Can anxiety affect sleep? Here's what to know

If you’re someone who struggles with anxiety, chances are you’ve had nights where your anxious thoughts keep you up for hours on end. Your mind spirals into worst-case scenarios and rabbit holes of negative thoughts, and the next thing you know, it’s 3 AM, and you haven’t gotten a wink of sleep. Then, the fact that you’re still awake becomes a source of anxiety itself.  

Sleep is foundational to our health—crucial for both physical and mental well-being. Trouble sleeping is a common symptom of many conditions, including anxiety disorders. Treating the root cause of your sleep troubles is essential, and there are various techniques and tools that can help you get better sleep.  

Read on to learn more about the link between anxiety and sleep and 7 tips for how to sleep when you have anxiety.

What’s the relationship between sleep and anxiety?  

There’s a clear link between anxiety and sleep disorders. For example, it’s very common to experience both anxiety and insomnia. Insomnia refers not just to trouble falling asleep, but also trouble staying asleep. Some people with anxiety-induced insomnia may struggle with getting to sleep in the first place, while others might fall asleep more easily at first but then wake up with nocturnal panic attacks or anxious thoughts that prevent them from falling back asleep. Or, you might wake up too early in the morning and not be able to go back to sleep.  

If you have anxiety and struggle with sleep, you’re in good (albeit tired) company. It’s estimated that 33% of people with insomnia have an anxiety disorder, and 50% of people with anxiety experience some kind of sleep difficulties.  

This can become an unfortunate cycle. You can’t sleep due to your anxiety, and then the sleep deprivation increases your anxiety levels. Not to mention, a lack of sleep can result in other symptoms like daytime sleepiness, trouble focusing, and irritability. Poor sleep can lead to poor mental health overall.  

How do anxiety disorders affect you at night?

If you have an anxiety disorder and sleep trouble, you might be wondering, “Why is my anxiety keeping me awake?”  

When your mind is racing or you’re stuck in a cycle of ruminations and “what-ifs,” you’re in a state of mental hyperarousal. Your brain is on guard and alert. Of course, when your brain is active and alert, it can be super hard to relax, let alone drift off to sleep.  

You might find that your anxiety worsens at night. This is because there are typically fewer distractions or activities that take up your attention when you’re lying in bed. The quiet stillness of the night can make anxious thoughts feel that much louder and more intense, and it can be hard to shake your excessive worrying when your day-to-day distractions aren’t present. Plus, by the time you get to bedtime, there might be a bothersome accumulation of all your stressors and triggers throughout the day––such as financial troubles, health issues, work stress, relationship drama, and more.

Over time, you might even develop anxiety and fear surrounding not being able to sleep, constantly looking at the clock and trying to figure out how many hours of sleep you’ll get, and this can make your night-time anxiety and sleep difficulties even worse. 


Cortisol, the stress hormone, may also come into play. Chronic stress and anxiety can cause higher cortisol levels. Cortisol is supposed to be highest in the morning and lower in the evening. However, if you have high levels of cortisol, this type of hormonal imbalance can cause you to have trouble sleeping or wake up in the middle of the night.  

Generalized anxiety disorder (GAD) can also manifest physically, causing a slew of physical symptoms that can keep you awake, too. Examples of physical anxiety symptoms are:

• Nausea
• Unexplained aches and pains, including stomach pain
• Chest tightness or chest pain
• Shortness of breath
• Sweating
• Fast heart rate or heart palpitations  

7 tips to help sleep when you have anxiety  

Thankfully, there are plenty of things you can try when you’re struggling with sleep. Here are 7 tips to calm down from anxiety at night and techniques to improve sleep despite anxiety.

1. Have good sleep hygiene

Before addressing the anxiety itself, take a step back and review the sleep hygiene basics. This will ensure you and your bedroom are set up for a good night’s sleep.  

• Have a steady sleep schedule with a consistent bedtime and wake-up time every day of the week. This helps regulate your circadian rhythm, which is your body’s natural clock.
• Ensure your bedroom has ideal sleeping conditions: dark, cool, and quiet. Invest in good curtains or use a sleep mask. Keep your room on the cooler side, and keep it quiet or play white noise to drown out any sounds you don’t have control over.
• Don’t drink caffeine or use any other stimulants too late in the afternoon or evening. Ideally, you should stop consuming caffeine 6 hours before bed.
• Avoid drinking alcohol or having large meals too close to bedtime.  
• Limit or avoid screen time before bed, since the blue light from screens (phone, tablets, or computers) can keep you awake.  

2. Use grounding techniques  

Grounding techniques aim to bring your mind and body into the present moment. They help distract you from your anxious, negative thoughts by bringing your attention to something else in the here and now. One example is the 3-3-3 rule, where you name three things you can see, touch, and hear. It can help to describe each of these things in detail to really anchor you in the present.  

You can also try deep breathing exercises to ground yourself and activate your parasympathetic nervous system, or the “rest and digest” system, lowering your heart rate and blood pressure. Box-breathing and 4-7-8 breathing are two simple breathing techniques you can use to feel more regulated, calm, and ready for bed.  

Progressive muscle relaxation (PMR) is another grounding option. PMR involves purposefully tensing up or squeezing and then relaxing different muscle groups throughout the body. Start down at your toes and then work your way up your body. Tighten and tense up your toes while you inhale, and hold the squeeze for around five seconds. Then, exhale as you release the muscles. Repeat the process for all the muscle groups in your body.  

