Sleep anxiety is a feeling of stress or fear about going to sleep. Anxiety is the most common mental health disorder in the U.S. Research suggests that most people with mental health disorders like anxiety also have some form of sleep disruption. Treatments may include therapy, better sleep hygiene or medication.
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.
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.
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When you can’t sleep due to anxiety, you may experience behavioral or emotional symptoms, which may include:
Physical effects of anxiety before bed may include:
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.
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.
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:
People with the following mental health disorders may also develop nighttime 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:
Your healthcare provider will perform a physical exam, review your medical history and discuss your symptoms. They may ask you questions like:
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:
Sleep anxiety treatment may include:
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:
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.
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:
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.
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.
Sleep anxiety is a feeling of fear or stress about falling asleep or staying asleep. Sleep problems and mental health disorders like anxiety are closely intertwined. One can often make the other worse, so it can feel like a never-ending cycle. But anxiety and sleep issues are both treatable. Talk to your healthcare provider about your symptoms. Together, you can build the right treatment plan for you.
Last reviewed by a Cleveland Clinic medical professional on 04/12/2024.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy