Panic Attacks While Sleeping: Understand and Manage the Nightmare of Nighttime Panic

Panic attacks can strike at any time, causing intense fear and discomfort. But imagine if these episodes occurred during your sleep, startling you awake in the middle of the night. These are called nighttime panic attacks.

According to a study published in Dialogues in Clinical Neuroscience, about 40-70% of people with panic disorder will experience at least one panic attack during sleep[1]. Panic attacks while sleeping can be particularly distressing because they interrupt a time that’s meant for rest and recovery. Waking up in panic can leave you feeling anxious, confused, and exhausted.

Can You Have a Panic Attack While Sleeping?

Contrary to what some people believe, panic attacks can indeed occur during sleep. Panic attacks are typically classified into several types, the main two being: expected and unexpected. Expected panic attacks are associated with known triggers or phobias. Unexpected panic attacks, on the other hand, occur without any identifiable cause and can strike at any time – including during sleep[2].

So, why do panic attacks happen while sleeping?

During the REM (rapid eye movement) stage of sleep, which is associated with dreaming, our brain activity is heightened. For individuals with panic disorder, this increased brain activity can potentially trigger a panic attack. Another theory suggests that changes in breathing patterns during sleep stages could also trigger panic attacks in susceptible individuals.

What Causes a Panic Attack While Sleeping?

There’s no one-size-fits-all answer when it comes to the triggers of panic attacks while sleeping. However, a range of factors are thought to contribute to their onset.

• Stress and anxiety: Chronic stress and heightened anxiety levels can increase the likelihood of experiencing panic attacks, including during sleep. Anxiety about specific situations or life events can often seep into our sleep, potentially manifesting as a panic attack.
• Sleep disorders: Certain sleep disorders, such as sleep apnea and insomnia, have been associated with an increased risk of panic attacks during sleep[3].
• Lifestyle factors: Poor sleep hygiene, irregular sleep schedule, excessive caffeine or alcohol consumption, and lack of physical activity can also contribute to the occurrence of nighttime panic attacks.
• Physical health conditions: Some physical health conditions, like heart disease or asthma, can increase the likelihood of experiencing panic attacks, including during sleep.

Panic attacks while sleeping can cause a variety of physical and mental effects.

Physically, they can lead to heart palpitations, trembling, sweating, shortness of breath, and a feeling of choking.

Mentally, they can cause feelings of impending doom, fear of loss of control, and derealization or depersonalization. The impact of these effects can be especially disconcerting at night when the body is supposed to be at rest.

What Happens When You Have a Panic Attack While Sleeping?

When you experience panic attacks while sleeping, you wake up suddenly in a state of intense fear and panic, despite there being no apparent danger or threat. The symptoms of a nighttime panic attack can be both physical and emotional, often mimicking those of other serious health conditions, which can add to the distress.

Physical symptoms can include rapid heart rate, chest pain, shortness of breath, trembling, sweating, and gastrointestinal discomfort. Emotionally, you may experience intense fear, a feeling of impending doom, and a fear of losing control or dying.

While daytime and nighttime panic attacks share many similarities, there’s a fundamental difference that makes panic attacks while sleeping particularly unsettling. Nighttime panic attacks occur out of the blue, while you’re at your most vulnerable. Waking up from a deep sleep to intense fear can be disorientating and frightening, and can often lead to increased anxiety about sleep itself.

Managing Nighttime Panic Attacks

Thankfully, panic attacks while sleeping can be managed and treated with a combination of medical treatment, therapy, lifestyle modifications, and self-care techniques.

• Medical Treatment: Certain medications, such as selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines, have been found effective in reducing the frequency and intensity of panic attacks[4]. These should only be used after a consultation with your doctor.
• Therapy: Cognitive-behavioral therapy (CBT) is often considered the gold standard in panic disorder treatment. It can help individuals understand the triggers and thought patterns that lead to panic attacks, and develop effective coping strategies[5].
• Lifestyle Modifications: Regular exercise, a healthy diet, maintaining a regular sleep schedule, and limiting caffeine and alcohol can help manage panic disorder symptoms.

Preventing panic attacks while sleeping can also involve a range of self-care techniques and coping strategies:

• Relaxation Techniques: Practices like progressive muscle relaxation, deep breathing exercises, and guided imagery can help calm the mind and body, promoting better sleep.
• Good Sleep Hygiene: Maintaining a cool, dark, and quiet sleep environment, sticking to a regular sleep schedule, and establishing a calming pre-sleep routine can improve sleep quality and potentially reduce the risk of nighttime panic attacks.
• Mindfulness and Meditation: Regular practice can help manage stress levels, promoting relaxation and better sleep.

We created a series of mindful lullabies to help you create a good environment for evening relaxation and meditation—check them out on Youtube!

Panic attacks while sleeping are a disconcerting experience that can significantly disrupt your life. However, understanding their causes and effects, and knowing how to manage them can help reduce their impact.

Remember, effective treatments and strategies are available, and seeking professional help is always recommended. You don’t have to tackle these nighttime fears alone.

If you’re looking for quick help with managing panic attacks while sleeping, try Mind Ease and app tailored to those who experience panic attacks. It has a variety of exercises and audio meditations designed to help you calm down at night.

Footnotes

[1]: American Psychological Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

[2]: Craske, M. G., & Waters, A. M. (2005). Panic disorder, phobias, and generalized anxiety disorder. Annual review of clinical psychology, 1, 197–225. https://doi.org/10.1146/annurev.clinpsy.1.102803.143906

[3]: Staner, L. (2003). Sleep and anxiety disorders. Dialogues in clinical neuroscience, 5(3), 249–258. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181635/

[4]: Bandelow, B., Reitt, M., Röver, C., Michaelis, S., Görlich, Y., & Wedekind, D. (2015). Efficacy of treatments for anxiety disorders: a meta-analysis. International Clinical Psychopharmacology, 30(4), 183-192. https://doi.org/10.1097/YIC.0000000000000078

[5]: Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440. https://doi.org/10.1007/s10608-012-9476-1