If you've ever woken up in a complete panic, you know what a frightening experience it can be. Your breathing quickens, your heart feels like it is beating so hard it might come out of your chest, and you feel irrationally afraid.

"I see this sort of thing all the time," says Carl Bazil, MD, director of the Epilepsy Sleep Division of the Department of Neurology at Columbia University Medical Center in New York City. (He's board-certified by the American Board of Sleep Medicine.) "It's a form of insomnia. You're wide awake and can't get back to sleep."

This disconcerting, panicked feeling may have served our ancestors well, when they were living in the jungle, fell asleep, and were awakened by growling tigers.

"The people who rolled over and went back to sleep probably got eaten, but those who woke up survived," Bazil says. "We inherited this response, which could be helpful in a real crisis." When there is not a real crisis, it becomes a problem because your brain goes into hyperactive overdrive even when it doesn't need to.

Besides stress, anxiety plays a huge role in nighttime panic attacks, says Matthew D. Mingrone, MD, a board-certified otolaryngologist. "Stress plays a big role in sleep disruption and can definitely affect your normal sleep cycle," he says. "So managing that stress becomes very important." Obstructive sleep apnea also can cause you to wake up in the middle of the night feeling very troubled, he says, and if you drink alcohol, chances are your sleep cycle will be interrupted.

Before deciding how to treat these middle of the night panic attacks, find out if there is a physical cause, says Shelby Harris, PsyD, CBSM, director of the Behavioral Sleep Medicine Program in the Sleep-Wake Disorders Center at Montefiore Medical Center in the Bronx. Once you are sure it is not due to a condition such as sleep apnea, seek help.

"If you wake up in [the] middle of night feeling panicked, do deep breathing or learn muscle relaxation," Harris says. "You need something that takes your mind off worrying because the more you lay in bed and worry, the more you see the cycle continuing."

Here's what to try:

Wind down. Make sure to do this for more than an hour before you go to bed, Harris says." Otherwise, you'll be worrying and thinking of everything," she says. "You may sleep for three or four hours but then, as your sleep gets lighter, you start thinking about everything again."

Learn to relax. In progressive relaxation, lie on your back, close your eyes, and consciously relax your body. After starting with your toes, move to your ankles and knees, then your legs and thighs, and finally your chest and abdomen. Make sure each body part is relaxed and if any part feels tense, make a conscious effort to relax that spot.

Keep a diary. "Write down all the things that are worrying you and what you can do about them," Harris says. "If there is nothing you can do, you have to say to yourself, 'I am doing all that I can.'"

Practice good sleep hygiene. Make sure your bedroom is cool, dark, and quiet, which makes it conducive to sleep. "Your bedroom should be a sanctuary," says Mingrone.




Sleep Disorders Center, Relaxation Techniques. University of Maryland Medical Center.