The best way to stop panic attacks and heightened anxiety at night is to first see them as a part of your larger picture of health.
Symptoms never happen in a vacuum, so if you have something as disruptive as panic attacks at night, it's often not an isolated symptom.
Certain medical conditions flare at night that can make anxiety-based symptoms worse. There are also biochemical processes that happen during that time that can precipitate panic attacks.
Fortunately, there is always an underlying reason you are experiencing a spike of anxiety and panic at night, as there are actionable steps you can take for relief.
Increased Anxiety and Panic Attacks and Your Overall Health
We are a remote consultation practice that specializes in complex and chronic illnesses.
Often, patients come to us when they have run through the usual channels of general practitioners and specialists and are left with debilitating symptoms and no viable treatment options.
It is common for anxiety and anxiety-related symptoms to be disregarded as unimportant because they are not life-threatening. Often, a patient is offered a symptom-suppressing pharmaceutical instead of a proper investigation into symptoms.
There are times when pharmaceuticals are the right option, but further investigation is always warranted as is the consideration of all available treatment options.
Your overall health matters when it comes to treating anxiety and panic attacks - as food allergies, intestinal health, histamine intolerance, underlying infection, low stomach acid, inflammation levels, incorrect supplementation, impaired methylation (detoxification) pathways, and nutritional deficiencies are just a few things that can directly contribute to panic attacks and anxiety at night.
Broader contributing factors like past trauma, environmental allergies, high stress levels, and the lack of a social support network can also make anxiety worse and increase the chances of panic attacks at night.
Importantly, these underlying contributing factors can be addressed. Once they are, the reduction or elimination of severe anxiety and panic attacks at night is absolutely within reach.
In this article, we will discuss just a few reasons why you may have panic attacks at night and some potential solutions.
Potential Causes of Panic Attacks at Night
While many of these categories are not formal designations of different forms of anxiety, they can be helpful in thinking about the potential causes of your symptoms.
Post-COVID-19 & Long Covid Anxiety and Panic Attacks
Incidences of heightened anxiety and panic attacks were so prevalent during the pandemic due to quarantines, social isolation, and widespread fear that it is difficult to statistically separate the prevalence of anxiety from the post-viral effects of COVID-19.
However, in our practice as well as in the latest research, we have seen that COVID-19 infections and Long Covid can directly cause increased anxiety and sleep disturbances. [1]
In this first citation, the prevalence of anxiety among COVID-19 patients was 47%, and the prevalence of sleeping disturbances was 34%.
How Post-COVID-19 Anxiety Can Feel ‘Different’
Many patients describe the anxiety after a COVID-19 infection or Long Covid as very different from the ‘normal’ anxiety they have experienced in their lives. Many report it as particularly strong, especially at night.
Racing thoughts can be particularly hard to control, and many feel a sense of impending doom, hopelessness, and the inescapable feeling that they will never be well again.
Patients often stress that these sensations - unlike ‘normal’ anxiety - are not associated with thoughts they have or everyday stressors. This can make the anxiety feel like it's coming from their body rather than their thoughts or feelings.
Inflammation-Based Anxiety
These sensations of ‘body anxiety’ can happen when you have rampant inflammation, which can trigger inflammation-based anxiety that can feel like it originates in your body instead of your mind. [2]
A variety of factors can cause inflammation-based anxiety. In the second citation, the inflammation-based anxiety is traced to inflammatory markers like acute phase proteins and inflammatory cytokines.
These markers indicate that your body is responding to a threat. Inflammatory markers like these could indicate acute infection (like strep or COVID-19), underlying infection (like a failed root canal or SIBO), or a chronic illness (like diabetes or Hashimoto’s Thyroiditis).
Importantly, inflammation can also indicate that your body is responding to perceived environmental threats (like air pollution, mold, or pollen) or even food sensitivities and allergies.
This is why specificity matters in the treatment of anxiety and panic attacks. Even knowing that inflammation is the ‘problem’ is not enough to formulate a treatment plan.
A thorough investigation is needed to determine what factors are informing your symptoms and how best to counter your body’s response.
Limbic-Based Anxiety
Pain and anxiety can perpetuate chronic symptoms, and pain can directly cause anxiety, just as anxiety can make pain worse. [3] Patients who have endured long-term or severe symptoms can also be dealing with a higher baseline of anxiety.
Your body can react to seemingly benign environmental substances because of an inflamed limbic system. Those who have extreme environmental sensitivities can even be forced to move homes or even to a different climate because of their effects.
This higher baseline of anxiety can amplify things like a high-stress job or sleep deprivation. This is why the treatment of symptoms is important, but so is addressing underlying factors like your emotional responses to pain and your stress levels.
Histamine-Based Anxiety
Histamine is an amino acid derivative secreted by basophils (a type of white blood cell), mast cells, and some neurons. [4] It functions as a paracrine secretion (localized hormone) and a neurotransmitter.
Although histamine is a factor in many symptoms, like hives and anxiety, it also plays a crucial role in tasks as seemingly disparate as gastric secretion, bronchoconstriction, and vasodilation.
Histamine is released in response to a perceived threat like an infection, injury, or allergy or even with changes in temperature. [5] When mast cells explode in your body, an increase in histamine is the result.
Normal histamine activity is part of a healthy, functioning immune system, but stress and infection can tip your body over a threshold and into the production of excess histamine.
What can also happen is that elevated histamine levels are not necessarily caused by its excessive release but by the body’s inability to clear it out of your bloodstream.
Your body naturally releases higher levels of histamine at night as well as after meals - so after dinner and close to bedtime is when many symptoms can spike even though you have felt fine throughout the day.
Excess histamine can be a contributing factor to anxiety, panic attacks, and insomnia.
Nutritional Deficiency-Based Anxiety
Nutritional deficiencies are often overlooked as a primary contributing factor in the development of anxiety-related symptoms.
Deficiencies in Vitamin D, B12, Magnesium, Potassium, Calcium, Selenium, and Omega 3s, just to name a few, can all directly contribute to anxiety as well as anxiety-like symptoms. [6] [7]
Many vitamins and minerals that are vital for a stable nervous system are also ‘quick-burning’ - meaning that they are depleted quickly during times of stress and anxiety. The longer symptoms last, it can happen that the greater your deficiency becomes.
A complete nutritional panel will determine exactly what your body requires. Estimating necessary supplementation based on symptom presentation is usually inaccurate.
Anxiety from Poor Glycemic Control
Blood sugar dysregulation/poor glycemic control is a common reason for insomnia, anxiety, and panic attacks, but you do not have to be diabetic, or even prediabetic, to have unstable blood sugar causing anxiety and panic attacks.
Ensuring a balanced diet with sources of protein, fats, and carbohydrates at every meal is a great way to ensure stable blood sugar throughout the day. A general rule is eating 3 meals a day every 4 hours, although some patients need a snack at the two-hour mark.
Not eating enough during the day - and particularly, not eating enough carbohydrates - often sets the stage for anxiety symptoms at night. Many patients have had their symptoms resolve completely after modifying a keto/paleo diet to accommodate more carbohydrates, especially at dinner.
Companion Symptoms To Panic Attacks
What other symptoms are you having when you have a panic attack at night? Do you have nausea, dizziness, joint pain, or gastrointestinal distress before or during one? Do you also experience hives, or do you alternate between feeling very hot and very cold?
Underlying factors of Long Covid and excess histamine can be associated with strong hypnic jerks (which feel like jolts of electricity when you are just about to fall asleep and are startled awake) which can precipitate insomnia. Sometimes waking up at the same time every night can indicate what kind of problem your body is trying to resolve.
Frequently, patients and doctors alike classify multiple symptoms under a diagnosis of ‘anxiety’ or ‘insomnia,’ but distinctions are important and can point you toward a solution.
Potential Solutions for Panic Attacks at Night
The information in this article and on this website are intended for informational purposes only and does not take the place of seeing a doctor and should not be used for the purposes of diagnosis. If you are experiencing severe symptoms, have chest pain, or have trouble breathing, go to a hospital right away. Consult a doctor before beginning or stopping any medications or interventions.
As with any supplement, you must take the right dose at the right time and in the right form in order for the desired effect to occur.
Too often, supplements are seen as a ‘no-risk’ alternative to pharmaceuticals, but poor quality or incorrect supplementation can cause serious problems just as pharmaceuticals can.
Always err on the side of caution when adjusting your diet or adding supplements.
Activated Charcoal at Night
This can be helpful for patients whose underlying contributing factors include elevated histamine levels, Long Covid, and even mold exposure. Patients have reported that taking it before bed can mitigate or eliminate symptoms.
Remember that activated charcoal can absorb minerals, supplements, nutrients, and medication, so it must not be taken at the same time as certain medications or supplements. In our patient population, this is not a long-term solution but a helpful stopgap until more permanent treatment options are enacted.
Magnesium Glycinate
This type of magnesium can be helpful as it increases magnesium levels in the brain and can have a particularly soothing effect on insomnia and anxiety symptoms. [8]
Rarely, magnesium glycinate can trigger more anxiety, especially for those with underlying mold exposure/toxicity.
