Why do I feel anxious at night?

Table of Contents

Tips to stop anxiety attacks at night

What is a night-time anxiety attack?

In a previous blog post we looked at why some people suffer with anxiety on waking. In this blog post, however, the focus is on those whose symptoms are worse at night. These are the people who get that anxious rush just as they are dropping off to sleep, or wake with a jolt in the middle of the night. Ever felt like that? I know I have!

Anxiety attacks are frightening at the best of times, but when they occur unexpectedly in the silence and darkness of night time, they can be particularly hard to endure. In theory, we are at our most relaxed when we are asleep, so it seems an unlikely time for anxiety to flare up. However, this is a common problem.

What causes anxiety attacks at night?

Night time anxiety or panic attacks, like their day time cohorts, result from the ‘fight or flight’ instinct being triggered by a perceived aggressor. In this case, the aggressor is likely to be mental angst resulting from pent up worries.

In the business of daily life they recede into the background only to rear their monstrous heads when all distractions disappear. In the stillness of the night there is no running away, and if we allow the worry monster to keep up its aggression, an anxiety attack may well ensue.

We also know that the brain does not fully switch off when we are asleep. How often does an event that occurred during the day lead to an odd dream during the night? Our brain naturally tries to process and sort out the day’s events and if these have been stressful then our dreams may well provoke anxiety too.

What does a night-time anxiety attack feel like?

Anxiety attacks can be frightening and overwhelming. They often begin with quickening, shallow breaths which can feel restricted, and in a sense, suffocating. For some, this type of hyperventilation may even cause vomiting.

Muscle tension is another common symptom of panic attacks and may lead to spasms and cramps, tingling and pins and needles. Some people feel trapped, as if they want to run away and escape (typical of the fight or flight instinct).

Others may go into ‘freeze’ mode, feeling temporarily paralysed as though their limbs are not reacting to the signals from their brain. Some report experiencing rapid changes in body temperature from very cold to excessively hot, accompanied by simultaneous shivering and sweating.

A typical anxiety attack of this nature should not last for more than 15 minutes.

What can I do to stop anxiety attacks at night?

Trying to fight a night time panic attack will only make it worse. Combat this as you would an anxiety attack during the day; try to slow down, breathe deeply, relax your muscles and calm your mind with whatever thoughts or images help to make you feel safe.

The adrenaline may continue to course through your body, so it is unlikely that you will be able to just to drop off back to sleep. You may even just begin worrying about not sleeping so it can help toget up and do something else to shift your focus. Ideally, simple activities like the ironing, listening to a calming meditation, reading an inspirational or gentle book etc. or even practising yoga poses for sleep may help.

Avoid any over stimulating activity. Only once you are feel ready for sleep should you go back to bed. When you lie down, remain calm by breathing deeply in through your nose and out through your mouth; if you are breathing correctly, your abdomen (not just your chest) will be rising on an in breath and falling on an out breath.

It is possible to learn how to rationally identify and accept the anxiety attack, and allow the fear to pass. With practise of sensible tools and techniques, anxiety attacks will diminish in severity and frequency.

Can I prevent night-time panic attacks?

Once you’ve had one attack a vicious cycle may ensue, in which you fear having another. To avoid this becoming a persistent problem, it is helpful to create a positive routine around bedtime. What could you do before bedtime to help you relax?

Perhaps take a bath in candle light with soft meditation music playing in the background, or talk about your worries early in the day with a friend so they don’t trouble you later.

If you think that you are not going to be able to fall asleep, then it is quite likely that you will have a battle on your hands. Try to follow some good sleep tips to switch off and give your brain a rest.

Are there remedies to help?

Many people look straight to conventional sleeping tablets or anti-anxiety medication to counter the effects of nocturnal anxiety attacks. However, it is best to follow the above lifestyle tips first to try to control the symptoms naturally. If you manage to control your symptoms this way, the results will be the most effective and long lasting with the fewest side effects.

I recommend…

In order to help with this, herbs can lend a helping hand. Herbal remedies are natural, so support good lifestyle techniques without the associated side effects of conventional medicine. For example, Avena sativa, also known as oats, has traditionally been used in relieving mild stress and anxiety in order to induce sleep. Fresh extracts of this herb are available in the licensed herbal remedy A.Vogel AvenaCalm Avena sativa oral drops.

How do you stop a night time anxiety attack? Share your top tips below.

“When you get these thoughts out of your head and onto paper, there is a good chance they will not infiltrate your mind when it’s actually time to go to sleep,” Dr. Roban says. “Many people also like to make lists in their journal of the things they need to do the next day.”

A Sleep Journal May Be the Sleep Hack You’ve Been Looking For

Oct. 16, 201701:07

Read, but not on your phone

Getting lost a book is beneficial for many reasons, and it can be pivotal to sleep health.

“Reading is a great way to quiet your mind and distract yourself from any anxious thoughts that might creep up at night. When you are engaged in a story, your thoughts are in the moment, instead of worrying about the future,” says Dr. Sal Raichbach, a licensed clinical social worker at Ambrosia Treatment Center. “On the other hand, the blue light emitted from cell phones does the opposite. Even if you turn down the brightness, blue light from LED screens interferes with the production of essential brain chemicals like melatonin that tell your body it’s time for bed.”

Pick up a real book, and I recommend from extensive experience with insomnia, that you pick the densest, dullest tome in your collection.

Keep the bedroom chilled and completely dark

We may want to consider keeping our bedroom just a tad cooler than we like, and leaving any nightstand lights off. (This means doing your reading in another room.)

“Ensure your bedroom is quiet, comfortable, ventilated, dark and cool,” says Elaine Slater, a psychologist and psychotherapeutic counselor. “Even a small amount of light in your bedroom can disrupt the production of melatonin and overall sleep.”

Take a tip from your kids with a strict bedtime routine (and a bath)

“We know how important it is for children to have a nighttime routine as it creates a sensed of structure and security, well the same goes for adults especially if you suffer from anxiety,” says Bianca L. Rodriguez, a psychotherapist and spiritual coach. “A bedtime routine can help you self soothe and act as a container for your anxiety. I recommend taking a warm bath or shower before bed to relax your muscles as the state of your body impacts the activity in your mind. Imagining frustrations, negative energy or worries flowing down the drain can help you approach sleep feeling more clear and calm.”

Proactively reduce stress during the day

Sometimes our anxious thoughts are simply the remains of a stressful day.

By taking a positive approach to your day and doing as much as you can to eliminate stress, you can create a peaceful night.

“Some of the best ways to deal with anxious thoughts at night are to reduce the stress you have to deal with during the day,” says Benjamin Ritter, a coach and consultant specializing in personal and professional leadership development. “You can avoid stressful people, be more open and honest about your feelings, and most importantly plan and strategize areas of your life. Reduce the number of decisions you have to make during the day and you’ll have more left over in your brain bank to deal with stress and anxiety at night.”

MORE WAYS TO REST BETTER

  • 7 Ways to Actually Get to Bed An Hour Earlier Tonight
  • 8 Sleep Mistakes You Can Fix Tonight
  • 16 Ways to Get a Better Night’s Sleep Without Popping a Pill

Want more tips like these? NBC News BETTER is obsessed with finding easier, healthier and smarter ways to live. Sign up for our newsletter and follow us on Facebook, Twitter and Instagram.

Get rid of sleep anxiety and insomnia: Your guide to a better night’s rest

Anxiety and insomnia are two very common problems that may hamper your ability to fall asleep. Both conditions can cause you to lay awake for hours, wondering if you will ever get even a wink of sleep before your day starts again. Additionally, both conditions can play off each other, making the other worse. If you struggle with anxiety or insomnia, or a mix of both, you’re not alone.

This guide will explore the definitions and symptoms of both conditions, how they can affect each other, and what you can do to treat, manage, and potentially stop your anxiety or insomnia from disrupting your sleep.

Facts About Anxiety and Insomnia

Experiencing occasional bouts of anxiety can be fairly common for most people, as anxiety is just an echo of our past survival mechanism of “fight, flight, or freeze” when faced with danger. Although the dangers have changed from animal predators to a fear of being late for meetings, the physiological components of our brains haven’t changed much: our brains still see the cause of our anxiety as a “danger” and thus kicks into action trying to find a possible solution or escape route.

Occasional anxiety is not a cause for concern, but many Americans experience a much more acute, recurring, and overpowering sense of anxiety, which can be the development of an anxiety disorder. Overall, about 40 million Americans suffer from anxiety disorders, and it is the most common mental illness in the U.S.

Anxiety disorders can be caused by very specific triggers (known as “phobias”) or can simply be excessive anxiety for extended periods of time that get in the way of everyday life, regardless of a specific trigger or actually being in danger. In these cases, the brain may flood the body with adrenaline, causing a person to experience heart palpitations, shortness of breath, or causing them to lose their concentration at work or school. Additionally, anxiety can cause serious sleep issues, such as insomnia. While experiencing anxiety attacks may cause many people to feel exhausted or fatigued, the act of falling asleep may actually become harder due to the anxiety and the body’s sense of worry or fear.

Insomnia is a common sleep disorder affecting 3 million Americans that is characterized by the inability to fall asleep or stay asleep for extended periods of time. It can often be a side effect of a larger problem (known as secondary insomnia), but it can also manifest independently for many people, without a predominant cause or identifying the trigger (known as primary insomnia).

