When Can Panic Attacks Happen

Nightmares Night Terrors And Night Anxiety

Finally, anything that can cause you anxiety while you sleep can also conceivably cause panic attacks. Once again, it’s a problem with hyperventilation. While having a nightmare, for example, you may be reacting to your dream by breathing quickly as though scared or running. This can cause you to hyperventilate in your sleep, which may cause a nocturnal panic attack.

How It Feels After A Panic Attack

A more likely possibility is that you had a single panic attack that leaves you feeling generally anxious, , and frayed. While panic attacks can be scary, they’re not dangerous. But the fear they may cause you can be more unsettling than the attack itself. That’s especially true if you’ve never had one before. When it’s your first episode, you may think you’re having a or a heart attack.

How do you tell if it’s a panic attack or high anxiety? It’s tricky. It helps to talk to your doctor, but a closer look at your symptoms often can give you some clues.

A true panic attack tends to have clear, intense, physical symptoms — a pounding , shortness of breath, and so on.

Anxiety can give you some of these, but they tend to be milder. Instead, you’ll have more mental symptoms like a racing mind, lots of worries you can’t stop, and a hard time focusing. You might also feel restless and have a hard time sleeping.

What Causes Sleeping Panic Attacks

Even though the panic attack is said to occur while you sleep, the idea that it’s a “sleeping panic attack” may be a little misleading. It’s very difficult to sleep throughout the course of these panic attacks, and the actual attack usually wakes you up, causing significant fear and disorientation.

There are many possible causes of panic attacks, generally speaking. Often, panic attacks during the day are caused by an interaction between your bodily sensations and your thoughts. During the night, however, this might not necessarily be the trigger, given that you’re somewhat disconnected from your bodily and mental processes. There are, however, additional issues that may affect those who suffer from nocturnal panic attacks. These issues include:

What Are Some Coping Mechanisms In The Moment

First things first: . You’re probably hyperventilating, but stabilizing your breathing can quickly calm your body’s fight-or-flight response.

Try counting your breaths. One deep breath in, one deep breath out. Count up to 10 and then start again until your breathing is back to normal.

Other quick coping strategies include:

• recognizing that what you’re experiencing is a panic attack
• finding an object to focus on

Symptoms Of Anxiety Disorders:

Anyone may experience these symptoms during stressful times. However, individuals with anxiety disorders may experience them in absence of stress, with more severe symptoms and/or with several symptoms appearing together.

• Inability to relax
• Rapid pulse or pounding, skipping, racing heart
• Nausea, chest pain or pressure
• Feeling a “lump in the throat”
• Dry mouth
• Feelings of dread, apprehension or losing control
• Trembling or shaking, sweating or chills
• Fainting or dizziness, feelings of detachment
• Thoughts of death

Living With Panic Disorder

Panic attacks are often unpredictable, even after your diagnosis. They can make you feel helpless. In addition to your treatment plan, consider these lifestyle changes to help reduce risk of a panic attack.

• Exercise. Physical activity can help you minimize stress. It can also calm your mind.
• Sleep. Not getting enough rest can leave you groggy. It can also cause you to be more emotional. This may make you more prone to anxiety and an attack.
• Skip the alcohol, caffeine, smoking, and any recreational drugs. Any of these can trigger a panic attack or make it worse.
• Join a support group. It’s always good to know you’re not alone. Many times, simply talking about your panic disorder can create a feeling that you have power over it.

This Is What A Panic Attack Feels Like

I have never seen a single case of this in over 40 years that could not be better explained by another diagnosis. The judgment that a rage response is “out of proportion” to an environmental stimulus is usually based on the evaluator’s lack of knowledge about a patient’s prior experiences which determine why the patient finds something upsetting.

To summarize, for panic disorder, as opposed to the occasional panic attack, the conventional psychiatric is that they occur “out of the blue” rather than as responses to environmental threats. If they only occur in the presence of one or more specific environmental threats, say snakes, then the person is diagnosed with a specific instead of panic disorder — a snake phobia in this case.

