Short and long term solutions for middle of the night panic

June 17, 2016 6:55 AM

So, I've recently started waking up in the middle of the night totally panicked-- racing heart, wide awake, but no corresponding thoughts/memories. Obviously, I'd like this to stop. Any advice for the short-term or longer-term, is there any particular therapeutic approaches that might help?

I found out some upsetting information about my immediate family that I didn't know before related to a pretty dysfunctional upbringing. This new information seems to have hit a very sore spot in me and although I feel fine mostly during the day, I am also waking up regularly in panic (I am sure that these two things are related). So, I am in the process of looking for a therapist to start seeing, and am looking for recommendations for therapeutic approaches that might be a good fit and would help me manage this middle of the night panic. Also, what should I be doing in the short term? (while exercise and meditation during the day are great, they don't seem to affect how well I can sleep at night)

posted by twill to Health & Fitness (15 answers total)

Best answer: I went through something similar a few years ago, and in the short term the following helped:

- cut all alcohol for a time. Even a glass of wine with dinner could cause me to wake up in a panic at 3am

- when I wake up, I would focus on counting down from 100. If I lose track because the swirling thoughts are so intrusive, I just gently remind myself that right now I'm thinking about counting and continue from approximately where I remember stopping.

Therapy will absolutely help in the long term, but it's ok to be more lenient on yourself to get through things right now.
posted by A hidden well at 7:15 AM on June 17, 2016 [4 favorites]

The nighttime panic and racing heart might be related to your emotional upset, and by all means seek therapy for that. Exercise and meditation are good. However, please do not dismiss the possibility of a medical issue. Sleep apnea can cause your exact symptoms, and one can develop sleep apnea at any time during adulthood even if you've never had it before. I had been told I snored and thought nothing of it for a while. I counteracted daytime sleepiness with extra coffee and thought I was fine. But after several episodes of middle-of-the-night waking in a panic with a racing heart, I became alarmed enough to see a cardiologist, who after ruling out heart problems referred me to a sleep specialist, who diagnosed moderate (not even severe) sleep apnea. The repeated lowering of oxygen from my sleep apnea was the cause of the panics and racing heart. Haven't had an episode since getting my CPAP device. Please discuss your symptoms with an M.D., and I hope you feel better soon.
posted by RRgal at 7:19 AM on June 17, 2016 [3 favorites]

Best answer: I've been suffering from the same type of thing for the past 7-8 months. It sucks. :/

Firstly, I recommend seeing a GP to make sure that your (heart) health is fine; i.e., that there is no physical cause for concern. Assuming that is the case, this fact alone should help (at least somewhat) you to deal better with the middle-of-the-night panics. You can begin by re-assuring yourself that nothing bad is really happening.

Another few ideas for dealing with panic in the moment.

(1) One of the things that helps ME the most is a simple distraction technique. You just come up with a category (US cities, Country names, Female names with 2+ syllables, Types of animals, Band names, etc.) and then try to come up with an example of that category for each letter of the alphabet. It is rare that I have to go through the alphabet a second time now before I am drifting back off to sleep.

(2) Another technique is is "ground yourself": So you state (in your head) facts about your present location/situation. E.g., "Today is Friday 17th of June. I am lying in my bed. It is XX-o-clock. The cat is down at my feet. And I am safe." So state facts, then repeat to yourself I am safe. Get your head to really accept that you are safe.

(3) Sometimes when it starts to kick off, I simply tell myself "stop being so ridiculous". I.e., I try to just dismiss the whole experience out of hand, and not turn it into a big deal. But this tends to only work when the heart-race is only just beginning to rise. If it is already going at a rapid pace, then use 2-3 above.

As for the type of therapy, you should probably seek out CBT (cognitive behavioural therapy): this is well-known for helping people successfully manage their anxiety.

Finally, as my GP told me: Prepare to be patient. Once anxiety has taken hold, it takes longer to get on top of than you would hope/like. As for me now: what I am experiencing currently isn't nearly as debilitating as it was when this whole thing first kicked off. It is certainly more bearable (though not gone altogether). So it does take time. BUT it can/does get better.

Best of luck.
posted by Halo in reverse at 7:24 AM on June 17, 2016 [6 favorites]

In terms of prevention, you will need to look at reducing your stress, perhaps medications and maybe therapy.

I've had incidents of middle-of-the-night panic and it's awful awful awful. my LONGEST panic attacks have been at night. I go from 0-60 in about 3 minutes and ride waves of terror for 1-4 hours. I've had to miss work from being completely zombified from an all-night panic.

No matter that you KNOW what's going on as it's happening, your Panic just decides to eff with you anyway.

If you can't get a prescription for lorazepam that dissolves under the tongue (its as fast as you can get it to work), get up, sit up and get something cool to hold in your hands for a distraction (I used to put ice cubes in a ziplock bag to play with). Sip icy cold water.

I try to distract my mind with something boring. Usually inane math equations. Or if I can sit still long enough, a typing test.

There's nothing to be ashamed of. This is something that happens to anxious people. If you go to your doctor and tell them you're having regular panic attacks and need a strategy... they should be able to help you.

Good luck. Panic is ... it's just terrible. (hugs)
posted by Dressed to Kill at 7:33 AM on June 17, 2016

Do have a quick chat with your doctor. Hypoglycemia can also make you wake up with your heart racing (apparently the most likely time for this is 2-3am but it kind of depends on when you eat dinner).

