Anyone who’s woken up with a racing mind at 3 a.m. knows that nighttime anxiety can wreak havoc on your sleep. If you’re working into the wee hours on a stress-inducing assignment, doomscrolling news headlines right before bed, or even juggling a larger-than-normal to-do list, your ability to relax might be compromised, resulting in less-than-stellar sleep. But anxiety at any point in your day can affect your ability to get a good night’s sleep.
What is anxiety?
The American Psychological Association defines anxiety as “an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.”
Anxiety is a part of normal life for most everyone, but there are varying degrees of anxiety, from everyday worries to overwhelming concerns associated with clinical conditions like generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder. While occasional anxiety is considered a normal part of life, about 1 in 5 American adults deals with an anxiety disorder characterized by chronic symptoms like irritability, racing heart rate, and feelings of impending doom, all of which can interfere with daily activities and relationships.
For some, anxiety can make falling or staying asleep difficult, whereas in other cases, anxiety can cause vivid nightmares or other disturbances. What can make matters worse is the fact that worrying about sleep can increase anxiety and diminish sleep, which can be a deprivation (i.e. not getting enough quality sleep) and can significantly impact anxiety levels as well — all of which reinforces the vicious cycle.
How can daytime worries impact nighttime rest?
The relationship between anxiety and sleep is multifaceted, but plenty of evidence shows that daytime worries can absolutely have a negative impact on nighttime rest. Insomnia, in particular, is highly prevalent in individuals who deal with anxiety disorders, and the clinical definitions of certain mental health conditions like generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD) have even been expanded to include sleep issues like insomnia and nightmares.
While anxiety itself is something everyone deals with occasionally, anxiety disorders involve intense, frequent, or even continuous “false alarm” arousal responses that can seriously affect sleep. In fact, research indicates about 24% to 36% of people with insomnia also have anxiety disorders. About 1 in 5 Americans experience anxiety disorders each year; people diagnosed with GAD may find it particularly difficult to fall or stay asleep.
While every person is different, it’s safe to say that daytime ruminations, stressors, and negative thoughts could very likely lead to sleep issues. While some people may toss and turn for a bit before drifting off to dreamland, others may struggle on a regular basis to get the recommended seven to nine hours of solid rest they need to function optimally. While there may not be anything inherently dangerous about the effects of anxiety on sleep, anyone who’s ever lost hours worrying about deadlines, finances, family troubles, or literally anything can attest: Anxiety-induced sleep loss is no fun.
“The long-term consequences are often surprisingly minimal,” says Chris Winter, neurologist, Sleep.com advisor, and author of “The Rested Child” and “The Sleep Solution.” “But in the short term, anxiety often prolongs the time it takes to fall asleep — especially for those anxious about sleeping — and distorts perceptions of sleep, often resulting in the individuals 'feeling' like they slept far fewer hours than they actually slept. It's not unusual for people to truly feel like they [didn’t] sleep at all.”
How to fall asleep with anxiety
There’s no one-size-fits-all solution to a problem like anxiety, but there are a myriad of strategies and treatment options that can effectively reduce worries, ruminations, and obsessive thought patterns.
“Talk to a psychiatric professional about treating your anxiety,” Winter says. “There are many options. I would question any medications designed to ‘make you sleep’ though. Remember, it's impossible not to sleep.”
While insomnia symptoms are common, affecting about 1 in 3 adults worldwide, Winter is referring to the fact that sleep is a biological certainty. “That simple certainty of nature fills me with optimism on the occasions when I find myself in bed, awake,” he said last year. With that in mind, it’s worth avoiding over-the-counter and prescription medications that “knock you out” if possible, as those won’t address the underlying issues perpetuating anxiety that culminates in sleep loss. Depending on the type of anxiety you’re experiencing and the severity of your symptoms, a mental health professional may suggest an antidepressant or anti-anxiety medication, but other pharmaceuticals, like sedatives, are intended for short-term relief, not long-term use.
The other most common treatment for anxiety that impacts sleep is psychotherapy. While there are different forms available, cognitive behavioral therapy (CBT) has been shown to be the most effective type for tackling anxiety disorders. CBT involves working with a trained specialist to learn specific coping skills that improve symptoms and can help improve quality of life. This type of treatment may also include exposure therapy when used to target anxiety, meaning a therapist may safely trigger your anxiety while helping you navigate the accompanying feelings so you can learn to manage the issue on your own.
There are also plenty of lifestyle tweaks that can help those with anxiety get more quality sleep. Practicing good sleep hygiene (i.e. cultivating healthy habits like maintaining a solid sleep schedule and controlling environmental factors like bedroom temperature) is one of the most important ways to set yourself up for the best rest possible. Additionally, incorporating breathing techniques into your everyday routine can help promote relaxation and quell anxiety. Some of the most common breath-based strategies include diaphragmatic breathing (breathing deeply into your belly versus into your chest) and box breathing (inhaling for four counts, holding the breath for four counts, and exhaling for four counts).
Another common — albeit seemingly counterintuitive — lifestyle technique to calm anxiety is to actually schedule time for worrying. As a common cognitive behavioral therapy (CBT) technique, “scheduled worry time” involves setting aside a specific time of day (ideally no more than 30 minutes) reserved for ruminations so these thoughts don’t hijack the rest of your day. One study, in particular, showed that individuals who scheduled worry time experienced significantly reduced anxiety compared to a control group and — surprise! — slept better.