Anxiety and insomnia: causes, symptoms and how to manage

Exploring the link between anxiety and insomnia, and how you can manage sleep difficulties to get a better night’s sleep.

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What is anxiety insomnia?

Do you lie awake at night worrying, to the point where you find it impossible to sleep? Insomnia, and other serious disturbances of sleep, are well established as a common symptom of anxiety disorders, as people’s worries disrupt their ability to sleep well.

If this is something you're struggling with, this guide, which contains a number of practical things you can do to manage your anxiety-related insomnia, might help you to get deal with the problem and get a better nights’ sleep.

Why does anxiety give me insomnia? 

If you go to bed feeling anxious, whether you’re worried about work, or something in your personal life, lying in bed without any distractions gives your mind the time to go over and over your worries.

This can lead to your anxiety building, and your body’s ‘fight or flight’ response being activated. This is known as 'mental hyper arousal'. This heightened sense of anxiety is our body’s way of protecting us in threatening situations and causes physical changes, including an increase in heart rate and the release of adrenaline, which are designed to help us be stronger (fight) or run faster (flight). If your anxiety triggers your fight or flight response while you’re in bed, these changes can over-stimulate your body, so that you can find it impossible to drop off to sleep.

Unfortunately, the link between anxiety and insomnia can act like a vicious circle. If you can’t sleep because you’re feeling anxious, this lack of sleep can make you tired, irritable and even more anxious the next day. You may struggle to get to sleep again the following evening, resulting in the cycle starting all over again.

If you’ve reached the stage where your anxiety is leading to insomnia and your insomnia then leads to more anxiety, it’s time to take steps to stop the cycle and achieve positive mental wellbeing again.

What does anxiety insomnia feel like?

Certain symptoms of anxiety can quickly combine to make it harder for you to sleep, resulting in anxiety-induced insomnia. Key psychological signs, like a persistent sense of worry, dread or apprehension, leave sufferers of anxiety-induced insomnia unable to relax, unwind and ultimately fall asleep.

Despite a physical sense of exhaustion and fatigue that often comes from anxiety, insomnia and anxiety can leave us ruminating (thinking deeply about something over and over again) in bed at night. It can be challenging, but there are ways to stop ruminating and get your anxiety-related insomnia under control.

Managing anxiety and insomnia

1. Try to relax

If you’re lying awake at night with your heart pounding, it’s likely your fight or flight response has been triggered. In these situations, try to get your body back into a relaxed, resting state. It sounds really simple, but just inhaling slowly and deeply can help massively. Take a deep breath through your nose, feeling your whole abdomen rise as you do so, before breathing out slowly through your mouth. Doing this for a few minutes can help you to feel calmer and more relaxed.

You can also consciously relax your muscles. Focus on different parts of your body, working all the way from the top of your head down to your toes, envisaging all of your muscles becoming gradually relaxed and heavy. Focus your mind on positive thoughts or images too. For example, imagine that you’re walking along a warm sandy beach or sat in a peaceful forest clearing – anything that will help you to feel relaxed.

2. Get up and do something

Sometimes, a useful way to reduce your anxiety is to physically focus on something completely different. If your worries are going round and round in your head in the middle of the night, getting up and doing something else for 5 or 10 minutes can help you to break away from your anxiety.

Try doing something that’s relaxing and not overly stimulating. You could listen to soothing music, do some simple yoga stretches, or read a chapter of your favourite book. When you then go back to bed, your mind will have had a chance to think more positively, helping you to switch off and drift to sleep.

If you do get up, don’t do anything too stimulating like playing on your phone or watching TV as this can make you more anxious and make it even harder to get to sleep.

3. Give yourself enough time for sleep

The average adult needs 8 or 9 hours of sleep per night. It’s important that you give yourself the chance to get this amount of sleep.

Where possible, try to go to bed at least 8 hours before you need to get up. If you go to bed too late, you may find that you're constantly checking the clock throughout the night and worrying about getting enough sleep. These negative thought processes can add to your anxiety, making it even more likely that you’ll struggle with insomnia.

4. Be organised and prepare for the next day

If you regularly go to bed feeling anxious about the upcoming day, make sure that you prepare for it the evening before. This can help to reduce your worries as you know everything is in hand for the next morning. You could try making a to-do list so you know you’ve got everything covered before you go to bed, and even have your clothes ironed and laid out ready for morning.

5. Practise good sleep hygiene

There are a number of things you can do more generally to help you get a better night’s sleep.

The first is to try and keep a consistent sleep routine. Try going to bed and waking up at the same time each day, even at weekends. This helps your body get into a routine and makes it more likely that you’ll be able to fall asleep each night.

You should also try to limit your intake of caffeine, sugar and alcohol late at night. These substances can make you feel wide awake and jittery, which will only fuel your anxiety. Also, try limiting the amount of fluid you drink before bed so you’re not waking in the night needing the toilet.

Also avoid using electronic devices, such as your mobile or tablet, within 30 to 60 minutes of your target bedtime. Electronic devices give off a bright light which can be overly stimulating and stop you getting to sleep.

Page clinically reviewed by Dr Ian Nnatu (MB BS, PG DIP (CBT), MSc, FRCPsych, MRCPsych) Consultant Adult Psychiatrist at Priory Hospital North London

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