How to cope with panic attacks at night

Getting a good night’s sleep is essential for our health and wellbeing. Sleep promotes rest and relaxation and gives us a chance to recuperate and let go of the stresses of the day. However, this isn’t the case for people who struggle with panic attacks at night.

Night time panic attacks, also known as ‘nocturnal panic attacks’ or ‘night terrors’, happen while you’re asleep and wake you up, often with the same symptoms as daytime panic attacks. However, while these nocturnal attacks usually only last for a few minutes, it can take a long time for you to calm down enough to go back to sleep after having one. This, coupled with worrying about whether you’re going to have another panic attack, may lead to insomnia.

Here, we provide advice on how to cope with panic attacks at night and give tips on how to reduce them.

What causes panic attacks at night?

If you wake up having a panic attack, it's not often clear why this has occurred - often there's no explanation. Similar to daytime panic attacks, symptoms can include feeling faint or dizzy, a pounding heart, shortness of breath, nausea and sweating. However, we do know that the brain doesn’t ‘switch off’ during sleep, so it’s possible for any pent-up worries or anxieties to manifest in our unconscious brains, causing a nocturnal panic attack. Also, struggling with daytime panic attacks makes it more likely that you'll experience panic attacks at night.

While nocturnal panic attacks can be sudden and frightening, they’re actually a common mental health condition. So what causes them?

Research suggests there are a number of factors that could increase the risk of someone suffering from both day and night time panic attacks. These include:

• Experiencing chronic stress in your day-to-day life
• Struggling with other mental health conditions, such as anxiety, depression, obsessive compulsive disorder (OCD) or post-traumatic stress disorder (PTSD)
• A lack of assertiveness - some evidence supports the idea that people who suffer from panic attacks have a passive style of communication or interactions with others
• Genetics – having a close relative such as a parent or sibling who suffers from panic attacks makes it more likely that you'll also develop panic attacks
• Alcohol, drugs or medication withdrawal
• The side effects of some medications
• Certain substances can also trigger panic attack symptoms, including caffeine and cannabis
• Chronic physical illnesses such as cancer
• Experiencing a significant personal loss, including bereavement, or the breakdown of a relationship
• Significant life changes such as losing a job, becoming a parent, and moving house

Panic attack symptoms at night

Panic attacks can happen day or night. They are sudden, unexpected episodes of intense anxiety, which can cause a variety of frightening symptoms. These include:

• Feeling out of control and disconnected from your surroundings
• Feeling faint, dizzy or light-headed  
• Chest pains and shortness of breath - tightness of the chest and feeling as though it’s a struggle to breathe
• A racing or pounding heart
• Hyperventilating
• Feeling as though you’re choking
• Nausea
• Muscle spasms and palpitations
• Excessive sweating
• Trembling or shaking
• Numbness and tingling, for example, tingling lips and numbness in your fingers and toes
• Fluctuating body temperature – feeling very hot or very cold

These symptoms can be so severe they sometimes make first-time sufferers believe they’re having a heart attack or a nervous breakdown. Over time, panic attacks can become more frequent, and the fear of having a panic attack becomes embedded, resulting in a 'vicious circle'. If you're particularly stressed or anxious, you might also experience what's known as hypnic jerks. These involuntary muscle sensations, like jolts, occur when you're in your lightest stage of sleep.

How to stop panic attacks at night

If you’re having a nocturnal panic attack, try the following:

• Don’t fight it - if you wake up and you’re having a panic attack, it’s important not to fight it, as this could make things worse. Accept the panic attack for what it is and let the feelings wash over you. Remember, it's only temporary, and it will fade eventually. You just need to let it happen
• Try and relax - try to get your body back into a relaxed state. Inhale deeply and exhale slowly to regulate your breathing. Relax your muscles, and try to focus your mind on positive thoughts and images
• Get up and do something - it’s unlikely you’ll be able to go straight back to sleep after a panic attack, which is why it’s important to do something to take your mind off your panic. Get out of bed and physically remove yourself from the situation. Try doing something relaxing to shift your focus, such as yoga stretches, listening to calm and gentle music, reading an inspirational book, or even a menial chore such as doing the ironing
• Go back to bed when you’re ready - only go back to bed when you’re beginning to feel tired again and ready for sleep. When you’re in bed, keep yourself calm by breathing deeply in through your nose and out through your mouth, to the extent that your whole abdomen, not just your chest, is rising and falling
• Give yourself enough time to get the sleep you need - it’s important to make sure you go to bed at least 8 hours before you need to get up so you’re giving yourself enough time to have a good night’s sleep. Going to bed too late and not leaving enough time for sleep may result in you constantly checking the clock and worrying that you’re not going to feel rested the next day. These negative thought processes can fuel anxiety, and potentially spiral into a panic attack
• Prepare yourself for the following day - many people struggle to get to sleep because they're anxious about the following day. You can try to reduce this anxiety by making sure that you have everything prepared. For example, you could have a to-do list, or even have your clothes laid out 
• Establish a consistent sleep routine - try and go to bed and wake up at the same time every day. Even at the weekend, try and get up at a time that isn’t too different from when you get up during the week
• Limit caffeine, sugar and alcohol before bed - these substances can make you feel anxious and jittery at night, and can prevent you from getting to sleep and staying asleep
• Avoid electronic devices late at night - avoid using electronic devices such as computers, mobiles and tablets within 30 to 60 minutes of your target bedtime. These devices give off light which can be overly stimulating and keep you awake