The panic attack guide: Real questions, real answers

Panic attacks can be confusing, terrifying and deeply isolating. Whether they appear suddenly or creep in during sleep, many people find themselves asking the same urgent questions: What is happening to me? Will it ever stop?

This guide offers real answers to common questions about panic attacks, their causes, and how to manage them.

What is a panic attack?

A panic attack is a sudden, intense wave of fear or distress that triggers a cascade of physical and psychological symptoms. These episodes often peak within minutes and may include:

• rapid heartbeat
• chest tightness or pain
• sweating
• shortness of breath
• trembling
• nausea
• dizziness
• a sense of detachment
• a fear of losing control, going crazy, or dying

They can feel completely overwhelming and often strike without warning, even when there is no real threat.

What does a panic attack feel like? A firsthand description

"It comes out of nowhere, like a wave coming over me. I feel it first in my tummy, one moment I’m fine, and the next, something shifts, like a switch flicked in my chest. It feels like a hot blanket wrapping tightly around me, suffocating but also burning. My heart pounds like it’s trying to escape my chest, and I can feel it in my throat and ears.

"I go cold and hot at the same time, my skin prickles, but I’m sweating. Nausea twists my stomach, and sometimes I need the bathroom urgently. It’s like my body is sounding every alarm at once. This can last under a minute, and then it just goes."

Everyone’s panic experience is unique, but many of these sensations are shared and grounded in our biology.

The biology of a panic attack

Panic attacks are sudden surges of intense fear or discomfort, often peaking within minutes. Biologically, they’re the result of your body’s 'fight-or-flight' system being activated inappropriately. Your body is reacting as if you are being chased by a huge mammoth in the Pleistocene Epoch, but you might be in the queue at the supermarket. 

Triggering the alarm system

Even without an external threat, your amygdala (a part of the brain responsible for fear and threat detection) can sound the alarm. This might be due to a misinterpreted sensation, an intrusive thought or sometimes nothing identifiable at all.

Sympathetic nervous system activation

This alarm sets off the sympathetic nervous system, which releases adrenaline (epinephrine) from the adrenal glands. This causes:

• increased heart rate (to pump blood to muscles)
• rapid breathing (to increase oxygen)
• dilated pupils
• sweating (to cool the body)
• reduced digestive activity (causing nausea or upset stomach)

These are all survival responses, but they become distressing when there’s no actual danger.

Physical sensations amplify panic

As your body responds, you notice these changes, which can increase fear ("Why is my heart racing? Am I having a heart attack?"), which in turn amplifies the panic, creating a vicious loop.

Parasympathetic system calms it down

Eventually, your parasympathetic nervous system (the 'rest and digest' system) kicks in, reducing adrenaline, slowing your heart rate and calming the digestive tract.

This is when you feel the panic “burning off” - though you may be left tired or emotionally raw.

What’s the difference between a panic attack and an anxiety attack?

While people sometimes use the terms interchangeably, they’re not the same.

A panic attack is a sudden, intense episode that usually peaks quickly and ends within 20–30 minutes. An anxiety attack isn’t a clinical term, but is often used to describe a prolonged period of worry or stress that builds over time.

Panic attacks are more abrupt, while anxiety attacks tend to be more gradual and linked to specific stressors. However, both experiences are valid and distressing, and they often overlap.

Panic attacks and menopause: Is there a link?

Yes, panic attacks often begin during perimenopause or menopause, even in women who’ve never experienced anxiety before. This is because hormonal changes, particularly the drop in estrogen and progesterone, can disrupt brain chemistry, affect mood regulation, and heighten the body’s stress response.

During menopause, some women experience:

• night sweats and heart palpitations that mimic panic
• increased emotional sensitivity or vulnerability
• sleep disruption that heightens nervous system dysregulation
• a shift in identity or life role that triggers anxiety

You are not alone if panic attacks have emerged or worsened during this phase of life. It is a recognised phenomenon and help is available through therapy, lifestyle support and sometimes hormone treatment.

Can unmanaged anxiety lead to panic attacks?

Often, yes. Imagine anxiety as drops of water filling a cup. If we don’t attend to our stressors, boundaries or emotional needs, the cup overflows, and that overflow is the panic attack.

Many people ignore or mask stress for months or even years, until the nervous system becomes overstretched. A panic attack is sometimes the body’s cry for help. It’s not irrational or weak. It’s a message.

Regular anxiety management, such as mindfulness, rest, journaling, therapy and saying no to what drains you, can help prevent that build-up and keep your emotional cup from spilling over.

What are nocturnal panic attacks?

Nocturnal panic attacks happen when you wake suddenly from sleep in a state of intense fear. These episodes are often accompanied by a racing heart, chest pressure, confusion and a sense of terror, all while the house is dark and silent.

