Nocturnal panic attacks occur while a person is sleeping. They cause a person to wake from sleep with symptoms such as a racing heartbeat, profuse sweating, and difficulty breathing.
All panic attacks can be frightening experiences, but they can be even more terrifying if they startle you out of your sleep. Nocturnal panic attacks can potentially contribute to sleep disturbances and leave you feeling tired throughout your day.
This article discusses the symptoms, causes, and treatments for nocturnal panic attacks. It also explores some of the steps you can take to prevent them from happening.
Symptoms of Nocturnal Panic Attacks
Nocturnal panic attacks can occur with no obvious trigger and awaken you from sleep. Somatic sensations, such as sweating, heart palpitations, and chest pain are common. Strong emotions combined with troublesome physical sensations may contribute to fear that the attack will lead to a loss of control over oneself.
As with panic attacks during the day, nocturnal panic attacks occur when a person experiences four or more of the following symptoms:
- Chest pain
- Chills or hot flushes
- Choking feeling
- Derealization or depersonalization
- Feeling dizzy, lightheaded, or faint
- Fear of dying
- Fear of losing control
- Feeling of being smothered
- Nausea or abdominal pain
- Numbness or tingling sensation
- Palpitations or fast heart rate
- Shortness of breath
- Sweating
- Trembling or shaking
Even though panic attack symptoms typically reach a peak within a few minutes before gradually subsiding, the effects of the attack can impact the person much longer. Excess worry and fear associated with this experience can often lead to insomnia.
Panic attacks are most commonly associated with panic disorder but have also been known to occur along with other mental health conditions, such as depression, post-traumatic stress disorder (PTSD), agoraphobia, and specific phobias.
Causes of Nocturnal Panic Attacks
Researchers are still trying to understand why some people experience nocturnal panic attacks. What they do know is that nocturnal panic attacks are frequent in people with panic disorders. Up to 71% of people with daytime panic attacks report experiencing a nocturnal panic attack at least once.1
That said, experts have identified some factors that can make a person more likely to have nocturnal panic attacks:
- A chemical imbalance in the brain
- Family history of panic attacks
- Major life stress
- Traumatic events
- Underlying conditions, such as depression or social anxiety disorder
Most nocturnal panics take place during non-REM sleep, primarily in stages 2 and 3. This means they’re not a response to Stage 4 sleep terrors. This also means that nocturnal panic attacks are different from nightmares, which mostly occur during REM sleep.2
Nocturnal Panic Attacks vs. Night Terrors
Night terrors, also known as sleep terrors, are a type of sleep disorder that leads to episodes of intense fear. While they share some similar symptoms, night terrors and nocturnal panic attacks differ.
Like nocturnal panic attacks, night terrors can involve symptoms of fear such as rapid breathing, racing heartbeat, and excessive sweating. However, they often also cause symptoms that are not characteristic of nocturnal panic attacks such as aggressive behavior and vocalizations such as yelling or screaming.
While nocturnal panic attacks cause the individual to awaken suddenly and remember the experience, people often have no memory of the night terror when they wake.
Treatments for Nocturnal Panic Attacks
Whether you are experiencing panic attacks that interrupt your sleep or that occur during your waking hours, help is available. Many people choose to start the recovery process by scheduling an appointment with their primary care physician.
Your doctor can assist you by ruling out other medical and sleep conditions. They can also discuss your treatment options, which typically involve psychotherapy, medications, or a combination of both.3
Psychotherapy
Cognitive-behavioral therapy (CBT) has been found effective in treating both daytime and nocturnal panic attacks.4 In CBT, a therapist helps a person understand and confront their symptoms in a safe environment.
CBT empowers people with techniques to better manage their panic-induced anxiety and develop better sleep hygiene.
Prescription medications
In addition to or instead of therapy, a doctor may prescribe one or more medications to help treat anxiety. Treatment with selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines has been shown to be especially effective in treating people who have nocturnal panic attacks.5
Panic attacks are often treated with prescribed medication. Medications such as antidepressants and anti-anxiety drugs may assist in lessening the frequency and intensity of nocturnal panic attacks.5
Coping With Nocturnal Panic Attacks
The biggest problem with nocturnal panic attacks is that, because they happen without warning, you’re unable to prepare or “talk yourself down.” Though it may seem like things are out of your control, there are several things you can do to manage your attack and get back to sleep:
- Learn how to control your breathing
- Practice positive self-talk
- Talk to a friend or family member
- Relax your muscles
Though these steps can help, it’s important that you seek professional help if your panic attacks are becoming more frequent or they are impacting other aspects of your life.
Preventing Nocturnal Panic Attacks
While there is no way to completely eliminate the possibility of having a nocturnal panic attack, there are steps you can take that may lower your risk. Prevention strategies that can help include:
- Limiting your caffeine intake, particularly in the afternoon and evening
- Eating a healthy balanced diet
- Getting regular exercise
- Finding ways to manage your stress levels
- Getting enough sleep and practicing good sleep hygiene
Getting professional treatment for anxiety, including psychotherapy and medication, may also help prevent nocturnal panic attacks. Treatment can reduce the frequency and severity of your anxiety symptoms, which often decreases the likelihood of having a nocturnal panic attack.