It’s the middle of the night and you suddenly wake up, terrified. You don’t know why. It seems like nothing has triggered your anxiety — after all, you were sound asleep! During sleep, your body is supposed to rest and rejuvenate. Instead you are anything but relaxed. Just as with a daytime panic attack, this nocturnal anxiety causes physical symptoms such as shortness of breath, heart palpitations, sweating, shaking, hyperventilation, and flushing. Some people feel a sense of dread.
Not everyone who has panic disorder experiences nocturnal anxiety, and those who do don’t necessarily have panic attacks during the day. According to a study published in the Journal of Clinical Sleep Medicine in 2013, nocturnal panic may be a distinct subgroup of panic disorder rather than being a milder form.
Is there a connection between sleep disorders and nocturnal panic?
No one knows for certain why some people experience nighttime panic attacks. One study explored whether such panic could be a result of difficulty breathing. These researchers found the participants did not have habitual snoring or sleep apnea and the panic was not caused by nightmares, night terrors, external noises, or other interruptions in the sleep.
Even if sleep disorders don’t cause nocturnal panic, they might play a role in frequency. A study published in the Global Journal of Medical Research found that people with nocturnal panic had more problems both falling asleep and staying asleep. One possible cause was avoidance. This is similar to people with panic disorder avoiding certain places, such as crowded malls, because they fear having a panic attack. Those with nocturnal panic might fear going to sleep, concerned that they will wake up in terror. Lack of sleep, however, can increase feelings of anxiety and could potentially lead to more frequent panic attacks, both during the day and at night.
According to French sleep expert Luc Staner’s article Sleep and Anxiety Disorders, published in Dialogues in Clinical Neuroscience, the loss of control during sleep could be a contributing factor. An unconscious feeling of lack of vigilance and the inability to know what is going on around you can cause you to stay in a heightened state of arousal while sleeping. This feeling that you are not in control of your surroundings might trigger a panic attack, even though you aren’t aware of your thoughts.
Treatment for nocturnal panic is the same as for daytime panic. A combination of medication and cognitive behavioral therapy can help. Some people might think that CBT, which works to reframe your thinking, won’t help because these panic attacks occur when you are sleeping and therefore can’t control your thoughts. However, if nocturnal panic is caused, even in part, by the feeling of a loss of control, learning to think of sleep in a different way could help. In addition, CBT can teach you ways of coping with and managing the panic when you do wake up, possibly helping you get back to sleep faster.