Many of us toss and turn or watch the clock when we can’t sleep for a night or two. But for some, a restless night is routine.
More than 40 million people suffer from chronic, long-term sleep disorders, and an additional 20 million report sleeping problems occasionally.
Stress and anxiety may cause sleeping problems or make existing problems worse. And having an anxiety disorder exacerbates the problem.
Sleep disorders are characterized by abnormal sleep patterns that interfere with physical, mental, and emotional functioning. Stress or anxiety can cause a serious night without sleep, as do a variety of other problems.
Insomnia is the clinical term for people who have trouble falling asleep, difficulty staying asleep, waking too early in the morning, or waking up feeling unrefreshed.
Other common sleep disorders include sleep apnea (loud snoring caused by an obstructed airway), sleepwalking, and narcolepsy (falling asleep spontaneously). Restless leg syndrome and bruxism (grinding of the teeth while sleeping) are conditions that also may contribute to sleep disorders.
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.
Treating your nighttime anxiety and addressing your sleep issues are essential steps in improving your quality of life.
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.
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.
This perceived “stress” can cause the body to experience an adrenaline rush, which makes it incredibly difficult to get to sleep.
Anxiety is an experience of everyday life. It typically functions as an internal alarm bell that warns of potential danger and, in mild degrees, anxiety is serviceable to the individual. In anxiety disorders, however, the individual is submitted to false alarms that may be intense, frequent, or even continuous. These false alarms may lead to a state of dysfunctional arousal that often leads to persistent sleep-wake difficulties. Indeed, population surveys indicate that the prevalence of anxiety disorder is about. About 24% to 36% in subjects with insomnia, complaints and about 27% to 42% for those with hypersomnia.1,2 Another point, further underpinning the relationship between anxiety and sleep is that sleep disturbance is a. diagnostic symptom for some anxiety disorders, such as generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD).
Anxiety states may be focused upon some particular situation or may be generalized. Usually, a combination and most people are suffering from the severe phobic disorder will have some degree of generalized anxiety. Likewise, patients with generalized anxiety often experience an increase in anxiety in certain situations. Moreover, various anxiety disorders share many biological and clinical similarities and are highly comorbid. Therefore, in this article, we will first discuss common features of the neurobiological basis of anxiety and its relationships with sleep physiology. Next, sleep disturbances and its treatment will be discussed; for clinical convenience, each of the different anxiety disorders will be discussed separately. Indeed, the treatment of the anxiety disorder significantly improves sleep; however, when the sleep disturbance predominates, its treatment may improve the management of the anxiety disorder.
What Are the Facts About Anxiety and Insomnia?
Experiencing occasional bouts of anxiety can be fairly common for most people, as anxiety is just an echo of our past survival mechanism of “fight, flight, or freeze” when faced with danger. Although the dangers have changed from animal predators to a fear of being late for meetings, the physiological components of our brains haven’t changed much: our brains still see the cause of our anxiety as a “danger” and thus kicks into action trying to find a possible solution or escape route.
Occasional anxiety is not a cause for concern, but many Americans experience a much more acute, recurring, and overpowering sense of anxiety, which can be the development of an anxiety disorder. Overall, about 40 million Americans suffer from anxiety disorders, and it is the most common mental illness in the U.S.
Anxiety disorders can be caused by particular triggers (known as “phobias”) or can simply be excessive anxiety for extended periods of time that get in the way of everyday life, regardless of a specific trigger or actually being in danger. In these cases, the brain may flood the body with adrenaline, causing a person to experience heart palpitations, shortness of breath, or causing them to lose their concentration at work or school. Additionally, anxiety can cause serious sleep issues, such as insomnia. While experiencing anxiety attacks may cause many people to feel exhausted or fatigued, the act of falling asleep may actually become harder due to the anxiety and the body’s sense of worry or fear.
Insomnia is a common sleep disorder affecting 3 million Americans that is characterized by the inability to fall asleep or stay asleep for extended periods of time. It can often be a side effect of a larger problem (known as secondary insomnia). Still, it can also manifest independently for many people, without a predominant cause or identifying the trigger (known as primary insomnia).
Some people suffer from both anxiety and insomnia, with each symptom being independent of the other. In these cases, known as bidirectional comorbidity, the two conditions can exacerbate each other, and it can be difficult to treat both independently. Additionally, anxiety can be a side effect of other, more serious psychiatric conditions, which can add to the difficulty of treating those with comorbid anxiety and insomnia.
There are many symptoms of anxiety. Everyone experiences anxiety differently. Symptoms can happen at any time 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
Another symptom a person with anxiety may also experience is a panic attack. A panic attack is an episode of extreme and intense fear, often accompanied by physical manifestations. The common symptoms of a panic attack include:
- a sense of impending doom
- increased heart rate and chest pains
- shortness of breath and throat tightness
- sweating, chills, and hot flashes
- dizziness or lightheadedness
- a feeling of detachment, or like nothing is real
In some cases, you may even wake up from a nocturnal panic attack. Nocturnal (nighttime) panic attacks have the same signs and symptoms of regular panic attacks, only they occur while you’re asleep.
If you experience a nocturnal panic attack, it may be hard to calm down and fall back asleep.
What Are the Types of Anxiety?
Anxiety disorders come in many forms. Below are some of the most common types, as well as some of their symptoms and effects.
