Understanding the Connection Between Anxiety and Sleep Problems

There is a close correlation between anxiety and sleep disturbances. While anxiety is a common human emotion, the feelings of fear and worry that accompany anxiety make falling asleep and staying asleep difficult.

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The Relationship Between Anxiety and Sleep

Studies show that the prevalence of sleep disorders, like insomnia and nightmares, is high in people with anxiety. Conversely, people with sleep disorders have a high rate of anxiety. The two conditions create a negative cycle of sleep issues and anxiety, not knowing which came first.

Understanding the interrelationship between sleep and anxiety is the key to long-term physical and mental health and well-being.

How Anxiety Affects Sleep

Individuals with anxiety often experience poor-quality sleep, including insomnia and nightmares. When anxious thoughts and feelings, like Worry, rumination, and fear are present at bedtime, they cause a state of hyperarousal which can have a significant impact on one’s ability to fall asleep and stay asleep throughout the night.

How Sleep Deprivation Influences Anxiety

When sleep is disrupted or insufficient, it can worsen symptoms of anxiety. According to a study published by the American Psychological Association, researchers found that anxiety symptoms increased even after short periods of sleep loss, such as the case where participants stayed awake only an hour or two later than usual.

When sleep loss is chronic, it can undermine our ability to regulate emotions, increasing risk of developing anxiety and anxiety-related disorders. When sleep loss occurs it causes physiological changes, which increase risk of developing anxiety and anxiety disorders. For instance:

The part of the brain associated with fear response (the amygdala) gets activated and impairs the function of the prefrontal cortex, the area responsible for rational thought, leading to an anxiety response.
The stress hormone cortisol rises when sleep is disrupted. Chronic lack of sleep can lead to chronic stress, leading to elevated risk for anxiety.
The body’s ability to tolerate stress is compromised, increasing susceptibility to anxious thoughts and feelings

The Vicious Cycle

There is a bidirectional relationship between anxiety and sleep disturbances, meaning each condition can lead to the other. Both conditions significantly impact health and well-being.

The interplay between anxiety and sleep begins with shared brain function, most notably:

The amygdala (area of the brain associated with fear and processes emotions) plays a pivotal role in both anxiety and sleep regulation.
The Hypothalamic-pituitary-adrenal (HPA) axis, the area of the brain responsible for stress response, influences both anxiety and sleep-wake cycles.

This relationship is complex, and research is ongoing. However, comprehensive and integrative treatment that involves both areas may break the vicious cycle of improving quality of life.

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Common Sleep Disorders Associated with Anxiety

Sleep disorders are widespread among individuals with anxiety. When anxiety becomes persistent, it can lead to various types of sleep disturbances. The most common types of sleep disorders associated with anxiety include insomnia, sleep apnea, and restless legs syndrome.

Insomnia

Insomnia is a sleep disorder that makes it difficult to fall asleep, stay asleep, or get quality sleep. There are three main ways insomnia can manifest:

Sleep onset insomnia is when you have trouble falling asleep.
Maintenance insomnia is when you wake up in the middle of the night, and you may or may not be able to fall back asleep, or if you fall back asleep it is restless. This is the most common form of insomnia.
Early waking insomnia is when you wake up too early in the morning and don’t fall back asleep.

Insomnia related to anxiety may be due to a heightened state of arousal caused by excessive negative thoughts, worry, and rumination.

Sleep Apnea

Obstructive sleep apnea is a sleep disorder that causes you to stop breathing while asleep. Your brain’s protection mechanism is to wake you up enough for you to breathe – you may not even realize you’ve stopped breathing in many cases, but it still is disruptive nonetheless and can cause serious long-term health consequences.

Research indicates that the breathing issues that accompany sleep apnea can result in several scenarios that explain the link between sleep disorder and anxiety. Sleep apnea can result in the following:

Daytime fatigue and stress, which can trigger anxiety.
Low blood oxygen causes damage and deterioration to organs, tissue, and the central nervous system.
Altered brain structure over time
Elevated carbon dioxide in the blood, due to a person’s impaired ability to exhale.

Restless Legs Syndrome

Restless Legs Syndrome (RLS) is a neurological disorder that causes an uncontrollable urge to move the legs. It can feel like a crawling, pulling, and deeply uncomfortable sensation in the lower legs. It often occurs when idle or at rest and is known to cause severe disruptions to sleep.

RLS symptoms make falling asleep or staying asleep difficult. Sleep-disrupting symptoms include twitching or kicking your legs in bed and an intense urge to get out of bed to move, stretch, or massage your legs. As a result, RLS leads to:

Fatigue or daytime sleepiness
Difficulty with memory, focus, and concentration
Mood changes, or mood disorders, like anxiety.
Research has established a link between RLS and anxiety, not only for the disruptions in sleep, but also the sensations caused by the condition can lead to intense feelings of stress.

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Identifying Signs and Symptoms of Anxiety-induced Sleep Problems

The symptoms that accompany anxiety, like rapid heart rate, nervousness, racing mind, can make it harder to unwind and fall asleep. This can result in anxiety-induced insomnia.

Recognizing Anxiety-Induced Sleep Problems

Symptoms of anxiety-induced insomnia to watch for include:
Racing thoughts, rumination, and worry.
Worry about being able to fall asleep, ruminating about why you can’t sleep, or worrying about going to bed for fear you won’t fall asleep or you’ll have nightmares.
Short and shallow breath, rapid heart rate, nervousness, shakiness, night-sweats, tension, and digestive issues.
Sleep disturbances, like difficulty falling asleep, waking in the middle of the night and not being able to fall back asleep, and nightmares.
Daytime fatigue, irritability, restlessness, and poor concentration

Assessing Sleep Quality

If you have anxiety and sleep is an issue, there are various tools and methods you can use to evaluate how well you’re sleeping, including looking at sleep patterns and potential triggers. Tracking sleep by writing down details can help hone in on the areas that need attention, such as:

Ability to fall asleep
Frequency and duration of nighttime wakefulness
Level of anxious thoughts at bedtime
Presence of physical symptoms of anxiety during the night, such as rapid heart rate, trembling, sweating, etc.
Nightmares or stress dreams
How easy is waking in the morning?

Sleep hygiene practices should also be taken into consideration, such as exposure to artificial light and screens before bed, caffeine and/or alcohol use, diet, and exercise patterns.

For some, it may be worth having a sleep study done for a more comprehensive look at your sleep. A compassionate professional with experience in anxiety and sleep disorders can help you evaluate your sleep and determine the best course of action for relief.

Strategies to Improve Sleep Amidst Anxiety

Living with anxiety is challenging enough without the added challenge of sleep disturbances and insomnia. However, there are strategies for getting anxiety-related insomnia under control.

Create a calming bedtime routine

A pre-sleep ritual will signal your body it’s time to rest. A bedtime routine doesn’t have to be complicated. Two of the most impactful things you can do is decide on a set bedtime and put away electronics at least one hour before your set bedtime.

During that hour, a wind-down routine may include:

A warm shower or bath, or otherwise cleaning up before bed (brushing teeth, washing face, etc.)
Reading
Knitting
Journaling
Listening to soft music
Stretching and mindful breathing.

Environmental Adjustments

Creating a dark, cool, and soothing environment to sleep in can also be incredibly helpful. Your bed should be a comforting place that is used specifically for rest. Investing in quality bedding and pillows can make your bed inviting for sleep.

Mindfulness, Meditation, and Relaxation Techniques

Incorporating mindfulness and relaxation practices can help to reduce nighttime anxiety, even if you do them earlier in the day. Daily meditation is known for its usefulness in reducing both anxiety and sleep issues.

Meditation works both on the mind and body, which makes it especially impactful on calming anxious thoughts and physical stress. Meditation often combines a clearing of the mind with the physical work of deep breathing, which brings deep relaxation to the mind and body.

Mindfulness and relaxation techniques are often practiced prior to meditation for a more comprehensive practice. Yoga, Breathwork, and practices such as progressive muscle relaxation put your focus on something other than your thoughts and feelings. These techniques have a calming effect on the central nervous system, which helps with anxiety and prepare your body for sleep.

When to Seek Professional Help

When persistent sleep issues warrant professional evaluation. When your anxiety-related sleep issues become frequent – persisting for more than a few weeks you should consider seeking a professional evaluation. If your daily life is impacted regularly and consistently, such as brain fog, daytime fatigue, or relationships are affected, it can also be an indication that you could use the help of a professional.

A qualified sleep specialist or therapist with experience in sleep disorders can help you get to the bottom of your sleep disturbances and help with long-term recovery. The right health practitioner will consider possible underlying causes for your anxiety and insomnia, such as hyperthyroidism and other hormonal issues, cardiac problems, and other health conditions.

Therapeutic Interventions

Anxiety-induced sleep disorders are best treated when a combination of therapeutic options are implemented, such as lifestyle modifications, cognitive behavioral therapy, and in some cases, medication.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

Cognitive Behavioral Therapy for Insomnia (CBT-I) is an effective therapeutic technique used to treat anxiety-related sleep issues. It is done alongside a trained therapist who will guide you through cognitive restructuring to address the root causes of sleep problems.