If you have tried magnesium glycinate in the past and noticed more anxiety, then it is a significant clue your liver’s biotransformation pathways may be impaired from mold exposure.
Cognitive Behavioral Therapy
Sometimes, nighttime symptoms can be particularly frightening, and trying to manage them long-term can lead to a fear/anticipation cycle that contributes to the perpetuation and escalation of symptoms.
CBT techniques can be beneficial in spite of underlying contributing factors. Patients who experience fear, anxiety, panic attacks at night as well as insomnia have found the Insomnia Coach’s YouTube Channel to be a useful free resource.
Functional Medicine
Since solutions for anxiety and panic attacks at night are heavily dependent on what is causing them, using functional medicine to isolate the source of your symptoms is ideal. Functional medicine employs specialized testing and natural, effective treatments to remove the barriers preventing your body from healing naturally.
A benefit of this approach is its patient-centric focus - with hour-long new patient appointments and 30-minute follow-ups.
How you arrived at your current health status matters. Unraveling the path that got you there requires time on the part of the practitioner. Sometimes, the key to your recovery is in an innocuous injury or an outpatient surgical procedure you had years ago.
At every follow-up appointment, treatment is adjusted to accommodate your changing healing trajectory and your new health goals.
Often, patients begin with the goal of simply being out of the shadow of severe, persistent symptoms but end up pursuing goals of going back to school or optimizing their health for a marathon.
Remote Consultations Available
We are a remote consultation practice currently accepting patients worldwide. Testing can be arranged through our practice or your general practitioner. Specialty test kits can be sent directly to you. If a blood draw is required, it can be arranged at a local blood draw center or hospital.
If you want to speak with Dr. Brian Lum directly, you can schedule a Free 15-minute consultation below or call or text our office at 913-728-5291.
Written by Stephanie Lum and Dr. Brian Lum
Disclaimer: If you think that you may have a medical emergency, call your doctor or 911 immediately. No action or inaction should be taken based solely on the contents of this information. Nor should you ever delay seeking medical advice or treatment due to the information contained on this Website. The information on this Website is not intended to diagnose, treat, cure, or prevent any disease or medical condition. The information discussed is not intended to replace the advice of your healthcare provider. Reliance on the information provided by this Website, Dr. Brian Lum, or Functional Healthcare Institute is solely at your own risk.
Bibliography
[1] Deng J, Zhou F, Hou W, Silver Z, Wong CY, Chang O, et al. The prevalence of depression, anxiety, and sleep disturbances in COVID-19 patients: a meta-analysis. Ann NY Acad Sci. (2021) 1486:90–111. https://doi.org/10.1111/nyas.14506
[2] Felger JC. Imaging the Role of Inflammation in Mood and Anxiety-related Disorders. Curr Neuropharmacol. 2018;16(5):533-558. doi: 10.2174/1570159X15666171123201142. PMID: 29173175; PMCID: PMC5997866.
[3] Elman, Igor, and David Borsook. 2018. “Threat Response System: Parallel Brain Processes in Pain Vis-à-Vis Fear and Anxiety.” Frontiers in Psychiatry 9: 29–29. https://doi.org/10.3389/fpsyt.2018.00029.
[4] Saladin, Kenneth S. Anatomy & Physiology : the Unity of Form and Function. Sixth edition. New York, NY: McGraw-Hill Education. 2012. G-9.
[5] Brown, RE, DR Stevens, and HL Haas. 2001. “The Physiology of Brain Histamine.” Progress in Neurobiology 63 (6): 637–72. https://doi.org/10.1016/S0301-0082(00)00039-3.
[6] Sahu, Prashant, Harish Thippeswamy, and Santosh K. Chaturvedi. 2022. “Neuropsychiatric Manifestations in Vitamin B12 Deficiency.” Vitamins and Hormones 119: 457–70. https://doi.org/10.1016/bs.vh.2022.01.001.
[7] Casseb, Gleicilaine A. S., Manuella P. Kaster, and Ana Lúcia S. Rodrigues. 2019. “Potential Role of Vitamin D for the Management of Depression and Anxiety.” CNS Drugs 33 (7): 619–37. https://doi.org/10.1007/s40263-019-00640-4.
[8] Ates, M., Kizildag, S., Yuksel, O. et al. Dose-Dependent Absorption Profile of Different Magnesium Compounds. Biol Trace Elem Res 192, 244–251 (2019). https://doi-org.ezp-prod1.hul.harvard.edu/10.1007/s12011-019-01663-0