When you wake up from sleep in a state of panic, for no apparent reason, this is known as a nighttime or nocturnal panic attack.
The symptoms of panic attacks at night and during the day are very similar, including a rapid heart rate, shortness of breath, tremors and chills, and intense fear.
Most people who experience nighttime panic attacks also experience daytime panic attacks. Nocturnal panic is currently not considered a distinct mental condition but is a type of panic attack that occurs in some people who suffer from panic attacks and panic disorder.
How to Calm Down From a Nighttime Panic Attack
Managing panic attacks at night is similar to dealing with them during the day. However, when you experience a panic attack at night, it tends to rip you out of sleep or a semi-sleep state, and this can feel especially confusing and terrifying.
The symptoms of a panic attack can leave you feeling helpless and out of control. That’s why it’s important to remember that it will pass and that you are safe – panic attacks are not dangerous, albeit very distressing.
Here is some advice on how to calm down from a nighttime panic attack:
Ride it Out
If you try to fight the panic and the symptoms, they can get worse. Assuming you are lying down, you might find it helpful to stay lying down or sit up. It’s probably better to avoid standing up as this could make you feel dizzy.
Be present in your body, experience the sensations, and take the stance of a curious observer. The symptoms are not life-threatening and will subside – this is important to remember because it will make it easier to ride it out until it fades.
A panic attack might cause difficulties breathing and tightness in your chest. This is because the fight/ flight response has been activated, and stress hormones are pumped through your system.
This causes your blood pressure and heart rate to rise, which can make breathing difficult–but remember that you are not suffocating, although it might feel like you are.
To get your breath back under control, focus on your stomach or the top of your lip and breathe naturally, without forcing it. Feel your stomach rise and deflate or feel the air brushing against your upper lip.
Any focal point will do as long as it helps you to bring your breathing back to normal.
Some people find that breathing exercises make panic worse so if after a few minutes the mindful breathing is not working, try something else. Listen to your body and do what feels right for you.
When you are experiencing a panic attack you often enter a sort of trance state and lose the grip on your surroundings, yourself, and sometimes reality.
Grounding techniques will allow you to return to your body and thus calm down your mind.
These techniques often involve going outside, having hot and cold sensory experiences, or submerging yourself in water. Of course, this is not practical when you are in bed, wanting to sleep.
However, if you experience panic attacks frequently, you could prepare a few items that you can use to ground yourself next time it happens. For example, you could have a flask with warm tea, smell sticks (e.g., lavender), or an object that you can hold and play with.
You can hold the object and use your five senses to explore what it feels, smells, and looks like. You can also practice mindfulness with your body, e.g., becoming aware of the weight of your body against the mattress or practicing progressive muscle relaxation.
Progressive Muscle Relaxation
You can do this alone or use a guided audio exercise (there are many online). Progressive muscle relaxation is a type of grounding technique that helps relieve body tension.
You can start with your toes and work your way up to the top of your head or start at the top and work your way down.
Move your attention through your body and relax each muscle one to three times (e.g., “my toes are relaxing, my toes are relaxing, my toes are relaxing”) – you can say it out loud or silently.
Practicing grounding techniques as often as possible is a good idea, even when you are not experiencing anxiety or panic. This will allow you to get used to the exercise, and your body will respond more quickly over time.
Mindfulness and Meditation
Although you can practice mindfulness and meditation while you are having a panic attack, some people find this difficult to do. It is best to build a practice of these when you are not having a panic attack so you can more easily use them when you are.
Doing a daily five-minute meditation or mindfulness exercise is enough. You can progressively increase the time, but the important thing is to remain consistent.
The aim is to use these tools to focus the mind and slow the racing thoughts. If your mind wanders, that’s totally normal. Once you notice your mind has drifted, just gently bring it back to your object of focus (e.g., your breath).
Knowing that panic attacks are not life-threatening and that the symptoms will fade is important to remember and will reduce the fear and sense of doom.
Feeling like you cannot cope can make the sense of panic worse. Therefore, trust in your ability to manage the symptoms and repeat phrases such as:
- “I can cope with this”
- “I am strong and I will get through this”
- “It is only fear, nothing bad will happen to me”
How to Stop Panic Attacks at Night
Reducing the likelihood of having a panic attack at night means taking preventative action. That involves taking care of what you consume in the hours before you go to bed, being organized, and building a good self-care routine.
