Panic Attacks: What They Feel Like, How Long They Last, Why They Happen at Night, and How to Tell Them Apart from a Heart Attack

Written by Dana Colthart, LCSW, CEDS | Clear Light Therapy | Englewood, NJ | Serving Bergen County and All of New Jersey

Introduction: If You've Had a Panic Attack, You Already Know How Terrifying It Is

Most people who experience their first panic attack end up in the emergency room. Not because they're overreacting but because the experience is genuinely alarming. Racing heart. Chest tightening. Trouble breathing. A wave of dread that arrives out of nowhere and tells you something is catastrophically wrong.

At Clear Light Therapy in Englewood, NJ, I work with clients across Bergen County, from Ridgewood and Tenafly to Paramus and Fort Lee, who come to me after months or even years of living in fear of their next panic attack. One of the most powerful things I can do for them is explain, clearly and clinically, what is actually happening in their body and brain when panic strikes.

This post answers the questions I hear most often:

• What does a panic attack actually feel like?

• How long do panic attacks last?

• Why do panic attacks happen at night?

• How can you tell the difference between a panic attack and a heart attack?

Understanding the answers doesn't make panic disappear but it does make it less powerful. And that's where recovery begins.

Part 1: What Does a Panic Attack Feel Like?

A panic attack is a sudden surge of intense fear or discomfort that peaks within minutes. It's not just feeling nervous or stressed. The physical symptoms are real, measurable, and often overwhelming.

Physical symptoms commonly reported:

• Heart pounding, racing, or skipping beats (palpitations)

• Chest pain or pressure — often confused with cardiac symptoms

• Shortness of breath or feeling like you can't get enough air

• Dizziness, lightheadedness, or feeling faint

• Tingling or numbness in hands, feet, or face

• Sweating, chills, or hot flashes

• Nausea or stomach upset

• Trembling or shaking

• Feeling like you might choke or throat is closing

Psychological symptoms that accompany them:

• Derealization: the world around you feels unreal, dreamlike, or distant

• Depersonalization: feeling detached from yourself, as if watching from outside your body

• Intense fear of losing control or "going crazy"

• Fear of dying, this is one of the most common and most distressing features

I want to say this clearly: the fear that you are dying during a panic attack is a symptom of the panic attack, not evidence that you actually are. This distinction matters enormously, and it's one of the things we work on directly in treatment.

Panic attacks are also unpredictable. They can happen during high-stress moments, but they can also happen while you're relaxed, watching TV, or falling asleep. This unpredictability is part of what makes them so distressing and why people often begin organizing their lives around avoiding them.

Part 2: How Long Does a Panic Attack Last?

This is one of the most Googled questions about panic and the answer is actually reassuring, even though it doesn't feel that way in the moment.

A panic attack typically peaks within 10 minutes and most episodes resolve within 20 to 30 minutes. By definition, the acute symptoms subside on their own.

However, the after-effects can linger significantly longer. After the peak passes, many people experience:

• Physical exhaustion, the body has just been through an intense stress response

• Emotional shakiness or tearfulness

• Lingering dread or "aftershock" anxiety

• Difficulty concentrating for the remainder of the day

Some people describe a cluster of panic attacks, multiple episodes within a short window, which can feel like one very long event. And the anticipatory anxiety that builds in the hours before a feared situation can make it hard to identify where "worry" ends and "panic" begins.

What determines how long a panic attack affects your life is not the length of the episode itself, it's what you do in response. Avoidance, reassurance-seeking, and safety behaviors tend to extend and amplify the panic cycle. Evidence-based treatment, specifically Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy (ACT), targets these responses directly.

At Clear Light Therapy, we work with clients in Bergen County and throughout New Jersey, both in our Englewood office and via telehealth, to break this cycle using the treatments the research actually supports.

Part 3: Why Do Panic Attacks Happen at Night?

Nocturnal panic attacks, panic attacks that occur during sleep or as you're falling asleep, are more common than most people realize. They are one of the more distressing presentations because there's no obvious trigger. You weren't even conscious. You weren't worrying. You were asleep. And then suddenly you're awake, heart pounding, convinced something is terribly wrong.

