Waking up in the middle of the night with palpitations and panic can be caused by physiologic or pathologic reasons. Common pathological factors include cardiac arrhythmia, cardiac neurosis, hypoglycemia, and so on. 1. Physiological reasons: For example, eating too much at dinner will lead to an increase in blood flow in the gastrointestinal tract, which in turn will lead to a relative lack of blood supply to the heart in the middle of the night when you go to sleep, resulting in palpitations and panic attacks. When you have nightmares, you will also wake up at night with palpitations and panic attacks. 2. Arrhythmia: If you wake up in the middle of the night with palpitations and panic, you need to consider whether it is accompanied by arrhythmia. For example, atrial fibrillation, supraventricular tachycardia. If such symptoms recur, 24-hour ambulatory ECG monitoring is recommended. 3. Cardiac neurosis: It is mainly due to the disorders of central nervous system regulation caused by mental factors, resulting in vegetative nervous system dysregulation. Palpitations and panic attacks may occur in the middle of the night. Prevalent in young and middle-aged women. 4. Hypoglycemia: Panic, sweating and obvious hunger are important clinical manifestations of patients with hypoglycemia. When diabetic patients use excessive glucose-lowering drugs, it may cause hypoglycemia in the early morning, which is manifested as waking up in the middle of the night with palpitations and panic. As you can see, there are many reasons for waking up in the middle of the night with panic attacks and palpitations, and it is recommended that you seek medical attention in a timely manner to clarify the cause of the problem and treat the symptoms.