It is also important that you address the cause of panic attacks by seeking the help of a medical professional and therapist.
Here are a few pieces of advice:
Drugs, alcohol, caffeine, and other stimulants can make anxiety and panic attacks worse. Ideally, you would cut these out of your life entirely but especially in the afternoon, evening, and before you go to bed.
Before bedtime you should engage in relaxing activities instead, such as drinking chamomile or lavender tea, practicing mindfulness, meditation, or yoga, and/or journaling.
Organize Your Life
Anxiety can feel worse at night because your distractions decrease, and you’re left alone with your thoughts. Also, the tiredness and darkness can make your thoughts feel more overwhelming and harder to control.
Sometimes anxiety can get worse in the evening and at night. This is most likely because there are not as many distractions and you are left alone with your thoughts. You might be worrying about the next day or anxiously reflecting on the day that has passed.
It can therefore be helpful to keep a diary and plan your day and week ahead, prepare what you will wear and eat the next day, and make a list of the things that need to be done.
Journalling is also helpful because it allows you to write down your thoughts and worries and thereby process and release them. Keeping thoughts bolted up in your mind can make it more likely that they will spiral and cause more anxiety.
Panic attacks are usually a symptom of other mental health difficulties like anxiety or post-traumatic stress. They are a way for your body and mind to communicate to you that there is something off-balance and in need of intervention.
Create a plan for how you will look after yourself better. For example, you could include meditation and mindfulness, exercise, hiking, painting – whatever makes you happy – into your life.
Seek support from friends and family, and learn to open up about your anxiety and emotions. Find a therapist to help you identify the causes and triggers of your panic attacks and establish coping strategies.
What Triggers Panic Attacks While Sleeping?
The reasons for nocturnal panic attacks are not entirely clear but one theory that has been supported by research is the “fear of loss of vigilance” theory.
This theory suggests that people with nocturnal panic attacks “fear states in which they are unable to react to danger or protect themselves from threat”.
When you fear states in which you are less able to protect yourself, such as sleep, you wake up more often and might have bad dreams or anxious thoughts.
Similarly to daytime panic attacks, your body might falsely believe there is danger and activate the fight/ flight response, which gives rise to the symptoms of a panic attack (increased heart rate, shortness of breath, etc.).
Chronically high levels of anxiety and stress can also contribute to the occurrence of nocturnal panic attacks. When you are anxious, you tend to wake up more often during the night; if you are prone to panic attacks, you might wake up in a state of panic.
Thyroid problems and sleep disorders, such as sleep apnea, can mimic the symptoms of panic attacks, e.g., waking up because you feel like you cannot breathe.
It is worthwhile speaking to a medical professional if you are experiencing panic attacks at night. They can help you to identify whether there may be any physical causes or whether a psychological intervention would be helpful.
Can You Die From a Panic Attack in Your Sleep?
The fear you experience as a result of a panic attack can make it feel like you might die but panic attacks at night or during the day are not fatal. Your heart might be racing, and you might feel confused, terrified, and short of breath, but panic attacks alone cannot kill you.
Panic attacks do not cause heart attacks although the symptoms can be similar to those experienced during a heart attack.
How is a Nighttime Panic Attack Different Than Nightmares or Night Terror?
There are some similarities between night terrors and panic attacks, but they are different things.
Night terrors tend to happen when you are half asleep or in a state of “clouded consciousness” whereas you are conscious during a panic attack. Night terrors have more to do with bad dreams or nightmares; panic attacks are caused by your mind and body going into fight/ flight mode (stress response).
They share some common features including a fast heart rate, difficulty breathing, sweating, trembling, and intense fear. Research has found that individuals with nighttime panic often have a history of sleep terrors in childhood.
Although it is believed they are somewhat related, their relationship is currently not clear.
Nakamura, M., Sugiura, T., Nishida, S., Komada, Y., & Inoue, Y. (2013). Is Nocturnal Panic a Distinct Disease Category? Comparison of Clinical Characteristics Among Patients with Primary Nocturnal Panic, Daytime Panic, and Coexistence of Nocturnal and Daytime Panic. Journal of Clinical Sleep Medicine, 9(5).
Smith, N. S., Albanese, B. J., Schmidt, N. B., & Capron, D. W. (2019). Intolerance of uncertainty and responsibility for harm predict nocturnal panic attacks. Psychiatry Research, 273, 82-88.