Brief Answer:
Progress and treatment of anxiety-panic attack

Detailed Answer:
Hi XXXXXXX thanks for asking from HCM.


Welcome back. I can understand your concern for your mother. The progress is good. Usually multiple diseases like disc pain, multivitamin deficiency and anxiety take time to respond. Another problem is "depression" which occurs due to mental stress related to illness and multivitamin deficiency. She will improve day by day. In next month, she will be much better.

Now coming to anxiety-panic attack treatment, you need to follow few tips

- Avoid anxiety inducing factor. It can be identified with daily experiences.

- Do yoga and meditation to calm and control

- One method is gradual desensitisation. It should be done under supervision of psychiatrist. In desensitisation, you will be exposed to the anxiety factor in progressively increasing dose. You will become resistant towards it.

- Acute attack can be controlled by benzodiazepine like lorazepam or alprazolam. You can take it after proper prescription.

- The palpitation can be controlled by tablet propranolol after proper prescription.

Coming to breathing from mouth during night, it can be due to nasal blockade (allergic rhinitis/sinusitis), habitual, obstructive sleep apnea (due to obesity over neck/tongue fall). You can confirm it by consulting general physician and ENT physician. He will examine her nose, oral cavity and neck. Some investigations like

X ray paranasal sinuses
Sleep study
will help in confirming diagnosis. The deviation of mouth towards left might be due to fatigue of jaw muscle due to persistent opening of mouth.

Hope it will her. If you need any help, do let me know.
Thanks. Take care.

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Brief Answer:
Nocturnal breathing problem

Detailed Answer:
Hi XXXXXXX XXXXXXX welcome back.


I got your point. She is having nocturnal (night) breathing problem. It could be

- Nocturnal asthma

Nocturnal asthma is a type of asthma, with symptoms like chest tightness, shortness of breath, cough, and wheezing at night, can make sleep impossible or difficult and leave you feeling tired and irritable during the day.
I am guessing it depending based on your history. But to confirm, you must observe her for

- Any whistling sound in night
- Are there frequent episodes of chest tightness, breathing difficulty during breathing.
- Inability to produce voice but able to move lips suggest exertional breathing problem. It occurs when patient is short of breath but wants to speak. Due to problem in letting air out, voice is not produced. If you face such situation, ask your mother to inhale deeply and avoid talking.
- You can also take help of chest physician for examination of her respiratory system (chest) during night. A wheeze in chest will suggest attack of asthma.

The reason behind asthma in night could be

- Cool air
- Hormonal changes (steroid hormone in body) that lead to airway constriction
- Some allergy from bed/pillow.

Another possibility is obstructive sleep apnea. It can manifest as

- Snoring problem
- Difficulty in breathing
- Sudden episodes of awakening and gasping for breath
- After awakening, patient has difficulty in speaking, moving limbs.

Heart disease like right side heart failure or disease can cause night time breathing problem. It can be checked by

- Presence of swelling in feet
- ECG and ECHO
- Measuring BP regularly

Please let me know, what features are more in her, so that we can conclude. Treatment will depend upon the condition. Asthma treatment is same.A long-acting bronchodilator delivered can be effective in preventing bronchospasm and symptoms of asthma during night.

Avoid AC in her room.

If she is having acid reflux problem, give her pantoprazole-domperidone in night, after proper prescription.

Ask her to sleep on a bed with elevated head end. You can do it by elevating the head end with bricks.

Hope it will help you. If any doubt, do let me know.
Thank you very much for the appreciation. It is my pleasure to help you and your mom.

Regards.

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