Anxiety & Insomnia: Connections & How to Cope

What Is Anxiety?

Anxiety is a disorder affecting 6.8 million adults in the US.¹ Anxiety is characterized by worry about multiple areas of life more days than not, impairing one’s ability to function and creating significant distress. Some of the symptoms include restlessness, difficulty concentrating, irritability, muscle aches, and insomnia. ²

What Is Insomnia?

Insomnia is a condition that makes it difficult for people to fall or stay asleep. Some people may toss and turn for hours trying to fall asleep, while others fall asleep easily only to wake up during the night and then have difficulty falling back to sleep. Insomnia can be short-term or chronic, and it can create tiredness, mental fog, and difficulty concentrating during the day.³

What’s the Link Between Anxiety and Insomnia?

Anxiety and insomnia contribute to each other, worsening symptoms of both disorders. Insomnia increases the risk of developing an anxiety disorder, and anxiety, specifically the accompanying worry and rumination contribute to insomnia.³

Sleep is one of the most important factors for maintaining mental and physical health. Adequate sleep helps the brain function well and makes people more emotionally and mentally resilient. Poor sleep increases negative thinking, makes it harder to deal with stress, makes it difficult to relax, and can create brain fog. All of these things can make it difficult to complete necessary tasks throughout the day.

Daytime stress can spill over into the night, making it difficult to fall and stay asleep. The mind can continue to go around and around, rethinking, doubting, and replaying decisions or interactions. Disrupted sleep is associated with more mental health conditions and is found to be linked to major depression, generalized anxiety, panic, phobias, and substance abuse.⁴

Can Anxiety Cause Insomnia?

Anxiety causes insomnia by creating patterns of negative thoughts, worry, and rumination. Many people with anxiety describe that their minds won’t shut off, their thoughts keep chattering, or they continue ruminating about things many hours into the night. Anxiety can also cause the body to feel keyed up, with an elevated heart rate or trouble breathing, and muscle tension. Furthermore, The stress of not falling asleep can keep the vicious cycle going.

How Do I Know if I Have Insomnia or an Anxiety Disorder?

Anxiety and insomnia have overlapping symptoms and can be hard to tell apart in some cases. Both conditions lead to poor sleep, feelings of distress, and difficulty functioning to some degree. There are, however, some key factors that can help you tell them apart.

Anxiety disorder is different from experiencing some anxiety-related symptoms. People with anxiety disorder worry about a lot of different things, most days for at least 6 months. These worries need to be considered “excessive” compared to what one would expect under the circumstances. They need to be significantly distressing enough to impact someone’s ability to carry out their day-to-day routines and responsibilities.

In addition to these criteria, in order to be diagnosed with an anxiety disorder, one must experience 3 of the following symptoms: Restlessness, fatigue, difficulty concentrating, irritability, muscle aches, and insomnia. ²

Insomnia is also a clinical disorder listed in the DSM-5. The primary characteristic is difficulty falling asleep, staying asleep, or waking up early without being able to fall back asleep for at least 3 months. Sleep difficulty must occur at least 3 nights a week and only applies to people who have the opportunity to sleep. For example, this may not apply to parents of newborns. Like all other mental health disorders, the symptoms must be significant enough to cause impairment in daily functioning, and can’t be attributed to another disorder or use of a substance. ²

13 Tips for Better Sleep with Insomnia Due to Anxiety

Insomnia can make anxiety feel worse, and vice-versa, and a lack of sleep can have a negative impact on almost any area of life, including mental health. Learning how to calm anxiety at night can reduce the impact of insomnia.