Several mechanisms contribute to nocturnal panic:

1. The transition between sleep stages

Panic attacks often occur during the shift from lighter to deeper sleep, particularly the transition into Stage 2 or slow-wave sleep. During these transitions, the body undergoes changes in heart rate, breathing, and blood pressure changes that, in someone with an already sensitized nervous system, can be misread as a threat signal.

2. Hypervigilance carries into sleep

During the day, distraction provides some buffer against anxiety. At night, that buffer disappears. A nervous system that has been running in low-grade threat mode all day has less to hold it in check during sleep.

3. Carbon dioxide sensitivity

Research suggests that some people with panic disorder have a heightened sensitivity to carbon dioxide, a byproduct of breathing that increases slightly during sleep. This can trigger a false alarm response in the brain, interpreting the CO2 shift as suffocation and launching a panic response.

4. Sleep deprivation itself increases panic risk

Poor sleep and anxiety have a bidirectional relationship. Anxiety disrupts sleep; sleep deprivation lowers the threshold for panic. This cycle can be self-reinforcing and requires direct clinical attention.

If you're waking up in the middle of the night in full panic, it's important to know: you are not in danger. Your brain has misfired an alarm. What you're experiencing is real but it is not a medical emergency. And it is treatable.

Part 4: Panic Attack vs. Heart Attack — How to Tell the Difference

This is the question that brings people to emergency rooms at 2am. And it's a completely understandable question, because the physical experience of a panic attack and a cardiac event can overlap significantly.

Both can involve chest pain, shortness of breath, heart palpitations, sweating, and a feeling that something is catastrophically wrong. So how do you tell them apart?

Features more common in panic attacks:

• Onset is sudden and peaks within 10 minutes

• Symptoms resolve within 20–30 minutes without intervention

• Strong psychological component: fear of dying, derealization, feeling of dread

• Tingling or numbness in the extremities (fingers, lips, toes)

• Hyperventilation, breathing too fast, which itself causes many of the physical symptoms

• Symptoms improve with slow, diaphragmatic breathing or grounding techniques

• History of anxiety, past panic attacks, or high stress

Features more common in a cardiac event:

• Chest pain that is pressure-like, squeezing, or radiates to the left arm, jaw, or back

• Symptoms that worsen with physical exertion and improve with rest

• Nausea, vomiting, or cold sweat alongside chest pain

• Symptoms that don't resolve on their own within 30 minutes

• Age, family history, or known cardiac risk factors

Here is the clinical guidance I give to clients: if you have any doubt, seek emergency medical care. Do not use the possibility that it might be a panic attack as a reason to wait out potential cardiac symptoms. Let the ER rule out cardiac causes, that's what emergency medicine is for.

Once cardiac causes have been ruled out, often multiple times, the clinical work becomes helping you trust your body again. That is central to panic disorder treatment. You learn to recognize the alarm system, understand that it's misfiring, and gradually reduce your fear of the sensations themselves.

This approach is called interoceptive exposure, deliberately inducing mild physical sensations similar to panic in a controlled setting and it is one of the most effective techniques we use at Clear Light Therapy for panic disorder.

Treatment for Panic Attacks in Bergen County, NJ

If you're reading this because panic attacks are affecting your life, your driving routes, your sleep, your social plans, your sense of safety in your own body, I want you to know that this is among the most treatable conditions we see.

At Clear Light Therapy in Englewood, we specialize in:

• Exposure and Response Prevention (ERP) for panic disorder and agoraphobia

• Acceptance and Commitment Therapy (ACT) to build psychological flexibility around anxiety symptoms

• Interoceptive exposure, learning to tolerate and defuse the body sensations of panic

• Psychoeducation, understanding exactly what is happening in your nervous system

We serve clients throughout Bergen County, including Ridgewood, Tenafly, Englewood, Paramus, Hackensack, Fort Lee, Mahwah, Wyckoff, Bergenfield, and Fair Lawn. We also offer telehealth therapy across New Jersey, including Hudson County, Morris County, and Monmouth County.

If you're ready to stop organizing your life around panic attacks, we're ready to help.

