Sleep Anxiety: Symptoms and Remedies (Science-Backed)

How do you get to sleep when your mind is racing?

Every type of anxiety disorder is associated with sleep disturbances (1). Even without a disorder, it’s still a problem that most people face at some point, to varying degrees of severity.

This post summarizes the latest research on sleep anxiety and how to get rid of it. Fair warning though, there’s no magic pill that’s going to fix everything instantly.

How to Test Sleep Anxiety

If you’re reading this for personal education, take our free online sleep anxiety test to get a quick indication of how high your sleep anxiety is. It only takes a minute or two.

The test is based on the Anxiety and Preoccupation about Sleep Questionnaire (APSQ), which has been proven to be quite accurate at predicting anxiety and sleep issues (2).

Aside from that, an anxiety disorder diagnosis requires professional observation and possibly a sleep study.

Causes of Sleep Anxiety

“Sleep anxiety” is not a disorder by itself, but more of a symptom.

There are many anxiety disorders (e.g. separation anxiety, panic disorders, etc.), and sleep disturbances are a known symptom of all of them.

But the main root cause of anxiety can vary widely based on the situation. One study showed that (3):

• Insomnia appeared before the anxiety disorder in 18% of cases
• Anxiety and insomnia appeared about the same time in 38.6% of cases
• Anxiety appeared before insomnia in 43.5% of cases

So there’s a strong link between the 2 conditions, but either one can trigger the other.

And it’s a problem for people of all ages, even young children, especially those with separation anxiety (4).

In cases where insomnia appears before anxiety, the anxiety is typically caused by:

• Worrying about sleeping well (getting to or maintaining sleep, biting their tongue, having nightmares)
• Worrying about being tired the next day, and all the potential performance consequences (e.g. not doing well at school or work)

In cases where anxiety appears first, there’s too many potential causes to count (e.g. work stress, relationships, moving, sickness, etc.). Some people even only have anxiety when sleeping next to someone.

And if you think about it a bit, either situation can lead to the other one, which is why anxiety and insomnia are bidirectionally related.

For example, stress from work can cause anxiety, which then causes sleep issues, which then causes even more anxiety during the day. It can be a vicious cycle.

SummarySleep anxiety isn’t a specific disorder, but a general description of having anxiety about sleeping well. It can develop as a result of spontaneous sleep issues, or from anxiety from one of the many facets of life.

Symptoms of Sleep Anxiety

The only reliable symptom of sleep anxiety is a racing mind that won’t quiet down at night and keeps someone from sleeping.

There may be other symptoms depending on if a person has an anxiety disorder, which may include (1):

• Feeling nervous
• Increased heart rate
• Breathing faster
• Sweating
• Trembling or being restless
• Jolting awake and feeling alert (5)

Being physically tired but unable to sleep can be a sign of sleep anxiety, but it could also be a biological issue like not having enough melatonin (from blue light exposure or another disorder).

Sleep studies do reveal differences in sleep architecture in some anxiety disorders, but not always reliably (6). It’s a tool a doctor might use as confirmation, but typically not the sole test used for diagnosis.

In many cases, sleep anxiety is worst at night while actively trying to sleep. It's why some people sleep better during the day when they feel less pressure.

SummarySleep anxiety is hard to diagnose as symptoms vary widely and can overlap with other sleep issues. Having high anxiety levels when thinking about sleep is the main sign of sleep anxiety.

Other Potential Symptoms and Side Effects of Sleep Anxiety

In some cases, people don’t even recognize that they have high levels of anxiety.

But those high levels of anxiety increase the risk of two major conditions: insomnia and depression.

It’s often when those symptoms come up and someone seeks treatment for them that the original anxiety is discovered.

Remedies to Overcome Sleep Anxiety

The best treatment method for sleep anxiety depends on both the severity of symptoms and the specific type of anxiety.

However, most prescribed treatments are not too different from how you treat insomnia or generalized anxiety disorder. You can typically treat both at the same time.

CBT for Sleep Anxiety

Cognitive behavioral therapy (CBT) that’s tailored towards insomnia or anxiety is usually the most effective treatment method for either condition (7).

At this point it has quite a bit of evidence behind it in either case.

CBT involves behavioral changes (sleep hygiene for the most part), and cognitive changes (restructuring how you view certain thoughts). You’re essentially looking for thoughts that cause you a lot of anxiety that aren’t fully rational, and then conditioning your mind to see them logically.

However, there aren’t too many studies specifically on sleep anxiety. The ones that do exist show positive results as expected.