There are also people that suffer from both anxiety and insomnia, with each symptom being independent of the other. In these cases, known as bidirectional comorbidity, the two conditions can exacerbate each other and it can be difficult to treat both independently. Additionally, anxiety can be a side effect of other, more serious psychiatric conditions, which can add to the difficulty of treating those with comorbid anxiety and insomnia.

Types of Anxiety

Anxiety disorders come in many forms. Below are some of the most common types, as well as some of their symptoms and effects.

Generalized Anxiety Disorder (GAD): GAD is a form of anxiety that people may experience for extended periods of time, normally more than six months, and is a response to stress related to work, personal health, social interactions, or everyday routines. GAD can create an extreme sense of fear or worry that stems from otherwise normal day-to-day routines or activities, and can significantly impact a person’s work, social, school, or general life. According to the ADAA, about 6.8 million Americans suffer from GAD every year. Some common symptoms may include:

  • Feelings of restlessness or being unable to calm down.
  • Easily fatigued.
  • Brain fog, or having difficulty concentrating and easily losing your train of thought.
  • Irritability.
  • Tight or tense muscles.
  • Unable to control or distract yourself from worrying.
  • Having sleep problems such as insomnia, restlessness, or feeling unsatisfied from sleep.

Obsessive-Compulsive Disorder (OCD): According to the National Institute of Mental Health, OCD is a condition affecting 2.2 million Americans that causes people to have reoccurring, uncontrollable, and disturbing thoughts, urges, or mental images (obsessions) that can create serious anxiety for the sufferer. This may cause the sufferer to repeat certain behaviors or actions (compulsions) in order to counteract the thoughts or mental images. This can include being unable to leave the home before turning off all the dials in the house and checking all the locks twice, or feeling a compelling urge to drive a specific route in order to avoid potential (but not real) dangers.

Although many people may feel obsessive or may double-check certain things twice, those with OCD typically spend more than an hour a day obsessing over the images or thoughts in their head, and many experience significant problems in their life due to their condition. Some people may also suffer from other anxiety disorders while also suffering from OCD.

Panic Disorder: Panic disorders are the result of experiencing unexpected and recurring panic attacks without warning or due to a specific trigger. The National Institute of Mental Health notes that 6 million adults in America have a panic disorder. These attacks are moments of intense fear that can peak within a few minutes of the initial start. In that time, the body may be flooded with adrenaline, and the person experiencing the panic may experience heart palpitations, severe sweating, trembling or shaking, shortness of breath, a feeling of impending doom, and a feeling of loss of control. Those who experience these attacks may do their best to avoid certain places, people, or situations that can trigger a panic attack, and in doing so, may cause serious problems in their life. Some of the most severe cases of panic attacks may cause agoraphobia or the fear of leaving the home.

Post-Traumatic Stress Disorder (PTSD): PTSD is the development of anxiety or fear due to a shocking, scary, or life-threatening and dangerous event. PTSD is characterized by recurring fears or stresses despite the sufferer no longer being near that event nor in a situation that is life-threatening. Some of the most common forms of PTSD develop from being involved in a war or being the victim of domestic violence or sexual assault, but even small events — such as the sudden death of a loved one — can cause PTSD symptoms to develop in some people. The National Institute of Mental Health states that about 7.7 million adults suffer from PTSD in America. Typically, PTSD can cause:

  • Recurring nightmares, flashbacks, or fearful thoughts related to the incident.
  • Avoidance of locations, people, thoughts, feelings, or events that may trigger the memory of the incident.
  • Being easily startled or feeling constantly “on edge.”
  • Difficulty sleeping.
  • Angry outbursts.
  • Trouble remembering certain details about the event or blocking it out entirely.
  • Negative thoughts about the self as well as the world.
  • Distorted feelings of guilt or blame.
  • Loss of interest in previously enjoyable activities.

Social Anxiety Disorder (Social Phobia): Social phobia is an intense fear or worry related to social or performance situations that, according to the ADAA, affects about 15 million Americans. One of the most common symptoms is a fear of embarrassment or being negatively judged by others. Most commonly, this arises in relation to school, work, or public places. The most intense form of social phobia is agoraphobia or the fear of leaving the house or being in public.

Types of Insomnia

From a medical standpoint, there are multiple levels to measure the severity of insomnia, as well as different types of insomnia.

The severity of insomnia can be broken down into five categories, which were highlighted in a 2019 study published by The Lancet Psychiatry that interviewed about 4,000 people who struggle with sleeping over a period of five years. At the beginning, end, and all throughout the five years, the participants were asked to rank their insomnia based on severity. A large portion of the interviewed population did not change their answers over that time period. Because of this, it’s believed that insomnia types can stay relatively stable throughout a person’s lifetime.

The categories and types are broken down as follows:

  1. Type 1: highly distressed, often struggling with neuroticism or prone to anxiety and feeling tense.
  2. Type 2: moderately distressed but sensitive to rewards or positive events.
  3. Type 3: moderately distressed and not sensitive to rewards or positive events.
  4. Type 4: slightly distressed and high reactivity, or being very sensitive to stressful life events.
  5. Type 5: slightly distressed and low reactivity, or being lowly sensitive to stressful life events.

Additionally, there are different forms of insomnia that a person may struggle with, including the following:

  • Acute insomnia: This is characterized by a brief experience with insomnia, often due to a stressful life event. It often resolves without the need for treatment.
  • Chronic insomnia: This is characterized by having difficulty falling asleep three or more nights a week, for longer than three months. There are many causes that may result in chronic insomnia, but chronic is distinguished by a long-term pattern of difficulty sleeping.
  • Comorbid insomnia: As mentioned previously, comorbid insomnia is the presence of insomnia alongside other medical conditions, either psychiatric or physical illnesses such as arthritis or chronic pain. In these cases, insomnia is not a side effect of the condition but exists independent of it.
  • Onset insomnia: This type of insomnia is characterized by difficulty falling asleep initially at the beginning of a sleep cycle.
  • Maintenance insomnia: This type of insomnia is characterized by difficulty staying asleep, though typically without issue falling asleep initially. Rather, the problem arises due to the afflicted waking up and being unable to fall asleep later at night.

Effects of Insomnia

Sleep is an essential function that the body needs in order to recuperate, heal, and maintain energy. If you’re struggling to get sleep due to anxiety, insomnia, or a mix of both, this can have some unfortunate side effects on the body if left untreated for an extended period of time.

Medical Side Effects

As noted by Healthline, long-term insomnia can lead to other medical issues such as:

  • Increased risk of stroke.
  • Asthma attacks.
  • Increased risk of seizures.
  • Weakened immune system functions.
  • Increased sensitivity to pain.
  • Increased risk of inflammation.
  • Increased risk of diabetes mellitus.
  • Increased chance of unhealthy weight fluctuation.
  • Heightened blood pressure.
  • Increased risk of heart disease.

Additionally, prolonged insomnia can shorten a sufferer’s life expectancy significantly. As noted through a collection of sleep studies, lack of sleep can increase a person’s risk of dying by up to 12% compared to those that get a regular 8 hours of sleep.

Mental Health Side Effects

Additionally, insomnia can cause adverse mental health side effects, including:

  • Depression.
  • Anxiety.
  • Feelings of confusion, irritability, or frustration.
  • Emotional instability.

One study found that the lack of sleep could impair the brain’s ability to process negative emotions or experiences, which in turn can increase a person’s chances of developing mental illnesses such as depression or anxiety. Primarily, lack of sleep could be affecting the processes of the amygdala, which is in the primary part of the brain responsible for emotion and memory.

In addition, insomnia may also result in an increased risk for accidents due to daytime sleepiness or may cause other issues related to work and school. It may also affect your sex drive, memory, and judgment.

How Anxiety Can Affect Sleep

Lack of sleep can lead to increased chances of anxiety, but anxiety can also cause a lack of sleep. Unfortunately, the two can intertwine quite a bit, causing one to exacerbate the other.

Anxiety can have a negative effect on your body’s ability to fall asleep as your brain is in “fight or flight” mode, thinking of all potential outcomes for whatever is causing the anxiety. Furthermore, anticipatory anxiety and specific anxiety about sleep can lead to sleep disturbance and insomnia, which then creates a feedback loop that can make both conditions worsen. Insomnia can also make you more irritable and more worried, as your brain is not getting all the sleep it needs in order to function at normal levels.

However, it’s not uncommon to experience anxiety related to sleep. As Winnie Yu, a writer for WebMD noted in her article “Scared to Sleep,” sleep anxiety is a form of performance anxiety. Many people may stress about not getting enough sleep to function, but the stress alone of trying to sleep can cause people to sit awake for hours. Additionally, other fears such as recurring nightmares, fear of sleep apnea (not breathing while being asleep), and more can all lead to disturbed sleep.

Does Anxiety Go Away?

For those people that are diagnosed with a legitimate anxiety disorder, the condition is unlikely to go away. Some people may be able to better control their anxiety disorder with the help and guidance of a therapist or psychologist, and medications may help further control the condition. There may also be specific coping mechanisms to help manage anxiety disorders, however, a permanent “cure” for anxiety does not currently exist.

For those that do not suffer from an anxiety disorder, but only have occasional or intermittent anxiety from time-to-time, this is normal and healthy behavior for many people. Temporary anxiety is likely to diminish over time, and if it is related to a specific place or person, removing yourself from those situations may help the anxiety go away after some time.

How to Get Rid of Anxiety So You Can Sleep Better

If you’re struggling to fall asleep due to anxiety, it could be that treating the anxiety will help solve your insomnia and lack of sleep as well. Anxiety disorders should only be diagnosed by a licensed therapist or medical professional, and these professionals can also help you find treatment regimens as well as, potentially, medications to control the condition. You should not try to self-medicate for anxiety disorders, and should only medicate per the medical advice and supervision of a psychiatrist.

Therapy

One of the most common and effective treatments for anxiety disorders is continued and guided therapy with a professional counselor or therapist.

The branch of therapy known as Cognitive Behavioral Therapy (CBT) can be effective for many people, as it helps patients suffering from anxiety disorders create new, positive thought pathways that can help when in anxious situations. There are three different types of CBT, each with an individualized approach in treatment, including interpersonal therapy, thought records, and modern exposure therapy.

Another form of therapy is Acceptance and Commitment Therapy, also known as ACT. This form of therapy is more focused on mindfulness training and taking action based on personal values, and is unique in that it is not focused on symptom reduction.

Mindfulness

Another useful tactic to combat anxiety is the act of mindfulness when faced with certain situations. As PsychCentral discusses in “Mindfulness: the Art of Cultivating Resilience” acting mindfully can help individuals make radical shifts in how they think and perceive situations by looking at them without judgment.

For example, if you’ve just been fired, you may think “I should have seen this coming” or “I deserve this and I’m a failure.” Mindfulness, however, allows you to look at this same situation, take time to focus on your body, and approach it with increased kindness, creativity, openness, and acceptance. Instead of thinking negatively about the situation, you may start to feel calmer instead, accepting the situation as an unfortunate one, but not one that will set you back.

It is important to keep in mind that mindfulness can take years to develop. It can be tricky to start, and it may help to have the guidance of a trained healthcare professional, but mindfulness can provide a new perspective that allows you to re-evaluate your anxieties and develop healthy coping mechanism to rethink situations in which they arise. For sleep, mindfulness can help your body naturally fall into unconsciousness as you focus solely on your breath.

Shifting Your Perspective

If you suffer from sleep anxiety, Winnie Yu also suggests in her WebMD article “Scared to Sleep” that shifting your perspective can help some people gain more sleep. It’s completely normal to have bad nights of sleep, and sometimes it’s unavoidable, but when you can tell yourself that you expect it to happen, your body may be more likely to relax and naturally fall into sleep.

What to Do When You Can’t Sleep: 9 Tips

Prioritizing a good night’s sleep isn’t just important for your general health, it can also help with feelings of anxiety, as your body is less likely to feel overwhelmed or on edge when you’ve slept well.

However, falling asleep can be difficult, so it’s important to build a strategy for a better night’s sleep. Below are some tips to try in order to improve your chances of falling asleep naturally.

Try Staying Awake

Often, one of the most ineffective ways to fall asleep is to try to force yourself to lay down. This will only result in you tossing and turning for hours, unable to fall asleep.

Instead, try avoiding the bedroom until you naturally feel sleepy. If this means spending the whole night awake, not getting any sleep, then try saving this technique for the weekend so you can catch some sleep when your body naturally wants to sleep.

Many people have a different circadian rhythm — the natural clock in our head that helps us fall asleep — and it could be that your rhythm simply occurs at an abnormal hour of the morning. Once you do start feeling sleepy, allow yourself to go to bed and focus on your breathing instead of any other anxieties.

Keep a Sleep Log

Sleep logs can be useful to help you catalog when you fall asleep and how much sleep you were able to get. You can also take note of all the activities you do before you fall asleep, and this may help you notice a pattern.

The National Sleep Foundation has a useful sleep log you can try to get yourself started. You can also create your own in a personal journal.

Get up at the Same Time Daily

Creating a routine can be an effective way to combat sleep anxiety and insomnia. By getting up at the same time every day, your body will naturally start to adjust your internal clock or circadian rhythm.

One sleep study, highlighted in the Guardian as “A Cure for Insomnia”, found that getting up at the same time every day helped the participant’s body feel sleepy around the same time every night. Over time, this helped the participant’s bedtimes become consistent.

However, creating a nighttime routine can also have similar effects. Winnie Yu for WebMD suggests creating a nightly routine can help relax your body as it starts to anticipate and expect sleep as you follow through each step. It can also help relieve anxiety, as you know what to expect each night and each morning.

Do a Bedroom Makeover

Another helpful trick is to make your bedroom a place for nothing but sleep. For some people living in small loft apartments, this might be tricky, but by putting up a divider or curtain, you may be able to simulate a similar “separate room” effect.

Regardless, redecorating your bedroom for a more comfortable and quiet environment can do wonders for your sleep health. Consider decluttering the room and regularly changing the bedding or adding a rug to make the space more appealing and comfortable.

If you come into your bedroom and still can’t sleep, don’t just lay there and wait for slumber to hit. Instead, get up after 15 minutes and work on some small projects until your body naturally feels sleepy.

Keep Your Room Cool

Keeping your room dark and cool can also have major effects on your ability to fall asleep. Avoid putting a space heater in your room (unless you really need it) so as to keep the room cooler than the rest of your house. You can also cut out some of the natural light and heat by installing blackout or custom curtains over your windows. The more “cave-like” you can make your bedroom, the easier it may be to fall asleep every night.

Limit Caffeine and Other Stimulants

For many people, cutting out caffeine from their diet can be very difficult, but caffeine can greatly hamper your ability to fall asleep. Additionally, as a stimulant, caffeine can make your anxiety much more pronounced, and you may have a difficult time calming down if you drink excessive amounts of coffee.

It could also be getting in the way of you achieving a good night’s sleep. Try avoiding caffeine at least four to five hours prior to when you want to go to bed.

If you know of any other forms of stimulants that you may be taking, try avoiding those at least a few hours before bedtime, as well.

Additionally, some recent studies, such as one conducted by Harvard Health, have come to find that “blue light” (any light that is blue in hue, which is common with televisions, laptops, and smartphones) can keep the brain active, stimulated, and awake, as it suppresses the secretion of the hormone melatonin. This is the hormone responsible for helping you fall asleep, so try avoiding blue light, or wearing amber glasses to suppress the effects of the light, at least two hours prior to bedtime.

Get Rid of Your Clock

Clocks can be a common trigger for anxiety, especially when you’re trying to fall asleep. Instead of having a clock by your bedside — where you can glance at it every time you struggle to fall asleep — keep a clock outside your room instead. Looking at the clock will only cause your anxiety to get worse, so avoid it altogether.

Try Relaxation Techniques

Another way to prep your body for bedtime is to practice some relaxation techniques as you prepare for bed. This can include:

  • Creating a warm bath to sit in for a few minutes prior to going to bed.
  • Listen to calming music as you brush your teeth, change, and get ready for bed.
  • Practice some deep breathing exercises or guided meditation.

Combine this tip with going to bed and getting up at the same time every day, and you may be able to create a relaxing sleep routine that will help your body naturally get sleepy. Routines can really do wonders in calming the brain. You can also get meditation-themed bedroom decor to make the space more conducive to relaxation, even when you aren’t trying to sleep.

Consider a Sleep Study for Insomnia and Mindfulness-Based Therapy

Finally, if you’re still struggling to find sleep, you can always resort to seeking out therapy. Similar to anxiety treatment, those suffering from insomnia can benefit greatly from CBT or other mindfulness-based therapy.

Additionally, participating in a sleep study may help you identify certain patterns related to your nighttime routine. It could be that your brain is unable to get a full cycle of REM sleep, or that your breathing is hampered by sleep apnea. Sleep studies will help you identify these issues, and may then be able to connect you with a professional doctor or therapist to work on treating the underlying issues.

As mentioned earlier, the Guardian article “A Cure for Insomnia” dives deep into a successful sleep study. The creator of the study and clinic, Hugh Selsick, paired a rigorous nighttime routine with CBT and found remarkable results.

One patient, Zehavah Handler, was so transformed by the study and routine that she decided to close her own business and try to open her own sleep study clinic. According to the article, her sleep schedule and mental state has improved dramatically: “There are occasional relapses, Handler said, usually brought on by a change in routine – a holiday away, Christmas – but by waking at a set time, leaving the bedroom after 15 minutes if she remains awake and re-implementing all of the rituals she learned at the Insomnia Clinic, it only takes a few nights to re-establish the routine.”

By Angela Epstein

It’s been a long, tiring day and you’re feeling shattered. Finally you crawl into bed, physically exhausted and ready for a good night’s sleep… only to find your mind has other ideas. Instead of drifting off into weightless slumber, your brain fires up, your pulse quickens and your head becomes crowded with endless worries you thought had been parked for the day.

‘Around 80% of people say their worries whirlwind out of control at night,’ says Nicky Lidbetter, chief executive of support group Anxiety UK. ‘With stress, we tend to worry about a specific, tangible problem. But with anxiety, we’re less aware of what we’re worrying about, so our reaction becomes the problem and we start feeling anxious about being anxious.’

And even if we do initially drop off, those worries can still crowd in if we wake up during the night. ‘The classic time to wake up seems to be between 2am and 4am,’ adds Dr Nerina Ramlakhan, author of Fast Asleep, Wide Awake. ‘Suddenly your brain starts to became very active, and problems that may well be solvable during the day become huge worries at night – made worse by the fact you can’t sort them out there and then.’

Here’s what to do when your body says sleep but your mind’s not listening.

1. Sleep by the clock

When it comes to sleep, timing is everything, as Dr Michael Breus reveals in a new ground-breaking book. Our circadian rhythm – also known as the biological clock – affects every aspect of our life, including our ability to sleep well.

