Why do I get panic attacks at night?

What is a nocturnal panic attack?

It means waking from sleep already in a panic. It isn’t a nightmare. Researchers say it starts in non-REM sleep, not dreaming sleep, and differs from night terrors and sleep apnoea.

It’s common in people with panic disorder. A review found 44% to 71% had had at least one.

The NHS says most panic attacks last 5 to 20 minutes, and some up to an hour. They’re frightening, but not dangerous. An attack won’t cause you physical harm.

The NHS warns most of these signs can come from other conditions too. So chest pain that fits the 999 signs below needs a 999 call, not breathing exercises.

Keep having them? See a GP. They may examine you to rule out other causes.

Why is my anxiety worse at night?

There’s less to distract you. A BHF heart nurse says that when it’s quiet we’re more aware of sensations in our bodies.

When you’re anxious, your body may feel more alert, and your mind may fill with worrying thoughts. Stress, anxiety and depression are among the most common causes of insomnia.

The NHS says caffeine, alcohol, sugary food and drinks, and smoking can all make panic attacks worse. Alcohol may make you sleepy at first, then lead to poor sleep later in the night.

Perimenopause and menopause can also make it harder to stay asleep, and night sweats add to it. See menopause and anxiety.

Tonight, note the time of your last coffee and your last drink. If they’re late, move them earlier. More in when to stop caffeine and alcohol and sleep.

What to do if you wake up in a panic

Keep the breathing going for at least 5 minutes. You may not reach 5 at first. The NHS says it helps most if you do it every day, so practise in the daytime too.

That first thought on waking is the part you can work on. In a sleep-lab study, people with night panic heard signals in their sleep. Those not told to expect strong body changes had much more distress and panic.

Another study suggests your thoughts once awake may play a bigger part than body changes in keeping night panic going. So have one line ready: this is panic, and it will pass.

Heart still pounding afterwards? See heart racing at night.

Anxiety when trying to sleep: what helps?

The NHS says insomnia usually gets better by changing your sleeping habits. Start with these.

Use part of that wind-down hour for the breathing exercise. It turns practice into habit.

Pharmacy sleep aids may help for 1 to 2 weeks, but the NHS says not to take them any longer. Some make you drowsy, which can make driving hard. Check with your doctor first.

More ideas in sleep hygiene and waking up at 3am.

How are night panic attacks treated?

The main NHS treatments for panic disorder are talking therapy and medicine.

CBT is a talking therapy that changes how you react to the feelings in your body. A review says evidence supports it for night panic. In a tiny study of 6 people, CBT cut night attacks faster than daytime ones.

Panic disorder may be diagnosed if you have regular, unexpected attacks, then at least a month of worry about having more.

Antidepressants can take 2 to 4 weeks to start working, and up to 8 weeks to work fully. Never stop or change a prescribed medicine without your prescriber.

For therapy aimed at sleep, see CBT for insomnia. For self-help, see natural remedies for anxiety.

When to speak to a GP

Book an appointment if:

• You’ve had symptoms of panic disorder, such as attacks that keep coming out of the blue.
• Changing your sleep habits hasn’t helped, you’ve had trouble sleeping for months, or it makes daily life hard to cope with.
• You’re struggling to cope with anxiety or panic, and what you’re trying yourself isn’t helping.
• Your breathing stops and starts in your sleep, you make gasping, snorting or choking noises, or you always feel very tired in the day. These can be signs of sleep apnoea.
• You have chest pain that comes and goes, or chest pain that goes away quickly but you’re still worried.

Call 999 for chest pain that is sudden and doesn’t go away, or that spreads to your arm, neck, jaw, stomach or back. It can feel like squeezing, pressure, burning or indigestion. Also call 999 for chest pain with sweating, feeling sick, light-headedness or shortness of breath.

Call 999 or go to A&E if someone’s life is at risk, or you feel you can’t keep yourself or someone else safe. For urgent mental health help, call 111 and choose the mental health option. Samaritans are on 116 123, day or night.