CBT-I treats insomnia by identifying and examining unhelpful thoughts and behaviors that interfere with sleep to improve sleep habits without relying on medication.

There is an educational component to CBT-I to help patients learn healthy sleep habits, such as consistent sleep schedules, bedtime routines, and creative healthy sleep environments.

Medication

Medication should only be used in severe cases of anxiety-induced insomnia. Research supports its use as a temporary tool while treating underlying reasons for your mental health condition. Medication can help improve the symptoms of sleep-related disorders like restless legs syndrome, making sleep less illusive.

However, medication alone will not take away your symptoms for the long term. Medication should be used with caution and under the supervision of a professional. Some medications can cause side effects, such as grogginess and sleepiness the following day, and in some cases, amnesia and thoughts of suicide have been seen. Dependency is also common with sleep medications, and therefore, so withdrawal can also become an issue.

It is recommended NOT to start any medication for anxiety or sleep without the guidance of an experienced and qualified health professional.

FAQs About Anxiety and Sleep

Can anxiety cause chronic insomnia?

Yes. Anxiety can cause chronic insomnia. Persistent worry, fear and nervousness make falling asleep and staying difficult. Also, sleep deprivation can make anxiety worse, contributing to a vicious cycle of anxiety and disrupted sleep.

Not only that, but Studies show chronic insomnia is a risk factor for developing anxiety disorders. So whether you have anxiety or chronic insomnia, you are at risk for the other.

If you think you have anxiety, insomnia, or both, you should seek help from a professional who can help you break the cycle.

Are there medications that can help with anxiety-induced sleep problems?

Some medications can help with anxiety-induced sleep problems. However, it is recommended that medications for such disorders be used as a temporary tool, and under the supervision of a qualified professional.

Medications used for anxiety-induced sleep disorders include:

Benzodiazepines (tranquilizers)
Antidepressants
Diphenhydramine (which should be used very sparingly, and not for more than 2 weeks in a row)

These medications have potential side effects and can be habit-forming. It is important to talk with a doctor before taking anything for anxiety and/or sleep.

How long does it take to see improvements in sleep after starting treatment for anxiety-induced insomnia?

Many individuals will notice improvements in sleep quality within a few weeks of starting treatment. However, everyone is different in how they may respond to treatment. Factors that contribute include:

Severity of symptoms
How long have they been living with symptoms
Commitment to treatment

The preferred treatment for anxiety-induced insomnia is cognitive behavioral therapy. Results from this type of therapy may take several weeks to a few months to show significant results, with most people experiencing improvement after 6-8 sessions. Treatment is long-lasting since it gets at the root of the problem and provides solutions to thought processes and behavior.

Are there medications that can help with anxiety-induced sleep problems?

Medications used for anxiety-induced sleep disorders include:

Benzodiazepines (tranquilizers)
Antidepressants
Diphenhydramine (which should be used very sparingly, and not for more than 2 weeks in a row)

These medications have potential side effects and can be habit-forming. It is important to talk with a doctor before taking anything for anxiety and/or sleep.

How long does it take to see improvements in sleep after starting treatment for anxiety-induced insomnia?

Severity of symptoms
How long have they been living with symptoms
Commitment to treatment

Conclusion

Anxiety and sleep disorders are intricately linked. Anxiety can disrupt sleep, which causes a sleep deficit, which worsens anxiety symptoms, and a vicious cycle ensues. Breaking the cycle is essential to long-term mental health and well-being.

A compassionate and experienced professional can help you evaluate your disorder(s) and uncover underlying causes. They can work with you using evidence-based therapeutic practices like CBT-I, lifestyle, and good sleep hygiene practices. They can also help determine if a sleep aid would benefit you during your healing and oversee that process with you.

References

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Becker PM. The biopsychosocial effects of restless legs syndrome (RLS). Neuropsychiatr Dis Treat. 2006 Dec;2(4):505-12. doi: 10.2147/nedt.2006.2.4.505. PMID: 19412498; PMCID: PMC2671952. https://pmc.ncbi.nlm.nih.gov/articles/PMC2671952/

National Center for Complementary and Integrative Health. (2022, June). Meditation and mindfulness: What you need to know.

https://www.nccih.nih.gov/health/meditation-and-mindfulness-what-you-need-to-know

Pharmacological Treatment of Mental Disorders in Primary Health Care. Geneva: World Health Organization; 2009. Chapter 6, Medicines used in generalized anxiety and sleep disorders. Available from: https://www.ncbi.nlm.nih.gov/books/NBK143206/

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