What Is Sleep Anxiety?
Expert Verified By: Dr. Shelby Harris 
For some people, bedtime (and the hours that follow) isn’t a calm, relaxing time that melts into a peaceful night’s sleep. Instead, it’s a swirl of emotions where panic, fear, and dread collide, ultimately impairing their sleep in a profound way. What we’re talking about here is sleep anxiety — a common condition that can snowball into sleep deprivation and a host of other significant health issues if left untreated.
Ahead Sleepopolis takes a closer look at sleep anxiety. We’ll examine its causes and symptoms and offer some tips for managing its effects on your life and sleep schedule.
What Is Sleep Anxiety?
“Sleep anxiety is characterized by worry about not being able to fall or stay asleep, as well as fears about getting enough sleep,” Annie Miller, a behavioral sleep medicine therapist and founder of DC Metro Sleep and Psychotherapy, tells Sleepopolis. “People with sleep anxiety are fearful that the lack of sleep they are experiencing may impact them in some negative way (i.e., not being able to perform tasks, negative effects on health, etc.).”
Miller explains that while fear and anxiety about not sleeping enough are often present throughout the day, those feelings typically worsen at night.
“Sleep anxiety before bed happens because nighttime is usually the quietest,” she says. “The busyness of the day is over, and your brain has more wide-open time to think and worry without distraction.”
Additionally, it doesn’t take much for sleep anxiety to settle in. “Once you have a poor night of sleep (even one time), your brain can latch onto fearful thoughts associated with not sleeping, and then the anxiety becomes what is called a conditioned response.” This means your brain now associates fear with sleep, and the cycle of anxiety simply repeats night after night.
What Are The Symptoms Associated With Sleep Anxiety?
While symptoms of sleep anxiety can vary from person to person, the most common symptoms include
- Difficulty falling asleep or staying asleep
- Heightened fear
- Fast heart rate
- Shortness of breath
- Dizziness
- Nausea
- Sweating
- Shaking
- Muscle tension
Beyond the physical and biological storm, those who battle sleep anxiety nightly are often caught in a loop of racing thoughts. Miller notes that, unfortunately, those thoughts are almost always “fear-based and center around not falling asleep.”
Common thoughts that accompany sleep anxiety include:
- I won’t get enough sleep
- I’ll be tired tomorrow
- I won’t be able to focus enough tomorrow to get my work done
- I’ll toss and turn all night
- Something is wrong with me
What Causes Sleep Anxiety Before Bed?
Everyone is different, and therefore triggers for sleep anxiety are different from person to person. Common causes of sleep anxiety include fear, other sleep disorders, mental health conditions, and orthosomnia.
Fear
“Sleep anxiety is often rooted in fears where one might anticipate something terrible happening to them while asleep,” says Miller. “As a result, people who suffer from sleep anxiety think that they should not sleep but instead stay awake, remaining alert and vigilant.”
Sleep Disorders
Interestingly, other sleep disorders like insomnia and some parasomnias can trigger or worsen sleep anxiety.
“Sleep anxiety is very common with insomnia,” says Miller. And in this case, the symptoms and effects between the two are cyclical. When someone regularly deals with insomnia, the mere thought of not sleeping can trigger sleep anxiety. Likewise, sleep anxiety can double down on the symptoms of insomnia.
Parasomnias are another trigger for sleep anxiety. Specifically, parasomnias that could potentially cause harm to the sleeper or their loved ones, like sleepwalking, for example. Nightmares and night terrors can also cause sleep anxiety — and understandably so. Terrifying images and dreams would be enough to keep anyone awake.
Mental Health Conditions
Mental health conditions like anxiety, depression, bipolar disorder, PTSD, and schizophrenia can also trigger sleep anxiety. Here again, the relationship can be cyclical. Depression, for example, can trigger sleep anxiety, and insufficient sleep as a result of sleep anxiety can trigger depression.
Orthosomnia
It may be a relatively new phenomenon, but orthosomnia, or the preoccupation with getting perfect sleep based on sleep tracker data, is becoming a huge trigger for sleep anxiety. For many people, their thoughts become so tangled up in the minutiae of their sleep that they end up feeling anxious about it and not sleeping at all. Unfortunately, something that was supposed to help us get more sleep ends up having the opposite effect.
What Happens When Anxiety Keeps Me Awake?
While an occasional sleepless night is nothing to worry about, rooted sleep anxiety can lead to a host of issues far beyond missing out on your forty winks. Prolonged sleep anxiety can lead to sleep deprivation, the side effects of which range from minor tribulations to more considerable health concerns.
