Anxiety trying to fall asleep

What is it, Causes, Symptoms & Treatment


What is sleep anxiety?

Sleep anxiety is fear or worry about going to sleep. You may be apprehensive about not falling asleep or not being able to stay asleep. Some people also have a distinct phobia, or fear, about sleep called somniphobia. They may think something bad will happen to them while they sleep, or that they shouldn’t sleep because they need to stay alert and watchful.

Sleep and psychiatric disorders, such as anxiety, often go hand in hand. If you have an anxiety disorder, you may find it hard to fall asleep or stay asleep. Similarly, if you have a sleep disorder, you might feel anxious or fearful before bed because you’re afraid you won’t get the rest you need. One condition usually makes the other worse, so it can feel like a never-ending cycle.

Who gets sleep anxiety?

Sleep anxiety can affect adults, teens and children. You may be more likely to develop anxiety at night if you have a sleep disorder such as:

  • Insomnia.
  • Narcolepsy.
  • Restless legs syndrome (RLS).
  • Sleep apnea.
  • Sleepwalking.

People with the following mental health disorders may also develop nighttime anxiety:

  • Anxiety disorders.
  • Bipolar disorder.
  • Depression.
  • Drug addictions or alcoholism.
  • Panic disorder.
  • Post-traumatic stress disorder (PTSD).
  • Schizophrenia.

How common is sleep anxiety?

Anxiety is the most common mental health disorder in the U.S., affecting about 40 million people. Research suggests that most people with mental health disorders such as anxiety also have some form of sleep disruption.

Symptoms and Causes

What causes sleep anxiety?

Anxiety is a natural part of being human. We’re meant to feel afraid or worried in dangerous situations. Stress and anxiety trigger our bodies to release hormones that help us react quickly to escape harm. But if you have chronic anxiety, you might feel stress or worry all the time. You may feel fearful of everyday situations like driving to work or even falling asleep.

Chronically high levels of these hormones, especially before sleep, can make it hard for your body to relax. You may have difficulty falling asleep. If you do fall asleep, you may wake up during the night with stressful or worrisome thoughts and not be able to fall asleep again.

The combination of a anxiety and insomnia can also be caused by a condition where there isn’t enough thyroid hormone in your bloodstream and your metabolism slows down (hypothyroidism).

Research suggests that anxiety can affect rapid eye movement (REM) sleep. This is the phase of sleep when you tend to have vivid dreams. If you have anxiety, the dreams may be disturbing or turn into nightmares that wake you.

Just as anxiety can affect sleep, sleep can affect anxiety. Sleep anxiety is a common characteristic of insomnia, wherein the individual begins to experience anxiety during the day and evening about poor sleep, which may help cause another night of bad sleep.

What are the symptoms of sleep anxiety?

When you can’t sleep due to anxiety, you may experience behavioral changes, including:

  • Feelings of being overwhelmed.
  • Inability to concentrate.
  • Irritability.
  • Nervousness.
  • Restlessness.
  • Sense of impending danger or doom.

Physical effects of anxiety before bed may include:

  • Digestive problems.
  • Fast heart rate.
  • Rapid breathing.
  • Sweating.
  • Tense muscles.
  • Trembling.

Some people also have nocturnal panic attacks. A panic attack is a sudden, intense burst of extreme fear. Nocturnal panic attacks only happen at night, and often wake you from sleep.

Diagnosis and Tests

How is sleep anxiety diagnosed?

Your healthcare provider performs a physical exam, reviews your medical history and evaluates your symptoms. They may ask you questions like:

  • Do you eat or drink anything before bed?
  • Does your anxiety always occur before bed?
  • How long does it take you to fall asleep?
  • How often do you wake up during the night?
  • What activities do you do before bed?

What tests help confirm a sleep anxiety diagnosis?

In some cases, your provider may do a sleep study to find out if you have a sleep disorder. Also called polysomnography, a sleep study is a test where you stay overnight in a sleep lab. Your healthcare provider evaluates how your body works during sleep by checking your:

  • Blood oxygen levels.
  • Body positioning.
  • Breathing.
  • Electrical activity in your brain.
  • Eye movements.
  • Heart rates and rhythms.
  • Leg movements.
  • Sleep stages.
  • Snoring or other noises you make during sleep.

