Sleep Health

How Does Anxiety Affect Sleep?

By Noelle Chandler

Almost everyone has experienced it. You climb into bed, turn off the lights, and suddenly your brain is running through your day at marathon speed. Did I turn in that report at work? Did I lock the front door? What about those bills due at the end of the week – how am I going to pay those? And that presentation I have to do tomorrow – am I prepared? Remember the last time I embarrassed myself?

It happens to the best of us. Anxiety is a normal, natural response to life stressors. It’s a state of heightened alertness that helps you become more aware of your surroundings and helps you prepare for possible dangers – whether that’s physical safety, like being alone in a dark parking lot, or emotional safety, like preparing yourself for a test or presentation. But when anxiety becomes so intense that it causes problems at work, school, or in your relationships, or if it lasts even after the stressful event or situation is resolved, these might be indicators of a deeper problem.

Anxiety – What exactly is it?

The American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.” Yep – anxiety isn’t “just in your head.” Affecting over 40 million people in the US alone, anxiety disorders are the most common mental health diagnoses. The National Institute of Mental Health (NAMI) outlines several different types of anxiety disorders; here are some of the most common:

Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder is characterized by “excessive” worry about everyday events or activities. It’s normal to worry to a certain degree about stressors like work, relationships, and any number of other life situations. “Excessive” usually means that the worry you’re experiencing is so severe that it’s impacting functioning in one or more areas of your life, and continues for more than six months regardless of the circumstances. For example, you might constantly be worrying about your finances, even when your bills are all paid, or worry excessively about your grades in school even if you’ve always been an A student.

Social Anxiety Disorder (SAD)

Social Anxiety Disorder, also sometimes called Social Phobia, is characterized by excessive worry or concern about social events or situations. This isn’t just shyness or discomfort. Again, diagnosis requires that Social Anxiety causes problems in one or more areas of life. The Social Anxiety sufferer usually worries so much about social situations that they avoid them altogether, leave early, or make excuses not to go. This may impact their ability to work, go to school, or maintain relationships with friends, family, or romantic partners. Specifically, they are typically worried about being negatively judged or rejected by others in social situations.

Obsessive-Compulsive Disorder (OCD)

Obsessive Compulsive Disorder is one frequently showcased on TV. But the symptoms are not nearly as amusing to the real-life OCD sufferer. It can be a devastating condition. The difference between OCD and Generalized Anxiety Disorder is that OCD requires two parts: obsessions and compulsions. Obsessions are repeated, intrusive thoughts and fears, images, or urges. Usually, they are about potential harm coming to themselves or loved ones. Compulsions are behaviors that the sufferer feels they must perform in order to relieve the anxiety. This can be both physical tasks like handwashing, or mental tasks, like checking or counting. The obsessions and compulsions can take up hours and hours of the day, severely impacting ability to function in everyday life roles. The OCD sufferer typically knows that their obsessions and compulsions don’t make sense. Yet, they feel powerless to resist the urge to engage in them. There are also different categories of OCD. For some, the obsessions and compulsions focus almost exclusively on their romantic relationship. For others, the theme is contamination – a fear that either they will become sick because of contamination, or that they will accidentally contaminate someone else and cause them to become sick or injured. Hoarding can also be a symptom, though there is also a separate diagnosis for Hoarding Disorder, which can look a little different. Sometimes the diagnosis of OCD can be tricky, because, for those that have only mental compulsions, they may not realize they’re engaging in compulsions at all. It’s not uncommon for these OCD sufferers to be diagnosed initially with Generalized Anxiety Disorder before an experienced clinician recognizes the difference.

Post-Traumatic Stress Disorder (PTSD)

Many people who experience distressing events will have flashbacks, nightmares, or intrusive memories about the event. However, the person with PTSD continues to be anxious and/or depressed about the event for months to years afterward. PTSD frequently goes hand in hand with Panic Disorder, but not always. And, it’s possible to develop PTSD not only from experiencing a trauma first-hand but also from witnessing or even hearing about it.

Panic Disorder (PD)

Panic Disorder is a little different than other anxiety disorders, in that often the panic attacks seem to come “out of the blue.” They occur suddenly, without much if any warning, and often can be detrimental to a person’s life; since they’re nearly impossible to predict, it can impact the ability to work, go to school, and any number of other life tasks. It can also be even more of a financial strain than other forms of anxiety. Often people who experience panic attacks experience a fear that they might be dying, which can seem very real, so they go to the emergency room. The cost of ER trips can really add up. Often, because the experience of having a panic attack is so distressing, the sufferer has a great deal of fear about having another one. Unfortunately, this only makes it more likely that a panic attack will occur.

Symptoms of anxiety disorders are frequently very similar, and many overlaps. It’s also common for a person to be diagnosed with more than one type of anxiety disorder. Some of the most common symptoms of anxiety disorders include:

  • Irritability
  • Muscle tension
  • Memory problems
  • Sleep problems
  • Easily fatigued
  • Feeling “keyed up” or “on edge”
  • Rapid heartbeat
  • Shortness of breath
  • Sweating
  • Trembling or shaking
  • Feeling “out of control,” like you’re “going crazy,” or a sense of “impending doom”
  • Intense fear of situations, environments, or objects that lead to avoidance

Again, it’s important to keep in mind that having one or more of these symptoms doesn’t mean you have an anxiety disorder – most of these symptoms appear in other physical and mental health conditions and are even normal reactions to a number of life events and situations. But if the symptoms become so intense you can’t stand it, or if they begin to cause problems in your life, give your doctor a call.

