Nocturnal Panic Attack: Symptoms, Causes, & Coping

Waking up in the middle of the night short of breath with a pounding heart and an overpowering sense of fear can be terrifying. Nocturnal panic attacks strike suddenly, pulling you from sleep into a state of intense distress. Unlike nightmares, these episodes don’t stem from bad dreams. Instead, they manifest without warning, leaving you wide awake, confused, and struggling to calm down. Panic attack symptoms at night can make it hard to fall back asleep, leading to exhaustion and increased anxiety at night.

For those who deal with nocturnal panic attacks, the fear of another episode can become just as troubling as the attacks themselves. Waking up in a panic can provoke long-term sleep difficulties and a heightened sense of dread at bedtime. This page explores what causes these nighttime surges of panic, how they differ from other sleep disturbances, and ways to manage them.

What is a nocturnal panic attack?

A nocturnal panic attack is an abrupt and unexpected episode of intense fear or distress that occurs during sleep, waking a person with a start. These attacks happen without an obvious trigger and can cause severe physical symptoms. Panic attack symptoms at night include a racing heart, breathing issues, sweating, and dizziness. Many people describe waking up in a state of terror, struggling to understand what’s happening.

Unlike nightmares, which involve vivid and often frightening dreams, nocturnal panic attacks do not stem from dream content. Instead, they appear deep within the brain, triggering the body’s fight-or-flight response. During the attack, the person becomes fully awake and alert, making it difficult to return to sleep. These episodes can be unsettling, leaving individuals anxious about bedtime and fearful of experiencing another attack in the future. 

How common are nocturnal panic attacks?

Panic attacks are fairly common, affecting about 11% of people each year [1]. Among those with panic disorder (an anxiety condition characterized by frequent panic attacks), up to 70% experience nocturnal panic attacks [2]. This means that for many individuals who already deal with panic attacks during the day, panic attacks at night can be an added challenge.

Even people who do not have panic disorder can experience nighttime panic attacks. They may occur as a reaction to stress, underlying anxiety, or certain medical conditions. Waking up with anxiety in the middle of the night can feel confusing and disorienting, making it difficult to pinpoint the cause. While nocturnal anxiety attacks can happen at any age, they are more frequently reported in teens and adults. Children are more likely to experience night terrors, which have similar symptoms but are different in nature [3].

What is the difference between night terrors and nocturnal panic attacks at night?

Both issues involve sudden awakenings and intense distress, but they are separate conditions with key differences.

• Awareness: People experiencing nocturnal panic attacks wake up fully aware of their fear and symptoms. Those having a night terror, by contrast, may appear awake but are actually in a deep sleep state. They often do not remember the episode in the morning.
• Behavioral reactions: Night terrors often involve dramatic physical responses like screaming, thrashing, or running out of bed. Nocturnal panic attacks usually cause internal distress with minimal outward activity.
• Triggers and causes: Night terrors are more common in children and are linked to sleep stage disruptions, while nocturnal panic attacks tend to affect adults and are often tied to anxiety disorders.

Because night terrors and nocturnal panic attacks can look similar from the outside, it may take a doctor or mental health professional to determine which one is occurring.

Symptoms and Causes

A nocturnal panic attack may cause intense physical and emotional symptoms, including:

• Rapid heartbeat or palpitations.
• Chest tightness or pain.
• Shortness of breath or a choking sensation.
• Excessive sweating.
• Shaking or trembling.
• Dizziness or lightheadedness.
• Nausea or stomach discomfort.
• Chills or hot flashes.
• A feeling of impending doom at night.
• Overwhelming fear, often without a clear cause.

Recognizing the signs of a panic attack while sleeping can help differentiate these episodes from other sleep disturbances.

Why Do I Wake Up Anxious?

The precise cause of nocturnal anxiety attacks is incompletely understood, but several factors may contribute:

• Anxiety and stress: Ongoing stress can build up, and the brain may release this tension during sleep, triggering a panic attack.
• Genetics: If close family members suffer from panic or anxiety disorders, this may raise the risk of experiencing panic attack symptoms at night.
• Sleep disorders: Conditions such as sleep apnea, which causes breathing interruptions during sleep, may contribute to panic attacks while sleeping [4].
• Brain chemistry changes: Imbalances in serotonin and norepinephrine can affect the body’s ability to regulate fear responses.
• Stimulants and substances: Alcohol, caffeine, and some medications can interfere with sleep patterns and increase the risk of waking up with anxiety attacks.

How long do nocturnal panic attacks last?

Panic attack symptoms at night typically peak within 10 minutes but can feel much longer due to their intensity. Some symptoms, such as increased heart rate or dizziness, may persist even after the main attack subsides.

After an attack, many people struggle with waking up in the middle of the night with anxiety, fearing another episode. This fear can provoke sleep deprivation, which, in turn, increases overall anxiety and the likelihood of more nocturnal panic attacks.

The Role of Lifestyle Factors in Nocturnal Panic Attacks

While panic attacks at night can seem random, certain lifestyle factors may increase the risk of waking up with a panic attack. High stress levels, poor diet, and lack of physical activity can all contribute to heightened anxiety, making the body more prone to experiencing panic episodes during sleep. Consuming too much caffeine or alcohol, especially before bedtime, can disrupt sleep patterns and increase the likelihood of waking up in the middle of the night with anxiety.

Another major factor is poor sleep hygiene. Inconsistent sleep schedules, excessive screen time before bed, and sleeping in an uncomfortable environment can make it harder for the body to relax. When the brain is overstimulated before bedtime, it may struggle to transition into deep sleep, making nocturnal panic attacks more likely.

Unresolved emotional stress is another common trigger of panic attack symptoms at night. People dealing with chronic anxiety, trauma, or depression may carry these unresolved feelings into their sleep cycle, leading to panic attacks while sleeping. Addressing mental health concerns through therapy, relaxation techniques, and self-care can dramatically reduce the risk of waking up with an anxiety attack.

How to Stop Nocturnal Panic Attacks

Many want to know how to stop panic attacks at night, and while it may not be possible to stop a nocturnal panic attack immediately, there are ways to shorten its duration and reduce its impact.

How to calm anxiety attacks at night:

• Breathe deeply: Take slow, deep breaths in through the nose and out through the mouth to ease tension and slow your heart rate.
• Ground yourself: Focus on your surroundings by naming five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste.
• Relax your muscles: Tense and then release different muscle groups to reduce physical tension.
• Remind yourself it will pass: Though waking up with a panic attack feels overwhelming, it is temporary. Telling yourself, “This will be over soon,” can help ease the fear. 

Long-term strategies to prevent nocturnal anxiety

• Improve sleep hygiene: Stick to a consistent bedtime routine to reduce anxiety at night.
• Manage daily stress: Techniques like meditation, journaling, or yoga can help prevent waking up with anxiety.
• Limit caffeine and alcohol: Stimulants like caffeine can heighten anxiety, while alcohol can interfere with sleep.
• Consider therapy: CBT (cognitive behavioral therapy) can help stop panic attacks at night by addressing negative thought patterns [5].

Can you die from nocturnal panic attacks?

Many people who experience waking up with panic attacks worry about serious health consequences. The good news is that panic attacks at night are not life-threatening, even though they can feel intense. While they may cause distressing symptoms like chest pain or a racing heart, they do not cause heart attacks or sudden death. However, chronic nocturnal anxiety can contribute to long-term health issues, including high blood pressure and fatigue.

The impact of nocturnal panic attacks on daily life

Nocturnal panic attacks don’t just disrupt sleep. They can have a lasting effect on daily life. The fear of waking up in a panic may prompt sleep avoidance, where individuals stay up later than usual or struggle to fall asleep due to anxiety. Over time, this can lead to chronic sleep deprivation, which affects mood, concentration, and overall well-being. Lack of restful sleep can also make the brain more reactive to stress, increasing the likelihood of more panic attacks in a vicious cycle.

Fatigue from interrupted sleep can spill over into the daytime, making it harder to focus at work or school. People who experience frequent nocturnal panic attacks may find themselves feeling irritable, emotionally drained, or continuously on edge. Everyday stressors may feel more overwhelming, and the lingering effects of nighttime anxiety can lead to increased worry about when the next attack will strike.

In some cases, nocturnal panic attacks can contribute to physical health problems. Poor sleep has been linked to a weakened immune system, increased blood pressure, and a higher risk of heart disease. Beyond this, some people may turn to unhealthy coping mechanisms, such as drinking alcohol or avoiding social activities, in an attempt to manage their anxiety.

Relationships can also suffer. Loved ones may struggle to understand what’s happening, especially if the person experiencing nocturnal panic attacks finds it difficult to explain their symptoms. This can create feelings of isolation, making it even harder to seek support.

Recognizing how nocturnal panic attacks affect daily life is the first fundamental step toward finding solutions. By addressing both the nighttime episodes and their daytime impact, individuals can regain control and improve their overall quality of life.

FAQs

How is a nocturnal panic attack diagnosed?

A doctor might diagnose nocturnal panic attacks based on panic attack symptoms at night and medical history. They might run tests to eliminate other conditions, such as heart disease or sleep disorders, that can cause similar symptoms. If no physical cause is found, a mental health professional may assess for panic disorder or anxiety-related conditions.

How can you stop a nocturnal panic attack?

Once a nocturnal panic attack begins, the best approach is to focus on slow, deep breathing and grounding techniques to help the body calm down. Reminding yourself that the attack will pass and using relaxation strategies, such as muscle relaxation or soothing imagery, can ease the intensity. While panic attacks typically have to run their course, reducing stress and improving sleep habits can help lower the chances of future episodes.

How is a nocturnal panic attack managed or treated?

Treatment often includes therapy, medication, or a combination of both. CBT (cognitive behavioral therapy) helps identify triggers and change thought patterns that contribute to panic attacks. In some cases, doctors may prescribe antidepressants, anti-anxiety medications, or beta-blockers to help manage symptoms.

What are the complications of nocturnal panic attacks?

Frequent nocturnal panic attacks can lead to chronic sleep problems, including insomnia and daytime fatigue. Over time, sleep deprivation can increase anxiety, worsen mood, and make daytime panic attacks more likely. The fear of future attacks may also cause people to avoid sleep, creating a cycle of stress and exhaustion.

Get Help Addressing Panic Attack Symptoms at Night at Connections Mental Health

If you need help fighting back against nocturnal panic attacks, we treat all mental health conditions in an immersive inpatient setting at Connections.

We limit group sizes to just six people, which allows you to benefit from peer support without missing out on one-to-one attention. The unique nature of all mental health issues means that all our treatment plans are personalized.

When you engage with a combination of talk therapies, medication management, and holistic interventions at Connections, you can set the stage for whole-body recovery from any type of panic disorder. 

Get immediate assistance by calling 844-759-0999. 

Sources

[1] https://www.msdmanuals.com/professional/psychiatric-disorders/anxiety-and-stressor-related-disorders/panic-attacks-and-panic-disorder

[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC3629320/

[3] https://kidshealth.org/en/parents/terrors.html

[4] https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090

[5] https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral