How to Sleep with Anxiety Disorders

What is anxiety?

We all experience anxiety occasionally - feeling on edge or fearful, heightened blood pressure, and sweating are common symptoms. Most people experience anxiety as a passing state in response to a specific stimulus.

However, some people’s anxiety rises to the level of an anxiety disorder (of which there are many). The American Psychiatric Association estimates that 30 percent of adults will have a diagnosable anxiety disorder at some point, making it the most prevalent mental health condition,^[1] even more so than depression.

Not all anxiety disorders share the same features and symptoms, nor do all involve insomnia. In the following sections, you’ll find summaries of some of the most common types of anxiety and their primary symptoms.

Does anxiety cause insomnia?

Insomnia isn’t so much caused by anxiety as it is a common symptom of anxiety.^[2] This makes sense, given that people prone to worrying (called mental hyperarousal) do so as they lay in bed trying to go to sleep.

Anxiety and insomnia are intertwined in another way - the inability to sleep can cause increased stress, which feeds into a person’s anxiety. Negative thoughts, like “I probably won’t sleep tonight,” can creep in, leading to anticipatory anxiety about sleeping, which makes matters worse.

Types of anxiety disorders that can cause insomnia

Specific phobias

Among anxiety disorders, specific phobias are the most common. It’s estimated that eight to twelve percent of American adults experience a clinical phobia at some point in a year.^[1]

Phobias include many common fears, like spiders, heights, and public speaking. No matter the subject of the phobia, patients have an excessive fear of it, which is persistent over time.^[3] In most cases, people understand that their fear is not proportional to the perceived danger. However, overcoming that fear often proves to be very difficult.

Typical symptoms include avoidance of the feared stimuli, accelerated heart rate, and sweating. Feelings of panic, dizziness, and nausea are also common. In some cases, insomnia might result due to the excessive fear associated with a phobia.

Social anxiety disorder

About seven percent of American adults have a social anxiety disorder.^[1] The hallmark symptoms of this type of anxiety include:

• Fear of embarrassment and humiliation
• Fear of being rejected and looked down upon
• Avoidance of social situations
• Extreme fear of speaking in public or being in front of crowds
• Extreme self-consciousness
• Periods of insomnia while worrying about upcoming social situations

Despite these symptoms, many people with social anxiety disorder want to be social. After all, humans are made to connect with others. However, the disorder causes so much distress that patients experience extreme discomfort during social experiences and may avoid social situations altogether.^[4]

Panic disorder

Panic disorder is a type of anxiety characterized by recurring panic attacks. During these attacks, patients experience overwhelming psychological and physiological distress. Panic attacks often include:^[1]

• Nausea, dizziness, or lightheadedness
• Trembling, shaking, numbness, or tingling
• Chest pain, shortness of breath, or a rapid heart rate
• Sweating, chills, or hot flashes
• Feelings of choking or being smothered

Sometimes, people also fear losing control or dying, leading to sleep anxiety and fear of going to sleep.

Panic attacks might occur in response to a specific stimulus, such as a feared object or situation. However, many people with panic disorder have unexpected attacks without apparent cause.

Approximately two to three percent of American adults have panic disorder.^[1]

Generalized anxiety disorder

Another common type of anxiety is generalized anxiety disorder or GAD. This type of anxiety occurs in about two percent of the U.S. population, though, as is the case with most anxiety disorders, it’s much more common in women than men.^[1]

Unlike a phobia in which a patient can expressly point to the cause of their anxiety, people with GAD might not be able to pinpoint a cause. However, day-to-day worries about work, life, or family matters are typically involved in developing feelings of anxiety.

The primary symptoms of GAD include:^[5]

• Excessive worry
• Difficulty concentrating
• Insomnia
• Feelings of irritability or nervousness
• Feelings of impending doom or danger

How to sleep with anxiety

While sleep typically improves once treatment for an anxiety disorder begins, there are some things you can do to ensure a better chance of a good night’s rest.

Alter the substances you ingest

Caffeine, nicotine, and alcohol each have effects that make sleep more difficult.^[9] Caffeine can keep you awake long after you ingest it. Like caffeine, nicotine is a stimulant, so it can disrupt your normal sleeping habits. Though alcohol is a depressant, drinking too much and too close to bedtime might necessitate waking up to use the restroom at night. Also, sugars present in wine and other alcohols can keep you up if you drink before bed.

