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Panic Attacks During the Night

written by: Emma Lloyd • edited by: Paul Arnold • updated: 5/11/2011

Can you have panic attacks in your sleep? The short answer to this question is yes, unfortunately you can. Sleep panic attacks aren’t necessarily the same as the kind you might have when awake, but they can be just as distressing.

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    Panic attacks can occur in your sleep, though the symptoms may be different than one during the day. Some may be unable to recognize or diagnose the problem, and this can be the most distressing part. It’s possible for someone to have sleep panic attacks even if they have never had daytime panic attacks, so the condition isn’t necessarily easy to diagnose.

    A night-time panic attack is simply a panic attack that occurs while you are asleep. It’s not quite that simple, however, as the emotions and physical sensations you might experience during a sleep panic attack can differ significantly from those you experience in a waking panic attack. That’s not always the case, of course, but it’s not at all uncommon for sleep panic attacks to be quite different.

    Many people with panic disorder have sleeping panic attacks, which might mean just one or a few attacks, or regular episodes at night for a long time. Overall, however, attacks that occur during sleep account for only a small proportion of all panic attacks.

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    Causes

    The exact nature of what causes panic attacks while sleeping has so far been difficult to determine. It is thought that the attacks are triggered as a result of responses to physical changes that occur during sleep, such as moving from one phase of sleep to another, or to changes in carbon dioxide levels that occur while sleeping. These physical changes are normal parts of sleep, but in someone with panic disorder the body responds in an abnormal fashion.

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    What do They Feel Like?

    Just like the panic attacks that occur while awake, those that occur while asleep can take different forms.

    One type of attack that might occur during sleep is that the individual wakes up with the feeling that a panic attack is about to happen. This can include all the typical symptoms of a waking attack, with the added confusion and disorientation of having just woken up suddenly. This type of attack can cause a significant feeling of disconnection from reality due to the rapid cycling from sleeping to waking, combined with the disconnection of a panic attack.

    In another type of attack, the person having the attack doesn’t wake up immediately, but instead remains asleep while part or all of the panic attack is occurring. Sometimes the person might have a panic attack similar to the one they might have while awake. In other cases symptoms that are entirely different from the normal waking symptoms might be experienced. These can include intense pain in the head or other parts of the body, intense feelings of pressure in the ears or lungs, teeth grinding, or other sensations.

    Someone who has this type of attack while sleeping might also be aware of being asleep. This is referred to as a lucid episode. When this happens the person might struggle to wake up, to try and end the attack, but be unable to do so.

    One or more episodes can cause significant distress and confusion, especially when the person doesn’t identify the episodes as sleep panic attacks. These feelings can easily lead to a fear of sleep or going to bed, which might turn into insomnia. Alternatively, someone might try to develop coping strategies such as sleeping at different times of the day, or sleeping in different locations.

    Ultimately, however, someone who experiences repeated episodes of panic attacks at night will require some form of treatment to reduce the frequency and severity of the attacks.

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    Treatment Methods

    For someone with panic disorder, treating sleep panic attacks is typically part of the overall treatment for the disorder. Treatment might include any combination of the following:

    • Medication
    • Talk therapy
    • Cognitive therapy
    • Self-care and coping strategies

    Many experts believe that therapy alone cannot cure panic attacks, so it’s important that treatment for panic disorder include multiple treatment types, whether the attacks occur when asleep or awake.

    Treatment doesn't always work to completely cure the attacks. Someone with panic disorder tends to still experience panic attacks, and the same is true of those that occur during sleep. Medication and other forms of treatment can, however, reduce the frequency and the severity of the attacks that occur.

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    References

    National Panic/Anxiety Disorder News: Anxiety & Panic Attacks Symptoms

    The London Sleep Center, Harley Street, London: Medical and Psychiatric Sleep Disorders

    The Mayo Clinic: Nocturnal panic attacks: What causes them?


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