How to Cope With Panic Attacks at Night: What to Do When You Wake Up Terrified

You are asleep, and then suddenly you are not. Your heart is hammering, your chest is tight, you are drenched in sweat and a wave of terror is rolling through you. For a moment you are sure you are dying. There was no nightmare, no noise, nothing to explain it.

If this has happened to you, you are not alone, and you are not in danger of losing your mind. This is a nocturnal panic attack, and there is a lot you can do about it.

What is a nocturnal panic attack?

A nocturnal panic attack is a panic attack that wakes you from sleep. Michelle Craske and Jennifer Tsao, in a review of research on the topic, describe them as abrupt awakenings with intense fear and physical symptoms, occurring without an obvious trigger, and as relatively common among people who also have daytime panic attacks. They usually come during the lighter stages of sleep, often in the first few hours after falling asleep.

Typical symptoms:

• pounding or racing heart,
• shortness of breath or a feeling of choking,
• chest tightness,
• sweating, chills or hot flushes,
• trembling, dizziness or tingling,
• nausea,
• a sense of unreality or doom,
• fear of dying or going crazy.

They usually peak within about ten minutes and fade over the next 20 to 30 minutes, though you may feel shaky and alert for longer.

Why they happen

The alarm system fires in sleep

David Clark’s classic cognitive model of panic suggests that panic occurs when normal bodily sensations are misread as dangerous, setting off a loop of fear and more sensations. During sleep, a small sensation such as a heartbeat variation or a change in breathing may be noticed by a sleeping but still-sensitive alarm system, and the loop begins before you are fully awake. Because you wake up mid-surge, the fear is already high.

Underlying panic or anxiety

Many people with nocturnal panic also have daytime panic attacks or panic disorder, or they are under stress. High daytime stress, sleep deprivation and worry about having an attack can all raise the odds.

Sensitivity to body sensations

People who watch their bodies closely may react strongly to ordinary changes, which can be amplified at night when there are no distractions. See why anxiety feels physical.

Other contributors

Caffeine, alcohol, nicotine, some medications and irregular sleep can all play a part. Medical conditions and other sleep disorders can mimic panic (see below). See does caffeine cause anxiety.

What to do in the moment

1. Remind yourself what this is

Tell yourself: “This is a panic attack. It feels terrible, but it is not dangerous, and it will pass.” Panic is an intense burst of the body’s alarm system; it does not cause heart attacks or insanity. If you have never had a medical check, see your doctor afterwards (and see the safety note below).

2. Sit up slowly and turn on a light

Moving slowly helps if you feel dizzy. A lamp helps your brain recognise where you are. Waking in the dark can intensify disorientation.

3. Ground yourself in the room

Use your senses: name five things you can see, four you can touch, three you can hear. Press your feet into the floor. Hold something cool. This pulls attention from the internal alarm to the present. See how to calm anxiety fast.

4. Slow your breathing

Breathe in through your nose for about four seconds, then out slowly through pursed lips for six. Gentle, slow breaths help counter the over-breathing that often accompanies panic. Do not force deep gulps.

5. Let the wave pass

Struggling against panic tends to intensify it. Try to float: “I can let this wave come and go.” Many people find that accepting the sensations, rather than fighting them, shortens the episode. See how to stop a panic attack.

6. Don’t go online to check symptoms

Searching tends to feed fear. See how to stop googling your symptoms.

7. Get up if you can’t settle

After the peak, if you are still wired, get out of bed. Go to a dim, calm room and do something quiet: read a paper book, sip water, listen to calm music. Return to bed when sleepy. Lying there ruminating teaches your brain to associate the bed with alertness.

8. Be gentle with yourself

Afterward, you may feel drained and shaky. Remind yourself that you coped. Avoid “what if it happens again?” spirals; use slow breathing and a calming activity.