Schedule a Free 15-Minute Consultation: danacolthart.com/contact-1

Dana Colthart, LCSW, CEDS

Clinical Director & Founder, Clear Light Therapy | Englewood, NJ

Dana Colthart is a Licensed Clinical Social Worker (LCSW) and Certified Eating Disorder Specialist (CEDS) with over a decade of clinical experience. She is the founder and clinical director of Clear Light Therapy, a specialized group practice in Englewood, NJ serving Bergen County and all of New Jersey. Dana earned her Master of Social Work from Fordham University and holds active licensure in New Jersey, Virginia, Massachusetts, Maryland, and Washington, DC.

Dana specializes in the evidence-based treatment of OCD, anxiety disorders, panic disorder, and eating disorders, with advanced training in Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy (ACT) from NOCD, the Mood and Anxiety Center, the Eating Recovery Center, and the IAEDP Foundation. She participates in bi-weekly supervision with nationally recognized OCD and eating disorder specialists.

She is a member of the International OCD Foundation (IOCDF), the International Association of Eating Disorders Professionals (iaedp), and the National Association of Anorexia Nervosa and Associated Disorders (ANAD). Her work has been featured in Everyday Health, Psych Central, Mel Magazine, CafeMom, and Vitamin Shoppe's What's Good.

NJ LCSW License: 44SC06050300 | VA LCSW License: 0904019187

MA LICSW License: LICSW128047 | MD LCSW-C License: 31725 | DC LICSW License: LC200003625

NPI: 1669186433

Clear Light Therapy | 60 Chestnut Street, Englewood, NJ 07631 | (609) 384-4874

danacolthart.com | @clearlighttherapynj

Angela Matus, LCSW

OCD & Anxiety Therapist, Clear Light Therapy | Bergen County, NJ

Angela Matus is a Licensed Clinical Social Worker (LCSW) and one of Clear Light Therapy's most trusted OCD and anxiety specialists. She holds a Master of Social Work from Kean University and brings a decade of mental health experience to her work with clients of all ages, from young children to older adults, across Bergen County, Hudson County, and New Jersey.

Angela specializes in Obsessive-Compulsive Disorder (OCD), anxiety disorders, and ADHD, using Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy (ACT) as her primary treatment approaches. She completed advanced ERP training through the Cognitive Behavioral Institute and holds additional expertise in ADHD assessment and executive functioning support. Angela integrates CBT, trauma-informed approaches, behavior management, and eating disorder-informed care when clinically appropriate.

Clients and colleagues describe Angela as a warm, brilliant, and highly effective therapist who creates a safe and structured space for meaningful change. She offers in-person therapy in Bergen County and Hudson County, as well as virtual therapy throughout New Jersey.

NJ LCSW License: 44SC06243600

NPI: 1851071682

Clear Light Therapy | 60 Chestnut Street, Englewood, NJ 07631 | (609) 384-4874

danacolthart.com | @clearlighttherapynj

Maya Golebiewski, LSW

Therapist, Clear Light Therapy | Bergen County, NJ

Maya Golebiewski is a Licensed Social Worker (LSW) at Clear Light Therapy in Englewood, NJ. She holds a Master of Social Work from Rutgers University and works with children, teens, and adults navigating trauma, depression, OCD, eating disorders, suicidal ideation, and complex emotional challenges rooted in chronic trauma and long-standing patterns.

Maya's therapeutic approach is warm, steady, and collaborative. She believes effective therapy is both safe and structured, a space where clients feel supported while being gently challenged to grow. She integrates Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy (ACT) to help clients reduce avoidance, weaken compulsive patterns, and build psychological flexibility. Rather than teaching clients to suppress difficult thoughts and feelings, Maya helps them relate to internal experiences differently, creating room for choice, confidence, and meaningful action.

Maya holds certifications in interpersonal violence and trauma treatment, the ARC (Attachment, Regulation, and Competency) framework, and yoga and meditation instruction. She brings a mind-body perspective to her clinical work, recognizing that trauma and anxiety live not only in thoughts but in the body. Her goal is to help every client feel less stuck, less alone, and more empowered in their own life.

NJ LSW License: 44SL07176900

NPI: 1821810227

Clear Light Therapy | 60 Chestnut Street, Englewood, NJ 07631 | (609) 384-4874

danacolthart.com | @clearlighttherapynj