Nocturnal Panic Attacks: Symptoms, Causes, & How to Cope

What Are Nocturnal Panic Attacks?

Nocturnal panic attacks are periods of intense anxiety symptoms that first emerge when the person is sleeping.¹ A person who wakes up in a state of panic is having a nocturnal panic attack, while others might have mini panic attacks when falling asleep. This specific form of panic attack will have many of the same symptoms as other panic attacks, like extreme worry, sweating, and fear, with the difference being the timing of the anxiety.

Nocturnal panic attacks can easily be confused with other panic attacks that happen when the person is awake. To be considered a nocturnal panic attack, the panic must wake the person from their sleep. A couple of things to keep in mind: First, just because the panic attack happens at night does not mean that it is technically a nocturnal panic attack. Second, just because the panic attack begins shortly after waking does not mean that it is a nocturnal panic attack.¹

Nocturnal attacks are unexpected and unpredictable, since there are no warning signs to indicate one is pending. As many as 30% of people in the U.S. with panic disorder will note nocturnal panic attacks.¹

Nocturnal Panic Attacks Vs. Night Terrors & Sleep Apnea

Separating nocturnal panic attacks from other physical health and mental health conditions can be difficult. Nocturnal panic attacks differ from:^1,2

• Night terrors: A night terror, also called sleep terror, is one type of sleep arousal disorder that wakes the person up in a fearful state during the first part of the night. The person will be confused and disoriented in the moment and usually forget about it by morning.
• Sleep apnea: People with obstructive sleep apnea may wake up with a choking sensation, but sleep apnea happens more often, lacks the intense panic, and is linked to prolonged daytime sleepiness.

Common Panic Attack Symptoms at Night

The symptoms of panic attacks at night will match other symptoms of panic attacks. Though the duration of the panic attack, symptoms, and experience will be the same, the most important difference is the timing. Typical panic attacks occur during the day, but nocturnal panic attacks happen while sleeping.

Like during the day, panic attacks at night occur when a person experiences at least four of the following symptoms at once:¹

• Heart changes, like palpitations, pounding heartbeat, or quick heart rate
• Excessive sweating
• Feeling shaky or trembling
• Feeling smothered or short of breath
• Sensation of choking
• Discomfort or pain in chest
• Nausea and stomach discomfort
• Dizziness, feeling unsteady, faint, or light-headed
• Sensation of chills or heat
• Numbness or tingling
• Feeling detached from self or feeling like life is not real
• Fear of “going crazy” or losing control of self
• Fear of dying due to intensity of symptoms

These symptoms must be part of an abrupt surge that peaks quickly. With nocturnal panic attacks, the surge must have already begun while asleep. It cannot begin some time after waking to be considered nocturnal.

What Causes Panic Attacks at Night?

The exact causes of nighttime panic attacks are not well understood by professionals. Some believe these attacks are the result of high stress levels, a genetic predisposition, or certain changes in brain functioning.^2,4

Factors that may cause a person to have panic attacks while sleeping include:^2,4

• Genetics. Having family members with a history of anxiety and panic can result in increased risk.
• High stress
• Sleep disorders
• Underlying medical issues like thyroid problems
• Physiological issues in the brain that communicate that the body is awake when it is actually asleep

Who Might Experience a Nocturnal Panic Attack?

Is not uncommon for people with panic disorder to suffer nocturnal panic attacks. Also those who experience daytime panic attacks will likely endure nighttime panic episodes.

People more at risk for panic attacks include:^1,5,6

• Women
• Smokers
• People who have family members who also experience panic attacks
• People who are encountering major life changes or stressful events such a loss of a loved one
• Individuals with an anxiety-related condition
• Those with sleep-wake disorder like insomnia
• Someone with past trauma
• People with posttraumatic stress disorder PTSD
• People who have depression

How Long Do Nocturnal Panic Attacks Last?

Like conventional panic attacks, nocturnal panic attacks can surge abruptly and often reach a peak within minutes. Similarly, nocturnal panic attacks can last the same amount of time as a regular panic episode. However, recovering and reaching a calmer state from a nighttime panic attack may take longer and make going back to sleep more difficult.⁷

Impacts of Panic Attacks at Night

Nighttime panic attacks result in issues both directly and indirectly. Directly, the person will feel immensely uncomfortable, fearful, and scared. Indirectly, these panic attacks and the fear of additional panic attacks can result in higher levels of stress and anxiety that spread throughout the individual’s waking life.

As the person begins to anticipate the next panic attack, they could:^1,2

• Be afraid to sleep
• Experience insomnia
• Develop negative coping skills to reduce symptoms like alcohol or drug use
• Experience more daytime anxiety

Long-Term Health Effects

Overall, panic attacks are extremely problematic and detrimental to the individual who experiences them.