Management and Treatment

How is sleep anxiety treated?

There are a variety of ways to manage sleep anxiety, including:

  • Cognitive behavior therapy (CBT).
  • Healthy sleep habits (sleep hygiene).
  • Medication.

How does cognitive behavioral therapy treat sleep anxiety?

CBT is a form of psychotherapy, or talk therapy. It teaches you how to change your behavior by changing the way you think. It’s a common treatment for people with anxiety. A special form of CBT called cognitive behavior therapy for insomnia (CBTI) focuses on helping people who have insomnia. This therapy can take anywhere from six to 12 weeks to produce results.

During CBT or CBTI, you may learn to:

  • Avoid behaviors or environmental factors that trigger your anxiety or make sleeping difficult.
  • Better understand how sleep and anxiety affect your brain and the rest of your body.
  • Change negative or inaccurate thinking about bedtime or sleep.

Your therapist may teach you how to sleep with anxiety by using biofeedback. Biofeedback trains you to control your body’s functions. You learn to relax your muscles, regulate your breathing, lower your heart rate and focus your attention. Your therapist might use special sensors to measure these bodily functions, or they may give you exercises, such as deep breathing and meditation, to do at home.

How can healthier sleep habits treat sleep anxiety?

Sleep habits, or sleep hygiene, are your routines around bedtime that can affect your sleep. Your healthcare provider may ask you to keep a sleep diary for several weeks. This is a daily log of your sleep habits. It can help identify things that might make it harder for you to fall asleep or stay asleep.

Some common ways to improve your sleep hygiene include:

  • Avoid drinking lots of fluids before bed, especially alcohol.
  • Do relaxing activities before bed, such as meditation or listening to soft, peaceful music.
  • Don’t consume caffeine in the late afternoon or evening.
  • Don’t go to bed unless you feel sleepy.
  • Go to bed and wake up at the same time each day.
  • If you don’t fall asleep within 20 minutes, get out of bed.
  • Make sure your bedroom is comfortable, quiet and softly lit.
  • Only use your bed for sleep and sex. For example, avoid watching television or doing work in bed.
  • Set a goal of getting at least seven hours of sleep every night.
  • Stop using electronic devices at least 30 minutes before bedtime.
  • Try not to eat right before bedtime. If you’re hungry, have a light snack and not a big meal.

How can medication treat sleep anxiety?

Your healthcare provider may recommend medication to treat anxiety or other mental health disorders. Medication can also help improve the symptoms of sleep-related disorders such as restless legs syndrome or insomnia.

But some medications might actually increase your anxiety or make sleeping harder when you first start taking them. If you experience these side effects, talk to your healthcare provider. Many over-the-counter sleep aids can also be habit-forming. Don’t start any medication for anxiety or sleep without your healthcare provider’s supervision.


How can I prevent sleep anxiety?

You may be able to reduce your risk of sleep anxiety by:

  • Eating a healthy diet.
  • Exercising regularly.
  • Practicing good sleep hygiene.
  • Taking medications for mental health disorders or sleep disorders as prescribed by your healthcare provider.

Outlook / Prognosis

What’s the prognosis (outlook) for people with sleep anxiety?

Most people can successfully manage their sleep anxiety with the right treatments. But remember that some treatments, such as medication or CBT, can take time to be effective. Don’t stop treatment prematurely if you think it isn’t working.

Are there long-term complications of sleep anxiety?

Prolonged anxiety or lack of sleep can affect your body in many ways. Sleep anxiety puts you at a higher risk for the following long-term complications:

  • Diabetes.
  • Heart attack.
  • Heart disease.
  • Heart failure.
  • High blood pressure.
  • Arrhythmia (irregular heartbeat).
  • Obesity.
  • Stroke.

Living With

How can I make living with sleep anxiety easier?

Anxiety or sleep problems can affect every aspect of your life, from your performance at work to your interactions with others. It may help to talk about your sleep anxiety with a therapist, co-workers, friends or loved ones. Support groups can also connect you to a community of people dealing with similar experiences.

