Quick answer (night panic): Stay in bed or sit upright, breathe 4-in/6-out for 1–3 minutes, do 5-4-3-2-1 grounding, and remind yourself “this will pass.” If unsure it’s panic (e.g., severe chest pain), call 112/999 in Ireland.
- Stay put. Sit up; feet on floor if needed.
- Breathe: in 4s, hold 2s, out 6s—repeat.
- Ground: 5 see, 4 touch, 3 hear, 2 smell, 1 taste.
- Reassure: “Scary, not dangerous. It passes.”
Table of contents
Having a panic attack in the middle of the night can be one of the most terrifying things you can experience; especially if you have never had panic attacks before. When I started having panic attacks in my sleep I had been working as a psychologist for many years, but that did not mean I woke up confused and realised this was a panic attack. I called my friend in the middle of the night to take me to hospital. I’m telling you of my personal experience to let you know the terror is real and one of the many reasons I work and write about panic so much.
Many people experience what are known as nocturnal panic attacks—sudden episodes of intense fear that strike while you’re asleep. If you wake in panic, follow this in-the-moment guide
In this article, I’ll explain what they are, why they happen, and what you can do—drawing on both clinical experience and my own personal story of recovery.
If you haven’t already done so, I recommend reading my Guide to Panic attacks as it explains everything you need to know, including all the frightening symptoms.
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What Are Nocturnal Panic Attacks?
A nocturnal panic attack is a sudden surge of fear that wakes you from sleep—usually from non-REM sleep when your body is at its most physically relaxed. Common symptoms include:
- A pounding or racing heart
- Shortness of breath or tight chest
- Drenching night sweats
- Shaking or chills
- A sense of doom or fear of dying
These are the same as daytime panic attacks, but the context—waking from sleep—makes them feel even more frightening and disorienting. When I read that back it sounds like I have never experienced panic so to give it some perspective, when I woke up during an attack I jumped out of bed, pulled on my clothes and went outside. Eventually, I started to leave clothes ready to pull on.
Rule Out Medical Causes First
When anyone comes to see me for therapy for panic, one of the first things I do during the assessment is to check that you have ruled out medical or metabolic causes for panic. I cannot do all of this during the assessment, nor can any psychologist as medical causes need to be ruled out by a medical professional such as your family GP or psychiatrist ( if you attended one.)
- Obstructive sleep apnea (especially if you snore or wake gasping) – you can read more about sleep apnea and panic attacks in this article.
The Irish Sleep Society can help diagnose and treat sleep disorders in Ireland - Respiratory issues like asthma
- Hormonal changes related to perimenopause or menopause
- Low blood sugar
- Cardiac arrhythmias
- Electrolyte imbalances, including low sodium or bicarbonate
- Medication changes, especially thyroid medication, antidepressants, or HRT
When I was recovering from an illness and adjusting thyroid medication, I had nights where I’d wake suddenly in a panic. This really set me back as I hadn’t had panic attacks at night for years. Later bloodwork revealed low sodium and low bicarbonate—a metabolic shift that can mimic panic. That experience taught me how physical and emotional systems are tightly connected, especially during sleep.
Why Night-Time Panic Feels Worse
When panic hits during the day, there’s usually some lead-up—stress, worry, or a triggering thought. But at night, there’s no warning. You go from unconscious to terrified in an instant.
In my own experience, most of my panic attacks came after I’d fallen asleep. And they were far more intense—because I didn’t have time to rationalise or prepare. Just waking in that sudden, fear-saturated state was enough to terrify me.
If this keeps happening, you may develop anticipatory anxiety—a fear of going to bed at all. You might find yourself:
- Staying up late to avoid sleep
- Checking your heart rate repeatedly
- Feeling afraid you might die in your sleep
This creates a vicious cycle where sleep becomes something your brain fears.
Breaking the Fear–Sleep Loop
If you’re currently going through nocturnal panic attacks, one of the most important things to understand is this:
Every night spent fearing sleep teaches your brain that bedtime is unsafe.
