Can you have a panic attack at night in your sleep?
Waking up with anxiety is nothing new for most people. You wake up and feel challenged by the day ahead of you or you wake up and begin thinking about unresolved problems. But can you experience anxiety and have a panic attack while still asleep?
The quick answer is yes. You can have a panic attack in your sleep. It's called a Nocturnal Panic Attack.
It is possible for you to be awakened by a panic attack or to be having a panic attack as you are waking from sleep. This is different than having a panic attack just after waking up.
Nocturnal panic attacks may begin while you are asleep but are usually only experienced as a panic attack cognitively as you are waking from sleep. This is because your conscious mind needs to be able to recognize the symptoms and consciously label it as a panic attack.
It is very common for someone who has panic attacks during the day to also have panic attacks while asleep. Nocturnal panic attacks usually only last a few minutes.
Symptoms of a Panic Attack
Palpitations, pounding heart, or accelerated heart rate
Trembling or shaking
Sensations of shortness of breath or smothering
Feelings of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, light-headed, or faint
Chills or heat sensations
Numbness or tingling sensations
De-realization (feelings of unreality) or depersonalization (being detached from oneself)
Fear of losing control or “going crazy”
Fear of dying
Panic attacks can be expected or unexpected.
A nocturnal panic attack is an example of an unexpected panic attack.
Expected panic attacks occur in specific situations that are either anxiety provoking or situations where a person experienced a panic attack and now avoids it for fear that it will trigger another one.
Why Do People Have Panic Attacks While Asleep?
Although specific causes for why you have panic attacks in your sleep are not known, there are some potential triggers.
Sleep Disorders and other psychological disorders could be potential triggers.
Obstructive Sleep Apnea: Obstructive sleep apnea is a potentially serious sleep disorder that causes breathing to repeatedly stop and start during sleep.
Excessive daytime sleepiness
Observed episodes of breathing cessation during sleep
Abrupt awakenings with gasping or choking
Waking up with a dry mouth or sore throat
Difficulty concentrating during the day
Mood changes such as depression or irritability
High blood pressure
When a persons breathing stops while they are asleep, their heart beats faster and stronger to get oxygen to the rest of the body. This often causes the person to wake up gasping for breath and experiencing a pounding heart.
This could cause a feeling of internal danger as the person is waking and trigger a panic attack.
Nightmares and Nightmare Disorder: Nightmares are associated with fearful and anxiety provoking dreams. A nightmare disorder is diagnosed when the nightmares repeatedly occur for an extended period of time and the nightmare is remembered.
Nightmares can trigger the sympathetic nervous system, causing you to experience rapid breathing, a rapid heart beat, and sweating during sleep and as you wake up.
These physical symptoms coupled with the anxiety and fear of the nightmare could trigger a panic attack in your sleep.
Posttraumatic Stress Disorder (PTSD): PTSD is a condition that causes the body’s fight or flight stress response to activate in reaction to intrusive thoughts, memories, images, and dreams of a traumatic event. PTSD may be responsible for nightmares that cause a person to experience a panic attack while asleep.
How Are Nocturnal Panic Attacks Treated?
The first thing to do is consult with your primary care physician to identify if there are any medical conditions such as a sleep wake disorder or other breathing/heart related condition.
Consult with a mental health professional to identify possible psychological causes for the symptoms such as an anxiety disorder.
Nocturnal panic attacks will decrease as any underlying anxiety issues are treated.
How To Cope With Panic Attacks At Night
Try not to get out of bed or leave the place where you are having the panic attack.
Avoiding your bed just confirms and maintains the belief that your bed is dangerous and you will quickly associate your bed with panic attacks.
1. Create Calm
To reduce the possibility of panic attacks at night, create a feeling of calm. Make your space calm and create calming routines such as:
Add things that are comforting and relaxing to your touch and sight
Play relaxing music
Use calming aromas such as lavender
Drink calming teas
Take warm baths or showers
Watch something funny
2. Reduce Worry and Anxious Thinking
Panic attacks at night can often be caused by worried thinking. Reduce your worry by labeling the worried thoughts and by detaching yourself from the thoughts.
Label Your Thoughts
Instead of focusing on the content of the worry, such as “What if I can’t remember what to say during my speech, I will look stupid,” focus on it being an unhelpful thought that causes anxiety.
This will move you away from the emotional content of the thought.
