How does anxiety affect sleep?
Anxiety keeps the body and mind on alert, and alert is the opposite of what sleep needs. The National Heart, Lung, and Blood Institute lists stress or worry about work, relationships, money or the death of a loved one among the things that raise the risk of insomnia. It adds a detail many people recognize: worrying about whether you will get enough sleep, and watching the clock, can raise the risk or make insomnia worse.
The National Institute of Mental Health lists trouble falling asleep or staying asleep, and feeling fatigued, among the common signs of generalized anxiety disorder. That does not mean everyone who sleeps badly has an anxiety disorder. It means the two often travel together, and that improving one tends to help the other.
Why worry gets louder at night
During the day, work, errands and conversation crowd out worried thoughts. At night there is nothing to compete with them. In a quiet place like the hills above Saluda or a farmhouse outside Mill Spring, the silence can make that even more noticeable.
A tired brain also judges risk less kindly. Problems that look manageable over morning coffee can feel overwhelming at three in the morning. Knowing that this is a normal effect of fatigue can help: a thought that arrives in the middle of the night does not have to be settled in the middle of the night.
Habits that help, according to federal health agencies
NHLBI and the National Institute on Aging recommend broadly similar sleep habits. None works for everyone, but together they give sleep a better chance:
- Go to bed and get up at about the same time every day, including weekends.
- Keep the bedroom cool, quiet and dark, and keep screens out of it where you can.
- Avoid caffeine late in the day; NIA mentions coffee, tea, chocolate and soda.
- Go easy on alcohol near bedtime; NHLBI notes it can make sleep lighter and more broken even if it helps you fall asleep.
- Get regular physical activity, but not right before bed.
- Build a wind-down routine, such as reading, quiet music or a warm bath.
What to do with the worries themselves
Many people find it helps to set aside a short worry time in the early evening: write down what is on your mind and one next step for each item, then close the notebook. If a worry returns in bed, you can remind yourself it is already written down. NIMH's stress fact sheet also suggests journaling and relaxation exercises such as slow breathing. More ideas, and a note on what the evidence does and does not show, are on our page about self-help for anxiety.
When sleep problems need more than good habits
NIA describes chronic insomnia as trouble sleeping that lasts more than three months and cannot be fully explained by another medical cause. If that sounds like you, or if poor sleep is affecting your mood, safety or work, it is time to talk to a professional rather than push through.
NHLBI says cognitive behavioral therapy for insomnia, often called CBT-I, is usually recommended as the first treatment for long-term insomnia and can be very effective. It is typically a 6- to 8-week plan and combines several parts: work on the anxious thoughts about sleep, relaxation training, a structured schedule for time in bed, and steps to rebuild the link between bed and sleep. NHLBI notes that it can be delivered by a doctor, nurse or therapist, in person, by phone or online.
Counseling for anxiety can also help sleep by addressing what you lie awake thinking about. Our page on how counseling helps anxiety explains what that looks like.
A word on sleep medicines and supplements
NHLBI describes a range of prescription sleep medicines, each with side effects, and says some are meant only for short-term use. It also says research has not shown melatonin to be an effective treatment for insomnia, and that over-the-counter antihistamine sleep aids can be unsafe for some people. This is general information only. Talk to your doctor before starting or stopping any sleep medicine or supplement, and see therapy or medication for anxiety for questions to bring.
When to see a doctor first
Not every sleep problem is anxiety. NIA notes that sleep apnea, restless legs and other conditions become more common with age, and that untreated sleep apnea can lead to serious health problems. Loud snoring, gasping, pauses in breathing that a partner notices, or strong urges to move your legs are all reasons to see your doctor. A sleep diary kept for a couple of weeks, as NIA suggests, makes that visit more useful.
For older readers, the page on anxiety in retirement looks at how sleep and worry change after work ends.
Getting help in Polk County
Laura Bass is a psychotherapist who works with adults, and anxiety is among the concerns she sees. She has a part-time office at The Healing Cottage in Columbus; call 704-706-3264 or use the contact page, and ask which days she is there.
Sleepless nights can make everything feel darker. If you ever have thoughts of harming yourself, call or text 988 at any hour, or call Vaya Health at 1-800-849-6127. If anyone is in immediate danger, call 911.
Common questions
Can anxiety cause insomnia?
It can contribute. NHLBI lists stress and worry about work, money, relationships or the death of a loved one among risk factors for insomnia, and NIMH lists sleep trouble among the signs of generalized anxiety. Poor sleep can then make anxiety harder to manage the next day. Because other conditions cause sleep problems too, mention lasting insomnia to your doctor.
Should I get out of bed if I cannot sleep?
Part of the stimulus control piece of CBT-I, as NHLBI describes it, is going to bed only when sleepy and getting out of bed if you cannot sleep, so that bed becomes linked with sleep rather than with lying awake. A quiet, dim activity elsewhere until you feel drowsy is the usual suggestion. A clinician can tailor this to you.
Is it safe to take melatonin for anxiety-related sleep problems?
Ask your doctor. NHLBI says research has not shown melatonin to be an effective treatment for insomnia and lists possible side effects, including daytime sleepiness, headaches and changes in blood pressure. Supplements are not reviewed by the FDA for safety and effectiveness before they are sold. Your doctor knows your other medicines and health conditions.
Can counseling help if my main problem is sleep?
Often, yes. NHLBI names CBT-I, a structured talk-based approach, as the usual first treatment for long-term insomnia, and anxiety counseling can ease the worries that keep you awake. Ask any counselor whether they work on sleep directly, and ask your doctor about sleep problems that could have a medical cause.