How Anxiety Influences Sleep

People who suffer from anxiety disorders frequently experience insomnia as a symptom of their anxiety. In fact, the link between anxiety and sleep is often considered a vicious circle, meaning that anxiety sufferers find it difficult to fall asleep or stay asleep due to increased worrisome thoughts at bedtime. In turn, lack of sleep decreases coping skills, increasing anxiety levels more the next day, resulting in more worry at bedtime, and even less sleep.


Mental hyperarousal, which is characterized by worry and intrusive thoughts, is known to be a key factor behind insomnia. Essentially, the person lays down to go to sleep, and thoughts keep running through their mind. People who suffer with anxiety disorders are known to have high sleep reactivity, which means that they react strongly to problems in life, thereby exacerbating their sleep issues. Excessive worry has been shown to affect sleeping habits, and can affect many other aspects of life, again feeding back to influence sleep.

Sleep Difficulties Accompany Many Anxiety Disorders

Sleep difficulties have been found for people with various types of anxiety including Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Post-Traumatic Stress, and Specific Phobias.

Generalized anxiety disorder is an excessive, uncontrollable worry about anything and everything that lasts for at least six months. People with this disorder stay alert to the possibility of danger, even when there is no real threat present. This can interfere with sleep because individuals do not feel safe in their surroundings, leading to difficulty falling asleep or staying asleep. Furthermore, people who experience generalized anxiety disorder may be unable to control worrying thoughts about current events or possible future problems like job security during the night.

OCD is an anxiety disorder characterized by repetitive thoughts and behaviors that interfere with daily life. This mental health condition usually begins in childhood or adolescence, although adults can develop OCD later in life as well. Sufferers will perform tasks such as checking doors multiple times or flicking light switches on and off repeatedly to ensure everything is “just right.” People who suffer from OCD typically have trouble falling asleep at night due to the racing thoughts. When otherwise not occupied, OCD-related thoughts can are free to occupy the mind and interfere with sleep. A substantial minority of OCD suffers do not fall asleep until the early morning hours.

With regard to phobias, a study published in the Journal of Anxiety Disorders found that individuals who developed fear during dental treatment had higher rates of insomnia than those who did not develop fear. By contrast, only about ten percent or less of people without any anxiety disorder will experience sleep problems.

After a traumatic event, such as an accident or unexpected death of a loved one, it is not unusual to experience sleep disturbances and nightmares. Up to 60% of those who have experienced a traumatic event will suffer from some degree of posttraumatic stress disorder (PTSD). Intrusive thoughts affect the ability to go to sleep, whereas nightmares affect the ability to stay asleep. The hyperarousal symptoms of PTSD affect both.

Anxiety and depression frequently occur together, perhaps because hopelessness and helplessness are common to both. Anxiety and depression both have their own independent effects on sleep. As such, when diagnosed together, they may affect sleep more than either disorder alone. Anxiety produces its own effects on sleep, including intrusive thoughts, hyperarousal at night, difficultly falling asleep despite feeling exhausted, unpleasant dreams, and excessive worry about falling asleep and about staying asleep. Depression can make it more difficult to fall asleep due to feelings of worthlessness and guilt. Additionally, episodes of mania or hypomania associated with bipolar disorder can lead to poor sleep.

Anxiety about Sleeping Reinforces Insomnia

One of the most common symptoms of people who suffer from anxiety is that they find it difficult to fall asleep or maintain a restful sleep. This is because their mind tends to race with thoughts, and as a result they have difficulty relaxing. Often times individuals who have bouts of insomnia will experience a build up of stress which leads them to worry about not being able to get a good night’s rest. If an individual continues this pattern over time, they may eventually become so anxious about going to sleep that their mind automatically associates bedtime with anxiety, making it even harder for them to relax and drift off into dreamland.

Lack of Sleep Also Reinforces Anxiety

The research evidence indicates that sleeping problems are not only a symptom of anxiety, but also a cause: Sleep affects your hormones and neurotransmitters, especially those involved in stress. Cortisol, the body’s major stress hormone, is secreted more by the adrenal glands when you are drowsy. Elevated cortisol at night increases alertness during the day, making it difficult to fall asleep or stay asleep. When you wake in the middle of the night and are unable to easily go back to sleep, you may feel tired the next day, become easily frustrated and annoyed by even minor stressors, and find it difficult to relax. Prolonged lack of sleep also makes it difficult for individuals to cope with stress in healthy ways because their bodies are fatigued and unable to handle daily tasks as well as they usually do.

How to Calm Anxiety and Get Better Sleep

Anxiety is one of the most treatable mental disorders, being frequently treated with cognitive-behavioral therapy. When anxiety occurs with insomnia, a specific form of cognitive-behavioral therapy called CBT-I is used. The vast majority of people treated with CBT-I improve on the Insomnia Severity Index, a common questionnaire used to evaluate insomnia.

Sleep Hygiene

Sleep hygiene is important for falling asleep each night. Important steps include avoiding caffeine, alcohol, and strenuous activity, having a period of low light during which you wind down, not checking email or social networks too close to bedtime, since these can get you engaged again, eliminating blue light from phone and tablet screens by not using these devices within an hour of bedtime, choosing to be relaxed instead of frustrated if you do happen to wake up in the early morning hours, which many people with anxiety do. Creating a ritual before bed can help your mind unwind after a long day at work or school.

Relaxation Techniques

Relaxation techniques can reduce anxiety and make it easier to fall asleep and remain asleep. Deep breathing, mindfulness meditation, and guided imagery are just a few approaches to relaxation that can help put your mind at-ease before bed or if you wake up during the night.

Some people with anxiety can’t sleep because of racing thoughts, which makes it difficult for them to relax and shut their mind down long enough to fall asleep. Engaging in an activity that focuses your attention on present experiences, such as listening to music or doing a puzzle, can help quiet your mind and calm your brain’s “excited” areas so you can more easily drift off into a peaceful slumber. Try some relaxing activities, such as reading a book or meditating .