If you wake up with a panic attack, it’s natural to feel disoriented and overwhelmed. You might have trouble distinguishing between a dream and reality, or you might even think you’re having a heart attack if you experience some discomfort in your chest.

Most panic attacks last no more than a few minutes, and the symptoms will gradually diminish during this time. If you wake up during a panic attack, you’re probably close to its peak, and the symptoms should start to ease soon.

The primary symptoms of a panic attack are similar, whether they’re during the day or at night, and can be divided into three categories. For your symptoms to be considered a panic attack, you must experience four or more of the following at the same time:

Physical symptoms

• sweating
• chills
• nausea
• heart palpitations
• feeling faint or unsteady
• trembling or shaking
• feeling dizzy or lightheaded
• shortness of breath
• chest discomfort or pain
• sensations of tingling or numbness
• hot flashes or chills

Emotional symptoms

• having a sudden fear of dying
• fear of losing control
• fear of being under attack

Mental symptoms

• feeling smothered or choked
• feeling disconnected from yourself or reality, which is known as depersonalization and derealization

It’s unclear what causes panic attacks or why 1 in 75 people develop the more chronic condition known as panic disorder.

Although nocturnal panic attacks are not due to any obvious in-the-moment triggers since they occur before the stage of sleep where nightmares occur, certain factors can increase your risk of experiencing a panic attack at night.

Genetics

If you have family members with a history of panic attacks or panic disorder, you might be more likely to experience panic attacks.

Stress

Anxiety isn’t the same thing as a panic attack, but the two conditions are closely related. Feeling stressed, overwhelmed, or highly anxious can be a risk factor for a future panic attack.

Brain chemistry changes

Hormonal changes or changes from medications may affect your brain’s chemistry. This may cause panic attacks.

Life events

Upheaval in your personal or professional life can bring about a great deal of worry or concern. This may lead to panic attacks.

Underlying conditions

Conditions and disorders may increase the chances of a panic attack. These may include:

• generalized anxiety disorder
• acute stress disorder
• post-traumatic stress disorder
• obsessive-compulsive disorder

Individuals with specific phobias may also experience panic attacks that wake them up.

Previous panic attacks

Fear of having another panic attack may increase anxiety. This could lead to sleep loss and increased stress, which increases the risk of having more panic attacks.

Blood tests, imaging tests, and physical exams can’t determine if you’re having a panic attack or if you have panic disorder. However, they can rule out other conditions that could cause similar symptoms, such as thyroid and heart diseases, among others.

If these test results don’t show an underlying condition, your doctor may discuss your symptoms and health history. They may also ask about your current stress levels and any events that could trigger panic attacks.

If your doctor believes you’ve been having panic attacks or have panic disorder, they may refer you to a mental health specialist for additional evaluation. A therapist or psychologist can help you understand the causes of panic disorder and work to eliminate them.

Both short-term and long-term treatment can help you manage your anxiety and help reduce your panic attack symptoms. Here’s what that may look like:

Treatment in the moment

If you’re experiencing a panic attack, these steps may help ease symptoms:

• Help yourself relax: Instead of thinking about the rushing feelings you’re having, concentrate on your breath. Focus on taking slow, deep breaths. Feel the tension in your jaw and shoulders, and tell your muscles to release.
• Distract yourself: If the symptoms of the panic attack feel overwhelming, you can try to distance yourself from the physical sensations by giving yourself another task. Count backward from 100 by intervals of three. Talk with a friend about a happy memory or funny story. Focusing your thoughts away from the sensations in your body helps them ease their grip.
• Chill out: Keep ice packets ready to go in your freezer. Apply them to your back or neck. Sip a glass of chilled water slowly. Feel the “cooling” sensation as it overtakes your body.
• Go for a walk: A bit of light exercise might help your body soothe itself. Ask a friend to walk with you if you can. The additional distraction will be a welcome relief.

Long-term treatments

If you have regular panic attacks, you may want to talk with your doctor about treatments that can help you reduce the attacks and prevent them from happening in the future. These treatments include:

• Therapy: Cognitive behavioral therapy (CBT) is a form of psychotherapy. During sessions, you will work with a therapist to understand your panic attack triggers. You’ll also develop strategies to help you ease symptoms quickly if they happen again.
• Medication: Your doctor may prescribe certain medications to help prevent future panic attacks. If you do experience a panic attack while on these medications, the symptoms may be less severe.

When to see your doctor

These signs might indicate it’s time to talk with your doctor about your panic attacks and possible treatments:

• you’re experiencing more than two panic attacks in a month
• you’re having difficulty sleeping or resting for fear of waking up with another panic attack
• you’re showing signs of other symptoms that might be related to the panic attacks, such as anxiety disorders or stress disorders

It’s not clear why people experience panic attacks at night, but certain triggers may increase the chances of waking up with one. You may have just one panic attack, or you may have several.

Panic attacks are treatable, and you can take steps in the moment to ease symptoms. You can also work to prevent future panic attacks with therapy and medications.