Panic Disorder Symptoms What Are Nocturnal Panic Attacks? By Katharina Star, PhD Katharina Star, PhD Facebook LinkedIn Katharina Star, PhD, is an expert on anxiety and panic disorder. Dr. Star is a professional counselor, and she is trained in creative art therapies and mindfulness. Learn about our editorial process Updated on October 26, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Tetra Images / Getty Images Table of Contents View All Table of Contents Symptoms Causes Treatment Coping All panic attacks can be a frightening experience, but they can be even more terrifying if they startle you out of your sleep. Known as nocturnal panic attacks, these attacks can potentially contribute to sleep disturbances and leave you feeling tired throughout your day. Symptoms Nocturnal panic attacks can occur with no obvious trigger and awaken you from sleep. Somatic sensations, such as sweating, heart palpitations, and chest pain are common. Strong emotions combined with troublesome physical sensations may contribute to fear that the attack will lead to a loss of control over oneself. As with panic attacks during the day, nocturnal panic attacks occur when a person experiences four or more of the following symptoms: Chest pain Chills or hot flushes Choking feeling Derealization or depersonalization Feeling dizzy, lightheaded, or faint Fear of dying Fear of losing control Feeling of being smothered Nausea or abdominal pain Numbness or tingling sensation Palpitations or fast heart rate Shortness of breath Sweating Trembling or shaking Even though panic attack symptoms typically reach a peak within a few minutes before gradually subsiding, the effects of the attack can impact the person much longer. Excess worry and fear associated with this experience can often lead to insomnia. Panic attacks are most commonly associated with panic disorder but have also been known to occur along with other mental health conditions, such as depression, post-traumatic stress disorder (PTSD), agoraphobia, and specific phobias. How to Recognize and Cope With Panic Attack Symptoms Causes Researchers are still trying to understand why some people experience nocturnal panic attacks. What they do know is that nocturnal panic attacks are frequent in people with panic disorders. Up to 71% of people with daytime panic attacks report experiencing a nocturnal panic attack at least once. That said, experts have identified some factors that can make a person more likely to have nocturnal panic attacks: A chemical imbalance in the brain Family history of panic attacks Major life stress Traumatic events Underlying conditions, such as depression or social anxiety disorder Most nocturnal panics take place during non-REM sleep, primarily in stages 2 and 3. This means they're not a response to Stage 4 sleep terrors. This also means that nocturnal panic attacks are different from nightmares, which mostly occur during REM sleep. Risk Factors Associated With Panic Disorder Treatment Whether you are experiencing panic attacks that interrupt your sleep or that occur during your waking hours, help is available. Many people choose to start the recovery process by scheduling an appointment with their primary care physician. Your doctor can assist you by ruling out other medical and sleep conditions. They can also discuss your treatment options, which typically involve psychotherapy, medications, or a combination of both. Psychotherapy Cognitive-behavioral therapy (CBT) has been found effective in treating both daytime and nocturnal panic attacks. In CBT, a therapist helps a person understand and confront their symptoms in a safe environment. CBT empowers people with techniques to better manage their panic-induced anxiety and develop better sleep hygiene. CBT for Panic Disorder Prescription medications In addition to or instead of therapy, a doctor may prescribe one or more medications to help treat anxiety. Treatment with selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines has been shown to be especially effective in treating people who have nocturnal panic attacks. Panic attacks are often treated with prescribed medication. Medications such as antidepressants and anti-anxiety drugs may assist in lessening the frequency and intensity of nocturnal panic attacks. Coping The biggest problem with nocturnal panic attacks is that, because they happen without warning, you're unable to prepare or "talk yourself down." Though it may seem like things are out of your control, there are several things you can do to manage your attack and get back to sleep: Learn how to control your breathing Practice positive self-talk Talk to a friend or family member Relax your muscles Though these steps can help, it's important that you seek professional help if your panic attacks are becoming more frequent or they are impacting other aspects of your life. How to Get Through a Panic Attack A Word From Verywell Daytime panic attacks on their own are immensely stressful events. Experiencing a panic attack at night can be downright terrifying. But the good news is that help is available. If you believe you are having nocturnal panic attacks, talk to your doctor or mental health professional. There are many effective treatments and strategies that help people overcome both daytime and nocturnal panic attacks. With the help of your doctor, you can find the treatment that is most effective for you. The Best Online Anxiety Support Groups 5 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Craske MG, Tsao JCI. Assessment and treatment of nocturnal panic attacks. Sleep Med Rev. 2005;9(3):173-184. doi:10.1016/j.smrv.2004.11.003 Hauri PJ, Friedman M, Ravaris CL. Sleep in patients with spontaneous panic attacks. Sleep. 1989;12(4):323-337. doi:10.1093/sleep/12.4.323 American Psychiatric Association. Practice guideline for the treatment of patients with panic disorder. Craske MG, Lang AJ, Aikins D, Mystkowski JL. Cognitive behavioral therapy for nocturnal panic. Behav Ther. 2005;36(1):43-54. doi:10.1016/S0005-7894(05)80053-X Nakamura M, Sugiura T, Nishida S, Komada Y, Inoue Y. Is nocturnal panic a distinct disease category? Comparison of clinical characteristics among patients with primary nocturnal panic, daytime panic, and coexistence of nocturnal and daytime panic. J Clin Sleep Med. 2013;9(5):461-467. doi:10.5664/jcsm.2666 Additional Reading American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC; 2013. By Katharina Star, PhD Katharina Star, PhD, is an expert on anxiety and panic disorder. Dr. Star is a professional counselor, and she is trained in creative art therapies and mindfulness. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for Panic Disorder Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.