THE BALANCE

Private admissions

Let’s talk about your next step.

Speak with our admissions team about treatment for you or someone you care about.

Your admissions team

Jil Moore
Jil MooreClient Relations Director
Cynthia Nakhle
Cynthia NakhleAdmissions Manager

Clinical resource

Sleep Anxiety

With anxiety affecting sleep in the long run, multiple issues related to emotional regulation, immunity, metabolism, and decision-making may arise, directly reducing the quality of life.

Medically reviewed byDr. Sarah Boss, MD
Stone residence with a swimming pool, lawn and palm trees

Quick Summary

  • Sleep anxiety involves escalating worry or fear around bedtime, which can make falling asleep, staying asleep, or returning to sleep difficult.
  • Anxiety and sleep disruption can reinforce each other, contributing to rumination, nightmares, fragmented sleep, and physical, cognitive, or behavioral symptoms.
  • Consistent sleep routines, exercise, reduced caffeine and screen use, relaxation practices, and professional support may help manage persistent difficulties.

Despite being a hot research topic, sleep science continues to amaze us. It’s the point where the trio of psychology, neurology, and wellness overlap, leading to a phenomenon that’s so crucial for our mental and physical health. Despite the significance, some are too afraid or anxious to sleep. This unusual phobia, often termed sleep anxiety or somniphobia, is real and carries the potential to destroy lives if not treated in time.

Experiencing high levels of anxiety now and then is typical. Throughout the day, you may go through one or more stressful situations provoking feelings of fear, worry, or nervousness. But these symptoms are particularly prevalent during sleep anxiety at bedtime, making it difficult to fall asleep no matter how tired or exhausted someone is. With anxiety affecting sleep in the long run, multiple issues related to emotional regulation, immunity, metabolism, and decision-making may arise, directly reducing the quality of life.

 In this article, find out more about sleep anxiety, what causes it, and how to overcome it.

Insomnia and other serious sleep disturbances have been widely recognized as common symptoms of anxiety. People with this underlying psychiatric disorder are often plagued with worry and often ruminate about their concerns in bed. As a result, their anxiety levels skyrocket close to bedtime, and this state of mental hyperarousal has been identified as a critical factor in sleep disturbances. Moreover, people with anxiety disorders also have higher sleep reactivity, which means they are more likely to have sleeping difficulties while facing stress.

Stressing out about falling asleep is a factor leading to disturbed sleep, and this distress gives rise to sleep anxiety that reinforces an individual’s preoccupation and sense of dread. Moreover, the negative thoughts they experience about going to bed also create challenges in developing a healthy sleep schedule. Even if such people can fall asleep, they often wake up with severe anxiety in the middle of the night and getting back to bed becomes a challenge for them. The situation often leads to sleep fragmentation that reduces the quality and quantity of sleep.

Several connections have been found between a lack of sleep and anxiety. Research indicates that pre-sleep rumination and anxiety can negatively affect REM sleep, a stage of sleep that involves vivid dreaming. High anxiety levels just before bed can provoke disturbing dreams leading to sleep disturbances. These nightmares, in turn, reinforce negative associations and fear around going to bed.

Interestingly, the association between anxiety and sleep deprivation go both ways. While anxiety fuels sleeping issues, the latter can also instigate or worsen the former. Researchers believe that people vulnerable to anxiety are usually more sensitive to the side effects of a lack of sleep which can quickly provoke or exacerbate the anxiety symptoms.