How long do these interludes last? Actual adrenaline-triggered panic attacks are usually 30-40 minutes minimum, sometimes 90 minutes or more. I find that I have those when I am stressed but more as a function of not eating/sleeping/relaxing/exercising well over a couple of weeks rather than directly related to the stress. Fixing my sleep, hydration, work-life balance etc fixes the problem. But, obviously, you'd want to make sure it's not an adrenal or pituitary malfunction before you just assume it's stress.
posted by Lyn Never at 7:33 AM on June 17, 2016

Response by poster: Thank you for all the responses so far. This panic started right after hearing upsetting information about something that happened in my family around the time i was born. So I'm 100% sure this panic is related to some sort of unresolved processing of this information, rather than an underlying medical issue.
posted by twill at 7:38 AM on June 17, 2016

When I had this problem, taking an ativan before bed helped enormously.
posted by Ragged Richard at 8:12 AM on June 17, 2016 [4 favorites]

Or a betablocker which is what is often prescribed for daytime panic attacks. Some panic attacks are actually precipitated by tachycardia--that is your heart starts racing and then you get panicked because your emotions respond in kind rather than the opposite which is what many people think.
posted by eglenner at 8:17 AM on June 17, 2016

Seroquel(which is an immediate release anti-psychotic that feels a lot like a sedative) is prescribed for this exact sleep problem. Ativan works too, but good luck getting any doctor to give it to you(they really hate prescribing it, it seems).

I took seroquel when I had really awful restless leg syndrome/myoclonia and panic in my sleep and it worked pretty well. Regular sleep meds like zopiclone gave me really awful sleep paralysis and nightmares. Ativan made me wet the bed, which was...less than ideal(but it is a muscle relaxant so kinda par for the course).
posted by InkDrinker at 8:20 AM on June 17, 2016

When I used to wake up panicked about work, it usually helped to write out a To Do list. That makes me wonder if a few minutes of journaling would help you get back to sleep, or if journaling before bed would help prevent it altogether. (Or would it make it worse, I wonder?)
posted by salvia at 9:00 AM on June 17, 2016 [1 favorite]

Best answer: The "I am safe" bit helps me tremendously (I will sometimes add "I am home, I am warm" to the beginning). And this may or may not apply to this particular situation since it's less of a "problem to be solved" for you, but I will stop and think "Is there anything that I can do about this right now, at 4 a.m.?" (or whatever time you wake up in the middle of the night). And since the answer is almost always "no," it makes me realize that I can deal with it in the morning. If the answer happens to be yes, I let myself get up and do one thing that would help.

If necessary, I will let myself get out of bed for a short period -- 30-45 minutes. I'll get a snack, watch an episode of a sitcom I like, something -- to pull myself out of the situation and distract myself.

I'm sorry you're going through this.
posted by darksong at 9:04 AM on June 17, 2016 [2 favorites]

Best answer: In re. seroquel, there are a lot of concerns about safety for off-label use for insomnia; here's one article, loads more out there for the interested Googler.

I've found long-acting benzodiazepines (in particular, flurazepam) useful for middle-of-the-night waking. I'm also finding it helpful to go to bed very early, fully understanding that I will wake in the night, not feel great, etc, but to remove the "go back to bed" stress part of it and just do relaxing what-not until drowsiness kicks back in; I'm "allowed" biphasic sleep. If you are getting to bed just fine, a short-acting benzodiazepine taken as soon as you wake might be more useful. (Obviously IANAD, just a long-term hardcore insomniac.)

I know screen time is not generally recommended with sleep difficulties, but since losing the ability to sleep through the night I've been watching my way through entire runs of TV shows that are fairly soothing and ask little from me. It replaces one habit (wake up, worry) with another (wake up, watch 'The Simpsons,' nod off in the middle of it), at least.
posted by kmennie at 9:37 AM on June 17, 2016 [4 favorites]

When I used to wake up in the middle of the night from nightmares with heart racing, this was low blood sugar. Cutting sugar from my diet and eating a hearty bedtime snack involving protein and fat (like cheese) largely put a stop to it, so long as I was consistent.
posted by Michele in California at 11:43 AM on June 17, 2016

This happens to me sometimes when I am stressed. What helps - cutting out caffeine, increasing exercise, and CBT techniques. Some people find magnesium or vitamin B supplements help with anxiety.

There are resources (apps, books) for CBT while you search for a therapist.

Halo in reverse also has some great advice. I also use distraction techniques (counting backwards room 100 by 7, imagining myself colouring or painting specific things) to fall back asleep and ward off the "what ifs".
posted by haunted_pomegranate at 2:47 PM on June 17, 2016

I have only ever had panic attacks that woke me from sleep. Mine aren't primarily racing-heart, though that's part of it -- chiefly it's an overwhelming, but contentless, sense of dread.

What helps me is to get up and sit in a well-lit room -- the bathroom does fine if you have a sleeping partner you don't want to disturb. A friend suggested a "grounding" technique of simply naming objects you see around you. "Toilet paper. Hairbrush. Sink. Faucet. Shower curtain. Bath mat." That helps too. I think the light, sitting upright, and naming objects all help to orient me, which has a calming effect.

It doesn't really work for me to keep lying in bed in the dark room, even if I tell myself I'm safe, in my own bed in my own room in my own house with my husband next to me. That does allow me to detach slightly and observe the panic attack happening, rather than be totally swept up in it, but it doesn't lessen the intense sense of impending doom. Getting up does lessen or even stop it.

I also have a prescription for a beta-blocker. Now, if I wake up having a panic attack, I swallow one of those as I get up, and it's over much faster.
posted by snowmentality at 2:58 PM on June 18, 2016