The more we understand circadian dyssynchrony – when the biological clock is out of kilter – the better we sleep, so his theory goes. In The Power Of When, Breus offers a programme for getting back in sync with our natural rhythm by making minor changes to our daily routine. This initially involves taking a simple quiz to establish what kind of chronotype we are (Lion, Bear, Dolphin or Wolf). On the basis of which category you fall into, Breus then outlines how to schedule your day for peak productivity and wellbeing by timing when it’s best to do everything – from eating and sleeping to going for a run and even having sex.

Going to bed at the correct bio time means you won’t lie awake feeling wired. Breus advises that Lions (morning-orientated optimists with a medium sleep drive) should go to bed as close to 10pm as possible, Bears (good sleepers who have a high sleep drive) at 11pm, Dolphins (neurotic light sleepers with a low sleep drive) at 11.30pm and Wolves (night-orientated extroverts with a medium sleep drive) at midnight.

MORE: 3 DIET CHANGES THAT CAN DECREASE ANXIETY

2. Wind down, not up

Sleep is a natural physiological process – but you can help it along and avoid additional anxiety by having a set wind-down routine. The goal of this is to relax your body and prime it for sleep. So if you’re going to bed at 10-11pm, set aside 30 minutes to an hour for an identical nightly pre-sleep routine. This may involve things such as taking a shower, washing your face and brushing your teeth, moisturising your face, putting on your PJs and climbing into bed with a book. Psychologist Susanna Halonen says, ‘The more identical you can make every evening, the more you train your body to prepare for sleep and the easier it will be to achieve.’

3. ​Keep a cork in it

‘Alcohol is a stimulant as well as a sedative,’ says Dr Guy Meadows of The Sleep School. ‘While many people use it to fall asleep, it is also metabolised so quickly that it can leave the body craving more.’ So when we drink alcohol close to bedtime, we are more likely to wake up in the early hours, leaving us primed for a night-time anxiety attack. As a rule of thumb, it takes an hour to process one unit of alcohol, so to be on the safe side, have a last glass of wine at 7pm if you intend to go to bed at 10pm.

4. Soak it up

Taking a relaxing bath can help de-clutter the mind. Try a few drops of Boots Therapy Relaxing Bath Essence – this contains lavender, which is a natural sleep aid. There’s an added benefit to bathtime, too: the fall in body temperature we experience when we get out of the bath is a signal for the brain to start producing sleep-inducing melatonin.

MORE: 15 THINGS PEOPLE WITH ANXIETY WANT YOU TO KNOW

5. Breathe and let go

Practising deep breathing can distract your mind from worries, explains Dr Ramlakhan. ‘Breathe in, hold for a few seconds and then breathe out – do this three times. Just follow the breathing as you do it.’ Breathing in this way instantly slows everything down, relaxes the mind and body, and helps channel your energy into the breathing action. The breathing will give way to the tiredness, which will overcome anxiety and help you fall asleep.

6. Junk the caffeine

Avoid caffeine after 2pm, suggests Will Williams. ‘Caffeine is a powerful stimulant, and it takes six hours for our body to recover from a single cup of tea or coffee. If you feel you need a hit of caffeine to get you through the afternoon, then consider learning to meditate to give you more energy throughout the day.’

7. Make your worries real

Write down what’s on your mind at least an hour before bed. By committing thoughts to paper, you control them – they no longer control you and live on paper instead of in your head. Mentally, you can tick them off. Dr Guy Meadows suggests giving each worry a nickname, too, such as The Nag. ‘We can’t help these thoughts coming in, but they’re only a problem when they start to consume us,’ he says. ‘By giving them names, you speed up the process of defusion, so when unpleasant thoughts crop up, you can just acknowledge them – oh, there’s The Nag again – and go back to what you’re doing.’

8. Get moving earlier

Strenuous exercise in the evening may cause your nervous system to be too wired to sleep, says meditation teacher Will Williams. So either restructure your day to exercise in the morning, or use meditation after exercise to calm everything down and bring you back into balance.

MORE: 7 WAYS YOU CAN HELP SOMEONE WITH ANXIETY

9. Set clear goals

Have a clear plan for the next day, says psychologist Susanna Halonen. ‘If you know what priority number one and two are, you’ll spend less time worrying because you know those are the first two things you’ll get done. The more you turn this into a habit, the more you realise that if you plan ahead and prioritise effectively, the more easily you can get the important things done. This will lower your anxiety and help you sleep better.’

10. Curb your cyberenthusiasm

If we’re going to feel worry-free at night, it’s crucially important to have a mental switch-off, says Neil Shah of The Stress Management Society. ‘So have a digital blackout for an hour before bed, unplugging all devices that could stimulate the mind.’ Boots pharmacist Tom Kallis adds that browsing the latest headlines online may feel like light relief, but it actually keeps your brain stimulated. He says, ‘If checking your phone is part of your end-of-day routine, do this at least half an hour before you turn the lights out so you give your eyes and brain a break. Put any electronics out of reach or on airplane mode so you won’t be tempted to pick them up in the night – or if you can, turn them off completely.’

LCD screens emit blue light, which is the same sort as sunlight, so plays havoc with our sleep hormones. ‘Checking Facebook last thing at night is like shining a miniature sun into your eyes,’ says Dr Guy Meadows of The Sleep School. ‘Our body clock gets confused and starts thinking it’s daytime again, so it inhibits the sleep hormone melatonin and releases the waking hormone cortisol.’

11. Leave the room

If you simply can’t get back to sleep because your head is buzzing with worry, don’t look at the clock – you’ll fret even more. ‘Just get out of bed and go into another room for 10 minutes,’ says Dr Ramlakhan. ‘Leaving the environment you feel uncomfortable in breaks the association with worries. But don’t start checking your phone or scrolling through Facebook.

Go into the living room and under a dim light read a few pages of a light-hearted book, or yesterday’s newspaper. When you feel calm, return to your bed and begin some deep breathing again.’ He adds, ‘Turn your pillow over when you get back into bed. It will feel cooler on your face and creates a separation from the last time you were lying there.’

This article was originally published in the December 2016 issue of Good Housekeeping.

MORE: HOW TO COPE WITH ANXIETY IN AN AGE OF TERROR

Like this? Subscribe to the Good Housekeeping newsletter.

To Improve Your Sleep, Try Some of the Following Strategies

Create a comfortable sleep environment. If you want to have a good sleep, it helps to create a comfortable sleep environment. Make sure that you have a supportive mattress and fresh, comfortable bedding. Also, try to ensure that your room is not too hot or cold, minimize noise, and block out light.

Relax. Try doing something to relax your body and mind before going to bed. Try taking a hot bath 90 minutes before you plan to go to bed. Or try a relaxation exercise (see Calm Breathing and Progressive Muscle Relaxation), meditation, or listening to calming music.

Have a snack. Although a heavy meal late in the evening can disrupt sleep, a healthy light snack in the evening can improve sleep. Try eating light cheese and crackers, turkey, or bananas, or drink a warm glass of milk. Avoid heavy, spicy or sugary foods.

Get physical. People who exercise tend to have more restful sleep. Exercising for at least 30 minutes 3 times a week can improve your sleep. So, get moving! Go for a walk or a run. The best time to exercise is in the late afternoon or early evening. Exercising in the morning, while good for you, won’t help with sleep as it is too far off. And exercising less than 2 hours before bedtime can actually interfere with sleep as its too close. Try for something in between.

Set a bedtime routine. Having a bedtime routine cues your body that it’s time to sleep. Establish a set routine that you follow every night. For example, have a hot bath, put on your pajamas, brush your teeth, and then listen to soft music and read on the couch until you start to feel sleepy and then go to bed.

Establish a fixed awakening time. Try waking up at the same time every day (even on weekends) no matter how well or how poorly you have slept. This way your body will begin to get used to a regular sleep rhythm.

Sleep only when sleepy. Don’t force yourself into bed at a particularly time if you’re not feeling sleepy. You’ll only lie awake in bed, frustrated that you can’t sleep.

Just for sleeping. Your bed should be used strictly for sleeping (sex is the only exception). Try to avoid reading, watching television, working, or studying in bed, because these activities keep your mind active, which gets in the way of sleep.

Get out of bed. If you can’t fall asleep after 20 to 30 minutes, get out of bed and do something boring (e.g. read the manual on how to program your clock radio, read the sports section of the newspaper if you’re not a sports fan) or try relaxing (e.g. meditate, listen to calm music, have a warm de-caffeinated drink). When you start to feel sleepy, try going back to bed. This strategy can feel like you are making things worse, but if you stick with it, it can really help.

Don’t worry. Leave your worries about work, school, health, relationships, etc. out of the bedroom. Try scheduling a “worry time” earlier in the evening to deal with your worries. If you wake up in the middle of the night worrying, try writing down your worries and tell yourself that you will address them in the morning.

TIP: Worrying about not sleeping doesn’t help – it just makes it more likely that you won’t sleep. Let go of your belief that you have to get 8 hours of sleep or you can’t function. Stop looking at the clock and stop trying to make yourself fall sleep. It will happen when it happens.

Avoid caffeine. Avoid consuming caffeine at least 4 hours before bedtime. This includes coffee, some teas, soft drinks and chocolate. Caffeine is a stimulant and it can keep you awake.

Avoid alcohol. Although you may think that alcohol will help you fall asleep, it interferes with sleep later in the evening. So, try to avoid consuming alcohol at least 4 hours before bed.

