Lack of Sleep and Anxiety: Connections & How to Cope

What Is Anxiety?

Anxiety is the feeling of unease or vague fear which is experienced when we are faced with stressful situations. It is a sign of an anxiety disorder when the feeling becomes so frequent, intense, and persistent (for 6 months or longer) that it interferes with everyday life. Anxiety can be provoked by life stressors, particular situations (situational anxiety), or social interactions (social anxiety). Anxiety disorders are very common, with 19% of adults in the US experiencing anxiety disorders each year.¹

Common symptoms of anxiety include:

• Feeling on edge, agitated or restless
• Frequent irritability
• Difficulty concentrating
• Excessive worry
• Often feeling tired or low energy
• Muscle tension
• Sweating
• Trembling
• Difficulty falling asleep, or staying asleep
• Stomach or intestinal distress
• Rapid breathing and/or heartbeat
• Avoidance behaviors, to avoid situations which provoke anxiety

What Is the Link Between Sleep & Anxiety?

Anxiety disorders have a strong connection to sleep disturbance. Anxiety can cause insomnia and insomnia can cause anxiety. According to Dr. Nishi Bhopal, psychiatrist and sleep disorder specialist, at least 80% of people with depression and anxiety have sleep issues.²

Anxiety can interfere with the normal stages of sleep. Feeling anxious and ruminating when trying to get to sleep can affect REM (Rapid Eye Movement) sleep. This can also lead to many types of anxiety dreams and more difficulty staying asleep.³

The mental health impacts of sleep deprivation include the possibility of instigating or worsening an anxiety disorder. People who are prone to anxiety are particularly sensitive to the effects of insufficient sleep. When a person is sleep-deprived, the body produces more of the stress hormone cortisol, which activates the nervous system. Consequences can include increased heart rate and faster breathing rate, both of which are associated with feeling anxious.

Can a Lack of Sleep Cause Anxiety?

The stress of not easily falling asleep can keep a person awake and worsen their sense of dread about getting to sleep. The worry about being able to fall asleep can become anticipatory anxiety, which can cause the person to avoid healthy sleep routines. For example, they might try going to sleep later or they might tolerate sleeping fewer hours. These attempts to avoid the stress of falling asleep often result in getting less sleep, which then contributes to the anxiety problem.

Can a Lack of Sleep Cause Panic Attacks?

Lack of sleep can be an indirect cause of panic attacks in someone who is vulnerable to having them. Sleep deprivation triggers a higher level of cortisol in the bloodstream, which activates the nervous system. Nervous system activation includes more shallow and rapid breathing. This change in breathing can trigger a panic attack in someone at risk. Panic attacks at night are not uncommon for those who have daytime panic attacks, although it is unknown what exactly triggers the nocturnal panic attacks.⁴

Effects of a Lack of Sleep

A lack of sleep can impact a person’s life in many ways in addition to increased anxiety symptoms. These include some immediate impacts such as trouble waking up in the morning and later impacts such as ongoing irritability and cognitive impairments. Longer term consequences can include stressed relationships and/or impaired work performance.

Lack of sleep can result in:

• Difficulty waking up or getting out of bed in the morning
• Feeling tired and low energy throughout the day
• Increased frustration or irritability
• Greater risk of accidents or injuries due to foggy thinking or inattentiveness
• Impaired decision-making
• Symptoms of depression, particularly low mood and negative thinking
• Dependence on prescribed or non-prescribed sleep medications
• Dependence on caffeine or other stimulants for alertness
• Poorer memory, trouble learning or poor problem solving
• Missing days of work or being less effective at work
• Conflict with family or co-workers due to not keeping up normal routines or obligations at home or at work
• Stressed relationships at home or at work due to increased irritability
• Weakened immune system
• Increased hunger and snacking and resulting weight gain

A lack of sleep for those with anxiety may also result in:

• Increased heart rate and blood pressure as a result of higher norepinephrine levels in the blood. Studies have shown that people with mild to moderate hypertension have increases in both heart rate and blood pressure when sleep-deprived.⁵
• Impaired memory. Brain imaging studies have shown that sleep is necessary to consolidate a memory, or “make it stick”. Research has shown that, without adequate sleep, it is more difficult to absorb new information and to recall it.⁶
• Less clear thinking. Studies have shown that a lack of sleep impairs a person’s ability to focus and to learn new information. For an anxious person who already has difficulty focusing, sleep deprivation would worsen this symptom.⁶
• More daytime worry or ruminating about being unable to fall asleep. This anticipatory anxiety can increase various anxiety symptoms for those who are already anxious.

