Panic attack symptoms: what it feels like and how to stop one

Panic attack symptoms hit fast and mostly in your body: a racing heart, short breath, shaking, sweating, dizziness, a tight chest and a sudden wave of dread. It can feel like a heart attack, or like you're losing your mind. What's actually happening is your body's alarm going off with no danger in sight, and it passes. Most panic attacks last between 5 and 20 minutes. To stop one, slow your out-breath, stay where you are, and let the wave peak instead of fighting it.

You're far from the only one. In a 2006 national survey of 9,282 US adults, 22.7% had had panic attacks without ever developing panic disorder. So it's common, even when it feels like it's only happening to you.

What a panic attack feels like

So what is a panic attack? It's a sudden rush of intense fear with strong physical symptoms, often for no clear reason. It can start while you're standing in line at the store, driving, lying on the couch or fast asleep. The strangest part is often the mismatch: nothing around you is wrong, and your body is acting like you're being chased.

These are the panic attack symptoms the NHS lists, grouped by where you feel them:

• Heart and chest: a racing heartbeat, chest pain.
• Breathing: shortness of breath, a choking sensation.
• Temperature: sweating, hot flashes, chills.
• Muscles and nerves: trembling, shaky limbs, numbness or pins and needles, tingling in your fingers.
• Head and stomach: dizziness, feeling faint, nausea, a churning stomach, a dry mouth.
• Mind: a feeling of dread or a fear of dying, and feeling like you're not connected to your body.

You won't get all of them, and the mix can change from one attack to the next.

The thoughts are symptoms of a panic attack too. "I'm having a heart attack." "I'm going to pass out." "I'm losing it." "I have to get out of here." In the moment they feel like facts. They're the alarm talking.

Hard as it is to believe mid-attack, the NHS says panic attacks are frightening but not dangerous, and an attack won't cause you any physical harm.

If it's your first one, or chest pain is the main thing you feel, get checked by a doctor once. Then you can stop wondering and treat the next one as panic.

Signs a panic attack is starting

Panic often gives a few seconds' warning, sometimes a minute or two. Learn the early signs of a panic attack and you can step in before it peaks. Watch for:

• Suddenly noticing your heartbeat, a thud or flutter you'd normally never feel.
• A rush of heat up your neck or into your face.
• A breath that doesn't seem to fill you, so you keep reaching for a bigger one.
• A tight throat, or a band around your chest.
• Feeling floaty or far away, as if the room is slightly unreal.
• A jolt of dread with nothing to explain it.
• The urge to leave, check your pulse or look up your symptoms.

The moment you spot one, say to yourself, "This is panic starting," and make your next out-breath slow and long. It's far easier to turn it around at a 3 out of 10 than at an 8.

Panic attack or anxiety attack?

People use the two terms interchangeably, and the help is mostly the same, but they usually describe different experiences. "Panic attack" has a specific meaning. "Anxiety attack" is an everyday phrase with no formal definition, and people mostly use it for anxiety that builds around a worry until it feels like too much. Here's how they tend to differ:

• How it starts. A panic attack hits suddenly, sometimes out of nowhere, even in your sleep. An anxiety attack usually builds over minutes or hours, around something specific.
• How strong it gets. Panic spikes to a sharp peak. Anxiety tends to run lower and grind on.
• How long it lasts. Most panic attacks are over within 20 minutes. A spell of anxiety can hang around all afternoon.
• Where you feel it. Panic lives mostly in the body: heart, breath, dizziness, dread. Anxiety leans on the mind: worry, restlessness, tension, what-ifs.

Plenty of people get both on the same day, hours of worry that boil over into panic. That's usually what an anxiety panic attack means.

Why anxiety can turn into a panic attack

A panic attack from anxiety tends to follow a loop:

1. Your baseline is already high. Weeks of stress, a short night, a third coffee or a hangover leave your body running hot.
2. You notice a sensation. A skipped beat, a light head when you stand up, a tight chest after the stairs.
3. Your mind reads it as danger. "Why is my heart doing that? What if it's something serious?"
4. Your body answers the alarm. Adrenaline speeds up your heart and your breathing, so the sensation gets stronger. Breathing fast can leave you dizzy and tingly on top.
5. The stronger sensation seems to prove the fear. "It's getting worse." Round it goes, faster each lap, until it peaks and burns out.

Then a second loop can start. The NHS describes people avoiding places where they've had an attack and ending up living "in fear of fear," which can bring on more attacks. You can break either loop at any step. Most of what works targets step 3: learning to read the sensation as adrenaline doing its job.

How to stop a panic attack while it's happening

How do you stop a panic attack once it's going? You can't flip it off like a switch, but you can stop feeding it and let it pass. The same steps work if you're trying to calm an anxiety attack.