Some people experience panic only at night, which can feel especially disturbing. This may be because:

• Daytime distractions mask underlying stress.
• Emotional suppression resurfaces during sleep.
• Hormonal changes affect nighttime brain chemistry.
• Cortisol levels begin to rise early in the morning, triggering an adrenaline spike.
• Past trauma or stress is stored in the body and released when the mind finally rests.

Even if you feel fine during the day, your nervous system may still be carrying unprocessed emotion or stress. You are not imagining it, and you are not alone.

Can exam stress cause panic attacks?

Yes. Exams create intense pressure, whether it's fear of failure, perfectionism or high expectations from others.

Young people are especially vulnerable if they feel judged by their results, are struggling with undiagnosed learning needs or are simply overwhelmed by the build-up of stress.

Panic attacks before or during exams can include nausea, shaking, going blank, or an urgent need to leave the room. These reactions are not attention-seeking. They are real, physiological responses to perceived threat.

Supportive strategies include:

• calming breathing techniques
• exposure to test environments during revision
• therapy to build emotional resilience
• parental or school support to reduce pressure and create safety

Do neurodivergent people experience panic attacks differently?

Yes, and this is often overlooked. Neurodivergent individuals, including those with ADHD, autism, dyslexia and sensory processing differences, may experience panic differently from neurotypical individuals.

Triggers might include:

• sensory overload from lights, sounds, smells, or crowds
• executive functioning difficulties leading to overwhelm
• suppressing or “masking” neurodivergent traits
• social or communication fatigue

For some, a panic attack may look like a shutdown, freeze, or meltdown rather than a traditional hyperventilating response. These are still panic attacks, just in a different form.

Support may include:

• sensory-friendly environments
• access to stim tools or safe spaces
• education on emotional literacy and self-regulation
• therapy with someone who understands neurodivergence

Should you avoid panic attack triggers?

It’s tempting to avoid triggers, and sometimes a short break can be helpful. But long-term avoidance can reinforce fear and reduce your confidence in handling life. Avoidance teaches your brain that the trigger is dangerous even when it’s not.

Instead, with the support of therapy, you can gently expose yourself to your triggers, learn to manage your body’s response and regain a sense of agency. 

That said, some triggers like caffeine, certain environments or overstimulation can be reduced or modified without shame. You are allowed to protect your peace while also building resilience.

Quick techniques to help during a panic attack

There’s no instant switch, but there are powerful grounding tools that can reduce intensity and help you feel safer:

• Cold water: Splashing your face or running cold water on your wrists activates the vagus nerve, helping your body shift into a calmer state.
• Deep belly breathing: Inhale for 4, hold for 4, exhale for 6. Repeat until your breath slows.
• 5-4-3-2-1 grounding: Name 5 things you can see, 4 you can touch, 3 you can hear, 2 you can smell, 1 you can taste. This brings you back into the present.
• Affirmations: Repeat “This will pass,” or “I am safe.”
• Movement: Walk around, stretch, or shake out your arms. Movement helps discharge excess adrenaline.

Practice these techniques regularly so they feel more familiar when panic hits.

Why telling someone to "calm down" during a panic attack doesn't help

While it may be well-intentioned, this often makes the person feel more misunderstood or ashamed. Panic attacks are not something someone can simply switch off. What they need is reassurance, safety and calm presence, not pressure to stop feeling what they’re feeling.

Will panic attacks ever go away?

Yes, they can. With time, support and self-awareness, panic attacks often reduce in frequency or stop altogether. For some people, they are a phase. For others, they return during times of stress, but can be managed well with the right tools.

Understanding the root cause of your panic, healing past trauma, making lifestyle changes, and accessing therapy are all part of the healing journey. You are not broken. You are responding to life in a way that makes sense, even if it doesn’t feel that way now.

Can medication help with panic attacks?

Medication can be very helpful, particularly when panic attacks are frequent, severe or affecting your daily life.

Medication is most effective when used alongside therapy and lifestyle support. Always consult a GP or psychiatrist to find what’s right for you.

Can a panic attack kill you?

No, although it can feel like it. Panic attacks are not life-threatening. They don’t cause heart attacks, strokes or suffocation. However, because they mimic serious medical conditions, it’s wise to see a doctor the first time to rule out other causes.

Once you understand what’s happening, the fear surrounding the sensations often begins to fade. Knowledge truly is power in managing panic.

Panic attacks are deeply distressing, but also deeply human. Whether they appear during sleep, during exams, in neurodivergent individuals or as a response to long-ignored stress, they are your body’s way of asking for attention and care. 

You are not alone. You are not weak. You are not going mad. There is help. There is hope. And there is healing.