A note from Cleveland Clinic

Sleep anxiety is a feeling of fear or stress about falling asleep or staying asleep. Sleep problems and mental health disorders such as anxiety are closely intertwined. One can often make the other worse, so it can feel like a never-ending cycle. But anxiety and sleep problems are both treatable. Talk to your healthcare provider about your symptoms and work together to build the right treatment plan. Common treatments include cognitive behavioral therapy (CBT), good sleep hygiene and medication.

Why do you get anxiety at night?

It’s bedtime, and not a creature is stirring…except for your racing mind, that is. Why is it that even after a relatively anxiety-free day, our minds sometimes go into overdrive when our heads hit the pillow?

Why does it happen at night?

Anxiety is a normal human emotion characterized by feelings of nervousness and worry. You may find yourself experiencing anxiety during stressful situations, such as a first date or job interview.

Sometimes, though, anxiety may linger around for longer than usual. When this happens, it can interfere with your daily — and nightly — life.

One of the most common times when people experience anxiety is at night. Many clinical trials have found that sleep deprivation can be a trigger for anxiety. Historically, research also suggests anxiety disorders are associated with reduced sleep quality.

When you lie down at night to unwind, your brain turns to all of the worries it didn’t have time for during the day. Frequently, this anxiety revolves around worries you can’t solve in the moment.

Chronic daytime stress puts your body into overdrive and taxes your hormones and adrenal system, which are directly linked to sleep — so sleep troubles may be a red flag telling you to address stress during your waking hours.

Nighttime anxiety can trigger a vicious cycle: A bad night’s sleep leads to exhaustion the next day and disrupts your body’s natural rhythms.


There are many symptoms of anxiety. Everyone experiences anxiety differently. Symptoms can happen anytime of the day, morning, or night. Common symptoms of anxiety include:

  • feelings of nervousness, restlessness, or worry
  • trouble concentrating
  • trouble falling asleep or staying asleep
  • gastrointestinal problems

Sleep issues and anxiety seem to accompany one another. Lack of sleep can be an anxiety trigger, while anxiety can also lead to a lack of sleep.

According to the Anxiety and Depression Association of America (ADAA), over 50 percent of adults say their anxiety levels affect their ability to get to sleep at night.

There’s very little scientific research on nighttime anxiety. Still, there are many reasons why your anxiety may be worse at night.

You may feel that your mind is racing, and you can’t stop your thoughts. You may be focused on the worries of the day or anticipating things on your to-do list for the next day.

Settle into your routines

  • When it comes to sleep, routine is your best friend.
  • Eating at the same time every day helps regulate your circadian rhythms.
  • Eating breakfast signals that it’s time for your body to wake up.
  • Regular daytime exercise releases endorphins and decreases levels of cortisol, the hormone behind stress.
  • Going to bed at the same time every night teaches your body to get sleepy around the same time.
  • But if you want to lessen nighttime anxiety, it’s still important to implement a specific nighttime routine.

Try quiet, tech-free activities that reduce your cortisol levels and help ease you into sleep, such as:

  • Taking a bath.
  • Reading a book.
  • Journaling.
  • Doing yoga stretches.
  • Try these pre-sleep snacks

If you’re worried you’ll be too worried to fall asleep, head off nighttime anxiety with these all-natural tricks:

  • Drink tart cherry juice or eat a bowl of tart cherries. Studies show that tart cherry consumption can help you sleep for up to 85 minutes longer because they’re a source of melatonin, a sleep aid that reduces inflammation in the body.
  • Make a mug of chamomile tea. This ancient herbal tea has been clinically shown to help reduce anxiety and promote sleep. 
  • Pop a Brazil nut or two. These big, buttery tree nuts are one of the world’s best sources of selenium, which can help your thyroid run smoothly and thus aid in sleep. Just two Brazil nuts have been shown to be as helpful as a selenium supplement.
  • Try not to consume caffeine late in the day, whether in coffee or elsewhere.

Put your phone to bed

Just say no to scrolling before bed — the practice of taking in a barrage of bad news online. And if anxiety keeps you awake or wakes you up, resist the temptation to break this rule and start using your phone. Your phone’s blue light signals your brain to turn back on, ultimately making it even harder to get to sleep. 

