Introduction

Many people find it very difficult to enjoy a good night’s sleep. Included in a few of the reasons these people give for their sleep difficulties are nocturnal panic attacks. Oftentimes they usually do not know it is a nocturnal panic attack until after consulting with a physician over fears of another serious health condition they have confused the panic attacks for. 

About 4% of the global population is affected by an anxiety disorder. Nocturnal panic attacks are classified alongside anxiety disorders. In addition to that, 1 out of every 4 people in the world experience it in their lifetime.¹ Panic attacks are as common among people assigned female at birth (AFAB) as amongst people assigned male at birth (AMAB).

In this article, we will discuss nocturnal panic attacks, their causes and associated risk factors. By extension we will also look at the interrelation between causes and risk factors, the impact of nocturnal panic attacks, and how nocturnal panic attacks can be identified, managed, and prevented.

Signs and Symptoms of Nocturnal Panic Attacks

Anxiety disorders have been classified as one of the most common types of mental health conditions in the United States of America.² Anxiety disorders, in a nutshell, are mental health conditions that make an individual anxious, fearful, frightened and for no obvious reason, and these feelings are not accounted for by another medical condition. Types of anxiety disorders include phobias, panic attacks, social anxiety and more. Some people may confuse anxiety disorders with everyday feelings of anxiety. The difference is that everyday anxiety is worrying about meeting needs and day-to-day activities, while the feelings of anxiety caused by an anxiety disorder are significant enough to disrupt the well-being of an individual. 

A panic attack on the other hand is when you suddenly experience intense fear which makes you feel like you are out of control, unreal and feelings of doom even when there is no danger around. A nocturnal panic attack is a sub-type of panic attack that causes sudden episodes of intense fear during non-REM (rapid eye movement) sleep.³ When it comes to sleep, there are two stages (REM and non-REM) you should be aware of. However, our attention is on non-REM sleep. Nocturnal panic attacks usually occur when you transition from non-REM to REM sleep. It can sometimes last up to an hour depending on the circumstances and other factors. Nocturnal panic attacks sometimes come after an unpleasant dream or nightmare. Some signs of nocturnal panic attacks include:

• Shortness of breath
• Feelings of intense fear or dread
• Racing heart
• Sweating
• Choking sensations
• Light-headedness
• Faintness
• Shaking or trembling
• Dry mouth
• Nausea or butterflies in the stomach
• Hot flashes or chills
• Needing to urinate or defecate
• A strong desire to escape the situation
• Depersonalisation (feeling like you are outside of your body or that your surroundings are not real)

Causes of nocturnal panic attacks

Generalised anxiety disorder

People who suffer from generalised anxiety disorder (GAD) can be affected by nocturnal panic attacks. Anxiety does not always stop while resting or when relaxing, especially for sufferers of GAD, who may have difficulty relaxing. Even when relaxing, the activity in the brain responding to anxiety can be triggered thereby causing a sufferer to wake during sleep, especially when moving from one sleep stage to the other. As long as the cause of the anxiety disorder is not addressed, nocturnal panic attacks are likely to persist. 

Depression

This is another mental disorder that may be accompanied by nocturnal panic attacks. Depression may be accompanied by disruptions to the sleep-wake cycle, which in turn can lead to nocturnal panic attacks. 

Insomnia

Insomnia is a sleep disorder in which an individual finds it hard to fall asleep and also stay asleep. Insomnia can cause nocturnal panic attacks due to the significant sleep disruption symptomatic of the disorder. 

Stress

Chronic stress is another cause of nocturnal panic attacks. Being restless and fatigued are common physical signs of prolonged stress. These may also lead to a person being unable to concentrate on sleep, thereby increasing the likelihood of nocturnal panic attacks through sleep disruption. 

Trauma

Experiencing a traumatic event can lead to short-term stress and negative mental responses, as well as long-term mental health and well-being impacts, such as post-traumatic stress disorder (PTSD). Both these short-term negative effects and PTSD may be accompanied by sleep disruption, nightmares, panic attacks, and anxiety, which may contribute to the risk of nocturnal panic attacks.

Genetic causes

Some people may have a high tendency to experience nocturnal panic attacks if their parents also have experienced nocturnal panic attacks or other anxiety disorders, as these have a hereditary or genetic element of risk.

Risk factors for nocturnal panic attacks

There are a number of additional factors which increase the risk of experiencing nocturnal panic attacks. These may include:

1. Alcohol abuse
2. Substance abuse
3. Job loss: significant life stressors, such as losing a job, may increase stress levels, thereby interfering with sleep
4. Withdrawal from substances: physical withdrawal from substances such as alcohol and illegal drugs can lead to a number of negative physiological consequences including increased anxiety, stress, nightmares, and sleep disruption
5. Excessive brain discharge
6. Poor eating habits
7. Health conditions such as respiratory illnesses and diabetes mellitus 
8. Poor sleep patterns

Impact of nocturnal panic attacks

Development of phobias

People may develop different coping mechanisms in response to nocturnal panic attacks based on avoiding perceived triggers. For example, some may believe that they cannot sleep in a high-level area like an upper storey of a building or cannot eat certain types of food, developing a phobia towards these factors as a consequence.

Heart-related problems

This is because nocturnal panic attacks are classified alongside anxiety disorders. The increased heart rate and blood pressure often experienced by someone with nocturnal panic attacks or an anxiety disorder place extra strain on the heart, increasing the risk of heart problems.

Constant unease

A nocturnal panic attack is often accompanied by fear, restlessness, and inability to concentrate, and people with nocturnal panic attacks often also experience a sense of unease. This may persist outside of sleep, leading to a constant sense of unease in their everyday life.

Managing nocturnal panic attacks

If you have noticed any of the aforementioned signs, here are a few pieces of advice you may wish to consider to help manage nocturnal panic attacks.

Understand that it can be treated

Gaining knowledge about what you are experiencing and your treatment and management options is the first step to recovering from panic attacks. This can help you to realise that it can be treated and assist you with expressing your experiences when seeking medical consultation. 

Be positive

A lot of the time working on reducing nocturnal panic attacks requires consistency and positivity. It might seem as if your management strategies and treatment is not working, but over time it may prove itself to be effective. Creating a positive motivational motto or affirmation personalised to your own needs, experiences, and motivations may help to keep you motivated and adhere to treatment and management. 

Engage in healthy behaviours

Engaging in healthy behaviours such as regular physical activity, healthy eating, playing your favourite games, or engaging in hobbies may help someone to deal with nocturnal panic attacks. These activities may help to relax the brain before going to bed. The brain normally releases certain pleasurable hormones to help calm down and prepare the body for sleep. All these activities mentioned earlier may help to reduce your stress levels and lower anxiety. 

FAQ’s

What is a nocturnal panic attack?

A nocturnal panic attack is a sub-type of panic attack that causes sudden episodes of intense fear and anxiety during non-REM sleep.

Can a nocturnal panic attack kill someone?

No. Untreated underlying conditions such as respiratory illness, diabetes, sleep disorders, and anxiety can lead to further complications with the potential of harming your health and possibly causing death, but nocturnal panics in and of themselves cannot cause death.

Are nocturnal panic attacks treatable?

Yes, It can be treated.

Summary

In this article, we have discussed what nocturnal panic attacks are, their various signs and symptoms, and the causes and risk factors associated with a nocturnal panic attack. This article also includes some potential strategies to manage nocturnal panic attacks and their associated causes. Having the knowledge and understanding of your symptoms and condition can help you to deal with whatever symptoms you are facing.