4. Practice mindfulness

There are countless ways to practice mindfulness, with meditation being the most popular method. Essentially, mindfulness refers to the practice of being fully present, observing your thoughts, feelings, and body sensations without judgment. You can create your mindfulness practice using mantras, visualization, or breathing techniques. Play around with different mindfulness methods to see what works best for you. There are many mindfulness apps or videos on YouTube. You can even search for meditations specific to sleep problems.  

5. Try journaling

Putting pen to paper can help slow down your thoughts if your mind is racing. Journaling is a great tool for expressing your feelings and externalizing the difficult emotions you’re experiencing. You can use your journal to get everything off your chest that’s keeping you awake.

Although it’s not journaling, per se, if one of the main reasons you can’t sleep is worrying about things you have to do tomorrow, research shows that writing a to-do list before bed can help. Write down what you know you have to do tomorrow, and then you can feel more rested knowing you’ll have that list ready to go when you wake up, and you don’t have to keep thinking about all your pending tasks right now.  

6. Exercise regularly

The benefits of exercise for sleep are twofold. First, exercise can help reduce overall anxiety levels. It releases endorphins, which are natural feel-good chemicals in your body that relieve stress and boost your mood. Second, exercise can increase your body’s natural melatonin production. Melatonin is a hormone that’s involved in your circadian rhythm and sleep patterns. Researchers have found that exercise can improve both sleep duration and sleep quality.  

7. Seek professional help

If you still have trouble sleeping even after trying various self-help methods and relaxation techniques, it’s important to seek help from a mental health professional to improve your sleep quality and quantity.  

A therapist can help you learn to identify your anxiety triggers and teach you specific coping skills to address your symptoms. You will learn to challenge negative thought patterns and beliefs that might be contributing to your anxiety, especially at nighttime.  

Cognitive behavioral therapy for insomnia (CBT-I) is an effective, evidence-based form of therapy specifically for treating insomnia. CBT-I will help you directly address the unhealthy, unhelpful thoughts you have surrounding bedtime, as well as give you guidance for specific behavioral adjustments to improve your bedtime routine and healthy sleep habits.

In some cases, a therapist might refer you to a psychiatrist who can determine whether or not you could benefit from medication.

Are there medications for sleep anxiety?

If your insomnia persists beyond a few weeks and is impacting your quality of life and functioning during the daytime, it’s time to consider professional help and, potentially, medication.

Various types of medications can help both anxiety and sleep issues. There are two approaches you can take when it comes to medications: addressing the underlying anxiety in general or addressing the sleep difficulty specifically. A psychiatrist will determine what’s best for your specific situation.  

Anti-anxiety medication

If you have an anxiety disorder that’s impacting multiple areas of your life, not just sleep, a doctor might suggest anxiety medication. The most common first-line treatment for anxiety disorders is a class of antidepressants known as SSRIs (selective serotonin reuptake inhibitors) which includes meds like Prozac and Zoloft. SNRIs (serotonin and norepinephrine reuptake inhibitors) such as Cymbalta or Effexor are also common.  

Other examples of anxiety meds are:

• Atypical antidepressants  
• Hydroxyzine
• BusPar (buspirone)
• Beta-blockers
• Tricyclic antidepressants (TCAs)
• Monoamine oxidase inhibitors (MAOIs)
• Benzodiazepines, like Xanax (alprazolam)—these medications are not always recommended or approved by your insurance

Sleep and insomnia medications

Another approach is using a sleep medicine, more specifically for insomnia treatment. Examples of these medications are:

• Melatonin receptor agonists
• Antiseizure medications or sedating antidepressants
• Dual orexin receptor antagonists (DORAs)
• Nonbenzodiazepines AKA “Z drugs”
• Benzodiazepines  

If you’re looking for a psychiatrist to help you out with anxiety and sleep, consider Talkiatry. We’re a national psychiatry practice that provides in-network virtual care so you can get the treatment you need for an anxiety disorder and sleep difficulties.  

To get started, complete our free online assessment to get matched with a psychiatrist.  

FAQs

Here are more answers to your questions about sleep and how it’s affected by anxiety.

Is insomnia a symptom of anxiety?

Yes, having trouble falling asleep and/or staying asleep are classic symptoms of anxiety. People with anxiety often find it hard to sleep due to their high stress levels, racing anxious thoughts, and uncomfortable physical symptoms.  

Why do I wake up in the middle of the night with anxiety?

If you have an anxiety disorder, sleep difficulties like insomnia are a common symptom. Insomnia refers not only to trouble falling asleep, but also staying asleep. So, if you have insomnia due to anxiety, you might find yourself waking up in the middle of the night and not being able to fall back asleep. The stress hormone cortisol could also be to blame.  

How do you treat sleep anxiety?  

When you experience anxiety and sleep disturbances, the key is to address your anxiety and the root causes of your anxiety. You can work on this with a licensed therapist who can help you learn helpful techniques to cope with sleep anxiety. You may also want to look specifically into cognitive behavioral therapy for insomnia (CBT-I). In some cases, a doctor may prescribe you sleep medications as part of your treatment.  

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.