It was a mischievous experience. You wake up at two or three in the morning with a racing heart. You feel sick. You may wonder if you are dying or having a heart attack. Usually, the episode passes in less than an hour. However, falling back to sleep can be difficult.

Many people are unaware that this phenomenon has a diagnosis of “night panic attack,” or they may think they must be having a forgotten nightmare (which is probably the case). This puts a lot of pressure on them.

What Are Nighttime Panic Attacks

Nocturnal panic attacks (also called night terrors or sleep terrors) are common, especially in people with anxiety disorders. It is estimated that 44% to 71% of people diagnosed with panic disorder have at least one nighttime panic attack, and a small number of these people experience panic attack symptoms only at night.

Although the physical symptoms of nighttime panic attacks are similar to those of daytime attacks, it can be difficult to pinpoint the trigger.

Unlike daytime panic attacks, which are often accompanied by a series of stressful events or anxious thoughts, nighttime panic attacks more often wake sufferers up at night, sometimes with no apparent warning signs at all.

Studies of nighttime panic attacks have found that these attacks are associated with several complications, including suicidal thoughts.

Among those diagnosed with panic disorder, the coexistence of nocturnal and daytime panic attacks was associated with more severe presentation, whereas attacks only at night were more associated with night terrors. Overall, less is known about this presentation than about panic disorder as a whole.

Nighttime Panic Attack Treatment Tips

Psychotherapy, including cognitive behavioral therapy and acceptance commitment therapy, is the treatment of choice for panic disorder. Still, treating nighttime panic attacks can be more difficult.

In cognitive behavioral therapy, a core premise is that our thoughts influence how we feel, but with nighttime panic attacks, a person is unlikely to be able to identify the thoughts that preceded the attack.

However, psychotherapy can still be helpful. Research shows that a combined fear of losing vigilance is associated with nighttime panic attacks, making it a potential target for cognitive intervention.

Additionally, behavioral changes in sleep hygiene may improve symptoms in some people. Research has shown that cognitive behavioral therapy is effective in reducing panic symptoms in patients with nighttime panic attacks, with only one patient experiencing an increase in symptoms over a year of follow-up treatment.

If you’re experiencing nighttime panic attacks, here are some things you can do to help you cope:

Relax before bed

• How we feel before bed often affects how we feel during sleep. When you fall asleep or in the hours before falling asleep, try something relaxing, like listening to soothing music or spending time with a pet.
• Emotional activities should be avoided at this time. For example, journaling can be very useful in improving your overall mental health, but if you notice yourself journaling about active topics, do it a few hours before bed.

Make plans ahead

• If you find yourself having frequent nighttime panic attacks or already feeling anxious when you go to sleep, be prepared.
• Keep something calming on your bedside table. It could be a cup of peppermint tea, a stuffed animal, or a card with positive hints that will help you. This can help you regain some sense of control.

Look for triggers

• Do you notice a pattern of panic attacks?
• Does this happen mid-week or on the weekend?
• Is drinking a trigger?

Make a doctor’s appointment

• If you’re struggling with panic symptoms at night, see your doctor to rule out underlying physical causes. Health challenges including sleep apnea and sleep-related seizures may share similar characteristics with panic attacks in some patients.
• If your symptoms stem from stress and anxiety, your doctor can also help and guide you through treatment.

Establish a bedtime routine

• Just like a helicopter needs time to land, we need time to decompress before going to bed. The more stressed we are at night, the more time it usually takes.
• Establishing a routine that includes gradually more relaxing activities over time may help you enter a sleep-like state of mind.

Don’t drink alcohol before going to bed

• While most people know that caffeine can disrupt sleep, many people find alcohol to be relaxing. However, alcohol can alter sleep structure.
• While I found no studies that specifically looked at the effects of alcohol on nighttime panic attacks, alcohol has been identified as a trigger for a variety of sleep-related problems.

Conclusion

Nighttime panic attacks can be very distressing, but the good news is there are treatments. Relief can be provided by psychotherapy, stress reduction, and sometimes medical intervention.