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Panic Attacks at Night: Why They Happen and What You Can Do



Friday, 19th October 2018

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Found yourself with a frightening rush of anxiety just as you’re nodding off? Or awoken by a panic-stricken jolt in the dead of the night?

Night-time panic attacks can be terrifying and they’re a lot more common than you might think. It’s believed that between 50 - 70% of people suffering Panic Disorder will suffer at least one panic attack during the night, but many will experience much more than this. It’s also possible to have multiple panic attacks in the space of just one night.

Whether this is your first - or one of many - panic attacks can be extremely scary.

What is a panic attack?

Panic attacks are characterised by a sudden onset of overwhelming fear or dread, and usually bring a barrage of unpleasant physical symptoms in their tow. These might include any of the following:

  • Hot/cold sweats
  • Rapid heartbeat (sometimes so much so that it feels like you’re having a heart attack)
  • Hyperventilation and shortness of breath
  • Changes in temperature e.g. suddenly feeling boiling hot or ice cold
  • Chest pains
  • An impending sense of doom
  • Feeling of being out of control or ‘out of your body’

Panic attacks usually won’t last much more than 10 mins but the after-effects (which can be emotional, physical, and cognitive) can stay long after the attack has passed.

Night-time panic attacks - sometimes referred to as ‘nocturnal panic attacks’ - can happen both when you’re ‘relaxing’ and trying to get to sleep but they can also strike bang in the middle of your sleep.

But surely bedtime is when we’re meant to be at our most relaxed? Unfortunately, it’s not as simple as that.

Let’s take a closer look.

Panic attacks in the middle of the night: why do they happen?

The most simple answer is: the brain is always active. In other words, it doesn’t switch off. Yes, that’s right - even when we’re sleeping.

Night-time is normally the time of day when we’re left alone to our own devices. During the day it’s easier to distract ourselves from worries and unpleasant thoughts than it is in the quiet of the night. If we’re someone that’s prone to anxiety, has a lot of pent-up worries or we’re currently under a lot of stress the likelihood is that we end up going to bed feeling anxious. This alone sets the brain onto ‘high alert’, and it remains this way whilst we’re sleeping too.

In high alert, your brain is essentially in ‘protection mode’ constantly looking out for threats, and this includes any changes it senses in the body. So if you went to bed feeling wired, when the body begins to relax as it naturally does when we sleep, it might perceive this as something dangerous and create a stress response.

So as strange as it might sound, panic attacks are actually your body’s way of trying to protect you.

Night Terrors

Panic attacks that happen whilst you’re asleep are usually caused by (the aptly named) Night Terrors. Night Terrors are considered to be a form of parasomnia, a sleep disorder which impacts the nervous system causing unusual behaviour.

Night Terrors are essentially episodes of intense fear whilst sleeping, and usually happen in the first third to first half of the night. You might awaken from a Night Terror with a frenzy of intense physical symptoms which cause you to panic, initiating the onset of a panic attack.

But what about when you have panic attacks at night before bed?

As mentioned above, night-time is often the time when we start processing all the stresses of the day, or worrying about the day ahead. Panic attacks before you go to sleep usually happen during stressful moments in life when we have something heavy weighing on our mind. Maybe it’s relationship worries, the pressures of work have been adding up, or perhaps we’re moving through a period of change that feels very overwhelming.

Once we’ve had one panic attack, the worry that it might happen again can create a vicious cycle where we start to fear falling asleep. Whilst this kind of reaction is a normal, human response, unfortunately it often ends up creating more anxiety in long run.

What to do if you're having a panic attack at night

If you’re having a panic attack, the NHS suggest taking the following actions:

  1. Close your eyes, and breathe slowly and deeply in through your nose.
  2. Next, exhale slowly and deeply through your mouth.
  3. If you can, continue this process as long as it lasts, counting 1 - 5 on each inhale and exhale.

A useful practice to memorise is the AWARE method. Aware stands for:

Accept that you’re having a panic attack, without any resistance. When we try to fight anxiety, we only exemplify it. It might feel scary, but try moving towards the anxiety rather than away from it.
Watch the anxiety. Where is it in your body? What kind of sensations does it bring up?
Act as if nothing is happening. Tricky, I know - but try to act as normal as you possibly can. Take deep breaths and remain calm. Stay present and feel all of the feels as you move through it. Remember, it will end.
Repeat all of the steps above until you start to feel the intensity of it dissipate.
Expect good! You can do this. Although it might not feel like it, nothing bad is going to happen. Panic attacks are horrible and scary but they will never harm you.

