Sleep and Anxiety: Relations, Effects, and Treatment

Anxiety and sleep have a cyclical type of relationship. Anxious thoughts can keep you up at night, but the lack of rest can wind up worsening anxiety symptoms.

People with anxiety can experience feelings of nervousness, tension, panic, and restlessness that result from traumatic life events, stress, or even a family history of anxiety. Anxiousness can also cause physical symptoms¹ such as increased heart rate, rapid breathing, sweating, trembling, weakness, and gastrointestinal problems.

Experts say anxiety disorders² are commonly associated with insomnia and other sleep disturbances. As a result, those with anxiety can end up sleeping less and experiencing more fragmented rest, worsening their quality of sleep.
Sleep quality is a measure referring to how well-rested you feel in the morning. Poor sleep quality can have detrimental ramifications on your physical and mental well-being.

Symptoms of poor sleep quality include negative emotions like irritability, difficulty concentrating and remembering things, less physical energy, and an increased likelihood of illness, and as mentioned, anxiety is also a potential side effect of inadequate rest.

Anxiety can come in multiple forms, and these different types of anxiety can affect sleep. Some common types of anxiety disorders include1:

• Generalized anxiety disorder (GAD) – Generalized anxiety disorder³ refers to a persistent worry about multiple everyday things, and these emotions can keep the person up at night. People with GAD may find themselves struggling with uncertainty, overthinking situations, or perceiving situations as worse than they are.
• Panic disorder – When someone has a panic disorder, they’ll experience frequent, intense anxiety that quickly escalates into physical symptoms like shortness of breath, palpitations, and chest pain. These are known as panic attacks1.
• Phobias – A phobia is an extreme fear of a particular person, object, activity, situation, or animal. In certain cases, the person could develop panic attacks from their phobia¹. Some people have a phobia of sleep, specifically, which is known as somniphobia.
• Separation anxiety – Separation anxiety is often associated with children and is when the child has a fear of being separated from their parent or guardian1. This type of anxiety is also seen in dogs⁴ and can develop if the dog was previously abandoned, has a change in schedule or where they live, or there’s a new family member living with them.

Other mental health conditions can cause anxiety that impairs sleep, such as:

• Post-traumatic stress disorder (PTSD) – PTSD can be triggered by a traumatic event such as an accident, physical abuse, military combat, or sexual violence. Those at a higher risk for PTSD⁵ include military members, first responders, those who’ve had childhood trauma, people with other mental health conditions or a family history of them, and people who drink or do drugs in excess.
• Obsessive-compulsive disorder (OCD) – OCD⁶ is a condition in which someone experiences certain obsessions or compulsions. According to experts, this condition can be caused by biological changes, genetics, or learned behaviors.

We mentioned earlier that sleep problems can exacerbate anxiety. Many people have sleep disorders, whether diagnosed or undiagnosed, that can affect the quality and amount of sleep they get, resulting in anxiety. The following are common sleep disorders that can trigger anxiety.

1. Insomnia
2. Narcolepsy
3. Restless Legs Syndrome
4. Sleep Apnea
5. Sleepwalking

Sleep disorders can be harmful to your physical and mental well-being. Short-term effects of inadequate rest include poor cognitive abilities, exhibiting more negative emotions, and less physical energy. Long-term effects of bad sleep include hypertension, heart attack, stroke, diabetes, obesity, and memory problems.

Insomnia is a sleep disorder in which a person has difficulty falling or staying asleep, and it is both a symptom and a cause of anxiety. Insomnia affects sleep quality by causing delayed sleep onset or disturbed rest. The dangers of insomnia⁷ include medical complications like high blood pressure and heart disease. Insomnia also increases your risk of accidents.

Learn more: Is insomnia genetic?

Narcolepsy is a sleep disorder in which a person has extreme daytime drowsiness and sudden urges to fall asleep. Narcolepsy can affect sleep quality by making it difficult to stay asleep at night, which can trigger anxiety symptoms. This condition can be dangerous because someone could experience a sudden sleep attack while on the road or operating machinery.

Restless legs syndrome (RLS) is a sleep disorder characterized by a persistent need to move your legs, especially at night. Experts say that restless legs syndrome⁸ may result from a dopamine imbalance in the brain, which could be hereditary or develop during pregnancy.