It’s important to review what you eat and when you eat it, too. For example, eating spicy foods before bed might result in stomach discomfort, like heartburn, that keeps you awake at night.

It’s also necessary to review the medications you take. If you’re taking a stimulant, your doctor might be able to prescribe similar, non-stimulant medicine that won’t keep you awake.

Find ways to induce sleep

One of the simplest solutions to poor sleep is to create a sleeping environment conducive to rest. For example:

• Avoid using your phone, tablet, or computer when you’re in bed. The blue light emitted from these devices can trick your brain into thinking it’s daylight hours.^[9]
• Remove your TV from the bedroom - it’s a distraction that might make sleeping more challenging.
• Ensure your bedroom is dark and quiet. Also, reduce the temperature by a few degrees, as the cooler air can help induce sleep.
• Relaxation techniques like meditation, deep breathing, or listening to music can help you get in a mindset for going to sleep.
• Reading a book (not on an electronic device) is another excellent way to take your mind off the day’s stressors and relax.

If you go to bed and aren’t asleep within 20 minutes or so, you need to get out of bed. If you stay in bed, the likelihood is high that you’ll toss and turn. By getting out of bed, you can do something to relax and put yourself back in “sleep mode.”

Form good sleeping habits

Another easy method to overcome anxiety and get more sleep is to focus on developing good sleeping habits. For example, you might try the following:

• Go to bed at the same time - even on holidays and weekends. Likewise, get up at the same time every day to help your body get into a predictable pattern of sleep and wakefulness.^[10]
• Exercise is a good way to relax and prepare for bed, so long as you don’t exercise too close to bedtime. The afternoon is a perfect time for a workout.
• If you take naps, keep them short. An hour is the absolute longest you should nap.^[9] Naps should also be early in the afternoon so as not to interfere with your normal nighttime sleep.
• Our sleep patterns are regulated by daylight.^[9] If you don’t get enough exposure to daylight (say, 30 minutes or more per day), your sleep patterns can be negatively affected. Plan time to be outside to help mitigate this problem.

When to seek professional help

If you’ve tried to manage your anxiety, your sleep problems, or both but to no avail, it’s time to see a professional.

Mental health providers can utilize a variety of therapies, medications, or both to help you address your anxiety and insomnia. These treatments include:

• Cognitive behavioral therapy (CBT) helps you identify and change the thoughts and behaviors that cause anxiety and prevent you from sleeping well. CBT for insomnia (CBT-I) goes even further and focuses on relaxation techniques, sleep restrictions (e.g., limiting napping), and other practical solutions for improving sleep.^[10]
• Bright light therapy is used to help regulate your internal clock. For example, if you wake up too early, you can use a lightbox to help recalibrate your body’s clock to help you sleep more regularly.^[11]
• Stimulus control therapy uses techniques discussed earlier (e.g., removing distractions from the bedroom and having a consistent time to go to bed and wake up) to help mitigate a “busy mind” that prevents you from falling asleep.^[12]
• Benzodiazepines like alprazolam and lorazepam help address anxiety symptoms in low doses and help induce sleep in high doses. Benzodiazepines are highly regulated due to the potential for dependence and the possibility of interactions with other medications.

Frequently asked questions about sleep and anxiety

Can anxiety cause nausea?

Yes. Anxiety nausea is common, as are other gastrointestinal problems like diarrhea, stomach cramps, and indigestion.^[13] This can also contribute towards problems with getting to sleep. 

How to tell if nausea is from anxiety?

The simplest way to determine the cause of your anxiety is to pay attention when you feel nauseous. If nausea occurs exclusively during periods of anxiety, there’s a good chance it directly results from your anxiety. However, if you have long periods of nausea that occur during non-anxious periods, the likelihood is that it's caused by something else.

Can stress cause nausea?

Yes. Just like anxiety and nausea, there is a link between stress and nausea. Your digestive system might go into overdrive when you’re stressed, with nausea and other symptoms like vomiting and bloating.^[14]