Woman with anxiety having trouble sleeping

How to Sleep with Anxiety

Medically reviewed on January 7, 2022. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.


Sleep is supposed to be the most relaxing part of the day—so why is hitting the hay so difficult for people? According to the CDC, about one-third of people don’t get a healthy amount of sleep, and that’s only counting the United States [1].

Sleep is vital for keeping the mind and body healthy, but the modern world is full of things that stop us from catching Zs. Did you know that one of the biggest culprits of anxiety is insomnia? Anxiety, along with other stress hormones such as cortisol, can contribute to sleeping problems2. Understanding hormones like cortisol vs. adrenaline, trying a cortisol test, and managing anxiety can keep stress levels and insomnia down.

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In this article, we’ll be discussing why anxiety diminishes your sleep quality and what you can do to fix it.

What Is Anxiety?

Anxiety isn’t an abnormal feeling. It’s normal to feel the tension and nervousness of anxiety every so often. Life gets stressful, and whether you are about to give an important presentation at work or waiting in line for a rollercoaster, some anxiety is natural. However, when those feelings become a part of your regular day and for no apparent reason, you can easily face some serious problems that can impact your health and quality of life [2].

Generalized anxiety disorder, often simply referred to as anxiety, is a mood disorder that is characterized by excessive, persistent worries about various things in life, usually when there’s nothing to worry about. You may anticipate disaster or be unnecessarily worried about money, work, family, or health. This worry may be difficult to control and can be intense enough to interfere with your daily life. For many, the mere thought of getting through the day can trigger extreme worry [3].

You can develop generalized anxiety disorder at any age. In the United States, generalized anxiety disorder is estimated to affect about 6.8 million adults per year or about 3.1 percent of the country’s adult population [3].

Generalized anxiety disorder can manifest in different ways, and many of its symptoms can overlap with other anxiety disorders, like panic disorder and obsessive-compulsive disorder [3]. While intense worry is the main symptom, other anxiety symptoms may include:

  • Overthinking plans and constantly developing solutions to all potential worst-case-scenario outcomes
  • Perceiving certain situations as threatening
  • Consistent indecisiveness rooted in fear of making the wrong decision
  • Inability to put aside worries
  • Problems with concentration, memory, and cognition
  • Restlessness or otherwise feeling constantly on edge [2]

This constant anxiety can also lead to physical symptoms, including:

  • Physical fatigue
  • Tension, pain, and aches in your muscles
  • Shaking, trembling, or generally feeling twitchy
  • Nervousness and irritability
  • Sweating
  • Digestive problems (nausea, diarrhea, irritable bowel syndrome) [3]

Anxiety and Sleep Disorders

As you can imagine, anxiety can also cause sleeping problems, from general insomnia to night terrors and beyond. The two are closely linked and can feed off of each other. Anxiety contributes to sleep problems, and increased sleep deprivation can lead to anxiety disorders. This can turn into a vicious cycle that can be difficult to manage [4].

Sleep problems have been found in people with all types of anxiety disorders, including posttraumatic stress disorder and obsessive-compulsive disorder. Studies show that upwards of 90 to 100 percent of Vietnam-era veterans with PTSD presented symptoms of insomnia.

There are even more nuances within sleep disorders caused by anxiety. Internalized stress about falling asleep can worsen sleep anxiety and essentially make you dread going to bed every night [4].

Those who can fall asleep may wake up feeling anxious in the middle of the night. Falling back asleep can be challenging as the mind races and worry grows. This can lead to sleep fragmentation, which reduces the number of hours of healthy sleep you get every night and diminishes sleep quality [4].

Anxiety, in general, can reduce the quality of sleep. Pre-sleep worries and anxiety can reduce rapid eye movement (REM) sleep. This is the phase of sleep when you are doing the most dreaming, but it also presents important physiological benefits. REM sleep stimulates the parts of your brain involved with learning and memory, and it is also associated with increased protein production [5]. Anxiety may disrupt or shorten REM sleep, or it may provoke more nightmares and more disturbing dreams, both of which can reinforce a fear or negative association with going to bed.

Health Risks of Poor Sleep

While the immediate effect is feeling tired in your waking life, sleep disturbance brought on by anxiety can cause a whole host of health problems. You may perform worse at school or work, have trouble thinking straight or remembering things, and may be more prone to injury. Sleep deprivation can also result in microsleep, which involves dozing off for just a few seconds. This can also lead to issues at work or school and can be dangerous when driving or operating machinery [4].

Sleep disorders also increase your risk of:

  • Heart disease
  • Stroke
  • Diabetes
  • High blood pressure [4]

As mentioned, sleep deprivation can make anxiety worse, but it can also have a significant effect on your emotional and mental health status and contribute to mood problems. Prolonged sleep disorders are known to contribute to major depressive disorder, bipolar disorder, and other mood conditions, all of which can then exacerbate anxiety-based issues [4].


See how your cortisol levels change throughout the day and whether they may be too high or too low with the easy-to-use, at-home Sleep & Stress Test.


Sleeping with Anxiety

The good news about anxiety is that it is a treatable mental health disorder. That doesn’t mean that treatment is always easy or a one-step process, but it does mean that you can find help when you need it.

If you have anxiety and experience sleep issues, the best place to start is to see a therapist. Cognitive behavioral therapy is one of the most common treatments for anxiety. It is a form of talk therapy that can help you identify and address your anxiety’s root causes or triggers and reorient any negative thinking that arises when anxiety is heightened. Therapy tends to be an ongoing process, but CBT has shown significant success in reducing anxiety [3].

Your therapist may also recommend the use of medication to reduce anxiety. Anxiety medications vary and include beta-blockers, antidepressants, and other medications. It’s important to understand that these drugs will not instantly cure anxiety, but they can help to better manage symptoms, giving you more control over your anxiety. Talk to your healthcare provider to discuss the side effects or potential interactions with other medication you may be taking [3].

Along with therapy and/or medication, you may benefit from some changes or additions to your lifestyle. Some helpful tips include:

  • Make your bed and bedroom the most comforting, relaxing spaces that you could imagine.
  • Avoid any devices with a screen at least an hour before bedtime.
  • Avoid alcohol and caffeine in the evenings.
  • Maintain a sleep routine that includes your usual washing up and brushing your teeth, on top of general relaxing activities (reading a book, meditating, and/or deep breathing exercises). Try to stick to that routine, even on weekends and vacation days.
  • Develop a sustainable exercise regimen. Regular exercise can reduce the stress associated with anxiety and help you feel tired when it is time for bed.
  • If you can’t sleep, avoid forcing yourself. Get out of bed, go to a quiet part of your home, and practice relaxation techniques like reading, meditation, or guided imagery.

Anxiety can be an expansive problem, and sleep interference is just one significant part of that. Taking the Everlywell Sleep and Stress Test can provide a deeper look at your health by measuring vital hormones involved with sleep, stress, and anxiety and may help you understand how to reduce stress hormones.


References

1. 1 in 3 adults don’t get enough sleep. Centers for Disease Control and Prevention. URL. Accessed January 7, 2022.

2. Generalized Anxiety Disorder (GAD). Anxiety & Depression Association of America. URL. Accessed January 7, 2022.

3. Generalized anxiety disorder. Mayo Clinic. URL. Accessed January 7, 2022.

4. Sleep Disorders. Anxiety & Depression Association of America. URL. Accessed January 7, 2022.

5. The Importance of REM Sleep & Dreaming. PsychCentral. URL. Accessed January 7, 2022.

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