Label thought, “It’s just an anxiety provoking thought.” Focusing on the content of the worry keeps you spinning round and round on the merry-go-round.
Labeling the thought as an “Anxiety Provoking Thought” allows you to step off the merry-go-round and observe it with some safe distance.
Detaching Yourself From The Worry
Sometimes the harder you try to stop a worry, the more you will have it. So instead of stopping the worry, detach yourself from it.
Here are some ways to detach yourself from the worry:
Allow the worry to flow into your head. Close your eyes and imagine the worried thought and/or image floating out of your head like a leaf, landing on a stream of water, and gently floating down the stream. Repeat this each time the worry pops into your head.
Close your eyes and project the worry on a black chalk board, then erase it with a large chalk eraser. Allow the worry to appear on the chalk board several times and erase it each time. You can then write more helpful words or thoughts on the blackboard such as “Calm” or “Sleep” if you are trying to get to sleep.
Close your eyes and imagine sitting in a large movie theater alone and project the worried thoughts as images onto a large movie screen and watch them while sitting in the back of the theater. You can imagine yourself eating popcorn while watching. Then imagine yourself watching from the projector booth where you can fast forward, rewind, and pause the images.
3. Refocus Your Attention
Focusing on the physical symptoms of a panic attack and the fearful thoughts adds more fuel to a panic attack.
Refocusing your attention shifts your brain from the cycle of panic by pulling your attention out of your head and outside of your body.
Tell yourself that it's only a panic attack and you know it will end.
Stop focusing on your symptoms and start focusing on something else in your environment, like how many colors there are in a picture on the wall or sounds that you can hear.
The symptoms of a panic attack begin to decrease because you are moving away from the danger of focusing on the uncomfortable symptoms and repeating something like “OMG, OMG, I’m going to die.”
4. Deep Breathing
Deep breathing, also known as diaphragmatic breathing, by far is the most helpful strategy to manage and minimize the symptoms of a panic attack.
Deep breathing gives you a sense of control over your body when feeling out of control during a panic attack, especially if you are hyperventilating or feeling dizzy.
When we are anxious we tend to breathe faster. We take in more oxygen and breathe out carbon dioxide. This causes an imbalance with too much oxygen and too little carbon dioxide in our blood. This condition is called respiratory alkalosis.
The extra oxygen can cause us to feel light-headed and feel tingling in our fingers and toes. Deep breathing helps correct the oxygen and carbon dioxide levels during panic attacks.
Deep breathing works to activate the parasympathetic nervous system which is responsible for producing a calm and relaxed feeling. The parasympathetic nervous system is also called the “Rest and Digest” response.
Deep Breathing Exercise
Inhale through your nose slowly by expanding from your belly first then fill your upper lungs for a count of 5
Hold your breath for a count of 2
Exhale slowly and forcefully through pursed lips for a count of 10
Repeat this 5 to 10 times or do it for at least 1 minute 2.
5. Progressive Muscle Relaxation
Progressive muscle relaxation is often used in conjunction with deep breathing to activate the parasympathetic, rest and digest, system.
As you tense and then release a muscle, it has to relax. Tensing each muscle group and then relaxing causes your muscles to become more relaxed than they were before tensing.
As a result the heart slows down because relaxed muscles don’t need as much oxygen. Breathing and blood pressure also slow down.
Progressive Muscle Relaxation Exercise
Begin by tensing your legs and buttocks for a count of 5, then relax
Tense your abdomen for a count of 5, then relax for a count of 5
Tense your arms for a count of 5, then relax for a count of 5
Shrug your shoulders to your ears and tense for a count of 5, then relax for a count of 5
Press your tongue to the roof of your mount for a count of 5, then relax for a count of 5
Tips: Let all of the tension release and flow out or your muscles. Exhale as you release the tension and relax. You should feel the muscles become loose and limp. Focus on the difference between the tension and relaxation as this is the most important part of the exercise.
Any kind of panic attack during the day, night, and in your sleep can be very frightening.
Panic attacks are not dangerous and are very treatable.
In addition to treating any underlying psychological condition that could be contributing to nocturnal panic attacks, the panic attacks themselves can also be treated.
For more information please click on the links below:
How to Stop A Panic Attack: 7 Steps
What To Do In A Panic Attack: 4 Great Ways to Cope
Panic Attacks In Children - How To Help Your Child