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Nighttime Panic Attacks – How to Conquer Them

White sheets and pillows on an empty, unmade bed as though someone just got out of it in the middle of the night.

Do you ever wake up at night for no reason? You didn’t have a nightmare. No alarms went off. You just woke suddenly, in darkness and silence, gripped with a terrible, inexplicable fear. If so, you may have had a nocturnal panic attack. We go to sleep at night, expecting a night of relaxed and restful sleep. So to awaken suddenly in darkness and silence, while having a nighttime panic attack, can be hard to endure.

What is a nighttime panic attack?

A nighttime panic attack, sometimes called a nocturnal panic attack, or NPA, feels an awful lot like a daytime panic attack, except that it occurs when you are asleep. Nighttime (nocturnal) panic attacks can occur for no apparent reason. It is estimated that nocturnal panic occurs between three to five percent of the general population. They often happen in the middle stages of sleep, usually between a half hour and three and a half hours after going to sleep. Nighttime panic attacks may be confused with night terrors, however, they are different. People who have night terrors generally don’t remember them, but someone who has a nighttime panic attack usually remembers the attack in the morning.

What are the symptoms?

Some symptoms are the same ones you may experience with a daytime panic attack, such as rapid heart rate, trembling, sweating, shortness of breath, hyperventilation, feeling too hot or too cold, and a sense of impending doom. But panic attacks that occur at night often involve more problems with breathing, such as shallow, rapid, or uneven breathing.

Many people also suffer from muscle tension. They may have muscle cramps or spasms, numbness, or a tingling sensation. Others may experience sudden changes in body temperature and some even feel temporarily paralyzed.

A typical attack lasts for 15 minutes or less, although it certainly may seem longer.

Who is affected?

Those people who do not have anxiety problems or panic attacks in the daytime, usually don’t have panic attacks at night. Among individuals with anxiety disorders, 40-70% are likely to have an attack at night. Certain health conditions, particularly in those with anxiety disorders, increase the likelihood of a nighttime panic attack. Note that none of these conditions alone can cause NPAs. However, when these issues occur in individuals with panic disorders, the chances of having a nighttime attack increase significantly. These include:

  • Hyperventilation Disorder – Hyperventilation, or rapid breathing, is a common symptom of nighttime panic attacks. A person who hyperventilates during sleep may wake up in the midst of a panic attack.
  • Obstructive sleep apnea – This occurs when the upper airway is blocked during sleep. People with sleep apnea may stop breathing for as much as 30 seconds. Most people wake up and go back to sleep, without even realizing it. But in anxiety-prone individuals, the symptoms, such as shortness of breath, may lead to a panic attack.
  • Gastroesophageal Reflux Disease (GERD) – Gastroesophageal reflux disease, also known as acid reflux disease, may cause breathing problems, sweating, or chest pains and sometimes triggers a nighttime panic attack.

Prevention tips

If you have had a nighttime panic, you may fear having another. To prevent a chronic pattern of attacks, start by practicing healthy sleep habits.

Calm your brain before bed by keeping a regular sleep schedule. Avoid the computer or other electronic screens. Establish a relaxing bedtime ritual. Take a warm bath with lavender, do some gentle yoga, or write in your journal. Eating well and exercising also helps. Getting treatment for any underlying medical conditions will also mitigate the effects of nighttime panic attacks.

How to Cope with Nighttime Panic Attacks

One of the biggest problems with these attacks is that they happen at night and without warning, so you are unable to prepare. If you do find yourself in the grip of a nocturnal panic attack, try to breathe deeply, relax all your muscles, and hold onto thoughts or images that make you feel safe and peaceful.

Taking control of your breathing is an important first step. You may wish to practice mindful breathing when you are not in the middle of a panic attack so that it is easier to do during an attack. Some people listen to a guided breathing exercise or keep a simple list of what they need to do next to the bed.

Calm your breathing by taking regular breaths in through your nose and then out through your lips. Do this to the count of five, hold one second, then do a slow exhale to the count of four. Wait for two seconds and then repeat. Keep your mind on your breathing. Do this repetitive breathing as many times as necessary, until your heart rate slows and your symptoms ease.

Muscle relaxation techniques are also helpful. Simply tense and then relax the different muscle groups, starting with your feet and working all the way up to your head. Take a deep breath, tighten the muscle, hold for a few seconds, then breathe out while relaxing the muscle. This reduces the tension in your body and combats the panic attack. Again, practice this technique when you are not in the throes of an attack.

Take prescribed anti-anxiety medications as needed according to your doctor’s instructions, but do not self-medicate, which may lead to frustration and more anxiety. You may be unable to just go right back to sleep. In that case, try to shift your focus. Don’t obsess about how tired you will feel in the morning. Sometimes it is best to get up and do something that calms you. Avoid stimulating activities, but if it relaxes you, listen to music or read a soothing book until you are ready to return to sleep.

There is no one cause of nighttime panic attacks, and researchers have many questions about the causes. You may need treatment for an underlying medical condition. Stress and anxiety are major contributors. Genetics may play a part, or it may just be the way your brain works. Nighttime panic attacks are terrifying. It helps if you educate yourself about the condition and take note of your own triggers and symptoms. Knowledge and preparation are powerful weapons in dealing with nighttime panic attacks.

It is important to remember that you are not alone. The experienced counselors at Real Life Counseling are here to help you. If you have questions or wish to make an appointment, contact us.