Nocturnal Panic Attacks: Causes, Symptoms, and Management
Nocturnal panic attacks, also known as night-time panic attacks, awaken you from sleep with experience of intense fear, terror, or discomfort. Simply put, nocturnal panic attacks are episodes of intense fear that occur during sleep.
It may seem that these episodes happen without a trigger and leave you feeling disoriented and anxious.
In this article, we will explore what nocturnal panic attacks are, their commonness, potential causes, differences from other night-time disturbances, and strategies for managing and preventing them.
1. About Nocturnal Panic Attacks
Nocturnal panic attacks are characterised by an unexpected, sudden feeling of fear that wakes you from sleep. You may wake up in a state of panic, experiencing physical reactions such as rapid heart rate, sweating, trembling, shortness of breath, and an overwhelming feeling that something terrible is about to happen.
What’s the Difference between Nocturnal Panic Attacks and Night Terrors?
Nocturnal panic attacks primarily affect adults and are different from night terrors. What is characteristic of nocturnal panic attacks is that people are awakened from sleep and are aware of the feelings and panic attack symptoms.
People experiencing night terrors are often unaware they’re having them. They may scream, trash, or even walk around while asleep. When a night terror ends, a person falls back to sleep and may not recall this happening in the morning.
2. How Common are Nocturnal Panic Attacks?
Nocturnal panic attacks are relatively common among individuals with existing anxiety disorders. It is less common for people without a history of panic attacks to experience them, but it happens.
According to studies published in SpringerLink, IntechOpen - Open Science Open Minds, Anxiety Help, between 40-70% of people with Panic Disorder (PD) experience nocturnal panic attacks. Estimates vary in numbers because of different definitions and criteria across these studies.
Though it is not fully understood, Nocturnal panic attacks are believed to result from brain activity during sleep, similar to daytime panic mechanisms.
3. Causes of Nocturnal Panic Attacks
While the exact cause of nocturnal panic attacks is not fully understood, it likely results from a combination of genetic, biological, and environmental factors.
Underlying factors may include:
- Genetics: A family history of anxiety disorders.
- Underlying Anxiety Disorders: Conditions such as generalised anxiety disorder, panic disorder, acute stress disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD)
- Stress and Lifestyle Factors: Chronic, high levels of stress, big life changes, or traumatic experiences can be the trigger.
- Medications and Substance Use: Certain medications, alcohol, and drug abuse can also contribute to these episodes.
- Physical Health Issues: Conditions such as sleep apnea, menopause, and other hormonal changes can also play a role.
4. How to Calm Down After a Nocturnal Panic Attack
CalmingExperiencing a nocturnal panic attack can feel overwhelming, but there are ways you can calm yourself down and regain control.
- Practice Deep Breathing: Slow, deep breaths can help regulate your heart rate and reduce feelings of panic. Try inhaling slowly through your nose for a count of four, holding your breath for a count of four, and exhaling slowly through your mouth for a count of four.
- Grounding Techniques: Focus on your surroundings or perform a simple task to shift your attention away from the panic. You can try describing objects in the room, touching different textures, or counting backwards from 100.
- Reassurance: Remind yourself that the panic attack is temporary and will pass. Positive affirmations like "I am safe," "This will pass," and "I am in control" can be helpful.
- Comforting Activities: You’ll unlikely be able to go back to sleep after a panic attack. Try calming activities such as reading, listening to soothing music, or doing gentle stretches. Avoid screens and bright lights as they can further disrupt your sleep.
- Progressive Muscle Relaxation: Tense and then slowly release each muscle group in your body, starting from your toes and working your way up to your head. This can help release physical tension and promote relaxation.
- Aromatherapy: Using calming scents like lavender or chamomile can help relax your mind and body. You can use essential oils in a diffuser or apply them to your pillow.
- Mindfulness and Meditation: Practicing mindfulness or meditation can help you stay present and reduce anxiety. Focus on your breath or a specific sensation in your body to ground yourself in the moment.
- Hydration: Drink a glass of water. Sometimes, the simple act of drinking water can help break the cycle of panic and bring a sense of calm.
5. How to Prevent Nocturnal Panic Attacks
By following these preventive steps, you
By following these preventive steps, you can reduce the number of NPAs.
- Maintain a Regular Sleep Schedule: Consistent sleep patterns can improve overall sleep quality and reduce the likelihood of nocturnal panic attacks.
- Create a Relaxing Bedtime Routine: Engage in calming activities before bed, such as reading or taking a warm bath.
- Limit Stimulants: Avoid caffeine and alcohol, especially in the hours leading up to bedtime.
- Manage Stress: Incorporate stress-reducing practices such as mindfulness, meditation, or yoga into your daily routine.
- Therapy and Medication: Cognitive-behavioral therapy (CBT) and medications prescribed by a healthcare professional can effectively manage anxiety and prevent nocturnal panic attacks.
6. Diagnosing Nocturnal Panic Attacks
The diagnosis involves a thorough evaluation by a healthcare professional.
