Panic attacks at night: can you have a panic attack in your sleep?

A panic attack at night can feel especially frightening. You might wake suddenly with a racing heart, shortness of breath or a sense of panic, often without understanding why.

Nighttime panic attacks, also known as ‘nocturnal panic attacks’ or ‘night terrors’, happen while you’re asleep and wake you up, often with the same symptoms as daytime panic attacks.

While these nocturnal attacks usually only last for a few minutes, it can take a long time for you to calm down enough to go back to sleep after having one. 

Here, we explain how panic attacks occur at night and ways you can manage them.

What is a panic attack at night?

A panic attack at night, sometimes called a nocturnal panic attack, is a sudden episode of intense fear that wakes you from sleep. You may go from being fully asleep to feeling panicked within seconds.

These attacks often include symptoms such as:

• A racing or pounding heart
• Shortness of breath or feeling like you can’t breathe
• Sweating or shaking
• Chest tightness
• A sense of losing control or impending danger

Although they feel overwhelming, panic attacks at night are not dangerous, even though the symptoms can feel very real.

Can you have a panic attack in your sleep?

Yes, you can have a panic attack in your sleep. These are known as nocturnal panic attacks and can occur without any obvious trigger. They often wake you suddenly, leaving you feeling frightened and disoriented.

Unlike nightmares, where you may not fully wake up, panic attacks at night usually bring you into full awareness, and you’re likely to remember the experience afterwards.

Some people only experience panic attacks at night, while others have them during both the day and night.

Panic attacks at night vs nightmares

Panic attacks at night are different from nightmares or night terrors:

Understanding this difference can help reassure you that what you’re experiencing, while distressing, is a recognised response.

What causes panic attacks at night?

If you wake up having a panic attack, it's not often clear why this has occurred - often there's no explanation.

The brain doesn’t ‘switch off’ during sleep, so any pent-up worries or anxieties can manifest in our unconscious brains, causing a nocturnal panic attack. Also, struggling with daytime panic attacks makes it more likely that you'll experience panic attacks at night.

There are a number of factors that could increase the risk of someone suffering from nighttime panic attacks:

• Experiencing chronic stress in your day-to-day life
• Struggling with other mental health conditions, such as anxiety, depression, obsessive compulsive disorder (OCD) or post-traumatic stress disorder (PTSD)
• A lack of assertiveness - some evidence supports the idea that people who suffer from panic attacks have a passive style of communication or interactions with others
• Genetics – having a close relative such as a parent or sibling who suffers from panic attacks makes it more likely that you'll also develop panic attacks
• Alcohol, drugs or medication withdrawal
• The side effects of some medications
• Certain substances can also trigger panic attack symptoms, including caffeine and cannabis
• Chronic physical illnesses such as cancer
• Experiencing a significant personal loss, including bereavement, or the breakdown of a relationship
• Significant life changes such as losing a job, becoming a parent, and moving house

Panic attack symptoms at night

Symptoms of panic attacks at night include:

• Feeling out of control and disconnected from your surroundings
• Feeling faint, dizzy or light-headed
• Chest pains and shortness of breath - tightness of the chest and feeling as though it’s a struggle to breathe
• A racing or pounding heart
• Hyperventilating
• Feeling as though you’re choking
• Nausea
• Muscle spasms and palpitations
• Excessive sweating
• Trembling or shaking
• Numbness and tingling, for example, tingling lips and numbness in your fingers and toes
• Fluctuating body temperature – feeling very hot or very cold

These symptoms can be so severe they sometimes make first-time sufferers believe they’re having a heart attack or a nervous breakdown.

If you're particularly stressed or anxious, you might also experience what's known as hypnic jerks. These involuntary muscle sensations, like jolts, occur when you're in your lightest stage of sleep.

If you experience a panic attack at night, it can help to focus on calming your body and reminding yourself that the feeling will pass.

How to stop panic attacks at night

If you’re having a nocturnal panic attack, try the following:

• Don’t fight it - accept the panic attack for what it is and let the feelings wash over you. Remember, it's only temporary, and it will fade eventually. You just need to let it happen
• Try and relax - try to get your body back into a relaxed state. Inhale deeply and exhale slowly to regulate your breathing. Relax your muscles, and try to focus your mind on positive thoughts and images
• Get up and do something - it’s unlikely you’ll be able to go straight back to sleep after a panic attack, so take your mind off it by getting out of bed and doing something relaxing to shift your focus, like somatic exercises or listening to calm and gentle music
• Go back to bed when you’re ready - only go back to bed when you’re beginning to feel tired again and ready for sleep. Make the bedroom for sleeping and nothing else
• Give yourself enough time to get the sleep you need - establish a good routine, as going to bed too late and not leaving enough time for sleep may result in you constantly checking the clock and worrying that you’re not going to feel rested the next day - which can fuel anxiety 
• Prepare yourself for the following day - many people struggle to get to sleep because they're anxious about the following day. You can try to reduce this anxiety by making sure that you have everything prepared 
  
• Limit caffeine, sugar and alcohol before bed - these substances can make you feel anxious and jittery at night, and can prevent you from getting to sleep and staying asleep
• Avoid electronic devices late at night - avoid using electronic devices such as computers, mobiles and tablets within 30 to 60 minutes of your target bedtime. These devices give off light which can be overly stimulating and keep you awake