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How to stop 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 the many individuals who struggle with panic attacks at night.

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

What are panic attacks?

Panic attacks 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 - a 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 experiencing 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’.

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 day time 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.

What causes night time panic attacks?

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

So far, research hasn’t found a single, clear-cut reason for why people experience panic attacks at night. 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 day time panic attacks makes it more likely that you will experience panic attacks at night.

Research suggests there are a number of other 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 will 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

How to cope with a panic attack at night

Waking up and discovering you’re having a panic attack can be an overwhelming and scary experience, and the fact that you’re probably still groggy and trying to ‘come round’ from sleep, can make you feel out of control and cause you to panic even more.

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 is 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 – you might be thinking about what caused the panic attack, and be worried that it’ll happen again if you go back to sleep. That’s 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. Then 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. Don’t do anything over-stimulating such as vigorous exercise, watching TV or playing on your phone, as these can make it even harder to be able to drift back to sleep.

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.

Tips to prevent panic attacks at night

Experiencing a panic attack at night may make you worry about having another, causing a vicious circle, and leading to insomnia. There are a number of things you can do to try and avoid this becoming a frequent problem, and ensure that you’re getting a good night’s sleep:

Give yourself enough time to get the sleep you need

On average, adults need eight to nine hours’ sleep each night to feel rested and refreshed. Therefore, it’s important to make sure you go to bed at least eight 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 are 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. You could also try introducing a consistent ‘wind-down’ routine in the evenings so you’re relaxed before bed. For example, you could have a warm bath, or read a book before going to sleep. This consistency can help you sleep better and more deeply, reducing the likelihood of being woken by a panic attack.

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. You could also try and limit the amount of liquids you drink before bed, so you don’t keep waking up needing the toilet and then find it difficult to get back to sleep again.

Avoid electronic devices late at night

You should avoid using electronic devices such as computers, mobiles and tablets within 30-60 minutes of your target bedtime. These devices give off light which can be overly stimulating and keep you awake. If you want to read before bed, make sure you read from an actual book or magazine, as opposed to a screen. Again, these steps can improve the quality of your sleep and make it less likely that you’ll wake up panicking.

Get help today

“Panic attacks can be very distressing to experience but can be effectively managed with suitable treatment. It is always better to seek help as soon as you identify the symptoms.” Dr Natasha Bijlani (CCST, FRCPsych, MBBS), Consultant Psychiatrist and panic attack specialist at Priory Hospital Roehampton, London.

Even though these steps can help, it’s important that you seek professional support if your panic attacks are becoming more frequent and are impacting on your ability to function. You could speak to your GP about your concerns or get in touch with Priory. We can provide you with access to expert psychiatrists, therapists and other mental health professionals, who will be able to support you with your challenges.

Page reviewed by Dr Natasha Bijlani (FRCPsych, MBBS), Consultant Psychiatrist based at Priory Hospital Roehampton London

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