The process typically includes:
- Clinical Interview: A detailed interview to gather information about your medical history, mental health history, and specific symptoms. This helps rule out other conditions that may mimic nocturnal panic attacks, such as sleep apnea or night terrors. A detailed assessment of nighttime symptoms, including their frequency, duration, and severity. Standardised questionnaires or scales may be used to evaluate the intensity and impact of the attacks.
- Medical Evaluation: A physical examination and possibly blood tests can also be done to rule out any medical conditions that could be contributing to the symptoms, such as thyroid disorders or cardiovascular issues.
- Sleep Study (Polysomnography): In some cases, a healthcare provider may recommend a sleep study to monitor sleep patterns, breathing, heart rate, and brain activity during the night. This can help identify any underlying sleep disorders or confirm the diagnosis of nocturnal panic attacks.
- Review of Medications and Substance Use: An assessment of any medications you are presently taking and use of substances such as alcohol or recreational drugs, as these can influence sleep and anxiety levels.
7. Treatment for Nocturnal Panic Attacks
,,The treatment of nocturnal panic attacks will utilise the same methods used for panic attacks and disorders.
Psychotherapy: Cognitive Behavioral Therapy (CBT) encourages the development of coping skills, methods of countering nighttime anxiety, and how the connection between thoughts, feelings and behaviours affects your anxiety and panic. Therapy modalities such as Acceptance and Commitment Therapy (ACT), Dialectical Behaviour Therapy (DBT), and others can also be explored.
Medication: Anti-anxiety medication and antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), can help reduce the symptoms of panic attacks. These include Fluoxetine, Paroxetine and Sertraline.
At What Stage of Sleep Do Nocturnal Panic Attacks Occur?
Most commonly, nocturnal panic attacks happen during late stage 2 to early stage 3 non-REM (rapid eye movement) sleep stages. Most often during the transition from deep sleep to lighter sleep stages.
Can You Die from a Panic Attack in Your Sleep?
Even though at the time it may seem like it, no, you cannot die from a panic attack in your sleep. The fear of death is a common symptom, but the psychological effects, while intense, are not a cause of death.
Nevertheless, chronic panic attacks can have a significant impact on your health as a whole. This is why it is important to seek treatment and management strategies.
8. The Relationship Between Nocturnal Panic Attacks and PTSD
Individuals with Post-Traumatic Stress Disorder (PTSD) and those who experience nocturnal panic share several similarities, including insomnia, reduced sleep efficiency, and sudden awakenings during sleep. While PTSD sufferers often wake due to nightmares, a significant number of awakenings may occur without any clear internal or external cause.
To better understand the relationship, we provided information about the overlap of the symptoms, contributing factors, diagnosis, and treatment of the two conditions.
How PTSD may lead to Sleep Problems and NPAs
- Hyperarousal: Individuals with PTSD often experience hyperarousal, which can contribute to the sudden onset of panic attacks during sleep.
- Nightmares: PTSD is commonly associated with distressing nightmares and flashbacks, which can trigger nocturnal panic attacks. These nightmares often involve re-experiencing the traumatic event, leading to intense fear and anxiety upon waking.
- Sleep Disturbances: People with PTSD frequently have trouble falling asleep, staying asleep, and achieving restful sleep. These disruptions can increase the likelihood of nocturnal panic attacks.
Other Contributing Factors?
- Trauma Exposure: Individuals with PTSD have experienced one or more traumatic events, which can significantly impact their mental health. The lingering effects of trauma can lead to persistent anxiety and fear, manifesting as nocturnal panic attacks.
- Anxiety and Fear: PTSD involves chronic anxiety and a heightened fear response, both of which are key components of panic attacks. This heightened state of anxiety can carry over into sleep, leading to sudden panic attacks during the night.
- Avoidance Behaviors: People with PTSD often engage in avoidance behaviours to cope with their trauma. This can include avoiding sleep due to fear of nightmares or panic attacks, which can further disrupt sleep patterns and exacerbate anxiety.
Diagnosing and Treating NPAs and PTSD
- Clinical Evaluation: Diagnosing nocturnal panic attacks and PTSD involves a thorough clinical evaluation. Mental health professionals are trained to assess the individual's trauma history, anxiety symptoms, and sleep patterns to determine the presence of both conditions.
- Integrated Treatment Approach: Treatment often involves addressing both PTSD and nocturnal panic attacks simultaneously. Cognitive-behavioural therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) for PTSD, particularly trauma-focused CBT, can help reduce the frequency and intensity of both nightmares and panic attacks. Medications such as SSRIs (Selective Serotonin Reuptake Inhibitors) can also be effective in managing symptoms of both conditions and alleviating feelings of anxiety.
- Sleep Hygiene and Stress Management: Improving sleep hygiene and incorporating stress management techniques can benefit individuals with both PTSD and nocturnal panic attacks. Establishing a regular sleep routine, creating a calming bedtime environment, and using relaxation techniques can help reduce sleep disturbances and anxiety.
If you or someone you know is experiencing nocturnal panic attacks and are seeking professional support, Psychology Blossom is here to help.
Our dedicated team of professional psychologists and counsellors offers compassionate and effective support to help you manage your anxiety and lead a fulfilling life.
Contact us today to learn more about our services and start your journey towards better mental health.
We're Here To Help You Blossom Into The Best Version Of Yourself.