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Can You Have Panic Attacks While Sleeping?

Panic attacks are intensely frightening events. They can hit you at any moment, and when they do they can completely wipe out your day. Many people find that the only time they get a break from either panic attacks or thinking about panic attacks is when they go to sleep.

But for some people, the fear doesn't stop there. While not as common, some people experience panic attacks while sleeping. This terrifying event will throw you awake and cause you immense fear and distress, but as usual the only thing that's wrong is that you suffer from anxiety.

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The Worst Type of Panic Attack

All panic attack types are incredibly stressful, and can make it much harder to go about your daily life. If you haven't taken my anxiety test to learn more about panic attacks, do so now. These attacks cause physical symptoms and mental symptoms that are so problematic they can cause people to fear leaving their own home.

But arguably nighttime panic attacks are the worst type of panic attacks, because they cause significant distress that not even a daytime panic attacks may cause:

  • They hit you by surprise with no warning.
  • They wake you up from sleep when your thoughts aren't entirely formed.
  • They prevent you from going back to sleep and cause sleep deprivation.
  • They create significant health fears.
  • They may cause you to fear sleep in the future.

Panic attacks are frightening enough. When it happens while you sleep out of the blue, it can be devastating – and may even hurt your relationships.

What Causes Sleeping Panic Attacks?

Even though the panic attack is said to occur while you sleep, the idea that it's a "sleeping panic attack" may be a little misleading. No one sleeps through these panic attacks, and the actual attack wakes you up and causes significant fear and disorientation.

There are many possible causes of panic attacks while you sleep. Not everyone that gets panic attacks is going to get them while sleeping, because normally the mind is what triggers the attacks and your mind is essentially not focused when you are awake. That means only those that have specific additional issues are likely to suffer from these attacks while sleeping. These issues include:

Sleep Apnea

Sleep apnea – also known as obstructive sleep apnea – is a common cause of sleeping panic attacks. Sleep apnea is actually a fairly common medical condition, and it occurs when something obstructs breathing in the upper airway.

This is most common in the overweight, but it rare cases it can affect those without a weight issue. The weight of the individual's neck prevents breathing in the throat. This can last as long as 30 seconds, and it's known as hypoventilation (or "not breathing" – not to be confused with hyperventilation, which is a common panic attack problem). Hypoventilation causes significant stress on the heart and has symptoms that are very similar to a heart attack.

Those without panic disorder tend to wake up and go back to sleep. Sleep apnea is actually one of the leading causes of poor sleep quality, because those with sleep apnea often have no idea they are waking up so often in the middle of the night. They wake up so briefly that their brain doesn't even wake up with it, and they go back to sleep without any memory that they woke.

But those with panic disorder don't have that luxury, because their minds and bodies are in a constant state of awareness or fear over how they feel. When they stop breathing because of hypoventilation they notice. They then wake up and the fear causes them to breathe too quickly, expelling too much carbon dioxide while taking in too much oxygen. This is known as hyperventilation, or "over breathing."

Hyperventilation is what causes most panic attack symptoms, including rapid heartbeat, chest pains, light headedness, shortness of breath, and more. The person ends up having a terrible panic attack that wakes them up from the night and prevents them from going back to sleep.

For these reasons, those with panic disorder are far more sensitive to sleep apnea than those without panic disorder, and this is what causes their severe panic attacks.

GERD – Gastroesophageal Reflux Disease

Acid reflux disease, also known as GERD, has also been linked to sleeping panic attacks. GERD itself is an irritating but fairly benign disorder. But it can affect you in your sleep, especially if you ate too closely before going to bed. Lying down after eating increases GERD symptoms considerably, and each of these symptoms is a trigger of panic attacks:

  • Chest pains
  • Stomach pressure
  • Light headedness
  • Night sweats
  • Hyperventilation

Some people also have trouble breathing, sore throats, and other issues that can become panic attack triggers. Many of those with nighttime GERD do not notice that they have any symptoms at night unless they wake up, and even if they wake up they simply deal with the discomfort and go back to sleep.

But others are not so lucky, and it's possible that their anxiety and GERD creates powerful panic attacks.

Hyperventilation Syndrome

Hyperventilation syndrome is another disorder that has been linked to causing and contributing to panic attacks. In fact, some believe that panic attacks cause hyperventilation syndrome to turn into its own separate condition – a condition that eventually triggers panic attacks.

