Panic attacks at night during perimenopause and menopause

Eileen Durward
Ask Eileen

06 November 2023

What do panic attacks at night feel like?

Many people suffer from panic attacks and anxiety attacks during the day, and they're very similar at night.

The symptoms you can experience are a sudden rapid heartbeat or palpitations, or your heart really starts to thump. You might start to get shortness of breath, you might start to almost pant, or you might find that you're having problems actually catching your breath.

You might find that you start to tremble, you get the shakes, you might suddenly get really cold, you get a sudden chill, and you can feel this intense fear or panic that can literally stop you in your tracks. So again, a lot of those who have these symptoms during the day will also suffer from them during the night.

Panic attacks in perimenopause and menopause and why can they trigger at night?

In most cases, panic attacks are caused by a drop in oestrogen. As a result, your nervous system can easily go into flight or fight mode. It only takes the tiniest thing to trigger this flight or fight mechanism, which can cause a panic attack and the symptoms I mentioned.

Changing hormones put an awful lot of stress on your body, and if you're also getting stressed during the day, if you're getting anxious during the day, then that stress and anxiety builds up and builds up, and then when you go to bed, your nervous system just goes, "I've had enough." And it literally lets go of everything, and that's when you get your panic attack.

You might find that you get panic attacks after hot flushes or night sweats. Again, it's all due to things like adrenaline and the nervous system being called into play here.

It can be low blood sugar levels during the night. If you think about it, if you have your main meal, maybe between 5 pm and 7 pm, and then don't have anything else to eat, your blood sugar levels are going to be very, very low, in the middle of the night. At that point, this could set off your nervous system and create a panic attack. And the really interesting thing here is that when a panic attack happens, you don't notice hunger. So, there you are in the middle of the night, your blood sugar levels are terribly low, and you've got this sudden panic attack, but you don't realise that it's actually hunger that's doing this. And then, of course, you try to get back off to sleep with really low blood sugar levels, and you can't because this panic just goes on and on.

It could be due to dehydration. If you haven't been drinking a lot during the day, or if you're drinking the wrong things at night, then you could end up being dehydrated in the middle of the night, which can set off a panic attack.

It can be literally anything that starts to rev up your nervous system, such as caffeine at night, or alcohol consumption.

It could be that you had a really spicy meal or a high-salt and sugary snack before bed. Even a bag of crisps or a chocolate biscuit in the evening can be enough to rev your nervous system up. Also, it could be what you're watching or reading before you go to bed. Do you enjoy scary movies, crime programs, or reading scary books? These can draw you in and create that sense of panic or anxiety. All of these things can rev up your nervous system to the point where it can ping in the middle of the night.

What can you do to help yourself?

One of the easiest things you can do to help prevent panic attacks or calm one down is slow, structured deep breathing.

Doing some deep breathing during the day, just for maybe a minute or two at a time, will help you get into the habit. If you're in a state of panic, you breathe very shallowly, and that keeps a panic cycle going. If you learn to do slow deep breathing, it switches that vicious cycle off. So, the more you can practice deep breathing, the easier you can click into it when you experience a panic attack, and that can make a huge amount of difference.

Have a calming bedtime routine. Maybe have some really nice meditation music just before you go to bed or while you're in bed as well. I have my Alexa in my bedroom, but not near my bed. You don't want these things too close. Very often, when I go to bed, I just ask for meditation music for an hour. I find that it really calms me down and gives me a good night's sleep.

Have a snack before bedtime. It needs to be a healthy snack, not a sugary, high-salt, or spicy one. So, it can be things like oatcakes and cheese, a little bit of avocado and cream cheese, or some Greek yoghurt with some nuts and seeds. Something that's going to stabilise your blood sugar levels and keep everything calm.

For those of you with a really sweet tooth, try a couple of the really big Medjool dates. They're lovely and sweet, but they contain lots of good fibre and things like magnesium in them, which again stabilise your blood sugar levels and help you get back to sleep.

Drink plenty of water throughout the day. Keep yourself well hydrated and have just a little shot glass of warm water before you go to bed. A lot of you keep asking, "Why does it have to be warm water?" If you take cold water just before you go to bed, it's going to shock your digestive system, and that's going to keep you awake, so warm water is just going to help calm everything down too.

Avoid caffeine and alcohol in the evening. With alcohol, yes, it can certainly get you off to sleep really quickly, but the chemical components of alcohol really sedate your brain, and the brain at some point will panic about that. It's almost as if you're in too much of a deep sleep, so that point of panic can wake you up with a panic attack. Additionally, alcohol can produce chemicals that keep you awake for up to three hours, so it is not a good sleep aid.

Have a magnesium supplement with your evening meal and try calming herbs such as Valerian and Hops, or Passionflower because they can help relax you and calm your nervous system down to help you sleep better.

When you get into bed as well, it can be really helpful just a minute or two of slow deep breathing to get yourself nice and settled.

The problem with a panic attack at night is that it can really wake you up and you can't just get back to sleep really quickly. So, the best thing to do here is maybe get up and have a warm drink. Again, not tea or coffee, but there is a lovely tea called Tulsi Tea, which is very, very calming. I find that a good one if I happen to wake up in the middle of the night and can't get back to sleep. It's warming, it's relaxing.

You could also read something very calming or listen to a little bit of music before you get back into bed. For example, you could try listening to some classical music or calming meditation music to help soothe your mind and help you get to sleep.

Acupuncture can very often be really helpful for this, or acupressure, or reflexology. These can all help to calm and reset your nervous system.

When do you need to go to the doctor about this?

If you find that these panic attacks are really causing issues, if they're getting really, really scary, if they're stopping you from doing things during the day, or if you're getting them every single night and you're really not rested, then that's the point where you may need to speak to your doctor. You might just need something a little bit stronger than herbs to get you through this particular phase.

I hope you find this one helpful. Again, it's another one that seems to be becoming more and more common. If you experienced panic attacks during the day or night, what did you do to help yourself? Please share. You know, as always, I love reading your stories.

And until next time, have a lovely week, and take care

You may also find these topics helpful:

Types of anxiety in menopause & what can help

6 things to do at night to help your menopause

How to calm night-time anxiety and sleep better in perimenopause and menopause

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