Restless legs syndrome affects sleep quality by making it harder to doze off, resulting in shorter sleep durations. The dangers of restless legs syndrome are the same as insomnia because it’s a byproduct of RLS. These dangers include cardiovascular problems, along with worse cognitive, emotional, and physical capabilities.

Find out more about restless legs syndrome.

Sleep apnea is a sleep disorder in which a person’s breathing periodically starts and stops while asleep. There are two types of sleep apnea⁹, obstructive and central. Obstructive results from a blockage in the upper airway, whereas central sleep apnea is caused by the brain not sending the right signals to the breathing muscles.

Sleep apnea can bring about or worsen anxiety, and it affects sleep quality by causing more disturbed rest because the individual often will wake up gasping for air. The dangers of sleep apnea include sleep deprivation, diabetes, medication and surgery complications, and liver problems.

Want to learn more? Read our in-depth guide on sleep apnea.

Sleepwalking is a sleep disorder that causes a person to get up and walk while asleep. The formal name for sleepwalking is somnambulism. Cleveland Clinic¹⁰ reports that anxiety and stress may lead to nighttime disturbances like sleepwalking.

A 2013 study from the American Academy of Sleep Medicine found that sleepwalking11 led to complications associated with poor sleep quality, such as daytime drowsiness, fatigue, and insomnia. They added that sleepwalking also caused depression and anxiety symptoms. Additionally, people who sleepwalk run the risk of hurting themselves.

Learn more about sleepwalking.

Yes, anxiety can cause sleep disorders. The most common sleep disorder triggered by anxiety is insomnia. As mentioned above, the physiological symptoms of anxiety (worrisome thoughts, heart racing, rapid breathing) can make it harder to fall and stay asleep2.

Experiencing anxiety also increases a person’s chance of having nightmares12, which are a form of parasomnia. Parasomnias are unpleasant experiences that happen when you sleep. Some other examples of parasomnias are sleepwalking and talking in your sleep.

There are ways to help yourself sleep with anxiety. Tips to increase sleep quality if you’re experiencing anxiety include relaxation exercises and improving your sleep hygiene.

Relaxation exercises can help your mind calm down and focus your attention away from what’s troubling you. Try some of these examples before bed to induce relaxation:

• Meditation
• Light yoga exercises
• Warm bath
• Reading (avoid stressful reading)
• Deep breathing

Sleep hygiene is a term for daytime and nighttime habits that can influence your sleep. Good sleep hygiene is often recommended to improve sleep quality, which should help alleviate anxiety in the process. Examples of good sleep hygiene include:

• Keeping a consistent sleep schedule
• Comfortable bedroom
• Avoiding electronics before bedtime
• Cutting back on caffeine and alcohol
• Regular exercise
• Not eating large meals late at night

Seeking professional help for anxiety through therapy or medication is also an option. Healthcare professionals will usually try therapy before resorting to medical intervention to improve anxiety and sleep.

Some therapies used to treat anxiety disorders include:

• Cognitive behavioral therapy (CBT): CBT¹³ is a form of psychotherapy that helps an individual learn how to change their behavior. CBT can teach someone how to avoid behaviors and environments that trigger anxiety or insomnia. They may also learn how to change any negative thoughts or emotions associated with rest. Sleep therapies like CBT may incorporate specific techniques like relaxation training and sleep hygiene.
• Interpersonal therapy (IPT): IPT¹⁴ is a type of therapy that concentrates on current problems or relationships in the patient's life rather than on childhood issues. The goal of IPT is to help the patient manage their interpersonal functioning and relationships.
• Psychodynamic therapy: Psychodynamic therapy¹⁵ centers on the patient’s “psychological roots of emotional suffering”, according to the American Psychological Association. This therapy aims to reduce symptoms and prompt a more healthy lifestyle. According to experts, this form of therapy has proven highly effective as well¹⁴.
• Exposure therapy: Exposure therapy¹⁶ is a treatment that has the patient confront their fears. This therapy is often useful for those with phobias, panic disorder, social anxiety, OCD, PSTD, and generalized anxiety disorder.

