Nocturnal Panic Attacks??

43 year old female with mvp (trivial) - checked yearly by cardiologist - February had 24 hour heart holter (showed pvc's and pac's), stress test (normal), echocardiagram (normal -other than the mvp).  Was having panic attacks throughout the day - doctor said I was probably overtly aware of the pvcs/pacs.  Recently started having what I believe to be nocturnal panic attacks - will be sleeping (which is hard for me to do anyway) and then it's like someone has jolted me .  That's when I will have a surge in heart rate (up to 125bpm from the mid to upper 50's), blood pressure will go up to 180/90, feel like I need to have a bowel movement, get shaky, then chills.  This is very frightening.  This will last about 20 - 30 minutes but then takes hours to get back to sleep.  Doctor says that it is anxiety and prescribed Paxil (10mg) and to increase my Toprol XL to 50mg a day (taken at night).  I do not want to take the Paxil, I would rather have a behavior change if this is in fact anxiety.  I am self employed and have a lot of stress running my own company.  Is this in fact anxiety or should I be having my doctor check for something else?  I have these at least four times a week and they are normally anywhere from 11:00pm - 3:00am.  It seems too frightening to just be anxiety????

[Cleveland Clinic]

I am not an expert on anxiety, you may want to check the psychiatry forums. However, the increased heart rate may be a manifestation of the panic attack or it may itself be the problem and which causes the anxiety. Which one comes first? You should also ask your cardiologist about the frequency of these PACs or PVCs to see if they could be trigerring these episodes.