Don’t smoke before bed. Try to avoid smoking at least 4 hours before bedtime as it can interfere with a good night’s sleep.

Skip the nap. Naps can interfere with normal sleep cycles. So, if you’re having trouble sleeping, avoid taking naps. That way, your body will be more tired when it’s bedtime.

Get some natural light. Try to spend some time outdoors or in natural light every day. Getting some sunlight early in the day can be helpful for setting your body’s natural wake and sleep cycle.

Keys to Success

Start small. Making small changes can have a large impact on your sleep. Don’t try to do everything all at once. Instead, pick 1 or 2 strategies and try them consistently. When you’re ready, try adding a new strategy. The goal is to slowly start increasing behaviours that can help you sleep, while reducing the things that are interfering with your sleep.

Be consistent. Pick a strategy and use it consistently. Try to do the same thing every night.

Be patient. These strategies can take time to improve your sleep. In fact, sometimes things can get worse before they get better. Hang in there and stick with it.

Chart your progress. Use the Sleep Diary form below to keep track of the strategies you’re using and your weekly progress.

Falling Asleep with Anxiety

How Anxiety Affects Sleep

Sleep problems caused by anxiety aren’t limited to people with diagnosed anxiety disorders.

“The spectrum ranges from everyday kind of problems that might make us anxious and affect sleep all the way to people diagnosed with anxiety disorders who are likely to have ongoing problems,” Dr. Neubauer said.

Anxiety can affect sleep at any time, but most commonly causes difficulty in falling asleep. People with higher levels of anxiety may feel anxious all the time and have trouble staying asleep. In general, Neubauer said, the risk for awakening in the night parallels the degree of anxiety.

“People with persistent insomnia also become anxious about sleep,” he said. “The more anxious they are about sleep, that undermines the ability to sleep well, and it becomes a self-fulfilling prophecy.”

In fact, a June 2013 study in the Journal of Neuroscience suggests that sleep deprivation contributes to anxiety by heightening people’s anticipatory and stress-inducing response processes.

Easing Anxiety Improves Sleep

The good news about anxiety and insomnia being so closely related is that, if you help one problem, you also help the other.

For example, Neubauer said, if you have an anxiety disorder, then getting treatment with cognitive therapy, meditation, or medication can have the indirect effect of improving sleep.

“Short of getting treatment for an anxiety disorder,” said Neubauer, “there are ways people can, on their own, sleep better.” For instance:

Practice relaxation techniques. Many approaches, such as nighttime meditation or yoga, can combat anxiety. Neubauer recommends you start by learning new relaxation techniques earlier in the day so you’re not putting too much pressure on yourself before bedtime. Then, once you’re comfortable with it, you can do it later in the day.

Get into a regular sleep routine. Going to bed and getting up at about the same time each day lets the body’s internal circadian clock work better. Getting up at odd hours can undermine that rhythm.

Schedule some idle time before bed. “A common problem is that, when people get into bed, it’s the first time they’ve had to ponder the day,” Neubauer said. Try to sit down and think about the day before you get ready for sleep. Jot down any concerns on a piece of paper if you need to remember tasks for the next day. Don’t use the time before bed to pay bills or other anxiety-inducing activity.

Cut out screen time. “It’s not a great idea to sit in bed with a tablet or screen and then try to fall asleep,” he said, adding that research has shown that the blue light in most electronic screens has the most potential to influence and delay the body’s natural circadian rhythms, making it harder to fall asleep.

Limit alcohol and caffeine. Having a glass of wine to help you get to sleep may be counterproductive. “Sleep after alcohol tends to be lighter, more disrupted, and less refreshing,” Neubauer said. Caffeine also can stay in your system for several hours, so avoid it later in the day if you’re having trouble going to sleep.

Don’t dwell on anxiety or emotional issues that are keeping you from falling asleep. It can be self-reinforcing and put too much pressure on trying to fall asleep. If you’re feeling anxious in bed, get out of bed and do something else, like reading or yoga.

Good sleep hygiene habits, like using your bedroom only for sleep and sex — not work or TV — and sleeping in a cool, dark, and quiet room equipped with some white noise if needed, can make it easier to fall asleep. But, if you still have persistent sleep problems caused by anxiety, talk to your doctor about treatment.

Sleep Disorders

Many of us toss and turn or watch the clock when we can’t sleep for a night or two. But for some, a restless night is routine.

More than 40 million Americans suffer from chronic, long-term sleep disorders, and an additional 20 million report sleeping problems occasionally, according to the National Institutes of Health.

Stress and anxiety may cause sleeping problems or make existing problems worse. And having an anxiety disorder exacerbates the problem.

Sleep disorders are characterized by abnormal sleep patterns that interfere with physical, mental, and emotional functioning. Stress or anxiety can cause a serious night without sleep, as do a variety of other problems.

Insomnia is the clinical term for people who have trouble falling asleep, difficulty staying asleep, waking too early in the morning, or waking up feeling unrefreshed.

Other common sleep disorders include sleep apnea (loud snoring caused by an obstructed airway), sleepwalking, and narcolepsy (falling asleep spontaneously). Restless leg syndrome and bruxism (grinding of the teeth while sleeping) are conditions that also may contribute to sleep disorders.

Anxiety Disorder or Sleep Disorder: Which Comes First?

Either one. Anxiety causes sleeping problems, and new research suggests sleep deprivation can cause an anxiety disorder.

Research also shows that some form of sleep disruption is present in nearly all psychiatric disorders. Studies also show that people with chronic insomnia are at high risk of developing an anxiety disorder.

Health Risks

The risks of inadequate sleep extend way beyond tiredness. Sleeplessness can lead to poor performance at work or school, increased risk of injury, and health problems.

In addition to anxiety and mood disorders, those with sleep disorders are risk for heart disease, heart failure, irregular heartbeat, heart attack, high blood pressure, stroke, diabetes, and obesity.

Treatment

If you suspect you have a sleep disorder, visit a primary care physician, mental health professional, or sleep disorders clinic. Treatment options include sleep medicine and cognitive-behavior therapy, which teaches how to identify and modify behaviors that perpetuate sleeping problems.

Treatment options for an anxiety disorder also include cognitive-behavior therapy, as well as relaxation techniques, and medication. Your doctor or therapist may recommend one or a combination of these treatments. Learn more about treatment options.

Reduce Anxiety, Sleep Soundly

To reduce anxiety and stress:

  • Meditate. Focus on your breath — breathe in and out slowly and deeply — and visualize a serene environment such as a deserted beach or grassy hill.
  • Exercise. Regular exercise is good for your physical and mental health. It provides an outlet for frustrations and releases mood-enhancing endorphins. Yoga can be particularly effective at reducing anxiety and stress.
  • Prioritize your to-do list. Spend your time and energy on the tasks that are truly important, and break up large projects into smaller, more easily managed tasks. Delegate when you can.
  • Play music. Soft, calming music can lower your blood pressure and relax your mind and body.
  • Get an adequate amount of sleep. Sleeping recharges your brain and improves your focus, concentration, and mood.
  • Direct stress and anxiety elsewhere. Lend a hand to a relative or neighbor, or volunteer in your community. Helping others will take your mind off of your own anxiety and fears.
  • Talk to someone. Let friends and family know how they can help, and consider seeing a doctor or therapist.

To sleep more soundly:

  • Make getting a good night’s sleep a priority. Block out seven to nine hours for a full night of uninterrupted sleep, and try to wake up at the same time every day, including weekends.
  • Establish a regular, relaxing bedtime routine. Avoid stimulants like coffee, chocolate, and nicotine before going to sleep, and never watch TV, use the computer, or pay bills before going to bed. Read a book, listen to soft music, or meditate instead.
  • Make sure your bedroom is cool, dark, and quiet. Consider using a fan to drown out excess noise, and make sure your mattress and pillows are comfortable.
  • Use your bedroom as a bedroom — not for watching TV or doing work — and get into bed only when you are tired. If you don’t fall asleep within 15 minutes, go to another room and do something relaxing.
  • Regular exercise will help you sleep better, but limit your workouts to mornings and afternoons.
  • Avoid looking at the clock. This can make you anxious in the middle of the night. Turn the clock away from you.
  • Talk to your doctor if you still have problems falling asleep. You may need a prescription or herbal sleep remedy.

Get Help

Find a Therapist who treats anxiety disorders.
Find a sleep disorders clinic.

Find Out More

American Sleep Association
Sleep Apnea
Sleep Disorders Health Center (WebMD)
Can’t Sleep? Sleep Expert Has the Answers
ADAA Member Philip Muskin Discusses Sleep (CBS News)
Sleepdex website

Other Resources

For more information about sleep disorders, BetterHelp has more information on the subject.

Being all cozied up at home in some silky PJs with a cup of chamomile tea in hand should be the ultimate safe space from anxiety. You’re far away from your boss, you’re no longer dealing with impatient commuters, and you don’t have anyone to answer to but yourself (i.e. your email is finally out of service for the night). So why do you feel more anxious now than you did all day long?

It seems like the complete opposite of how anxiety should work, but that’s kind of the hallmark of dealing with it, right? You never know when it’s going to strike. As it turns out, anxiety being minimal during the day then coming in like a ton of bricks once you’re winding down at night is a super-common experience. “It’s the first time of the day when no one is asking you any questions or you’re trying to complete a task. It’s when you’re first alone with your thoughts, and the entire day’s worth of thoughts come into your mind, which causes a level of anxiety,” clinical psychologist Michael Breus, PhD, tells me.

