Sleep Anxiety

Overview

What is sleep anxiety?

Sleep anxiety is fear or worry about going to sleep. You may be apprehensive about not falling asleep or not being able to stay asleep. Some people also have a distinct phobia, or fear, about sleep called somniphobia. They may think something bad will happen to them while they sleep, or that they shouldn’t sleep because they need to stay alert and watchful.

Sleep and psychiatric disorders, such as anxiety, often go hand in hand. If you have an anxiety disorder, you may find it hard to fall asleep or stay asleep. Similarly, if you have a sleep disorder, you might feel anxious or fearful before bed because you’re afraid you won’t get the rest you need. One condition usually makes the other worse, so it can feel like a never-ending cycle.

Who gets sleep anxiety?

Sleep anxiety can affect adults, teens and children. You may be more likely to develop anxiety at night if you have a sleep disorder such as:

People with the following mental health disorders may also develop nighttime anxiety:

How common is sleep anxiety?

Anxiety is the most common mental health disorder in the U.S., affecting about 40 million people. Research suggests that most people with mental health disorders such as anxiety also have some form of sleep disruption.

Symptoms and Causes

What causes sleep anxiety?

Anxiety is a natural part of being human. We’re meant to feel afraid or worried in dangerous situations. Stress and anxiety trigger our bodies to release hormones that help us react quickly to escape harm. But if you have chronic anxiety, you might feel stress or worry all the time. You may feel fearful of everyday situations like driving to work or even falling asleep.

Chronically high levels of these hormones, especially before sleep, can make it hard for your body to relax. You may have difficulty falling asleep. If you do fall asleep, you may wake up during the night with stressful or worrisome thoughts and not be able to fall asleep again.

The combination of a anxiety and insomnia can also be caused by a condition where there isn’t enough thyroid hormone in your bloodstream and your metabolism slows down (hypothyroidism).

Research suggests that anxiety can affect rapid eye movement (REM) sleep. This is the phase of sleep when you tend to have vivid dreams. If you have anxiety, the dreams may be disturbing or turn into nightmares that wake you.

Just as anxiety can affect sleep, sleep can affect anxiety. Sleep anxiety is a common characteristic of insomnia, wherein the individual begins to experience anxiety during the day and evening about poor sleep, which may help cause another night of bad sleep.

What are the symptoms of sleep anxiety?

When you can’t sleep due to anxiety, you may experience behavioral changes, including:

  • Feelings of being overwhelmed.
  • Inability to concentrate.
  • Irritability.
  • Nervousness.
  • Restlessness.
  • Sense of impending danger or doom.

Physical effects of anxiety before bed may include:

  • Digestive problems.
  • Fast heart rate.
  • Rapid breathing.
  • Sweating.
  • Tense muscles.
  • Trembling.

Some people also have nocturnal panic attacks. A panic attack is a sudden, intense burst of extreme fear. Nocturnal panic attacks only happen at night, and often wake you from sleep.

Diagnosis and Tests

How is sleep anxiety diagnosed?

Your healthcare provider performs a physical exam, reviews your medical history and evaluates your symptoms. They may ask you questions like:

  • Do you eat or drink anything before bed?
  • Does your anxiety always occur before bed?
  • How long does it take you to fall asleep?
  • How often do you wake up during the night?
  • What activities do you do before bed?

What tests help confirm a sleep anxiety diagnosis?

In some cases, your provider may do a sleep study to find out if you have a sleep disorder. Also called polysomnography, a sleep study is a test where you stay overnight in a sleep lab. Your healthcare provider evaluates how your body works during sleep by checking your:

  • Blood oxygen levels.
  • Body positioning.
  • Breathing.
  • Electrical activity in your brain.
  • Eye movements.
  • Heart rates and rhythms.
  • Leg movements.
  • Sleep stages.
  • Snoring or other noises you make during sleep.

Management and Treatment

How is sleep anxiety treated?

There are a variety of ways to manage sleep anxiety, including:

  • Cognitive behavior therapy (CBT).
  • Healthy sleep habits (sleep hygiene).
  • Medication.

How does cognitive behavioral therapy treat sleep anxiety?

CBT is a form of psychotherapy, or talk therapy. It teaches you how to change your behavior by changing the way you think. It’s a common treatment for people with anxiety. A special form of CBT called cognitive behavior therapy for insomnia (CBTI) focuses on helping people who have insomnia. This therapy can take anywhere from six to 12 weeks to produce results.

During CBT or CBTI, you may learn to:

  • Avoid behaviors or environmental factors that trigger your anxiety or make sleeping difficult.
  • Better understand how sleep and anxiety affect your brain and the rest of your body.
  • Change negative or inaccurate thinking about bedtime or sleep.