Here are some tips for improving sleep when you have insomnia due to anxiety.⁵

1. Stay awake during the day: It can feel tempting to take a nap during the day when you have insomnia and feel tired, but that may make the problem worse. Sleeping during the day can make it harder to fall asleep at night, which creates a vicious cycle.
2. Keep a sleep journal or log: Keep track of your sleep/wake time so you can start to identify any contributing patterns.
3. Wake up at the same time each day: This can help your body get into a routine so that you are tired and ready for sleep at the same time every evening.
4. Keep your bedroom cool and comfortable: Maintaining an optimal temperature in your room can aid with sleep. Find the right temperature for you and stick to it.
5. Avoid stimulants, such as caffeine: Caffeine too late in the day can impede the ability to sleep. As a starting point, you could eliminate all caffeine or other stimulants at noon.
6. Practice relaxation techniques before bed: Relaxation and grounding techniques like gentle yoga, stretching, breath practice, or guided imagery can be great ways to get into a calm, relaxed state before bed.
7. Take a warm bath: One study showed that a warm bath 2-3 hours before bed can significantly reduce the time it takes to fall asleep. Grab your favorite bubble bath and try a nice warm soak. ⁶
8. Listen to a guided meditation: There are many wonderful, relaxing meditations for anxiety available. Experiment and find one that you enjoy.
9. Avoid screens one hour before bed: Some people find that the light from cell phones and other devices interferes with sleep. Try avoiding screens altogether, or switch your phone to nighttime mode.
10. Read something lighthearted or calming: A lighthearted novel, inspiring story (or even a boring textbook!) might be just the thing to quiet the mind and reduce insomnia.
11. Do a brain dump: Keep a pad of paper or journal next to the bed. If your mind starts chattering, write it all down! It doesn’t have to be a big, flowery memoir, it can simply be a list of the thoughts rattling around.
12. See a doctor: Talk to a medical professional to learn about additional treatment options and rule out other disorders.
13. If all else fails, don’t worry about it: Sometimes, lying in bed worrying about not sleeping feeds insomnia. If you can’t sleep, get up and do a relaxing activity like a puzzle, reading, or having some tea.

Treatments for Insomnia Due to Anxiety

If you’ve tried the tips above to cope with insomnia and you still aren’t sleeping well due to anxiety, it may be a sign that treatment could help. There may be different treatments available depending on whether anxiety is causing insomnia, or insomnia is causing anxiety. For instance, a sleep study could be a good idea to rule out medical causes, or therapy to help stop ruminating and anxious thoughts.

Sometimes the guidance you need can be found in therapy. You can find an online therapist to meet your specific needs in a convenient format. Or, you may find a good match using a therapist directory. No matter what path you choose, therapy can offer you a path forward toward healing.

Treatment options for insomnia related to anxiety include:

Cognitive Behavioral Therapy (CBT)

CBT for anxiety can help rewire and change the negative thoughts that feed insomnia with worries and a negative mindset. CBT is a tried-and-true therapeutic approach that is shown to be effective in reducing anxiety.

Hypnotherapy

Hypnotherapy is a guidance-based technique that can reduce insomnia by calming anxious thoughts and body sensations related to anxiety.

Stress Inoculation Training

SIT is a treatment model with the goal of protecting you from the effects of future stressors. This can help you shift your thoughts and beliefs about the stressors in your life and how you cope with them, reducing the anxiety that fuels insomnia.

Biofeedback

Biofeedback is a process where electronic monitoring helps a person voluntarily control automatic bodily functions, such as heart rate. One promising variation uses virtual reality to allow participants to reduce their anxiety based on reading signals from their brains and bodies to reduce stress.

Medications

Medication for anxiety could be an option to help reduce symptoms and negative thoughts that lead to insomnia. If this might be an option for you, talk to your healthcare provider about how to get anxiety medication. There are also medications available for sleep issues. Don’t hesitate to ask for help, but keep in mind that medications come with risks as well as benefits.

EMDR

For people who have a history of trauma, EMDR uses eye movements to help decrease anxious and distressing thoughts and triggers related to past trauma.

Final Thoughts

Insomnia and anxiety symptoms can be difficult to deal with, especially in the way that they can fuel each other to create a never-ending cycle. Fortunately, there are ways to cope, stop the cycle, and get a good night’s rest.