Generalized Anxiety Disorder
How to Manage Sleep Anxiety and Get a Good Night’s Rest
Sleep anxiety is when you feel worried, scared, or anxious about being able to sleep well at night.
Sleep anxiety can be caused by insomnia, and it can also make insomnia worse.
Therapy, lifestyle changes, and medications can all help to manage sleep anxiety.
It feels terrific when you get a good night’s sleep — and pretty miserable when you don’t. A poor night’s sleep can leave you feeling tired as well as frustrated, stressed, and anxious. You may even start to feel like you’re “bad” at sleeping or dread getting into bed at night.
If this sounds familiar — and you worry a lot about sleeping — you might have sleep anxiety. Sleep anxiety is worry or fear about going to bed, or about falling or staying asleep. It’s kind of like stage fright, but for sleeping. And for some people, sleep anxiety can become so severe that it actually starts to get in the way of daily life.
But here’s the good news: Sleep anxiety is common and treatable. You can overcome it. After all, humans have evolved over thousands of years to be great sleepers. Sometimes we just need a little help getting back on track.
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Read on for more information about sleep anxiety and insomnia, and how they’re connected. We’ll also help you understand how sleep anxiety is treated, and how you can get back to sleeping well at night.
Sleep anxiety is worry or fear about going to sleep at night. It’s different from feeling anxious while you’re in bed. It’s actually worry about sleeping.
When you have sleep anxiety, you might think:
I won’t be able to fall asleep tonight.
I’ll be awake for hours before I can fall asleep.
I’ll wake up a lot during the night.
I’ll be tossing and turning all night long.
I’ll only be able to get a few hours of sleep.
I’ll be so tired tomorrow that I won’t be able to function.
I’m a bad sleeper, or there must be something “wrong” with me.
There’s nothing I can do about my sleep problems.
Like many other types of anxiety, sleep anxiety can have physical symptoms, too. For example, when you’re feeling anxious, you might experience the following sleep anxiety symptoms:
Fast heartbeat
Shallow breathing
Muscle tension
Physical restlessness
Upset stomach
Though sleep anxiety isn’t an “official” medical diagnosis, sleeping poorly can definitely make you feel more stressed the next day.
Struggling to sleep? Learn about common causes of poor sleep, including stress and anxiety and medical conditions.
Understanding and treating anxiety: Learn about the different treatment options to help manage anxiety symptoms.
Cognitive behavioral therapy for insomnia (CBT-I): CBT-I can help you learn how your thoughts, feelings, and actions affect your sleep.
Yes, sleep anxiety can cause insomnia. This is because stress and anxiety can disrupt sleep. But it can be hard to tell which comes first: anxiety or insomnia. Anxiety can cause sleeping problems, but insomnia can also cause daytime anxiety. This means that anxiety and insomnia can make each other worse.
Here’s an example of how anxiety and insomnia can create a cycle of poor sleep:
You go to bed feeling anxious about getting to sleep.
While in bed, your anxiety makes it harder to fall and stay asleep.
You wake up the next day feeling even more anxious and stressed.
You go to bed that night, and the cycle starts again.
Researchers have also found that the brains of people who haven’t slept well look very similar to the brains of people with anxiety disorders. The sleep-deprived brain makes more stress hormones, like cortisol, which can make you feel more on edge.
If you experience sleep anxiety, or your anxiety prevents you from falling asleep at night, consider visiting your primary care provider or a mental health professional. They can help you understand whether you have sleep anxiety, another anxiety disorder, insomnia, or a combination.
To figure out if you’re experiencing sleep anxiety, the healthcare professional will do a physical exam and ask you questions about your symptoms and sleep habits. They may recommend that you do polysomnography (a sleep study) to understand other possible causes of sleep disturbances.
You might believe that anxiety is behind your poor sleep. But the healthcare professional will rule out other possible causes first, like a medication side effect or medical problem.
Causes of sleep anxiety can include:
Medications: Certain medications — including popular ones for ADHD (attention deficit hyperactivity disorder), asthma, and pain — can cause insomnia. Even antidepressants you may have been prescribed for anxiety can have this side effect.
Physical illnesses: Symptoms of health conditions related to the heart, blood vessels, lungs, thyroid, stomach, and brain can keep you awake at night.
Habit-forming substances: Alcohol and other drugs with a risk for dependency and addiction, caffeine, and nicotine can also make it hard to get a good night’s rest.
Your healthcare team may also ask about your daily habits and see if anything about them is making it hard for you to sleep. For example, traveling often for work or working overnights can offset your circadian rhythm (an internal “clock” that regulates your sleep-wake cycle). Eating late in the evenings can lead to acid reflux or discomfort when lying down. Watching TV or being on your computer or phone before you go to bed can also make it hard to fall asleep.
Additionally, the healthcare professional may talk to your spouse or partner to get a sense of how you are when you sleep. Some people wake up many times a night because of sleep apnea, a health condition in which your breathing stops and starts during sleep. Another sleep disorder called restless leg syndrome creates an uncontrollable urge to move your legs. This urge typically happens while you’re trying to go to sleep. In some cases, you may not notice some of these sleep disturbances, but your partner will.
