Sleep and Anxiety Disorders

Sleep and anxiety are closely connected, with each having a powerful influence on the other. Anxiety disorders can make it difficult to fall asleep, stay asleep, or get restful sleep, while poor sleep can worsen anxiety symptoms and make it harder to cope with everyday stress. Over time, this can create a cycle that’s difficult to break without addressing both conditions.

Below, we’ll explore the relationship between sleep and anxiety disorders, why they’re so closely linked, and treatments that can help improve both.

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What Is Anxiety?

Anxiety disorders are the most common type of mental illness, with more than 30% of American adults experiencing an anxiety disorder at some point in their lives. Trusted Source National Institute of Mental Health (NIMH)The NIMH is the lead federal agency for research on mental disorders.View Source They’re characterized primarily by a feeling of worry and unease. And while it’s normal to experience anxiety occasionally in response to fearful or stressful situations, in anxiety disorders Trusted Source National Institute of Mental Health (NIMH)The NIMH is the lead federal agency for research on mental disorders.View Source, this distress becomes excessive. People with anxiety may also experience:

• Extreme nervousness
• Poor concentration
• Irritability and restlessness
• Fear or sense of impending doom
• Tense muscles
• Rapid breathing and heartbeat
• Night sweats
• Trembling
• Gastrointestinal distress
• Fatigue

Types of Anxiety Disorders

Anxiety is a core element of a number of specific disorders, although not all are categorized strictly as anxiety disorders.

• Generalized anxiety disorder (GAD): People with GAD have significant, looming worries about many different things that can cause an overarching sense of anxiety.
• Panic disorder: Extremely intense episodes of fear, known as panic attacks, that usually last for a few minutes at a time are the defining feature of panic disorder.
• Social anxiety disorder: This disorder involves an extreme fear of social settings and potential embarrassment in front of other people.
• Specific phobias: Specific phobias are intense fears caused by particular triggers. Some of the most common include agoraphobia (a fear of open or enclosed spaces, being in a crowd, or being alone) and separation anxiety.
• Obsessive-compulsive disorder (OCD): In OCD, a person obsesses about an issue in a way that it provokes anxiety, and this causes a compulsion, which is their attempt to control or eliminate that anxiety.
• Post-traumatic stress disorder (PTSD): This condition can arise after a person is exposed to a painful or disturbing situation. People with PTSD may relive the stressful event, feel on-edge, and have potentially debilitating anxiety.

Can Anxiety Cause Sleep Loss?

Serious sleep disturbances, including insomnia, have long been recognized as a common symptom of anxiety disorders. People who are plagued with worry often ruminate about their concerns in bed, and this anxiety at night can keep them from falling asleep.

When you feel anxious, your body’s stress response kicks in. It releases hormones like cortisol and adrenaline. These hormones raise your heart rate and keep your brain alert — the opposite of what you need to fall asleep. This state is called hyperarousal. It’s one of the main reasons anxiety and insomnia often occur together. People with high sleep reactivity are especially affected. Their sleep is more easily disrupted by stress than other people’s.

Sleeping difficulties have been found for people with various types of anxiety including generalized anxiety disorder, OCD, and PTSD. In several studies, over 90% of people with PTSD associated with military combat Trusted Source National Center for PTSDThe mission of the National Center for PTSD is to advance the clinical care and social welfare of America's Veterans and others who have experienced trauma, or who suffer from PTSD, through research, education, and training in the science, diagnosis, and treatment of PTSD and stress-related disorders.View Source have reported symptoms of insomnia.

Anxiety disorders can also occur alongside other mental health problems like depression. According to the Anxiety and Depression Association of America (ADAA) Trusted Source Anxiety and Depression Association of America (ADAA)ADAA's mission focuses on improving quality of life for those with anxiety, depression, OCD, PTSD, and co-occurring disorders through education, practice, and research.View Source , nearly 50% of people with depression are also diagnosed with an anxiety disorder.

Can Lack of Sleep Cause Anxiety?