The exact symptoms of sleep anxiety may vary from one person to another. These symptoms usually begin at night, close to bedtime, and may include the following:

Physical

  • Fast heart rate
  • Shortness of breath
  • Palpitations
  • Dizziness
  • Nausea
  • Sweating
  • Shaking
  • Chest pain
  • Rapid heartbeat

Cognitive

  • Fear of losing control
  • Altered sense of reality
  • Fear of negative evaluation from others
  • Fear of physical injury
  • Poor concentration
  • Confusion

Behavioral

  • Agitation
  • Bedtime avoidance
  • Freezing
  • Pacing
  • Nervousness
  • Frustration
  • Edginess
  • Tension

Sleep

  • Inability to get comfortable
  • Repeated tossing and turning
  • Troubling falling or staying asleep

Practicing a good sleep routine can significantly ease the symptoms of sleep anxiety for most people. Keep the following tips in mind to follow good sleep hygiene:

Exercise regularly

Exercise has been found to improve sleep and lower anxiety. However, do not try to engage in any exercise before going to sleep as it may have the opposite effect on sleep. Prefer hitting the gym in the morning or afternoon to regulate the sleep-wake cycle and manage sleep anxiety.

Change your environment

Control the amount of light and sound that enters your room to get a restful sleep through the night. As a rule, a darker, quieter, and cooler room can increase your chances of calming down an anxious mind and falling asleep. If possible, take a relaxing bath or a shower shortly before bedtime to lower your body temperature and transition into slumber more easily.

Limit caffeine and

Drinking too much or caffeine or consuming it too close to bedtime can increase anxiety and hinder sleep. Make sure to have your last cup of coffee before 4 in the evening and limit the amount of you have at night. Keep the body hydrated if you regularly use or caffeinated drinks.

Relax your mind

Many relaxation techniques have been proven to relax your mind throughout the day and improve sleep at night. Some activities to try in this context include meditation, breathing exercises, and yoga. Even if you cannot practice these techniques every day, simply taking a walk down the neighborhood and breathing in the fresh air can calm the mind and relax a racing mind.

Reduce screen time

Gadgets of all types, including tablets, TV, and phones, emit a specific type of light rays that keep the human brain wide awake. Checking email on your phone or working just before going to bed can also trigger anxious thoughts in some people, making it difficult to calm down the brain. Hence, avoid using these gadgets at least one hour before bedtime. Alternatively, consider reading a book or listening to music to quiet the mind and prepare it for sleep.

Ask for help

Managing anxious thoughts and worry and improving sleep can sometimes become more complicated than exercising every day or turning off your phone at night. If you feel like your sleep anxiety is getting out of control and nothing you do can manage it, do not hesitate to seek help from an expert.

If you think you or someone you love is suffering from sleep anxiety that negatively impacts your life, seeks help from a mental health professional for a proper diagnosis and the right kind of support. These mental health professionals are adequately trained to curate an action plan for improving sleep and controlling an anxious mind at night. This action plan usually includes therapy, medication, or a combination of two.

Some common elements of most sleep anxiety treatment programs are mentioned below:

Cognitive Behavioral Therapy (CBT)

CBT is a popular therapy used by therapists to help clients address the negative connotations they associate with sleep at night. With this therapy, clients can have a chance to take a step back, identify how their negative beliefs and thought patterns are making them feel anxious, and learn ways to manage them healthily.

If appropriately applied, CBT also helps them recognize the fears that clients hold around sleep. It also equips them with tools to reframe their mindset so that these fears can have less of an impact on their rest.

Exposure Therapy

Once clients have developed coping strategies to deal with sleep anxiety, they are usually encouraged to think about naps, deep sleep, and sleep without feeling anxious. Known as exposure therapy, this method helps individuals reduce their anxiety and fear around sleep. It also enables such people to practice their newly learned coping strategies to get a restful sleep at night.

Mindfulness

Many treatment programs include a holistic approach to managing sleep anxiety. These programs often use mindful meditation to quieten their fears and take charge of them. With mindfulness, such people learn how to identify an unhelpful thought, acknowledge it at the moment, and let it pass without letting it take hold of them.

Sleep anxiety is natural and can drastically impact life despite not being widely recognized. It can alter your ability to function normally and lead to poor physical health due to a consistent lack of sleep at night. If you or someone you know has been spending more and more time avoiding sleep or if you experience extreme anxiety every time you think about going to bed, talk to a mental health specialist today.

