Panic Attacks at night: Nocturnal Panic Attacks (NPAs)
When you are woken up from sleep at night by the feeling of intense fear, terror, or discomfort this can be described as a nocturnal panic attack, or panic attack at night. They can leave you feeling disoriented and anxious and may seem to happen without any trigger. This experience can be frightening, especially when it appears suddenly and without any clear cause. People who go through this often report feeling as though their body and mind betray them during what should be a restful period, which adds to the distress.
In this article, you will read about:
- What are Panic Attacks at night?
- Are they common?
- Causes
- How to calm down after a nocturnal panic attack?
- How to prevent one?
- Diagnosis
- Treatment
- NPA and PTSD
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, dizziness, nausea, and an overwhelming feeling that something terrible is about to happen. These episodes disrupt rest and often make returning to sleep difficult, which means they affect not only the night in which they occur but also the following day due to fatigue and irritability. People with frequent nocturnal panic attacks may develop a fear of going to bed, creating a negative association with sleep itself.
What’s the Difference between Nocturnal Panic Attacks and Night Terrors?
NPAs primarily affect adults and are different from night terrors. What is characteristic is that people are awakened from sleep and are aware of the feelings and panic attack symptoms. They remember the fear vividly and may lie awake for hours processing the experience. This awareness distinguishes nocturnal panic attacks from other parasomnias, and it also contributes to the heightened anxiety about recurrence.
People experiencing night terrors are often unaware they’re having them. After an episode of screaming, thrashing, or even walking, they will fall back to sleep completely unaware of this when they wake up in the morning. Most often, they affect children. This distinction is critical in diagnosis and treatment planning, since mistaking one condition for the other can lead to ineffective strategies. Night terrors tend to fade as children grow older, while nocturnal panic attacks often persist without proper management.
2. Are They Common?
They are relatively common among those who are already suffering from some anxiety disorder. It can happen among people without a history of panic attacks but very rarely. According to studies published in SpringerLink, IntechOpen, and Anxiety Help, between 40-70% of people with Panic Disorder (PD) experience NPAs. The criteria and definitions are not standardised across studies, which is why the numbers vary. Regardless of statistics, even a single episode can feel traumatic to those who go through it, and the fear of recurrence often fuels anxiety during the day.
Though it is not fully understood, panic attacks at night are believed to result from brain activity during sleep, similar to daytime panic mechanisms. This suggests that panic can cross from waking to sleeping states, triggered by neural misfiring or heightened sensitivity to stress. Research into sleep stages shows that disruptions in the balance between REM and non-REM sleep might play a role, which means that sleep itself becomes both a trigger and a casualty of the condition.
3. Causes of NPAs
The exact cause is not fully understood, but it is probably a result of a combination of different factors, such as genetic, biological, and environmental. Underlying factors may include genetics, stress, lifestyle, medication and substance abuse, and preexisting physical health problems. The interplay between these elements makes it challenging to identify a single cause, and often, multiple risk factors overlap in one person’s life.
- Family history of anxiety disorders increases susceptibility. A genetic predisposition can heighten sensitivity to stressors.
- Other anxiety disorders such as generalised anxiety disorder, panic disorder, OCD, and PTSD contribute to risk.
- High levels of stress, major life changes, or trauma can trigger NPAs in previously healthy individuals.
- Excessive alcohol use, drug use, or certain medications may interfere with brain chemistry and sleep, making NPAs more likely.
Beyond these risk factors, researchers also note that people with high anxiety sensitivity — meaning those who interpret bodily sensations as dangerous — are particularly prone to nocturnal panic attacks. Even normal changes in breathing during sleep may be misinterpreted as suffocation, leading to panic.
4. How to Calm Down After a Panic Attack at Night
Experiencing a nighttime panic attack can feel overwhelming, but there are ways you can calm yourself down and regain control. These coping methods focus on grounding, relaxation, and reassurance. The key is to interrupt the cycle of fear, calm the body, and reassure the mind.