12 Tips for Improving Sleep with Anxiety

Usually, there is no single fix for sleep problems. Most people with sleeplessness need to employ several changes on a consistent basis over time. This is in part due to the fact that there are numerous different causes of sleep disruption, including biological, psychological, and environmental factors, plus lifestyle habits.⁷  However, there are some basic tips for improving sleep when you are struggling with a lack of sleep.

Here are 12 tips for improving sleep quality:

1. Maintain a Healthy Sleep Schedule

Set an alarm to wake up at the same time each day in order to establish a sleep routine. Having a routine time to wake up can make it easier to fall asleep at roughly the same time also. It may take a few nights of less than adequate sleep, but in time, it can allow you to feel tired at an earlier hour.

2. Stay Physically Active

Studies show that moderate aerobic exercise increases the amount of slow wave sleep a person gets. Slow wave is the deepest level of sleep and is the stage in which both brain and body rejuvenate.⁸ Aerobic exercise also triggers the release of endorphins, which can cause wakefulness for some people. For this reason, it’s important for each individual to determine whether they are better off exercising earlier in the day rather than in the evening.

Exercise doesn’t have to be aerobic to benefit sleep. Studies have shown that there are mental health benefits of exercise of various forms, including power lifting and yoga for anxiety. Exercise has been shown to elevate mood and decompress the mind, making it easier to fall asleep.⁸

3. Turn Off Devices 1-2 Hours Before Bed

The blue light emitted by many devices has a stimulating effect similar to caffeine. Light is the major factor in regulating our circadian rhythms of sleep and wakefulness. Blue light is critical to avoid before sleep because it suppresses the body’s release of melatonin, which is the hormone that makes us feel drowsy. Commonly used sources of blue light include smartphones, TV screens, tablets, E readers, and video game consoles.⁹

4. Block Out Light

Daylight from sunshine can also have the effect of disrupting our sleep, making it more difficult to fall asleep or to stay asleep in the early morning hours. Hanging black out curtains is one way to reduce the effects of sleeplessness caused by daylight.

5. Try Guided Meditation for Sleep

There are many versions of meditation for sleep which can be found online and range from 5 minutes to 20 minutes.  These usually encourage focus upon breathing slowly and allowing thoughts to come and go without trying to force them away. Attention is gradually shifted to physical sensations in the body and the conscious relaxation of muscles.¹⁰

Another option is to try meditation for anxiety. This form of meditation helps by encouraging the person to notice their own anxious thoughts and to identify them as simply ideas rather than truths or realities. By gaining this awareness, it is easier to let the thoughts go as meaningless symptoms of anxiety. Although not specifically intended for sleep, this might be helpful for those whose ruminations keep them awake.

6. Make Your Bedroom Peaceful & Pleasant

Physical comfort that comes from having a comfortable bed, pillows and sheets can make a big difference in sleep quality. Any changes to make the room more relaxing and conducive to sleep can improve your ability to fall asleep and stay asleep.

7. Avoid Alcohol, Caffeine, & Nicotine

The stimulating effects of caffeine and nicotine can make it more difficult to fall asleep, especially if used in the afternoon or evening. It can take up to 10 hours to completely clear caffeine from your bloodstream.¹¹ The amount of time for the body to clear nicotine varies widely, with a minimum time of 2-3 days.  Nicotine disrupts sleep by interfering with the neurotransmitters which regulate sleep.¹²

As a sedative, alcohol can make it easier to fall asleep, but it reduces the quality of the sleep overall. The time spent in REM sleep is decreased as the time in slow wave sleep increases. The general effects are more disruptions of sleep and fewer total hours.¹³

8. Avoid Eating Before Bed

The effect of food is to energize the body and brain. Eating before bed disrupts sleep by fueling the body and interfering with the circadian rhythms of sleep and wakefulness. The ideal window of time between the last meal and getting to sleep is 3 hours. This gives the body time to digest the food without having additional time in which the person might feel hungry again.¹⁴

If eating before bed is the only option due to work schedules or other circumstances, it’s helpful to limit yourself to healthy sources of protein and fats. This should help to avoid being too hungry to fall asleep while causing the least disruption to sleep.

