We’ve all been there: you’re exhausted from a long day and just want to relax and go to bed, but your brain isn’t on the same page. Instead, your mind chooses to dwell on earlier mistakes, replay what should have been, and worry about the next day. Your breathing and heart rate increases, you feel panic looming, and feel a bit sweaty…you’re having an anxiety attack.
First things first. What exactly is an anxiety attack? While “anxiety attack” is not a medical term, many people and some experts use it to describe any sustained period of higher-than-normal anxiety. Others use it interchangeably with “panic attack,” which is a recognized medical term that describes sudden episodes of intense fear and panic.
In this article, we will be using the term ‘anxiety attack’ to describe the sustained period of higher-than-normal anxiety. If you’re looking for ways to calm down during a panic attack, check out: How long do panic attacks last? for expert tips.
Anxiety attacks at night, sometimes also called nocturnal panic attacks, can hinder your sleep quality. But what exactly triggers a nighttime anxiety attack, and what can you do about it? Let’s take a closer look.
With busy calendars and long to-do lists, there’s a lot to be stressed about these days. While sometimes it’s one stressor that plagues our minds, oftentimes it’s the impact of multiple triggers that build up throughout the day and overwhelms us at night. The cumulative effect of these can make it difficult to wind down, cause nervousness, and intensify nighttime anxiety and panic.
Stressors vary from person to person, but they can include everyday tasks like back-to-back meetings, writing an important email, or coming home to a pile of dirty dishes. Some other common triggers include:
If you’re tossing and turning at night, adjusting your sleep hygiene (which includes your bedtime habits and sleep environment) may help. For example, if you’re drinking coffee until 4pm or scrolling through your social feeds in bed, these habits can keep you alert and disrupt your sleep-wake cycle.
This might not seem like a big deal but disrupting your cycle even a few nights in a row can have a ripple effect due to the resulting lack of sleep. It can potentially contribute to the development of sleep disorders like insomnia, which increases your risk or exacerbate an already existing anxiety and depressive disorder.
In fact, people with insomnia are 17 times more likely to experience anxiety compared to someone who obtains adequate sleep, according to research. There’s no doubt that a night of high-quality sleep is linked to better mental health.
If you’re living with an anxiety disorder, it’s probably not surprising that drinking too much caffeine (think: coffee, tea, soda or energy drinks) can brew anxiety or trigger panic attacks. Caffeine is a stimulant that boosts energy and alertness by influencing your central nervous system (CNS), which includes your brain.
Caffeine triggers the release of adrenaline, a hormone linked to your fight-or-flight response. This causes your heart rate and blood pressure to increase and can intensify feelings of nervousness, jitters, shortness of breath, and racing thoughts.
Not only that, but a common side effect of caffeine (especially late in the day) is that it can wreak havoc on your sleep, which worsens symptoms of anxiety. Caffeine blocks the effects of adenosine, a neurotransmitter that promotes relaxation and quality shuteye, which can last as much as 6 hours after drinking. To prevent a vicious cycle of poor sleep and increased anxiety, limit your daily intake and avoid caffeine at least 6 hours before bedtime.
If you’ve ever experienced nocturnal (i.e. nighttime) panic attacks or had your anxious thoughts take over in the evening, you’re not alone. With fewer distractions, it’s easy to overthink and wander into worries that might have been suppressed during the day. Plus, fatigue and exhaustion from earlier activities can make it harder for your mind and body to relax and wind down.
What’s more, hormones like cortisol, the stress hormone, also play a role in rousing nighttime anxiety. Cortisol usually follows your sleep-wake cycle, peaking in the morning and tapering off as the evening sets in, but stress can throw off this cycle, causing levels to remain elevated at night. This hormonal imbalance can lead to increased anxiety and restlessness, making it harder to sleep and cope with the stressors at hand.
There are a few different strategies you can try to ease nighttime anxiety attacks and enjoy an overall better night of sleep.
Penning down your thoughts, worries, and experiences on paper is an effective way to calm your mind and process your emotions; its benefits are even backed by science. Journaling allows you to externalize your feelings from the day and gives your mind a break from constantly replaying them. Writing also promotes self-reflection and self-awareness.
As you write, you can explore the underlying roots of your anxiety attacks, identify any patterns, and gain insight into your thoughts and behaviors. This self-reflection allows you to better understand yourself – and your triggers, helping you to find ways to cope or resolve the issues. Aim to devote about an hour to your worry journaling during the daytime, as journaling too close to bedtime can sometimes carryover into your sleep and lead to insomnia.
Reading a book in the evening can help ease your mind and promote a good night’s sleep. When you immerse yourself in a story, it takes your mind away from the daily stressors or anxious thoughts and shifts your focus to a good story.