The most important thing to take away is that we actually end up giving anxiety more power when we attempt to avoid it or distract ourselves from what’s happening. Moving closer to it, we take back the control and allow ourselves the opportunity to realise that no matter how uncomfortable it is, nothing bad is going to happen. Feel the fear, all of it - and let it wash right over you.

Here’s what to do if you’ve just had a panic attack.

OK, the worst of it’s over. Just remember that your body is on high alert right now so it’s probably going to take a while to wind back down again. This means sleep is probably out of the question for a while, and that’s fine. No one enjoys tossing and turning in bed so embrace that you’re awake, and get up and about. Go to the bathroom, and splash some cold water on your face. The cold provides a shock to the system which encourages the body to go into survival mode, ultimately lowering your heart rate.

Next, try and find a really practical, mundane task you can do. When you change your physical location it’s easier to move your energy elsewhere. Try clearing out the dishwasher, sweeping the floor, tidying the fridge… Whatever it is, make it as boring and mundane as possible - something that gets you right back into your body and doesn’t require much brainpower. Remember, you’re not trying to distract yourself here you’re just getting on with normal run-of-the-mill stuff whilst the symptoms start to drift away.

If you woke up in a sweat, have a nice warm shower, put some new sheets on the bed and change into your comfiest, cleanest PJs. Removing the physical evidence let’s you start afresh and get back to your sparkling best as quickly as possible.

Gradually, you’ll start to feel your body start to relax. Return to bed only when you feel ready. If it’s not time yet, try meditating or taking some long, deep breaths until your body starts to wind down back down again.

How to stop nocturnal panic attacks

To stop panic attacks, the best thing you can do is learn better ways of managing your general anxiety. We spoke to one of our psychotherapists, Christine Retson Hogg, who said,

“We are shaped, or pushed on by genomes, genetic inheritance, our temperament, and our upbringing, our problems, handicaps, conflicts and fear. But if we have a brain and want change then we can do something about our problem. The cause for the effect is vital, if we have the courage to face ourselves and the challenges of our human life, we may be frightened but we can change with the aid of good therapy”.

Speaking to a therapist can help you treat the root of your anxiety, and find tools and techniques to create real, lasting positive changes in your life.

In the meantime, creating a positive night-time routine can help create a nourishing environment to naturally wind down and prepare the body for sleep:

  1. Try talking to a partner, family member or friend about the things that are worrying you so you don’t give them space to fester. No matter what it is, it’s always better out than in.

  2. Have a bath or warm shower before you go to bed. The warmth will help ease your muscles, and relax your body before bedtime.

  3. Keep a pen and paper handy on your bedside table. If you start worrying about things, write them down (or add them to a list on your phone). Worrying about things at night-time when you can’t do anything about them is fruitless. By writing them down, you can come back to the important stuff at a more constructive time.

  4. Cut out alcohol for the time-being. Whilst alcohol can temporarily cloud our worries, it’s also a major anxiety trigger. Same goes with caffeine. Limit alcohol and make sure you don’t drink any tea or coffee post-5pm.

  5. Keep active. Never overlook the importance of exercise when it comes to both physical and mental well-being.

  6. Next time you’re struggling to get to sleep, try taking your focus away from getting to sleep and instead move it to you physical sensations. Think about how deliciously comfortable it is to be in bed.

  7. When stressful thoughts arise, imagine yourself locking them up in a little box and throwing away the key. Remind yourself: now’s not the time.

  8. Set yourself a designated ‘worry time’. This is a whole half an hour of the day when you allow yourself to worry about as many things as you want. When you start worrying outside of this time, remind yourself to put it to rest until your next time worry time.

  9. If you find yourself struggling to get to sleep for a long time, get up and out of bed until you start to feel drowsy again. Bed should become your sleep sanctuary and it’s important that you don’t start relating it to any anxious, sleepless nights.

  10. Some people find that certain foods can trigger their anxiety. Next time you have a panic attack at night, try and write down what you ate before you went to bed. You might start to see a pattern with specific food groups, and find that cutting them out helps.

When to seek help

If you’re suffering panic attacks, then your baseline anxiety levels are probably very high. Please remember: you don’t have to go through this alone. Reach out for support if your panic attacks have started to interfere with your enjoyment of everyday life. This might include any of the following things happening:

  • They’ve become frequent.
  • Panic attacks are impacting your sleep pattern.
  • Lack of sleep means that you’re feeling the affects in the daytime too.

Read more about panic attacks, and the different ways therapy can help you overcome them here.

Looking for a therapist? Find a therapist in your area.