If you can’t sleep…

If you wake up with anxiety in the middle of the night, these practical tips can help you stop tossing and turning:

  • Write it down. Keep a journal next to your bed where you can jot down your worries.
  • Listen to soothing music. Studies show that relaxing tunes can calm your autonomic nervous system, which leads to slower breathing, reduced heart rate, and lower blood pressure, all of which help you sleep.
  • Get up but stay calm. If you simply can’t snooze, it’s OK to get out of bed — just be smart about what you do next.
  • And try to avoid self-medication with food, alcohol, or sleep aids, which can provide short-term help but won’t get to the root of your issues.

Meditate on it

  • Gently part your lips.
  • Exhale, making a “whoosh” sound as you do.
  • Silently inhale as you press your lips together for a count of four.
  • For a count of seven, hold your breath.
  • Exhale for a count of eight, and make the whooshing sound again.
  • Repeat this four times as you first start; work up to eight repetitions.


It’s important to remember that it can take time to find the right treatment approach for your anxiety. Because of this, you and your doctor may choose to use a variety of different treatment options.

Treat underlying conditions

There are some medical conditions that can cause symptoms of anxiety. They include:

  • heart disease
  • hyperthyroidism
  • diabetes
  • chronic pain
  • irritable bowel syndrome
  • certain brain tumors

If any of these conditions are causing your nighttime anxiety, your doctor will want to treat them first.

The bottom line

Finally, if nothing seems to help your nighttime anxiety, check in with a physician or therapist, who can help get to the bottom of underlying medical conditions or anxiety disorders.

There are many reasons why your anxiety may be worse at night. Daily stressors, poor sleep habits, and other health conditions can lead to increased anxiety and panic attacks at night.

However, there are many treatments available that can help ease your anxiety and improve your quality of sleep. If you’re concerned that your nighttime anxiety and lack of sleep are affecting your life, it’s never too late to take advantage of the mental health resources available to you.

These online resources can help you find a mental health professional near you:

  • American Psychiatric Association’s Find a Psychiatrist
  • American Psychological Association’s Psychologist Locator
  • Anxiety and Depression Association of America’s Find a Therapist

As you (try to) fall asleep, remember: Mindfulness is key. Rather than worrying about the future, focus on what’s within your control right now — like getting to sleep.

To schedule an appointment with Primary Care of Roxborough for an evaluation call us at 215-487-1887 or visit

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Short-term restless sleep - symptoms, diagnosis, treatment in Zheleznodorozhny


Sleep disturbance is a fairly common problem. Frequent complaints of poor sleep are made by 8-15% of the adult population of our planet, and 9-11% use various sleeping pills. This figure is even higher among the elderly. Sleep disorders can be found at any age, and each age category has its own disorders. There are sleep disorders that begin in childhood and do not leave a person all his life, for example, narcolepsy.

Sleep disturbance can be primary, which is not associated with organ pathology, or secondary, resulting from other diseases. Sleep disorders occur as a result of various diseases of the central nervous system or mental disorders. A number of somatic diseases cause insomnia in patients under the influence of shortness of breath, pain, angina attacks, coughing or arrhythmia, frequent urination, itching, etc. Intoxication of various origins, including in patients with oncology, causes drowsiness. Sleep problems that are pathological in nature can develop due to hormonal abnormalities, for example, during the pathology of the hypothalamic-mesencephalic region (tumor, epidemic encephalitis, etc.).

Classification of sleep disorders

1. Insomnia is insomnia, a violation of the process of falling asleep and sleeping.

  • Psychological refers to the psychological state, can be situational (temporary) or permanent.

  • As a result of taking alcohol or drugs:

1. chronic alcoholism;

2. prolonged use of drugs that activate or depress the central nervous system;

3. syndrome of withdrawal of sleeping pills, sedatives or other drugs;

1. syndrome of decreased alveolar ventilation;

2. sleep apnea syndrome;

2. Hypersomnia, which is increased sleepiness

  • Psychophysiological, which is associated with the psychological sphere, can be permanent or temporary

  • As a result of taking alcohol or medications;

  • As a result of mental illness;

  • As a result of various breathing disorders during sleep;

  • Narcolepsy

  • As a result of other pathological conditions

3. Wrong mode of wakefulness and sleep

1. slow sleep syndrome

2. premature sleep syndrome

3. syndrome in which there is no 24-hour cycle of sleep and wakefulness

4. Parasomnia, which is characterized by impaired functioning of systems and organs associated with sleep or awakening:

Sleep disturbance symptoms

Symptoms of sleep disorders can be varied and are determined by the type of disorder. However, regardless of sleep disturbance, in a short period of time it can lead to a change in the emotional background, performance and attentiveness of a person. Children at school age have learning problems, they learn new information worse. It is not uncommon for a patient to come to the doctor complaining of worsening health, while not realizing that this is related to disturbed sleep.

