Anxiety about not being able to sleep When you feel anxious or afraid of not being able to fall asleep. It is that enduring fear that comes on as you’re preparing for bed and makes you shudder at the very thing that should herald peace.
This is a pretty common type of anxiety. Given that anxiety disorders are the most common type of mental illness in the U.S., however, sleep anxiety is an issue that affects a lot of people. What makes it even more difficult is that anxiety and sleep issues frequently coexist. You find it increasingly difficult to fall asleep when you’re anxious. When you don’t get a good night’s sleep, anxiety only gets worse.
The upside is that sleep anxiety is very treatable. Some people get relief through therapy, particularly therapies that focus on changing worried thoughts about sleep. Consider simple adjustments to your bedtime routine and sleep environment, too, that can make a big difference. Medication helps sometimes as well, especially when the anxiety is severe.
The trick is to recognize that you’re not in this alone, and effective help is available. Sleep anxiety can be pretty intense, but with the right tools and support, it is possible to get to a place where you approach bedtime without the anxiety.
Related: 5 minute mindfulness meditation
What Is Sleep Anxiety?
Sleep anxiety refers to both the fear of sleeping and worrying about the fact you are asleep. And yet it is not the same as generalized anxiety, it is a rendering of it: my bedtime anxiety is about the dissolution of existence (and existence is the stuff, as are anxiety and bed and bed-sleeping). Those with sleep anxiety often dread bedtime. They might lie awake for hours wondering if they can get enough sleep.
Anyone can suffer from this condition. Adults and children are both affected. Sleep anxiety is frequently comorbid with other anxiety disorders or sleep difficulties such as insomnia.
The Sleep Anxiety Cycle
- Sleep anxiety is a vicious cycle:
- You are concerned about getting a poor sleep
- This worry keeps you awake
- When you sleep badly, you tend to be more anxious
- Increased anxiety makes sleep harder
- The cycle continues
Ending this vicious cycle involves understanding what is causing your sleep anxiety and finding effective treatment techniques.
How common is sleep anxiety?
Here’s how I would rewrite that information:
Anxiety affects about 40 million Americans — and it’s the most common mental health disorder in the United States. That’s roughly 1 in 8 people suffering from an anxiety disorder.
What researchers have found is troubling, but not surprising — if your mind wrestles with anxiety, your sleep is likely to be affected, too. The link between mental health and sleep is deep. If you have anxiety, depression or other mental health issues, you likely don’t sleep very, very well. Their minds remain active when they should be resting.
This creates a difficult situation. Bad sleep exacerbates anxiety, and anxiety makes good sleep almost impossible. It’s a little bit like getting caught in a vicious cycle where one problem feeds the other. Knowing this connection can also help explain why so many people lie in bed awake with racing thoughts when they desperately need rest.
The good news is that treating one — either the anxiety or the sleep problem — often improves the other. Leave anxiety out of bed: When you sleep better, you’re better prepared to manage anxious thoughts. The net result of dealing with anxiety effectively is that you are better able to sleep soundly.
Related: 10 Sleep Experts on What to Do When You Can’t Sleep at Night
Common Causes of Sleep Anxiety
Sleep anxiety doesn’t develop overnight. Several factors can contribute to its development:
Stress and Life Changes
Major life events often trigger sleep anxiety. These include:
- Job loss or work stress
- Relationship problems
- Moving to a new home
- Financial difficulties
- Health concerns
- Death of a loved one
Mental Health Conditions
Sleep anxiety frequently occurs with other mental health issues:
- Generalized anxiety disorder
- Depression
- Post-traumatic stress disorder (PTSD)
- Panic disorder
- Obsessive-compulsive disorder (OCD)
Medical Conditions
Certain health problems can cause or worsen sleep anxiety:
- Sleep apnea
- Restless leg syndrome
- Chronic pain
- Heart conditions
- Thyroid disorders
- Hormonal changes
Lifestyle Factors
Daily habits can contribute to sleep anxiety:
- Excessive caffeine intake
- Alcohol consumption
- Irregular sleep schedule
- Too much screen time before bed
- Lack of physical activity
- Heavy meals before bedtime
Past Traumatic Sleep Experiences
Previous negative sleep experiences can create lasting anxiety:
- Childhood sleep terrors
- Sleep paralysis episodes
- Nightmares or night terrors
- Panic attacks during sleep
Sleep Anxiety Symptoms
Sleep anxiety symptoms occur both during the day and at night. Recognizing these signs helps you identify the problem and seek appropriate treatment.
