You’re fast asleep, and then you’re wide awake with a pounding heart, short of breath, sure something terrible is happening. If panic keeps waking you, here’s what’s going on and what helps.
Night-time panic attacks wake you suddenly from sleep with a racing heart and intense fear. They’re common in panic disorder, come from deep non-dream sleep rather than nightmares, and respond to the same treatment as daytime panic, especially CBT. Chest pain always needs checking.
What a night-time panic attack is
You wake suddenly, already in panic: heart pounding, breathless, sweating, shaking, sometimes with chest discomfort or a fear that you’re dying. Unlike a night terror, you’re fully awake and remember it afterwards.
It’s common. In studies, between four and seven in ten people with panic disorder have woken in a panic at least once, and a smaller group have it again and again.
It isn’t a bad dream
Sleep-lab studies show these attacks come out of non-REM sleep, often as light sleep deepens, and usually in the first part of the night. That’s different from:
- Nightmares: vivid, remembered dreams, usually later in the night. Our guide to recurring nightmares covers them.
- Night terrors: screaming or thrashing while still asleep, rarely remembered, and mostly in children.
- Sleep paralysis: being unable to move for a moment as you fall asleep or wake. See our guide to sleep paralysis.
Why it happens
The leading explanation, from years of research by the psychologist Michelle Craske and colleagues, is that some people with panic become wary of letting go: of relaxing, drifting off or being less alert. During sleep, your breathing and heart rate shift naturally. If those changes feel unexpected, your brain’s alarm can fire and wake you in panic. In experiments, people who were told to expect those body changes were less distressed by them.
Other causes a doctor should check
Some conditions can wake you in a similar state, and they need their own treatment. See a doctor if you notice:
- Loud snoring, gasping or choking in your sleep, or daytime tiredness: possible sleep apnoea. A bed partner often notices first.
- Burning in the chest, a sour taste or coughing at night: possible acid reflux.
- A racing or irregular heartbeat that doesn’t settle: possible heart rhythm problems.
- Night sweats and waking shaky if you have diabetes and take insulin or some tablets: possible low blood sugar.
- Evening drinking, or cutting down on sleeping pills or tranquillisers: withdrawal can cause night-time anxiety and panic.
- Weight loss, feeling hot and shaky, or a fast heartbeat by day: possible overactive thyroid.
If you wake with chest pain, breathlessness that doesn’t settle or fainting, or if this is your first attack or it feels different, get emergency help: call 112, or 767 in Lagos. Our guide to panic attack or heart attack? explains why chest pain always needs checking.
During a night-time attack
- Stay where you are, sit up and turn on a soft light.
- Breathe slowly: in for a count of five, out for a count of five.
- Remind yourself it will pass. Most panic attacks peak within minutes.
- Ground yourself: name things you can see, hear and touch.
- Don’t breathe into a bag. Slow breathing works without the risks.
- Afterwards, do something calm before trying to sleep again, and tell someone you trust in the morning.
What helps in the long run
- Therapy. Cognitive behavioural therapy (CBT) is the recommended treatment for panic disorder. In a trial of CBT aimed at night-time panic, both night and day attacks fell, and standard panic CBT may be enough for many people.
- Steady sleep habits. Wake at the same time every day, wind down for an hour before bed, and avoid caffeine and alcohol within six hours of bedtime.
- Don’t lean on alcohol or sleeping pills. Alcohol disrupts the second half of the night, and withdrawal from sedatives can itself cause panic.
- Medicine, if needed. A doctor may offer medicine for panic disorder alongside or instead of therapy.
You can find a therapist who works with anxiety and panic, by video, voice or chat. Read more about panic disorder in Nigeria, sleeping better and anxiety.
Frequently asked questions
Why do I wake up having a panic attack?
Night-time panic attacks come out of deep, non-dream sleep. Researchers think normal changes in breathing and heart rate during sleep can set off the brain’s alarm in people prone to panic.
Suggested read: Social Anxiety at Parties and Owambes
Are night-time panic attacks dangerous?
The panic itself isn’t dangerous, but other causes such as heart rhythm problems or sleep apnoea need ruling out, and chest pain always needs checking.
Is it a nightmare or a panic attack?
Nightmares are vivid dreams you remember, usually later in the night. Night-time panic attacks wake you suddenly without a dream, usually earlier in the night.
How do I stop panic attacks at night?
CBT for panic works for night-time attacks too. Steady sleep habits help, and so does cutting out alcohol and caffeine in the evening. See a doctor to rule out other causes.
Can sleep apnoea cause panic attacks?
Sleep apnoea can wake you gasping or choking, which can feel like panic, and the two can happen together. A doctor can arrange a sleep test.
This article is awaiting clinical review. It’s based on published research and health guidelines, and we’ll update it once a clinician has reviewed it.
