A nighttime, or nocturnal, panic attack is characterized by sudden waking and feelings of terror. Nocturnal panic attacks differ from night terrors because patients usually remember the attack in the morning. According to the "Internet Journal of Neurology," panic attacks tend to happen in the middle stages of sleep, usually as a person is transitioning from stage 2 to stage 3 sleep. If you have panic attacks at night, you may also have them in the daytime, or the attacks could be the result of another condition such as a seizure disorder or sleep apnea.
Pulmonary and Respiratory Symptoms
Most nocturnal panic attacks are characterized by difficulty breathing, hyperventilation and a rapid or irregular heartbeat. These two symptoms together can cause arm and leg twitching or numbness and tingling in the hands and feet. Other people might feel tightness or pain in the chest. Some people who have nocturnal panic attacks believe they are having a stroke or heart attack, and the fear of dying can compound the symptoms.
Some people with nighttime panic attacks wake up suddenly with a feeling that they are choking or suffocating or that they can't inhale and exhale. They might make a gagging sound or flail with their arms and legs. While sometimes this feeling has a physical cause, such as a blockage in the airways caused by a condition like sleep apnea, in other cases there is no physical cause for this feeling.
Heavy sweating is another common symptom of nocturnal panic attacks. The sweating might be accompanied by other changes in body temperature such as hot flashes or feeling chilled. Flushing in the face is also a symptom of a nighttime panic attack.
A symptom common to all nighttime panic attacks is an intense feeling of fear. Like daytime panic attacks, this feeling often has no rational cause. People wake up suddenly with a feeling of doom or dread and the feeling can last up to 20 minutes, even after the physical symptoms have mostly abated. Some people might also feel dissociated from their bodies or from reality. Since nocturnal panic attacks happen in earlier stages of sleep, they are rarely associated with nightmares. Physical symptoms can trigger the fear, and these symptoms often make the fear more intense. The fear of having another nocturnal panic attack can also contribute to more attacks.