Physical Symptoms
Your body shows clear signs of sleep anxiety:
- Racing heart – Your pulse quickens when thinking about bedtime
- Sweating – You may perspire even in cool conditions
- Muscle tension – Your body feels tight and rigid
- Shallow breathing – You breathe quickly and feel short of breath
- Stomach upset – Nausea or digestive issues occur
- Headaches – Tension headaches develop from stress
- Fatigue – You feel tired but can’t sleep
Emotional Symptoms
Sleep anxiety affects your mental state:
- Dread – You feel scared about bedtime approaching
- Worry – Constant thoughts about sleep problems
- Irritability – You become easily frustrated
- Sadness – Feeling down about sleep struggles
- Helplessness – Believing you can’t control your sleep
- Overwhelm – Feeling unable to cope with sleep issues
Behavioral Symptoms
Sleep anxiety changes how you act:
- Avoidance – Delaying bedtime or avoiding the bedroom
- Checking – Constantly looking at the clock
- Tossing and turning – Unable to find a comfortable position
- Getting up frequently – Leaving bed multiple times
- Seeking reassurance – Asking others about sleep
- Using sleep aids – Relying on medications or supplements
Sleep-Related Symptoms
The actual sleep problems include:
- Difficulty falling asleep – Taking more than 30 minutes to fall asleep
- Frequent awakenings – Waking up multiple times during the night
- Early morning awakening – Waking up too early and unable to return to sleep
- Unrefreshing sleep – Not feeling rested despite adequate sleep time
- Nightmares – Disturbing dreams that wake you up
What triggers sleep anxiety?
The first tab is a repeat of what I already covered, so here’s another way to write that information:
It’s normal to feel anxious — it’s part of how humans have survived. Anxiety takes over and helps us to act when we really need to, say, respond to a threat. Your body dumps stress hormones into your blood, which allow you to focus on the threat, and gives you a surge of energy, so you can escape or fight back. It is a response that has kept humans alive for thousands of years.
The issue begins when the anxiety refuses to turn off. If you’re chronically anxious, your body remains in this state of high alert even when you know you’re safe. You may become anxious about common things, such as your morning commute or simply going to bed at night. Your mind perceives these ordinary activities as threats.
When stress hormones remain high, particularly into the evening, your body can’t switch into sleep mode. It’s like when your internal alarm system is blaring and you’re trying to fall asleep. You may lie awake staring at the ceiling or fretting over sleeping through the a.m., even though that will only make it harder to fall back to sleep.
Occasionally, medical conditions exacerbate this. When your thyroid is overactive, for example, it inundates the body with hormones like adrenaline that keep you hovering on high-alert mode, unable to relax. It’s a reason sleep problems can themselves be a cause of, or harbinger of, physical problems that require medical attention.
Anxiety disrupts your dream sleep, too — the REM stage when your brain processes memories and emotions. You could experience nightmares that wake you up, shaking, and more anxious than when you went to bed.
Which is the cruel irony of anxiety — poor sleep makes it worse, and anxiety makes sleep more elusive. You find yourself dreading bedtime when it’s still light outside, because you know there may be another sleepless night ahead. This anxiety about sleep can then become its own kind of anxiety, making for a self-feeding cycle that is difficult to break without assistance.
How Sleep Anxiety Affects Your Health
Sleep anxiety doesn’t just affect your nights. It impacts your overall health and daily functioning.
