For many people, going to bed offers relief and rest from a busy day. But for those who experience anxiety, the nighttime stillness can allow worries to set in sometimes.
Having anxiety during the day is hard enough, but anxiety also makes it difficult to quiet your mind and body to go to sleep. When your anxiety is causing you to lie awake night after night, unable to sleep, it can be unbearable. And once the pattern is set, it’s easy to find yourself stuck in a vicious circle: anxiety causes you to lose sleep, and frequently losing sleep can make anxiety worse.
Luckily, there are ways to break the cycle. We’ll explain how anxiety impacts sleep and share tips on how to get the nightly rest you’ve been dreaming of.
The science behind anxiety and sleep
Let’s start with a little about how sleep works.
Sleep happens by balancing two forces that oppose each other. The first force is called sleep pressure. The longer you’re awake, the stronger this force becomes. If you’re awake for 16 hours, you’ll be tired. After 24 hours of being awake, sleep is more likely. And after 72 hours, it becomes difficult to stay awake.
The second force resists sleep pressure by pushing you awake. This force is an alerting signal that ebbs and flows based on your internal clock (or circadian rhythm). It gets stronger as the day progresses and then drops off at night. When this force drops in the evening, all the sleep pressure you built up during the day pushes you to sleep.
Why does anxiety keep us awake?
The alerting signal force uses many of the same neurochemicals as anxiety. This is likely a leftover adaptive trait that aided our survival in the past. Anytime you feel anxious, worried or threatened, the alerting signal gets stronger. It’s your brain’s way of saying, “If this is a threat, you should stay awake and deal with it.”
In today’s world, we are rarely foregoing sleep to run from predators, but the anxiety generated by the modern threats we face is largely the same.
What happens when you don’t get enough sleep
According to the Centers for Disease Control and Prevention, adults need between 7-9 hours of sleep each night to feel rested, energized and alert the next day. While sleep needs can vary from one person to the next – some of us require closer to nine hours of sleep, and others can get away with seven exactly – it’s best to keep your sleep between 7-9 hours. No more and no less.
We all have an occasional sleepless night or two, but frequently sleeping less than seven hours or experiencing fragmented sleep is linked to an increased risk of:
- High blood pressure, heart attack and stroke
- Anxiety, depression or irritability
- Poor coordination, resulting in frequent accidents
- Memory problems, difficulty concentrating and impaired learning
Sleep is sometimes referred to as the third pillar of health, with the other two being nutrition and exercise. For your best health, all three must be balanced.
How to tell the difference between anxiety and sleep disorders
Sleep disorders and anxiety can go hand in hand, and it can be hard to know which came first. That’s why it’s important to get to the root of what is truly causing your sleeping difficulties. Especially since sleep disorders caused by anxiety, like insomnia, can remain even after anxiety is being properly managed. The same can be said for sleep disorders that cause you anxiety. After treatment, anxiety around the condition can linger.
Common sleep disorders that are linked to anxiety include:
Unlike anxiety about unrelated things that affects sleep, sleep anxiety is specific apprehension around sleep itself. People with sleep anxiety feel anxious about whether they’ll be able to fall asleep or stay asleep; whether they’ll experience nightmares, sleepwalking or sleep paralysis; or whether they’ll wake up gasping for air due to sleep apnea.
If this struggle continues night after night, you can start to “dread the bed.” Someone with sleep anxiety isn’t anxious during the day, but once they start thinking about going to bed, their anxiety rises.
Insomnia can be categorized as either acute or chronic. Acute insomnia lasts less than three months and is typically related to stressful periods in life. Insomnia becomes chronic when it occurs three or more nights a week for three months or longer. Anxiety that regularly keeps you up at night can cause acute insomnia, which may eventually become chronic.
Nocturnal panic attacks
When someone has a nocturnal panic attack, they wake up from sleep feeling intense panic. They’ll also show other signs of a panic attack, like sweating, shaking, shortness of breath and a racing heartbeat. It can take a long time to recover from a nocturnal panic attack, and the fear of another one happening can prevent a return to sleep.
Nocturnal panic attacks are relatively common among those with panic disorder. One study reported that up to 71% of people who experience daytime panic attacks have had at least one nocturnal panic attack.
A great first step to getting some answers is to make an appointment with a primary care doctor or clinician. Primary care doctors can diagnose and treat hundreds of conditions, and they can refer you to our mental and behavioral health or sleep medicine services, if needed.