Your therapist may teach you how to sleep with anxiety by using biofeedback. Biofeedback trains you to control your body’s functions. You learn to relax your muscles, regulate your breathing, lower your heart rate and focus your attention. Your therapist might use special sensors to measure these bodily functions, or they may give you exercises, such as deep breathing and meditation, to do at home.

How can healthier sleep habits treat sleep anxiety?

Sleep habits, or sleep hygiene, are your routines around bedtime that can affect your sleep. Your healthcare provider may ask you to keep a sleep diary for several weeks. This is a daily log of your sleep habits. It can help identify things that might make it harder for you to fall asleep or stay asleep.

Some common ways to improve your sleep hygiene include:

  • Avoid drinking lots of fluids before bed, especially alcohol.
  • Do relaxing activities before bed, such as meditation or listening to soft, peaceful music.
  • Don’t consume caffeine in the late afternoon or evening.
  • Don’t go to bed unless you feel sleepy.
  • Go to bed and wake up at the same time each day.
  • If you don’t fall asleep within 20 minutes, get out of bed.
  • Make sure your bedroom is comfortable, quiet and softly lit.
  • Only use your bed for sleep and sex. For example, avoid watching television or doing work in bed.
  • Set a goal of getting at least seven hours of sleep every night.
  • Stop using electronic devices at least 30 minutes before bedtime.
  • Try not to eat right before bedtime. If you’re hungry, have a light snack and not a big meal.

How can medication treat sleep anxiety?

Your healthcare provider may recommend medication to treat anxiety or other mental health disorders. Medication can also help improve the symptoms of sleep-related disorders such as restless legs syndrome or insomnia.

But some medications might actually increase your anxiety or make sleeping harder when you first start taking them. If you experience these side effects, talk to your healthcare provider. Many over-the-counter sleep aids can also be habit-forming. Don’t start any medication for anxiety or sleep without your healthcare provider’s supervision.

Prevention

How can I prevent sleep anxiety?

You may be able to reduce your risk of sleep anxiety by:

  • Eating a healthy diet.
  • Exercising regularly.
  • Practicing good sleep hygiene.
  • Taking medications for mental health disorders or sleep disorders as prescribed by your healthcare provider.

Outlook / Prognosis

What’s the prognosis (outlook) for people with sleep anxiety?

Most people can successfully manage their sleep anxiety with the right treatments. But remember that some treatments, such as medication or CBT, can take time to be effective. Don’t stop treatment prematurely if you think it isn’t working.

Are there long-term complications of sleep anxiety?

Prolonged anxiety or lack of sleep can affect your body in many ways. Sleep anxiety puts you at a higher risk for the following long-term complications:

Living With

How can I make living with sleep anxiety easier?

Anxiety or sleep problems can affect every aspect of your life, from your performance at work to your interactions with others. It may help to talk about your sleep anxiety with a therapist, co-workers, friends or loved ones. Support groups can also connect you to a community of people dealing with similar experiences.

A note from Cleveland Clinic

Sleep anxiety is a feeling of fear or stress about falling asleep or staying asleep. Sleep problems and mental health disorders such as anxiety are closely intertwined. One can often make the other worse, so it can feel like a never-ending cycle. But anxiety and sleep problems are both treatable. Talk to your healthcare provider about your symptoms and work together to build the right treatment plan. Common treatments include cognitive behavioral therapy (CBT), good sleep hygiene and medication.

Last reviewed by a Cleveland Clinic medical professional on 06/13/2021.

References

  • American Association of Sleep Technologists (AAST). ? Accessed 6/14/2021. What Is Polysomnography (https://my.clevelandclinic.org/health?q=hypothyori)
  • Anxiety & Depression Association of America (ADAA). . Accessed 6/14/2021. Facts & Statistics (https://adaa.org/understanding-anxiety/facts-statistics)
  • Anxiety & Depression Association of America (ADAA). . Accessed 6/14/2021. Sleep Disorders (https://adaa.org/understanding-anxiety/related-illnesses/sleep-disorders)
  • American Academy of Sleep Medicine (AASM). . Accessed 6/14/2021. Sleep Education (http://sleepeducation.org/essentials-in-sleep/healthy-sleep-habits)
  • Sleep Foundation. . Accessed 6/14/2021. Anxiety and Sleep (https://www.sleepfoundation.org/mental-health/anxiety-and-sleep)
  • Sleep Foundation. . Accessed 6/14/2021.Cognitive Behavioral Therapy for Insomnia (CBT-I) (https://www.sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomnia)

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