Introduction

A nocturnal panic attack is a sudden feeling of fear or anxiety that wakes people up from their sleep during the night. They cause individuals to wake up in fear, causing issues with breathing, heavy sweating, and a racing heart.¹

Nocturnal panic attacks generally last a few minutes, however, you might need some time to relax and be able to go back to sleep.¹ 

People who suffer from panic attacks during the day are more likely to have nocturnal panic attacks. About 11% of Americans have a panic attack each year and about 70% of people who suffer from panic attacks also have nocturnal panic attacks. 

Night panic attacks can be confused with night terrors (parasomnia). However, the difference between both cases is that people with night terrors or nightmares are usually not aware that they are having these bad dreams, whereas panic attacks wake people up from their sleep. This makes them aware of the feelings of fear and anxiety that they are going through. 

Nocturnal panic attacks mainly affect teenagers and adults.² Night terrors are more likely to affect children, although adults can also experience them.

Potential causes

It is unknown why people have panic attacks. Potential causes that may be involved include genetics, stress, and changes in how your brain perceives and processes fear and anxiety 

Anxiety attacks usually happen during the day, when a situation that is not dangerous causes this response. Similarly, nocturnal panic attacks do not have a clear cause.³ 

Potential triggers of nocturnal panic attacks, aside from daytime panic attacks, include:²

• Anger issues 
• Depression 
• Insomnia 
• Obsessive-compulsive disorder (OCD) 
• Traumatic events 
• Changes in sleep patterns 
• Substance abuse disorder 

Sometimes other conditions, like a sleep disorder or thyroid problem can result in symptoms that are similar to those seen in panic attacks

We must understand the cause of nocturnal panic attacks to help reduce them, as getting enough rest is crucial for our health and general well-being. 

 People who suffer from nocturnal panic attacks often do not get enough sleep. This is because it takes time to fall back asleep after having a panic attack, and sometimes the worry of having another panic attack can cause insomnia.²

Psychological triggers

Anxiety disorders

Having general anxiety disorder (GAD), social anxiety, and daytime panic attacks can result in nocturnal panic attacks. This is because these disorders, which cause worry and fear during the day, do not stop at night. The constant worry and stress that these people feel during the day makes them more likely to go through these panic experiences at night. 

Additionally, people with anxiety disorders have a heightened sensitivity to body changes in heart rate or breathing rate. Therefore, changes in their body while sleeping might result in panic attacks. 

Furthermore, when people have several panic attacks during the day or night, they become scared of going through another one. This increases the chance of them going through another one, entering a cycle.

Hyperarousal is when a person is vigilant, both psychologically and physically. It occurs in individuals with GAD as overproduction of adrenalin keeps them in “fight-or-flight” mode. High adrenaline causes symptoms such as increased heart rate, quickened breathing, and tense muscles. People in “fight-or-flight” mode have difficulty relaxing and sleeping. 

People with anxiety often worry a lot before sleep, as they have trouble stopping the rushing thoughts. This can later resurface during the night, causing their panic attacks.

Stress in a person’s everyday life involving someone’s work, relationships, or other factors, can also result in night panic attacks. Additionally, post-traumatic stress disorder can cause difficulty falling asleep and can resurface while sleeping, which can also result in nocturnal panic attacks.

Emotional triggers

Fear of loss of control

The fear of losing control affects people who suffer from panic attacks, as they are incapable of managing the stressful feeling of not being able to control specific situations involving themselves or their environment. During sleep, this fear increases as you feel you have even less control over these situations. 

As you relax while sleeping, you feel more vulnerable. This can increase anxiety levels, eventually triggering a panic response as your body can sense this vulnerability as a threat. 

This is increased if you sleep in an unknown environment, such as a hotel. 

Additionally, the feeling of falling asleep (such as the experience of “falling” as you transition between sleep stages) can cause a panic attack for someone who fears losing control.

Unresolved emotions

Unresolved emotions like grief, anger, guilt, or sadness can be ignored during the day when people are preoccupied with work or other daily activities. However, these emotions can resurface at night. This resurfacing can cause physical symptoms that are similar to those seen during a panic attack, such as increased heart rate. 

Unresolved emotions might affect your dreams, which can trigger panic attacks when the feelings that these disturbing dreams cause are too intense.

Feelings of isolation or loneliness

People often feel lonely or isolated. These feelings are strengthened at night when everyone’s asleep and alone in a quiet room. This can additionally increase their feelings of vulnerability, which can lead to a panic attack.

The interaction between psychological and emotional triggers

Psychological and emotional triggers often interact in a way that creates a cycle causing anxiety and nocturnal panic attacks. 

This cycle begins when a psychological trigger, such as a negative thought or fear, causes someone to feel certain emotions, like anxiety or fear of losing control. For example, somebody could worry about a task the next day at work. This can then cause the person to feel fear or anxiety, which can lead to further negative thoughts that intensify the negative emotions, causing a loop.

Transition into sleep is a time when psychological and emotional triggers become intensified. As the mind relaxes, a person has less control over their thoughts and emotions, which can cause their anxiety to increase. If these thoughts develop they can result in a panic attack.

Coping with panic attack triggers

Cognitive-behavioural strategies and relaxation techniques reduce a person’s fear of losing control.

Grounding techniques help patients anchor themselves to the moment they are living by making them focus on different senses, such as sounds, and what they are seeing or touching. This way their attention is focused on the sensations rather than on anxious thoughts. These techniques can be practised before going to sleep and help individuals become more present and in control of their physical sensations.

Therapy and journalling can be useful in unresolved emotions. You can learn to identify these emotions and how to deal with them. These activities help people gain the strength to attend social activities and build a social support network.

Relaxation techniques like deep breathing, progressive muscle relaxation and mindfulness can be used to reduce anxiety and panic attacks. Progressive muscle relaxation consists of tensing and relaxing muscle groups in the body. 

Lifestyle changes, such as having a regular sleep schedule and exercising can also make it easier to fall asleep, reducing the chances of having a panic attack while sleeping. 

Altogether, these different techniques can reduce the likelihood of having panic attacks.⁴

Summary

Nocturnal panic attacks are stressful episodes that disrupt sleep. They are more common among those who suffer from daytime panic attacks. The potential causes, including genetic, emotional, and psychological factors, are crucial for managing and preventing these attacks.

The interaction between psychological and emotional triggers plays a significant role in the occurrence of nocturnal panic attacks. Negative thoughts and heightened emotions can create a cycle that intensifies as the mind relaxes before sleep, making individuals more vulnerable to panic attacks. 

Addressing these triggers through cognitive-behavioral strategies, therapy, and relaxation techniques can significantly reduce their impact. 

If you or someone around you is suffering symptoms of nocturnal panic attacks you must seek help from a professional to be able to regain a balanced and healthy life.