Anxiety and insomnia are two very common problems that may hamper your ability to fall asleep. Both conditions can cause you to lay awake for hours, wondering if you will ever get even a wink of sleep before your day starts again. Additionally, both conditions can play off each other, making the other worse. If you struggle with anxiety or insomnia, or a mix of both, you’re not alone.
This guide will explore the definitions and symptoms of both conditions, how they can affect each other, and what you can do to treat, manage, and potentially stop your anxiety or insomnia from disrupting your sleep.
Facts About Anxiety and Insomnia
Experiencing occasional bouts of anxiety can be fairly common for most people, as anxiety is just an echo of our past survival mechanism of “fight, flight, or freeze” when faced with danger. Although the dangers have changed from animal predators to a fear of being late for meetings, the physiological components of our brains haven’t changed much: our brains still see the cause of our anxiety as a “danger” and thus kicks into action trying to find a possible solution or escape route.
Occasional anxiety is not a cause for concern, but many Americans experience a much more acute, recurring, and overpowering sense of anxiety, which can be the development of an anxiety disorder. Overall, about 40 million Americans suffer from anxiety disorders, and it is the most common mental illness in the U.S.
Anxiety disorders can be caused by very specific triggers (known as “phobias”) or can simply be excessive anxiety for extended periods of time that get in the way of everyday life, regardless of a specific trigger or actually being in danger. In these cases, the brain may flood the body with adrenaline, causing a person to experience heart palpitations, shortness of breath, or causing them to lose their concentration at work or school. Additionally, anxiety can cause serious sleep issues, such as insomnia. While experiencing anxiety attacks may cause many people to feel exhausted or fatigued, the act of falling asleep may actually become harder due to the anxiety and the body’s sense of worry or fear.
Insomnia is a common sleep disorder affecting 3 million Americans that is characterized by the inability to fall asleep or stay asleep for extended periods of time. It can often be a side effect of a larger problem (known as secondary insomnia), but it can also manifest independently for many people, without a predominant cause or identifying the trigger (known as primary insomnia).
There are also people that suffer from both anxiety and insomnia, with each symptom being independent of the other. In these cases, known as bidirectional comorbidity, the two conditions can exacerbate each other and it can be difficult to treat both independently. Additionally, anxiety can be a side effect of other, more serious psychiatric conditions, which can add to the difficulty of treating those with comorbid anxiety and insomnia.
Types of Anxiety
Anxiety disorders come in many forms. Below are some of the most common types, as well as some of their symptoms and effects.
Generalized Anxiety Disorder (GAD): GAD is a form of anxiety that people may experience for extended periods of time, normally more than six months, and is a response to stress related to work, personal health, social interactions, or everyday routines. GAD can create an extreme sense of fear or worry that stems from otherwise normal day-to-day routines or activities, and can significantly impact a person’s work, social, school, or general life. According to the ADAA, about 6.8 million Americans suffer from GAD every year. Some common symptoms may include:
- Feelings of restlessness or being unable to calm down.
- Easily fatigued.
- Brain fog, or having difficulty concentrating and easily losing your train of thought.
- Tight or tense muscles.
- Unable to control or distract yourself from worrying.
- Having sleep problems such as insomnia, restlessness, or feeling unsatisfied from sleep.
Obsessive-Compulsive Disorder (OCD): According to the National Institute of Mental Health, OCD is a condition affecting 2.2 million Americans that causes people to have reoccurring, uncontrollable, and disturbing thoughts, urges, or mental images (obsessions) that can create serious anxiety for the sufferer. This may cause the sufferer to repeat certain behaviors or actions (compulsions) in order to counteract the thoughts or mental images. This can include being unable to leave the home before turning off all the dials in the house and checking all the locks twice, or feeling a compelling urge to drive a specific route in order to avoid potential (but not real) dangers.
Although many people may feel obsessive or may double-check certain things twice, those with OCD typically spend more than an hour a day obsessing over the images or thoughts in their head, and many experience significant problems in their life due to their condition. Some people may also suffer from other anxiety disorders while also suffering from OCD.
Panic Disorder: Panic disorders are the result of experiencing unexpected and recurring panic attacks without warning or due to a specific trigger. The National Institute of Mental Health notes that 6 million adults in America have a panic disorder. These attacks are moments of intense fear that can peak within a few minutes of the initial start. In that time, the body may be flooded with adrenaline, and the person experiencing the panic may experience heart palpitations, severe sweating, trembling or shaking, shortness of breath, a feeling of impending doom, and a feeling of loss of control. Those who experience these attacks may do their best to avoid certain places, people, or situations that can trigger a panic attack, and in doing so, may cause serious problems in their life. Some of the most severe cases of panic attacks may cause agoraphobia or the fear of leaving the home.
Post-Traumatic Stress Disorder (PTSD): PTSD is the development of anxiety or fear due to a shocking, scary, or life-threatening and dangerous event. PTSD is characterized by recurring fears or stresses despite the sufferer no longer being near that event nor in a situation that is life-threatening. Some of the most common forms of PTSD develop from being involved in a war or being the victim of domestic violence or sexual assault, but even small events — such as the sudden death of a loved one — can cause PTSD symptoms to develop in some people. The National Institute of Mental Health states that about 7.7 million adults suffer from PTSD in America. Typically, PTSD can cause:
- Recurring nightmares, flashbacks, or fearful thoughts related to the incident.
- Avoidance of locations, people, thoughts, feelings, or events that may trigger the memory of the incident.
- Being easily startled or feeling constantly “on edge.”
- Difficulty sleeping.
- Angry outbursts.
- Trouble remembering certain details about the event or blocking it out entirely.
- Negative thoughts about the self as well as the world.
- Distorted feelings of guilt or blame.
- Loss of interest in previously enjoyable activities.
Social Anxiety Disorder (Social Phobia): Social phobia is an intense fear or worry related to social or performance situations that, according to the ADAA, affects about 15 million Americans. One of the most common symptoms is a fear of embarrassment or being negatively judged by others. Most commonly, this arises in relation to school, work, or public places. The most intense form of social phobia is agoraphobia or the fear of leaving the house or being in public.
Types of Insomnia
From a medical standpoint, there are multiple levels to measure the severity of insomnia, as well as different types of insomnia.
The severity of insomnia can be broken down into five categories, which were highlighted in a 2019 study published by The Lancet Psychiatry that interviewed about 4,000 people who struggle with sleeping over a period of five years. At the beginning, end, and all throughout the five years, the participants were asked to rank their insomnia based on severity. A large portion of the interviewed population did not change their answers over that time period. Because of this, it’s believed that insomnia types can stay relatively stable throughout a person’s lifetime.
The categories and types are broken down as follows:
- Type 1: highly distressed, often struggling with neuroticism or prone to anxiety and feeling tense.
- Type 2: moderately distressed but sensitive to rewards or positive events.
- Type 3: moderately distressed and not sensitive to rewards or positive events.
- Type 4: slightly distressed and high reactivity, or being very sensitive to stressful life events.
- Type 5: slightly distressed and low reactivity, or being lowly sensitive to stressful life events.
Additionally, there are different forms of insomnia that a person may struggle with, including the following:
- Acute insomnia: This is characterized by a brief experience with insomnia, often due to a stressful life event. It often resolves without the need for treatment.
- Chronic insomnia: This is characterized by having difficulty falling asleep three or more nights a week, for longer than three months. There are many causes that may result in chronic insomnia, but chronic is distinguished by a long-term pattern of difficulty sleeping.
- Comorbid insomnia: As mentioned previously, comorbid insomnia is the presence of insomnia alongside other medical conditions, either psychiatric or physical illnesses such as arthritis or chronic pain. In these cases, insomnia is not a side effect of the condition but exists independent of it.
- Onset insomnia: This type of insomnia is characterized by difficulty falling asleep initially at the beginning of a sleep cycle.
- Maintenance insomnia: This type of insomnia is characterized by difficulty staying asleep, though typically without issue falling asleep initially. Rather, the problem arises due to the afflicted waking up and being unable to fall asleep later at night.
Effects of Insomnia
Sleep is an essential function that the body needs in order to recuperate, heal, and maintain energy. If you’re struggling to get sleep due to anxiety, insomnia, or a mix of both, this can have some unfortunate side effects on the body if left untreated for an extended period of time.
Medical Side Effects
As noted by Healthline, long-term insomnia can lead to other medical issues such as:
- Increased risk of stroke.
- Asthma attacks.
- Increased risk of seizures.
- Weakened immune system functions.
- Increased sensitivity to pain.
- Increased risk of inflammation.
- Increased risk of diabetes mellitus.
- Increased chance of unhealthy weight fluctuation.
- Heightened blood pressure.
- Increased risk of heart disease.
Additionally, prolonged insomnia can shorten a sufferer’s life expectancy significantly. As noted through a collection of sleep studies, lack of sleep can increase a person’s risk of dying by up to 12% compared to those that get a regular 8 hours of sleep.
Mental Health Side Effects
Additionally, insomnia can cause adverse mental health side effects, including:
- Feelings of confusion, irritability, or frustration.
- Emotional instability.
One study found that the lack of sleep could impair the brain’s ability to process negative emotions or experiences, which in turn can increase a person’s chances of developing mental illnesses such as depression or anxiety. Primarily, lack of sleep could be affecting the processes of the amygdala, which is in the primary part of the brain responsible for emotion and memory.
In addition, insomnia may also result in an increased risk for accidents due to daytime sleepiness or may cause other issues related to work and school. It may also affect your sex drive, memory, and judgment.
How Anxiety Can Affect Sleep
Lack of sleep can lead to increased chances of anxiety, but anxiety can also cause a lack of sleep. Unfortunately, the two can intertwine quite a bit, causing one to exacerbate the other.
Anxiety can have a negative effect on your body’s ability to fall asleep as your brain is in “fight or flight” mode, thinking of all potential outcomes for whatever is causing the anxiety. Furthermore, anticipatory anxiety and specific anxiety about sleep can lead to sleep disturbance and insomnia, which then creates a feedback loop that can make both conditions worsen. Insomnia can also make you more irritable and more worried, as your brain is not getting all the sleep it needs in order to function at normal levels.
However, it’s not uncommon to experience anxiety related to sleep. As Winnie Yu, a writer for WebMD noted in her article “Scared to Sleep,” sleep anxiety is a form of performance anxiety. Many people may stress about not getting enough sleep to function, but the stress alone of trying to sleep can cause people to sit awake for hours. Additionally, other fears such as recurring nightmares, fear of sleep apnea (not breathing while being asleep), and more can all lead to disturbed sleep.
Does Anxiety Go Away?
For those people that are diagnosed with a legitimate anxiety disorder, the condition is unlikely to go away. Some people may be able to better control their anxiety disorder with the help and guidance of a therapist or psychologist, and medications may help further control the condition. There may also be specific coping mechanisms to help manage anxiety disorders, however, a permanent “cure” for anxiety does not currently exist.
For those that do not suffer from an anxiety disorder, but only have occasional or intermittent anxiety from time-to-time, this is normal and healthy behavior for many people. Temporary anxiety is likely to diminish over time, and if it is related to a specific place or person, removing yourself from those situations may help the anxiety go away after some time.
How to Get Rid of Anxiety So You Can Sleep Better
If you’re struggling to fall asleep due to anxiety, it could be that treating the anxiety will help solve your insomnia and lack of sleep as well. Anxiety disorders should only be diagnosed by a licensed therapist or medical professional, and these professionals can also help you find treatment regimens as well as, potentially, medications to control the condition. You should not try to self-medicate for anxiety disorders, and should only medicate per the medical advice and supervision of a psychiatrist.
One of the most common and effective treatments for anxiety disorders is continued and guided therapy with a professional counselor or therapist.
The branch of therapy known as Cognitive Behavioral Therapy (CBT) can be effective for many people, as it helps patients suffering from anxiety disorders create new, positive thought pathways that can help when in anxious situations. There are three different types of CBT, each with an individualized approach in treatment, including interpersonal therapy, thought records, and modern exposure therapy.
Another form of therapy is Acceptance and Commitment Therapy, also known as ACT. This form of therapy is more focused on mindfulness training and taking action based on personal values, and is unique in that it is not focused on symptom reduction.
Another useful tactic to combat anxiety is the act of mindfulness when faced with certain situations. As PsychCentral discusses in “Mindfulness: the Art of Cultivating Resilience” acting mindfully can help individuals make radical shifts in how they think and perceive situations by looking at them without judgment.
For example, if you’ve just been fired, you may think “I should have seen this coming” or “I deserve this and I’m a failure.” Mindfulness, however, allows you to look at this same situation, take time to focus on your body, and approach it with increased kindness, creativity, openness, and acceptance. Instead of thinking negatively about the situation, you may start to feel calmer instead, accepting the situation as an unfortunate one, but not one that will set you back.
It is important to keep in mind that mindfulness can take years to develop. It can be tricky to start, and it may help to have the guidance of a trained healthcare professional, but mindfulness can provide a new perspective that allows you to re-evaluate your anxieties and develop healthy coping mechanism to rethink situations in which they arise. For sleep, mindfulness can help your body naturally fall into unconsciousness as you focus solely on your breath.
Shifting Your Perspective
If you suffer from sleep anxiety, Winnie Yu also suggests in her WebMD article “Scared to Sleep” that shifting your perspective can help some people gain more sleep. It’s completely normal to have bad nights of sleep, and sometimes it’s unavoidable, but when you can tell yourself that you expect it to happen, your body may be more likely to relax and naturally fall into sleep.
What to Do When You Can’t Sleep: 9 Tips
Prioritizing a good night’s sleep isn’t just important for your general health, it can also help with feelings of anxiety, as your body is less likely to feel overwhelmed or on edge when you’ve slept well.
However, falling asleep can be difficult, so it’s important to build a strategy for a better night’s sleep. Below are some tips to try in order to improve your chances of falling asleep naturally.
Try Staying Awake
Often, one of the most ineffective ways to fall asleep is to try to force yourself to lay down. This will only result in you tossing and turning for hours, unable to fall asleep.
Instead, try avoiding the bedroom until you naturally feel sleepy. If this means spending the whole night awake, not getting any sleep, then try saving this technique for the weekend so you can catch some sleep when your body naturally wants to sleep.
Many people have a different circadian rhythm — the natural clock in our head that helps us fall asleep — and it could be that your rhythm simply occurs at an abnormal hour of the morning. Once you do start feeling sleepy, allow yourself to go to bed and focus on your breathing instead of any other anxieties.
Keep a Sleep Log
Sleep logs can be useful to help you catalog when you fall asleep and how much sleep you were able to get. You can also take note of all the activities you do before you fall asleep, and this may help you notice a pattern.
The National Sleep Foundation has a useful sleep log you can try to get yourself started. You can also create your own in a personal journal.
Get up at the Same Time Daily
Creating a routine can be an effective way to combat sleep anxiety and insomnia. By getting up at the same time every day, your body will naturally start to adjust your internal clock or circadian rhythm.
One sleep study, highlighted in the Guardian as “A Cure for Insomnia”, found that getting up at the same time every day helped the participant’s body feel sleepy around the same time every night. Over time, this helped the participant’s bedtimes become consistent.
However, creating a nighttime routine can also have similar effects. Winnie Yu for WebMD suggests creating a nightly routine can help relax your body as it starts to anticipate and expect sleep as you follow through each step. It can also help relieve anxiety, as you know what to expect each night and each morning.
Do a Bedroom Makeover
Another helpful trick is to make your bedroom a place for nothing but sleep. For some people living in small loft apartments, this might be tricky, but by putting up a divider or curtain, you may be able to simulate a similar “separate room” effect.
Regardless, redecorating your bedroom for a more comfortable and quiet environment can do wonders for your sleep health. Consider decluttering the room and regularly changing the bedding or adding a rug to make the space more appealing and comfortable.
If you come into your bedroom and still can’t sleep, don’t just lay there and wait for slumber to hit. Instead, get up after 15 minutes and work on some small projects until your body naturally feels sleepy.
Keep Your Room Cool
Keeping your room dark and cool can also have major effects on your ability to fall asleep. Avoid putting a space heater in your room (unless you really need it) so as to keep the room cooler than the rest of your house. You can also cut out some of the natural light and heat by installing blackout or custom curtains over your windows. The more “cave-like” you can make your bedroom, the easier it may be to fall asleep every night.
Limit Caffeine and Other Stimulants
For many people, cutting out caffeine from their diet can be very difficult, but caffeine can greatly hamper your ability to fall asleep. Additionally, as a stimulant, caffeine can make your anxiety much more pronounced, and you may have a difficult time calming down if you drink excessive amounts of coffee.
It could also be getting in the way of you achieving a good night’s sleep. Try avoiding caffeine at least four to five hours prior to when you want to go to bed.
If you know of any other forms of stimulants that you may be taking, try avoiding those at least a few hours before bedtime, as well.
Additionally, some recent studies, such as one conducted by Harvard Health, have come to find that “blue light” (any light that is blue in hue, which is common with televisions, laptops, and smartphones) can keep the brain active, stimulated, and awake, as it suppresses the secretion of the hormone melatonin. This is the hormone responsible for helping you fall asleep, so try avoiding blue light, or wearing amber glasses to suppress the effects of the light, at least two hours prior to bedtime.
Get Rid of Your Clock
Clocks can be a common trigger for anxiety, especially when you’re trying to fall asleep. Instead of having a clock by your bedside — where you can glance at it every time you struggle to fall asleep — keep a clock outside your room instead. Looking at the clock will only cause your anxiety to get worse, so avoid it altogether.
Try Relaxation Techniques
Another way to prep your body for bedtime is to practice some relaxation techniques as you prepare for bed. This can include:
- Creating a warm bath to sit in for a few minutes prior to going to bed.
- Listen to calming music as you brush your teeth, change, and get ready for bed.
- Practice some deep breathing exercises or guided meditation.
Combine this tip with going to bed and getting up at the same time every day, and you may be able to create a relaxing sleep routine that will help your body naturally get sleepy. Routines can really do wonders in calming the brain. You can also get meditation-themed bedroom decor to make the space more conducive to relaxation, even when you aren’t trying to sleep.
Consider a Sleep Study for Insomnia and Mindfulness-Based Therapy
Finally, if you’re still struggling to find sleep, you can always resort to seeking out therapy. Similar to anxiety treatment, those suffering from insomnia can benefit greatly from CBT or other mindfulness-based therapy.
Additionally, participating in a sleep study may help you identify certain patterns related to your nighttime routine. It could be that your brain is unable to get a full cycle of REM sleep, or that your breathing is hampered by sleep apnea. Sleep studies will help you identify these issues, and may then be able to connect you with a professional doctor or therapist to work on treating the underlying issues.
As mentioned earlier, the Guardian article “A Cure for Insomnia” dives deep into a successful sleep study. The creator of the study and clinic, Hugh Selsick, paired a rigorous nighttime routine with CBT and found remarkable results.
One patient, Zehavah Handler, was so transformed by the study and routine that she decided to close her own business and try to open her own sleep study clinic. According to the article, her sleep schedule and mental state has improved dramatically: “There are occasional relapses, Handler said, usually brought on by a change in routine – a holiday away, Christmas – but by waking at a set time, leaving the bedroom after 15 minutes if she remains awake and re-implementing all of the rituals she learned at the Insomnia Clinic, it only takes a few nights to re-establish the routine.”