Waking at night in a panic is terrifying and exhausting. You may feel you’re having a heart attack or dying but aren’t sure why. This is the reality for those suffering from nocturnal panic attacks.

Can You Have a Panic Attack in Your Sleep?

People often associate panic attacks with specific triggers that occur while someone is awake. However, individuals can have these attacks while sleeping without a known trigger. During a nocturnal panic attack, individuals jolt awake in a panic. They may experience physical symptoms and intense emotions, including terror and an impending sense of doom.

Symptoms of Nocturnal Panic Attacks

Nighttime panic attacks are similar to those that occur during the day. The difference with the nocturnal type is that an individual wakes up in the middle of the attack. This makes it harder to identify a trigger and negatively impacts sleep. Symptoms may include:

• Racing heart
• Sweating
• Chills
• Chest pains
• Hyperventilating or difficulty breathing
• Intense fear, terror or panic
• Sense of loss of control
• Feeling detached from your body or reality
• Shaking or trembling
• Dizziness or lightheadedness
• Nausea
• Feeling like you’re choking
• Sense of impending doom
• Numbness or tingling sensation in extremities
• Feeling like you’re having a heart attack or dying

Causes of Nocturnal Panic Attacks

There hasn’t been one specific cause of nighttime panic attacks or panic disorder identified. It’s commonly believed to be a combination of factors. These include differences in how a person’s brain and nervous system perceive and process stress, fear and anxiety, and genetic and environmental factors. Individuals at a higher risk of having nocturnal panic attacks are those with:

• Daytime panic attacks
• Sleep problems (e.g., insomnia or sleep apnea)
• Mental health conditions (e.g., anxiety disorders, depressive disorders, obsessive-compulsive disorder or substance use disorders)
• Trouble coping with emotions and stress
• Stressful life event(s)
• History of trauma
• Issues ruminating on negative thoughts at bedtime

What To Do During a Nocturnal Panic Attack

When you wake up at night in the middle of a panic attack, you can try different calming strategies to help you get through it. It’s a good idea to practice these techniques when calm and not in the middle of an attack so you’re prepared to use the strategy when needed.

Each person is unique in which strategies work best for them, so try different techniques to determine which ones suit you.

• Try the 4-7-8 deep breathing exercise. Breathe in from your nose for four seconds. Hold your breath for seven seconds. Then exhale through your mouth for eight seconds.
• Try a grounding activity like the 5-4-3-2-1 method. Go through your senses and identify five things you can see, four things you can touch, three things you can hear, two things you can smell and one thing you can taste.
• Eat a sour piece of candy
• Take a cold shower or splash cool water on your face.
• Acknowledge how you’re feeling and say encouraging statements to yourself. It helps if you write them ahead of time when you’re calm. For example, “Right now I’m terrified, but I know this is temporary,” or “I feel like I’m dying. It will be over soon.”

How To Cope

If you believe you have nocturnal panic attacks, reach out to your healthcare provider first. They can diagnose the issue and provide treatment recommendations. Ways to help manage panic attacks include:

• Therapy
• Medication
• Engage in activities that help you manage stress (e.g., spending time with loved ones, indulging in a hobby, journaling or meditating).
• Set up a bedtime routine that helps you relax before bed.
• Reduce caffeine intake.
• Exercise regularly
• Eat a nutritious and balanced diet

Diagnosing and Treating Nocturnal Panic Attacks

Seek help if anxiety or panic attacks impact your daily life. This may look like having trouble sleeping, regular panic attacks, physical and mental fatigue, difficulty concentrating, frequent fear of having another panic attack or irritability.

Your healthcare provider can assess for other health conditions that may be causing the panic attacks or mimic symptoms. These include heart conditions and thyroid problems. They’ll rule out night terrors, which look similar to panic attacks. However, an individual is unaware during the night terror, unlike during a panic attack.

Treatment options include psychotherapy, such as cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT). Common medication types used to treat panic disorder include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants (TCAs).

If nocturnal panic attacks are impacting you or a loved one’s daily life, help is available. The Nobu app contains free tools such as mindfulness activities, guided video lessons and goal tracking. You can also connect with a licensed therapist for an additional fee. Download the Nobu app at the App Store and Google Play store today.