Panic disorder might be considered a prime example of something that would pit “biological” psychiatrists against psychotherapists. In people who suffer from panic disorder, the attacks do seem to come out of nowhere. Sufferers can be sitting quietly in their house doing almost nothing when one comes on. They can even be jolted awake from them in the middle of the night, without having had a nightmare. A tendency to have panic attacks tends to run in families, so clearly some people are more genetically prone to get them than others.

So does this mean that panic disorder is purely and entirely a brain disease? Is its classification as an anxiety disorder incorrect? Does it have nothing to do with chronic stressors?

Use Muscle Relaxation Techniques

Much like deep breathing, muscle relaxation techniques can help stop your panic attack in its tracks by controlling your body’s response as much as possible.

Consciously relax one muscle at a time, starting with something simple like the fingers in your hand, and move your way up through your body.

Muscle relaxation techniques will be most effective when you’ve practiced them beforehand.

Ways To Help Yourself

Small changes can help prevent further panic attacks.

• Practice breathing exercises regularly. They can help prevent panic attacks and help while they’re happening too.
• Physical activity can reduce stress and tension and improve your mood.
• Eating regular healthy meals can keep your blood sugar stable which can boost your energy and mood.
• Avoid caffeine, alcohol and if you can. These can make panic attacks worse.
• Try . It’s a way of being fully present and engaged in the moment that can help with anxiety.
• Join a peer support group. They bring together people who have had similar experiences to help each other. Anxiety UK, No Panic and all run support groups and other services.

How Are Panic Attacks Managed Or Treated

Psychotherapy, medications or a combination are very effective at stopping panic attacks. How long you’ll need treatment depends on the severity of your problem and how well you respond to treatment. Options include:

• Psychotherapy:Cognitive behavioral therapy is a type of psychotherapy, or talk therapy. You discuss your thoughts and emotions with a mental health professional, such as a licensed counselor or psychologist. This specialist helps identify panic attack triggers so you can change your thinking, behaviors and reactions. As you start to respond differently to triggers, the attacks decrease and ultimately stop.
• Antidepressants: Certain medications can make panic attacks less frequent or less severe. Providers may prescribe serotonin selective reuptake inhibitors , serotonin-norepinephrine reuptake inhibitors or tricyclic antidepressants . SSRIs include fluoxetine and paroxetine . SNRIs include duloxetine and venlafaxine . TCAs include amitriptyline and doxepin .
• Anti-anxiety medications: Benzodiazepines are the most commonly prescribed anti-anxiety medication to treat and prevent panic attacks. They help with anxiety but have risks of addiction or dependence. These medications include alprazolam and lorazepam .

You May Be Able To Stop It Yourself

In a more subtle panic attack, you may actually be able to have some control over the symptoms. In some cases, you may even be able to stop the panic attack in its tracks.

” the person might be able to take a quick break from what they are doing, calm down, and get it to pass.” Dr. Saranga says. While those with more severe panic attacks may tap into some of this with skills learned in therapy, more subtle panic attacks can usually be stopped more easily.

Ways A Subtle Panic Attack Differs From A Serious One

Eva Taylor Grant

Differentiating everyday anxiety, stress, anxiety disorders, and panic attacks can be quite confusing. One of the reasons these different issues all blend together is that they exist on a spectrum. Even serious panic attacks, which conjure images of severe distress, vary a lot between subtle and incredibly distressing.

One of the reasons that it’s important to understand the varying symptoms of panic attacks is that panic attacks are incredibly personal. “Anxiety can look and feel slightly different for each of us, and the way we interpret signs of anxiety and panic can be influenced by our cultural experience, the way we were socialized, and our own personal expectations for ourselves,” licensed clinical social worker Laura Federico, MS, tells Bustle. ” Noticing the signs of anxiety, or interpreting panic symptoms as they begin to increase, may be challenging if we aren’t taught how to validate our emotional experiences.” Therefore, it’s important to understand and validate that even a subtle panic attack is worth taking care of.

