Midnight Anxiety

For a child, evenings and nights can be the most terrifying times of the day. What they are experiencing is called "nocturnal anxiety." Also known as "midnight anxiety" and "nighttime anxiety," nocturnal anxiety is particularly common in children, with nearly two-thirds encountering it at some point during childhood. Children form associations between nighttime and separation from the caregiver, which can cause them to experience loneliness and distress. But many adults, too, struggle with increased feelings of personal loss, solitude and sadness when darkness falls.

Causes

• The most common causes of nighttime anxiety in children are worries about the day's events, separation from the parents, "what if" thoughts, imaginations gone wild, scary dreams and unfamiliar noises. In adults, causes include physical conditions such as thyroid abnormalities, exhaustion and sleep deprivation and mental disorders, such as post-traumatic stress disorder, generalized anxiety disorder, panic disorder, depression, bipolar disorder and schizophrenia. The anxiety that typically comes along with these conditions tends to intensify late at night because this is the time with fewest external distractions to take our minds away from our worries.

Symptoms

• Symptoms of nocturnal anxiety include physical symptoms such as night sweats, nausea, upset stomach, trembling, muscle tension, headache, dizziness, difficulty breathing and heart palpitations, and psychological symptoms include obsessive worries, frustration, anger, sadness and feelings of loneliness and personal loss. Nocturnal anxiety in children often gives rise to behavioral symptoms such as bedtime procrastination, difficulties sleeping, restless sleep and screaming.

Treatment

• In children, the best way to treat nighttime fears is to take their worries seriously. Adults who suffer from nighttime fears may need to seek professional help. A professional counselor can help determine whether there is a deeper psychological problem. Medication is sometimes needed to effectively treat nocturnal anxiety. The most common anti-anxiety medications on the market are the fast-working benzodiazepines, which can be used in the short term to treat acute symptoms, and the slower-working serotonin reuptake inhibtors, which can be used over a longer time period.

Complications

• Even if darkness is not an initial cause of nighttime anxiety, people who suffer from nighttime anxiety may begin to associate their fear symptoms with darkness. This can result in achluophobia, or fear of darkness. Achluophobia can linger, even after the initial trigger has gone away. Like other forms of anxiety, nocturnal anxiety left untreated can lead to serious psychological disorders, such as generalized anxiety disorder and depression. For some, alleviating symptoms of nocturnal anxiety with alcohol can be tempting, but alcohol tends to worsen the condition. Those who "self-medicate" with alcohol could also end up with a serious addiction on top of the anxiety.

Long-Term

• Sleep deprivation, which is common in long-term sufferers of nighttime anxiety, can lead to semi-permanent changes in the brain's neural connections, suggests Seung-Schik Yoo, an associate professor of radiology at Harvard Medical School. Using functional MRI, Yoo and his colleagues showed that sleep deprivation causes the amygdala, the area of the brain that processes negative emotional stimuli, to respond abnormally to the environment. Neurons in the amygdala normally "fire" when the brain interprets a signal in the environment as a sign of an impending threat. Sleep deprivation causes the amygdala to react in much the same way, even when there is no external danger, explains Yoo.