Panic attacks are exaggerated stress responses that are often made worse by a sufferer's misinterpretation of their symptoms. Panic attacks are caused by the fight or flight response which leads to elevated heart rate and blood pressure, muscle contraction and anxious thought patterns. As this gets worse it can also lead to hyperventilation, chest pain and dizziness. This in turn leads the sufferer to become scared that they might be experiencing a serious health issue and as such they can end up thinking themselves into a frenzy and actually considerably worsening their own symptoms.
Often panic attacks come on during stressful points in our lives. Sometimes they will be triggered by busy and crowded areas – especially for people who suffer with social phobia or agoraphobia – and sometimes they can occur as a result of other phobias.
What's also common though is to get panic attacks at night. In other words, you might just be lying there only then to find yourself having a sudden attack. This is one of the most common times to experience these events in fact and this can be confusing at first. Why would lying down and relaxing for the night result in you becoming so stressed that you have a full blown attack? Why are panic attacks at night so common?
Panic attacks that occur at night are sometimes referred to as 'nocturnal panic attacks'. These can either occur as you are trying to get to sleep, or while you are asleep causing you to suddenly wake up during the onset of a panic attack.
Often panic attacks that take the latter form are the result of night terrors. Night terrors are a type of sleep disorder (or 'parasomnia') which cause fear and dread during the first hours of stage 3-4 NREM sleep. Night terrors are common in children and can result in patients waking up screaming and crying with a fever. They can also occur in adults however and particularly during times of stress or insomnia. Night terrors can also coincide with nightmares and result in many of the same fight or flight symptoms associated with stress and which are known to cause panic attacks.
When it comes to getting panic attacks at night, this can often be the result of ruminations as well as heightened focus on bodily symptoms and processes. Often, the reason that we experience panic attacks is that we mistake the symptoms for those of a heart attack or another serious health condition. Chest pain is common during panic attacks because stress elevates the heart rate and contracts the chest muscles while also resulting in hyperventilation. Combined, these effects cause symptoms that are not dissimilar from the early symptoms of a heart attack. As a result, patients can end up working themselves into even more of a panic which causes normal stress to progress to a severe panic attack.
When you're lying alone in the dark trying to get to sleep, you will be much more likely to hear your own heart rate and to focus on it – especially if you notice it starting to get quicker or louder. As a result, you will become more likely to convince yourself that you may be having some kind of heart attack. At the same time, you'll be more likely to notice your chest tightening and your breath speeding up.
Alone at night is also when many of us will ruminate about the things that are causing us stress. If you're having a difficult time at work then you might start dreading the idea of having to go in the next day. Or you might start worrying about things you forgot to do the day before prior to leaving the office.
Some people even find that sleeping in itself can be stressful. We all know that it's important to get to sleep so that we will have lots of energy and focus the next day. As a result we can then end up putting a lot of pressure on ourselves to sleep, thinking that we won't be able to perform if we don't. This can in turn result in ruminations and frustration as we toss and turn and work ourselves up. Not only is this about the worst thing you can do when trying to convince yourself to get to sleep but it's also a recipe for disaster that can cause panic attacks at night.
With all this in mind then, how do you prevent panic attacks at night?
The solution is all about trying to keep yourself calm and to avoid thinking stressful thoughts. Don't try and 'force' yourself to get to sleep and likewise don't stress yourself by worrying about things that are out of your control. Take the approach of putting your worries and stresses aside in a mental box and throwing away the key. This way you can then deal with your problems another day when you're awake rather than lying there stressing about them when you can't do anything constructive.
Some people find that focusing on their breathing can help, while other people also find it useful to use mental exercises like counting sheep. Keeping a pen and paper by your bed can also be useful as it allows you to write down the things that are making you stressed rather than having to think about them all day.
Another important tip is to try and make sure that you are tired when you get to bed. Being more active in the day and getting more fresh air can make a big difference and this is particularly effective because exercise helps the body to produce more 'feel good' hormones like serotonin. If you aren't tired when you go to bed, try reading for a while with a dim light. This will prevent you from thinking stressful thoughts while calming your mind and body ready for sleep.
Finally, try to remove the pressure you may be placing on yourself to get to sleep. Instead focus on just relaxing and enjoying the feeling of being in bed. As soon as you enjoy being in bed you'll find that you're able to doze off and panic attacks at night become less common.
If none of this works then you should also look into addressing the panic attacks themselves. You can do this with various different types of therapy. Cognitive behavioral therapy is one very popular approach for treating panic attacks and so too is exposure therapy.