- Practice Deep Breathing: Inhale slowly for four counts, hold for four, exhale for four. This helps regulate your heart rate and reduces hyperventilation.
- Grounding Techniques: Describe objects around you, touch textures, or count backwards from 100. Redirecting focus reduces anxiety.
- Reassurance: Affirmations like “I am safe” or “This will pass” help counter catastrophic thinking.
- Comforting Activities: Read or listen to calming music instead of screens. Avoid bright lights that can make falling back asleep harder.
- Progressive Muscle Relaxation: Tighten and release muscle groups from toes upward to release tension.
- Aromatherapy: Lavender or chamomile oils on pillowcases or diffusers promote relaxation.
- Mindfulness and Meditation: Focusing on breath or sensations can anchor you in the present moment.
- Hydration: Drinking water can provide a physical reset and comfort.
5. Prevention
By following preventive steps, you can reduce the number of NPAs. Prevention strategies often involve lifestyle adjustments that improve both physical and mental resilience.
- Maintain a consistent sleep schedule to stabilise your circadian rhythm.
- Avoid overstimulation before bed. Choose relaxing routines like warm baths or light reading.
- Avoid coffee, nicotine, or alcohol close to bedtime, as they affect sleep architecture.
- Incorporate mindfulness, meditation, or yoga into daily life to manage stress.
- Therapy and prescribed medications can provide long-term relief and prevent recurrence.
6. Diagnosis
Diagnosis involves a clinical interview, medical evaluation, sleep studies, and review of medications or substances. Professionals distinguish NPAs from conditions such as sleep apnea or night terrors. Comprehensive assessment ensures appropriate treatment. Often, patients are also evaluated for coexisting mental health conditions like depression or generalised anxiety disorder, which can complicate the clinical picture.
7. Treatment
Treatment of nocturnal panic attacks is similar to daytime panic disorders. CBT teaches coping strategies and reframes anxious thought patterns. ACT, DBT, and other approaches may also help. Medications such as SSRIs (e.g., Fluoxetine, Paroxetine, Sertraline) can be prescribed to reduce symptoms when therapy alone is insufficient.
At What Stage of Sleep Do NPAs Occur?
Most commonly, they happen during late stage 2 to early stage 3 non-REM sleep, particularly during transitions between deep and lighter sleep stages. This timing suggests a link between the brain’s regulation of fear responses and natural sleep cycles.
Can You Die from a Panic Attack in Your Sleep?
No, panic attacks do not cause death. While the fear of dying is a common symptom, the physical effects of a panic attack, though severe, are not fatal. However, chronic attacks can impact long-term health by elevating stress hormones and disrupting sleep quality. Over time, this can weaken the immune system and increase vulnerability to illness.
8. Nocturnal Panic Attacks and PTSD
Individuals with PTSD often experience insomnia, nightmares, and sudden awakenings that overlap with NPAs. PTSD symptoms like hyperarousal, flashbacks, and avoidance can trigger nighttime panic. Combined treatment—trauma-focused CBT, EMDR, and SSRIs—can address both conditions simultaneously. Stress reduction techniques and improved sleep hygiene are also essential.
Understanding the overlap of PTSD and nocturnal panic attacks is important because it shows how trauma can continue to affect the body long after the original event. Sleep disturbances are among the most distressing symptoms of PTSD, and when coupled with NPAs, they can significantly reduce quality of life.
If you or someone you know is experiencing nocturnal panic attacks, Psychology Blossom is here to help. Our team of professional psychologists and counsellors provides effective support for managing anxiety and regaining a sense of calm. Early intervention not only reduces distress but also prevents the condition from worsening over time.
Contact us today: +65 8800 0554, +65 8686 8592, or hello@psychologyblossom.com.
We recommend This Video to those who wants to learn more about Nocturnal Panic Attacks.
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