How Does Anxiety Affect Your Sleep?

Long Story Short

• Nearly one in three U.S. adults experience anxiety at some point in their lives. (1)
• Anxiety is often associated with sleeping problems: About two out of three people with generalized anxiety disorder experience significant sleep disturbances. (2) 
• Anxiety and stress can disrupt your sleep-wake cycle, delaying the time you fall asleep or causing you to wake up too early. (3)
• Not only can anxiety cause sleeplessness, but losing sleep can also increase feelings of anxiety and stress. (4)
• Sleep anxiety, a specific fear about not being able to fall or stay asleep, can create a cycle of worry that makes it even harder to get restful sleep. (5)
• To sleep better with anxiety, try creating a consistent bedtime routine, avoiding clock-watching, and getting out of bed if you can’t sleep after 20 minutes. (6)(7)
• Natural remedies like chamomile tea and cannabidiol (CBD) may help calm anxiety to help you get a good night’s sleep. (8)(9)

Most people have moments when they feel uneasy or concerned throughout their lives. This is known as anxiety, and it’s a natural human response to life’s challenges. For example, feeling nervous before a job interview is normal. 

However, when anxiety becomes persistent and difficult to control, it may indicate an anxiety disorder — a mental health condition that can significantly impact a person’s life. (10) If this sounds familiar, you’re not alone: Nearly one in three adults in the U.S. will experience an anxiety disorder at some point during their lives. (1)

What’s more, anxiety and sleep often have a complicated relationship. Many people with anxiety struggle with sleep issues. This is especially true for those with generalized anxiety disorder, where about two out of three people affected also experience significant sleep problems. (2)(4) The worry and stress can make it hard to sleep, and the lack of good sleep can make anxiety worse during the day. (4)

Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t take the place of medical advice and supervision from your healthcare provider. If you feel you may be suffering from any sleep disorder or medical condition, please see a trained professional immediately.

How Anxiety Affects the Body

Anxiety affects the body by triggering a series of physical responses. (11) When you’re anxious, your body goes into what’s called the “fight or flight” mode, which is controlled by the sympathetic nervous system. (12) This is an automatic response that’s meant to protect you from danger. Here’s what happens: (13)

• Your brain, specifically a part called the amygdala, senses a threat (even if it’s just worry or stress, not actual physical danger). (7)
• This triggers the release of stress hormones in your body.
• These hormones activate your sympathetic nervous system, the part of your body that prepares you to fight off a threat or run away from it.

That fight or flight mode creates symptoms of anxiety, which can be both physical and emotional. Everyone experiences anxiety differently, and you might notice some symptoms more than others. For example, someone with anxiety may: (11)

• Feel restless or on edge
• Be unable to concentrate
• Have trouble sleeping
• Notice a rapid heartbeat
• Have excessive sweating
• Have difficulty breathing
• Be nauseous or have stomach discomfort
• Feel muscle tension

These symptoms can be debilitating over time, taking a toll on your physical and mental health.

What’s the Connection Between Anxiety and Sleep?

The link between anxiety and sleep is rooted in how anxiety affects your body and mind. “Fundamentally, anxiety is incompatible with sleep,” Audrey Wells, M.D., sleep physician and founder of Super Sleep MD, tells Sleepopolis. 

According to Wells, when you’re anxious, your mind and body are on high alert, which goes against what you need for sleep. Instead of relaxing and feeling peace and safety to fall asleep, anxiety keeps you on edge.

Research shows that people who have dealt with anxiety for a long time often struggle with sleep problems. (4) It’s a two-way street: anxiety can make it hard to sleep, and not getting enough sleep can make it more difficult for your brain to manage anxiety. (4)

Is Anxiety Preventing You From Sleeping?

Many people find they can’t sleep due to anxiety, which affects their rest in multiple ways. (3) Not only can anxiety affect your ability to fall asleep, but Wells says it can make it difficult to go back to sleep if you wake up during the night.

Some people with anxiety might still fall asleep relatively easily if they’ve been awake all day because their sleep drive — the body’s need for sleep — is high. (14)  Wells explains that if you wake up in the middle of the night, your sleep drive may not be as strong because you’ve already had some. If anxiety kicks in at this point, it can be hard to fall back asleep.

