Nocturnal Panic Attacks

What is a nocturnal panic attack?

A nocturnal (night) panic attack is a sudden feeling of fear that wakes you from sleep. You wake up in a state of panic, experiencing physical reactions like a racing heart, sweating and difficulty breathing (gasping for air).

How common are nocturnal panic attacks?

About 11% of Americans experience a panic attack every year. As many as 7 in 10 people with panic disorder (recurrent panic attacks) also have nocturnal panic attacks.

What’s the difference between nocturnal panic attacks and night terrors?

Night terrors are a disruptive sleep disorder (parasomnia). A person experiencing a night terror has symptoms like those of a nocturnal panic attack. One key difference is awareness.

People experiencing night terrors are often unaware they’re having them. They may look like they’re awake — and they may scream, jump out of bed and run around. They’re actually asleep, and it’s difficult (and often not recommended) to wake them. When a night terror ends, a person falls back to sleep. They may not remember the event in the morning. Children are more likely to have night terrors, although adults have them, too.

A panic attack wakes you from sleep. You’re aware of the feelings of fear and other panic attack symptoms. It may take a long time to fall asleep again. Nocturnal panic attacks primarily affect teens and adults.

What causes panic attacks at night?

Experts don’t know why some people experience panic attacks. Something affects how your brain and nervous system perceive and process fear and anxiety. Most panic attacks happen during the day, usually when a nonthreatening situation triggers a panic response. Similarly, nocturnal panic attacks don’t have a basis in the situation.

What are risk factors for nocturnal panic attacks?

You’re more likely to have panic attacks at night if you have them during the day. Other risk factors include:

• Anger or hostility issues.
• Anxiety disorder.
• Depression.
• Insomnia or sleep apnea.
• Obsessive-compulsive disorder (OCD).
• Substance use disorders, including alcohol use disorder.

What are the symptoms of a nocturnal panic attack?

Nocturnal panic attacks cause the same symptoms as attacks that occur during the day. However, research suggests that people who have panic attacks at night may have more severe breathing symptoms. They may struggle to catch their breath (shortness of breath) or feel like they’re choking or having a heart attack.

Signs of a nocturnal panic attack include:

• Chest pain.
• Chills.
• Intense feeling of terror.
• Nausea.
• Profuse sweating (hyperhidrosis).
• Racing heart rate.
• Tingling or numbness in fingers or toes.
• Trembling or shaking.

How long do nocturnal panic attacks last?

Nocturnal panic attack symptoms usually peak in less than 10 minutes and then subside. It may take a while to fall back to sleep.

How are nocturnal panic attacks diagnosed?

Your healthcare provider may order tests to rule out health problems like heart disease and thyroid disease that cause symptoms similar to panic attacks. If they don’t find a physical cause, your healthcare provider may diagnose nocturnal panic attacks based on symptoms and risk factors.

How can you stop a nocturnal panic attack?

Once a panic attack starts, the only option is to let the symptoms run their course. Some people find they can reduce an attack’s severity with deep, controlled breathing or muscle relaxation exercises. Your healthcare provider may prescribe medication to lessen your symptoms.

How are nocturnal panic attacks managed or treated?

Your healthcare provider may recommend a combination of medications and therapy to stop nocturnal panic attacks. These are the same treatments for daytime panic attacks.

Nocturnal panic attack treatments include:

• Antidepressants and anti-anxiety medications can lessen the frequency and severity of panic attacks. Panic attacks may go away completely. These medications may take up to six to eight weeks to fully work.
• Benzodiazepines can quickly reduce severe symptoms, but these medications are habit-forming. You may build up a physical tolerance, so they won’t work as well. It can be very difficult to stop using them. Examples include alprazolam (Xanax™) and clonazepam (Klonopin™).
• Beta-blockers, such as propranolol (Inderal™), may reduce the physical symptoms of a panic attack. Your healthcare provider might prescribe these medications to take as needed when you sense a panic attack coming on.
• Cognitive behavioral therapy (CBT) is a type of psychotherapy (talk therapy). You meet with a licensed counselor or psychologist who helps identify panic attack triggers. With CBT, you learn to change how you think about and respond to these triggers. Over time, panic attacks decrease and may stop completely.

What are the complications of nocturnal panic attacks?

Waking up in a panic is very disruptive to a good night’s sleep. Concerns about having a panic attack at night may cause you to delay going to bed or lead to insomnia.

Lack of sleep affects health in many ways. It can lead to:

• Anxiety and depression.
• Difficulty concentrating or remembering things.
• Increased stress and irritability.
• More frequent daytime panic attacks.
• Poor performance at work or school.
• Weight gain.

Can you prevent nocturnal panic attacks?

These steps may lower your risk of having panic attacks:

• Eat a healthy diet, cut back on caffeine and exercise regularly.
• Find healthy ways to manage stress, like meditation, tai chi or calling a friend.

Talk to your healthcare provider before taking herbal supplements or over-the-counter medications. Certain ones can heighten anxiety.

What is the prognosis (outlook) for people who have nocturnal panic attacks?

Panic attacks are treatable. Most people get symptom relief through therapy and medications. Once you have a handle on daytime panic attacks, the frequency and severity of nighttime panic attacks should also improve.

When should I call my healthcare provider?

You should call your healthcare provider if you experience:

• Breathing problems.
• Chest pain.
• Difficulty concentrating.
• Extreme irritability.
• Insomnia.
• Panic attacks that last more than 15 minutes.
• Persistent anxiety that interferes with daily life or sleeping.
• Signs of sleep apnea like loud snoring or gasping for breath.

What questions should I ask my healthcare provider?

You may want to ask your healthcare provider:

• Why am I having panic attacks at night?
• What’s the best treatment for nocturnal panic attacks?
• How long will I need therapy?
• How long do I need to take medications?
• Should I look out for medication side effects?
• Should I watch for signs of complications?

A note from Cleveland Clinic

If you’re not sure if you’re having nocturnal panic attacks, don’t be embarrassed to talk to your healthcare provider. They can help you find the cause and offer treatments that can help. Therapy can teach you strategies to manage triggering events and prevent attacks during the day. Preventing panic attacks during the day should help get rid of panic attacks at night.