So sure, it’s totally normal—just not much fun!—to lay in bed sweating about any and every worry you held off during the day. But how are you actually supposed to wind down and get some shut-eye with all those thoughts hovering over you? To combat the anxiety—and even any physical symptoms that arise, like heavy breathing, a rapid heart rate, and chills—it helps to start preparing hours before you hit the sheets, then focus on calming your body down once you do.

“It’s when you’re first alone with your thoughts, and the entire day’s worth of thoughts come into your mind, which causes a level of anxiety.” —Michael Breus, PhD, clinical psychologist

“It takes all day to create a sleep problem at night. If you ignore your stress and anxiety all day long, you can’t expect it to magically disappear at bedtime, allowing you to sleep soundly until morning,” Dr. Breus says. “Relaxation exercises, mindfulness meditation, and mind-body exercise can all help reduce your stress throughout the day, as well as in the evenings before bedtime. Many of the natural supplements that help sleep are also beneficial for stress and anxiety, including magnolia bark, magnesium, and CBD.”

So there you have it: a doctor-approved reason to sip on a soothing CBD latte right before bedtime. By giving yourself a little TLC throughout the day and after you get home at night, you’ll be primed to getting a great night of sleep. Of course, if symptoms persist, seek the opinion of a doctor so you can find a solution that works for you.

We want to talk about anxiety—take this quick survey to help:

Here’s what to do instead of taking deep breaths to treat an anxiety or panic attack. Or, find out how you can be extremely supportive when dating someone with anxiety.

Tips for beating anxiety to get a better night’s sleep

Many people with anxiety disorders have trouble sleeping. That’s a problem. Too little sleep affects mood, contributing to irritability and sometimes depression. Vital functions occur during different stages of sleep that leave you feeling rested and energized or help you learn and forge memories. Sleep usually improves when an anxiety disorder is treated. Practicing good “sleep hygiene” helps, too. Here are some steps to take:

  • Go to bed and wake up at the same time every day, even on weekends.
  • Daylight helps set sleep patterns, so try to be outdoors while it’s light out for 30 minutes a day.
  • Exercise regularly (but not too close to bedtime). An afternoon workout is ideal.
  • Keep naps short — less than an hour — and forgo napping after 3 p.m.
  • Avoid caffeine (found in coffee, many teas, chocolate, and many soft drinks), which can take up to eight hours to wear off. You may need to avoid caffeine entirely if you have panic attacks; many people who experience panic attacks are extra-sensitive to caffeine.
  • Review your medications with a doctor to see if you are taking any stimulants, which are a common culprit in keeping people up at night. Sometimes it’s possible to switch medicines.
  • Avoid alcohol, large meals, foods that induce heartburn, and drinking a lot of fluid for several hours before bedtime.
  • If you smoke, quit. Smoking causes many health problems, including compromising sleep in a variety of ways.
  • Keep your bedroom cool, dark, and quiet, without distractions like TV or a computer. Avoid using an electronic device to read in bed; the light from the screen can trick your brain into thinking it is daytime. If your mattress is uncomfortable, replace it.
  • Reading, listening to music, or relaxing before bed with a hot bath or deep breathing can help you get to sleep.
  • If you don’t fall asleep within 20 minutes of turning in (or if you wake up and can’t fall back to sleep in 20 minutes), get out of bed and do something relaxing until you feel sleepy.

For additional tips and strategies for living with anxiety, buy Coping with Anxiety and Stress Disorders, a Special Health Report from Harvard Medical School.

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

What To Do When Anxiety Gets Worse In The Evening

Everyone experiences anxiety differently. There are people that wake up and already struggling with significant anxiety. While they experience most of their anxiety in the mornings and it tends to last all through the day, it is almost never as bad as it is when they get up.

But there are others that experience anxiety that gets worse in the evenings. Many still have anxiety throughout the day, but it is during the evening hours when their anxiety tends to become far more overwhelming.

Causes of Evening Anxiety

Anxiety that gets worse in the evenings may be caused by several issues, including the association of bedtime with stress, a lack of distraction forcing you to think about your anxiety, and simply being drained from the day.

The causes of evening anxiety are somewhat unclear, in that there is not anything in particular about anxiety that should cause it to increase in the evenings. This means evening sufferers likely have a specific cause to their symptoms. Possible causes include the following:

  • Post-Work Stress – Many people experience considerable anxiety after work, because of the lasting experience of their work day. When suffering from repeated work-related stress, it is not uncommon for tension to build, increasing the potential for late-night anxiety.
  • Morning Distractions – Throughout the morning and afternoon, you tend to be very busy. Distractions serve as an important tool for relieving anxiety. So those who are busy at work and/or in the morning tend to be less likely to dwell on stress. But once all the busyness subsides, so do the distractions, allowing anxiety to bubble on the surface.
  • Sleep Therapy – Sleep is its own natural form of therapy, and anxiety is a cumulative condition. So it is possible that every time you sleep your anxiety dissipates, and then over time as you go throughout your day it builds itself back until you sleep again.
  • Restless Leg Syndrome – Restless leg syndrome is a condition that starts in the evenings and can lead to pain and discomfort in the legs. It may make it harder to sleep and stimulate anxiety symptoms whenever it reoccurs.
  • Late Night Associations – For many, anxiety becomes associated with events. For example, if you often fight in bed with your spouse, then going to bed will create more anxiety even if you are not currently fighting. It is possible that you have had several arguments or problems around dinner time or later, and so when you start to approach that time of day your body becomes anxious in anticipation.
  • Physical Responses – Some people find that they are more prone to hyperventilation in the evenings, as well as experience more aches, pains, and fatigue. Those with anxiety attacks may react to these feelings with heightened anxiety. Since each person has their own triggers, those with evening anxiety may have more evening triggers.

This list is only preliminary. It is also possible that some individuals are more prone to biological responses as well. Brain chemistry fluctuates based on energy levels, time of day, diet, and other factors that may differ at night compared to during the day. Also, some people become their own mental enemy in the evening.

As soon as you start to wonder whether or not you are more prone to evening anxiety, you are also psyching yourself up to anticipate evening anxiety. As strange as it sounds, the very realization that you have evening anxiety may make evening anxiety more likely.

The most likely reason is simply the lack of distractions. Anxiety tends to take over when we are lost in our own thoughts, and unfortunately, most people have little to think about at night that prevents them from focusing on their anxiety. But again, it may be any combination of causes.

How to Prevent Evening Anxiety

There are some very simple ways to reduce evening anxiety, at least comparatively. Overall, the only way to guarantee that you do not get anxiety in the evenings is to manage your anxiety altogether. But in the absence of that option, there are strategies that can help you break the cycle of anxiety at night. These include:

  • Staying Busy – The first thing you need to do is try to stay busy. No matter how tired you are from work, make sure that you have planned several things to do once you are off work that you enjoy. This will reduce the time spent moping or lost in your own head, which is important for reducing anxiety.
  • Post Work Exercise – You should also make sure that you are physically active. One of the best short-term anxiety cures is aerobic exercise. If you can get yourself exercising right before or while your anxiety hits, you will find that your anxiety symptoms decrease and your ability to cope with stress improves.
  • Creating a Boring Routine – If staying busy and exercising is not something you can do, a boring routine may help. Routines are all about comfort. As long as your routine involves doing something, you will find that the act of knowing exactly what you are doing at all times can be very calming to the mind and body.
  • Goal Setting – You should also consider giving yourself goals – goals that you can work on every night. This relates to staying busy, of course, but they also ensure that each night is spent focusing on the future, not just the present. Even if one of those goals is to finish a jigsaw puzzle, as long as you are working on it, you will improve your ability to cope with anxiety.
  • Self-Awareness – Finally, make sure that you are aware of your anxiety and its triggers. The more in-tune you are to the way you feel, the more you can break the anxiety cycle. When you start feeling anxiety at night, do not try to fight it. Acknowledge it to yourself, try to examine what you are actually doing during your anxiety, and then work on figuring out how to manage it. Fighting anxiety exacerbates it, but accepting it and moving forward can significantly reduce its impact.

These are all tools designed to break the evening anxiety cycle. They are not going to cure your anxiety altogether, because they are not anxiety coping skills. Instead, it will work towards helping you properly assess evening anxiety and possibly reducing it.

You will still need to partner any of these strategies with a long-term anxiety treatment. It ensures you experience less anxiety overall, not just at night.

What Causes Anxiety At Night And How To Deal With It

By Jon Jaehnig

Updated February 01, 2020

Reviewer Wendy Boring-Bray, DBH, LPC

Anxiety at night is caused by the same triggers as anxiety during the day. However, the combination of anxiety and trouble sleeping can mimic other conditions and the different setting of night versus day can make you think that it’s something else. So, what causes anxiety at night and what can you do about it?

Anxiety At Night Can Be Stressful – Just Know That You Are Not Alone Ready To Talk About It? Get Matched With A Licensed Therapist Here

Source: unsplash.com

What is Anxiety?

Anxious feelings are the body’s normal alarm-response to psychological or physical threats, real or imagined, and can, therefore, be affect any person. In mild degrees, it is even considered ‘serviceable to the individual.’ Anxiety can be triggered by normal stress-inducing events and have distinct symptoms. It can also manifest as generalized anxiety. Some people are just more prone to anxiety than others, based on hereditary factors and temperament. However, most people are familiar with these general anxiety symptoms. Anxiety can make you feel like you’re all alone. However, almost twenty percent of the population suffers from anxiety. Less than half of those people get the help they need, but you can be part of that percentage.

