How long does a panic attack last?
A panic attack is short, even though it feels long. According to the NHS, most panic attacks last between 5 and 20 minutes, and some have been reported to last up to an hour. The symptoms settle on their own, even if you do nothing in particular.
After an attack, the body calms down more slowly than it revved up. That’s why you may feel tired, restless or shaky for a while afterwards. This after-effect does not mean the attack is continuing. If your symptoms don’t ease or they get worse, get checked.
Sometimes several attacks come one after another, and they can feel like one long attack. The breathing and grounding methods in our panic attack first aid guide help you ride out the wave.
Physical symptoms
The physical symptoms of a panic attack are often the first ones you notice. They result from the activation of the body’s sympathetic nervous system, that is, the fight-or-flight reaction. Each symptom has a biological explanation behind it.
Heart palpitations and rising heart rate
The heart starts pounding strongly and quickly. The feeling can be so strong that the heartbeat is felt in the chest, throat, and even ears. This is due to the effect of adrenaline: the body prepares to act in a threatening situation and pumps blood to the muscles more efficiently.
Heart palpitations are one of the most frightening symptoms because many associate them with heart disease. During a panic attack your heart rate can rise sharply. It feels frightening, but the panic attack itself is not dangerous. If you have chest pain or palpitations for the first time, or you are unsure of the cause, get medical help.
Chest pain and a pressing sensation
Chest pain is another symptom that causes great worry. In a panic attack, chest pain usually results from tension in the chest muscles and the effects of hyperventilation. The pain is typically sharp or stabbing, and it can move from place to place.
In cardiac chest pain, on the other hand, the pain is usually pressing, radiates to the left arm, and is linked to physical exertion. You can’t reliably tell the difference yourself, though: if the chest pain is new or you aren’t sure what is causing it, call your local emergency number.
Shortness of breath and feeling of choking
Many experience during a panic attack the feeling that they aren’t getting enough air or that they’re choking. Paradoxically, the problem is usually the opposite: hyperventilation, that is, breathing too quickly, leads to a drop in blood carbon dioxide levels, which causes the feeling of shortness of breath.
The body actually gets more oxygen than it needs. That’s why slow, regular breathing is one of the most effective ways to ease an attack.
Dizziness and feeling of fainting
Dizziness results from hyperventilation and changes in blood pressure. The drop in blood carbon dioxide level causes the brain’s blood vessels to constrict, which feels like dizziness. Many fear they will faint, but during a panic attack fainting is very rare because blood pressure usually rises rather than falls.
Trembling and shaking
Trembling of the body is a direct result of the combined effect of adrenaline and muscle tension. The body is primed to act, but because no physical action takes place, the energy releases as trembling. The trembling can be subtle or strong, and it can continue for a moment after the attack.
Sweating
Sweating is part of the body’s alarm reaction. The body prepares for physical performance and tries to cool itself in advance. Sweating can be general or focused on the armpits, hands, and forehead.
Nausea and stomach pain
Digestive symptoms result from the fight-or-flight reaction directing blood away from the gut and into the muscles. The stomach can feel sore, nauseated, or as if it’s in a knot. Some also experience diarrhea.
Numbness and tingling
Numbness and tingling in the hands, feet, or face is a common and frightening symptom. It results from changes in blood calcium balance caused by hyperventilation. When the carbon dioxide level drops, blood pH rises, which affects nerve function and causes tingling symptoms.
Hot and cold waves
Sudden waves of heat or cold are linked to changes in circulation. As blood is directed to large muscles, skin circulation changes, which causes temperature sensations. These symptoms are harmless but emotionally unpleasant.
Panic attack or heart problem: when to call for help?
Chest pain, palpitations and shortness of breath are among the most common panic attack symptoms, but the same symptoms can also come from the heart. You can’t reliably tell the difference from the sensations alone.
If you have chest pain or strong palpitations for the first time, or you are not sure what is causing your symptoms, call your local emergency number. Ruling out a heart cause is a job for healthcare, not for self-assessment. It is always better to have it checked than to be left wondering.
Once a doctor has examined you and found that your symptoms come from panic, recognizing similar sensations becomes easier. Still get checked again if your symptoms change, feel stronger than usual, or if chest pain or breathlessness lasts longer than your attacks usually do.
Psychological symptoms
Alongside the physical symptoms, a panic attack involves psychological symptoms that can be just as frightening.
Strong fear and terror
The definition of a panic attack includes strong fear or terror. This fear can be directed at something concrete (I’m dying, I’m losing control, I’ll go crazy) or it can be an undefined but overwhelming feeling of terror.
Fear of death
Many feel genuine fear of death during a panic attack. The intensity of the physical symptoms makes body and mind believe that something is seriously wrong. This is one reason why the first attack often leads to the emergency room.
Derealization and depersonalization
Derealization means a feeling that the surroundings feel unreal, dreamlike, or strange. Depersonalization means a feeling of being detached from yourself, as if watching yourself from outside.
These experiences can be frightening, but they are the brain’s protective mechanism against strong stress. They pass with the attack.
Fear of losing control
The feeling of losing control (starting to scream, doing something embarrassing, or “going crazy”) is a common but unfounded fear. During a panic attack a person may feel they’re losing control, but in reality their behavior remains under control.
