Sleep Anxiety

What is sleep anxiety?

Sleep anxiety is fear or worry about going to sleep. You may be scared 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 disorders and mental health disorders like 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.

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 like anxiety also have some form of sleep disruption.

What does sleep anxiety feel like?

When you can’t sleep due to anxiety, you may experience behavioral or emotional symptoms, which may include:

• 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.

What triggers sleep anxiety?

Anxiety is a natural part of being human. You’re meant to feel afraid or worried in dangerous situations. Stress and anxiety cause your body to release certain hormones that help you 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 back asleep.

The combination of anxiety and insomnia can also be caused by hyperthyroidism, a condition where your thyroid is overactive and there’s too much thyroid hormone in your bloodstream. It’s a well-known cause of sleep dysfunction.

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, which occurs when you begin to experience anxiety during the day and evening about poor sleep, which may lead to another night of bad sleep.

What are the risk factors for 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 like:

• Insomnia.
• Narcolepsy.
• Restless legs syndrome (RLS).
• Sleep apnea.
• Sleepwalking.

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

• Anxiety disorders, including panic disorder and post-traumatic stress disorder (PTSD).
• Mood disorders, including major depression and bipolar disorder.
• Alcohol and substance use disorder.
• Schizophrenia.

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:

• Diabetes.
• Heart attack.
• Heart disease.
• Heart failure.
• High blood pressure.
• Arrhythmia (irregular heartbeat).
• Obesity.
• Stroke.

How is sleep anxiety diagnosed?

Your healthcare provider will perform a physical exam, review your medical history and discuss 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 sleep anxiety tests can help confirm a 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.

How can I overcome sleep anxiety?

Sleep anxiety treatment may include:

• Cognitive behavior therapy for insomnia (CBT-I).
• Medications for sleep and/or anxiety.

Cognitive behavioral therapy for insomnia (CBT-I)

CBT-I is considered first-line treatment for insomnia and is often misrepresented as talk therapy or sleep hygiene. The behavioral components go far beyond the information commonly found on the internet or what your friends or family may tell you, such as decreasing caffeine or avoiding electronic devices at bedtime.

When people have insomnia, they often associate their bed as a place to worry and be distressed. CBT-I teaches them how to break that association and to retrain their body and mind to see the bed as a place for sleeping by focusing on limiting total time in bed, getting out of bed when awake, and keeping regular sleep and wake times.

CBT-I may also include relaxation strategies and mindfulness techniques. Thoughts and feelings about sleep are examined and tested to see if they’re accurate, while behaviors are examined to determine if they promote or disrupt sleep. Treatment is brief and time-limited and typically lasts around four to eight sessions.

During CBT-I, 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.

Sleep anxiety medication

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 like 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.

How can I prevent sleep anxiety?

You may be able to reduce your risk of sleep anxiety by improving your sleep habits.

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, like meditation or listening to soft, peaceful music.
• Don’t consume caffeine in the late afternoon or evening.
• 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.

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, like CBT-I, can take time to be effective. Don’t stop treatment early if you think it isn’t working.

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.