Medications often used to treat anxiety disorders include:

• Benzodiazepines are a type of medication that’s often prescribed to treat anxiety. Benzodiazepines are sedatives that help relax the muscles and mind. Xanax and Valium are examples of better-known Benzodiazepines. According to the Mayo Clinic, this type of medication is solely for short-term use to help relieve symptoms1. When taking any medication, you want to exercise caution and follow the doctor’s prescription exactly, but because these are also sedatives, you want to be sure you’re not taking them when driving, operating machinery, or during any other task that requires full alertness.
• Antidepressants are sometimes used for anxiety, more specifically, Selective Serotonin Reuptake Inhibitors¹⁷ (SSRIs). Well-known examples of SSRIs are Zoloft, Prozac, Celexa, and Lexapro. According to the Anxiety and Depression Association of America, these medications help quiet anxious thoughts and can also help with sleep, muscle tension, and headaches. They add that doctors typically prescribe a gradual dosage increase of antidepressants over 4-8 weeks, and though you may experience initial unpleasant side effects, these typically go away or lessen over time¹⁷.
• Sleep medications can alleviate anxiety by improving your rest. A physician may prescribe sleeping pills to treat insomnia, but these are supposed to provide a temporary solution. Some people may opt to use natural sleep aids like melatonin or chamomile tea instead of prescribed or over-the-counter medications.

Anxiety and sleep have a cyclical relationship, with one often worsening the other. While understandably frustrating for those experiencing this issue, there are multiple treatment options.

At-home practices could help alleviate anxiety and foster better sleep, including meditation, good sleep hygiene, yoga, and deep breathing. However, people can also seek out professional treatments as well, such as therapy and prescribed medications. While Sleep Advisor sources our details from trusted health and science sources, we are not medical professionals ourselves and encourage our readers to talk with a doctor or therapist for more details on anxiety and improving their symptoms.

References

1. “Anxiety disorders”. Mayo Clinic. Last modified May 4, 2018. https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961.
   Staner MD, Luc.
2. “Sleep and anxiety disorders”. Dialogues in Clinical Neuroscience. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181635/. 2003.
3. “Generalized anxiety disorder”. Mayo Clinic. Last modified October 13, 2017. https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/symptoms-causes/syc-20360803.
4. “Separation Anxiety”. American Society for the Prevention of Cruelty to Animals. Webpage accessed January 13, 2023. https://www.aspca.org/pet-care/dog-care/common-dog-behavior-issues/separation-anxiety.
5. “Post-traumatic stress disorder (PTSD)”. Mayo Clinic. Last modified December 13, 2022. https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967.
6. “Obsessive-compulsive disorder (OCD)”. Mayo Clinic. Last modified March 11, 2020. https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432.
7. “Insomnia”. Mayo Clinic. Last modified October 15, 2016. https://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167.
8. “Restless legs syndrome”. Mayo Clinic. Last modified March 1, 2022. https://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/symptoms-causes/syc-20377168.
9. “Sleep apnea”. Mayo Clinic. Last modified December 23, 2022. https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631.
10. “Sleepwalking”. Cleveland Clinic. Last modified January 22, 2020. https://my.clevelandclinic.org/health/diseases/14292-sleepwalking.
11. “Adult sleepwalking is serious condition that impacts health-related quality of life”. American Academy of Sleep Medicine. https://aasm.org/adult-sleepwalking-is-serious-condition-that-impacts-health-related-quality-of-life/. 2013.
12. “Nightmare disorder”. Mayo Clinic. Last modified June 5, 2021. https://www.mayoclinic.org/diseases-conditions/nightmare-disorder/symptoms-causes/syc-20353515#:~:text=Nightmare%20disorder%20is%20referred%20to,eye%20movement%20(REM)%20sleep.
13. “What is Cognitive Behavioral Therapy?”. American Psychological Association. https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral. 2017.
14. “What is Interpersonal Psychotherapy (IPT)​?”. Centre for Addiction and Mental Health. Webpage accessed January 13, 2023. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/interpersonal-psychotherapy.
15. “Psychodynamic Psychotherapy Brings Lasting Benefits through Self-Knowledge”. American Psychological Association. https://www.apa.org/news/press/releases/2010/01/psychodynamic-therapy#:~:text=Psychodynamic%20therapy%20focuses%20on%20the,patterns%20in%20the%20patient%27s%20life. 2010.
16. “What Is Exposure Therapy?”. American Psychological Association. https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy. 2017.
17. Gomez, Angela F., Hofmann PhD, Stefan G. “SSRIs and Benzodiazepines for General Anxiety Disorders (GAD)”. Anxiety & Depression Association of America. https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/ssris-and-benzodiazepines-general-anxiety. 2020.