Sleep is an activity you probably tried to avoid as a child. And yet, as an adult, you may find yourself longingly dreaming of sleep. Most people now struggle with getting enough sleep and some even experience sleep-related anxiety. Understanding the difference between occasional anxiety, an anxiety disorder, and a sleep disorder may be helpful as you evaluate whether you need professional support to address the relationship between anxiety and sleep in your life.

If you can identify why you are having trouble sleeping, you may actually be able to make behavioral or environmental changes to help calm your sleep anxiety.

WHAT IS ANXIETY?

According to the American Psychological Association, anxiety is an emotion that produces feelings of tension and worry. Anxiety can also produce physical symptoms including sweating, trembling, fatigue, difficulty concentrating, increased blood pressure and accelerated breathing rate. According to the Anxiety & Depression Association of America, anxiety is the most common mental health condition in the United States, impacting about 18 percent of adults each year. It is normal to experience occasional anxiety, but persistent anxiety should be cause for concern.

WHAT IS ANXIETY DISORDER?

Your anxiety may actually be an anxiety disorder if your worrying is not proportional to the situation and begins to impact your daily life. If you are experiencing a recurring and overpowering sense of worry, and are avoiding certain situations due to that worry, you may benefit from seeing a licensed mental health professional for support. Anxiety disorders are often treatable, but unfortunately, only about 37 percent of people suffering from an anxiety disorder receive professional help.

WHAT IS SLEEP DISORDER?

Interestingly, anxiety and sleep disorders are often connected. According to the American Psychological Association, sleep disorders are conditions that affect your ability to fall asleep, your ability to stay asleep and the quality of your sleep - as well as your ability to properly function while awake. Sleep disorders are often associated with other medical problems, and some may be symptoms of mental health conditions such as depression, anxiety or cognitive disorders. There are several different common sleep disorders.

TYPES OF SLEEPING DISORDERS

Insomnia is a sleep disorder associated with difficulty falling or staying asleep. Nearly 40 percent of Americans will experience insomnia at some point in their lifetime. Insomnia is often situational and infrequent, like before a big test or after a long flight. However, it can also be chronic - meaning it happens at least 3 nights a week for 3 months or more. Insomnia can be the result of a health condition like asthma, arthritis, cancer, heartburn or chronic pain. Using substances like alcohol or medication can also cause insomnia. Whether your insomnia is tied to a health problem or not, the inability to sleep at the proper time can lead to anxiety.

Other common sleep disorders include obstructive sleep apnea, parasomnias (walking or talking during sleep), narcolepsy (overwhelming daytime drowsiness) and restless leg syndrome. Interestingly, a person can have an anxiety disorder and a sleep disorder at the same time, and they can each make the other condition even more challenging to manage without professional support. If you are experiencing ongoing difficulty with worrying thoughts or difficulty sleeping, share this information with a healthcare professional to determine whether treatment or mental health support is needed to improve your situation.

HOW CAN ANXIETY IMPACT YOUR SLEEP?

If you are anxious about something, this worrying may impact your ability to fall asleep or stay asleep. And, unfortunately, not being able to sleep can in turn lead to more anxiety. This creates a negative loop between worrying thoughts interfering with your ability to sleep, which then leads to increased anxiety about your inability to sleep, creating ongoing issues with disrupted sleep. Having an anxiety disorder makes this feedback loop even more pronounced and difficult to manage.

Ironically, while you are experiencing anxiety you may feel exhausted or fatigued. However, once you try to relax or fall asleep, you may find that your body resists. This is because anxiety stimulates your body, including increasing your blood pressure. Therefore, seeking help from a licensed mental health provider for an anxiety disorder or sleep disorder is an important first step. Also, if you have occasional anxiety that is impacting your sleep, understanding why you are anxious and having trouble sleeping is important for addressing the cause so you can get back to catching up on your zzz’s.

WHAT IS KEEPING YOU AWAKE AT NIGHT?

In addition to stress and worry, your inability to fall asleep or stay asleep may also be due to:

HOW CAN YOU SUPPORT A GOOD NIGHT'S SLEEP?

Addressing your worries as well as additional factors that may be impacting your sleep can ultimately help reduce your sleep anxiety.

PAIN AND DISCOMFORT

If you are experiencing pain or discomfort that is so significant that it keeps you from being able to sleep, you will want to bring this to the attention of your healthcare provider. This may signal a health concern that warrants further investigation. You may also want to discuss with your healthcare provider whether your sleep position is exacerbating your pain while in bed. Reading this post will provide you with more information about the connections between sleep position and health and this post explains why you may be waking up with pain and stiffness. The answer to your discomfort and subsequent sleep anxiety may also be due to insufficient support, which can be addressed with a new mattress, foundation, or pillow - or training yourself to sleep in a new position.

FOOD INTAKE AND SUBSTANCE USE

Your body’s discomfort may also be due to what you are eating or drinking. The food and substances you introduce into your body can increase your anxiety and impact your sleep. For example, if you have known stomach distress when you eat certain foods, choosing to still eat that food may result in anxiety in anticipation of the cramping or restroom urgency that will likely follow. Also, the specific foods you eat and the time of day that you eat them can impact your sleep, which is further explained in this post on fasting.

Moreover, certain substances can lead to increased anxiety symptoms such as caffeine and nicotine. For example, in people predisposed to anxiety disorders, caffeine intake may produce sweaty palms, a pounding heart, and ringing in the ears, which may lead to a panic attack. Therefore, it is best to avoid stimulants like caffeine and nicotine if you experience anxiety, and especially to avoid them in the few hours immediately prior to bedtime.