Additionally, the relationship between anxiety and sleep is complicated by that tricky fight or flight response. (15) While this natural reaction is hugely necessary for dealing with real dangers, it can become a wholly unnecessary barrier to restful sleep when you’re lying awake thinking about an email you forgot to send or a phone call you’re dreading. 

When anxiety triggers your fight or flight response, your body prepares for action (run or fight) instead of winding down for rest. (13) As a result, anxiety can leave you wide awake, even when you’re physically tired.

Why Do I Get Anxiety Before Bed?

Anxiety before bed can occur for many reasons. During the day, you might be busy with work, errands, social interactions, or the constant distraction of your phone. These activities can keep your brain plenty occupied, which in turn keeps anxious thoughts at bay. (16) 

But as the day ends and things quiet down, those anxious thoughts may rear their head or become more intense. (16) You may lay down for bed and find your brain begins to process all the worries and concerns you’ve pushed aside during the busy day, Wells says, and these ever-so-pleasant racing thoughts can significantly impact your ability to fall asleep. (16) 

Other reasons that can cause you to have anxiety before bed include:

• Life’s stressors: Concerns about the next day’s responsibilities or upcoming events can flood your thoughts as you try to sleep. This might include worries about work, school, or other personal obligations. (17)
  
• Fear of sleeplessness: Ironically, worrying about not being able to fall asleep can cause anxiety before bed. (18)

On top of all that, anxiety can affect your sleep through nightmares. Research shows that if you’re dealing with anxiety, you’re more likely to have nightmares. (19)(20) If they’re relatively frequent, the worry about experiencing these bad dreams can itself create anxiety before bed, making it even harder to fall asleep.

Does Sleep Deprivation Cause Anxiety?

While anxiety can make it harder to sleep, sleep deprivation (not getting enough sleep) can also worsen anxiety symptoms. (21)(22) This can create a vicious cycle, potentially leading to a downward spiral of worsening symptoms and sleep problems. (23)

And sleep deprivation is no joke. When you don’t get enough sleep, your brain doesn’t function at its best. In addition to worsening anxiety, sleep deprivation can, in the short-term: (24)

• Make you more irritable and more likely to snap at things
• Affect your ability to handle stress
• Make it more challenging to concentrate and think clearly

That’s just a handful of short-term symptoms. Left unchecked, long-term sleep deprivation can lead to more serious health issues like a weakened immune system, heart problems, and even trouble with memory and dementia. (24)(25)

What Does Sleep Anxiety Feel Like?

Sleep anxiety occurs when you’re anxious about sleeping or falling asleep. (26) Unlike nighttime anxiety, which involves worrying about various life issues at bedtime, sleep anxiety is focused on the fear of not being able to fall asleep or stay asleep. (4) “You recognize that you’re having this pattern [of not being able to fall asleep], and you can start to anticipate it,” Wells explains.

People with sleep anxiety may have thoughts like: 

“What if I can’t fall asleep tonight?”

“I’ll be exhausted tomorrow if I don’t sleep now.”

Wells explains that you may also lie awake doing mental calculations. For example, you might think, “If I can just fall asleep right now, I’ll still get one more hour of rest before I have to wake up.” As pragmatic as it seems, this can actually make stress worse and keep you from relaxing and drifting off.

What are Sleep Anxiety Symptoms?

Sleep anxiety can manifest in a lot of ways, affecting both your body and mind. Common sleep anxiety symptoms include: (26)

• Excessive worry about falling asleep
• Fear of not getting enough sleep
• Irritability related to sleep concerns
• Avoiding going to bed
• Constantly checking the clock

Wells says you may also experience physical symptoms such as: (26) 

• Difficulty relaxing in bed
• Rapid heartbeat
• Feeling too hot or cold, especially cold hands and feet
• Muscle tension or restlessness

What Causes of Sleep Anxiety?

Several factors can cause sleep anxiety, many of which interact with each other. These include: (26)(27)

• Existing sleep disorders like insomnia (difficulty falling or staying asleep) or sleep apnea (when breathing repeatedly stops and starts during sleep)
• Anxiety disorder
• Past traumatic experiences, especially related to nighttime or sleep
• Fear of nightmares
• Concerns about issues that might occur during sleep
• Uncomfortable sleep environment (noise, light, temperature)
• Caffeine or stimulant use, especially later in the day
• Sleep effort (trying too hard to fall asleep), which makes it hard to relax and actually drift off

Often, sleep anxiety is caused by a combination of these factors rather than a single cause.