Over time, your nervous system can begin to associate the act of lying down, the darkness, or even getting sleepy with danger. This makes it harder to fall into deep, restorative sleep—and keeps your brain on high alert through the night.
Even if you appear calm on the outside, your body might be running a hidden background program that says: “It’s not safe to let go.”
But the brain is changeable. These fear-sleep patterns can be rewired.
What Causes Nocturnal Panic Attacks?
From a neuroscience and behavioural medicine perspective, these attacks happen when your autonomic nervous system becomes dysregulated. Night-time is when your parasympathetic (“rest and digest”) system should be dominant—but chronic stress, hormone shifts, illness, or trauma can tilt that balance.
Common contributors include:
- Unprocessed stress or trauma stored in the nervous system
- Hormonal shifts (especially in menopause, thyroid conditions)
- Changes in HRV—your nervous system’s ability to switch between stress and calm
- Withdrawal from medications, caffeine, alcohol, or antihistamines
How to Treat Night-Time Panic
The recommended treatment is Cognitive Behavioural Therapy (CBT), which helps reframe and retrain the mental and physical responses that drive panic.
- You can read more on the model of CBT in this guide
- or read how CBT is used to treat panic attacks, or
- Learn how to stop panic attacks in this article.
CBT is as effective for nocturnal panic as it is for daytime attacks. In my online course for panic attacks, I guide you step-by-step through:
- Understanding the brain’s panic loop
- Calming your nervous system
- Rebuilding safety around sleep
What You Can Do Tonight
Even if this pattern has been happening for months, it’s possible to begin breaking it tonight:
- Create a bedtime buffer. Step away from screens and intense thoughts at least an hour before bed.
- Use calming rituals. Breathwork, grounding, or slow stretching can signal safety to your brain.
- Support your biology. Low electrolytes like sodium or bicarbonate can increase nervous system instability at night. Make sure you’re hydrated —especially if you’ve recently changed medications.
- Reassure yourself if panic strikes. Try saying: “This feels scary, but I’m not in danger. My body is learning how to feel safe again.” Some people try breathing into a paper bag during panic attacks, but this can make things worse—especially at night. I explain why here in this short post: Should You Use a Paper Bag for Panic Attacks?
- Keep a gentle log. Don’t obsessively track symptoms—but note what helps. That awareness builds confidence.
When to Seek Help
If your night-time symptoms persist or worsen, speak to a GP or psychologist. Ask for:
- Blood tests (including sodium, bicarbonate, thyroid, and hormones)
- A sleep study if obstructive sleep apnea is suspected
- Support with therapy, or a structured plan to retrain your system
You don’t have to live in fear of your own sleep. I’ve been through this myself—and with the right knowledge and tools, you can absolutely recover.
FAQs
They’re often “nocturnal panic”, where the nervous system triggers panic from sleep—commonly in non-REM sleep. Stress, illness, hormone shifts, sleep apnea, or medication changes can contribute. (See your GP if unsure.)
They’re extremely frightening but not dangerous by themselves. Seek urgent help (112/999) if pain is new/severe or you suspect a medical problem.
Sit up, breathe 4-in/6-out for 1–3 minutes, do 5-4-3-2-1 grounding, and repeat a calming phrase (“This will pass. I’m safe.”). Then use a short, familiar wind-down before returning to bed.
CBT, gentle evening routines, limiting stimulants, and treating factors like sleep apnea help. Rebuilding a sense of safety around sleep is key.
3am “surges” can be stress-related awakenings; nocturnal panic is a full panic episode from sleep. The in-the-moment steps above help either way.
No—modern advice is paced breathing and grounding. Paper-bag breathing isn’t routinely recommended. Why paper bag breathing no longer recommended for panic
Next steps:Panic Attack Counselling (hub) · CBT for Panic Attacks · How to Stop Panic Attacks · Exposure therapy for panic