Psychosomatic insomnia. Insomnia is situational when it lasts no more than three weeks. People who suffer from insomnia are less likely to fall asleep, often waking up in the middle of the night, and find it difficult to get back to sleep. They are characterized by early morning awakening, feel the lack of sleep after sleep. Because of this, they experience irritability, emotional instability, overwork. The situation is complicated by the constant worries of patients about disturbed sleep and the anxious expectation of the night. The time during which they try to fall asleep lasts twice as long for them. Situational insomnia is caused by the emotional state of a person under the influence of certain psychological phenomena. Often after the effects of stressful conditions cease, sleep returns to normal. But in certain cases, difficulties in falling asleep, as well as nighttime wakefulness, become commonplace, and the fear of insomnia further worsens the situation, which leads to the formation of regular insomnia.

Insomnia resulting from the use of alcoholic beverages or medications. Long-term regular consumption of alcohol can lead to deviations in the organization of sleep. There is a shortening of the phase of REM sleep and the patient often wakes up in the middle of the night. After the alcohol intake is stopped, the problem usually disappears after two weeks.

Disturbed sleep may be a side effect of medications taken that excite the nervous system. Long-term use of sleeping pills and sedatives also leads to insomnia. Over time, the effect of the drug declines, and increasing the dose leads to a short-term improvement in the situation. Due to disturbed sleep, aggravation is possible, despite increased doses. In such situations, systematic short-term awakenings are noted, and a clear boundary between sleep phases also disappears.

When a mentally ill person has insomnia, he has a constant feeling of intense anxiety at night, quite sensitive and superficial sleep, frequent awakenings, daytime apathy, and fatigue.

Sleep apnea or sleep apnea is a short-term interruption in the flow of air into the upper respiratory tract that occurs during sleep. Such a pause in breathing is usually accompanied by snoring or restlessness. There are obstructive apneas, which begin as a result of the closure of the lumen of the upper respiratory canals during inspiration, and central apneas, related to deviations in the work of the respiratory center.

Insomnia during restless legs syndrome begins to develop as a result of a feeling that forms in the depths of the calf muscles, which requires movement of the legs. The desire to move the legs appears before sleep and disappears when walking begins, but then it may resume again.

Diagnosis of sleep disorders

Polysomnography is the most common way to study sleep disorders. This examination is carried out by a somnologist in a specialized laboratory in which the patient spends the night. While the patient is sleeping, various sensors simultaneously record the bioelectrical activity of the brain (EEG), cardiac activity (ECG), respiratory actions of the anterior abdominal wall and chest, the air flow that is inhaled and exhaled, oxygen saturation of the blood, etc. Everything that happens in the ward is filmed and a doctor is on duty. Thanks to this examination, it is possible to examine the state of brain activity and the work of the main body systems during each five stages of sleep, to establish deviations and find the cause of disturbed sleep. Another way to diagnose sleep disorders is to study the average sleep latency (SLS). It is used in identifying the causes of drowsiness and plays an important role in the process of diagnosing narcolepsy. The study includes five attempts to fall asleep that are made while awake. Each attempt is given 20 minutes, the interval between these attempts is two hours. The average sleep latency is the time it takes the patient to fall asleep. When it is more than 10 minutes, this is normal, from 10 to 5 minutes is a borderline indicator, less than 5 minutes already indicates pathological drowsiness.


