Nocturnal panic attacks: Why they happen & 4 ways to manage

Key Takeaways

A nocturnal panic attack is a panic attack that begins when you are fully asleep or just beginning to wake up.
The unpredictable nature of nocturnal panic attacks can add a level of anxiety and stress to going to sleep at night.
Nocturnal panic attacks may reduce your quality and quantity of sleep, but there are adjustments you can make to improve your sleep and reduce your overall anxiety.

Nocturnal panic attacks are not just panic attacks that happen during the night. They are specifically panic attacks that begin while you are sleeping or shortly after you wake up. Because they’re typically unpredictable, they can add a layer of stress and anxiety to your sleep routine.

While not everyone with panic attacks will experience nocturnal panic attacks, they are fairly common. In fact, the majority of people with panic attacks experience at least one nocturnal panic attack. Fortunately, all panic attacks are highly manageable with the right support.

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What do nocturnal panic attacks feel like?

The signs and symptoms of nocturnal panic attacks usually match those of a typical panic attack. One major difference may be your ability to sense the attack coming. At times, people can recognize the start of a panic attack and try to prevent it from escalating. But with a nocturnal attack, you may be in the middle of the attack by the time you wake up.

The most common symptoms of a nocturnal panic attack are:

Pounding heart or increased heart rate
Sweating
Shaking
Shortness of breath
Choking sensation
Pain or discomfort in your chest
Nausea or stomach distress
Feeling dizzy or lightheaded
Feeling confused or like you’re not yourself
Fear of losing control
Fear of dying
Tingling sensation in your hands or feet
Feeling cold or very hot

These symptoms may create a very intense and uncomfortable experience. While they can be distressing, panic attacks are not dangerous. Nocturnal panic attacks may feel like they last for a long time. In most cases, though, they last for only a few minutes. After the panic attack is over, you may have lingering feelings of stress, anxiety, and fatigue that goes away with time.

The relationship between panic attacks and sleep quality

Falling asleep with a history of nocturnal panic attacks can be very stressful. If you’re going to bed with the fear of a panic attack, you might find that your sleep is restless. In an effort to avoid a panic attack, you may delay sleep, set alarms to periodically wake you up, or use alcohol and other substances before going to bed.

All of these precautions could negatively affect your sleep quality. Falling back asleep after an attack may be difficult as well, which could leave you feeling tired the next day.

Know that while nocturnal panic attacks can be distressing, there are effective strategies you can use to get a better night’s sleep.

Reducing the risk of nighttime panic attacks

There is good evidence to show that reducing your daytime anxiety can have a positive effect on nighttime panic. So some options that could help reduce the symptoms of your nocturnal panic attacks include lifestyle changes that center around the goal of reducing your current levels of stress and anxiety. These options include:

Shifting your exercise routine: Try a new form of exercise or try exercising at different times of the day to create positive change.
Changing up your diet: The food you eat can have an impact on your sleep quality. Experiment with different foods at different times of the day to study their effects.
Reducing your use of alcohol and other substances: Alcohol, caffeine, and other substances can all negatively impact your sleep, especially if you consume them later in the day. Try to avoid these substances or reduce your use of them if possible.
Spend more time with people you love: Doing things you love with people you care about is almost always a healthy lifestyle change that can reduce your levels of anxiety and panic.

Professionals treatment options

If you’ve tried lifestyle changes but are still experiencing nocturnal panic attacks, it may be time to seek help from a mental health professional.

One type of therapy that can help with panic attacks is cognitive behavioral therapy (CBT). This type of therapy helps you learn about the connection between your thoughts, feelings, and behaviors. Mindfulness-based therapies can also help by teaching you how to build awareness of your symptoms to reduce fear and worry.

There are also medications that can reduce anxiety and improve sleep. You can talk to your mental health provider about whether medication may be right for you.

Find care with Rula

Nocturnal panic attacks can have a significant negative impact on your life, affecting your sleep, mental health, and overall well-being. Fortunately, all types of panic attacks are manageable with the right support. And that’s where Rula comes in.

Our extensive network of therapists and psychiatric providers means that you can find someone to help you manage your symptoms in just a few clicks. And our therapist-matching platform can help you easily find someone who takes your insurance and is available to meet with you as soon as tomorrow.

About the author

Eric Patterson, LPC

Eric Patterson, LPC is a professional counselor with over 10 years of experience helping people of all ages reach their goals and improve their well-being.

Rula's editorial process

Rula's editorial team is on a mission to make science-backed mental health insights accessible and practical for every person seeking to better understand or improve mental wellness. Rula’s clinical leadership team and other expert providers contribute to all published content, offering guidance on themes and insights based on their firsthand experience in the field. Every piece of content is thoroughly reviewed by a clinician before publishing.