Managing Sleep Anxiety

Managing sleep anxiety requires addressing the underlying issues that are causing the anxiety in the first place. The first step is recognizing sleep anxiety as a distinct problem. Once identified, you can start to address it directly. (26)

Below we share tips on how to get better sleep with anxiety, but you don’t have to face sleep anxiety alone. Many people feel embarrassed about sleep struggles, but reaching out to a medical professional for support is important. Wells suggests not waiting too long to get help, as a healthcare provider can help you create a plan to manage sleep anxiety effectively.

How Anxiety and Insomnia Are Connected

Maybe you toss and turn at night, unable to fall asleep. Or you wake up in the middle of the night and struggle to drift off again. You may find yourself wide awake far too early in the morning, feeling exhausted even after a full night in bed. These are all common signs of insomnia, a sleep disorder that affects many people. (28)

Insomnia can be short-term (lasting for days or weeks) (29) or long-term (lasting three months or more). (30) Short-term insomnia can happen due to an event or stress, while long-term insomnia is often linked to other problems, like medical conditions, medications, or other sleep disorders. (29)

When you don’t get enough good sleep because of insomnia, you can feel drained and moody during the day. Insomnia can also affect your health, work performance, and quality of life. (31)

Unsurprisingly, anxiety and insomnia often go hand in hand. Insomnia can develop if you have sleep anxiety for a long time or anxiety at night. (31) What’s more, some research has found that insomnia can actually cause anxiety. (32) That means addressing insomnia may be important not only for improving sleep, but also for managing anxiety.

We know insomnia diagnoses can be scary, but they don’t mean you’ll never sleep well again. Instead, it may mean that it’s time to reach out to your healthcare provider. They can offer targeted support, which might include Cognitive Behavioral Therapy for Insomnia (CBT-I), stimulus control therapy, lifestyle changes, or in some cases, medication. (28)

How to Sleep With Anxiety

If you’re struggling with sleep and anxiety, these strategies can help calm your mind and improve your rest: (7)(6)

• Create a nighttime ritual. Establish a consistent routine before bed that focuses on reducing anxiety and stress. This could include gentle stretching, reading a book, or listening to calming music. A regular ritual tells your body that it’s time to wind down.
• Stick to a regular sleep schedule. Go to bed and wake up at the same time every day, even on the weekends. We know it’s easier said than done, but this helps regulate your body’s internal clock and can make falling asleep easier.
• Avoid watching the clock. Watching the time go by can increase anxiety about not sleeping. Turn your clock away from view to reduce sleep-related worry.
• Get out of bed if you can’t sleep. If you’re lying awake for more than 20 minutes, get up and do a calming activity until you feel sleepy. This helps prevent your bed from becoming associated with sleeplessness and anxiety.
• Create a restful environment. This includes keeping your bedroom dark, quiet, and cool. Remove electronics from your bedroom, as the blue light can interfere with sleep and notifications can trigger anxiety.
• Limit caffeine and alcohol. Both can interfere with sleep quality. Avoid caffeine in the afternoon and evening, and limit alcohol, especially close to bedtime.
• Exercise during the day. Exercise allows you to take control of your actions and can help reduce anxiety by acting as a form of exposure therapy, says Wells. “Plus it’s going to increase your drive for sleep,” she adds.
• Make time for boredom during the day. You can do this by scheduling short periods without distractions in your day — yep, that includes your phone. Wells says this allows your brain to process thoughts and worries and can help calm your mind at night.
• Do a daily “brain dump”. Wells suggests writing down your thoughts and worries each day. This helps slow down racing thoughts and lets you look at your concerns more calmly, which can reduce anxiety at night.
• Practice relaxation techniques. Try deep breathing exercises or meditation before bed to calm your mind and reduce anxiety.
• Consider a weighted blanket. Some people find the pressure of a weighted blanket soothing and helpful for reducing anxiety at night.
• Ensure your bed is comfortable. A supportive mattress and comfortable bedding can make a big difference in your ability to relax and fall asleep.