How to prevent more

Keep a steady sleep routine

Regular sleep and wake times, a wind-down routine and enough sleep reduce vulnerability. See how to build an evening routine for better sleep.

Cut back on triggers

Reduce caffeine (especially after noon), alcohol, nicotine and heavy late meals.

Manage daytime stress and worry

Schedule worry time, exercise, relax and talk about stress. See a gentle guide to worry time.

Reduce fear of the attacks

Fear of having another attack can itself keep you awake and primed. Learning what panic is, and practising not fighting the sensations, weakens the cycle.

Get treatment

Cognitive behavioural therapy for panic, which includes education, breathing retraining, and gradual exposure to feared body sensations, has strong evidence. Medication can also help some people. A doctor or therapist can guide you. See why do I feel more anxious at night.

When it might not be panic

Some conditions can cause night-time awakenings with a racing heart or breathlessness, so a medical check is sensible if the episodes are new or frequent:

• sleep apnoea (loud snoring, gasping or breathing pauses),
• night terrors or nightmares,
• acid reflux,
• heart rhythm problems,
• thyroid problems,
• low blood sugar,
• side effects of medications or substances.

Seek urgent medical care for chest pain, pain spreading to the arm or jaw, severe breathlessness, fainting or if you are unsure whether it is a heart problem.

A worked example

Dan wakes at 2 a.m. several times a month with a racing heart.

1. Name it: “This is panic. It will peak and pass.”
2. Light and slow movement: he turns on the lamp and sits up.
3. Grounding: he names five things he sees and presses his feet to the floor.
4. Breathing: in for four, out for six, for five minutes.
5. Let it pass: he stops fighting and notices the wave fading.
6. Settle: after twenty minutes he reads in a dim chair and returns to bed.
7. Prevention: he stops caffeine after noon, keeps a steady bedtime and sees his doctor, who rules out heart and thyroid problems and refers him for CBT.

After two months the attacks are rarer and less frightening.

Common mistakes

• Fighting the sensations. It tends to prolong them.
• Checking your pulse constantly. It fuels fear.
• Lying in the dark ruminating. Get up if needed.
• Avoiding sleep out of fear. It worsens sleep loss.
• Using alcohol to sleep. It disrupts sleep and can trigger night waking.
• Ignoring medical symptoms. Get a check.

When to seek help

Talk to a doctor or therapist if:

• panic attacks wake you repeatedly,
• you fear going to sleep,
• you have daytime panic attacks or avoid places or activities,
• you have symptoms of sleep apnoea or other sleep disorders,
• you drink or use substances to cope,
• you feel hopeless or have thoughts of harming yourself.

The National Institute of Mental Health has information on panic and anxiety disorders. If you are in crisis, contact your local emergency number or, in the United States, call or text 988. See our disclaimer.

Frequently asked questions

Can you have a panic attack in your sleep?

Yes. Nocturnal panic attacks wake you from sleep, usually in the lighter stages, with intense fear and physical symptoms.

How long does a night-time panic attack last?

Usually 5 to 20 minutes at peak, with lingering shakiness afterwards.

Is a nocturnal panic attack dangerous?

Panic itself is not dangerous, but get checked by a doctor, especially if it is new, and seek urgent care for chest pain or severe breathlessness.

What is the difference between a panic attack and a nightmare?

A nightmare is a vivid frightening dream that you remember; a nocturnal panic attack wakes you with fear and physical symptoms and often no dream content.

What should I do after a night panic attack?

Ground yourself, breathe slowly, get up if you can’t settle and return to bed when sleepy.

How can I stop them happening?

Keep a regular sleep schedule, reduce caffeine and alcohol, manage stress and consider CBT.

The bottom line

A panic attack at night is terrifying but not dangerous, and it follows a pattern: it peaks and it passes. Name it, turn on a light, ground yourself, breathe slowly, let the wave go and get up if you need to. Look after your sleep and stress, check with a doctor and consider CBT. With understanding, the nights become safe again.