Physical Health Effects
Poor sleep from anxiety leads to:
- Weakened immune system – You get sick more often
- Weight gain – Hormonal changes affect appetite
- High blood pressure – Stress hormones increase blood pressure
- Diabetes risk – Sleep loss affects blood sugar control
- Heart problems – Increased risk of heart disease
- Premature aging – Skin and overall appearance suffer
Mental Health Impact
Sleep anxiety worsens mental health:
- Increased anxiety – General anxiety levels rise
- Depression – Sleep problems contribute to depression
- Mood swings – Emotional regulation becomes difficult
- Reduced resilience – Harder to cope with daily stress
- Cognitive impairment – Memory and concentration suffer
Daily Life Consequences
Sleep anxiety affects your ability to function:
- Work performance – Productivity and focus decline
- Relationships – Irritability strains connections with others
- Decision making – Judgment becomes impaired
- Safety concerns – Increased accident risk
- Social withdrawal – Avoiding activities due to fatigue
Are there long-term complications of sleep anxiety?
When sleep anxiety is a chronic issue, it doesn’t only rob you of your nights — it can seriously impact your health in the long run. Your body requires quality sleep to heal and maintain key functions. Left untreated, it can lead to serious medical conditions.
The dangers are more potent than many of us realize. Insomnia also adds to the burden on your heart and blood vessels. Over months and years that can cause high blood pressure, uneven heartbeats and even heart attacks. Your heart and blood vessels just can’t take that constant sock.
Lack of sleep also interferes with the way your body processes sugar and with your weight management. This makes it more likely you will get diabetes or become obese. When you are tired, your body wants to eat high-calorie food and has difficulty controlling its hunger hormones. The pounds can sneak up on you without you knowing why.
Most terrifying yet is the higher risk of stroke. Bad sleep disrupts blood flow to your brain and promotes inflammation throughout your body. These changes can harm blood vessels and increase your risk of having a stroke.
The link between sleep and heart health is especially strong. Individuals with longstanding sleep woes are at increased risk for heart disease and heart failure. Your heart does more work when you’re sleep-deprived, and over time that can lead to damage.
These are not just numbers — they are actual and gradual consequences. The good news is that addressing sleep anxiety can help prevent these outcomes. When you work to improve your sleep, you’re not just feeling better day to day. You’re protecting yourself over the long haul.
Diagnosis and Tests
How is sleep anxiety diagnosed?
And here is my reworked version of the content, stripping it of all its juice.
When you go see your doctor about sleep anxiety, they are going to want to understand the whole picture of what’s taking place. The visit typically begins with a basic physical examination and a discussion of your overall health history. Your doctor wants to know if you have any medical conditions that may be contributing to your inability to sleep.
Then comes the detective work. Your doctor will take a thorough sleep and anxiety history from you. They’re seeking hints about what’s causing your sleep issues and when they began.
Anticipate inquiries about your nightly routine. Your doctor may inquire about what you eat or drink before bedtime, as caffeine, alcohol or a heavy meal can disrupt sleep. They will even want details about what you’re doing at bedtime — scrolling through your phone, watching TV or working — just prior to your attempt at sleep.
Timing questions are crucial. On average, how long do you lay still in bed before you can fall asleep? Do you wake up over and over throughout the night? Does your anxiety peak at bedtime, or do you worry about sleep all day?
And your doctor also pays attention to patterns. Do you sleep worse on any specific nights? Do weekends differ from weekdays? Is there anything badly happened at the time when your difficulty in sleeping started?
What sleep anxiety tests can help confirm a diagnosis?
Here’s how I rewrote that information:
Occasionally your doctor may suggest a sleep study to take a closer look at what’s happening while you sleep. This type of overnight test, known as polysomnography, can uncover sleep disorders that aren’t apparent when you simply talk about your symptoms.
No need to worry — a sleep study is not as scary as it might seem. You’ll pass the night in a hotel-like room at a sleep center, comfortable enough that it’s hardly fair to call it a hospital. The staff will fit you with sensors to put on your body before bed, but they’re meant to be as unobtrusive as possible.
As you doze, these sensors silently log nearly everything your body is doing. They monitor how efficiently oxygen is getting through your blood and whether your breathing remains even throughout the night. If you have sleep apnea, for instance, the test will capture those moments when you stop breathing or breathe only shallowly.
The sensors also monitor your brain activity, allowing them to view with precision when you fall asleep and navigate various sleep stages. Your eye movements indicate when you’re in REM sleep, while leg sensors will notice any restlessness that could be interrupting your slumber.
