Nocturnal panic attacks: symptoms, causes & how to stop them
Clinically reviewed by Dr. Chris Mosunic, PhD, RD, CDCES, MBA
Learn the causes and symptoms behind nocturnal panic attacks and how long they can last. Plus, 9 tips to ease your anxiety and stop a panic attack at night.
Waking up in the middle of the night with a racing heart and feeling scared and confused is more common than you might think. These nocturnal panic attacks can be quite unsettling, leaving you feeling anxious even after they pass. But, beginning to understand what these nighttime episodes are, including their symptoms and what causes them, you can start taking steps to manage panic attacks during the night.
What is a nocturnal panic attack?
Nocturnal panic attacks are intense, sudden onsets of anxiety that occur during sleep. They can cause you to wake up feeling overwhelmed and frightened. While they’re not as commonly discussed as their daytime counterparts, nocturnal panic attacks are a significant concern for many people.
One of the challenges of nocturnal panic attacks is that they can come without any warning—one minute you’re sleeping, and the next you feel overwhelmed with panic. Their symptoms are similar to daytime panic attacks, but as they happen while you’re asleep they can make many people feel out of control and worried about going to sleep.
If you experience an attack, it usually only lasts for a few minutes. But it can feel longer because of the intense fear and confusion it may cause. After the attack, you may have difficulty getting back to sleep—you could feel anxious or uneasy for the rest of the night.
Understanding that nocturnal panic attacks are a common experience for many can be reassuring. The good news is once you know more about what causes them and how to manage them, you can start taking steps to reduce their impact on your life.
6 symptoms of panic attacks at night
When a nocturnal panic attack strikes, knowing the most common symptoms can help you understand what’s happening to you. And possibly feel a bit less out of control. If you have physical symptoms that linger, it can be wise to consult your healthcare provider.
1. Chest pain: A nocturnal panic attack can bring a feeling of having a heavy weight on your chest, which can be alarming.
2. Chills or hot flashes: You might suddenly feel very cold, or you might feel unusually hot and start sweating.
3. Intense feeling of terror: During a panic attack, you might feel an overwhelming sense of fear, as if something terrible is about to happen.
4. Nausea: You might feel like you’re going to vomit, adding to the distress of the panic attack.
5. Hyperhidrosis (excessive sweating): You might find yourself sweating a lot more than usual, even if the room isn’t hot.
Racing heart rate: Your heart might start beating very fast, which is a typical response during a panic attack, as your nervous system is out of balance.
4 causes of nocturnal panic attacks
Understanding what causes nocturnal panic attacks, such as stress and anxiety, and the complications they can lead to is another important part of managing them.
Anxiety and panic disorders: Unfortunately, anxiety doesn’t always take a break when you’re resting. If you already have anxiety during the day, it can sometimes continue into your sleep.
Depression: Depression can affect your mind and body in many ways, including an increase of panic attacks at night.
Insomnia or sleep apnea: Trouble sleeping or breathing issues during sleep can be a trigger for panic attacks.
Emotional stress: If you’re dealing with a lot of stress, anger, or hostility, these feelings don't just disappear at bedtime. They can sometimes manifest as panic attacks while you sleep.
4 complications from nocturnal panic attacks
Nocturnal panic attacks are more than just a bad night's sleep—they can impact your daily life in many ways.
Nocturnal panic attacks can increase stress and irritability
After a night of panic attacks, you might feel more stressed or get easily annoyed during the day.
Nocturnal panic attacks can lead to daytime panic attacks
If you experience panic attacks at night, it’s possible to start having them during the day, too, which can be even more distressing.
Nocturnal panic attacks can cause poor performance at work or school
Lack of good sleep and increased anxiety can make it hard to focus and do well in your daily activities.
Nocturnal panic attacks can lead to body changes
Sometimes, the stress and anxiety from these panic attacks can lead to changes in appetite, brain fog, and negative effects on your body from excessive tiredness.
Preventing nocturnal panic attacks
Sometimes, the best offense is a good defense. If you’ve dealt with nocturnal panic attacks, you may want to take some future steps to prevent them.
Consider Cognitive Behavioral Therapy (CBT)
CBT can be very effective in changing the thought patterns that contribute to anxiety and panic attacks. If you don’t have a therapist on hand, try reaching out to your healthcare provider or insurance company to learn more about your options.
