Nocturnal Panic Attacks: When They Strike and How to Cope

Nocturnal Panic Attacks (NPA)

You wake up from a deep sleep in a state of high anxiety. As your heart races and your respiration quickens, you may be convinced you are having a heart attack. But while cardiac arrest shares similar symptoms with the physical aspects of a nocturnal panic attack, the similarities stop there. Although you may feel like you are dying, in reality, nocturnal panic attacks are not permanently harmful. Nocturnal panic attacks are very similar to regular panic attacks – the only difference being, of course, that you are asleep when the panic is triggered.

Nocturnal Panic Attacks Symptoms

Nocturnal panic attacks happen during the night when a person is asleep and they do not seem to have an independent cause or trigger. Usually, the person will be awakened in a state of fear and anxiety. The symptoms are very similar to a panic attack that occurs during the daytime. They would include profuse sweating, trembling, a rapid heartbeat, heavy breathing, trembling, chills or flushing, and an impending sense of doom or hopelessness.

These conditions are very distressing and the person may think that he/she is in the process of experiencing a heart attack. The panic attack itself usually lasts no longer than 10 minutes or so, but the individual is left with a high degree of unease and very tense anxieties and emotions.

Nocturnal Panic Attacks generally occur when an individual is in between stages 2 and 3 of sleep

Nocturnal panic attacks are more common in people with any anxiety disorder, especially if he/she experiences panic attacks during daylight hours. Studies show that two out of five people who experience panic attacks regularly will also experience nocturnal panic episodes.

When Do Nocturnal Panic Attacks Occur?

Nocturnal panic attacks generally occur when an individual's body transitions from stage 2 sleep, which is light, to stage 3 sleep, which is deep sleep. This usually occurs within 90 minutes of falling asleep.

During stage 2 sleep, the brain begins to slow down and the body starts to relax. However, the body is still somewhat responsive to the environment. This is why people can sometimes be woken up by loud noises or sudden movements during stage 2 sleep.

When the body transitions to stage 3 sleep, the brain waves slow down even further and the body becomes completely paralyzed. This is a time when the body is most vulnerable to anxiety and panic attacks.

The reason why nocturnal panic attacks often occur during this transition is not fully understood. However, it is thought that the sudden change in brain activity and body paralysis can trigger a panic attack in people who are already prone to anxiety.

What Causes Nocturnal Panic Attacks

Some experts believe that if you are prone to sleep apnea, you may trigger a panic attack by gasping for breath, which causes the same “flight or flight” response in the body as hyperventilating when awake. [In obstructive sleep apnea, the fleshy part of the back of the throat relaxes to the degree that it obstructs the air passage and causes the breathing to stop, sometimes for up to a minute. When a person is not breathing, a state of panic can set in, and in this case, lead to a full-blown panic attack.]

Other experts feel that gastroesophageal reflux disease (GERD) can trigger panic attacks. The burning feeling in your chest that occurs when gastric juices move back up the esophagus can trigger feelings of anxiety while you sleep, causing you to awaken.

Others argue that laryngospasm, a condition in which the vocal cords tighten as you sleep, may also cause pain and therefore feelings of panic.

While all of these triggers cause a physical sensation that triggers panic, some experts argue that some people are simply predisposed to nocturnal anxiety attacks because their subconscious is so reluctant to “surrender” power and relax.

One of the most popular misconceptions about nocturnal panic attacks is that they are the same thing as nightmares. But if you have ever awakened from one in the middle of the night, you know that you don’t recall any kind of dream that precipitated your sudden onset of panic. That’s because nightmares generally occur during stage four of sleep – the deepest sleep stage you experience. Nocturnal panic attacks, as we know, are triggered when the body transitions between stages two and three.

There are several factors that can increase the risk of experiencing a nocturnal panic attack, including:

• Panic disorder: People with panic disorder are more likely to experience nocturnal panic attacks than people without panic disorder.

• Stress: Stress can trigger a panic attack, both during the day and at night.

• Sleep deprivation: When you are sleep deprived, you are more likely to experience anxiety and panic attacks.

• Underlying medical conditions: Some medical conditions, such as thyroid problems and heart disease, can cause symptoms similar to those of a panic attack. If you have an underlying medical condition, it is important to rule it out before treating your nocturnal panic attacks.

• Substance abuse: Alcohol and drugs can trigger panic attacks, both during the day and at night. If you are struggling with substance abuse, it is important to seek treatment.