Hyperventilation syndrome is when your body essentially breathes "too shallow." The problem with shallow breathing is not that you are getting an inadequate supply of oxygen. The problem with shallow breathing is that you are letting out too much carbon dioxide. Carbon dioxide is needed in your body for it to operate, and when you breathe too shallow you don't give your body enough time to create carbon dioxide while breathing out the CO2 still inside of your body.

Most people with hyperventilation syndrome have no problems sleeping at night, so this isn't the most common cause of panic attacks while sleeping. But some people's hyperventilation disorder is so problematic that they do take shallow or fast breaths at night, start to hyperventilate, and ultimately trigger a panic attack.

Nightmares, Night Terrors, and Night Anxiety

Finally, anything that can cause you anxiety while you sleep can also conceivably cause panic attacks. Once again, it's a problem with hyperventilation. While having a nightmare, for example, you may be reacting to your dream by breathing quickly as though scared or running. This can cause you to hyperventilate in your sleep, when wakes you up and triggers a panic attack.

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It doesn't matter what causes your panic attacks. If you learn to control your anxiety, your panic attacks will stop during the day and at night.

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How to Respond to Sleeping Panic Attacks

Sleeping panic attacks are harder to control than daytime panic attacks because there is no warning. You can't take what you've learned and apply it to stop your panic attack from happening, nor can you distract yourself or prepare yourself so that the panic attack is less severe. Sleeping panic attacks hit you by complete surprise, and often occur at a point in your sleep when your disorientation prevents you from thinking critically about what's happening.

The good news is that since many panic attacks that occur while sleeping have an underlying issue that can be addressed, you can first start combatting these issues and see if it improves your long term outlook with nighttime panic disorder. For example:

  • Eat Healthy/Exercise, Etc. Sleep apnea (and to a lesser extent, GERD) are often caused by excess weight. Talk to your doctor about developing some type of weight loss or health plan that can reduce sleep apnea if it occurs. You'll find that if you do have sleep apnea and you can burn off some of that excess weight and prevent the apnea from occurring, your panic attacks will stop with it. In addition, exercise is extremely valuable for fighting anxiety, so you may find it has several benefits for your daytime stress as well.
  • Antacids and Acid Reflux Treatments If you have GERD, you can try something similar. Talk to your doctor and see if you qualify for a GERD diagnosis. If so, antacids and many over-the-counter acid reflux treatments can be highly valuable at controlling some of the symptoms of GERD while you sleep. You should also make the lifestyle changes (like not eating before you go to bed) that are effective for controlling GERD.
  • Panic Attack Reminder Sheet Finally, consider putting something near where you sleep that can help you talk yourself down when you wake up with a panic attack. Some sort of inspirational reminder or "how to" list to calm yourself down when you wake up in a panic is important. Also, if you find that you can't go back to sleep, try to go out into your home and do something fun. Distract yourself. Remind yourself that you had a panic attack, everything is okay, and all you need to do is calm down. Fighting your panic attack and trying to go back to sleep while stressed often doesn't work.

Since these anxiety attacks occur at night and are generally not in your control, they are not easily preventable while you still deal with panic attacks and their triggers. Nevertheless, the above tips should help you improve your ability to control panic attacks while you look for a treatment that deals with them directly.

How to Stop Anxiety and Panic

Of course, even if you reduce the frequency of your nighttime panic attacks, you are still going to find yourself suffering if you continue to deal with panic disorder. That's why you need to make sure that you find the appropriate long term treatment for reducing the frequency and severity of your panic attacks and doing whatever it takes to prevent them from coming back.

I've worked with hundreds of people suffering from both daytime and nighttime panic attacks in the past. No matter what you are suffering from, you need to start with my free anxiety test. Using your symptoms it will devise a plan that will help you stop your anxiety forever.

Start the test here.


Ley R. Panic attacks during sleep: a hyperventilation-probability model. J Behav Ther Exp Psychiatry. 1988 Sep;19(3):181-92.

Lopes, Fabiana L., et al. Nocturnal panic attacks. Arquivos de neuro-psiquiatria 60.3B (2002): 717-720.

Craske, Michelle G., and Jennie CI Tsao. Assessment and treatment of nocturnal panic attacks. Sleep Medicine Reviews 9.3 (2005): 173-184.

Sarísoy, Gökhan, et al. Panic disorder with nocturnal panic attacks: symptoms and comorbidities. European Psychiatry 23.3 (2008): 195.

Author: Micah Abraham, BSc Psychology, last updated Sep 28, 2017.

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