Panic attacks are linked to:^1,3

• Higher rates of depression, generalized anxiety, and panic disorder
• Greater physical health concerns
• Higher rates of suicide

How to Stop Panic Attacks at Night

Once the panic attack starts, you cannot magically stop it. What you do and how you respond can make the next one easier and shorter, though. Because panic attacks can feel so surprising and trigger so much fear, finding an appropriate course of action can be challenging. By making slight adjustments to their thoughts and behaviors, a person can limit the negatives of having a panic attack, or help someone else during a panic attack.

If you experience a panic attack at night, cope by trying the following:

• Identifying the attack: Remind yourself that it is a panic attack, not a heart attack or other scary event.
• Remind yourself that panic attacks bring discomfort, not danger: Panic attacks are awful, but they rarely end with real physical harm.
• Remember that all panic attacks end: Knowing that the panic is not permanent can ease the fear.
• Focus on your breathing: Paying attention to your breath and working to slow and extend the inhalation and exhalation can prevent symptoms from worsening.
• Focus on an object: Place an object by your bed, so when a nocturnal panic attack occurs, you can pick up and hold the object to feel grounded and safe.
• Document the experience: After the attack is over, write down the experience to gather information about what worked and what may have triggered the event.

How Are Nocturnal Panic Attacks Diagnosed?

There isn’t a formal way to diagnose nocturnal panic attacks as a separate category. Nonetheless, going to your primary care physician is a good place to start if you want to figure out what you are really struggling with. In general, a health care clinician can help to establish the presence of an underlying medical condition that may produce similar symptoms like a thyroid or heart problem or if you may be dealing with a psychiatric disorder like panic disorder. Regardless of whether you have a formal diagnosis or not, you can still seek and receive professional support to help you manage your nocturnal panic episodes.^8,9

Treatment for Panic Attacks at Night

The treatment of nocturnal panic attacks will utilize the same tactics used for other panic attacks. The hope is that by managing all panic attacks with therapy and medication treatments, the nocturnal panic attacks will be reduced as well.

Therapy

Cognitive behavioral therapy (CBT) for panic disorder is often the standard treatment option. CBT encourages the client to recognize how the connection between their thoughts, feelings, and behaviors affects their anxiety and panic.

CBT sessions can involve:¹⁰

• Thought reframing
• Behavioral modification
• Relaxation techniques
• Mindfulness
• Communication skills

While CBT is often the frontline treatment, many forms of therapy can treat panic attacks. People may explore acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and others to achieve their mental health goals.

Finding a therapist can feel like an intimidating process, so consider viewing an online therapist directory for available options.

Medication

Either alone or in addition to therapy, anxiety medication can reduce the symptoms of panic attacks. A variety of antidepressants, sedatives like benzodiazepines, and anticonvulsant medications are available.¹⁰

Like with other medications, it is crucial the individual meets with their prescriber to discuss the best options for their needs and the possible adverse effects and how medication may make you feel. Your primary care physician, psychiatrist, or nurse practitioner could assist you in making informed decisions.

How to Prevent Panic Attacks at Night

Preventing panic attacks is the goal, and there are plenty of helpful tips a person can employ to succeed in this area. Best of all, many of these tips include small changes that can result in big differences.

To prevent nocturnal panic attacks, try the following:¹¹

• Acknowledge your anxiety: The best way to start treating your anxiety is my acknowledging and accepting it. Call it what it is and don’t feel ashamed by your struggle with panic.
• Address your diet: The foods you eat during the day could have a huge impact on your sleep and nocturnal panic. Stick to healthy, whole foods with plenty of fiber and protein to keep you full all night.
• Exercise away your stress: Moving your body has a tremendously positive impact on stress, so consider starting a walking program or hitting the gym to melt away your anxiety.
• Avoid the negative coping skills: A great diet and exercise plan can be quickly undone by negative coping skills like alcohol and other drug use. Don’t give into the temptation to have a drink before bed. It won’t help in the long run.
• Practice relaxation: Deep breathing, muscle relaxation, yoga, and meditation are all wonderful relaxation techniques that can reduce and prevent panic.
• Incorporate better sleep hygiene: Getting to sleep at the same time in a dark, cool, calm room can improve your sleep and decrease the risk of nocturnal panic.

Don’t be discouraged if these tips do not immediately wipe away your panic. It may take weeks or months of consistent practice to meet your goals, but the process is always worthwhile.

When to See a Doctor

If even your best efforts are not leading to the desirable results, it may be time to schedule an appointment with a mental health professional. It does not mean you are doing anything wrong; it only means your anxiety is too formidable to manage alone.

Final Thoughts

Day or night, panic attacks can feel scary, threatening, and intimidating, but they can get better with time and effective techniques. Start with helpful lifestyle changes and call in the professionals as needed. A few changes to your thoughts and behaviors can end with you feeling the way you want.