Why panic attacks happen while you sleep

Nocturnal panic attacks are not just panic attacks that happen during the night. They are specifically panic attacks that begin while you are sleeping or shortly after you wake up. Because they’re typically unpredictable, they can add a layer of stress and anxiety to your sleep routine.

While not everyone with panic attacks will experience nocturnal panic attacks, they are fairly common. In fact, the majority of people with panic attacks experience at least one nocturnal panic attack. Fortunately, all panic attacks are highly manageable with the right support.

What do nocturnal panic attacks feel like?

The signs and symptoms of nocturnal panic attacks usually match those of a typical panic attack. One major difference may be your ability to sense the attack coming. At times, people can recognize the start of a panic attack and try to prevent it from escalating. But with a nocturnal attack, you may be in the middle of the attack by the time you wake up.

The most common symptoms of a nocturnal panic attack are:

• Pounding heart or increased heart rate

• Sweating

• Shaking

• Shortness of breath

• Choking sensation

• Pain or discomfort in your chest

• Nausea or stomach distress

• Feeling dizzy or lightheaded

• Feeling confused or like you’re not yourself

• Fear of losing control

• Fear of dying

• Tingling sensation in your hands or feet

• Feeling cold or very hot

These symptoms may create a very intense and uncomfortable experience. While they can be distressing, panic attacks are not dangerous. Nocturnal panic attacks may feel like they last for a long time. In most cases, though, they last for only a few minutes. After the panic attack is over, you may have lingering feelings of stress, anxiety, and fatigue that goes away with time.

How long do nocturnal panic attacks last?

Nocturnal panic attacks can feel like they last a long time. In reality, most panic attacks are brief. Many episodes peak within a few minutes and begin to fade shortly after.

Even though the most intense symptoms pass quickly, it may take longer for your body to calm down. You might feel shaky, tired, or anxious for a while after the attack. Some people also have trouble falling back asleep because they worry another panic attack will happen.

If nocturnal panic attacks occur often, they can disrupt sleep and leave you feeling exhausted the next day.

What causes nocturnal panic attacks?

There is not always a single cause of nocturnal panic attacks. Instead, they usually happen when several factors affect the body’s stress response during sleep.

Some possible causes and triggers include:

• Sleep stages: Nocturnal panic attacks often occur during lighter sleep stages. These stages make it easier for the brain to wake suddenly when stress signals appear.

• Stress hormones: Your body naturally begins releasing stress hormones like cortisol in the early morning hours. If you already feel anxious or stressed, this hormone shift can increase alertness and trigger panic symptoms.

• Hyperarousal: People with anxiety disorders often have a nervous system that stays on high alert. This state, called hyperarousal, can make the brain react strongly to small changes during sleep.

• Nightmares or disturbing dreams: Intense dreams can trigger fear and physical stress reactions that wake you suddenly.

• Mental health conditions: Panic disorder, anxiety disorders, and chronic stress are linked to a higher risk of nocturnal panic attacks.

• Sleep disruption: Poor sleep, irregular sleep schedules, or sleep disorders can make nighttime panic episodes more likely.

In many cases, nocturnal panic attacks happen during periods of high stress. Understanding what may be triggering your symptoms can help you and your healthcare provider find the best ways to manage them.

How nocturnal panic attacks affect sleep quality

Falling asleep with a history of nocturnal panic attacks can be very stressful. If you’re going to bed with the fear of a panic attack, you might find that your sleep is restless. In an effort to avoid a panic attack, you may delay sleep, set alarms to periodically wake you up, or use alcohol and other substances before going to bed.

All of these precautions could negatively affect your sleep quality. Falling back asleep after an attack may be difficult as well, which could leave you feeling tired the next day.

Know that while nocturnal panic attacks can be distressing, there are effective strategies you can use to get a better night’s sleep.

How to prevent nighttime panic attacks

There is good evidence to show that reducing your daytime anxiety can have a positive effect on nighttime panic. So some options that could help reduce the symptoms of your nocturnal panic attacks include lifestyle changes that center around the goal of reducing your current levels of stress and anxiety. These options include:

1. Shifting your exercise routine: Try a new form of exercise or try exercising at different times of the day to create positive change.

2. Changing up your diet: The food you eat can have an impact on your sleep quality. Experiment with different foods at different times of the day to study their effects.

3. Reducing your use of alcohol and other substances: Alcohol, caffeine, and other substances can all negatively impact your sleep, especially if you consume them later in the day. Try to avoid these substances or reduce your use of them if possible.

4. Spend more time with people you love: Doing things you love with people you care about is almost always a healthy lifestyle change that can reduce your levels of anxiety and panic.

Professionals treatment options

If you’ve tried lifestyle changes but are still experiencing nocturnal panic attacks, it may be time to seek help from a mental health professional.

One type of therapy that can help with panic attacks is cognitive behavioral therapy (CBT). This type of therapy helps you learn about the connection between your thoughts, feelings, and behaviors. Mindfulness-based therapies can also help by teaching you how to build awareness of your symptoms to reduce fear and worry.

There are also medications that can reduce anxiety and improve sleep. You can talk to your mental health provider about whether medication may be right for you.

How to stop a nocturnal panic attack in the moment

Waking up in the middle of a panic attack can feel frightening. The goal in the moment is to slow your breathing and help your body settle. Panic attacks are uncomfortable, but they are not dangerous.

Some strategies that may help include:

• Focus on slow breathing. Try taking slow breaths in through your nose and out through your mouth. This can help regulate your nervous system and reduce physical symptoms like a racing heart.

• Ground yourself in the present moment. Look around the room and notice a few things you can see, hear, or feel. Grounding techniques can help bring your attention away from panic and back to the present.

• Remind yourself what is happening. Silently tell yourself that you are experiencing a panic attack and that it will pass. Naming the experience can sometimes reduce the fear around the symptoms.

• Sit up or change your position. Some people find it helpful to sit up in bed or place their feet on the floor until the wave of panic begins to fade.

• Avoid fighting the panic. Trying to force the feelings away can sometimes make them stronger. Instead, allow the sensations to rise and fall while focusing on calming your breathing.

Most nocturnal panic attacks peak quickly and fade within a few minutes. As your body settles, it may become easier to relax and return to sleep.

Clinician’s take

In my experience, when someone wakes up in a nocturnal panic attack, the first step is to remind themselves that the sensations are frightening but not dangerous. Slowing the breath and focusing on grounding techniques can help the body gradually return to a calmer state.

Brandy Chalmers, LPC

Clinical reviewer