Generalized Anxiety Disorder (GAD): GAD is a form of anxiety that people may experience for extended periods of time, normally more than six months, and is a response to stress related to work, personal health, social interactions, or everyday routines. GAD can create an extreme sense of fear or worry that stems from otherwise normal day-to-day routines or activities, and can significantly impact a person’s work, social, school, or general life. According to the ADAA, about 6.8 million Americans suffer from GAD every year. Some common symptoms may include:
- Feelings of restlessness or being unable to calm down.
- Easily fatigued.
- Brain fog, or having difficulty concentrating and easily losing your train of thought.
- Tight or tense muscles.
- Unable to control or distract yourself from worrying.
- Having sleep problems such as insomnia, restlessness, or feeling unsatisfied from sleep.
Obsessive-Compulsive Disorder (OCD): According to the National Institute of Mental Health, OCD is a condition affecting 2.2 million Americans that causes people to have reoccurring, uncontrollable, and disturbing thoughts, urges, or mental images (obsessions) that can create serious anxiety for the sufferer. This may cause the sufferer to repeat certain behaviours or actions (compulsions) in order to counteract the thoughts or mental images. This can include being unable to leave home before turning off all the dials in the house and checking all the locks twice, or feeling a compelling urge to drive a specific route in order to avoid potential (but not real) dangers.
Although many people may feel obsessive or may double-check certain things twice, those with OCD typically spend more than an hour a day obsessing over the images or thoughts in their head, and many experience significant problems in their life due to their condition. Some people may also suffer from other anxiety disorders while also suffering from OCD.
Panic Disorder: Panic disorders are the result of experiencing unexpected and recurring panic attacks without warning or due to a specific trigger. The National Institute of Mental Health notes that 6 million adults in America have a panic disorder. These attacks are moments of intense fear that can peak within a few minutes of the initial start. In that time, the body may be flooded with adrenaline, and the person experiencing the panic may experience heart palpitations, severe sweating, trembling or shaking, shortness of breath, a feeling of impending doom, and a feeling of loss of control. Those who experience these attacks may do their best to avoid certain places, people, or situations that can trigger a panic attack, and in doing so, may cause serious problems in their life. Some of the most severe cases of panic attacks may cause agoraphobia or the fear of leaving home.
Post-Traumatic Stress Disorder (PTSD): PTSD is the development of anxiety or fear due to a shocking, scary, or life-threatening and dangerous event. PTSD is characterized by recurring fears or stresses despite the sufferer no longer being near that event nor in a life-threatening situation. Some of the most common forms of PTSD develop from being involved in a war or being the victim of domestic violence or sexual assault. Still, even small events — such as the sudden death of a loved one — can cause PTSD symptoms to develop in some people. The National Institute of Mental Health states that about 7.7 million adults suffer from PTSD in America. Typically, PTSD can cause:
- Recurring nightmares, flashbacks, or fearful thoughts related to the incident.
- Avoidance of locations, people, thoughts, feelings, or events that may trigger the memory of the incident.
- Being easily startled or constantly feeling “on edge.”
- Difficulty sleeping.
- Angry outbursts.
- Trouble remembering certain details about the event or blocking it out entirely.
- Negative thoughts about the self as well as the world.
- Distorted feelings of guilt or blame.
- Loss of interest in previously enjoyable activities.
Social Anxiety Disorder (Social Phobia): Social phobia is an intense fear or worry related to social or performance situations that, according to the ADAA, affects about 15 million Americans. One of the most common symptoms is a fear of embarrassment or being negatively judged by others. Most commonly, this arises in relation to school, work, or public places. The most intense form of social phobia is agoraphobia or the fear of leaving the house or being in public.
In many cases, treating anxiety requires a dual approach. Both psychotherapy and medication may be used in conjunction to produce the best results.
There are various types of medications your doctor may prescribe for your anxiety. They can discuss a medication’s pros and cons, availability, and more with you.
The most common drugs prescribed for acute anxiety attacks are benzodiazepines. The most common drugs prescribed for long-term cases of anxiety are antidepressants.
For some people, alternative medicine is another treatment option for anxiety.
The research on herbal and botanical medicine for anxiety is much more limited than traditional medicine. However, a systematic review of trusted Source from 2010 did find that both nutritional and herbal supplementation may be worthwhile therapies for anxiety.
There’s strong evidence for the effectiveness of supplements containing passionflower, kava, L-lysine, and L-arginine.
Keep in mind that the U.S. Food and Drug Administration doesn’t regulate the quality or purity of supplements as they do for drugs. Talk to your doctor before trying supplements to make sure no interactions will occur.
When to See a Doctor?
Constant anxiety that makes it difficult to sleep at night can affect your daily quality of life. Your work or school performance may worsen, and you may find it hard to complete your normal day-to-day tasks.
If anxiety and lack of sleep are affecting your life in this way, it’s important to reach out to a doctor or mental health specialist for help.
For some people, nighttime anxiety can lead to insomnia. Insomnia is defined as persistent trouble falling or staying asleep. Chronic insomnia can have adverse health effects, including an increased risk of:
- health conditions, such as high blood pressure and a weakened immune system
- mental health conditions, such as depression
Whether your doctor makes a diagnosis of anxiety, insomnia, or both, reaching out is the first step in the treatment process.
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.