Depending on the cause of sleep disturbance, treatment by a neurologist is prescribed. With somatic pathology, therapy is directed to the underlying disease. The reduction in the depth of sleep, as well as its duration, which occurs in the elderly, is a natural process and often only needs an explanatory consultation with the patient. Before resorting to sleeping pills, it is recommended to monitor compliance with the basic principles of healthy sleep: do not go to bed in a state of excitement or anger, do not eat before bedtime, do not drink alcohol, strong tea, coffee at night, do not fall asleep during the day, do not forget about the lesson sports, but do not exercise at night, keep the bedroom clean. Patients who have disturbed sleep are advised to go to bed and wake up at the same time every day. If you haven’t been able to fall asleep for 30-40 minutes, you need to get up and keep busy until sleep appears. Evening relaxing treatments will be useful: a warm bath or a walk. Psychotherapy, various soothing techniques often help to solve the problems of disturbed sleep.

In the medical treatment of sleep disorders, benzodiazeline drugs are often used. Tablets with a short period of exposure - triazolam, midazolam are prescribed when the process of falling asleep is disturbed. However, their reception is often accompanied by side reactions: confusion, agitation, disturbed morning sleep, amnesia. Long-acting sleeping pills - diazelam, chlordiazepoxide, flurazelam are used for frequent nocturnal or early morning awakenings. But, they often cause daytime sleepiness. In such situations, they resort to the help of drugs of the average period of exposure - zolpidem and zopiclone. These drugs have a lower risk of developing dependence or tolerance.

Another group of drugs that are used for sleep disorders are antidepressants: doxelin, amitriptyline, mianserin. They are not addictive, they are suitable for aged patients, patients who have a depressive state or suffer from chronic pain syndrome. However, due to the large number of side effects, its use is limited.

If the case is severe and the drugs could not give the desired result, then they resort to antipsychotics that have a sedative effect: chlorprothixene, levomepromazine, promethazine. When mild pathological drowsiness is diagnosed, mild CNS stimulants are prescribed: ascorbic and glutamic acid, calcium-containing drugs. When the violations are pronounced - psychotonic drugs: imipramine, iproniazid.

How to Overcome Sleep Anxiety

If you deal with anxiety or sleep disturbances on a regular basis, there are a few simple strategies that can help calm your mind, relax your body, and make it easier for you to sleep. Changing bedtime habits takes time and patience, but over time they can help reduce anxiety.

1. Practice good sleep hygiene
Sleep hygiene refers to the various habits that are necessary for good quality sleep. Best practices include reducing daytime sleep to 30 minutes, limiting stimulants like coffee and alcohol closer to the night, and going to bed and waking up at the same time.

2. Practice meditation
Begin by sitting quietly for a few minutes and focusing on your breath. Learning to quiet your mind and meditate can help you deal with stress, both during the day and before bed. If meditation is difficult for you, try relaxing yoga poses to help your body prepare for sleep.

3. Exercise
Regular exercise has been found to help people fall asleep faster and sounder. Even moderate-intensity exercise, such as brisk walking, can improve sleep for those with chronic insomnia.

4. Take time to relax
Proper sleep preparation will allow your mind and body to slow down before you go to bed. Take at least 30 minutes to take a bath, read a book, listen to a podcast, or listen to soothing music. These transitional rituals can set your brain to associate certain activities with getting ready for bed.

5. Avoid stress before bed
Leave the office, work, news and social networking for the day. Experts suggest creating a transition time between work and sleep, which will help you tune in to a good rest.

6. Write down your worries on paper
Instead of letting thoughts and to-do lists go round and round in your head, write them down so your brain has a plan for the next day. Research shows that it may help you fall asleep faster.

7. Stay out of bed if you can't sleep
If you've been in bed for more than 20 minutes and still can't sleep, reset. Get up, get out of the bedroom and engage in a sleep-inducing activity like having a cup of tea or reading a book. This action on conditioned reflexes, known as stimulus control, can help shorten the time it takes to fall asleep.

8. Limit Your Gadget Use
Our laptops, phones and tablets emit blue light that suppresses melatonin, making the brain think the sun has risen. Try not to use gadgets one or two hours before you plan to go to bed so as not to disrupt your circadian rhythm.

9. Maintain favorable sleep conditions
Controlling light, sound, and temperature can increase your chances of calming your mind and falling asleep easily. The bedroom should be dark, quiet and cool. Pink noise can also help you focus on your sleep.

10. Get the mattress that suits you
When you sleep on an uncomfortable mattress, pressure builds up and pain points build up on your body, causing you to toss and turn.

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