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.

In this article, you will read about:

1. What are these episodes of intense fear?
2. Are they common?
3. Causes
4. How to calm down after a nocturnal panic attack?
5. How to prevent one?
6. Diagnosis
7. Treatment
8. 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, and an overwhelming feeling that something terrible is about to happen.

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.

People experiencing night terrors are often unaware they’re having them. After an episode of screaming, trashing, 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.

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 – Open Science Open Minds, Anxiety Help, between 40-70% of people with Panic Disorder (PD) experience NPAs. The criteria and definitions are not standardised across these studies, this is the reason why the numbers in estimates vary.

Though it is not fully understood, panic attacks at night are believed to result from brain activity during sleep, similar to daytime panic mechanisms.

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. Let’s get into more detail when there is a higher risk of panic attacks at night:

• If a person has a family history of anxiety disorders.
• If a person is suffering from other anxiety disorders such as generalised anxiety disorder, panic disorder, acute stress disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).
• If a person experiences a lot of stress and has been through a big life change or traumatic experience.
• If a person is drinking too much, doing drugs or taking certain medication.

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.

1. Practice Deep Breathing: 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. This can help regulate your heart rate and reduce feelings of panic.
2. Grounding Techniques: Try describing objects in the room, touch different textures, or count backwards from 100.  You will not be focused on the panic attack as much as you used to be by focusing on your surroundings or performing a simple task.
3. Reassurance: Positive affirmations like “I am safe,” “This will pass,” and “I am in control” can be helpful. They help to remind yourself that the panic attack is temporary and will pass.
4. Comforting Activities: It will be difficult to go back to sleep fast after a panic attack. Try to calm yourself by reading, listening to calming music, and stretching. Don’t turn on the TV or your smartphone. Screens and bright lights will stimulate you even more.
5. Progressive Muscle Relaxation: Squeeze and slowly relax each muscle group in your body, starting with your toes and working up to your head. The tension you feel will be reduced and you will start to relax.
6. Aromatherapy: Scents like lavender or chamomile can be calming and help relax your mind and body. You can use them as essential oils. Put some on your pillowcase or in the diffuser.
7. Mindfulness and Meditation: 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.
8. 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. Prevention

By following these preventive steps, you can reduce the number of NPAs.

• A regular sleep schedule is a must. If you set up a routine for sleeping, it can improve the quality of sleep you are getting and decrease the chances of panic attacks at night
• Don’t overstimulate yourself before going to bed. Try doing relaxing activities, such as taking a warm bath, or reading.
• No coffee or alcohol several hours before sleep.
• Try to manage stress as best as you can. Mindfulness, meditation, or yoga could become a part of your daily routine.
• Therapy (especially cognitive-behavioral therapy) and medication that a healthcare professional prescribes for you, are quite helpful in managing anxiety and nocturnal panic attacks.

6. Diagnosis

The diagnosis involves a thorough evaluation by a healthcare professional.

The process typically includes:

1. 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 panic attacks at night, 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.
2. 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.
3. 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.
4. 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

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, they 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.

This being said, chronic panic attacks can have a negative impact on health.

8. 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

First, let’s talk about feeling on edge or hyperarousal. People suffering from PTSD are easily startled and are constantly on edge. This can be one reason why NPAs appear.

Second, nightmares and flashbacks of trauma while sleeping are not uncommon for people suffering from PTSD. These dreams can cause the onset of NPAs.

Third, when a person is not getting enough quality sleep, they cannot rest properly. This makes them susceptible to NPAs. PTSD causes problems with getting enough sleep, like difficulties falling asleep and waking up very often during the night.

Other Contributing Factors?

People suffering from PTSD have been exposed to one or more traumatic events. This can have a significant impact on their mental health. Consequences can be persistent fear and anxiety which can lead to the appearance of nocturnal panic attacks.

Anxiety and fear that come hand in hand with PTSD are key components of panic attacks. This state of heightened anxiety can affect sleep, leading to sudden panic attacks during the night.

To avoid reliving the trauma, people suffering from post-traumatic stress disorder engage in avoidance behaviours, including avoiding sleep. This can have the opposite effect since avoiding sleep to avoid nightmares and panic attacks can make the quality of sleep even worse.

Diagnosing and Treating NPAs and PTSD

• Clinical Evaluation: Diagnosing NPAs 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.
• Combined 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.
• Better Sleep and Stress Control: 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.

Message: +65 8800 0554

Phone: +65 8686 8592

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