Last reviewed:
Feb 17th 2023
M.A., LPCC
Nocturnal panic attacks are a common symptom of panic disorder that occur at night, potentially causing ongoing sleep disturbances. Symptoms are similar to daytime panic attacks but may vary slightly and are typically treated with therapy and medication.
Nocturnal panic attacks are panic attacks that happen while asleep, causing the individual to wake up at night with a feeling of intense fear, and may be a severe symptom of panic disorder [1].
Panic disorder is a common psychiatric condition, characterized by regular panic attacks and an ongoing fear of the reoccurrence of a panic attack [2]. Research suggests that up to two thirds of people with a diagnosis of panic disorder experience day and nighttime panic attacks, although there are many cases of people experiencing only nocturnal panic attacks with none during the day [1][3].
There is also research to suggest that nocturnal panic may be a distinct disorder with differing causes and risk factors [4][5]. Studies show that the severity and prevalence of certain symptoms and the prevalence amongst age groups and genders differ between those with only nocturnal panic attacks compared to those with nocturnal and daytime panic attacks or only daytime panic attacks [3][6].
For example, panic disorder is more common in females than males, typically emerging in early adulthood [2], but nocturnal panic attacks without daytime panic attacks, is more common in males and above the age of 40 [5]. Similarly, people with only nocturnal panic attacks may require different treatment to those with only daytime or daytime and nocturnal panic attacks [7].
As such, further research into these conditions is required to ascertain a clear picture of the causes, severity, and treatment of nocturnal panic attacks. These differences also highlight the importance of seeking professional advice and treatment to ensure symptoms are managed appropriately and effectively [5][7].
Symptoms of nocturnal panic attacks are similar to those of a daytime panic attack, although studies have found that there is a greater occurrence of breathing difficulties and choking sensations during nocturnal attacks [4][6][8].
Other symptoms of nocturnal panic attacks may include [6][9]:
Daytime panic attacks may be caused by an environmental or external trigger or stressor [10]. However, these triggers do not occur during sleep, so the cause of nocturnal panic attacks is not clear. While some contributing risk factors may be the same for both day and nighttime panic attacks, some may differ [5][11].
Risk factors contributing to the occurrence of nocturnal panic attacks may include:
Nocturnal panic attacks can cause ongoing sleep disruptions and may lead to:
Many people who experience panic attacks feel reluctant to ask for help from loved ones or professionals because panic attacks are commonly misunderstood [7]. However, without appropriate treatment panic attacks are likely to continue and symptoms may worsen, so it is important to seek help [2].
Psychotherapy, particularly cognitive behavioral therapy (CBT), can be an effective treatment for panic disorder and can help to reduce the occurrence of panic attacks. CBT aims to alter negative thoughts and behaviors and provide positive coping strategies, which can help to alleviate anxieties that may cause panic attacks and help to manage symptoms during an attack [9][11].
A doctor or mental health professional may prescribe medication to help manage the occurrence of nocturnal panic attacks. Antidepressants, such as fluvoxamine, sertraline, and amitriptyline, may be prescribed to help manage symptoms of panic disorder and help to reduce negative emotions that may occur during and following panic attacks [5][9].
Benzodiazepines, including anxiolytics such as lorazepam and diazepam, or hypnotics such as triazolam and zopiclone, may be prescribed to reduce acute symptoms of anxiety and aid in sedation [5]. However, these medications can be habit-forming, so are typically not prescribed long-term or may not be prescribed at all.
It is important to take medications exactly as prescribed by your doctor, as taking too much or too little, skipping doses, or suddenly stopping your medication can cause adverse effects and worsen your mental and physical health.
If you experience nocturnal panic attacks, you may be able to reduce your symptoms by [9][10]:
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