Mild panic attack symptoms: a limited attack
Not all panic attacks are full-blown. In a mild or limited panic attack there are fewer than four symptoms (in a full attack at least four). Symptoms of a mild attack can include, for example:
- Mild heart palpitations
- Sweaty hands
- Brief shortness of breath
- Momentary feelings of anxiety without full panic
Limited attacks are more common than full-blown ones, and many experience them without recognizing them as panic attacks. They can be a sign that stress levels have risen, and they’re worth paying attention to. Also see stress symptoms and anxiety symptoms, since many symptoms overlap.
Nighttime panic attacks
A panic attack can also happen at night. For many people an attack wakes them from sleep, and some have one just as they are falling asleep, when the body relaxes and the mind notices a change in heart rate or breathing. The first moments are especially frightening because when you wake you don’t immediately understand what’s happening.
Nighttime panic attack symptoms
- You wake suddenly to strong anxiety or fear
- Physical symptoms (heart palpitations, sweating, trembling, shortness of breath) are immediately strong
- The attack usually lasts as long as during the day and settles on its own
- Falling asleep again can be difficult, and the next day may feel heavy
Why do nighttime attacks happen?
The exact mechanism of nighttime attacks isn’t fully understood. Research suggests they’re linked to physiological changes during sleep, such as variations in heart rate or breathing, which the body interprets as threatening. Stress, accumulated anxiety, and insomnia increase the risk of nighttime attacks.
A nighttime panic attack is not the same as a nightmare or a night terror, even though they can resemble each other. A panic attack doesn’t come from a frightening dream: it often wakes you without any dream you can remember.
Exhaustion and panic attacks
Many people describe feeling completely drained after an attack. That makes sense: the alarm response uses a lot of energy, and the body needs time to recover. Tiredness, heaviness and tearfulness after an attack are common.
Exhaustion can also sit behind the attacks. Long-term stress, lack of sleep and burnout keep the nervous system on high alert, so the body’s alarm system fires more easily. If your attacks started during a demanding period, looking after your recovery is an important part of easing them.
Intensity and variation of symptoms
Panic attack symptoms vary by person and from attack to attack. The same person can experience very different attacks at different times. For some, physical symptoms predominate; for others, psychological. The intensity of symptoms can also vary:
- Mild attacks: a few symptoms, short duration, manageable
- Moderate attacks: several symptoms, clearly unpleasant, but functional capacity partly retained
- Severe attacks: many strong symptoms simultaneously, fear of death or losing control, complete inability to function during the attack
The intensity of symptoms doesn’t tell the severity of the disorder: even mild attacks can significantly limit life if they cause constant fear and avoidance behavior.
How to distinguish a panic attack from other conditions?
Because panic attack symptoms resemble many physical illnesses, it’s important to rule out other causes especially with the first attacks.
Conditions to distinguish a panic attack from
- Heart problems: Chest pain, shortness of breath, and heart palpitations can be linked to heart disease. ECG and laboratory tests help in distinguishing.
- Hyperthyroidism: Causes heart palpitations, sweating, trembling, and anxiety.
- Low blood sugar: Trembling, sweating, and dizziness can resemble a panic attack.
- Asthma: Shortness of breath can be confused with a panic attack.
According to clinical care guidelines, in diagnosing panic disorder it’s important to rule out somatic causes especially when symptoms first begin.
What to do when you recognize the symptoms?
Recognizing the symptoms is itself a management method. When you know it’s a panic attack and not a heart attack, the fear eases and the attack often passes more quickly.
You’ll find a thorough guide to practical management methods, such as breathing exercises, grounding techniques, and cognitive reframing, in our article on panic attack first aid and management.
If attacks recur, it’s also worth reading how individual attacks develop into panic disorder and what can be done about it.
Frequently asked questions
What does a panic attack feel like?
Many people describe a panic attack as a sudden wave of terror that comes out of nowhere. The heart pounds, the chest tightens, breathing feels hard and the surroundings can seem unreal. At the same time there can be a strong sense that you are about to die, faint or lose control. The feeling is real, but the danger is not: the attack settles on its own.
What is the difference between a panic attack and an anxiety attack?
A panic attack starts suddenly, peaks quickly and passes, and its physical symptoms are very intense. Anxiety usually builds gradually around a worry or stress and can last longer but less intensely. In everyday language the terms are often used interchangeably. Read more about what a panic attack is and how it differs from an anxiety attack.
Is high blood pressure a common symptom of a panic attack?
During an attack the body is in alarm mode, so heart rate and blood pressure can rise temporarily. The rise is part of the stress response and settles once the attack passes. If you get high readings at rest too, or you have diagnosed high blood pressure or heart disease, talk to a doctor. Chest pain or strong palpitations for the first time are always a reason to call your local emergency number.
Is panic disorder hereditary?
Many factors play a part in panic disorder, and a tendency to it can run in families. The NHS lists having a close family member with panic disorder as one of the factors it is thought to be linked to, alongside stressful life events. The exact cause is not known, and many people develop it with no family history. Read more in our panic disorder guide.