Anxiety and Sleep – A Vicious Cycle

The link between anxiety and sleep is well-established. You probably already realized that stress and anxiety can lead to sleep deprivation. But research from The Anxiety and Depression Association of America (ADAA) indicates that it can also work the other way around – sleep deprivation can also cause anxiety. This can lead to a vicious cycle where you don’t sleep because you’re anxious, which then makes the anxiety worse, which makes it even harder to sleep. Chronic insomnia can greatly impact mood regulation – when you’re tired, things that might usually roll off your back can seem intolerable, sparking anger, anxiety, or depression, which can also make it more difficult to sleep. But don’t worry – there are a few things you can try at home.

First, make sure you’ve got the right mattress. The Better Sleep Council suggests replacing your mattress every 7 – 10 years. There are a number of factors that go into choosing the right mattress for you – check out our Mattress Buying Guide for more info. If you’ve got the right mattress, and you’re still having trouble sleeping, here are a few things you can try:

  • Deep Breathing and Guided Meditation. There are a TON of apps out there designed to help you calm your mind before bed – some of the most popular are Calm, Insight Timer, Aura, Headspace, and Breethe.
  • Read a Book. This works better for some people than others; the important thing is to swap out screen time, as the blue light from your TV, tablet, phone, and other devices can throw off your circadian rhythm – the timer in your head that says it’s time to sleep or wake up – and decrease the amount of melatonin your brain produces – one of the primary hormones responsible for making you feel tired.
  • Get Out of Bed. If you lay in bed for twenty minutes and still can’t fall asleep, get up and do something else – maybe try one of the activities above, like meditation or reading a book, or listen to music. Lying there awake can lead your brain to associate your sleeping environment with wakefulness – and probably a fair amount of frustration and anxiety, too.
  • Work on that Bedtime Routine. A good bedtime routine looks a little different for everyone; but making sure you go to bed, and wake up, at the same time every day – yes, even weekends – is one of the most important parts of a good bedtime routine.
  • Sleep Hygiene. No, we’re not talking about brushing your teeth – though that’s important too. Sleep hygiene includes a regular bedtime routine, as well as environmental factors – like making sure your room is cool, dark and quiet; avoiding eating & exercise too close to bedtime; using the bedroom just for sleep – not working, watching TV, etc.; avoiding or reducing alcohol and caffeine use; and keeping your eyes off the clock.

When At-Home Strategies Aren’t Working

Anxiety is, of course, only one of several challenges that lead to sleeping problems. Other sleep disorders, mental health disorders such as depression or anxiety disorders, and physical health disorders can cause trouble sleeping – both falling asleep, and staying asleep. Sleep apnea, insomnia, panic attacks, sleepwalking, narcolepsy, and restless leg syndrome are some of the most common. So, if you’re having trouble sleeping, again, it’s important to talk to your doctor or even a sleep specialist. They can help give you an accurate diagnosis and treatment, and medical advice. If an anxiety disorder is a culprit, here are a few of the things they might suggest:

  • Cognitive Behavioral Therapy (CBT). CBT is by far one of the most effective and well-researched behavioral therapies for anxiety and stress disorders – and, by extension, it can also work wonders for sleep. There are several different techniques and therapies that fall under the CBT umbrella, but in general, CBT is used to identify unhealthy patterns of thinking and behavior and substitute healthier, more effective behaviors.

CBT is usually very structured, and often you’ll be assigned “homework” to practice the skills you learn in therapy in your everyday life. It’s often quicker than traditional psychotherapy – aka “talk therapy,” and most insurance companies are often more willing to cover it.

  • Medications. Often, combining mental health therapy with medication leads to even better results than just one or the other alone. There are a TON of different medications that can help with sleep and pros and cons to each. For example, benzodiazepines like Xanax, Klonopin, and Valium tend to work quickly, with fewer side effects; but they can also be addicting, and your body can get used to them quickly so that you need more and more for it to work. These are usually only prescribed as a short-term fix, and sometimes require a trip to a specialist, like a psychiatrist, as primary care doctors sometimes can’t prescribe them.

Antidepressants, like Prozac, Zoloft, Celexa, and numerous others, can have more side effects in some people, and take longer to work – sometimes 60 – 90 days. On the plus side, they can often be taken long-term, and since they’re not addictive, doctors are more willing to prescribe them – and most primary care doctors and even nurse practitioners can prescribe these.

Beta-blockers often used to treat high blood pressure, can also sometimes help with anxiety as they help with some of the physical symptoms – rapid heartbeat, shaking/trembling, and blushing.

Your doctor will be able to help you decide which medication is best for you by considering any other medications you’re on, your health history, and other health issues.

Final Thoughts

As you can see, getting a good night’s rest can be trickier than it sounds – especially when anxiety rears its head, or tries to join you in bed. But anxiety disorders and sleep disorders are treatable, and there are so many options you and your doctor can choose from. Sleep is so important to keep yourself both mentally and physically healthy. Don’t let anxiety stand in your way.


About the Author

Noelle Chandler

Noelle is a Clinical Mental Health Counselor from St. Louis, MO. She provides therapy to adolescents and adults in individual and group settings. Prior to joining The Center for Mindfulness & CBT, Noelle worked as a Crisis Counselor for Crisis Text Line; as an intern at the Counseling and Social Advocacy Center at UMSL; and as an intern at St. Louis Behavioral Medicine Institute’s Intensive Outpatient Program for OCD and Anxiety-Related Disorders. There, she completed specialized training in Exposure and Response Prevention (ERP), which is a powerful, evidence-based treatment for anxiety, depression, and more. She also specializes in mental health treatment for individuals with chronic pain conditions.

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