Maintain a healthy lifestyle for overall mental wellness
Regular movement, a balanced diet, and sufficient sleep can significantly impact your overall mental health and reduce the likelihood of panic attacks. Sometimes, just taking a few minutes to meditate or go for a walk can help immensely.
Journal before bed to calm your mind
Sometimes writing down your worries or thoughts before going to sleep can help clear your mind and reduce anxiety. You might consider keeping a worry journal near your bed to write in before you go to sleep, or if you wake up in the night.
Manage stress during the day to improve your sleep
Engage in activities that reduce stress, like yoga, meditation, or spending time in nature. Hobbies that you enjoy can also be great stress relievers.
Treat underlying conditions such as sleep apnea
Addressing conditions such as sleep disorders, anxiety, or depression with the help of a healthcare professional can decrease the frequency of nocturnal panic attacks. If you think you might have a sleep disorder, consult your doctor.
How to stop nocturnal panic attacks
Dealing with nocturnal panic attacks can feel overwhelming, but there are effective ways to ease their symptoms and even prevent them. While you can't always stop a panic attack once it starts, these steps can help manage the symptoms and reduce their frequency. This can lead to better sleep and more peaceful nights.
1. Recognize the panic attack
When you wake up feeling panicked, remind yourself that these are all symptoms of a panic attack. Getting clear about what is going on, and that you may have experienced it before, can help reduce your fear and help you bring things under control.
💙 Practice the art of Noticing with Tamara Levitt in this guided meditation aimed at helping you acknowledge all that’s happening in the present moment.
2. Practice deep breathing
Take slow, deep breaths. Slowly inhale through your nose, hold for a few seconds, and exhale through your mouth. Repeat this several times to help calm your body and reduce the intensity of the panic attack.
💙 Overcome Stress and Anxiety in this guided breathing exercise to release tension led by Dr. Julie Smith.
3. Use relaxation techniques
Try methods like progressive muscle relaxation, where you tense and then relax different muscle groups to help calm your body. You can also use visualization or guided imagery, where you picture a calm, peaceful place in your mind.
💙 Relax the body and settle the mind before bed (and if you wake in the middle of the night) with this gentle Evening Wind Down sequence.
4. Keep a nightlight on
Sometimes, waking up in complete darkness can increase panic. A soft nightlight can help orient you when you wake up feeling anxious.
💙 It might also be soothing to play a relaxing soundscape that brings peaceful images to mind like Green Noise (with River) or even Jasper Lake.
5. Have comforting items nearby
Keep things like a comforting blanket, a stress ball, or even a soothing scent (we love lavender for reducing stress) close to your bed. These can provide a sense of security and comfort.
💙 Did you know that you can be your own comfort? Tamara Levitt explores the idea of Self-Nurturing, a practice to help create a comforting environment within yourself.
Nocturnal panic attacks FAQs
What causes nocturnal panic attacks?
Nocturnal panic attacks can happen for several reasons. Sometimes, if you're dealing with anxiety during the day, it can carry over into your sleep. Other factors like depression, sleep disorders (like insomnia or sleep apnea), and even daily stress can trigger these attacks. Your brain and body don’t just shut off when you sleep—they can still respond to these stressors, resulting in a panic attack.
How do you fix nocturnal anxiety?
Fixing nocturnal anxiety involves a few different steps. First, it's helpful to understand what's causing your anxiety. Once you know the cause, you can start addressing it, maybe with the help of a therapist or counselor. Establishing a relaxing bedtime routine can also help calm your mind before you sleep. This might include activities like reading a book, listening to relaxing music, or doing some gentle stretches. Additionally, practicing stress-reduction techniques like meditation or deep breathing exercises can be very beneficial.
How do I stop waking up in the middle of the night with anxiety?
To stop waking up with anxiety, try to create a sleep environment that's calm and comfortable. This means your bedroom should be a relaxing space, free from distractions like loud noises or bright lights. Stick to a regular sleep schedule, even on weekends, to regulate your body's clock. Avoid caffeine and heavy meals before bedtime as they can disrupt your sleep. If anxiety still wakes you up, practice deep breathing or relaxation techniques to calm your mind and help you fall back asleep. If this is a frequent problem, it might be a good idea to speak with a healthcare professional for more tailored advice.
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