One minute you’re asleep, and the next you’re awake and terrified. Your heart is racing, it’s hard to breathe and you’re sweating, well, a lot.
Panic attacks are never enjoyable. And while uncommon, nocturnal panic attacks, which occur at night when you are sleeping, can feel particularly frightening.
What is a nighttime panic attack?
First things first: Yes, it is possible to have a panic attack at night while you sleep.
“A panic attack is an acute crescendo of anxiety that usually lasts less than 30 minutes,” says Dr. Jen Erickson, a UW Medicine psychiatrist. “It can happen any time of day in any situation.”
Your amygdala, the part of your brain activated during a panic attack, doesn’t require you to be conscious to be activated. This means you can experience the physiologic symptoms of a panic attack while being fully asleep, though most people who have panic attacks while sleeping will wake up (and are sometimes jolted awake) because of the symptoms.
Nighttime panic attack symptoms are the same as daytime panic attacks symptoms:
- Increased heart rate
- Shortness of breath
- Feeling out of your body
- A sense of doom
- Feeling like you’re having a heart attack
What causes panic attacks at night?
Your brain and body are hardwired to experience anxiety as a tool to scan your environment and keep you safe. It’s when harmless stimuli trigger your fight or flight response that anxiety becomes a problem, Erickson says. This is heightened with panic attacks, as your body has an extreme, potentially debilitating response.
There are several reasons you may have a panic attack at night or while you sleep. At night, there may be fewer distractions, so you’re left alone with your thoughts; your body may have more aches and pains that accumulated throughout the day; or the darkness could be tied to stress or a traumatic event. This buildup of stressors during your day can lead to a panic attack at night or while you sleep.
“Nightmares and poor sleep can cause people to wake up in the middle of the night and have panic,” Erickson says. “For some people, nighttime panic attacks are what happen when they’re extremely stressed or in stressful situations.”
How is a nighttime panic attack different than nightmares or night terrors?
If you wake up in a panic, you’re likely asking yourself ‘What just happened?’ And while it may have been a panic attack, there are other things that cause nighttime panic.
Night terrors are more common in children than adults, and they are characterized by intense fear, screaming, flailing and sleepwalking — all of which occurs while you’re still asleep.
“Most people won’t remember night terrors, because they occur at a time in your sleep when you aren’t building memories,” Erickson says.
In contrast, nightmares occur during a period of sleep when you can build memories (which is why you can recall your nightmare). You likely have some experience with nightmares where you wake in a panic and remember the dream that scared you, but then are able to calm yourself down.
Nightmares can lead to nocturnal panic attacks by triggering the physiological symptoms of panic. However, the two are different. A nocturnal panic attack involves a more heightened, extreme panicked state (shortness of breath, doom, elevated heart rate, etc.) once you’re awake, and it may take a longer period to calm down.
“You can think of a nightmare as bit of a spark that you can kind of stomp out,” Erickson says. “When someone has a panic attack, however, it’s more of fire that is a little stronger. It will take some time to burn out.”
How to calm down from a nighttime panic attack
Panic attacks are awful, but they do tend to follow a predictable course: They build to a certain peak or plateau and then come down. To help yourself through a panic attack, try these ways to plateau (and feel calmer) faster.
Waking up during or just after a panic attack is disorienting. If you wake up panicked, it helps to remind yourself you are safe in that moment.
Erickson recommends asking yourself these three questions to help calm yourself down:
- Where am I?
- What’s going on?
- Is the room safe?
For example, you might tell yourself, “I am in my room. I had/am having a panic attack, but it will end, and I will be OK. I am safe right now.”
“Take a breath if you need to, turn on a light, and reorient yourself to the situation you’re in,” Erickson says.
If you wake up while having a panic attack, distracting yourself from the anxious thoughts can help you calm down sooner.
- Breathing techniques, like square breathing (in for four, hold for four, out for four, hold for four) or five finger breathing.
- Counting the straight lines near you.
- Noticing and naming the shapes around you.
Give yourself grace
Doing activities that relieve stress — be it mindfulness and meditation, exercise, a nightly wind-down routine, a morning routine and/or eating a healthy diet — can help lower your chance of tipping into a panic attack.
If you are having panic though, give yourself some grace.
“One of the very first things I say to patients is let’s not catastrophize you having a panic attack as a failure,” Erickson says.
Working with your primary care doctor or a mental health expert can give you skills to manage and decrease panic attacks. You should also talk to your doctor if you are frequently waking up in the middle of the night or are unable to return to a normal heart rate, as these could be signs of other conditions, such as sleep apnea.
While stress, anxiety and panic attacks happen, better sleep and more peaceful nights are possible.
“Waking up and having a routine, using psychotherapy techniques and having access to appropriate mental health care support are often keys to decreasing panic attacks at night,” Erickson says.