Sleeping with the Enemy:
How does Anxiety Target your Sleep?
By Mark Mattei,
Expert Reviewed by Kali Patrick
Disclaimer – Nothing on this website is intended to be a substitute for professional medical advice, diagnosis, or treatment… Read More Here.
Although it was the middle of the night, I remember my first episode as clear as day. In the weeks prior, I had been abnormally stressed and extremely sleep deprived.
On the night in question, my mind was particularly preoccupied. I was living away from home for the first time in my life and I missed my family.
Somewhere between my memories and worrying about my family’s well-being, I had rolled onto the floor and found myself lying in the fetal position, hyperventilating, and freaking out about everything and nothing; a feeling I would come to know all too well.
At the time I was ashamed to talk about it. I was a man, and men are supposed to be strong, not cowering on their living room floor.
So, for months I sucked it up, not telling a soul. This was an enemy I would have to fight on my own.
Little did I know there were more than 40 million other people dealing with the same symptoms I was experiencing. According to the National Institute of Mental Health, anxiety is a condition that affects 31% of American adults at some point in their lives.
I was not alone, this condition did not make me weak and knowing both of those things made me feel a lot better.
Now, having a better understanding of what I was experiencing, I see how my sleep deprivation and stress had teamed up against me. However, the question remains: what came first, the anxiety or sleep deprivation?
Was it my lack of sleep that caused me stress, or was it my angst that caused my sleep deprivation? Or was it just an unlucky genetic trait passed to me from one of my anxious relatives? Or could it have been a disastrous cocktail of all three?
Stick around to see what the current studies are saying.
Generalized Anxiety Disorder
Excessive worry or anxiety that can be difficult to control that directly interferes with everyday function and behavior.
“People with generalized anxiety disorder may anticipate disaster and may be overly concerned about money, health, family, work, or other issues… They may worry more than seems warranted about actual events or may expect the worst even when there is no apparent reason for concern.” — Anxiety and Depression Association of America [1]
“Sleep disorders are found in over 50 percent of patients with a generalized anxiety disorder. Difficulty in falling and staying asleep is the most common sleep disturbance. People with anxiety disorders report a high level of psychological distress and are unable to relax enough to sleep at night. Insomnia in turn can raise anxiety levels.” — Cleveland Clinic [2]
Panic Disorder
Those who have this condition, experience sudden and repeated panic attacks that may last for several minutes, or even hours.
“Panic attacks are characterized by a fear of disaster or of losing control; even when there is no real danger.” — National Institute of Mental Health [3]
“Nighttime (nocturnal) panic attacks can occur with no obvious trigger and awaken you from sleep. As with a daytime panic attack, you may experience sweating, rapid heart rate, trembling, shortness of breath, heavy breathing (hyperventilation), flushing or chills, and a sense of impending doom.” — Craig N. Sawchuk, Ph.D., L.P. (Mayo Clinic) [4]
Post Traumatic Stress Disorder (PTSD)
This condition arises after a frightening event, that is often perceived as life-threatening.
“People who experience PTSD may have persistent, frightening thoughts and memories of the event(s), experience sleep problems, feel detached or numb, or may be easily startled. In severe forms, PTSD can significantly impair a person's ability to function at work, at home, and socially.” — National Institute of Mental Health [5]
“…up to 70% of veterans report trauma related sleep disturbances…Sleep disturbances can manifest in a variety of ways. Commonly reported sleep disturbances in patients with PTSD include nightmares, anxiety provoking dreams, frequent awakenings, difficulty falling asleep (sleep latency), difficulty staying asleep (sleep fragmentation), decreased total sleep time, and restless sleep.” — Mental Health Clinician [6]
Social Anxiety Disorder
This condition is characterized by someone being nervous or afraid of social interactions that could lead to potential scrutiny or cause the person to be around unfamiliar people.
“The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating.” — National Institute of Mental Health [7]
“Given that social anxiety disorder is one of the most prevalent anxiety disorders, socially anxious individuals may be particularly vulnerable to insomnia… Our data support the contention that social anxiety is associated with insomnia and suggest that depression may play a vital role in this co-occurrence.” — Department of Psychology, Florida State University [8]
Obsessive Compulsive Disorder (OCD)
“Obsessive-compulsive disorder is often a long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions), and behaviors (compulsions) that he or she feels the urge to repeat over and over.” — National Institute of Mental Health [9]
“A late bedtime is associated with lower perceived control of obsessive thoughts, according to new research from Binghamton University, State University of New York.”— Science Daily [10]
Researchers at the UCLA Semel Institute for Neuroscience and Human Behavior described that, “In clinical practice and in research, it is not unusual to find the coexistence of two or more diagnosable conditions in the same patient or at least symptomatic overlap,” demonstrating that these conditions can often coincide with other mental illnesses. Medical professionals have indicated that this overlay in symptoms can often make it difficult for practitioners to diagnose and treat their patients.