A 2015 study concluded that even online CBT can be effective (8)

These findings corroborate the efficacy of online CBT for insomnia, and suggest that these effects were produced by changing maladaptive beliefs, as well as safety behaviors.

Another study found a similar result that online CBT was effective for children as well (9).

One very important note is that CBT isn’t always effective.

In general, CBT has amazing results, but one research team found that in the most severe cases of insomnia in those with social anxiety disorder, CBT has limited effectiveness (10).

We will likely see more studies looking at the effectiveness of CBT in different types of anxiety disorders, but just know that it’s not a simple fix for everyone.

SummaryCBT is an effective and safe way to treat both anxiety and sleep issues in most people with these problems. However, there are concerns that it isn’t effective enough for those with severe sleep issues.

Mindfulness Based Training

While it’s not that heavily studied, there is some evidence that mindfulness based stress reduction (MBSR) could be part of an effective treatment plan for sleep anxiety.

Many elements of MBSR overlap with CBT, so it’s not too surprising.

However, one study of 108 people with social anxiety disorder (SAD) and 38 healthy control subjects found that MBSR was even more effective than CBT (11).

It wasn’t a huge difference, and it’s just one study, but it was a well-designed study that deserves to be paid attention to.

SummaryWhile more research needs to be done, mindfulness based stress reduction could be part of an effective sleep anxiety treatment plan.

Relaxation Techniques for Sleep Anxiety

While it’s easier said than done, relaxation is the general goal state for those with an anxiety disorder.

That brings up the question of whether or not relaxation techniques would work for those with sleep anxiety.

Right now there isn’t much evidence to say either way, although there is some evidence that relaxation therapies like acupuncture and yoga can help improve sleep quality a bit (12).

Here’s what I’ve come across so far:

• Hypnosis - A 2018 review of current studies on hypnosis for sleep found that 58.3% of them found a benefit of hypnosis on sleep quality with low risk of side effects (13). However, there aren’t many high quality studies to make a strong conclusion.
• Progressive muscle relaxation - This technique involves contracting and relaxing muscle groups one at a time, usually for multiple rounds. There’s a decent amount of evidence that this helps with anxiety (see graph below), and could be useful for sleep anxiety (14). Again, more research is needed.

SummaryRelaxation techniques have some evidence that they can be a useful part of a sleep anxiety treatment plan. However, they are unlikely to be complete remedies on their own and typically will only play a small role at most.

Medications for Sleep Anxiety

Behind CBT, sleep and anxiety medication is the second main treatment method that is usually prescribed for those with sleep anxiety.

CBT is usually preferred due to potential side effects of medication, but medications are sometimes deemed necessary depending on the situation evaluated by a doctor.

Research into medication for sleep disturbances in those with anxiety disorders reveal several different medication options that are usually effective (1,6):

• Antidepressants (specifically TCAs)
• Benzodiazepines (BZDs)
• Beta blockers
• Selective serotonin reuptake inhibitors (SSRIs)

SummaryMedication for sleep anxiety cases is prescribed on a case-by-case basis by medical professionals. There are several options if one doesn’t work or produces significant side effects.

Summary: Sleep Anxiety and Insomnia

Sleep anxiety is very common and can lead to long term health side effects if not treated.

It’s a difficult condition to treat, and there are no magical tips that will cure it.

Anyone with significant sleep anxiety needs medical guidance to find a treatment plan for them. This is not something that the vast majority of people can fix by themselves. It typically takes therapy, medication, and time to get rid of sleep anxiety.

References

1. Sleep and anxiety disorders
2. Psychometric properties of an insomnia-specific measure of worry
3. Place of chronic insomnia in the course of depressive and anxiety disorders
4. Pre-Sleep Arousal and Sleep Problems of Anxiety-Disordered Youth
5. Sleep disturbance in anxiety disorders
6. Sleep disturbance in generalized anxiety disorder and its treatment
7. Treatment of anxiety disorders
8. Sleep-Related Safety Behaviors and Dysfunctional Beliefs Mediate the Efficacy of Online CBT for Insomnia
9. Does an Online CBT Program for Anxiety Impact Upon Sleep Problems in Anxious Youth?
10. Sleep quality predicts treatment outcome in cbt for social anxiety disorder
11. Sleep quality and treatment of social anxiety disorder
12. Acupuncture for insomnia
13. Hypnosis Intervention Effects on Sleep Outcomes: A Systematic Review
14. Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19