Anxiety and Sleep: Understanding the Cycle Between Anxiety and Sleep Problems

In my practice, I'd guess that 80% or more of the people I see for insomnia also struggle with anxiety. And if I consider the clients who come to me for anxiety issues, a similar number also have trouble sleeping. Why is this? Why does anxiety cause sleep problems and why does insomnia cause anxiety? The answer is in the body's need for perceived safety to sleep and how lack of sleep impacts our brain.

Insomnia Causing Anxiety

If you've ever had a bad night of sleep, you know that the next day you may feel more irritable or moody. Why is this? While we sleep, our brain is doing important work processing emotions and memories. A lack of sleep can interrupt this process and make it harder to regulate emotions.

In the brain, the amygdala plays an important role in emotional responses, fear, and the fight-or-flight response, while the prefrontal cortex helps with emotional regulation, impulse control, logic, and reasoning. When we're sleep deprived, the amygdala can become more reactive, while communication between the amygdala and prefrontal cortex becomes less effective. The result is that we may be more likely to react strongly to anxiety-provoking triggers.

As sleep problems develop into chronic insomnia, people often become anxious about sleep itself. Nighttime can become a setting for thoughts like, “What if I can't sleep again tonight?” “If I just fall asleep right now, I can still get four hours,” or “If I can't sleep tonight, I won't be able to function tomorrow.” That worry can then add another layer of anxiety to the sleep problem.

Anxiety Causing Insomnia

In addition to some basic physiological processes, our bodies and minds need to feel safe enough to sleep. When someone is anxious the threat detection system in their brains is on high alert- the opposite of safety. Imagine camping in the woods and trying to sleep when there are threatening noises in the trees around you- it would be pretty difficult, right?

When someone gets into bed without tending to their anxiety sleep becomes quite difficult. This is true for anxiety that is being carried throughout the day but also for the anxiety that develops when people have thoughts like "if I just fall asleep right now I can still get 4 hours". In both cases, the brain is receiving the same basic message: something is wrong, stay alert. Unfortunately, alertness and sleep are competing processes. The more anxious someone becomes about whether they will sleep, the more activated they become, creating a cycle in which anxiety makes sleep harder and difficulty sleeping creates even more anxiety.

How to Disrupt the Anxiety and Sleep Cycle

The cycle of anxiety and poor sleep does not have to go on forever. Here are some practical steps for breaking the cycle:

• Use your waking hours to learn strategies to manage anxious thoughts, feelings, or sensations. Bedtime should not be the time and place you attempt to wrangle your anxious thoughts.

• Address any unresolved trauma or emotional difficulties. Emotions and pain don't just go away because it's inconvenient to have them and unresolved emotions or trauma have a sneaky way of showing up at bedtime.

• Develop a healthy wind-down routine. If your nighttime consists of doom scrolling for a couple hours before bed or being busy and productive way past sundown, it's time to look at other options for easing into sleep.

• Stop trying to sleep. This sounds counter-intuitive, but the more we try to sleep the harder it becomes to do so. If you're struggling to fall asleep and anxious thoughts start popping up, set them aside and focus on relaxing your body and enjoying the experience of resting comfortably in your bed instead.

If You Need More Help

If insomnia or anxiety have taken over your life, help is available. Both insomnia and anxiety can be treated with therapy. There are many therapists who specialize in anxiety, using strategies like Acceptance and Commitment Therapy (ACT), Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP) and others. The gold standard treatment for insomnia is called Cognitive Behavioral Therapy for Insomnia (CBT-I). There are far fewer therapists who are trained in this treatment but you can find one through this CBT-I Directory.