If you don’t know what panic attacks are, count yourself lucky because they can be debilitating.

The symptoms can differ for different people, but often include physical symptoms accompanied by an overwhelming sense of panic. For example:

• For some people they may be focused on their heart rate, and panic because they think they may have a heart attack (even though they’re not going to have one).

• For other people they may be focused on their breathing and find that their throat is constricting. This makes them worry that they may have an asthma attack or may even die (but they don’t).

• And still for others, they may be focused on their stomach, begin to feel a bit nauseous, and worry that they will vomit (even though they might not).

That latter example was me the first year after finishing high school.

So I know of the experience - I learned that the mind can make us physically sick.

But I also learned about solutions - and that our mind is powerful enough to make us healthy.

Why Can Panic Attacks Occur When Waking from Sleep?

When We’re Awake

Before describing how panic attacks can happen when waking from sleep, it’s important to understand a key component of panic attacks.

Panic attacks can begin from a physical symptom (eg, heart rate, breathing rate).

But the fuel on the fire is - the Misinterpretation of a Physical Sensation.

This misinterpretation can set off a cascade of events that happen very quickly - and increase in intensity.

So for example - when I was 18 years old, I would sit down in a lecture theatre in preparation for my Architectural Studies lecture (as you may have guessed, I didn’t become an architect). I’d notice a sensation in my stomach. I would then think “That doesn’t feel comfortable”. Very soon, my stomach felt more uncomfortable. I would then think “I hope I don’t get sick” and “That would be embarrassing vomiting here in the lecture theatre” and “Everybody would stare at me in disgust”. Sure enough, I soon felt very nauseous.

When We’re Waking From Sleep

One way we can categorise different stages of sleep is whether it’s relaxing (ie, light and deep stages of sleep) or stimulating (ie, REM sleep).

Most people have heard that REM sleep is associated with dreams (which is true).

But another name for REM sleep is Paradoxical Sleep. It means it’s a type of sleep that is completely opposite to others.

During REM sleep, our heart rate is higher than any other stages of sleep And our breathing is not slow and deep - it’s quite irregular. Our brain is also much more active in REM sleep than other stages of sleep (whether we remember our dreams or not).

And REM sleep is actually a lighter stage of sleep than most people think. This means we can wake up out of REM sleep more easily than other stages of sleep.

Basically, the stage is set for a Panic Attack when we wake from REM sleep.

We can wake up and notice certain physical sensations - like our heart is beating faster than it should - or that our breathing is a bit funny. And because our mind was quite active during REM sleep, this continues when we wake - with thoughts racing through our minds.

All of these physical and cognitive ‘symptoms’ can trigger that Misinterpretation of our Physical Sensations.

And thus, the cascade of events occur, with our wheels spinning us towards another panic attack.

So let’s put the brakes on those spinning wheels by looking at 2 ways to deal with these panic attacks.

What to Do About Waking Up in Panic

As psychologists, we help people find what contributes to a problem.

In this situation, these panic attacks have a (1) physiological contribution (faster heart rate, irregular breathing) and (2) a cognitive contribution (misinterpreting physical sensations as something dire).

Solution One

The first thing to do is reverse the physiological contribution - and it’s probably what a lot of people do naturally in response to a racing heart and irregular breathing.

And that is to regulate your breathing.

People have different methods of doing this - with different ‘counts’ when breathing in, pausing, and breathing out. So find which type of counting method is most comfortable for you.

This might sound basic, but finding the most comfortable breathing method is important when you’re in this state. Because as soon as you feel uncomfortable, Misinterpretation can fuel the panic again.

And this brings us to a very important point. Whilst you’re breathing and counting, thoughts can still race through your mind. So it’s important to occupy your mind when you’re breathing.

Sometimes counting is enough - sometimes it’s not.

If not, simply think to yourself which action you prefer:

• the cool refreshing air entering your body when you breathe in, or

• the warm relaxing air leaving your body as you breathe out

If you load up your mind with counting and evaluating which breathing action is more positive, it reduces the chances of other unhelpful thoughts entering your mind. This ‘loading technique’ is sometimes called Cognitive Load.

Solution Two

You really need to reduce your physiology first before doing Solution Two, as it allows you to think better.

Although Misinterpretation of Physical Sensations can feel a bit automatic, it’s important to quickly counter this ‘unhelpful’ way of thinking with a ‘helpful’ counter-thought.

Now you’ve learned more about the physical effects of REM sleep occurring when we wake up, it’s important to repeat these facts to yourself if you feel panicking shortly after waking up

It could be something as simple as repeating to yourself “This is just normal REM sleep”.

Again, this repetition is using Cognitive Load to your advantage - but it can also be a true fact - that those physical sensations are because you were just in REM sleep.

Here’s another key thing - as you keep practicing these solutions and they begin to work, you can also use History to your advantage. For example “This has happened before, and it was just me waking from REM sleep”.

With enough practice - and focusing more on successfully turning these panic attacks around - you become more resilient.

I truly hope you find benefit from practicing these techniques, and even get to the point where you realise your mind is powerful and it can make you healthy.

Feel free to share your experiences in the comments below.

- Prof Mike Gradisar