Panic attacks don’t occur only during our waking hours; some people have them at night, awakening them.

Research shows panic attack symptoms are similar, whether awake or asleep. But night terrors can be defined by differences in how severe and frequent these signs are experienced. Both daytime and nighttime panic attacks exhibit some similar symptoms; however, individuals experiencing daytime panic attacks tend to describe more physical manifestations, such as racing thoughts and feelings of chest tightness or suffocation.

Daytime panic seems linked to fearful thoughts, unlike nighttime attacks, suggesting a mental, not biological, explanation for nocturnal episodes. You can find it difficult to breathe, experience a rapid heartbeat, and perspire heavily. Nocturnal panic attacks are more common in those with panic disorder or panic attacks. But the number of symptoms of nocturnal panic attacks are wide-ranging and somewhat troubling both to the patient and those who are diagnosing any disorder because of the diversity.

Nocturnal panic disorder is characterized by waking up in the middle of the night feeling extremely afraid or uncomfortable, with accompanying cognitive and somatic signs of arousal. Palpitations, a racing heart, or an increased heart rate; perspiration; shakiness or trembling; feelings of suffocation or difficulty breathing; choking sensations; chest pain or discomfort; nausea or abdominal distress; dizziness, unsteadiness, lightheadedness, or fainting; chills or heat sensations; paresthesias, or numbness or tingling; depersonalization, or a sense of detachment from oneself; fear of losing control, or “going crazy,” and, finally, a fear of death. Despite the abundance of symptoms, there is little difference between panic attacks that happen while awake and those that happen throughout the night. However, the number of symptoms can lead to difficulty in diagnosis.

We know how panic attacks during the day can disrupt our lives, even the lives of people we would assume are free from such episodes, but that's not the case as you'll see in this video. Who is the person admitting to discomforting anxiety attacks and how have they affected her life? It's Kendall Jenner and she explains it all.

But what about panic attacks over which we seemingly have no control and that come upon us as we are sleeping? This remains a vaccine problem for patients and healthcare. There seem to be many explanations offered, and they are varied from biological to unconscious to what we eat, and even to stomach upset. Can we lay the blame for them on one thing? Probably not because they may have many things that caused them to occur and, for each, there has to be a definitive solution.

The clinician must take an appropriate history in order to make the diagnosis. Potentially useful are multidisciplinary treatments that include neurologists and psychiatrists, as well as methods to track the patient’s reaction to treatment. Creating a standardized method to distinguish nocturnal panic disorder from other sleep-related illnesses could be a way to advance this area of study.

There is usually no obvious cause or explanation when you awaken with a panic episode. Some of the symptoms may be the same as those of a daylight panic attack. On the other hand, since our brains do not “turn off” while we sleep, any concerns or worries that we have been carrying around with us during the day may resurface while we are sleeping and trigger a panic attack when we wake up. Additionally, if you have trouble controlling your panic attacks during the day, you are more likely to have them during the night.

Handling Nighttime Panic Attacks

There are several things that you can do if you awaken with a panic attack at night, and they include:

1. If you wake up in the middle of a panic attack, it is crucial that you do not try to force yourself to stop or resist the attack. Recognize the panic attack for what it is. Keep in mind that this is just transitory and will pass. You must simply allow things to transpire.
2. Reestablish a state of relaxation in your body by making an effort to relax. Breathe normally by taking deep breaths in and out gently. Untense your muscles and direct your attention to pleasant mental imagery.
3. If you are having a panic attack and can not seem to get back to sleep, it is best to distract yourself from the terror by getting up and doing something. Arouse yourself physically and get out of bed. If you are having trouble refocusing, try some yoga stretches, some soft music, a motivational book, or even something as mundane as ironing.
4. Retire to your bed only when you are absolutely exhausted; do not return to your bed until you are ready to sleep again. If you are having trouble relaxing while lying in bed, try breathing deeply in through your nose and out through your mouth. Make sure your entire belly moves in rhythm with your breath, not just your chest.
5. To ensure you get a decent night’s sleep, give yourself plenty of time to wind down before bedtime. A good rule of thumb is to get to bed at least eight hours before your alarm goes off. You can find yourself anxiously watching the clock and questioning if you will feel refreshed the following day if you stay up too late and do not give yourself enough time to sleep. Anxieties brought on by negative thinking can lead to a panic attack.
6. Many people have trouble sleeping because they are worried about what is to come the next day, so make sure you are ready for it. You can attempt to alleviate this worry by ensuring that you are well-prepared. A to-do list or an organized closet are two good examples.
7. Get into the habit of going to bed and waking up at around the same times each day. Try to maintain a fairly consistent wake-up time throughout the week, including on weekends.
8. If you suffer from nighttime anxiety and jitters, as well as trouble falling or staying asleep, cutting back on sweets, coffee, and alcohol before bed may help. I knew a very famous actor who told me that he had problems getting to sleep at night and had to drink almost 2 bottles of wine. As anyone will tell you, that is a very bad way to deal with sleeplessness. In fact, it causes more problems than it solves.
9. Do not use any electronic devices, including smartphones, tablets, and laptops, in the hour or two leading up to your intended bedtime. The light that these gadgets emit can be too stimulating and cause you to stay awake all night long.

As you can see, there are a number of things you can do and one of them is to realize that you do have control over this, and there are things you can do to help yourself. Of course, if you have repeated difficulties with nocturnal panic, and if any of your symptoms seem to be related to something of physical concern, you should be checked out by your physician and, possibly, someone specializing in sleep medicine.

In fact, it's always in your best interest to share these difficulties with your treating physician and to discuss potential future treatment. One caution should be that sleep medications are not indicated on a chronic basis. These medications, while useful for the short term, meaning, one or two days, can bring on catastrophic results, as the research has shown.

One thing that we do notice is that a regular schedule and learning to relax, not only during the day, but especially prior to going to sleep at night, is essential. Whatever way you decide to relax is something that you will determine and one that works best for you. There are many patients and professionals offering their ways of relaxing, but that may not be what helps you.

If you need to get up to do a crossword puzzle or put a puzzle together or, as mentioned earlier, iron some clothes, that's fine. Even getting up and moving around and regulating your breathing will help.

I recall a woman recounting her initial panic attack at a pre-convention cocktail party abroad. She felt that she was going to lose her mind and she was drawn to the large glass windows and felt almost compelled to move closer to them. Her fear of harming herself actually assisted her to turn around and return to the people at the party. In days and weeks following, she did establish schedules that helped her and she went on to found a major anxiety disorders association to help others.

Nocturnal panic attacks still present difficulties in diagnosis, but you do have power and you can exercise it when you need to do it.