Chest pain, shortness of breath, cold sweat at my back, trembling hands, can't sleep properly (i always wake-up at 2am until 5am since kindergarten), back pain, lost appetite

Professional Assessment: Given the constellation of symptoms including chest pain, autonomic features (cold sweats, trembling), and chronic sleep disturbance pattern since childhood, the primary differential diagnoses include Generalized Anxiety Disorder (GAD) with possible panic attacks, though cardiac conditions (e.g., mitral valve prolapse, which is more common in young females) must be ruled out as a matter of urgency. The pathophysiological mechanism likely involves dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, leading to elevated cortisol levels and sympathetic nervous system activation, which explains the cluster of physical symptoms including sleep disruption and autonomic manifestations. Given the patient's young age and female gender, additional risk factors to consider include thyroid dysfunction, autoimmune conditions, and the significantly higher prevalence of anxiety disorders in young adult females. Immediate cardiac workup is indicated (including ECG, troponin levels, and thyroid function tests), followed by psychological assessment and possible sleep study, as the chronic nature of the sleep disruption pattern suggests a potential underlying circadian rhythm disorder that may be exacerbating the current symptomatology.

Based on the symptoms cluster, I recommend starting with daily anti-anxiety medication (such as Buspirone or SSRIs) combined with cognitive behavioral therapy to address both the physical symptoms and sleep disturbance pattern. For immediate relief, practice deep breathing exercises 4-6 times daily and take Magnesium supplements (400mg) before bedtime to help with muscle tension and sleep quality. Additionally, implement a strict sleep hygiene routine including no screen time 2 hours before bed, keeping your bedroom at 65-68°F, and using white noise to maintain sleep continuity. For additional treatment recommendations, ask in the chat.