Brief Answer: Hi Detailed Answer: Hello, Thanks for your query. I appreciate your efforts for medical consultation in so much distress. Important aspects of your query are: • 26 year old female • Complaints of: scare of sleeping and lack of sleep. From your history, in my view, it appear that you had panic attack (severe anxiety attack) due to that you went in ER followed by anxiety symptoms which is causing you insomnia and scare to sleep. Finding hole in lung can be a incidental findings. Let ask your treating physician if all symptoms can be explained with that. Some time medical problem can also cause panic attack which can lead to anxiety problem or phobia even after solution of medical issue like in your case. Other symptoms of anxiety which may or may not be present in your case: nervousness, restlessness, mild irritability, excessive worry regarding own health (like you have fear of respiratory chokking in sleep), tremor, muscle spasm, heaviness in body, easy fatigability, headache, sleep disturbance, palpitation and dry mouth. Let me know if you have some of these symptoms to help you better. Wish you good health. Regards, http://bit.ly/Dr-Ashish-Mittal

---

Brief Answer: Hi Detailed Answer: Hello again, Thanks for follow up. Palpitation and muscle spasms are symptoms of anxiety. It also make anxiety more probable diagnosis in your case. There is need for treatment from psychiatrist, if symptoms cause significant personal distress or affect personal/professional life like in your case. Both drug and non drug treatment like cognitive behaviour therapy (form of psychotherapy) are used for treatment. Choice of treatment depends on severity of symptoms, personal preference and availability of treatment. In drug treatment of anxiety two types of medicine used. For immediate relief of anxiety benzodiazepines group of medicines (like clonazepam) are used for short duration (due to risk of dependence). For long term relief most commonly SSRI (selective serotonin reuptake inhibitors like paroxetine) are used. SSRI takes around 3-4 weeks to show its effect, till that time benzodiazepines control the anxiety symptoms. All these medicines are prescription medicine and given after in person examination by psychiatrist. Apart from that following steps will also help you in sleep: -Fix time to sleep and wake up. Do not take any nap. -Do not use caffeine (tea, coffee and cold drink) till 4 hour before sleep -Use less than 2 cup tea/coffee use per day -Use your bed only for sleep -Do not watch television/use net till 1 hour before sleep. -Prevent bright light exposure before sleeping. Wish you good health. Regards

---