MEDICATIONS

Some medications produce anxiety as a side-effect when it wasn’t present before, or they can make your existing anxiety worse. For example, some migraine medicines include caffeine as one of the ingredients, which may stimulate the body and cause difficulty sleeping. Also, corticosteroids used to treat asthma, allergies, arthritis, and bronchitis may also stimulate the body leading to sleep difficulties for some people. In addition, ADHD medicines act as stimulants and can make you feel anxious and cause difficulty with sleep, especially if you are taking high doses. Some thyroid and seizure medicines can also trigger anxiety for some people. If you are taking one of these types of medications and are also experiencing anxiety or difficulty sleeping, continue to take your medications as they are prescribed, but also schedule an appointment to speak to your doctor about possible options for changing the dose or time of day you take the medicine - or finding an alternative medicine to reduce these side-effects.

ENVIRONMENT

Your environment can also produce anxiety and interfere with your ability to sleep. According to Maslow’s Hierarchy of Needs, your basic needs need to be met to ensure your survival. If your basic needs for food, water, warmth, rest, safety, and security (both physical and emotional) are not being met, it is challenging to function well in other aspects of your life. As you can see sleep (rest) and anxiety (safety) both fall within this category, as well as environmental factors that can impact that sleep. Hence, optimizing your environment for sleep may help you calm your anxiety about falling and staying asleep.

WARMTH

According to the Sleep Foundation, adjusting your thermostat so your bedroom is between 60 and 67 degrees Fahrenheit during the night may help optimize your sleep environment. In addition to lowering the ambient temperature, selecting sheets and pajamas made from a fabric like bamboo helps draw moisture away from your skin – which may help improve your sleep. Choosing latex pillows, which are naturally breathable, or cooling gel pillows to provide relief at the neck may also help with regulating your body temperature.

SOUND

External noise during the night, such as that from airplanes or traffic, may disrupt sleep. Your body’s response to this unwanted noise may include excess production of hormones such as adrenaline and cortisol (associated with stress and anxiety) and elevated heart rate and blood pressure. Therefore, it is best to eliminate as much nighttime noise as you can. If there is environmental noise you cannot eliminate, such as from a barking dog, then using earplugs or a white noise machine to help block the external noise may be a good option.

FOOD

As mentioned earlier, researchers have found a relationship between sleep and food. There is also a relationship between anxiety and the type of food you eat and the timing of when you eat. In general, keeping a steady blood sugar level by eating small meals at consistent times throughout the day can be helpful. There are also specific nutrients you may want to consider to help calm your anxiety including:

REST

Consistency is key to sleep health. Getting enough rest one night, but then providing little opportunity for sleep another night, can be detrimental for anyone - especially if you already struggle with anxiety and sleep. In fact, researchers found that sleep deprivation leads to a significant increase in anxiety levels. Try sticking with a consistent bedtime and waking time each day. That should also include setting a bedtime routine for yourself that allows time for winding down at the end of the day. Also, turn off all electronic devices at least an hour before bed as part of this routine.

SAFETY AND SECURITY

Security is the physical focus on ensuring that external factors do not cause harm, while safety is the mental feeling of being protected from the factors that cause harm. When addressing anxiety it is best to approach, rather than avoid, anxiety-provoking safety and security triggers. Therefore, improving the security in your environment can help improve your feeling of safety, which can help reduce your sleep anxiety. One part of this is developing an exit plan for an emergency, including making sure you have a safe meeting spot outdoors as well as items like flashlights and emergency gear. Whether you live in an area with tornadoes or frequent power outages from ice storms, developing an emergency plan can allow your brain to relax knowing you have a strategy and supplies ready if an emergency ever occurs. Also, creating a bedtime routine for yourself that includes comforting activities may help your brain recognize you are safe and secure - and thereby reduce sleep anxiety. Developing the feeling of safety can also help you return to sleep if you wake up in the night. Try following a consistent nightly routine that involves locking windows and doors, activating the home security system (if you have one), and leaving an outdoor security floodlight or indoor night light on. Going through the motions of this routine each night before bed may provide peace of mind and help improve your sleep if safety and security are causing you anxiety.

SOUND

External noise during the night, such as that from airplanes or traffic, may disrupt sleep. Your body’s response to this unwanted noise may include excess production of hormones such as adrenaline and cortisol (associated with stress and anxiety) and elevated heart rate and blood pressure. Therefore, it is best to eliminate as much nighttime noise as you can. If there is environmental noise you cannot eliminate, such as from a barking dog, then using earplugs or a white noise machine to help block the external noise may be a good option.

SUMMARY

If you are worried about falling asleep or staying asleep, ask yourself whether the anxiety you are experiencing is occasional - and if you are still able to function despite the concern. If your anxiety is frequent (3 or more days a week), or is beginning to limit your ability to function in your day-to-day life, you may want to contact your primary care provider for a referral to a mental health professional for support. A licensed therapist will identify a therapeutic approach that may be helpful for addressing your anxiety such as Cognitive Behavior Therapy (CBT), Acceptance and Commitment Therapy, or Exposure Therapy, among others.

If you are experiencing infrequent issues with anxiety at bedtime that are only occasionally interfering with your sleep, take steps to be sure your basic physical needs are met (food, water, rest, warmth, safety, and security). By improving your environment and sticking with a sleep routine, you will be one step closer to achieving a good night’s rest. Paying attention to your nutrition, room temperature, security, environmental noise and sleep comfort - including having a supportive mattress and pillows for your unique body and sleep position - can provide an optimal sleep environment to help calm sleep anxiety and leave you feeling more well-rested.