Here are seven ways a subtle panic attack can differ from a more serious one, according to experts.

What Questions Should I Ask My Doctor

If you have panic attacks, you may want to ask your healthcare provider:

• Why am I having panic attacks?
• What is the best treatment for panic attacks?
• How long will I need therapy?
• How long do I need to take medications?
• Should I look out for medication side effects?

A note from Cleveland Clinic

Panic attacks can be extremely uncomfortable. Although they’re not physically harmful, they can take a toll on your mental health and stop you from doing the things you love. Don’t be embarrassed to tell your healthcare provider that you have panic attacks. Your provider can help you overcome fears and anxieties that trigger attacks. You can get better with treatments like psychotherapy and medications.

Last reviewed by a Cleveland Clinic medical professional on 08/12/2020.

References

How To Respond To Sleeping Panic Attacks

Sleeping panic attacks are harder to control than daytime panic attacks because there is no warning. You can’t take what you’ve learned and apply it to stop your panic attack from happening, nor can you distract yourself or prepare yourself so that the panic attack is less severe. Sleeping panic attacks hit you by complete surprise, and often occur at a point in your sleep when your disorientation prevents you from thinking critically about what’s happening.

The good news is that since many panic attacks that occur while sleeping have an underlying issue that can be addressed, you can first start combating these issues and see if it improves your long term outlook with nighttime panic disorder. For example:

Since these anxiety attacks occur at night and are generally not in your control, they are not easily preventable through a focus on identifying and avoiding triggers, which is how day-time panic attacks are often managed. Nevertheless, the above tips should help you improve your ability to control panic attacks while you look for a treatment that deals with anxiety more generally.

What Are The Signs And Symptoms Of Panic Disorder

People with panic disorder may have:

• Sudden and repeated panic attacks of overwhelming anxiety and fear
• A feeling of being out of control, or a fear of death or impending doom during a panic attack
• Physical symptoms during a panic attack, such as a pounding or racing heart, sweating, chills, trembling, breathing problems, weakness or dizziness, tingly or numb hands, chest pain, stomach pain, and nausea
• An intense worry about when the next panic attack will happen
• A fear or avoidance of places where panic attacks have occurred in the past

What Happens During A Panic Attack

Panic attacks are associated with physical symptoms that include:

• Shaking or trembling
• Feeling that your heart is pounding or racing
• Sweating
• Feeling that you are choking
• Nausea
• Tingling or numbness in your hands, arms, feet or legs
• Chills or hot flashes
• Sense of unreality or dreamlike sensations

A person may also have an extreme fear of losing control, going crazy, or dying during a panic attack. It is very rare for a person to have all of these symptoms at once. However, the presence of at least 4 symptoms strongly suggests that a person has panic disorder.

Many of the symptoms that occur during a panic attack are the same as the symptoms of diseases of the heart, lungs, intestines, or nervous system. The similarities between panic disorder and other diseases may add to the person’s fear and anxiety during and after a panic attack. For example, you may believe that you are actually having a heart attack.

Just the fear of having a panic attack is often enough to trigger the symptoms. This is the basis for a condition called agoraphobia. A person who has agoraphobia finds it difficult to leave home because he or she is afraid of having a panic attack in public or not having an easy way to escape if the symptoms start.

The Causes Of Unexpected Panic Attacks

Expected panic attacks are typically associated with a specific trigger such as crowds, flying or exams, whereas unexpected panic attacks have no apparent trigger and can seem to happen for no reason.

It is not yet known what causes panic attacks but certain factors may play an important role, including genetics, mental health conditions, major stress or having a predisposition to stress.

Panic attacks are typically experienced as a result of misinterpreting physical symptoms of anxiety. Heart palpitations may be mistaken for symptoms of a heart attack, breathlessness or feeling faint may be taken as a sign that a person is collapsing or dying, and the racing thoughts can lead a person to think that they are losing control of their mind.

