A 28-year-old man with panic disorder reports waking from sleep at night with intense fear, tachycardia, and dyspnea. These nocturnal panic attacks characteristically occur during which sleep stage?

• A REM sleep
• B Stage N1 (NREM 1)
• C Sleep-wake transition only
• D Stage N2 or N3 (NREM 2 or 3) ✓

Explanation

Nocturnal panic attacks in panic disorder arise from NREM sleep, typically stage N2 or N3 (slow-wave sleep), not from REM sleep or dreams. This distinguishes them from nightmares, which occur during REM sleep. The absence of a dream narrative during nocturnal panic is a key clinical feature.

Reference: Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 11th ed.

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