Over the short term, sleep deprivation stemming from sleep anxiety can lead to:
- Moodiness and irritability
- Daytime sleepiness
- Fatigue
- Impaired memory
- Impaired reaction time
- An increased stress response
Sleep deprivation that endures for weeks, months, and even years can lead to more profound health issues, including:
- Dementia
- High blood pressure
- Diabetes
- Heart attack
- Heart disease
- Stroke
Can Sleep Anxiety Lead To Insomnia?
According to Miller, anxiety about sleep can lead to insomnia. “When we fear a negative consequence [of sleeping], our brain begins to perceive sleeping as dangerous and threatening,” she says. Subsequently, “our brains release cortisol and adrenaline in response to those feelings of fear and impending danger.” So instead of our body going into relaxation mode for sleeping, we end up feeling hyper-alert or vigilant, aka wide awake. And when this cycle repeats itself night after night, you’re now dealing with insomnia.
And remember, too, that sleep anxiety and insomnia have a bidirectional relationship (as we noted earlier.) Sleep anxiety can lead to or worsen insomnia, and insomnia can stoke the fires of sleep anxiety.
How To Overcome Sleep Anxiety
Sleepless nights don’t have to be a given. If you find that your brushes with sleep anxiety are becoming a bit too frequent, Miller says that lifestyle changes and modifications to your sleep hygiene may be your keys to getting some shut-eye.
Restrict Your Sleep Schedule
“This sounds counterintuitive, but one of the biggest problems with sleep anxiety is giving yourself too much time in bed,” says Miller. “Keeping your time in bed limited to a specific window is essential. This is a good way to build sleep drive so your body craves sleep. Ultimately, this will help you fall and stay asleep more easily.”
If You Can’t Sleep, Get Out Of Bed
In the same vein as restricting your sleep schedule, Miller recommends “limiting the amount of time you spend ‘trying’ to sleep.” In the case of sleep anxiety, Miller suggests giving yourself a maximum of 15 to 20 minutes to get things sorted. If you still can’t sleep when the time is up, she says, “get up, get out of bed, and do a quiet activity until you feel sleepy again.”
Don’t Watch The Clock
Watching the clock only serves to compound your fears and frustration, so Miller suggests paying no mind to the time. Instead, she advises “setting an alarm for the morning and putting your phone on the other side of the room or turning your alarm clock around.”
Track Anxious Thoughts And Replace Them
In something akin to journaling, Miller suggests being mindful of and/or writing down your anxious thoughts about sleep (i.e., if I don’t sleep, I won’t function tomorrow) and then challenging those thoughts. Ask yourself, Is this a fact? Probably not.
“Most of the time, we can get through the day just fine,” says Miller. “We end up focusing on other things and sometimes even lose sight of our fearful thoughts.” Instead of replaying the loop, she recommends “finding a more rational thought to allow yourself to identify with.”
Other Tips For Managing Sleep Anxiety
- Practicing good sleep hygiene – (This includes maintaining a consistent sleep and wake schedule, establishing a relaxing bedtime routine, limiting screen time, exercising regularly, and creating a soothing sleep environment.)
- Meditating
- Avoiding stressful activities or conversations before bed
- Journaling
When To Consult A Doctor
“If you find that you’re so anxious about whether or not you will or won’t sleep and you’re extremely rigid about your sleep hygiene, you may want to talk to a doctor,” says Dr. Shelby Harris, Sleepopolis’ director of sleep health.
You might also consider consulting your doctor if sleep anxiety (and ensuing insomnia) persists at least three times a week for three months or longer, according to Miller.
Miller also notes that while “many medical professionals focus on treating insomnia with medications, sleep doctors may prescribe a sleep study if symptoms indicate that a sleep study is needed. Moreover, therapists and behavioral sleep medicine providers can help by providing [Cognitive Behavioral Therapy] for insomnia, which can help change your thoughts and behaviors around sleep.”
The Last Word From Sleepopolis
Sleep anxiety is a common condition, the hallmark of which is racing, fearful thoughts about sleep. Along with implacable worries about sleeping, sleep anxiety can be accompanied by physical symptoms such as a racing heart, shortness of breath, sweating, dizziness, or muscle tension. Sleep anxiety is manageable with lifestyle changes and enhanced sleep hygiene practices, but if symptoms persist, you may want to speak with your doctor.
