have more severe dyspnea, suggesting that autonomic dysfunction plays a major role in nocturnal panic attacks, while psychosocial and cognitive problems are the main cause of daytime panic attacks. For the treatment and prevention of this disease, psychotherapy is the mainstay, supplemented by pharmacological treatment. The aim of treatment is to block panic attacks and reduce secondary fear and avoidance behaviors. The first step should be to remove exogenous factors such as coffee drinking, or undesirable behaviors such as sleep deprivation that exacerbate panic attacks, and try to return to a normal lifestyle, especially healthy sleep habits. The purpose of this article is only to convey the prevalence of this condition. If there is any bias in the analysis of this article, we ask for the apologies of our readers. Because, the purpose of this article is not to learn about this disease, but only to remind all readers that if they find friends around them with a similar condition, in addition to thinking about a physical disease, don’t forget that it could be a psychological disease causing sleep problems. This disease loves to disturb at night, the symptoms are similar to “heart restlessness”. The serious ones are afraid to sleep at night, which is actually the “panic” road to heaven.