While almost all research suggests a correlation between GAD, it may be important to note that contrary findings have been made about OCD and PTSD.
“There is some indication for alteration in sleep maintenance in generalized anxiety disorder and for both sleep initiation and maintenance in panic disorder,” Staner said. “no clear picture emerges for obsessive-compulsive disorder or posttraumatic stress disorder.”
If you or someone you love suffers from either of these conditions, it may be best to consult with a mental healthcare professional to see how they feel on the matter in order to take the proper steps towards recovery.
Stress versus Anxiety
Anxiety and stress are similar, but it is important to not confuse stress with GAD. While stress may lead to the development of this condition and anxiety can cause stress, they are not the same (even though they may appear so from the outside).
Luc Staner, Belgian Psychiatrist, may describe the difference best when he writes, “Anxiety is an experience of everyday life. It typically functions as an internal alarm bell that warns of potential danger and, in mild degrees, anxiety is serviceable to the individual. In anxiety disorders, however, the individual is submitted to false alarms that may be intense, frequent, or even continuous.” [11]
Ph.D. and Certified Registered Nurse Practitioner, Timothy J. Legg, reviewed and approved an essay that describes stress as an event or demand that causes frustration or nervousness. Differentiating between GAD and stress the essay reads, “Anxiety is a feeling of fear, worry, or unease. It can be a reaction to stress, or it can occur in people who are unable to identify significant stressors in their life.”
Stress is related to real events, like an exam or job interview. This is a feeling that often goes away. Anxiety can be based on both the tangible as well as the unknown, like living with a constant worry of death or financial ruin, without any palpable rationale behind these fears.
Anxiety: A Mysterious Origin
“Depression and anxiety are not simple conditions and there is no single cause.” Professor Peter Kinderman, Head of the Institute of Psychology at the University of Liverpool [12]
This condition is still largely misunderstood by many in the general public and even scientists who've spent their lifetimes researching the subject are reluctant to name any one definitive cause. Theories as to where it comes from are helping researchers better understand its mechanism and how it can be effectively managed.
Do Genetics Play a Role?
Studies have demonstrated that conditions like GAD, as well as others, can have genetic origins. This German study demonstrates that GAD has a heritability of approximately 30%, meaning that 3 out of 10 people likely have the condition because of their genetic traits versus other outside causes.
Is It Contagious?
Other research indicates emotions as being contagious through what are called mirror neurons. A study performed by a group of researchers in the Netherlands states, “In recent years, evidence has accumulated for the existence of a mirror neuron system (MNS) for actions in humans.”
This evidence, while still new, suggests that people can contract emotions that can influence human behavior. How this affects anxious people is through what is known as a stress contagion. Carla Marie Manly Ph.D., a clinical psychologist in Santa Rosa told Health.com, “Stress contagion is the tendency to absorb others’ stress, anxiety, and tension.”
This stress contagion functions through mirror neurons in anxious parties when said person surrounds themselves with friends or family members who are presenting stressful behavior, potentially leading to or heightening generalized anxiety or panic attacks.
While stressful emotions can be contagious it is also helpful to know that happy, calming, and otherwise, likewise, positive emotions can influence other people. So, a good way to treat your own anxious behavior, it might be beneficial to surround yourself with some chill, down to earth, and good-natured people.
Traumatic Events
Another trigger that can lead to these conditions is threatening or stressful events that begin a cycle of anxious behavior. A study at the University of Liverpool which analyzed 32,000 participants, found that a traumatic event is one of the most common causes of these conditions.
Lead researcher on the study, Professor Peter Kinderman said, “Whilst we know that a person's genetics and life circumstances contribute to mental health problems, the results showed that traumatic life events are the main reason people suffer from anxiety…” He continued, “However, the way a person thinks about and deals with, stressful events is as much an indicator of the level of stress and anxiety they feel.”
A traumatic event could be defined as
- the death of a loved one,
- a near-death experience,
- a gruesome injury,
- or any other stressful situation found to impact mental health.
So what Does Sleep, or the Lack of It, Have to do with it?
