Why Do I Wake Up With Panic Attacks at Night

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You jolt awake with your heart pounding, struggling to catch your breath, sweating, and filled with dread, with no memory of a bad dream. This may be a nocturnal panic attack, a panic attack that wakes you from sleep. These episodes usually happen during deep, non-dreaming sleep, often in the first few hours of the night, and they can be frightening and confusing because there is no obvious trigger. Nocturnal panic attacks are fairly common in people who also have daytime panic attacks, though some people only have them at night. They are not dangerous, and they respond to the same treatments as daytime panic.

It Could Be a Lot of Things

Nocturnal panic. The body's alarm system fires during sleep, possibly in response to subtle changes in breathing or heart rate, and the brain wakes in panic.

Nightmares. If you wake from a vivid frightening dream that you remember, it may be a nightmare rather than panic, as described on the page about nightmare disorder.

Sleep apnea. Pauses in breathing can cause sudden waking with gasping or choking, sometimes mistaken for panic. Snoring and daytime sleepiness are clues.

Reflux or other medical causes. Acid reflux, heart rhythm changes, low blood sugar, or medication effects can cause night waking.

Trauma. People with PTSD may wake suddenly with fear or memories, as described on the page about nightmares about the same event.

Hormonal changes. Night sweats in perimenopause can trigger waking with a racing heart and anxiety, as described on the page about anxiety in perimenopause.

Why Panic Can Strike During Sleep

During sleep, the body naturally shifts in breathing and heart rate. In people who are sensitive to body sensations, small changes may be read by the brain as danger, triggering the panic response. Daytime stress and anxiety can also leave the nervous system primed. After a few episodes, people may start dreading sleep, which increases arousal at bedtime and can create a cycle, as described on the page about why some people dread going to bed.

When It Looks More Like Panic Disorder

If nocturnal attacks happen repeatedly and you worry about having more, or if you also have daytime panic attacks, it may be part of panic disorder, as described on the page about panic attacks vs. panic disorder.

What Can Help

• During an episode. Remind yourself it is a panic attack and will pass, breathe slowly with a longer exhale, and ground yourself by noticing the room around you, as described on the page about what to do during a panic attack.
• Avoid checking or googling symptoms in the middle of the night, which can heighten fear.
• If you cannot fall back asleep, get up briefly, do something calm in dim light, and return when sleepy.
• Reduce stimulants. Limit caffeine, alcohol, and late heavy meals.
• Manage daytime stress with regular exercise and wind-down routines.
• Get checked. A physician can rule out sleep apnea, reflux, or heart issues.

When to Get Support

If nighttime panic attacks are frequent, affect your sleep, or make you afraid to go to bed, therapy can help. Cognitive behavioural therapy for panic, sometimes combined with CBT for insomnia, is effective, as described on the page about CBT for insomnia.

Getting Support at Pacific Maple Psych Centre

If panic attacks are waking you at night, therapy can help you understand them and sleep with less fear.