The Effects of Nocturnal Panic Attacks

Nocturnal panic attacks do not cause the same devastating physical effects that a heart attack will cause, but they can be disruptive to people’s lives nonetheless. People who suffer from them may not be able to get adequate sleep or they may feel too nervous about falling asleep because they fear the nocturnal panic attacks so greatly. Not getting enough sleep can have serious consequences on people’s emotional and physical well-being. If you suffer from nocturnal panic attacks, you must get help for your condition.

In a study conducted by the Penn State College of Medicine, the physicians discovered a link between panic disorder, NPAs, and depression. People are more likely to suffer from depression if they have been diagnosed with panic disorder and report NPAs. In addition, people who have NPAs and depression are highly likely to experience insomnia and sleep disturbances. 92.3% of patients in this survey reported sleep issues.

Not having enough sleep can have a devastating effect on your health. In children, lack of sleep can make children unable to learn and process information, which can seriously impede their progress in school. In adults, lack of sleep can cause major health issues, such as an increased risk of diabetes, stroke, hypertension, obesity, and heart attack.

Too little sleep will also contribute to anxiety, drowsiness, irritability, trouble focusing, difficulties with paying attention, learning and remembering problems, migraines, and depression. These factors can put you at risk for serious incidents, such as car wrecks and industrial accidents because your fatigue can impair your judgment. One expert likened a lack of sleep to driving while drunk, so it’s not something to take lightly.

How to beat a nocturnal panic attack

If you're prone to panic attacks, nighttime can be a particularly tough time. Maybe you have trouble falling asleep because you're anxious about what might happen during the night. Or perhaps you wake up in the middle of the night with a racing heart and a feeling of impending doom. If you're someone who suffers from them, you know how important it is to find a way to beat a nocturnal panic attack. Here are a few tips to help you:

• If you do have a panic attack, try to stay calm — don't fight the symptoms. Remember that it will eventually pass and that you're not in danger. Ride out the wave of anxiety and it will eventually subside.

• Breathe slowly and deeply. Relax your muscles. Get out of bed and do something relaxing. Go back to bed when you feel relaxed.

• Anxiety is often worsened by lack of sleep, so if you are not getting enough rest, this could be a contributing factor. Make sure to establish a regular sleep schedule and create an environment that is conducive to relaxation. This may include dimming the lights in your bedroom and avoiding screen time in the hours leading up to sleep. (Find here → How to Fall Asleep with Anxiety) 

• If you have identified a specific worry or concern that is causing your nocturnal panic attacks, it can be helpful to write down your thoughts in a journal before going to bed. This can help to lessen your anxiety by getting your worries out of your head and onto paper. If you find yourself ruminating on a particular worry, try to defuse it by focusing on the evidence that supports the opposite of your worry. For example, if you are worried that you will fail an upcoming test, remind yourself of all the times you have studied hard and been successful.

• There are several relaxation techniques that can help manage nocturnal panic attacks. Try progressive muscle relaxation, focusing on each muscle group from head to toe. Meditation can also be beneficial in reducing stress and promoting calm. Here is a quick video on a simple meditation technique for relaxation and sleep...⇩

How to deal with nocturnal panic attacks: Treatment

Begin by seeing a physician to make sure that you don’t suffer from any of the physical triggers that can cause panic attacks, such as sleep apnea, GERD, or laryngospasm. A doctor can help prescribe a treatment regimen to correct these ailments.

Treatment for nocturnal panic attacks includes anti-anxiety medications and psychotherapy.

In addition, your physician may advise you to change your diet, cutting back on your consumption of caffeine, sugar, and alcohol as these substances can make it more difficult for you to get adequate sleep at night.

Your doctor may also advise you to increase your exercise regimen, making sure to get between 30 and 45 minutes of aerobic exercise at least three times per week. Exercise has proven stress reduction effects on the body and can help you sleep more easily at night.

In addition to dietary and lifestyle changes, you should seek out a self-help regimen that will help you ease the anxiety you feel upon wakening with a nocturnal panic attack. Using several different relaxation techniques, including breathing exercises, meditation, and progressive muscle relaxation (PMR), you can seize control of your body and your mind even when your heart is racing and you can’t catch your breath. Self-help courses can help you identify which type of techniques work best for your own particular needs when you have a panic attack, allowing you to customize your treatment for the most effective response.