Have you ever woken up from a deep sleep feeling sweaty, nauseous, and afraid? If this has happened to you, you might have had a nocturnal panic attack. According to the American Psychological Association a panic attack is “a sudden onset of intense apprehension and fearfulness in the absence of actual danger, accompanied by the presence of such physical symptoms as heart palpitations, difficulty breathing, chest pain or discomfort, choking or smothering sensations, sweating, and dizziness.”

It’s common for someone to also experience fears of losing control, dying, having a heart attack, passing out, or going crazy when they have a panic attack. Some people become afraid of the panic attacks themselves, which can lead to panic disorder.

Panic attacks can be scary and distressing, especially if they occur out of the blue, with no apparent reason. But when panic attacks interrupt your sleep, they can also be disorienting. When you wake up feeling panicky, it can take a few moments to realize what may be happening- you’re having a nocturnal panic attack.

In this article you’ll learn what a nocturnal panic attack is, what causes panic attacks, and why panic interrupts sleep. We’ll also discuss strategies for dealing with panic attacks at night and getting back to sleep. Continue reading if you’re ready to gain insights into why panic is interrupting your sleep and what to do about it.

What does a nocturnal panic attack feel like?

A panic attack can be terrifying and distressing, especially if it happens in the middle of the night, out of the blue, for no apparent reason. If you have a nocturnal panic attack, you could feel some or all of these things:

Heart palpitations
Shortness of breath
Feeling cold and shaky
Intense fear and worry
Chest pain
Feeling hot and sweaty
Dizziness and lightheadedness
Muscle tension
Nausea, vomiting, or upset stomach
Feelings of dread

Panic attack symptoms can also include depersonalization and derealization. Depersonalization is when you may feel outside of or disconnected from your body. Similarly, derealization is when you may feel things aren’t real.

Many people are afraid of panic attacks when they happen and can even become afraid of the panic sensations themselves. Panic attacks are uncomfortable and can be distressing, but it’s important to understand that they’re not dangerous or harmful. Learn more about treatment for panic here.

What causes panic attacks?

In general panic attacks are triggered by the fear center in our brain, known as the amygdala. The amygdala is a part of our brain responsible for the fight-or-flight response. When the amygdala thinks you are in a life-threatening dangerous situation, it will trigger the fight-or-flight response to keep you safe.

When the fight-or-flight response is triggered, you’ll start to feel the physical sensations of panic like getting hot and sweaty, noticing your heart is breathing faster, and feeling your muscles tense up. This is happening because your amygdala is preparing your body to fight the danger or run from the danger.

While this is happening in your body, the flight-or-flight response also impacts your thinking. You may start to feel intense feelings of fear or dread. You may start to worry about worst-case scenario situations. You may even begin to feel afraid of the panic itself.

These fear and worry thoughts are being triggered by your amygdala. Why? Because your amygdala wants you to be focused on the danger. If you’re paying close attention to the danger, then you can decide to fight or run from the danger, and you’ll stay safe. That’s the amygdala’s logic.

All of this happens automatically when the amygdala senses a life-threatening dangerous situation. Often the fight-or-flight response gets triggered so quickly that we may not even realize where the danger is at first. This is a life-saving response when we’re actually in danger.

So what’s the problem here? The problem is that your amygdala will react in situations where it thinks there’s danger, even if no real danger exists. This is what happens when you have a panic attack.

The amygdala senses threat and danger.
It starts the fight-or-flight response.
You feel the physical sensations of panic.
And you have fear and worry thoughts.
But there’s no actual life-threatening danger.

The fight-or-flight response was designed to keep you safe from danger. But the amygdala can get it wrong. When this happens, you’ll experience a “false alarm,” meaning that your fight-or-flight response will start even if there’s no real danger.

Why do I have panic attacks when sleeping?

Panic attacks occur when your amygdala thinks you’re in danger. The amygdala starts the fight-or-flight response which leads to physical sensations of panic and fear and worry thoughts. But the amygdala can get it wrong.

When you’re at home, sleeping in your warm and cozy bed, you’re safe. There is no life-threatening danger when you’re secure inside your house in the middle of the night. Then why do you have a panic attack?

Panic attacks occur when you’re sleeping because the amygdala thinks there’s danger. It is the amygdala’s job to keep you safe from danger. So when it’s triggered, the amygdala will continue to be scanning your environment for cues of danger. It will stay on high alert at all times. This experience of always being on the lookout for danger is called hypervigilance.

The amygdala is on high alert and focused on keeping you safe all the time. This process doesn’t stop at night. So if your amygdala thinks you’re in danger, it will start the fight-or-flight response. When this happens you can wake up in the middle of the night having a panic attack.