Lifestyle changes can significantly improve sleep, especially when anxiety is involved. (33) Wells recommends focusing on ways to activate the parasympathetic nervous system (your body’s natural relaxation system) more often. While the sympathetic nervous system triggers the “fight or flight” response we discussed earlier, the parasympathetic system promotes a “rest and digest” state. You can engage this calming system through relaxation techniques and help reduce anxiety’s impact on your nightly routine.

How to Calm Anxiety at Night Naturally

Many people look for natural methods to calm anxiety and improve sleep quality. Supplements and natural remedies are popular choices, but it’s a good idea to approach them with caution. Of course, everybody is different, so what works for your friend may not work for you.

Always talk to your healthcare provider before trying any new supplement, especially if you’re taking other medications or have existing health conditions. While some natural remedies have scientific backing, others are based more on personal experiences. Here’s a list of common natural remedies for anxiety and sleep:

• CBD (Cannabidiol): Research about CBD’s effect on sleep is still in its early stages. For instance, a small study showed CBD helped with sleep at first, but the results became less clear over time. (8) Another review of studies found that we simply don’t have enough solid evidence yet to make firm claims about CBD’s sleep-promoting effects for sleep disorders. (34) If you’re considering CBD, Wells recommends starting with a low dose of 2.5 milligrams (mg), taken an hour before bedtime. She also suggests not taking it every night, and giving yourself at least two days off each week to prevent tolerance.
• Magnesium: Research on magnesium’s effect on sleep is still in progress. (35) Some studies hint at its potential benefits for sleep quality, but scientists are still working to fully understand how magnesium might help with sleep. (36) While magnesium’s effects might be mild, Wells says even a placebo effect can be beneficial if it helps you relax. (36) With so many types of magnesium, it may be difficult to decide which magnesium is best for sleep and anxiety. Wells has a handy tip: If you tend to have loose stools, go for magnesium glycinate. On the flip side, if constipation is more of an issue, magnesium citrate could be the way to go.
• Essential oils: While not directly impacting sleep, essential oils like lavender or chamomile can create a calming bedtime routine. (37) Wells notes that their main benefit comes from creating a smell association with sleep, which can be powerful when used consistently. This means when you regularly use a specific scent as part of your bedtime routine, your brain starts to link that smell with sleep, potentially making it easier to drift off when you encounter that aroma.
• Chamomile tea: If brewing a soothing cup is more your thing, the best tea for sleep and anxiety might already be in your pantry. Chamomile tea is an age-old remedy that has been helping people relax for centuries. A study found that chamomile extract helped reduce anxiety symptoms over eight weeks, working as well as some traditional anxiety medications but with fewer side effects. (38)

What About CBT-I for Sleep?

If chronic insomnia has become your unwelcome bedmate, especially when anxiety’s involved, there’s good news — and it doesn’t involve taking sleeping pills. CBT-I is a go-to treatment for chronic insomnia that has seen a great deal of success. (39)(40) 

This six- to eight-week therapy addresses the root causes of your sleep problems and helps you rewire your brain to associate bed with sleep. This is especially helpful if anxiety is your sleep nemesis. CBT-I teaches you how to identify the thoughts and behaviors that contribute to your sleep issues and how to replace them with better sleep habits. (41) 

While one-on-one professional help is ideal, it’s not always readily available. In that case, Wells says to consider app-based therapy options or start by adjusting your sleep hygiene practices. Sometimes, cleaning up your sleep habits can make a big difference before you seek more intensive help.

Talking To Your Doctor

Don’t be shy about bringing up sleep and anxiety issues with your healthcare provider — they’ve likely heard it all before. If you’re tossing and turning at night or your mind won’t shut off for more than a few days, that’s definitely worth mentioning.

According to Wells, a sleep medicine physician can be a great starting point. These specialists are trained to address all sorts of sleep issues. But if you can’t see a specialist right away, your primary care physician or mental health therapist can also be helpful.

When you talk to your doctor: (42)

1. Be honest about your sleep struggles and anxiety symptoms
2. Describe how these issues are affecting your daily life
3. Mention any strategies you’ve already tried
4. Ask about potential treatment options, including both medical and non-medical approaches

FAQs

The Last Word From Sleepopolis

It’s no surprise that sleep and anxiety don’t mix, but luckily there are plenty of solutions out there for those of us who unwittingly save our worries for bedtime. From reworking your bedtime routine to talking with your healthcare provider and trying CBT-I, there are options out there to help you get the good night’s sleep you need.

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