Sleeping with Panic: Tips for Managing Nighttime Panic Attacks

Waking up in the middle of the night drenched in sweat, your heart pounding, and gasping for breath is no one’s ideal image of a peaceful night’s rest. Yet, this is the reality for many who experience nighttime panic attacks. While these incidents may seem inexplicable and random, understanding them can be the first step towards better management and healthier sleep patterns.

Nighttime panic attacks are essentially panic attacks that occur during sleep, abruptly waking a person from their slumber[1]. As with panic attacks during the day, these nocturnal disruptions are characterized by intense fear and anxiety coupled with physical symptoms like rapid heartbeat, sweating, shaking, shortness of breath, and a sense of impending doom[2]. However, they can be particularly distressing due to the disorientation and vulnerability associated with being jolted awake.

✨ To help you create a relaxing sleeping environment we created a series of peaceful lullabies like the one below. Try it out as background music for reading this post!

What causes a panic attack while sleeping? Scientists believe that a complex interplay of psychological and physiological factors contributes to panic attacks. These include genetic predisposition, chronic stress and anxiety, and dysregulation of the body’s normal sleep processes[3].

Understanding the symptoms of a nighttime panic attack can help in dealing with them effectively. Alongside the physical sensations mentioned earlier, these may include: feelings of choking or suffocating, chest pain, nausea, dizziness, chills or hot flashes, numbness, and derealization (feeling detached from reality) or depersonalization (feeling detached from oneself).

Knowing all this theory is definitely helpful. But, what you are probably wondering is how exactly you can prevent nighttime panic attacks from happening, or how to go through them with more control.

Below are 5 practical tips to help you. You probably already know some of them, but we hope you’ll find something new that you can start implementing today.

🧸 Tip 1: Create a Comforting Sleep Environment

The environment in which you sleep plays a crucial role in the quality of your sleep and can impact the occurrence of nighttime panic attacks. In fact, research indicates that creating a sleep-friendly environment can reduce anxiety and promote better sleep[4].

Here are some tips how you can create an inviting sleep environment:

• Keep the bedroom cool, dark, and quiet: Research shows that cooler temperatures aid in sleep as our body temperature naturally drops when we sleep[5]. Moreover, darkness and quiet also help signal to our body that it’s time to rest.
• Use comfortable bedding and pillows: Invest in a good-quality mattress and pillows to ensure optimal comfort. A study found that the quality of bedding and pillows has a significant impact on sleep quality[6].
• Use a white noise machine to block out external sounds: If you live in a noisy environment, consider using a white noise machine. White noise machines emit a consistent sound that can help drown out other noises and have been found to promote sleep[7].
• Avoid stimulating activities before bed, such as watching TV or using electronic devices: The light from screens can interfere with the body’s production of melatonin, a hormone that helps regulate sleep. Studies have found that using electronics before bed can lead to poor sleep quality[8]. Try reading a book or doing a gentle yoga sequence instead to wind down before bed.

😌 Tip 2: Practice Relaxation Techniques Before Bedtime

Managing nighttime panic attacks doesn’t just start at bedtime—it can be beneficial to incorporate relaxation techniques into your daily routine.

Studies have found that regularly practicing relaxation techniques can reduce anxiety and may even prevent panic attacks[9].

Here are a few you might try:

• Deep breathing exercises: This involves inhaling deeply through the nose, holding the breath for a few moments, and then exhaling slowly through the mouth. Deep breathing can help calm the body’s stress response and promote relaxation[10].
• Progressive muscle relaxation (PMR): This technique involves tensing and then relaxing each muscle group in the body one at a time. Progressive muscle relaxation has been found to reduce anxiety and improve sleep quality[11].
• Guided imagery: This involves visualizing peaceful scenes or images to promote relaxation. Research has shown that guided imagery can reduce anxiety and improve sleep[12].

Mind Ease can guide you through each of the above exercises to help ensure better sleep.

✅ Tip 3: Establish a Consistent Sleep Routine

Creating a routine isn’t just for managing your daily activities; it can also significantly improve your sleep quality and help prevent nighttime panic attacks.

Here’s how you can build a consistent sleep routine:

• Go to bed and wake up at the same time every day: Sticking to a regular sleep schedule, even on weekends or holidays, can help reinforce your body’s sleep-wake cycle and lead to more consistent, quality sleep.
• Avoid caffeine, alcohol, and nicotine before bedtime: These substances can interfere with your ability to fall asleep and the quality of your sleep. It’s best to avoid them for at least several hours before bedtime.
• Don’t eat heavy meals before bedtime: Eating a large meal can cause discomfort from indigestion that can make it hard to sleep. If you’re hungry close to bedtime, opt for a light snack.
• Don’t nap during the day: While napping isn’t necessarily a problem for everyone, for others, daytime napping can interfere with nighttime sleep. If you do choose to nap, limit yourself to about 20 to 30 minutes and make it during the midafternoon.

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👩‍⚕️ Tip 4: Seek Professional Help

If you find that your nighttime panic attacks persist despite your best efforts to manage them, don’t hesitate to seek professional help. A mental health professional can offer you the tools and strategies to cope with your panic attacks and provide the necessary treatment.

• Talk to a therapist or counselor about your nighttime panic attacks: Cognitive-behavioral therapy (CBT) has been found to be particularly effective in treating panic attacks and panic disorder[14]. A therapist or counselor can help you understand the triggers and thought patterns that lead to panic attacks and provide strategies to manage them.
• Consider medication to help manage symptoms: Medication can sometimes be beneficial for managing panic attacks. Anxiolytics, antidepressants, and certain types of sedatives can help reduce the frequency and intensity of panic attacks. However, medication should always be taken under the supervision of a healthcare provider, and the risks and benefits should be discussed thoroughly.

