You shoot awake from a dead sleep, sweating, heart racing, and short of breath. You have an awful sensation, but you’re not sure why. You feel a deep sense of dread as the walls close in around you. Are you dying? Are you having a heart attack? What is going on?
If this describes you, you might be experiencing nocturnal panic attacks (NPA). Having a panic attack at night can be terrifying. Understanding what we’ve learned about nocturnal panic attacks, including their symptoms, who’s most likely to experience them, and methods for treating and coping with them can help. Read on to learn more.
What is a Nocturnal Panic Attack?
Nocturnal panic attacks are episodes that shockingly and suddenly awaken you with strong emotions, mixed with uncomfortable physical sensations. They’re similar to panic attacks experienced when you’re awake but wake you up from your sleep. The episodes don’t necessarily physically hurt you, but they can be incredibly frightening and make you feel totally out of control.
Symptoms of Nocturnal Panic Attacks
Can you pass out from a panic attack in the middle of the night? Yes, you can. In fact, it’s one of the symptoms. A nocturnal panic attack can occur with no known trigger, and it can awaken you from sleep with potential physical anxiety symptoms, including:
- A feeling of being smothered
- Shortness of breath
- Feelings of confusion and desperation
- Dizziness, lightheadedness, or faintness
- Rapid heart rate or heart palpitations
- Pain in the abdomen
- Sense of impending doom
- Chest pain
- Trembling and shaking
- Hot flashes or chills
- Feeling choked
- Fear of dying
To be diagnosed with and treated for nocturnal panic attacks, at least four of the above symptoms must be present.
What Causes a Panic Attack in Your Sleep?
Researchers aren’t completely sure why some people have nocturnal panic attacks. It is known, however, that people who suffer from other types of panic disorders are more at risk.
“It can be caused by several factors, from stress to over-worrying, but it varies from person to person.”
While diurnal (daytime) panic attacks generally have identifiable triggers, you might not understand why you have a panic attack while sleeping. Experiencing a panic attack in sleep can be caused by a variety of factors, including:
- Underlying mental health conditions like social anxiety disorder or depression
- A family history of nocturnal panic attacks or panic disorder
- A traumatic event like the death of a loved one
- Imbalanced chemicals in the brain
- A majorly stressful life event
A panic attack in the middle of the night can be caused by any of the above possibilities, or a combination of more than one.
“Multiple factors can cause it. Stress, nighttime rumination, over-worrying about what is pending the next day, and unresolved issues are amongst the main ones.”
Who Might Experience a Nocturnal Panic Attack?
Anyone can experience a nocturnal panic attack, especially people with panic disorder. Elevated stress and anxiety levels also increase the risk for a nocturnal panic attack. Others who may be at risk for nocturnal panic attacks include:
- People with a sleep disorder like insomnia or sleep apnea
- Those with post-traumatic stress disorder (PTSD)
- People with general panic or anxiety disorder
Nocturnal panic attacks don’t typically induce lasting physical harm. Other than the panic attack hangover, however, the psychological effects can linger for a long time.
Treatment for Nocturnal Panic Attacks
There’s no definitive cure regarding how to stop panic attacks at night. A nocturnal attack occurs without warning or apparent cause. It’s not currently possible to accurately predict when an NPA will occur, which makes research quite difficult.
However, there are some methods of treating and coping with nocturnal panic attacks that are known to help reduce their frequency and intensity. If you suffer from frequent panic attacks in the middle of the night, consider:
- Practicing mindfulness meditation and breath control
- Using peaceful forms of exercise, like yoga and Tai Chi
- Taking a hot Epsom salt bath before bedtime
- Relaxing your mind and body with massage
- Practicing self-affirmations before sleep
- Talking with family and loved ones
All of the above are thought to help reduce the occurrence of night time panic attacks. However, if you find that your NPAs are affecting your life negatively, or occurring more frequently, then it might be time to seek professional assistance from a therapist.
There are several additional options known to reduce and help manage nocturnal panic attacks, including:
- Medications like selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines
- Daily management techniques like relaxing, meditating, and exercising
- A type of psychotherapy called cognitive-behavioral therapy (CBT)
The best treatment for nocturnal panic attacks is patient-dependent, but often involves a combination of CBT and prescription medications that can help reduce anxiety and stress.
“They can be treated the same way as anxiety and other panic attacks. With the help of a mental health professional who specializes in anxiety disorders or CBT, you can see good results in a relatively short period of time.”
Although we’re not yet sure exactly what causes nocturnal panic attacks, remember that people with other types of panic disorders do have elevated risk. A medical condition like PTSD, chronic depression, high anxiety, and chronic stress are all believed to contribute to the occurrence of NPAs.
Anyone can experience a nocturnal panic attack. After waking up with jarring, uncomfortable physical and mental sensations, you might first think you’ve had a nightmare. However, nightmares, night terrors, and nocturnal panic attacks each have unique symptoms and are separate phenomena.
Take the steps to minimize your nocturnal panic attacks
There’s not one clearly defined, effective technique for totally alleviating or managing your nocturnal panic attacks. Not everything will work equally well for every person. However, there is some good news. The methods for treatment and coping we’ve discussed here can help you experience less intense, less frequent NPAs.
Some people completely cease having any nighttime panic attack after successful therapy and the continuation of self-management techniques. Others can decrease the number and intensity of the NPA episodes they experience.
If you believe you’re experiencing recurring nocturnal panic attacks, then begin practicing some of the centering, relaxing techniques outlined above. Especially in the evenings when you’re winding down and preparing for sleep, it can help to put your mind in a gentle state of relaxation, reducing the likelihood of having a nocturnal panic attack.
If self-management techniques don’t seem to be working for you, or if your NPAs begin to occur more frequently and are more severe, seek professional help from a therapist or another mental health professional. Learning to manage nocturnal panic attacks can help reduce your stress, ease your mind, and restore your energy.
1. Craske M, Tsao J. Assessment and treatment of nocturnal panic attacks. Sleep Med Rev. 2005;9(3):173-184. doi:10.1016/j.smrv.2004.11.003. https://pubmed.ncbi.nlm.nih.gov/15893248/. Accessed December 20, 2021.
2. Muskin, M.D., M.A. P. What Are Anxiety Disorders?. Psychiatry.org. https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders. Published 2021. Accessed December 20, 2021.