Distress about falling asleep can create a sleep anxiety that reinforces a person’s sense of dread. These negative thoughts about going to bed, a type of anticipatory anxiety, can create challenges to healthy sleep schedules and routines. Research indicates that anxiety and pre-sleep rumination may affect vivid dreaming during rapid eye movement (REM) sleep. Anxiety can provoke nightmares and disturbing dreams that create a higher likelihood of sleep disruptions and may reinforce fear around going to sleep.

At the same time, strong evidence indicates that sleep deprivation can instigate or worsen anxiety disorders. Researchers have found that people who are prone to anxiety are especially sensitive to the effects of insufficient sleep on mood and emotional health. The bidirectional relationship means that anxiety and sleep deprivation can be self-reinforcing; worrying causes poor sleep, while further sleep difficulties cause greater anxiety.

People with obstructive sleep apnea (OSA), a sleep disorder that causes repeated lapses in breathing and interrupted sleep, have been found to have higher rates of mental health problems, including depression, anxiety, and panic disorder.

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How to Sleep With Anxiety

Although the impacts of anxiety disorders can be substantial, they are one of the most treatable mental health disorders. Any person who has persistent or significant anxiety and/or sleeping problems should talk with a doctor who can best assess their situation and discuss the benefits and downsides of the potential treatment options in their case.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is a common treatment for anxiety disorders. It’s a type of talk therapy that works to reorient negative thinking, and it has had success in decreasing anxiety. Studies have found that CBT can often reduce anxiety even in people who have insomnia Trusted Source Behavioral Sleep MedicineView Source.

Addressing anxiety can pave the way for better sleep, but severe cases of insomnia may persist after CBT for anxiety. CBT for insomnia (CBT-I) may be a useful next step in these cases.

Anti-Anxiety Medications

Several different types of medications are approved to treat anxiety disorders including anti-anxiety drugs, antidepressants, and beta-blockers. These medications are intended to mitigate symptoms rather than cure the underlying anxiety.

Sleep Hygiene

Because of the multifaceted relationship between anxiety and sleep, getting better rest may help combat feelings of anxiety. Building healthy sleep habits and a consistent routine can make going to bed a more pleasant experience. This includes:

• Sticking to a consistent sleep schedule: Go to bed and wake up at the same time every day, even on weekends.
• Making your bed more comfortable: Invest in a supportive mattress and pillow and comfortable sheets.
• Keeping your bedroom for sleep only: Avoid working, scrolling, or watching stressful content in bed.
• Eliminating sources of sleep disruption: Try blackout curtains to limit light exposure and earplugs to reduce noise.
• Avoiding caffeine and alcohol: Both can disrupt sleep and heighten anxiety, especially later in the day.

Relaxation Techniques

Trying relaxation techniques can help identify ways to get rid of anxiety and make it easier to fall asleep quickly and peacefully. Relaxation exercises may be a component of CBT and can break the cycle of worry and rumination.

• Trying deep-breathing exercises: Slow, controlled breathing can calm your nervous system. Try box breathing: inhale for 4 counts, hold for 4, exhale for 4, hold for 4, then repeat.
• Try progressive muscle relaxation Tensing and releasing each muscle group in turn can ease physical tension caused by anxiety.
• Write down your worries before bed Getting thoughts out of your head and onto paper can reduce mental rumination.

You may also want to try scheduling times to actively worry, as this may eliminate worrying time as you lay down for sleep. 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.

When to See a Doctor

Occasional nights of worry and poor sleep are common, but persistent problems may signal something more serious. If anxiety or sleep difficulties last for weeks or begin to interfere with your daily functioning, it’s a good idea to seek professional help. Warning signs include:

• Struggling to fall or stay asleep at least three nights per week
• Experiencing significant daytime fatigue, trouble concentrating, or irritability
• Ongoing or excessive worry that feels difficult to control
• Panic attacks, frequent nightmares, or heightened anxiety at night
• Dependence on alcohol, medications, or sleep aids to fall asleep

A doctor or sleep specialist can help determine whether you are experiencing an anxiety disorder, a sleep disorder, or both. Treatment may involve therapy, lifestyle changes, or medication. Addressing these issues early can break the cycle of anxiety and sleep problems and improve overall well-being.

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