9. Avoid Long Daytime Naps

While short naps generally don’t interfere with nighttime sleep, long or frequent naps can disrupt nighttime sleep. For most adults, a 10 to 20 minute nap is long enough to get the benefits without causing problems with sleep at night. Individual factors make a difference in how much sleep might be of benefit and what time of day is best for taking a nap. A general guideline for those with daytime work schedules is to keep any naps before 3 PM.¹⁵

10. Write Down Thoughts

When thinking or mental planning is keeping you awake, consider writing down your thoughts on paper. This might allow you to rest assured that you won’t forget what you’re thinking about or what your next step is to fix a problem you’re having. This self-reassurance can help quiet your mind so that you can fall asleep.

Another way to make it easier to fall asleep is to simply write down something for which you feel grateful in that moment. Even simple thoughts, such as gratitude for your pets or for the quiet of your home, can be effective. Studies have shown that writing down thoughts of gratitude improves sleep quality and sleep duration.¹⁶

11. Don’t Lie in Bed Awake

When you stay in bed awake after about 20 minutes of trying to fall asleep, you begin to associate your bed with being tense or anxious. This association makes it more difficult to relax and fall asleep. Lying in bed awake at night has the effect of disrupting good sleep habits.

After 20 minutes of frustration trying to get to sleep, it’s better to get out of bed and do something which is calming or even boring for you. This might be reading a book, stretching, or doing some deep breathing. Avoid screens; those will create problems with blue light. Wait until you feel sleepy or drowsy before you get back to bed. In this way, you’ll gradually break the association between being in bed and feeling tense.

12. Silence Devices

Make it a priority to be able to stay asleep once you’ve fallen asleep. To prevent sleep interruptions from your phone or tablet, silence your notifications during sleeping hours. You can still use your phone’s alarm while keeping other notifications silenced.

When to Seek Professional Help

If coping on your own with a lack of sleep doesn’t work, it may be beneficial to find an online therapist. While many people occasionally have trouble falling asleep or staying asleep, sleep problems can become persistent and regular. Chronic sleep problems can interfere with mood and/or functioning and lead to other problems. It’s never too soon to seek help, whether it’s for a specific sleep problem or for an underlying cause of the sleep problem.

The connection between sleep and anxiety suggests that treatment for anxiety can be very beneficial to improving sleep. Options for treating anxiety include medications and therapy for anxiety. Therapy helps by targeting the distressing thoughts and emotions so that the tension and nervousness are lessened.

Treatment options for anxiety include:

• Cognitive Behavioral Therapy (CBT): The most effective therapy treatment is CBT for anxiety. The therapist helps the client to identify the thoughts that create or maintain their anxiety symptoms. The client is then guided to replace these thoughts with less distressing and more calming thoughts. With practice, the result is feeling more at ease and having relief of symptoms.
• Eye Movement Desensitization and Reprocessing (EMDR): When anxiety is strongly associated with past trauma, such as in PTSD, EMDR has been demonstrated to be successful in reducing symptoms. EMDR uses eye movements, finger tapping, and/or tones to stimulate a healing process in the brain and “unlock” traumatic memories and the symptoms connected to them.¹⁷
• Anxiety Medications: For people who have moderate to severe anxiety, medication can be very helpful in relieving symptoms. While medication for anxiety is not intended to cure the anxiety disorder, it does help to reduce symptoms. The combination of medication and therapy for anxiety is more effective than medication alone.
• Over-the-Counter Supplements: Supplements should only be taken under the guidance of a physician and are generally less effective than prescribed medication for anxiety. Certain supplements have been known to promote relaxation, potentially helping with anxiety: L-theanine, lavender, and chamomile. An ancient remedy, ashwagandha, has been shown to lower levels of the stress hormone cortisol in the bloodstream.¹⁸
• Relaxation Techniques: There are several effective relaxation techniques that can be easily learned and used throughout the day. These include deep breathing, progressive muscle relaxation, and guided imagery. Autogenic training is another relaxation technique, although it is more difficult to master and often takes professional guidance to learn.
• Hypnotherapy: Hypnosis involves getting the mind and body to relax and be ready to accept helpful suggestions for change. Hypnosis for sleep can help to indirectly manage anxiety by improving the ability to fall asleep and get good quality sleep. After being taught by a qualified therapist, a person can use self-hypnosis to calm themselves and facilitate falling asleep.

Final Thoughts

Having anxiety symptoms and a lack of sleep can be difficult and might feel overwhelming at times. There are ways to cope with both, and stop the cycle of sleep deprivation and anxiety. If you have tried coping on your own but are still struggling, it may be time to seek professional help. There are various effective treatments for anxiety and asking for help is the first step.