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If this is your first episode, or you have chest pain, pain spreading to your arm or jaw, or you are fainting, please seek immediate emergency care.
Waking Up in a Panic Attack (Nocturnal Panic Relief)
Waking up gasping, shaking, or with a racing heart at night? See what the sources say about night-time panic, how to calm down in bed, and when to see a doctor.
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Do this first, read later
- 1Stay where you are, if possible.
- 2Breathe slowly and deeply: in through your nose, out through your mouth.
- 3Focus on positive, peaceful and relaxing images.
- 4Remind yourself that the attack will pass and that it is not life threatening.
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What a nocturnal panic attack is
Craske and Tsao define nocturnal panic as waking from sleep in a state of panic. In their review of the research they describe it as a common occurrence among patients with panic disorder, with 44 to 71 percent reporting at least one such attack. The National Institute of Mental Health (NIMH) likewise says that panic attacks can occur at any time, sometimes even during sleep.
The NHS describes a panic attack as a rush of intense mental and physical symptoms that can come on very quickly and for no apparent reason. Its list includes a racing heartbeat, sweating, nausea, chest pain, shortness of breath, trembling, chills, dizziness and a feeling of dread or a fear of dying. Waking into those symptoms can be frightening.
What the research says about panic during sleep
Craske and Tsao describe nocturnal panic as a non-REM event that is distinct from sleep terrors, sleep apnea, nightmares and dream-induced arousals. So a night-time panic attack is described as a different thing from a nightmare.
They also report that more recent studies suggest patients with nocturnal panic do not differ from patients without it on sleep architecture, sleep physiology, self-reported sleep quality or severity of panic disorder. The sources on this page do not explain exactly why a panic attack happens during sleep. The NHS says the exact cause of panic disorder is not fully understood.
How to calm down without leaving bed
The NHS suggests these steps when you feel a panic attack coming on. They fit in bed as well as anywhere else. Cleveland Clinic lists similar ones.
- Stay where you are, if possible (NHS).
- Breathe slowly and deeply. Cleveland Clinic suggests breathing in as slowly, deeply and gently as you can through your nose and out slowly through your mouth.
- Remind yourself that the attack will pass, and remember that it is not life threatening (NHS).
- Name what is happening. Cleveland Clinic says knowing that you are having a panic attack, and not a dangerous health episode, can help manage the fear.
- Focus on positive, peaceful and relaxing images (NHS).
- Relax your muscles one muscle group at a time, and focus on the present: the feel of the mattress, the weight of the blanket, the sounds in the room (Cleveland Clinic suggests relaxing muscles and mindfulness).
Getting back to sleep afterwards
The sources on this page do not give sleep advice for after an attack, so this page keeps it simple. Once the worst has passed, stay somewhere comfortable and quiet and let your body settle.
The NHS says that sugary food and drinks, caffeine, alcohol and smoking can all make panic attacks worse, so it is sensible to avoid them. Cleveland Clinic also lists caffeine, alcohol and smoking among things to avoid.
Nocturnal panic or something else?
Panic is not the only thing that can wake you suddenly at night. The NHS says most panic attack symptoms can also be symptoms of other conditions or problems, so you may not always be having a panic attack. Cleveland Clinic says a healthcare provider may run tests to rule out conditions that cause similar symptoms, such as heart disease, thyroid disease and respiratory (breathing) problems.
The NHS describes sleep apnoea as a condition in which your breathing stops and starts while you sleep. Its listed symptoms are your breathing stopping and starting, gasping, snorting or choking noises, waking up a lot and loud snoring, and during the day feeling very tired, finding it hard to concentrate, mood swings, or a headache when you wake up. The NHS says it can be hard to tell if you have sleep apnoea, and that it may help to ask someone to stay with you while you sleep so they can check for the symptoms.
When to see a doctor
Cleveland Clinic says that if you have chest pain, trouble breathing or lose consciousness, you should seek emergency medical care, and that you should call a healthcare provider if panic attack symptoms last longer than 15 minutes.
The NHS says to see a GP if you make gasping, snorting or choking noises while you sleep, your breathing stops and starts while you sleep, or you always feel very tired during the day. It also says to see a GP if you have been experiencing symptoms of panic disorder.
If you ever have thoughts of harming yourself, contact emergency services or a crisis line straight away. In the U.S., call or text 988, and in a life-threatening situation call 911 (NIMH).
If night-time panic keeps coming back
This page is self-help and cannot say what is behind your night-time episodes. If they keep happening, talk to a GP or your own doctor, who can explain what options exist for you. The NHS says panic disorder is treatable, so it is best to get medical help as soon as you can.
Breathe with the circle: 4 in, 6 out
Breathe in through your nose for 4 and out through your mouth for 6, gently and without forcing it. Keep going for a couple of minutes.
Frequently Asked Questions
Are night panic attacks different from daytime attacks?
Craske and Tsao define nocturnal panic as waking from sleep in a state of panic, and describe it as a non-REM event that is distinct from nightmares. NIMH says panic attacks can occur at any time, sometimes even during sleep.
Should I stay in bed or get up?
The NHS advice for a panic attack is to stay where you are, if possible. The sources cited here do not give advice about getting up. If you have chest pain, trouble breathing or lose consciousness, seek emergency medical care instead (Cleveland Clinic).
Why do I wake up in the night with my heart racing?
It could be a panic attack, since the NHS lists a racing heartbeat among the symptoms, but the NHS also says most panic symptoms can be symptoms of other conditions. If you also make gasping or choking noises or your breathing stops and starts, the NHS says to see a GP about sleep apnoea.
Can a nocturnal panic attack be dangerous?
The NHS says panic attacks are frightening but not dangerous, and Cleveland Clinic says attacks by themselves are not dangerous or harmful to your health. A doctor can check that nothing else is causing your symptoms, especially if the episodes are new or come with chest pain.
Will I be scared to go to sleep now?
The NHS describes a cycle of living "in fear of fear" after panic attacks, and Cleveland Clinic says the fear of having a panic attack is often enough to trigger one for some people. If worry about the next night is affecting you, talk to a GP or your own doctor.
Sources
- Assessment and treatment of nocturnal panic attacks (Craske & Tsao, 2005) — Sleep Medicine Reviews
- Panic disorder — NHS
- Sleep apnoea — NHS
- Panic Disorder: What You Need to Know — National Institute of Mental Health (NIMH)
- Panic Attacks & Panic Disorder — Cleveland Clinic
Last reviewed . This guide is general information based on the sources above and is not a substitute for advice from a doctor or mental health professional who knows your situation.
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