Anxiety At Night

At night, your brain and subconscious mind continue to process and deal with challenges experienced during the day. If the challenge is severe, it could lead to insomnia or other sleep disturbances. In extreme cases, you could wake up from a panic attack, experience night terrors, or have sleep paralysis. Many people also experience “stress dreams.” These dreams usually involve everyday actions in which things go terribly wrong. Stress dreams aren’t as vivid or jarring as night terrors but can still disturb sleep.

Insomnia or sleep disturbances such as nightmares or night terrors are diagnostic markers for normal anxiety, as well as anxiety disorders. During a time of great stress, a person’s hormonal system is affected, so it can become common for people who are going through this to wake up at night or feel extreme anxiety. It can even battle to get back to sleep. Whatever is causing anxiety during the day, is likely to show up at night too.

Types of Nocturnal Anxiety

It is important to note the distinction between normal nocturnal anxiety, and nocturnal anxiety due to an anxiety disorder. The former can be addressed and solved with a few lifestyle changes, supplemented with therapy and counseling. The latter, however, can only be diagnosed by a medical doctor or psychiatrist and is best treated with medication and lifestyle changes.

Symptoms Of Normal Anxiety at Night

Knowing the difference between normal anxiety and something else can be important for getting the help that you need. While most people with anxiety share some common symptoms, the complete set of symptoms is different for everybody. Below are some common symptoms of normal anxiety, but remember you may not experience all of these to have normal anxiety.

  • Occasional worry about circumstances like a break-up, stress at work, conflict, or a child’s illness.
  • Embarrassed or feeling self-conscious when facing an uncomfortable social situation.
  • Experiencing physical symptoms such as the jitters, mild sweating, or even dizziness over a pending big exam, a business deal, or an event like getting married.
  • Sadness, insomnia, and anxiety or worry immediately following a traumatic event.
  • Realistic and appropriate fear of a threatening situation, person or object.
  • The normal need for assurance of a safety, security, and good health.

Source: unsplash.com

For most, symptoms of anxiety at night will disappear once the stressors are gone, alleviated, or managed. In the case of a great life upheaval or trauma, anxiety symptoms can last for months. If they last longer, it may be time to visit a medical professional, as you may be suffering from an anxiety disorder.

Anxiety disorders are a group of mental disorders characterized by distinct symptoms. Mental disorders can only be diagnosed and treated by a professional doctor or psychiatrist. Once again, you don’t need to have all of these symptoms to have an anxiety disorder. If you have a lot of them or some of them fit you really well, it’s best to talk to a healthcare provider.

  • Worrying constantly, chronically, and without logic or reason so that it affects relationships, causes emotional and physical distress, and interferes with your normal functioning every day. People will also experience impaired concentration due to worrying.
  • Avoiding social interaction and common social situations for fear of embarrassment, humiliation, or judgment.
  • Repeated, random panic attacks (even at night), feelings of impending doom and terror coupled with constant worrying over and fear of another panic attack.
  • Persistent nightmares, night terrors, or flashbacks of a traumatic event months or even years after the event.
  • Irrational fear, sometimes resulting in avoidance of a harmless to mildly threatening object, situation, or person.
  • Irrational fears of perceived threats that result in compulsive behavior such as chronic hand-washing, continuously checking that a place is locked for the night, etc.

As stated above, if you experience any or all of the above symptoms, seek out professional help.

Dangers of Long-Term Nocturnal Anxiety

Continuous sleep deprivation or insomnia due to anxiety can lead to more problems. Our hormone and autonomic nervous systems are especially vulnerable to prolonged or repeated stress- the latter of which, if left untreated, can even lead to “a dysfunctional arousal state and pathological anxiety states.” For this reason, it’s very important to manage stress and nip its effects in the bud. If not, it could cause chronic insomnia and even sleep deprivation- both of which will usher in a host of health problems. That’s bad news and is best avoided.

In the United States, insomnia is the most common specific sleep disorder. Approximately 30% of adults report short-term problems with sleeping, while 10% experience chronic insomnia. Not all people who have anxiety develop insomnia, and not all people who develop insomnia have anxiety. However, if you do experience insomnia, you need to be careful of its harmful effects.

Why is this bad? Not getting adequate sleep can give rise to an array of health problems.

  • Increased risk of Type 2 Diabetes
  • Delayed wound healing
  • Reduced growth hormones
  • Deficits in working memory and attention
  • Depression
  • Uncontrollable or unwanted weight gain or weight loss

How Can I Address Anxiety At Night?

The sooner you address the anxiety that keeps you awake at night, as well as any other excessive symptoms, the better. Humans are creatures of habit, and it is possible, even probable, to get into the habit of feeling anxious. It’s never good to suppress any feelings, and truly facing anxiety and its causes is of paramount importance in order to avoid a maladaptive response to stress. The following are tips for dealing with stress, which is the #1 cause of anxiety. Do note that only persistence with the following will result in long-term benefits. Over time, these will become good habits and serve as valuable tools to stay in control of anxiety, instead of remaining under anxiety’s debilitating influence.

  • Exercise – This is one of the most effective way to quickly lower stress hormones in the body and set off a cascade of biological processes that promote both physical and mental health. We’re built to move, not sit for hours in front of a computer or TV. Studies have shown that even walking for only 15 min a day can reduce all-cause mortality by 14%.

Anxiety At Night Can Be Stressful – Just Know That You Are Not Alone Ready To Talk About It? Get Matched With A Licensed Therapist Here

Source: unsplash.com

  • Develop a Nighttime Routine – For night anxiety that results in sleep problems, limit strenuous exercise to the morning or early afternoon and also consider mentally soothing exercises like yoga, Tai Chi, and Chi Qong. Some people find that reading a book helps – but that’s not the same as reading on your phone. Electronic devices give off a harsh, artificial light that can trick your body into staying up longer. Other things that might help you fall asleep include caffeine-free herbal teas. You may want to cut out caffeine afternoon as well.
  • Meditation – This is scientifically-proven to reduce stress and anxiety. It calms the mind and improves brain function- if practiced daily. Consider learning a specific technique, such as Transcendental Meditation (TM), which has over 40 years of studies proving its efficacy in managing stress and anxiety disorders. “No other stress management technique has anywhere close to TM’s amount of hard data in support of its claims to reduce stress,” says Norman Rosenthal, MD, of the U.S. National Institutes of Mental Health.
  • Diet – Avoid large and late suppers and stimulants like coffee or chocolate. Also, lower sugar intake and replace with fruit. Avoid fast food and processed foods. If necessary, visit a dietician for specific dietary advice. Many people also turn to alcohol to help them sleep. Alcohol can help you fall asleep, but it makes it harder for you to stay asleep. It’s probably better to toss and turn for a bit longer and stay asleep all night than to fall asleep sooner and wake up early.
  • Play Music – The link between emotions and music is a strong one. MindLab International with Dr. David Lewis-Hodgson has tested this particular ambient music track for anxiety, with a proven 65% reduction in participant symptoms. Listen to this or other soothing music before going to bed.
  • Supplementation- Vitamin B12 has been proven beneficial for neurological functioning and is effective in treating mild anxiety. Deficiencies will manifest as irritability, memory impairment, depression, psychosis and heart irregularities. You can also consider taking a natural sleep supplement, such as chamomile tea, melatonin, valerian, St John’s Wort or kava-kava, before bedtime.

Source: pexels.com

What Is Enough Sleep For Me?

As you work on dealing with nighttime anxiety, it is important to track your sleep and know how much sleep you need to be healthy. As we age, we need less sleep, but sleep doesn’t become less important as we age. Be sure to get enough hours of shut-eye for your age group:

Getting Help

Cognitive-behavioral therapy has been shown to be effective in permanently reducing anxiety symptoms and can help with anxiety at night. If your symptoms are related to a traumatic event or series of events, therapy or counseling is strongly recommended.

Most often, treating the cause of the anxiety will solve sleep or nighttime issues. Be sure to exclude any physiological causes of anxiety or insomnia, and consider getting help. Even if diagnosed with an anxiety disorder, adjacent therapy will be very helpful in managing symptoms. Therapy or counseling is an excellent tool for delving into your mind and seeking out reasons behind high anxiety levels. Every person is unique, as is our response to situations.

BetterHelp’s online therapists and counselors are professionally trained to uniquely assist you with anxiety at night, or anxiety in general, and they could be all you need to regain your healthy sleep patterns. If meeting with a counselor or therapist over the internet seems strange to you, consider reading the following reviews from real BetterHelp users.

Counselor Reviews

“I tried a few counselors and almost gave up until I found Colleen. I love her! She’s easy to talk to, really gets me and best of all she makes me feel like I’m talking to a friend. She’s given me some great tips and I’m sleeping better already most nights.”

“Dr. Broz had made a significant impact on my life. After just one session with her I was able to get more sleep and handle issues with my husband and young kids better. She’s empathic and very easy to talk to. I would recommend her to anyone looking for help with stress, sleep issues, anger or relationship advice. Thanks Sandra for everything you do for me and all your patients.”

How can I calm my anxiety at night?

When the evening comes, all you want to do is get a good night of sleep. There are many things you can do to calm nighttime anxiety. Some people find that meditation helps with anxiety. Others notice that reading a book before bedtime relaxes them. Having a nighttime routine can alleviate some of the anxiety one experiences at night. For example, after dinner, take a bath, then get into pajamas, read a book, or listen to an audiobook. You could drink a calming warm beverage like a cup of tea. Then dim the lights, and meditate. After that, you can lay down and go to sleep.