And your heart is monitored, too — the test will chart your heart rate and rhythm and make note of any abnormalities. Even the noises you emit are captured, from snores to sleep talking.
The techs keep track of the positions in which you sleep and how often you move around. All of this data together forms a full picture of your sleep health your doctor can use to diagnose certain sleep disorders and suggest the best treatments.
During the study, most people sleep relatively well, and the data produced can, at long last, offer some clues about why a good night’s sleep has been so hard to come by.
Professional Treatment Options
Effective treatments exist for sleep anxiety. Professional help often provides the best results.
Cognitive Behavioral Therapy for Insomnia (CBT-I)
CBT-I is the gold standard treatment for sleep anxiety. This therapy helps you:
- Identify negative thoughts – Recognize unhelpful sleep-related beliefs
- Challenge worried thoughts – Learn to question anxious thinking
- Develop coping strategies – Build skills to manage anxiety
- Improve sleep habits – Create better bedtime routines
- Practice relaxation – Learn techniques to calm your mind
CBT-I typically involves 4-8 sessions with a trained therapist. Research shows it’s more effective than medication for long-term sleep improvement.
Medications for Sleep Anxiety
Several medications can help manage sleep anxiety:
Antidepressants
- SSRIs (Selective Serotonin Reuptake Inhibitors) – Help with both anxiety and sleep
- SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) – Address anxiety and depression
- Tricyclics – Older antidepressants that can improve sleep
Anti-Anxiety Medications
- Benzodiazepines – Provide quick relief but risk dependence
- Buspirone – Non-addictive option for anxiety
- Hydroxyzine – Antihistamine with calming effects
Sleep Medications
- Zolpidem (Ambien) – Helps with falling asleep
- Eszopiclone (Lunesta) – Assists with staying asleep
- Ramelteon (Rozerem) – Regulates sleep-wake cycle
Note: Always consult with a healthcare provider before starting any medication. These medications should be used under medical supervision.
Other Professional Therapies
Additional therapeutic approaches include:
- Acceptance and Commitment Therapy (ACT) – Helps accept anxiety without fighting it
- Mindfulness-Based Stress Reduction – Teaches present-moment awareness
- Biofeedback – Helps control physical responses to anxiety
- Hypnotherapy – Uses relaxation and suggestion techniques
Self-Help Strategies and Home Remedies
Many effective strategies can help manage sleep anxiety at home. These techniques work best when used consistently.
Sleep Hygiene Improvements
Good sleep hygiene forms the foundation of better sleep:
Create an Ideal Sleep Environment
- Keep it cool – Set temperature between 60-67°F (15-19°C)
- Make it dark – Use blackout curtains or an eye mask
- Reduce noise – Use earplugs or white noise machine
- Comfortable bedding – Invest in quality pillows and mattress
- Remove distractions – Keep TVs and work materials out of bedroom
Establish a Consistent Schedule
- Same bedtime – Go to bed at the same time every night
- Same wake time – Wake up at the same time every morning
- Weekend consistency – Maintain schedule even on weekends
- Avoid long naps – Limit daytime sleep to 20-30 minutes
Develop a Bedtime Routine
Create calming activities before bed:
- Start 30-60 minutes before bed – Give yourself time to wind down
- Take a warm bath – Raises then lowers body temperature
- Read a book – Choose something light and enjoyable
- Listen to calm music – Soft, slow music promotes relaxation
- Practice gentle stretches – Release physical tension
Relaxation Techniques
These methods help calm your mind and body:
Deep Breathing Exercises
- 4-7-8 breathing – Inhale for 4, hold for 7, exhale for 8
- Box breathing – Inhale for 4, hold for 4, exhale for 4, hold for 4
- Belly breathing – Focus on breathing into your diaphragm
Progressive Muscle Relaxation
- Tense and release – Tighten muscle groups for 5 seconds, then relax
- Start with toes – Work your way up to your head
- Focus on the contrast – Notice the difference between tension and relaxation
Mindfulness and Meditation
- Body scan meditation – Pay attention to each part of your body
- Loving-kindness meditation – Send good wishes to yourself and others
- Guided imagery – Visualize peaceful, calming scenes
Lifestyle Changes
Daily habits significantly impact sleep anxiety:
Nutrition and Timing
- Avoid large meals – Stop eating 3 hours before bed
- Limit caffeine – No caffeine after 2 PM
- Reduce alcohol – Alcohol disrupts sleep quality
- Try herbal tea – Chamomile, passionflower, or valerian root
Physical Activity
- Regular exercise – Aim for 30 minutes most days
- Not too late – Finish vigorous exercise 4 hours before bed
- Gentle evening activities – Try yoga or stretching
Screen Time Management
- Digital sunset – Stop all screens 1 hour before bed
- Blue light filters – Use on devices if you must use them
- Charging station – Keep phones and tablets outside bedroom
Cognitive Strategies
Change how you think about sleep:
Thought Challenging
- Identify worried thoughts – Notice what you’re thinking about sleep
- Question accuracy – Are these thoughts realistic?