It can seem impossible to fall asleep when you’re feeling anxious, no matter how tired you are. Try not to become frustrated with yourself or the situation, as that can make your anxiety worse. Instead, try some of the sleeping tips below.
Use relaxation techniques
Relaxation techniques can help accumulated sleep pressure overcome the alerting signal, and calm us enough to fall asleep. These techniques include:
- Breathing skills: Focusing on your breath can help lull you to sleep. Try belly breathing, which uses the muscles of your diaphragm rather than those of your neck and chest to pull air deep into your lungs. Or the 4-7-8 technique, which involves inhaling through your nose for 4 seconds, holding your breath for 7 seconds and exhaling through your mouth for 8 seconds.
- Progressive muscle relaxation: Anxiety causes multiple physical responses, one of which is muscle tension. During progressive muscle relaxation, you tense and then release individual muscle groups, like your neck, shoulders and legs, one at a time.
- Guided imagery: When trying to fall asleep, picture yourself in relaxing, pleasant environments instead of stressful situations. Whether that’s lounging on a beach, sitting in a field or walking through a forest, you can choose a scene that helps you feel most calm.
- Meditation: Meditating before bed allows you to quiet your thoughts and settle your body, bringing on sleep gradually and naturally. If you’re not sure where to start, there are plenty of guided meditations available online.
- Yoga: Yoga is beneficial for your health and mental well-being at any time of the day, but look for specific routines you can do just before bed to help both your mind and body wind down from the day. There are even yoga poses you can do from your bed.
- Constructive worry: Set aside planned time in the evening, before you get in bed to sleep, during which you allow yourself to think about the things that are bothering you. And try to do so in a positive, productive way that puts more focus on solutions.
Keep a notebook near your bed
The calm and quiet of a dark bedroom can create a mind that is anything but. All the thoughts that were pushed aside during the events of the day have a chance to resurface.
Keep a notebook or notepad near your bed to start a nightly journaling practice. You can use the space to reflect on your day, write lists, plan how you’ll complete future tasks and leave yourself reminders. When you put all those racing thoughts onto paper, you empty them from your mind and sleep may come easier.
An expanding body of research suggests that direct exposure to nature can have a range of health benefits. Being outside during the day helps reinforce your body’s circadian rhythm, or your sleep and wake cycle. Exposure to sunlight, especially right after you wake up, can help you stay alert throughout the day, and help you fall asleep once the sun goes down.
Getting outside is also a good time to go for a walk, take a bike ride, or play with your kids. Moving your body is an excellent way to ease stress and anxiety, and makes it more likely you’ll be tired at night.
Foster a healthy sleep environment
To set yourself up for sleep success, make sure your room is dark, cool and quiet before you go to bed. If your room is too quiet, or you need to drown out other noises, you can try using a fan or a white noise machine.
You may also want to tidy up your sleep space each night and get a few things ready for the next day. Laying out your planned outfit, clearing off your desk and uncluttering your nightstand are all things that can help you be more organized, both physically and mentally.
Don’t lie awake in bed for longer than 20 minutes
When you’re trying to fall asleep, getting out of bed seems like the last thing you should be doing. However, you can make your sleeplessness worse by staying in bed and forcing sleep to come.
If you’re still tossing and turning after 20 minutes of trying to fall asleep, get out of bed and engage in a relaxing activity, like drawing, reading, knitting or crocheting. Then, get back into bed as soon as you start to feel tired.
Avoid eating, working or watching shows while in bed. Instead, reserve your bed for sleep. Your mind can then associate the act of getting into bed with sleep and start to automatically settle whenever you pull back the covers.
Other helpful sleep tips include:
- Set a consistent sleep schedule: Wake up at the same time every morning and go to bed at the same time every night, even on the weekends.
- Avoid screens before bed: The blue light from electronics mimics sunlight and can confuse your circadian rhythm. Put screens away at least one hour before going to sleep.
- Say no to naps: No matter how tired you feel during the day, it’s better to catch up on sleep at night than try to nap in the afternoon. Naps can throw off your sleep schedule and keep you wide awake much later than you’d like.
Finding help for anxious sleep
We all go through stressful and anxious times in our lives, but those are usually the times we need good sleep the most. If anxiety consistently keeps you from sleep or interrupts your sleep for more than three weeks, start by talking to your primary care doctor.
Primary care doctors can diagnose and treat hundreds of conditions, and they can refer you to our mental and behavioral health or sleep medicine services, if needed.