Questions

Frequently Asked Questions

What is the difference between sleep anxiety and Insomnia?
While the two terms are pretty similar, they cannot be used interchangeably. Sleep anxiety or somniphobia is a type of anxiety disorder characterized by a fear that may keep one from sleeping no matter how exhausted they are. This psychiatric issue may stem from multiple fears, such as fear of health problems, fear of death, or worrying about nightmares.
Insomnia, on the other hand, is a chronic sleep disorder that makes it difficult to fall or stay asleep. People with insomnia often stay awake late, wake up in the early hours of the morning, or may not feel sleepy at all, even past bedtime.
Why am I so scared of going to sleep?
Sleep anxiety may occur due to multiple reasons. For instance, individuals may fear going to sleep because they fear experiencing night terrors or nightmares. Alternatively, they may believe something terrible might happen to them during sleep, such as a fire or burglary. Many people, especially those with an underlying generalized anxiety disorder, may become a lot more anxious around bedtime. No amount of distraction or support can calm them down enough to go to sleep.
For most people, the following three causes trigger sleep anxiety at any point in life:
Genetics
Exposure to trauma in adulthood or childhood
Sudden or drastic changes in life, such as loneliness, financial problems, or divorce
Can anxiety cause a lack of sleep?
The human body is naturally designed to feel tired and relaxed close to bedtime. However, with underlying anxiety, it may end up feeling the exact opposite. For such people, sleeping is perceived as a possible threat that activates their fight or flight response. As this response is activated, their bodies fill up with adrenaline that causes them to experience shortness of breath, palpitations, racing thoughts, loss of concentration, nausea, and other anxiety symptoms. These symptoms can make it extremely difficult to fall asleep.

Editorial evidence

Evidence & sources

Selected clinical guidelines, peer-reviewed research, and public-health sources used in this article.

01Relaxation Techniques: What You Need To Know | NCCIH. (www.nccih.nih.gov).View source
02ClinicalTrials.gov. (n.d.). Search of: insomnia cognitive behavioral therapy.View source
03National Institute of Mental Health. (2024). Anxiety disorders.View source
View all 17 sourcesShow fewer sources
04American Psychiatric Association. (2013). Anxiety disorders.View source
05National Heart, Lung, and Blood Institute. (2022). Insomnia.View source
06National Center for Biotechnology Information. (n.d.). Chronic Insomnia – StatPearls – NCBI Bookshelf.View source
07www.cochrane.org. (n.d.). Interventions for preventing falls in older people living in the community | Cochrane.View source
09Anxiety & Depression Association of America. (n.d.). Anxiety and sleep.View source
10National Institute for Health and Care Excellence. (2019). Generalised anxiety disorder and panic disorder in adults: Management.View source
11www.cochrane.org. (n.d.). Water infusion versus air insufflation for colonoscopy | Cochrane.View source
12Centers for Disease Control and Prevention. (2022). Sleep and sleep disorders.View source
15American Academy of Sleep Medicine. (2021). Cognitive behavioral therapy for insomnia (CBT-I).View source
16American Psychological Association. (n.d.). Anxiety.View source
17Substance Abuse and Mental Health Services Administration. (n.d.). Find support.View source
What this includes
01

Clinical context

Clear information is framed around complex and co-occurring presentations.

02

Individual factors

Assessment remains essential because needs and risks differ from person to person.

03

Next steps

A confidential conversation can help clarify the most appropriate route forward.

Not sure where the situation fits?

Your admissions team

Jil Moore
Jil MooreClient Relations Director
Cynthia Nakhle
Cynthia NakhleAdmissions Manager

A confidential first conversation can help clarify the presentation and whether our setting is appropriate.

THE BALANCE
A PLACE TO BEGIN

Ask about our care

Ask a question or talk with our AI assistant about our care.