Anxiety comes in many forms, from the general worry that comes from everyday life to the intense fear caused by major psychiatric disorders. As debilitating as anxiety can be to our mental and physical health, it’s also corrosive to our quality of sleep—whether you’re a college student pulling an all-nighter or a veteran jolted awake from a nightmare caused by PTSD. This guide covers how anxiety and sleep are interrelated, change with age, and what you can do to improve both.
Anxiety and Sleep
Nearly 40 million people in the US experience an anxiety disorder in any given year. More than 40 million Americans also suffer from chronic, long-term sleep disorders. Those numbers aren’t a coincidence. Anxiety and sleep are intimately connected: The less sleep you get, the more anxious you feel. The more anxious you feel, the less sleep you get. It’s a cycle many insomnia and anxiety sufferers find hard to break.
“anxiety and sleep are intimately connected: the less sleep you get, the more anxious you feel.”
Common anxiety symptoms like restlessness, increased heart rate, rapid breathing, and gastrointestinal (GI) problems make it difficult to fall asleep.
Because insomnia and anxiety are so closely linked, one of the first steps in treatment is to determine which is causing the other — that is, which is the primary cause and which is the secondary symptom. “Sometimes, insomnia is secondary,” says psychotherapist Brooke Sprowl, “in that it is caused by another primary disorder such as depression, anxiety, or a medical condition. In this case, usually treating the primary disorder [improves] the insomnia.”
Whether insomnia is the primary or secondary cause, natural remedies like magnesium glycinate and melatonin have been shown to help with sleep, says Sprowl. Non-medication treatments like cognitive behavior therapy along with good sleep hygiene are also effective at combating insomnia and anxiety.
Health Risks of Insomnia
Insomnia affects cognitive functions and cripples school and work performance. According to one study, 70% of college students with lower GPAs also had difficulty falling asleep. Insomnia also slows reaction times, raising the risks of driving a car or operating heavy machinery.
Sleep deprivation is also bad for your physical health, increasing your risk for developing high blood pressure and heart disease. And long-term sleep disruptions may even raise the risk of some forms of cancer.
Common Sleep Disorders
There are many forms of sleep disorder besides insomnia. All interrupt sleep, threaten our health, and increase nervousness and stress. Here are a few common ones:
Delayed Sleep Phase SyndromeAnyone who has changed time zones or experienced “jet lag” understands the effects of delayed sleep phase syndrome (DSPS). When your sleep and wake cycles don’t align with the current time zone, you feel groggy when you shouldn’t.
While these symptoms are temporary for most, people with DSPS stay out of sync for long stretches of time, negatively affecting their work and activities. Because people with DSPS are forced to conform to the external clock rather than their internal one, they suffer from lack of sleep and increased anxiety.
Obstructive Sleep Apnea
Obstructive sleep apnea is when a sleeper’s relaxed airways close and obstruct breathing. Interrupted breathing episodes occur numerous times during sleep and are usually accompanied by snoring.
Obstructed airways result in lowered oxygen levels and increased carbon dioxide in the blood. Sufferers are often unaware they have the condition. Sleep apnea increases the risk of heart disease, stroke, diabetes, and cancer. Sleep studies are required to diagnose obstructive sleep apnea.
Forms of Anxiety
How do you know if you have garden-variety nervousness or a more serious anxiety disorder? Usually, the difference is how significantly your anxiety affects your life.
For someone at a party who doesn’t know anyone, a certain level of anxiety is normal. However, if their anxiety is interfering with daily activities (e.g. making friends, school work, job performance), They may have a serious anxiety disorder.Whether social nervousness or a serious phobia, every form of anxiety will affect your quality of sleep if it goes on long enough. Below are descriptions of the five major anxiety disorders. If you think you may have one, consult your physician or therapist about diagnosis and treatment.
Generalized Anxiety Disorder
People with generalized anxiety disorder (GAD) display excessive anxiety and worry most of the time. Instead of one source of anxiety, sufferers tend to worry about multiple things simultaneously. GAD symptoms will last at least six months and begin to negatively affect social interactions like school, work, and family life. GAD affects 6.8 million adults (3.1 percent of the U.S. population), yet only 43 percent of sufferers receive treatment.
Social Anxiety Disorder
The fear of public speaking (glassophobia) is still ranked alongside death as a the number one fear among 20 percent of Americans. Social phobias like public speaking apply to formal situations, but for people with social anxiety disorder, their fear extends into informal interactions like eating and drinking in front of others. People with social anxiety disorder struggle when meeting new people, making friends, interacting with teachers, or buying items at a checkout counter.
Obsessive-Compulsive Disorder (OCD)
Those with obsessive-compulsive disorder (OCD) have recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). OCD sufferers often perform repetitive “rituals” like washing their hands, checking, counting, or cleaning. The rituals are intended to lower anxiety levels, but the result is temporary. Obsessive-compulsive disorder is often associated with poor sleep, especially if repetitive behaviors involve getting out of bed.
Panic attacks are unexpected episodes of intense fear followed by physical symptoms like chest pain, heart palpitations, and shortness of breath. These episodes of intense anxiety are the major result of panic disorder. Because panic attacks manifest without warning, the fear of having another one is a major source of fear itself.
Panic disorder makes insomnia worse for many sufferers. Most people will experience only one or two panic attacks in their lifetime. But anyone who has panic attacks frequently enough that they live in fear of having another one, probably has panic disorder.
