What are Nocturnal Panic Attacks?

Have you ever experienced a sudden overwhelming fear that lasted for several minutes? Where your heart is pounding, you sweat profusely, and feel like you can’t breathe, at night when you are asleep? Then you might be experiencing a nocturnal panic attack. 

A panic attack is a brief period of intense anxiety, which causes the physical sensations of fear. The brain’s “flight-or-fight” response, which triggers the autonomic nervous system, is thought to be the cause of a panic attack. The body when faced with danger the body releases a variety of hormones, including adrenaline, which causes the heart rate, respiration, and blood flow to increase in the muscles in preparation for fighting or fleeing. 

But when this response is triggered without any actual danger, A person may experience the symptoms of a panic attack in harmless and stress-free situations, such as while asleep, this is referred to as a nocturnal panic attack. A nocturnal panic attack occurs only during the night when the patient is asleep, waking the person up. 

People who have frequent panic attacks, for a prolonged period are often diagnosed with panic disorder, which is a type of anxiety disorder. Undiagnosed panic disorder can severely affect the person’s life and their ability to perform everyday functions, like driving and sleeping.  There are numerous disorders like panic disorder, social anxiety, substance abuse, PTSD, and depression, which can lead to nocturnal panic attacks. 

These attacks occur suddenly while the patient is asleep. Panic disorder is often accompanied by frequent daytime panic attacks, as its primary feature, yet some patients experience panic attacks predominantly during sleep. Many researchers have agreed that despite the same symptoms occurring for both nocturnal  and daytime panic, patients reported a greater number of physical symptoms such as increased heart rate, chest aching, and smothering sensations, during nocturnal panic compared to  daytime panic attacks  

Symptoms of a nocturnal panic attack include: 

• Chest ache
• Intense chills
• feeling of terror or fear
• Nausea
• Profuse sweating
• Racing of heart
• Tingling in fingers or toes
• Numbness
• Trembling or shaking  

In research done by Cranske and Tsao (2005), waking up as a result of external stimuli like thunder, loud noises, nightmares, or night terrors is not the same as having a nocturnal panic episode. Nocturnal panic happens during the shift from light to deep sleep in late stage II sleep to early stage III sleep, not during the same stages of sleep as other types of sleep disturbances. Night terrors happen during stage IV sleep, which is far later in the sleep cycle than  nocturnal panic, while nightmares happen during REM sleep Compared to people who only panic while awake, those who suffer nighttime panic attacks frequently report more insomnia and struggle to fall back asleep thereafter 

People with chronic nocturnal panic attempt to postpone going to sleep for as long as possible to prevent panic episodes, which results in a fear of going to sleep, we all are aware that Long-term sleep deprivation hurts both physical and mental health, so How can one’s nocturnal panic attacks be managed or treated? 

Once a panic attack starts, the only thing one can manage to do is let the symptoms pass through, Some research articles state that patients can reduce an attack’s severity with deep,  controlled breathing and muscle relaxation exercises. Psychiatrists may prescribe medication to lessen the symptoms. A doctor or licensed psychiatrist might recommend a combination of medications and cognitive therapy to stop and reduce nocturnal panic attacks, but there are no specific treatments for night panic attacks. The medication is the same for both day and night as the symptoms overlap. 

Managing Nocturnal Panic Attacks

Patients can manage their nocturnal panic attacks in three ways  

• Reality test: asking certain questions after the attack for example “Where am I”, “What’s going on”, “What am I seeing”, and “Is this room safe” and answering these questions “I’m in my room right now. I’m having a panic attack right now, but it will pass and I’ll be fine. Right now, I’m safe.” This exercise gives a relief and reality check. 
• Distraction: doctors recommend doing breathing exercises or counting and perceiving various objects around and their shape and colour. 
• Healthy lifestyle: Practice mindfulness and meditation, exercise, eating a healthy diet,  proper routine at night  

Nocturnal panic attack and its medication : 

• Anti-anxiety medications are given which can lessen the frequency and severity of panic attacks. Panic attacks may go away completely. These medications must be taken up to six to eight weeks to fully work.
• Benzodiazepines rapidly alleviate symptoms; however, their habit-forming nature can lead to the development of physical tolerance, diminishing their effectiveness over time. It can be really hard to stop using them once started.
• Beta-blockers, like propranolol, may reduce the physical symptoms of a panic attack. Licensed therapists may prescribe these medications to be taken as needed when a panic attack is coming. 

Cognitive behavioural therapy

Patients meet with a licensed psychologist who assists in identifying their triggers. Through this process, individuals learn to modify their perception and response to panic attack triggers. With time, the frequency of panic attacks diminishes, and individuals may ultimately overcome their panic disorder.

Physical problems including hyperthyroidism, hyperparathyroidism, heart disease, lung disease, drug usage, and dysautonomia should be taken into consideration by therapists before any treatment, especially for night panic attacks. 

Nocturnal panic attacks are frequently observed in patients with panic disorder, yet they are frequently overlooked or misdiagnosed. This can occur because patients may not report sleep disturbances, or they may misinterpret symptoms as night terrors or breathing issues. Consequently, there is a pressing need for further research to delineate distinct symptoms of nocturnal panic attacks, enhancing their diagnosis and treatment. Nocturnal panic attacks are treatable, with proper treatment, medication and a healthy lifestyle, the patient can reverse the symptoms of any form of panic disorder.