If you have any of these conditions, treating them may help you sleep better at night — and relieve your sleep anxiety.
If you're anxious about sleeping at night, know that you aren’t alone. You can learn to sleep well again. And, once you’re sleeping better, you may find that your sleep anxiety will go away.
So, where do you begin? If your sleep problems aren’t caused by a health problem or medication, the best place to start is with good sleep habits and therapy.
The first-choice treatment for ongoing insomnia is cognitive-behavioral therapy for insomnia (CBT-I). This is a special type of CBT that involves learning how to manage your sleep-related thoughts and behaviors.
CBT-I uses exercises and behavioral changes to help you:
Think about yourself — and your sleep patterns — in a more positive way
Sleep better at night
Manage your sleep anxiety and any anxious or racing thoughts at night
Reinforce your body’s sleep-wake cycle
Reinforce the connection between being in bed and being asleep
Learn how to use good sleep hygiene (sleep practices) in your daily life
You can do CBT-I with a therapist or even on your own with a book or workbook. There are online courses that can help as well.
Good sleep habits are key to a restful night’s sleep. This may include:
Getting up at the same time every day
Keeping your bedroom quiet, cool, and dark
Not using screens before bedtime or while in bed
Avoiding caffeinated drinks in the afternoon or evening
Using your bed only for sleep or sex
Not taking naps during the day
Avoiding bright or blue light at bedtime
Getting exercise and sunlight during the day
In some cases, medication can also be helpful for sleep anxiety — especially when it’s used along with CBT-I. There are some types of medications that relieve anxiety. Other medications can help you fall or stay asleep. And some medications even do both at the same time.
The type of medication your healthcare team recommends will depend on a range of factors, like your age, health, and symptoms, as well as side effects and medication costs.
That said, here are some of the medications available to treat insomnia and sleep anxiety:
Sleep aids: These include prescription medications, such as eszopiclone (Lunesta), zolpidem (Ambien), zolpidem ER (Ambien CR), and zaleplon (Sonata). These can help you fall or stay asleep. But they do come with side effects and can be habit-forming.
Antidepressants: Some antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), can cause problems with sleep. But some antidepressants, such as trazodone (Desyrel) and doxepin (Sinequan), can be used at low doses to help you sleep. Antidepressants can also be used to directly treat your anxiety.
Melatonin-like medications: These medications include ramelteon (Rozerem). They mimic a natural substance that your body makes called melatonin, which helps to regulate your sleep-wake cycle.
Sleep anxiety can interfere with sleep. And sleep is very important for your health. Sleep helps you learn and form new memories. It also helps remove toxins from your brain that build up while you’re awake. After a sleepless night, it can be harder for you to concentrate on work or school, and you’re more at risk for accidents or injuries.
A lack of sleep or poor sleep can raise your risk for anxiety disorders or make them worse. And over a long period of time, they can also raise your risk for many health problems, including:
In short, sleep is important for both your physical and mental health. Not only does a regular good night’s sleep help improve your anxiety, but it can also make you feel more alert and refreshed and help you function well in everyday life.
Yes, studies suggest that magnesium may help you fall asleep faster and stay asleep longer. But the research on magnesium for sleep is somewhat mixed, so your healthcare team probably won’t recommend it as a routine sleep aid. That said, it’s a low-risk option to try for most people, as magnesium supplements usually don’t cause side effects. Keep in mind that there are also lots of magnesium-rich foods, including nuts, grains, and beans.
Yes, studies suggest that magnesium may help you fall asleep faster and stay asleep longer. But the research on magnesium for sleep is somewhat mixed, so your healthcare team probably won’t recommend it as a routine sleep aid. That said, it’s a low-risk option to try for most people, as magnesium supplements usually don’t cause side effects. Keep in mind that there are also lots of magnesium-rich foods, including nuts, grains, and beans.
Yes, melatonin may help reduce anxiety in some situations. For example, one study showed that melatonin helped adults lower anxiety before surgery. Taking melatonin for a short time — about 1 to 2 weeks — is safe for most people. Melatonin has side effects and can interact with some medications, so it’s best to talk with a healthcare professional first.
CBD (cannabidiol) is a chemical from cannabis plants that’s advertised as a treatment for anxiety and insomnia (and many other conditions). Several studies have looked at the use of CBD to treat both anxiety and insomnia. The results have been somewhat positive. But there are a couple of things to keep in mind:
CBD isn’t approved by the FDA, so it’s not regulated. This means you can’t be sure the amount of CBD on a label is the dose you’re actually getting.
CBD doesn’t cause a “high” like tetrahydrocannabinol (THC). But many CBD products may have more THC than advertised, which can trigger anxiety.
CBD doesn’t have a clear dose to treat either anxiety or insomnia.
Scientists are still learning about CBD’s side effects and interactions with other medications.
Sleep anxiety and insomnia can be a vicious cycle: Poor sleep makes you anxious, and then your anxiety fuels your insomnia. But, if you’re dealing with sleep anxiety and worry about getting a good night of sleep, there are steps you can take to get back on track. Cognitive-behavioral therapy for insomnia (CBT-I), good sleep hygiene, and medications can all help you sleep better at night.
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