Here's How Anxiety and Sleep Are Related

Can’t sleep and have anxiety? A bedtime routine and exercise might help. Here’s why insomnia and anxiety disorders are related.

If you can't sleep at night due to stress and worry, you may have anxiety or a sleep disorder—or both. Sleep problems are linked not only with daily stress, but with anxiety disorders, such as generalized anxiety disorder and post-traumatic stress disorder (PTSD).¹

Sleep and anxiety have a two-way relationship. Improving the quality of your sleep can greatly help with anxiety. In turn, managing your anxiety can help you sleep. Making several lifestyle changes can help you reduce those long nights when you can't sleep and have anxiety. Here, you'll find a quick overview of the connections between anxiety and sleep, as well as what you can do to get a better night's rest.

The Connection Between Anxiety and Sleep

Anxiety can make it difficult for someone to fall and stay asleep. But the reverse is also possible—difficulty falling asleep can lead to anxiety.

This is because getting enough sleep can reduce stress, improve your mood, and restore your ability to think and remember things. Your sleep schedule also factors into your overall health. Sleeping at night and waking in the morning helps maintain your natural biological clock for when your body should be asleep or awake—or, your circadian rhythm.² When your internal clock is off or you can't get enough sleep, that can lead to a buildup of stress, negative emotions, and anxiety.³

Insomnia and Anxiety

About a third of U.S. adults aren't getting enough sleep—a healthy amount is at least 7 hours of sleep a night, according to the CDC.⁴

Insomnia is the most common sleep disorder.⁵,⁶ Typical symptoms include difficulty or inability to fall asleep, waking up frequently at night, and waking up too early in the morning.⁶

Insomnia can have a detrimental impact on both mental and physical health. It can lead to:⁵,

  • Sleepiness during the day
  • Feeling irritable
  • Difficulty remembering, focusing, and learning
  • Depression
  • Anxiety

Waking frequently during the night can interfere with the body's ability to process emotionally stressful events and memories—which usually happens at night when sleeping. And severe cases of disrupted sleep can also increase emotional distress.⁵

Some people can develop insomnia in response to stressful life situations, while other people might be predisposed to developing it if they tend to lose sleep when stressed. Several studies have also found that disrupted sleep and insomnia are associated with the development of anxiety symptoms.⁷

Anxiety Disorders and Sleep

For some people, the feelings of stress and worry are persistent and overwhelming due to an anxiety disorder. People with anxiety disorders can also experience sleep disruptions or lack of sleep and might even have insomnia or another sleep disorder at the same time.¹

Anxiety disorders are the most common mental health condition in the U.S., affecting over 40 million adults.Several types are associated with sleep disruptions, which can then worsen anxiety-related symptoms:

  • Generalized anxiety disorder: This is a persistent and chronic feeling of restlessness, agitation, and difficulty concentrating, the periods of which can last for months or more. Insomnia and other sleep disorders frequently accompany this condition.⁹
  • Panic disorder: This causes recurring, unexpected panic attacks—sudden bouts of fear, increased heart rate, and other physical symptoms.¹⁰ People with this condition can experience panic attacks at night, which can wake them up or affect their ability to fall asleep.¹¹
  • Post-traumatic stress disorder (PTSD): This anxiety disorder can develop after a traumatic event or situation in which there was grave physical harm. Insomnia and nightmares causing interrupted sleep are typical symptoms of PTSD.¹²

How to Get a Better Night's Sleep if Anxiety Is Affecting Your Sleep

Getting enough good sleep each night is essential for your health. It helps ease stress and certain anxiety disorders and has numerous benefits for mental and physical health. If you're having trouble sleeping due to anxiety, there are a number of techniques you can try to improve the quantity and quality of the rest you get.

Schedule Your Sleep

How much sleep do you need? Adults should get 7 to 8 uninterrupted hours a night, while children should get 9 to 12 hours. Even more sleep is needed for toddlers and infants.² To make sure you get enough restful sleep, you can block off consistent times for going to bed and getting up. Make a dedicated effort to keep your sleeping patterns sufficient and regular.

Create a Bedtime Routine

It helps to develop a regular, relaxing routine before going to bed. Setting aside daily stresses and worries may prime your mind for rest. You can try:¹

  • Meditation or deep breathing exercises
  • Taking a bath
  • Listening to relaxing music
  • Reading

What to avoid before bed

For better quality sleep, avoid taking certain substances in the hours before bedtime. For instance, avoid foods and beverages with caffeine, which can keep you awake at night; these include coffee, tea, and chocolate. Also, avoid smoking or chewing tobacco, as it contains nicotine, which can disrupt sleep. Similarly, drinking alcohol interrupts your body's ability to achieve deep, restful sleep, so skip drinks before bed.¹

Get Exercise

Regular physical activity can help improve your sleep and reduce anxiety. Specifically, researchers have found moderate to very intense exercise can reduce the time it takes to fall asleep, increase the duration of deep sleep, and improve sleep quality.¹³

Key factors for an effective exercise routine include:¹⁴

  • Designating time: Adults should aim for 150 minutes of moderate activity—including two days of muscle strengthening activities—a week. That total could be broken up into 30 minutes of exercise a day, for five days, for instance.
  • Aerobic activities: These help work out your lungs and include brisk walks, cycling, swimming laps, and jogging.
  • Strength exercises: These target your muscles, such as lifting weights or resistance training. Seek out guidance to learn how to do these workouts safely.
  • Being careful: If you aren't used to exercising, start small and build from there. Do what you can to avoid injury or overexerting yourself.

