Coping with Panic Attacks at Night

If you’ve ever had a panic attack, you know just how scary the experience can be. Panic attacks can come on suddenly and feel as though they last for a long time, even if they only last for a minute or two. During a panic attack it can be hard for a person to express themselves coherently. Nocturnal panic attacks are a common symptom of Panic Disorder1, but can also occur during withdrawal from substance abuse.

What is a panic attack?
Panic attacks are characterised by a sudden onset of intense anxiety. When they happen, the person suffering might experience of range of distressing symptoms, such as2:

  • Loss of a sense of control
  • Rapid breathing, shortness of breath
  • Heart palpitations, chest pain
  • Feeling as though you are being choked
  • Nausea
  • Faint, dizziness
  • Shaking
  • Sweating
  • Tingling extremities
  • Body temperature fluctuation
  • Muscle spasms

When a panic attack happens for the first time, a person can feel as though they are suffering from a heart attack, or that they are having a nervous breakdown. The experience of having a panic attack can be so terrifying that sufferers may fear having another one in the future. Sometimes this fear can trigger a panic attack, which creates a vicious cycle of anxiety.
Some people experience panic attacks in the middle of the night. These are sometimes called ‘night terrors’, or ‘nocturnal panic attacks’. The attack begins during sleep and wakes up the person. The symptoms are the same as above, but can be more problematic as it can be difficult to return to sleep after waking up from a night terror.

Why do I get panic attacks at night?
Panic attacks can make a person feel as though they are completely alone in their experience. The thoughts and feelings that come up can be deeply personal and difficult to rationalise. However, nocturnal panic attacks are more common than many sufferers believe.3
While there are no exact reasons as to why nocturnal panic attacks occur, there are some potential factors that may contribute to their occurrence. Even when we are asleep, the brain isn’t completely switched off. Thought, feelings, and emotions that are with us throughout the day can manifest as dreams and nightmares when we sleep, and if they are vivid and intense a panic attack can occur. The anxieties we experience, even subtle, mild anxieties, can manifest in our unconscious mind and lead to a nocturnal panic attack.
Some of the main factors that contribute to nocturnal panic attacks include4:

  • Frequent stress
  • Anxiety, depression, PTSD, Panic Disorder and other mental health conditions
  • Genetic factors (if a family member experiences panic attacks, you may be more likely to suffer too)
  • Substance withdrawal
  • Excess caffeine
  • Excess cannabis
  • Chronic illness
  • Significant loss, such as the death of a loved one or a break up
  • Major life changes, such as becoming a parent, or losing a job

Consequences of Night Time Panic Attacks
Not only are panic attacks emotionally and mentally taxing, they can also cause significant disruptions to your daily life. When you wake up from a night time panic attack, it can be extremely difficult to fall asleep again. It can take some time for the mind and body to calm down enough to return to sleep, and the fear of having another panic attack can make a person not even want to be in bed. As a result, there will be a lack of high quality sleep, which can make it extremely difficult to be fully committed and present the following day5. Fortunately, panic attacks and other anxiety disorders can be managed effectively with professional help.

How to Cope with Panic Attacks at Night
If you are suffering from night time panic attacks, it may be a sign that your mind and body are having difficulty coping with stress. It is worth investigating the roots of your frightening experiences with a professional therapist or counsellor.
In the meantime, we would like to offer some tips to help you cope with nocturnal panic attacks so that you can reduce their severity and the impact they may be having on your daily life.

Don’t resist it
Waking up to a panic attack can be terrifying, but resistance can amplify the experience. It may help to become more familiar with panic attacks by reading about them (as you are now) or discussing them with a trained doctor or therapist. Once you become familiar with them and understand what is happening in the body throughout the experience, it may become easier to accept them when they happen and let them take their course.

This step is much easier said than done, especially when in the throes of an attack. However, it is possible to relax by bringing you awareness to your breath and focusing on deep inhales and long, slow exhales. When we breathe deep into the diaphragm, and take long slow exhales, we signal to the brain and nervous system that we are not in danger.6 This can help to calm the mind and body and increase the likelihood that you will successfully return to sleep.

Get active
If returning to sleep seems impossible, or just something you would much rather avoid for a little while, occupy yourself. Read, cook, exercise – anything that will occupy your mind and body. By removing yourself from the situation and placing your attention on something other than your distress, you increase the likelihood that you will soon relax.

Can I prevent a panic attack?
Panic attacks can result from excess stress in our lives. They can happen to anyone, but people who already suffer from anxiety-related disorders such as Panic Disorder or PTSD are at a higher risk of experiencing them. Fortunately, there are some preventative measures you can take to reduce your likelihood of experiencing the symptoms of panic attack.
If you know that you suffer from night time panic attacks, try to get an advantage over the clock by going to bed earlier. This way, if you wake up from an attack and it takes you a long time to go back to sleep, you increase your amount of potential sleeping hours.
Limit stimulant intake before bed. This includes caffeine and sugar. Substances such as these exacerbate anxiety and can keep you awake and on edge in the late hours.
Prepare for the next day. Organise your clothes, think about what you will have for breakfast, make sure you know what time you have meetings or appointments, and so on. If you prepare for the following day in advance, you have one less thing to worry about as you fall asleep.

Professional Help at Addcounsel
While we have outlined some basic coping tips for night time panic attacks above, there are times when it is wiser to seek professional help. Panic attacks can be a strong indicator of another health condition. Characterised by overwhelming stress, many people who suffer from nocturnal panic attacks may also experience the symptoms of anxiety, depression, and fatigue. In terms of substance use, panic attacks (night time panic attacks in particular) can develop either following untreated cessation of use, or as a side effect of ongoing use.
At Addcounsel we pride ourselves on providing high quality mental health treatment, delivered with clinical excellence. We have a team of over 80 experts in their field who can give an expert diagnosis, followed by a compassionate and personalised treatment program. This can all be delivered from the luxury of one of our five-star Central London properties.

1 Nakamura, Masaki et al. “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 : JCSM : official publication of the American Academy of Sleep Medicine vol. 9,5 461-7. 15 May. 2013, doi:10.5664/jcsm.2666
2 Cackovic C, Nazir S, Marwaha R. Panic Disorder. [Updated 2020 Jun 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:
3 Lopes, Fabiana L et al. “Diurnal Panic Attacks With And Without Nocturnal Panic Attacks: Are There Some Phenomenological Differences?”. Revista Brasileira De Psiquiatria, vol 27, no. 3, 2005, pp. 216-221. Fapunifesp (Scielo), doi:10.1590/s1516-44462005000300010. Accessed 28 Oct 2020.
4 Fletcher, Jenna. “Panic Attacks At Night: Causes And How To Cope”. Medicalnewstoday.Com, 2019, Accessed 28 Oct 2020.
5 Overbeek, Thea MD, PhD*†; van Diest, Rob PhD*; Schruers, Koen MD, PhD*†; Kruizinga, Femmie MSc*†; Griez, Eric MA, MD, PhD*† Sleep Complaints in Panic Disorder Patients, The Journal of Nervous and Mental Disease: July 2005 – Volume 193 – Issue 7 – p 488-493 doi: 10.1097/01.nmd.0000168233.43673.0e
6 Ma, Xiao et al. “The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults.” Frontiers in psychology vol. 8 874. 6 Jun. 2017, doi:10.3389/fpsyg.2017.00874


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