Just like many of the reasons listed above, losing sleep or having a sleep disorder can either cause or make the condition worse. In fact, nearly all psychiatric disorders are linked to some sort of sleep issue.
The Harvard Health Newsletter points out that sleep disorders (like insomnia) were traditionally considered symptoms of a condition. However, recent studies (observing both adults and children) have concluded that these sleep issues “may raise the risk for, and even directly contribute to, the development of some psychiatric disorders.” This is evident across both sleep health and mental health studies.
“Sleep disturbances-(particularly insomnia – are highly prevalent in anxiety disorders and complaints such as insomnia or nightmares have even been incorporated in some anxiety disorder definitions, such as generalized anxiety disorder and posttraumatic stress disorder,” Staner said.
Harvard Health agrees with this describes but they go further by describing the neurological connection between the two:
“Sleep disruption — which affects levels of neurotransmitters and stress hormones, among other things — wreaks havoc in the brain, impairing thinking and emotional regulation. In this way, insomnia may amplify the effects of psychiatric disorders and vice versa.”
Common Sleep Disorders Related to GAD
Nightmares
“A nightmare is a disturbing dream associated with negative feelings, such as anxiety or fear that awakens you. Nightmares are common in children but can happen at any age, and occasional nightmares usually are nothing to worry about.” — Mayo Clinic [13]
While the fear of nightmares can cause anxiety and nightmares can be a dreamlike reflection of anxiety, these conditions do not always correlate. One study demonstrates that they are often actually quite independent of each other.
Insomnia
“Population surveys indicate that the prevalence of anxiety disorder is about 24% to 36% in subjects with insomnia complaints and about 27% to 42% for those with hypersomnia.” — Luc Staner, M.D. [11]
Insomnia and GAD quite often coexist in patients. Either condition can be a symptom or cause of the other and it is often quite difficult to know which came first. If you are having trouble with insomnia, take a look at our list of best mattresses for insomnia.
Nocturnal Panic Attacks
“Nocturnal panic, waking from sleep in a state of panic, is a common occurrence among patients with panic disorder, with 44-71% reporting at least one such attack. Nocturnal panic is a non-REM event that is distinct from sleep terrors, sleep apnea, nightmares or dream-induced arousals.” — Department of Psychology, University of California [14]
This condition is shown to be most severe among patients who experience both daytime and nocturnal panic attacks and may share a similar pathophysiology as adult night terrors.
Treatment Options
Because the symptoms of GAD and sleep issues so frequently correlate and have an alternating cause and effect relationship, treating one condition often addresses the other.
“Indeed, the treatment of the anxiety disorder significantly improves sleep,” Staner writes. “However, when a sleep disturbance predominates, its treatment may improve the management of the anxiety disorder.”
Cognitive Behavioral Therapy
This is a form of goal-driven psychotherapy where the patient meets with their doctor to change thought patterns relating to their problem in order to adjust behavior. This approach has been successful in treating both insomnias as well as anxiety.
“The present study examined these aspects in 44 GAD patients who participated in a treatment study specifically addressing excessive worries through Cognitive Behavioral Therapy interventions… Results indicate that this cognitive behavioral therapy package for GAD does have a significant impact on sleep quality even if sleep disturbances were not specifically addressed during treatment.” — School of Psychology; Research Center, Laval University [15]
Relaxation Techniques
Whether it be meditation, yoga, breathing exercises, muscle relaxation, prayer, or many of the other similar approaches that are used to help calm the mind and body, techniques such as these have been successful in clinical studies to help fight insomnia and anxiety.
“One set of skills used to supplement other CBT skills (such as exposure and cognitive skills) are relaxation skills. Relaxation skills address anxiety from the standpoint of the body by reducing muscle tension, slowing down breathing, and calming the mind.” — Department of Medicine, University of Michigan [16]
Sleep Hygiene
These are the routines and habits necessary to getting a good night’s rest on a consistent basis. Establishing a good sleep environment and routine before bed can help make all the difference in both the quality and quantity of rest.
“Several studies have observed the major repercussions of sleep hygiene on insomnia and mood and in this regard, the specific effect of naps, caffeine, and relaxation is linked to the risk of suffering from anxiety.” — Department of Psychology, University of Quebec [17]
“Ease the transition from wake time to sleep time with a period of relaxing activities an hour or so before bed. Take a bath (the rise, then fall in body temperature promotes drowsiness), read a book, watch television, or practice relaxation exercises. Avoid stressful, stimulating activities—doing work, discussing emotional issues.” — Harvard Medical School [18]
Medication
While physicians will generally recommend other approaches first, they may prescribe or recommend medications for more serious cases of anxiety or sleep disturbance.
