How to calm an anxiety attack at night: a step-by-step plan

It’s the middle of the night. You wake suddenly with your heart pounding, your chest tight and a feeling that something is very wrong. Or you’ve been lying awake for an hour, and the worry has slowly tipped into panic.

Anxiety attacks at night are especially frightening. It’s dark, everyone else is asleep, and there’s nothing to distract you. Here’s exactly what to do, step by step.

If you have chest pain that spreads to your arms, back, neck or jaw, severe trouble breathing, or you feel faint, call 911 (or your local emergency number) now.

What to do during a night-time anxiety attack

1. Sit up and switch on a soft light. Sitting up makes breathing easier, and a little light helps your brain register where you are and that you’re safe. Keep it dim, not bright overhead light.
2. Breathe out slowly. In through your nose for 4, out through your mouth for 6. Keep going for a few minutes. The long out-breath is your body’s brake pedal.
3. Name what’s happening. “This is a panic attack. It feels terrible, but it can’t hurt me. It will peak and pass.” Most panic attacks peak within about 10 minutes.
4. Ground yourself in the room. Feel the cool sheet under your hand, your feet on the floor, the weight of the duvet. Name a few things you can see in the soft light.
5. Cool down. Night-time panic often comes with a hot, sweaty feeling. Kick off the covers, sip cold water or hold something cool to your face.
6. Let the wave pass. Don’t fight it or try to force sleep. Your only job right now is to let your body settle.

What not to do

• Don’t check the time. Working out how little sleep you’ll get adds a fresh worry.
• Don’t start scrolling. News, social media and symptom searches wake your brain right up. If you use your phone, use it only for something calming, like a breathing exercise or soft sounds.
• Don’t lie there trying hard to sleep. Effort and sleep don’t mix.
• Don’t reach for alcohol. It might help you drop off, but it makes sleep lighter and more broken later in the night.

Getting back to sleep

Once the panic has passed, you may feel wired, shaky or wide awake. That’s adrenaline, and it takes a while to clear.

• Give yourself 20 minutes or so. If you’re still wide awake after roughly that long (no need to check the clock), get up.
• Go somewhere calm and dim. Sit in another room with a soft light. Read something gentle, listen to quiet sounds or a story, fold laundry, or do slow breathing.
• Go back to bed when you feel sleepy, not just tired. Sleepy is the heavy-eyelid, yawning feeling.
• Repeat if you need to. It can feel like you’re losing sleep, but it teaches your brain that bed is for sleeping, not for worrying. This is a core part of CBT for insomnia, the recommended treatment for long-term sleep problems.

Why anxiety attacks happen at night

• Fewer distractions. In a quiet, dark room, worries and body sensations have your full attention.
• Your body’s night-time changes. As you fall asleep and move between sleep stages, your heart rate, breathing and temperature shift. If you’re primed to notice body sensations, those normal changes can set off the alarm.
• Stress from the day. Worries you’ve pushed aside all day often surface at night.
• Tiredness. A tired brain is more reactive to threat and less able to calm itself down.
• Caffeine, alcohol and nicotine. Caffeine can stay in your system for many hours. Alcohol wears off in the early hours and can leave you jumpy. Nicotine withdrawal overnight can make you restless.

Waking from sleep in a state of panic has a name: a nocturnal panic attack. It’s common in people with panic disorder. Studies suggest that between about 44% and 71% of people with panic disorder have had at least one. They happen during non-dreaming sleep, which is why there’s usually no nightmare to explain them.

Our post on why anxiety is worse at night explains more about the reasons.

Making night-time anxiety attacks less likely

• Wind down for an hour before bed. Dim the lights, put work and news away, and do something calm.
• Have a “worry time” earlier in the evening. Spend 15 minutes writing down what’s on your mind and one next step for each worry. Then close the notebook.
• Keep caffeine to the morning. Have your last coffee, tea, soda or energy drink by early afternoon.
• Go easy on alcohol, especially in the evening.
• Keep regular sleep and wake times, even at weekends.
• Practise slow breathing in the day, so it comes naturally at night.
• Make your room cool, dark and quiet, or use steady sounds like rain to mask sudden noises.

When it could be something else

Waking up at night with a racing heart or breathlessness isn’t always anxiety. See a doctor if you:

• wake up gasping or choking, snore loudly, or feel very sleepy in the day, which can be signs of sleep apnea
• wake with heartburn, a sour taste or coughing, which can be acid reflux
• often get breathless when you lie flat, or have swollen ankles
• have diabetes and wake up sweaty and shaky, which can be low blood sugar
• wake from vivid nightmares about a frightening past event, which can be part of PTSD
• have night sweats with weight loss or fever

And if anxiety attacks keep waking you up, see a doctor anyway. They’re very treatable.

When to get help

Talk to a doctor if night-time anxiety attacks happen often, if you’re starting to dread going to bed, or if poor sleep is affecting your days. Cognitive behavioural therapy (CBT) works well for panic attacks, including night-time ones. If you’ve been sleeping badly for three months or more, ask about CBT for insomnia (CBT-I).

Frequently asked questions

Why do I wake up at 3am with anxiety?

The early hours are when your sleep is lighter and you wake more easily, and stress hormones like cortisol start rising towards their morning peak. If you’re stressed, it’s easy to surface fully and for worries to rush in. A wake-up at 3am is normal. What turns it into anxiety is often the worry about being awake.

Is it normal to wake up in a panic?

Yes. Nocturnal panic attacks are common, especially in people who have panic attacks during the day. They’re frightening, but not dangerous. If they’re new, or come with gasping, choking or chest pain, see a doctor to rule out other causes.

Should I get up or stay in bed during a night-time anxiety attack?

Sit up in bed while the panic peaks. If you’re still wide awake after it has passed, get up and go somewhere calm and dim until you feel sleepy. Lying in bed wide awake for a long time teaches your brain to link bed with worry.

Can listening to something help me get back to sleep?

For many people, yes. Steady sounds like rain or waves, or a gentle story, give your mind something soft to rest on instead of your worries. Keep the volume low and avoid anything with sudden changes.

How Breatheasy can help

Breatheasy is ready when you wake up in a panic. Tap “I’m feeling anxious” and Luma walks you through it: rate how strong it feels, breathe slowly as your phone pulses gently, so you can keep your eyes closed, then see how far the anxiety came down. When it has passed, fall back asleep to calming sleep sounds like rain and waves, or a bedtime story read by Luma. Breatheasy is coming soon to iPhone and Android.

Sources

• Assessment and treatment of nocturnal panic attacks, Craske and Tsao, Sleep Medicine Reviews, 2005
• Panic disorder, NHS
• Insomnia, NHS
• Sleep apnoea, NHS
• Breathing exercises for stress, NHS
• Panic Disorder: What You Need to Know, National Institute of Mental Health