These misinterpretations – which a person may be unaware that they are doing – can trigger a panic attack, which seems to appear out of the blue.

What Is An Anxiety Attack

Panic and anxiety attacks may feel similar, and they do share a lot of emotional and physical symptoms. Believe it or not, you can experience both anxiety and a panic attack at the same time. For example, you might experience anxiety while worrying about a potentially stressful situation, like riding an elevator. When the elevator arrives, anxiety may culminate into a panic attack.

Symptoms of an Anxiety Attack can be both mental and physical.

Mental:

Questions To Ask Your Doctor

• What is causing my panic disorder?
• What treatment is best for me?
• Should I take a medicine?
• Will I have to take medicine the rest of my life?
• Is there any kind of therapy I should try?
• How long will I have to be in therapy?
• I’m afraid to leave my house. What should I do?
• Is there a possibility that my panic attacks will come back after treatment?

Panic Disorder: What Is It

Panic disorder is a condition characterized by repeated, unpredictable panic attacks that can cause feelings of impending death, heart attack-like symptoms, and a disconnection from reality. People having panic attacks often experience palpitations, shortness of breath, dizziness, among other physical symptoms, and an intense urge to flee the situation. The condition is rare in childhood, but often manifests in adolescence, when a teenager might make repeated trips to doctors and the emergency room before the psychiatric disorder is diagnosed. Attacks can happen at any time and may be triggered by a variety of cues; a key feature of panic disorder is that fear of an attack can trigger a fresh one.  For this reason, many kids with panic disorder avoid the locations of previous episodes and other places where help would not be available or escape would be difficult—ie enclosed or crowded places.  Cars, tunnels, bridges, and subways can all be worrying to a child with panic disorder. Some kids with the disorder will avoid leaving the house alone; extreme cases may even become housebound.

Stress Anxiety And Then Panic: Neal’s Story

As Sideman says, his attack occurred in the early 1990s, and few people seriously considered the possibility of a panic attack in a 39-year-old man. So he went home thinking all would be fine, only to have another, more severe attack one week later.

Now, looking back, the situation seems clearer.

“I was under a lot of stress — starting a new business, working 16-hour days, a close friend was ill and dying, and on top of all that, I was doing a super heavy workout regimen at the gym with a trainer,” Sideman says. “So it was a lot of physical stress, emotional stress, and a lot of financial stresses.” He says he also can see roots of anxiety in his childhood and teen years as well as in other family members.

In the moment, he didn’t know what to think because it can be tough to know what a panic attack is like until you have one. His second panic attack “was really a full-blown panic attack, where I thought I was going to die,” Sideman says. “I thought I was going to pass out, not wake up, go crazy, have a heart attack.”

He recalled being terrified, and the response he chose was one that can actually make panic disorder worse: He started to avoid the situations where he had attacks.

Panic Attack Vs Anxiety Attack

Panic attacks are different from anxiety attacks in several important ways. An anxiety attack is an intense or extended episode of anxiety. It is more severe than the normal symptoms of anxiety but not as severe as a panic attack. An anxiety attack usually includes one or more of the following symptoms:

• Feeling restless, wound-up, or on edge
• Difficulty concentrating or your mind going blank
• Fatigued
• Muscle tension and chest pain
• Irritability
• Difficulty controlling worries

An anxiety attack involves a period of intense apprehension about the future. They can also occur before panic attacks. One of the key differences between an anxiety attack and a panic attack is that the former usually features worries about something in particular. Panic attacks, on the other hand, may not involve stress relating to future events. Panic attacks are the body’s response to the perceived threat of imminent danger.

Also, unlike panic attacks, anxiety attacks usually aren’t signs of an anxiety disorder. An anxiety attack is a more extreme form of the anxiety we feel in response to stressful situations. A final distinction between the two is that a panic attack is abrupt and short-lived while an anxiety attack is gradual and more prolonged.

You May Be Able To Mask It

If you’re having a panic attack, but it’s relatively mild, you may be able to mask it. While it may be distressful for you, others around you may not realize what’s happening.