Remember that the amygdala can get it wrong. The fight-or-flight response and subsequent panic attack that occurs while you’re sleeping is a false alarm. There’s no real danger present when you’re asleep. But a false alarm is what causes you to have a panic attack when you’re sleeping.

How to deal with panic attacks that interrupt sleep

If you’ve ever had a nocturnal panic attack you know that they can be disorienting. It can be quite scary and alarming to wake up having a panic attack. But panic itself isn’t dangerous or harmful. There are a few things that can help you cope when panic attacks interrupt sleep.

Act on the facts

When a panic attack wakes you up from sleep it can be scary, distressing, and disorienting. In a moment like this, it’s first important to remind yourself that you’re safe. Pausing and noticing that you’re in the safety of your bedroom, with no danger present can be a good first step.

Next, it can help to remind yourself that panic attacks themselves aren’t dangerous or harmful. Sometimes saying out loud to yourself “This is just a panic attack” can help. Telling yourself additional facts about the situation can reduce the intensity and duration of the panic as well.

Because the amygdala is triggered when you are having a panic attack, it might be helpful to remind yourself of these facts:

I’m safe in my bedroom, there’s no real danger
This is just a false alarm. I’m not in danger
This is just a panic attack
Panic attacks aren’t dangerous
Panic attacks aren’t harmful
My amygdala made a mistake
This is just the fight-or-flight response

Relaxation exercises

Being woken up by a panic attack in your sleep can be scary, not to mention frustrating. Once you’ve realized that you’re safe at home, that you’re just having a panic attack, and that this is just a false alarm, you can take additional steps to cope.

If you’re still feeling anxious after a panic attack, it can be hard to get back to sleep. Relaxation exercises can help your body begin to calm down and relax. When you practice relaxation exercises, the parasympathetic part of your nervous system will get stimulated. The parasympathetic part of your nervous system is responsible for your body feeling calm, relaxed, and ready to sleep.

There are many ways to practice relaxation, so it’s important to find what works for you. Here are a few types of relaxation exercises you can try:

Deep breathing, also called belly breathing
Meditation & mindfulness
Guided imagery
Progressive muscle relaxation

Writing and journaling

Calming down your body physically and starting to relax is important for getting back to sleep. But after a panic attack wakes you up at night, you may have lingering fear and worry thoughts. Worrying can sometimes make it hard to fall back asleep.

If worry is keeping you up, writing or journaling can help. Simply writing down your worry thoughts can help get them out of your head. If that doesn’t work, you could try also writing down the facts about panic. If these simple writing tasks don’t work, you can take a more in-depth approach.

Journaling about your experience, including your physical sensations, worry thoughts, fears, and emotions can be helpful. This journal is only for you, so don’t worry about punctuation, grammar, or spelling. Just write. For convenience, try keeping a pen and paper by your bedside. That way, you can easily start writing or journaling if a panic attack wakes you up in your sleep.

Help with panic attacks

Panic attacks can be scary, distressing, and disruptive, whether they occur during the day or if panic interrupts your sleep. Seeking therapy from a mental health professional can help. Cognitive behavioral therapy (CBT) is the best treatment for panic attacks.

CBT is an approach to treating panic attacks that includes multiple components. It’s based on the idea that the ways you react to having a panic attack (what you think and what you do) can either increase or decrease the intensity of the experience. In CBT the focus is on changing your thinking and changing your actions to reduce the intensity, frequency, and duration of the panic attacks. If you’re interested in a CBT approach to treating your panic attacks, find a licensed mental health provider who is an expert in CBT for panic and anxiety.

Summary

Understanding the reasons behind nocturnal panic attacks can help you start to deal with them more effectively. By recognizing that a panic attack that interrupts your sleep is simply a false alarm triggered by your amygdala, you can start to regain control over your panic attacks.

While panic attacks that interrupt sleep are scary, distressing, frustrating, and disorienting, there are many things you can do to deal with them effectively. Remembering and acting on the facts is often the first step to understanding what just happened. A next step might be to try a few relaxation strategies to activate the parasympathetic nervous system. If worrying is still keeping you awake writing and journaling can help your mind calm down.

If you think therapy is right for you, working with a mental health professional who specializes in Cognitive Behavioral Therapy (CBT) is a good idea. CBT is the best treatment for panic attacks. To learn more about how to get over all of your phobias in therapy, check out my CBT for Anxiety or Therapy for Panic page or schedule a free 15-minute consultation today.

What Causes Panic Attacks at Night? When Panic Interrupts Sleep