1. Name it. Out loud or in your head: "This is a panic attack. It's adrenaline. It peaks and then it passes." The NHS advice for the moment includes reminding yourself that the attack will pass and isn't life threatening.
2. Stay where you are, if you can. Sit down, lean on a wall, put your feet flat on the floor. Bolting teaches your brain that the place was the problem.
3. Make your out-breath longer than your in-breath. Try the physiological sigh: breathe in through your nose, sip in a little more air on top, then let it out slowly through your mouth until you're empty. Do three to five rounds. If you'd rather count, breathe in for 4 and out for 6. Box breathing (in 4, hold 4, out 4, hold 4) suits people who like an even rhythm. If holding your breath feels bad mid-attack, drop the holds.
4. Let the feelings be there. This sounds backwards. In a 2003 experiment with 60 women who were highly sensitive to anxiety sensations, everyone breathed air with extra carbon dioxide, which brings on panic-like feelings. Those coached to mindfully observe the sensations reported less intense fear and fewer catastrophic thoughts, and avoided less, than those coached to control their symptoms with deep breathing or given no instructions. So keep breathing slowly, and treat the breath as something to follow while the wave passes. You don't have to make the feelings stop. Try: "Okay, heart. Race if you need to. I'll wait."
5. Anchor yourself in the room. Name five things you can see, four you can touch, three you can hear, two you can smell and one you can taste. Or hold something cold and describe it to yourself in detail.
6. Ride out the peak. Check the clock if it helps. Most attacks are done in 5 to 20 minutes, and once you're past the top, it eases.
7. Afterwards, carry on in a smaller way. Drink some water, eat something if you can, then go back to what you were doing, even a shorter version. Finishing the errand or the meeting shows your brain you were safe the whole time.

Panic attacks in your sleep

A panic attack in your sleep feels like being yanked awake: heart pounding, breath short, a flood of dread, and often no nightmare to explain it. That's because a dream isn't behind it. A 2005 review of nocturnal panic describes it as a non-REM event, distinct from nightmares, sleep terrors and sleep apnea. It isn't rare, either. Among people with panic disorder, 44% to 71% report having had at least one.

It's extra frightening when you're groggy and everyone else is asleep. What to do:

1. Sit up and turn on a low light. Feet on the floor. Lying still in the dark leaves the fear with nothing else to look at.
2. Tell yourself what woke you. "I woke up in a panic attack. It's adrenaline. It will pass."
3. Do slow sighs. Three to five rounds, long and slow on the way out.
4. Leave the clock alone. Working out how much sleep you've lost adds a second worry on top of the first.
5. Get up for a bit if you're wired. Do something dull in low light, and go back to bed when you feel heavy.

If panic attacks while sleeping keep happening, go easy on caffeine and alcohol in the evenings. If it's racing thoughts more than full panic that keep you up, here's what helps when you're anxious at 2 a.m.

Can a panic attack last for days?

One attack doesn't last that long. The NHS says most last between 5 and 20 minutes, and some have been reported to last up to an hour. When it feels like a panic attack has gone on for days, it's usually one of these:

• Attacks in waves. Several attacks close together, with high anxiety in between, can blur into one long one.
• The aftermath. A big attack can leave you drained, achy, shaky or foggy for the rest of the day, sometimes longer. Your body just ran a sprint.
• Waiting for the next one. Bracing for another attack keeps your body on alert, which is the "fear of fear" loop again.
• Background anxiety. A stressful stretch can keep you humming at a 6 out of 10 for days, with spikes on top.

For those days, treat yourself the way you would after a bad flu: proper sleep, regular meals, water, a short walk outside. Keep doing normal things in smaller versions rather than staying home, since avoiding things feeds the cycle.

If attacks keep coming back, or the worry about the next one has hung around for weeks, tell your doctor. It's common and very treatable.

Coping skills for the next one

Panic attack coping skills work best when you practice them on calm days, so they're automatic when you need them.

1. Write your script now. Put three lines in your phone's notes: "This is panic. It peaks and passes. Breathe out slow and stay put." Read it at the first sign.
2. Practice the breath when you're calm. A minute or two of slow sighs or box breathing each day, so the pattern is ready when your mind isn't.
3. Get used to the sensations on purpose. A 2018 analysis of 72 trials with 4,064 people picked apart CBT for panic to see which pieces matter. Interoceptive exposure, bringing on the body sensations deliberately until they lose their scare, was linked with better results. Gentle versions: run in place for a minute, spin in a desk chair until you're dizzy, or breathe through a thin straw for 30 seconds. Notice the fast heart and the light head, and notice that nothing bad follows. If you have a heart or lung condition, skip the running and the straw.
4. Go back, in small steps. If you've been avoiding somewhere since an attack, return in pieces: drive past, then park outside, then go in for two minutes.
5. Watch the fuel. The NHS lists caffeine, alcohol, sugary food and drinks, and smoking as things that can make attacks worse.
6. Keep a short log. After each attack, jot down the time, the place, what you'd had to eat or drink, how you'd slept and what was on your mind. Patterns show up within a few weeks. Here's what a month of mood check-ins can show you.
7. Talk it through afterwards. Telling the story start to finish takes the mystery out of it and helps you spot where the loop began. A friend works. So does typing it out to an AI at 3 a.m., when no one else is up. If that feels odd, here's why talking to AI about your feelings isn't weird.

Breathe through it with Moodu

Moodu has the physiological sigh and box breathing built in, each with an on-screen timer, so you can follow along instead of counting while your heart pounds. Open one at the first sign and stay with it until the wave passes.

Once it's over, or when you can feel one building, open Anxiety Alleviation, its guided conversation for anxious moments. It starts with: "Anxiety can be loud. On a scale of 1 to 10, where is it right now, and what's it saying?" From there it talks it through with you one question at a time, from what set it off to what you'll do first next time. You can type, or tap the mic and say it out loud.

Chats are encrypted before they're saved and never used for ads. Moodu is $39.99 a year after a 3-day free trial, or $4.99 a week.