💞 Tip 5: Take Care of Yourself During the Day

Nighttime panic attacks aren’t solely influenced by what happens right before bed or during sleep. How you take care of yourself during the day plays a significant role in your mental and emotional health, which in turn, can affect the likelihood of experiencing a panic attack at night.

• Exercise regularly: Regular physical activity can help reduce anxiety by boosting your mood and acting as a natural stress reliever[15]. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.
• Eat a healthy, balanced diet: What you eat impacts your mood and energy levels. A diet rich in fruits, vegetables, lean protein, and whole grains can provide the nutrients needed for good mental health.
• Manage stress with relaxation techniques or activities you enjoy: We’ve already mentioned some relaxation techniques, but it’s also important to take time each day to do things you enjoy. Whether it’s reading a book, listening to music, or spending time with loved ones, these activities can all help reduce stress and promote better mental health.
• Avoid substances that can trigger panic attacks, such as caffeine or alcohol: As mentioned earlier, these substances can interfere with your sleep and potentially contribute to panic attacks.

In conclusion, remember that you’re not alone in experiencing nighttime panic attacks, and it’s okay to seek help. Take advantage of resources like Mind Ease, which offers exercises to calm down quickly, breathing exercises, and specific meditations for panic attacks. While these steps can require some time and effort to implement, they can significantly improve your sleep quality and reduce the occurrence of nighttime panic attacks, bringing you closer to peaceful, restorative nights.

Footnotes:

[1]: Meuret AE, Rosenfield D, Seidel A, Bhaskara L, Hofmann SG. Respiratory and cognitive mediators of treatment change in panic disorder: evidence for intervention specificity. J Consult Clin Psychol. 2010;78(5):691-704. doi:10.1037/a0019552

[2]: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

[3]: Klein DF. False suffocation alarms, spontaneous panics, and related conditions. An integrative hypothesis. Arch Gen Psychiatry. 1993 Apr;50(4):306-17. doi: 10.1001/archpsyc.1993.01820160076007. PMID: 8466386.

[4]: Mastin DF, Bryson J, Corwyn R. Assessment of sleep hygiene using the Sleep Hygiene Index. J Behav Med. 2006 Jun;29(3):223-7. Epub 2006 Mar 25. PMID: 16565928.

[5]: Okamoto-Mizuno K, Mizuno K. Effects of thermal environment on sleep and circadian rhythm. J Physiol Anthropol. 2012 May 31;31(1):14. doi: 10.1186/1880-6805-31-14. PMID: 22647282; PMCID: PMC3427038.

[6]: Jacobson BH, Gemmell HA, Hayes BM, Altena TS. Effectiveness of a selected bedding system on quality of sleep, low back pain, shoulder pain, and spine stiffness. J Manipulative Physiol Ther. 2002 Feb;25(2):88-92. doi: 10.1067/mmt.2002.120415. PMID: 11896314.

[7]: Spencer JA, Moran DJ, Lee A, Talbert D. White noise and sleep induction. Arch Dis Child. 1990 Jan;65(1):135-7. doi: 10.1136/adc.65.1.135. PMID: 2405780; PMCID: PMC1792473.

[8]: Chang AM, Aeschbach D, Duffy JF, Czeisler CA. Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proc Natl Acad Sci U S A. 2015 Jan 27;112(4):1232-7. doi: 10.1073/pnas.1418490112. Epub 2014 Dec 22. PMID: 25535358; PMCID: PMC4313820.

[9]: Manzoni GM, Pagnini F, Castelnuovo G, Molinari E. Relaxation training for anxiety: a ten-years systematic review with meta-analysis. BMC Psychiatry. 2008 Jun 2;8:41. doi: 10.1186/1471-244X-8-41. PMID: 18518981; PMCID: PMC2424287.

[10]: Ma X, Yue ZQ, Gong ZQ, Zhang H, Duan NY, Shi YT, Wei GX, Li YF. The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Front Psychol. 2017 Jun 6;8:874. doi: 10.3389/fpsyg.2017.00874. PMID: 28626434; PMCID: PMC5455070.

[11]: Twohig MP, Hayes SC, Plumb JC, Pruitt LD, Collins AB, Hazlett-Stevens H, Woidneck MR. A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. J Consult Clin Psychol. 2010 Oct;78(5):705-16. doi: 10.1037/a0020508. PMID: 20873905; PMCID: PMC3173690.

[12]: Menzies V, Kim S. Relaxation and guided imagery in Hispanic persons diagnosed with fibromyalgia: a pilot study. Fam Community Health. 2008 Jul-Sep;31(3):204-12. doi: 10.1097/01.FCH.0000324481.44035.07. PMID: 18552605; PMCID: PMC3683756.

[13]: Crowley K. Sleep and sleep disorders in older adults. Neuropsychol Rev. 2011 Mar;21(1):41-53. doi: 10.1007/s11065-010-9154-6. Epub 2010 Dec 7. PMID: 21136148; PMCID: PMC3050090.

[14]: Cuijpers P, Karyotaki E, Weitz E, Andersson G, Hollon SD, van Straten A. The effects of psychotherapies for major depression in adults on remission, recovery and improvement: a meta-analysis. Can J Psychiatry. 2014 Apr;59(4):211-20. doi: 10.1177/070674371405900408. PMID: 25007410; PMCID: PMC4191949.

[15]: Stubbs B, Vancampfort D, Rosenbaum S, Firth J, Cosco T, Veronese N, Salum GA, Schuch FB. An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis. Psychiatry Res. 2017 Mar;249:102-108. doi: 10.1016/j.psychres.2016.12.020. Epub 2016 Dec 23. PMID: 28088704.