Why do I wake up with a panic attack?
A nocturnal panic attack wakes you from sleep with a racing heart and dread, with no dream behind it. One explanation is that a body in alert mode reads the normal breathing and heart rate shifts of deeper sleep as a threat.
Try the practice nowWhat happens in your sleep
A nocturnal panic attack is a panic attack that wakes you suddenly from sleep. Your heart pounds or races, your breathing speeds up, and you can feel like you cannot get enough air. You may also sweat, shake, feel hot or cold flushes, and wake with a strong sense of dread.
These attacks usually happen in the first few hours of sleep, during non-dreaming sleep. As you sink into deeper sleep, your breathing and heart rate shift. A body that has been in alert mode for weeks can read those normal shifts as a threat and sound the alarm.
Nightmares are different because they come from dreaming sleep later in the night, and you remember the dream. A nocturnal panic attack wakes you straight into the physical surge with no dream and no obvious trigger.
Why waking in panic feels terrifying
Waking straight from deep sleep into a pounding heart, shaking, and short breath feels alarming because nothing in your room or your thoughts explains why your body is racing.
A panic attack is not dangerous. It does not stop your heart or your breathing, and it passes. Most panic attacks last between 5 and 20 minutes, and they build to a peak and then settle even when they feel endless.
When you wake in panic, switch on a dim light, slow your exhale, and remind yourself that the wave peaks and passes. Leave the clock and your phone alone: checking them keeps you wired.
Why it happens after calm days
After weeks of anxiety, the body can stop switching between rest mode and alert mode and stay in alert mode. Because the body holds that state, a nocturnal panic attack can happen after a calm day, even when you went to sleep feeling fine.
After waking in panic a few times, many people start to fear going to sleep or try to stay awake. That extra pressure keeps your system on guard at bedtime and makes sleep lighter.
This state is trainable with daily practice. Panic attacks are also treatable, mainly with talking therapy (CBT).
Try the Physiological Sigh in bed
- Lying in bed or wherever you are, take a full breath in through your nose into the back of your chest and ribcage.
- When it feels full, top up with an extra sip of air through your nose.
- Let it all go in a completely relaxed exhale, with an audible sigh if you like.
- Do three in a row, and pause for a moment after each to let it settle.
When to check with a doctor
- You snore loudly, gasp or choke in your sleep, or someone notices pauses in your breathing (signs of sleep apnea).
- You have chest pain, or your heartbeat stays fast or irregular after the panic settles (call emergency services for chest pain).
- You wake breathless and have to sit up to breathe, or your ankles are swollen.
- You take insulin or diabetes tablets that can cause low blood sugar at night.
- It happens most nights, or you have started avoiding sleep.
- You often wake drenched in sweat, or you have a fever or weight loss.
- You feel low or have thoughts of harming yourself (in the US call or text 988, in the UK and Ireland call Samaritans on 116 123).
- You have never had these night-time symptoms checked.
Practice with the Stateshift app
Common questions
How do I tell a nocturnal panic attack apart from sleep apnea?
Sleep apnea can also wake people gasping for air. Its signs are loud snoring, pauses in breathing that someone else notices, waking with headaches and feeling very sleepy in the day. A doctor can check for sleep apnea if any of those signs fit.