“Clinical guidelines generally recommend prescribing benzodiazepines to treat anxiety or insomnia that is severe, disabling and causing extreme distress. Health care providers should consider that benzodiazepine (types of medicine) use is associated with dependence liability and withdrawal symptoms, and should, therefore, be used at the lowest effective dose for the shortest period of time (maximum 4 weeks).” — Geneva: World Health Organization; 2009. [19]
Things to Avoid
Substance use and abuse can exacerbate and cause both sleep problems and anxious symptoms. These drugs can be avoided or controlled to reduce the rate and severity of these conditions.
“Generalized anxiety and sleep disorders may be the consequence of medical conditions, psychiatric conditions (mood or anxiety disorders), concomitant medicine treatments or medicine withdrawal, substance abuse (caffeine, nicotine, alcohol), stress and bad habits.” — Geneva: World Health Organization; 2009. [19]
Caffeine
It is the most widely used psychoactive drug worldwide. Many people know that caffeine can affect sleep but what most people do not know is that it can heighten symptoms.
“The results showed that a group with a higher caffeine intake tends to have… a higher score of depression, anxiety, insomnia, and stress. When influential factors were adjusted, the severity of depression and anxiety increased with statistical significance.” — Department of Family Medicine, Kyungpook National University School of Medicine (Subjects were Korean adolescents) [20]
Nicotine
The use of nicotine has been shown to increase symptoms linked to insomnia and other sleep disturbances but the data on its tie to anxiety is still unclear. Many smokers use nicotine to reduce panic symptoms while other reports have found that smokers feel increased anxiety after nicotine use.
“Cigarette smokers are four times as likely as nonsmokers to report feeling unrested after a night's sleep. Smokers also spend less time in deep sleep and more time in light sleep than nonsmokers. Researchers speculate that the stimulating effects of nicotine could cause smokers to experience nicotine withdrawal each night, which may contribute to disturbances in sleep.” — American College of Chest Physicians [21]
Alcohol
Like with insomnia, alcoholism and anxiety have a comorbid relationship. Anxiety can lead to heavy drinking and alcoholism can lead to various psychiatric disorders.
When it comes to sleep, many think that a nightcap will help them drift off to slumberland, but while alcohol consumption may help some folks relax, it does not typically lead to a more restful and restorative night’s sleep.
“Many individuals use alcohol for its sleep-promoting effects. Nonetheless, alcohol disrupts sleep through multiple mechanisms, such as disrupting electrophysiologic sleep architecture, triggering insomnia, and contributing to abnormalities of circadian rhythms and short sleep duration (SSD) in cross-sectional studies. Alcohol also increases breathing-related sleep events such as snoring and oxygen desaturation, especially in those with pre-existing problems.” — Current Opinion in Psychology [22]
Tips and Tricks for Anxious Sleepers
See your Doctor
You’ve heard it before. It is the go-to phrase that health and wellness writers use time and time again, but it is also our best piece of advice. We don’t claim to have all the answers, and we’re not in a position to know your body like you or your doctor does.
Improve Your Sleep Environment
The bedroom should be a place conducive to rest. Nick Littlehales, a professional sleep coach and author of the book Sleep, indicates the only purpose of a bedroom should be for sleeping. He recommends sleepers have a dark and cool environment.
This can be achieved by using blackout curtains and keeping the air conditioner around 66 degrees at night. Littlehales strongly suggest removing a TV or computer from the bedroom as well as keeping your phone in another room and limiting the use of any blue light emitting devices to one hour before sleep.
Sleepers should also establish a routine that prepares them for sleep. Taking a bath or shower before bed can help the body relax and give you some time to yourself. Likewise, reading a book can help distract you from life’s worries.
Anxious types often have their minds racing before they sleep. A recent study shows that journaling can be a resourceful way of getting all your thoughts out and planning for the next day before your head hits the pillow.
If all Else Fails, Try The Routine Again
That’s right, get out of bed and do it again. The last thing you want to do is create a negative relationship with your sleep space, so, some experts recommend that sleepers leave their room and try and read a book or listen to relaxing music in a separate, dimly lit room.
It is best not to do anything that involves blue lights (smartphone, TV, computer) or is overly engaging. Just be sure not to relax too much while sitting on the sofa, it’s best if you still get to sleep in your bed.
If you are looking for some great quality mattresses, take a look at our list of the Best Mattresses of 2023.
Shed Some Tears
When talking to someone or taking time to yourself, it is okay to cry. Dr. William Frey observed that stress hormones are released in emotional tears, and while other studies question whether or not crying is truly self-soothing, many people admit to feeling better after a good sob.
Talk With A Loved One
Being afraid to talk about it was one of my greatest downfalls when I first had anxiety. Like journaling, talking about our worries, problems, and our most outrageous fears can help us get them off our minds. Disclosing our feelings helps us to feel affirmed and can help us to realize that we’re not alone.
So, now that you have taken the first step to success by learning what to do and how to do it, the next thing is to implement this knowledge and these practices into your daily and nightly routines. As you do so, you may just find that you have control over these conditions and they no longer have control over you.
That’s not to say they are not still there, but these tools can help you more effectively manage your life. As someone who has struggled with this disorder and sleep for the last decade, I’ve been able to use many of these tools. When used effectively and repeatedly, they can and will work.
If you began reading this article by Googling, “Anxiety and Sleep” hopefully you are good and tired by this point in my essay. You have also taken in a ton of sleep inhibitory blue light, so now you just need to lock your phone or shut down your computer so you can get all this blue light out of your face ASAP and get some sleep. Good night!
[1] Generalized Anxiety Disorder (GAD), Anxiety and Depression Association of America
[2] Sleep & Psychiatric Disorders, Cleveland Clinic
[3] Panic Disorder: When Fear Overwhelms, National Institute of Mental Health
[4] Nocturnal Panic Attacks: What Causes Them?, Mayo Clinic
[5] Post-Traumatic Stress Disorder (PTSD), National Institute of Mental Health
[6] Treatment of sleep disturbances in post-traumatic stress disorder, Mental Health Clinician
[7] Social Anxiety Disorder, National Institute of Mental Health
[8] Social Anxiety and Insomnia: The Mediating Role of Depressive Symptoms, National Center for Biotechnology Information
[9] Obsessive-Compulsive Disorder (OCD), National Institute of Mental Health
[10] People Who Go to Bed Late Have Less Control over OCD Symptoms, Science Daily
[11] Sleep and Anxiety Disorders, National Center for Biotechnology Information
[12] Traumatic Life Events Biggest Cause of Anxiety, Depression, Science Daily
[13] Nightmare Disorder, Mayo Clinic
[14] Assessment and Treatment of Nocturnal Panic Attacks, National Center for Biotechnology Information
[15] Insomnia and Generalized Anxiety Disorder:: Effects of Cognitive Behavior Therapy for GAD on Insomnia Symptoms, Science Direct
[16] Relaxation, Michigan Medicine, University of Michigan
[17] The Relationship between Sleep Habits, Anxiety, and Depression in the Elderly, National Center for Biotechnology Information
[18] 12 Simple Tips to Improve Your Sleep, Harvard Medical School
[19] Medicines Used in Generalized Anxiety and Sleep Disorders, National Center for Biotechnology Information
[20] The Relationship of Caffeine Intake with Depression, Anxiety, Stress, and Sleep in Korean Adolescents, National Center for Biotechnology Information
[21] Smoking Linked To Sleep Disturbances, Science Daily
[22] Alcohol and sleep-related problems, Current Opinion in Psychology
Mark Mattei
Mark sleeps like it's his job, and we often have to remind him that it’s not. He likes to study sleep health, writing content, and producing videos on his findings. When he’s not, he’s likely writing the great American screenplay, growing out his beard, or spending time with his family.
Kali Patrick
Sleep Wellness Coach
Sleep Wellness Coach
Kali Patrick is a sleep wellness coach, therapeutic yoga and meditation teacher, & corporate wellness speaker who helps stressed out, busy professionals learn to sleep better, improve their energy, reduce anxiety, & build their stress resilience.
Prior to becoming a sleep wellness coach, Kali spent over 20 years as a type-A perfectionist, over-achieving manger working in Boston-area technology companies. Her wellness coaching and therapeutic yoga certifications and training are complimented by her own experience and recovery from insomnia & burnout.
Kali is passionate about helping others navigate the delicate balance between high productivity and optimal well-being. She especially has success with those who have a hard time falling or staying asleep because of stress & anxious thoughts.
Learn more about Kali and her practice, A Journey Into Health, at kalisleepcoach.com.