Post-Traumatic Stress Disorder (PTSD)
Everyone who experiences a traumatic event feels a certain level of anxiety. Our fight-or-flight responses help protect us, whether from a physical attack or a natural disaster. Once the event is over, some residual anxiety is normal—but, eventually, anxiety levels return to normal.
For some people, however, this never happens. Instead, they develop post-traumatic stress disorder (PTSD)—an anxiety disorder where sufferers continually re-experience the fear of a traumatic event(s) long after it has passed. One of the most common symptoms of PTSD is intense nightmares, which are major sleep disruptors.
Although PTSD causes sleep disorders, the disorder also contributes to acquiring PTSD. One sleep study of National Guard members showed this causal relationship. The National Guard members were screened for sleep disturbances a few months before deployment to Iraq. A year later, they came back and were tested for PTSD. Researchers found that soldiers who had sleep disorders before they were deployed were more likely to have PTSD afterward. While PTSD is often associated with military veterans, anyone experiencing a traumatic event can develop symptoms. For example, one in eight heart attack survivors develop PTSD.
Tips for Sleeping With Anxiety
The nightly rituals and sleep habits you use make up your sleep hygiene. Having good sleep hygiene increases your chances of getting quality sleep and relieving anxiety. Bad sleep hygiene includes eating too late, sleeping on a bad mattress, or living near a noisy interstate.
Some changes to your sleep habits are relatively easy to make, others not so much. But each one you can address is another step towards getting a good night’s sleep and reducing anxiety.
Keep a Tight Sleep Schedule
The more you stick to a sleep routine, the faster you’ll fall asleep. Like any other habit, sleep is highly sensitive to change. Sleeping only in your bed (not the recliner) or waking up at the same time on weekends are both effective sleep rituals. They send strong signals to your brain when it’s time to sleep and wake. Alter your routine, and your sleep will suffer.
Sleep schedule consistency also helps lower anxiety levels. Anxiety is about the fear of the unknown. Adhering to a strict sleep schedule reinforces a strong sense of control and predictability into your life.
Regular exercise is often touted as one of the best ways to get a good night’s sleep, relieve tension and eliminate stress. However, if you want to get the most benefit from exercise, do it at the right times.
Exercise releases endorphins and revs up your body and brain. Doing it too late in the evening or just before bedtime makes it harder to fall asleep. Plan your exercise regimen for morning or afternoon. Give your body time to come down and soak in the relaxing effects of physical exercise.
Meditation is a treatment for insomnia that helps lower anxiety.
Mindfulness meditation brings your attention to the present experience by eliminating thoughts about the past and future. It helps you focus on the now by eliminating backward, revisionary thoughts and forward-looking worries. Since the past and future are the subject of most worries, mindfulness helps eliminate those anxiety-producing thoughts.
One study of middle-aged adults showed that six weeks of mindfulness awareness meditation resulted in less insomnia, fatigue, and depression compared to a control group. Get started with meditation by choosing a mindfulness program that’s right for you.
Mindfulness meditation is only one technique in a larger sleep treatment strategy called cognitive behavior therapy, which helps you identify and change thoughts and behaviors that cause sleep problems.
Dampen Distracting Noises
We still have the high levels of alertness our early ancestors employed to stay alive for thousands of years. That’s why even sounds slightly above a whisper (30 decibels) can still disrupt our sleep. With sleep disruptors this quiet, you may not even know they’re affecting you. Here are a few ways to tamp down unwanted nightly noise:
- Use a
to cover random sounds within your sleep space.
- Try earplugs designed for sleeping.
- Soften hard surfaces like floors and walls with rugs or acoustic foam.
- Soundproof curtains for windows.
- Don’t run dishwashers and washing machines at night.
- Plant thick hedges outside your bedroom window to block exterior noises.
Turn Off Bad Lighting
Different lighting colors and intensities affect our circadian rhythms. Bright blue sunlight tells our brains it’s time to get up, dim amber-colored lighting signal that it’s almost time for sleep. That bright street lamp outside your bedroom window may be counteracting your brain’s signal to go to bed. But you can fight light pollution by following these tips:
Improve Sleep-Space LightingUse thick window covering to block out external light. Adjust your alarm clock to a lower intensity setting. Unplug non-essential electronics that contain bright LED indicator lights. Keep your sleep environment as dark as possible, and use strategically placed night lights for safe travels to the bathroom.
Block Blue Lighting Before BedThere are also lights that disrupt your sleep before you lay down. Laptops, tablets, and cell phone screens all emit a blue light that tricks your brain into thinking the sun is still up. They also inhibit the release of melatonin.
Avoid staring into screens an hour or two before bedtime. If digital device abstinence isn’t an option, set your displays to “night mode”. This automatically changes screen colors from blue to amber at sunset—the longer wavelength light won’t disrupt your circadian rhythm. Also, try wearing blue light blocking glasses in the evening.
Get a Mattress and Pillow That Fits You, when we lay on an unsupportive mattress or overly stuffed pillow, pressure points build on our sides, back, and neck. These pressure points cause us to literally toss and turn in an attempt to find a comfortable position all night. Relieve pressure points by getting a mattress and pillow that conforms to your body. Most modern memory foam, latex, and elastic polymer mattresses are designed to conform to your body while also supporting it—but tests show mixed results. Your pillow should support the curves of your head and neck while keeping your head cool. Good air circulation keeps your head cool and comfortable. Look into getting a pillow that offers proper airflow.