But it’s also an effective form of self-care, as it provides a quiet and solitary space that promotes calm and relaxation. Just be sure to find a cozy spot someplace other than your bed. Reading in bed can cause your brain to become confused about whether to be awake or asleep in your bed – and you want to ensure your body and mind knows that once you’re in bed, it’s time to shut down for the night.
Stretching is a great way to fend off the physical symptoms of anxiety and stress. Whether you join a yoga class or engage in a few simple stretches before bedtime, the physical movements of stretching can help relax your muscles, release tension, and promote normal breathing patterns.
The reason being: stretching is a relaxation technique that activates your body’s parasympathetic nervous system (PNS), which is your body’s counter-stress response to promote a sense of calm. Plus, it stimulates the release of endorphins, the feel-good hormones that can boost mood and alleviate anxiety symptoms.
Establishing a night routine that practices good sleep hygiene can help keep your circadian rhythm, your body’s internal clock, consistent. So, when nighttime comes around, your mind and body recognize it’s time to relax and prepare for sleep. This not only helps prevent racing thoughts from amplifying at night but can help you get quality sleep. And when you’re well-rested, you’re able to think clearly, regulate your emotions, and better cope with stress to improve your overall well-being.
Some effective tips for better sleep, according to experts:
Meditation can be a powerful method to soothe your mind before sleep by creating a state of mental stillness and mindfulness. When you’re practicing meditation, you generally focus on one thing, like a particular sensation in your body or engaging in breathing exercises.
This practice helps train your mind to become more aware of the present moment and let go of any intrusive thoughts. It also encourages self-compassion and acceptance. Rather than berating yourself for overthinking or worrying, mindfulness can remind you that stress and anxiety are a normal part of life – and to take one step at a time. To calm anxiety, take 5-10 minutes to sit still, close your eyes, and take deep breaths.
Many of us jump from screen to screen throughout the day: we work on a computer, watch our favorite shows on the TV, and catch up on the latest social media trends on our phones. And while we might think these habits help us to relax at the moment, research shows that excessive screen time is actually linked to mental health conditions, such as depression, anxiety and loneliness.
On top of that, screens emit blue light that mimics daylight, which not only activates your brain, but also interferes with melatonin production and can cause sleep disorders and other health problems that can trigger or amplify symptoms of anxiety.
To avoid using screens too close to bedtime, make yourself a digital curfew (at least an hour before you sleep) for your phone and other electronics. And instead, engage in good sleep hygiene habits like reading a book, listening to music, or meditation to calm your mind and prepare for bed.
While the techniques above can be useful tools to unwind and relax, if your nighttime anxiety is frequently keeping you awake or impacting your day-to-day activities, it’s best to connect with a healthcare professional who can make an accurate diagnosis and suggest treatment options.
At Talkiatry, you’re able to work with a psychiatrist from the comfort of your own home and you can schedule your first appointment in a matter of days. To get started, take our free online assessment, to see if Talkiatry is right for you and get matched with a psychiatrist.
In your first appointment, your psychiatrist will be able to evaluate your symptoms and you’ll work together on a personalized treatment plan. Your treatment plan may include medications, talk therapy such as cognitive behavioral therapy (CBT), or both. Treatment can make a huge difference in your symptoms and quality of life.
Dr. Austin Lin is a double board-certified adult and addiction psychiatrist who has been in practice for over 9 years. At the center of Dr. Lin’s clinical approach is a strong emphasis on establishing trust and using a collaborative approach to help patients develop an individualized and cohesive plan so that they are able to achieve their goals.
Dr. Lin's practice focuses on medication management. Typically, he offers this in conjunction with supportive therapy, motivational interviewing, and/or cognitive behavioral therapy in 30-minute follow-up visits. Occasionally, Dr. Lin may recommend that additional therapy is needed and ask that you bring a therapist into your care team in order to provide the best outcome.
Dr. Lin received his medical degree from St. George’s University School of Medicine. He went on to complete his residency in psychiatry at Harvard South Shore, an affiliate of Harvard Medical School, where he served as Chief Resident and earned his 360° Professionalism award. He then had additional training in Addiction Psychiatry through his fellowship at the University of Texas Southwestern Medical Center. After completing training, Dr. Lin has worked as an Addiction Psychiatrist and Director of Adult Services in the Trauma and Resilience Center (TRC) at the University of Texas Health Science Center at Houston (UTHealth). He specialized in treating patients with a history of depression, anxiety, trauma, and substance use disorders.
Dr. Lin has held an academic appointment at UTHealth, and he has spent his professional career supervising and teaching medical students and psychiatry residents.