Waking up with a panic attack

You're asleep, and then you're not. Your heart is pounding, your body is shaking, and you feel like something terrible is happening, even when there's no obvious danger. You're in your bed, in the dark.

Waking up with a panic attack is frightening. For many people the worst part comes after: the fear that it will happen again, which makes it hard to fall asleep at all. In the first minute, hold yourself and let the breath out slow down. Below is how, and how to get back to sleep.

First, one check. If you have chest pain, pain spreading to your arm or jaw, or trouble breathing that won't settle, call emergency services now. Don't wait to see if it passes.

What's happening in your body

Think of a smoke alarm that goes off because you burned the toast. The alarm is real, the noise is real, but there's no fire.

A panic attack is often like that: your body's alarm system going off without a danger you can see. Your heart speeds up. Your breathing gets fast and shallow.

That fast breathing matters. It can bring dizziness, tingling and a tight chest, which feel like even more proof that something is wrong. So the alarm gets louder. Why that happens is in breathing into a paper bag.

Panic at night can come out of nowhere, or after a bad dream, or after a sound that wakes you. The Cleveland Clinic describes nocturnal panic attacks as a sudden fear that wakes you from sleep, often with trouble breathing and a racing heart. They're different from night terrors: with panic you're awake and you feel the fear, while a night terror happens in your sleep and you often don't remember it.

It happened to me

Sometimes I woke up in panic mode, after a bad dream, or because I heard a noise that wasn't real. It was really disturbing. My body was shaking, and my heart was racing. Back then I couldn't fall back asleep.

Now, if it happens, I start focusing on my breath right away, I calm down quickly, and it isn't a problem anymore. I can fall back asleep.

Try this now: the first minute

If you've checked for the emergency signs above, you don't need to get up, and you don't need to understand what caused it.

The first minute

1. Hold yourself. Cross your arms over your chest: tuck one hand under the opposite armpit, near your heart, and rest the other hand on the opposite shoulder. A small hug, from you to you. It's a simple hold for anxiety: you feel contained by your own arms. It's usually done sitting or standing; here it's adapted for bed.

2. Feel what's under you. The mattress, the pillow, the weight of your body. Look around for a moment if it helps you know where you are.

3. Take a few gentle breaths. Breathe in softly through the nose, not big. Then breathe out slowly, through the nose or through soft lips. If you can, let the breath out be a little longer than the breath in. Don't force it.

The next few minutes

4. Keep going if it helps. A few more slow breaths. Count them only if counting helps. You don't need to reach a number or a certain kind of calm.

5. Then let the breath be normal, keep your hands where they are, and notice whatever changes. Your heart doesn't have to slow down right away.

If focusing on your breath makes things worse, stop. Open your eyes, let your breath do whatever it wants, and just feel the mattress holding you. Keep your arms where they are, or let them go.

How long: a minute or two, then as long as you need. The worst of a panic attack usually passes within 10 minutes (Cleveland Clinic), though sleep can take longer to come back. How often: whenever you wake up like this. If you practice the slow out-breath during the day, it may come more easily at night. The 2-minute long exhale timer is a good way to practice. It uses a set rhythm, 4 seconds in and 8 out. That's for daytime. At night, use whatever feels easy.

Skip the big gulps of air. Small breath in, slow breath out.

Getting back to sleep

After a panic attack your body needs a little time to come down. Don't fight it and don't try to force sleep.

• Keep the room dark. If you need light, keep it low.
• Stay away from the phone, especially from searching your symptoms.
• Keep breathing slowly, with longer exhales, until you feel heavy again.
• Still wired after a while? Follow the steps in waking up at 3am.

FAQ

Why do I wake up in panic for no clear reason?

Sometimes it follows a bad dream, a noise or a stressful period. Sometimes there's no clear reason at all. Your body's alarm system can fire during sleep, the same way it can during the day. If it's new for you, get checked by a doctor, because a racing heart or chest symptoms can have other causes too. Panic attacks can be treated, and the Cleveland Clinic lists talking therapy and medication.

How do I stop a panic attack at night?

You can't always switch it off, but you can help it pass. Don't take big breaths. Hold yourself, one hand under the arm and one on the shoulder, and feel the bed under you. Then take a few gentle breaths, letting each breath out be a little slower than the breath in.

Should I get out of bed after a panic attack?

Not straight away. Do the first few minutes in bed, with the self-hold and the slow breath out. Only if you're still wide awake much later is it worth getting up for a bit.

Keep going

• Long exhale breathing: practice it during the day.
• Waking up at 3am every night: when it's thoughts, not panic.
• Breathing into a paper bag: does it work?: and what to do instead.
• Free 10-minute practice for the moment you turn the light off.

Sources: J. Hall, Breathe (Breath Awareness to Release Anxiety) · M. Pistono, Breathe How You Want to Feel (overbreathing and its symptoms, p. 114) · Cleveland Clinic, Nocturnal panic attacks · Alessio's own experience.