“During a subtle panic attack, for someone who knows what is happening, might be able to mask it from others and work through it so that it quickly passes,” Dr. Reshmi Saranga M.D., a psychiatrist and founder of Saranga Comprehensive Psychiatry, tells Bustle. In more severe panic attacks, the physical symptoms can be harder to hide.

Learn About Panic Attacks And Anxiety

Knowledge is power. With more information about panic attacks, you can be aware of your symptoms, feel more in control, and shorten your attacks.

While many people experience a panic attack just once or a few times, others experience them as part of an existing anxiety disorder. Learning about anxiety can help you better manage it.

What Causes Panic Disorder

Panic disorder sometimes runs in families, but no one knows for sure why some family members have it while others don’t. Researchers have found that several parts of the brain, as well as biological processes, play a key role in fear and anxiety. Some researchers think that people with panic disorder misinterpret harmless bodily sensations as threats. By learning more about how the brain and body functions in people with panic disorder, scientists may be able to create better treatments. Researchers are also looking for ways in which stress and environmental factors may play a role.

Can You Prevent A Panic Attack

You don’t have to live your life in fear of panic attacks. There are several tools and techniques you can use to help manage your attacks and even prevent them.

A good way to prevent panic attacks is to create a plan that will help you feel more in control. If you have a plan worked out for when an attack comes on, you can potentially shorten the duration and frequency of attacks.

Your plan might include:

• practicing a deep breathing exercise or doing progressive muscle relaxation
• focusing a grounding technique like the 5-4-3-2-1 technique
• reading a sheet of paper describing panic attacks, to help rationalize the fear of dying
• having a short list of mantras either on a sticky note or in your phone to open, saying something like “I am going to be OK, these are just symptoms of panic.”

You may want to seek support and let your family, friends, or coworkers in on your plans for when you’re in specific situations.

For instance:

• At home, you can teach your partner or roommate a relaxation technique that they can do with you when you’re in the midst of an attack. Breathing together may help you feel more grounded and focused.
• At work, you may want to simply give a trusted coworker or boss a heads up that you experience panic attacks. Sharing this information can feel scary, but it can also make your office feel like a safer space.

Other ways to prevent future attacks include:

What Is Panic Disorder

Panic disorder is a mental health condition, and panic attacks are a symptom.

Many people experience at least one panic attack at some point, but people with panic disorder experience recurrent attacks.

The symptoms typically arise in early adulthood, around the ages of 18–25 years, but panic disorder can develop in children. It is twice as likely to occur in females as males.

Genetic and biological factors may increase the likelihood of having panic disorder, but scientists have yet to identify a link with any specific gene or chemical.

The disorder may develop when a person with certain genetic features faces environmental stresses. These include major life changes, such as having a first baby or leaving home. A history of physical or sexual abuse may also increase the risk.

Panic disorder may develop when a person who has experienced several panic attacks becomes afraid of having another one. This fear can cause them to withdraw from friends and family and refrain from going outside or visiting places where a panic attack may occur.

Panic disorder can severely limit a person’s quality of life, but effective treatments are available.

How Can I Prevent Panic Attacks

Your healthcare provider can help you identify triggers that bring on panic attacks. During psychotherapy, you learn strategies to manage triggering events and prevent an attack. You can also take these actions to lower your odds of having a panic attack:

• Cut back on .
• Talk to your doctor before taking herbal supplements or over-the-counter medications. Certain substances can increase anxiety.

Anxious Trends During Childhood

A second reason why people develop panic attacks is that as children, they may have grown up in an atmosphere which, for one reason or another, failed to teach them that the world was “their oyster”, a safe place in which they could happily pursue their own enjoyment. Maybe there was an early death in the family, severe illness, or some other serious problem like alcoholism or divorce. Maybe the parents were themselves anxious and over protective, perhaps in response to their own anxiety disorder. Perhaps the child learned to spend too much time and effort taking care of others, trying too hard to please others, and feeling responsible for the happiness of others.