Mental Health

Night-time panic attacks: what are they? And why do they happen?

Welcome to Sleepless Nights, Stylist’s weekly series designed to help you put your Sunday night anxiety and worries to bed. This week, we’re exploring the mysterious world of night-time panic attacks – and how to get them under control. 

The only thing worse than waking up in the middle of the night is doing so in a state of panic.

Night-time panic attacks, or ‘night terrors’ as they are sometimes called, are surprisingly common, but they can feel overwhelming if you’ve never experienced one before. Characterised by symptoms including a racing heart, sweaty palms or a shortness of breath, night-time panic attacks are intense, unexpected bouts of anxiety that wake you up in the middle of the night, rather than stopping you getting to sleep in the first place.

However, just because they don’t occur when you’re trying to get to sleep, doesn’t mean night-time panic attacks can’t contribute to conditions such as insomnia.  

Indeed, while night-time panic attacks typically only last for short periods, trying to calm yourself down enough to get back to sleep after having one can take a long time. You may also worry about falling back to sleep for fear of another panic attack happening, or put off going to sleep in the first place.

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In short, night-time panic attacks can have a big impact on your overall mental health and wellbeing, making finding ways to cope with them (and in the long term, stop them from happening) super important.

To find out more about what could be causing your night-time panic attacks, and how to get them under control, we asked Dr Meg Arroll, chartered psychologist on behalf of Healthspan, to answer some of the most commonly-asked questions about them. Here’s what she had to say.  

A woman lying in bed struggling with a night-time panic attack
Night-time panic attacks can contribute to sleep conditions such as insomnia.

What are night-time panic attacks?

“Nocturnal panic attacks are when we wake from a sleep state with a sense of panic,” Dr Arroll explains. “These are common in people who also have panic attacks in their waking hours.”

According to Arroll, night-time panic attacks are distinct from other “waking triggers” such as “night terrors, sleep apnoea or dream-induced arousals” because these periods of intense anxiety are not associated with “obvious triggers” – a fact that can make them feel unpredictable and difficult to control.

“Night-time panic attacks usually occur within non-REM sleep phases, from 2-3 hours after going to sleep, last for 2-8 minutes and most often only happen once per night,” Dr Arroll adds. “However, it can prove very difficult for people to get back to sleep after a panic attack and these events often stick vividly in the mind.” 

What are the symptoms of a night-time panic attack?

Symptomatically, night-time panic attacks typically only differ from regular panic attacks in the sense that they wake you up. Apart from that, Dr Arroll explains, they tend to trigger the same kinds of symptoms

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“Nocturnal panic attacks can be incredibly distressing,” Dr Arroll explains. “Individuals experience the classic physical symptoms of panic attacks such as a racing heart and palpitations, shortness of breath, sweating, chest pressure, dizziness or light-headedness and for some, fear of dying or worries around sanity.”

According to the NHS, other symptoms of a panic attack include:

  • Nausea
  • Trembling
  • Hot flushes
  • Chills
  • A choking sensation
  • Numbness or pins and needles
  • Dry mouth
  • A churning stomach
  • Feeling like you’re not connected to your body

For a full list of symptoms, you can check out the NHS website.

It’s important to remember that while these symptoms may feel sudden and frightening, they’re not dangerous, so there’s no need to worry about particular symptoms. 

What causes night-time panic attacks?

One of the most frustrating things about night-time panic attacks is that research hasn’t been able to identify exactly why they happen, although it’s thought to be down to a number of factors – for example, people with panic disorder are more likely to deal with night-time panic attacks.

Conditions such as post-traumatic stress disorder (PTSD) and OCD are also thought to increase the chance of a night-time panic attack, as well as strenuous life events and experiencing chronic stress.

“The research on nocturnal panic attacks is limited, but what seems to be happening is that changes in physiological state are triggered by low-level somatic sensations, so much so that an anxiety response becomes conditioned and develops into a full-blown panic attack,” Dr Arroll suggests.  

A woman sat up in bed after a night-time panic attack
Symptoms of a night-time panic attack include sweating, shortness of breath and a racing heartbeat.

How to cope with night-time panic attacks

Although you can’t stop night-time panic attacks in the moment, there are things you can do to help yourself cope, both in the moment after the attack and in the long-term. 

How to calm yourself down after a night-time panic attack 

Once you’ve had a night-time panic attack, the first thing you’ll want to do is help calm yourself down so you can get back to sleep, which can be done in a number of ways, including via deep or diaphragmatic breathing.

“Diaphragmatic breathing exercises may help to activate the parasympathetic nervous system which halts the stress response, allowing us to go back to sleep,” Dr Arroll explains.  

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Other ways to calm yourself down in the moment include focusing on positive, peaceful and relaxing images, practicing mindfulness meditation or doing something to distract yourself from your anxiety, such as walking around the room or pouring yourself a cup of (non-caffeinated) tea.

How to prevent night-time panic attacks

Although there’s no guarantee that you can avoid night-time panic attacks completely, there are some things you can do to help reduce the risk of them developing.

Cognitive behavioural therapy (CBT) has been shown to be an effective treatment for nocturnal panic attacks, with significant reductions in both daytime and night-time events, and other gains such as lowered heart rate, less leg movement and increased cardiac variability while sleeping,” Dr Arrol explains.  

Other preventative measures recommended by the NHS include trying complementary therapies such as massage and aromatherapy, doing regular physical exercise to reduce stress and tension and avoiding caffeine and alcohol.

If you visit a GP to seek help for night-time panic attacks, they may also recommend medication such as antidepressants

How to cope with fear of night-time panic attacks

One of the less-talked about side effects of night-time panic attacks is the anxiety and worry it can trigger surrounding sleep. Because night-time panic attacks can be so frightening and distressing, some people may develop a fear of the attacks themselves, and worry about going to sleep for fear of waking up in a state of panic.

Dr Arroll explains: “Overtime we can become anxious about sleep itself, often leading to sleep procrastination where we watch just one more episode on Netflix, complete a couple more tasks on a to-do list or generally potter about instead of going to bed.

“This fear of a bad night’s kip is of course a self-fulfilling prophecy as by the time we get to bed we’re often highly anxious and it can take a great deal of time for our minds and bodies to power down.” 

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If you’re struggling with worries about sleep – or sleep anxiety, as it is also known – there are a number of things you can do to calm your worries, such as practicing good sleep hygiene and creating a ‘sleep sanctuary’.

For more information on coping with sleep anxiety, you can check out our guide.  

If you’re struggling to control your night-time panic attacks or would like some more advice on how to cope, make sure to contact your GP.

For more advice on looking after your mental health, you can find support and resources on the mental health charity Mind’s website and NHS Every Mind Matters or access the NHS’ list of mental health helplines and organisations here.

If you are struggling with your mental health, you can also ask your GP for a referral to NHS Talking Therapies, or you can self-refer.

For confidential support, you can also call the Samaritans in the UK on 116 123 or email jo@samaritans.org.     

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