What causes panic attacks at night?

Many people suffer from panic attacks. It’s difficult when they occur at night. Some individuals have panic disorder, where they feel panicked out of the blue. Some people find that their anxiety is heightened at night. That could be for many reasons. It’s important to talk to a mental health professional if you are experiencing panic attacks. They can help you get to the bottom of the cause of them. One thing to keep in mind is that there may be triggers that are impacting your anxious feelings at night. Maybe you experienced a traumatic experience that took place at night. If there’s a reason for your panic attack, it might be that. It could be worth it to speak to a therapist who specializes in trauma, who can help you work through these triggers and cope with panic attacks.

How do you calm down anxiety?

Anxiety and stress can weigh on a person. For some people, they are coping with both depression and anxiety. For others, they are managing a high level of anxious thoughts. People who deal with generalized anxiety find themselves worrying a lot. The last thing you want to do is make anxiety worse. It can be a difficult condition to live with, but there are things you can do to help yourself and reduce anxiety. Different techniques work for generalized anxiety. Some people find that ice-diving helps panic attacks. You can take a bowl of ice and stick your nose in it for 30 seconds. The shock of the cold to your system can alleviate a panic attack. Some individuals find that naming five things you see, hear, taste, feel, and smell can calm anxiety. These are grounding exercises that you can try when you are experiencing high levels of anxiety. Dealing with nighttime anxiety can be tricky, but there’s hope.

What helps night time anxiety?

Some people find that their anxiety is worse at night. One thing that can help nighttime anxiety is knowing the cause. There are techniques you can use to ease anxiety, and you can learn them. One thing you can try is identifying the times at night that you feel anxious. Understanding if there’s a pattern can help you work through these anxious thoughts and feelings. It makes anxiety worse when the cause is unknown. Once you know when you’re anxious, you can start learning techniques to deal with your anxiety. It also depends on what your symptoms are. If you are having a racing heart, learning breathing techniques can help slow your heart rate. You might consider investing in a weighted blanket. These can help people with anxiety feel safe. Talk to a mental health professional and discuss your anxiety symptoms. They can suggest techniques to manage your nighttime anxiety best.

How long can anxiety last?

There is no concrete answer to how long anxiety lasts. There’s no way to know because it differs from person to person. When you’re suffering from anxiety it may feel like it’s going to last forever. The good news is that’s not true. Anxiety is different for each person, but one thing we do know is that it does get better with treatment. There are a variety of symptoms of anxiety. Some people may experience shaking or sweating, while others ruminate on their problems. There is, however, a rough time frame for how long panic attacks can last. A panic attack typically lasts 20-30 minutes. Remember, when you are experiencing a panic attack, it will end. It generally peaks around the 10-15 minute mark, and then anxiety will decrease after that. For generalized anxiety, it can linger for days. That’s why it’s crucial to speak to a therapist about your symptoms so you can learn coping strategies to manage your anxious thoughts.

Why do I feel like I’m dying when I’m falling asleep?

If you feel uncomfortable before you fall asleep at night, it may be because you have a sleep disorder, or it could be an extreme amount of anxiety. It’s important to discuss your symptoms with your healthcare provider. Some people experience intense panic attacks while they are trying to sleep, and it can feel like you are dying. These attacks require medication attention, and you should speak to a therapist, or a psychiatrist. You don’t have to suffer from panic alone. Some skilled professionals see these symptoms every day and can support you.

Can anxiety wake you up at night?

Anxiety can wake you up at night for many reasons. You might wake up with night sweats from a bad dream. You may be anxious about something that happened during the day. You may find that you’re going through a particularly difficult time in life, and you can’t seem to stop thinking about it. These thoughts make you wake up suddenly during the night. For people who cope with depression and anxiety, these two emotions could be draining you. As a result, you could also wake up in a panic attack. It’s essential to understand the cause of your anxiety, and if it’s situational or a chronic condition. These are things you can discuss in therapy.

How can I relax my mind to sleep?

One way to relax your mind is to meditate. Meditation is a proven relaxation method where you can let your mind rest. You don’t have to change the thoughts in your brain. Allow your mind to flow freely; let the feelings be there. There’s no pressure to do or act. Releasing your mind will allow your thoughts to slow down, and you will find yourself drifting off to sleep. Another thing you can try is writing in a journal before bed. That way, you can get the thoughts out of your mind and on paper. It will make for a more restful sleep. You can discuss relaxation techniques with your therapist, and see which ones work for you.

Conclusion

Stress and anxiety aren’t often related, but they often go together. If you’ve tried everything and there’s no other explanation for your late nights, anxiety could be keeping you up. That doesn’t mean that you have to put up with it. Help is out there; get the help you need and enjoy restful nights again. Take the first step today.

Turn down the noise in your head for a more restful night

As you tuck into bed at night, do the thoughts in your brain refuse to slow down when you turn off the lights? Instead of winding down, it’s a wave of worries about everything from paying your credit card bill on time to an upcoming meeting with your boss. That non-stop chatter about what might occur tomorrow is a sign of anxiety and, for many, it’s a serious roadblock to getting a good night’s sleep.

According to the National Institute of Mental Health, the number of people struggling with anxiety is staggering. Anxiety has become the number one mental health issue in North America, affecting approximately 40 million Americans (18% of adults). Some estimates put this number higher at around 30% since many people with anxiety don’t know they have it or don’t seek treatment.

Simply put, it’s a national epidemic.

When it comes to sleep, anxiety is a key part of a toxic cycle because it makes getting to sleep and staying asleep difficult. What’s more, it becomes a source of worry itself, worsening the original anxiety – a chicken-and-egg problem. Did the anxiety cause poor sleep or did poor sleep cause anxiety? One feeds the other, experts say.

“Insomnia is often co-morbid with anxiety and depression,” explains Elika Kormeili, a Los Angeles-based licensed therapist specializing in online counseling for anxiety and insomnia and founder of the Center for Healthy and Happy Living. “This means they often occur together. It’s hard to tell which comes first, but anxiety makes it harder to sleep and lack of sleep tends to make people more anxious.”

The bad news is that even as you manage to nod off, your anxiety is still active. “While we sleep, our mind is still active and maybe processing information,” she says. “If we don’t take time throughout the day to process information and to unwind, then stress/anxiety can make it difficult to fall asleep or stay asleep.”

Fortunately, there are tried-and-true ways to tame anxiety so you can get quality rest, courtesy of these mind-soothing tips from trusted experts

1. Prep by day for nighttime calm

Kormeili says, “I recommend to all my clients (online and in-office) to take time every day to unwind. Even if you’re really busy – especially if you are really busy – you need to find simple strategies to cope with stress like practicing deep breathing while sitting in traffic.”

2. Practice gratitude for better sleep

Studies have shown the benefits of expressing gratitude, ranging from increased productivity to greater happiness and better sleep. Kormeili often recommends that her clients think of 3 or 4 things they’re grateful for every night. You can, of course, do this as often as you want.

3. Get out of bed if you can’t sleep

Don’t keep staring at the clock, tossing and turning. Abandon ship! As Kormeili says, “Your bed should be used for sleep and sex – not for worry!” She suggests going into another room to do something mundane, like folding laundry or filling up some pages in your adult coloring book.

4. Download your thoughts to allow you to fall asleep

Bedtime can turn into a time when you start to think about all the things you need to do tomorrow, creating a never-ending list of tasks swirling around in your brain. Stop the thought tornado by writing down all the things you’re trying to remember. With them safely recorded, your mind can be more at ease and you can deal with them upon waking.

5. Meditate at bedtime

“Meditation helps people relax, focus, and tune in to their innermost feelings moment-to-moment. This is extremely useful for relaxation and winding down to sleep,” says Dr. Fran Walfish, a Beverly Hills family and relationship psychotherapist and author of The Self-Aware Parent. She cites the example of a stressed-out couple she counseled who began to meditate together for 30 minutes each evening. They not only slept more deeply but also felt closer to one another. Try an app like Buddhify or Headspace for guided meditations.

6. Try a white noise machine to help you fall asleep

A low level of constant noise can be useful for distracting your anxious mind, shifting the focus away from troubling thoughts to the constant noise produced from a white noise machine. A simple fan also does the trick – as does a sleep app on your phone. Just make sure that the volume is quite low – barely audible – to keep sound in the background.

7. Keep a worry journal beside your bed

Anxiety is always about “what ifs” and trying to be prepared by situations that may or may not occur – a kind of fruitless rehearsal for potential problems. It’s not an effective tactic and can compromise our wellbeing over the long term. Keep a notebook by your bed to jot down any worries. The act of recording them can zap their power. Review them in a few days when you can ask yourself, “Did the situations I was so worried about actually happen?” Over time, you may learn that the majority don’t become reality, helping to ease anxiety.

8. Don’t wait for rock bottom before asking for help

If anxiety rears its ugly head on a regular basis and disrupts your sleep, seek support and talk to your doctor (or sleep doctor) about possible solutions. It’s not something you need to just live with or to accept. Sweet dreams are within reach.

Rest well & wake up ready to go!

Better sleep gives rise to better mornings, bringing your goals into focus and dreams within reach. Hungry for more sleep info? Dig into these posts:

  • Reduce stress, sleep better
  • What the experts have to say about overcoming sleep deficit
  • 12 essential life hacks to battle stress & safeguard your sleep