- Reframe negatively – Create more balanced thoughts
- Practice positive self-talk – Replace criticism with compassion
Worry Time
- Set aside time – Designate 15 minutes daily for worrying
- Write down concerns – Get them out of your head
- Problem-solve – Focus on what you can control
- Leave worries behind – Don’t carry them to bed
When to Seek Professional Help
While self-help strategies work for many people, professional help may be necessary in certain situations.
Warning Signs You Need Professional Help
Seek medical attention if you experience:
- Chronic insomnia – Sleep problems lasting more than 3 months
- Severe anxiety – Panic attacks or overwhelming fear about sleep
- Suicidal thoughts – Any thoughts of self-harm
- Substance use – Relying on alcohol or drugs to sleep
- Daytime impairment – Unable to function at work or home
- Physical symptoms – Chest pain, heart palpitations, or breathing problems
Types of Healthcare Providers
Different professionals can help with sleep anxiety:
Primary Care Physicians
- Initial assessment – Evaluate symptoms and medical history
- Basic treatments – Prescribe medications or recommend lifestyle changes
- Referrals – Connect you with specialists when needed
Sleep Medicine Specialists
- Comprehensive evaluation – Detailed assessment of sleep disorders
- Sleep studies – Overnight monitoring if needed
- Specialized treatments – Advanced therapies for complex cases
Mental Health Professionals
- Therapists – Provide CBT-I and other therapeutic approaches
- Psychologists – Offer testing and therapy
- Psychiatrists – Prescribe medications and provide therapy
What to Expect During Treatment
Treatment typically involves:
- Initial assessment – Detailed history and symptom evaluation
- Sleep diary – Tracking sleep patterns for 1-2 weeks
- Treatment plan – Customized approach based on your needs
- Regular follow-ups – Monitoring progress and adjusting treatment
- Gradual improvement – Most people see benefits within 2-4 weeks
What’s the prognosis (outlook) for people with sleep anxiety?
The good news is that sleep anxiety is highly treatable. Most individuals, when they start to doze off to sleep at night, are familiar with the sensation of worry and fears that plague them at the end of the day. Lying awake with racing thoughts doesn’t have to be your nightly fate.
However, recovery takes patience. Some treatments, particularly therapy modalities such as CBT-I (Cognitive Behavioral Therapy for Insomnia), are more gradual long-term strategies, rather than quick fixes. You may not see jaw-dropping results in your first couple of weeks of use, and that’s OK.
FAQs
Is anxiety about sleep an actual medical condition?
Yes, fear of sleep is a real thing. It can happen by itself or in combination with other anxiety disorders. It is diagnosed and treated by mental health professionals using criteria for specific disorders.
How long does it take to beat sleep anxiety?
Recovery time varies by individual. Most people will start to see an improvement in about 2-4 weeks of professional treatment. You may need months of treatment and practice to recover fully.
Does sleep anxiety go away?
And although some individuals may temporarily sleep a little better here and there, sleep anxiety typically never fully resolves on its own without intervention. Professional intervention, along with regular self-care, is usually the most successful.
How does sleep anxiety differ from insomnia?
Sleep anxiety is the fear or fear of sleep, whereas insomnia is the inability to fall asleep or remain asleep. Anxiety about sleep goes a long way to cause insomnia, but you can have insomnia without anxiety too.