It may be worth timing intense workouts for mornings or afternoons, rather than the evening.¹ A few studies suggest that moderately intense exercise may affect circadian rhythm and sleep quality depending on when you exercise. In general, any physical exercise can help improve sleep, compared to none at all.¹³

Screen Out the Screens

Watching TV or using a computer or other digital device can also affect your ability to fall asleep. Increased screen time can negatively impact sleep for people of all ages. For teens and children, who need more sleep than adults, increased screen use is associated with delayed bedtimes and less sleep overall.¹⁵

You can designate at least a half hour before going to bed as screen-free time. Don't use your phone in bed if you're trying to fall asleep. Make a rule for kids that they can't use devices before bedtime.¹⁵

Create a Restful Space

Make sure your bed is primarily a space for rest and relaxation. Don't work in bed and keep it free of distractions that can keep you up. Wait until you feel tired and relaxed before climbing under the covers.¹

Start Over and Don't Clock-watch

If you haven't fallen asleep within about 15 minutes of lying down, get up, go to another room, and do something relaxing. Read a book for a few minutes, have a drink of water, or just sit and breathe deeply before trying to fall asleep again. Also, don't watch the clock—turn their faces away from you so you can't see them from bed. Knowing the time may add anxiety and cause you to toss and turn.¹

When to See a Healthcare Provider

While there are ways to improve your sleep and anxiety at home, it is best to visit your healthcare provider if you continue to have difficulty sleeping or your symptoms worsen.

A provider can determine whether you have insomnia or an anxiety disorder or another sleep-related condition. They can also develop a specific treatment plan, which may include medication, therapy, and ways to manage stress.¹,

Summary

Anxiety and sleep can be intertwined. Persistent stress and worry can impact your ability to get rest, and disruptions or difficulties sleeping are common signs of anxiety disorders.¹ The key is to be proactive about your health.

There are many techniques and lifestyle changes you can adopt to improve your sleep and ease nighttime anxiety. You can also visit a healthcare provider for a diagnosis, as well as additional ways to manage insomnia or an anxiety disorder. The sooner you're getting more sound sleep, the better off your overall health will be.

Sources

  1. Anxiety and Depression Association of America. Sleep disorders.
  2. US Department of Health and Human Services. Get enough sleep.
  3. McEwen BS and Karatsoreos IN. Sleep Deprivation and Circadian Disruption. Sleep Med Clin. 2015;10(1):1-10. doi: 10.1016/j.jsmc.2014.11.007
  4. Centers for Disease Control and Prevention. Data statistics: short sleep duration among adults.
  5. Van Someren EJW. Brain mechanisms of insomnia: new perspectives on causes and consequences. Physiol Rev. 2021;101(3):995-1046.doi:10.1152/physrev.00046.2019
  6. National Institutes of Health. Insomnia. MedlinePlus.
  7. Kalmbach D, Anderson J, Drake C. The impact of stress on sleep: pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders. J Sleep Res. 2018;27(6):e12710. doi:10.1111/jsr.12710
  8. Anxiety and Depression Association of America. Anxiety Disorders: Facts and statistics.
  9. National Institute of Mental Health. Anxiety disorders.
  10. Substance Abuse and Mental Health Services Administration. Table 3.10 Panic Disorder and Agoraphobia Criteria Changes from DSM-IV to DSM-5. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. 2016.
  11. Nakamura M, Sugiura T, Nishida S, Komada Y, Inoue Y. Is nocturnal panic a distinct disease category? Comparison of clinical characteristics among patients with primary nocturnal panic, daytime panic, and coexistence of nocturnal and daytime panic. J Clin Sleep Med. 2013;9(5):461-467. doi:10.5664/jcsm.2666
  12. Gehrman P. Sleep problems in veterans with PTSD. U.S. Department of Veterans Affairs.
  13. 9. Dolezal BA, Neufeld EV, Boland DM, Martin JL, Cooper CB. Interrelationship between sleep and exercise: a systematic review. Adv Prev Med. 2017;2017:1364387. doi:10.1155/2017/1364387
  14. Centers for Disease Control and Prevention. How much physical activity do adults need?
  15. Hale L, Kirschen G, LeBourgeois M et al. Youth screen media habits and sleep. Child Adolesc Psychiatr Clin N Am. 2018;27(2):229-245. doi:10.1016/j.chc.2017.11.014
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