Why does anxiety get worse at night?

Symptoms of night-time anxiety

Symptoms of generalized anxiety run the gamut from feelings of restlessness to an inability to control feelings of worry. Irritability, difficulty concentrating, and physiological symptoms like headaches, stomach aches, and muscle pains are also common.^[1]

Anxiety at night can present many of the same psychological and physiological symptoms. For example, you might lie in bed, unable to sleep because of worry about something at work. Likewise, you might be unable to stay asleep because of the headaches and stomach aches associated with your anxiety.

Moreover, some people can experience panic attacks at night. Nocturnal panic attacks are prevalent among people with panic disorder, a type of anxiety disorder. Typically, these attacks occur during the first stages of sleep and involve any number of symptoms, including, but not limited to:^[2]

• Feelings of fear upon waking
• A choking sensation
• Nausea
• Dizziness
• Feelings of derealization or depersonalization

Other potential symptoms of panicked anxiety at night include rapid heartbeat, sweating or chills, and chest pain.

What causes anxiety at night?

Stress is the principal cause of anxiety at night (and during the day, for that matter). For most of us, the day's stressors are passing, so we experience some anxiety, but those feelings pass pretty quickly.^[3]

An anxiety disorder is different, though. Someone with an anxiety disorder isn’t just overly nervous. Instead, you can experience extreme levels of anxiety and fear. This anxiety and fear can worsen at night as the quiet time in bed allows the mind to wander and worry to creep in.

Aside from being a reaction to stress, anxiety at night is partly caused by genetic factors. For example, research shows that people are more likely to develop an anxiety disorder if a close biological relative has an anxiety disorder.^[1]

Your physical health can also determine whether you experience anxiety. Some conditions, like heart complications and hyperthyroidism, are risk factors for developing anxiety. Environmental factors are involved, too. For example, experiencing adverse life events (e.g., job loss, divorce) can make it more likely to experience anxiety symptoms.^[1]

So, if we consider the question, “Why do I get anxiety at night?,” the answer is that it’s likely the result of many reasons. Like any other human behavior, anxiety is a complex experience that manifests because of a potentially complex mixture of genetic and environmental influences.

How does anxiety affect sleep?

Anxiety at night can significantly impact your ability to sleep. In some cases, anxiety can cause insomnia. Unfortunately, insomnia can also trigger more anxiety, creating a vicious cycle of sleeplessness and anxiety. Research indicates that certain types of anxiety disorders, namely generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder (OCD), are more likely to have co-occurring insomnia.^[4]

On the other end of the spectrum, some people with anxiety experience hypersomnia or periods of excessive daytime sleepiness. Hypersomnia seems most prevalent among people with a phobic disorder, though hypersomnia also occurs among people with generalized anxiety disorder and panic disorder.^[4]

Another possibility is that anxiety, insomnia, and hypersomnia occur together. In this case, someone with anxiety experiences sleeplessness, followed by periods of extreme daytime sleepiness. Research shows people with OCD are the most likely to experience both insomnia and hypersomnia.^[4]

Does a lack of sleep cause anxiety to get worse?

When you don’t get enough sleep, you experience physical and psychological symptoms like tiredness, fatigue, irritability, and mind fog. But a lack of sleep can also contribute to worsening anxiety symptoms.

Research shows that not getting enough sleep (or not getting enough quality sleep) increases the likelihood of negative reactions to stressors. Likewise, a lack of sleep can lead to diminished positive emotions.^[5]

In other words, without enough sleep, we can’t properly regulate our emotions, see the world clearly, or deal with stress effectively. Even minor stressors - an unexpected traffic jam on the way to work, for example - can trigger an emotional response (e.g., honking and screaming at other motorists) in a sleep-deprived person who wouldn’t normally engage in those kinds of behaviors.

But the link between a lack of sleep and anxiety goes even deeper. Studies show that a lack of sleep or insufficient quality sleep increases the chances of developing a mental health disorder. In fact, a lack of sleep can contribute to anxiety in otherwise healthy people.^[5] It can also trigger the onset of depression.

People with mental health conditions can also experience more severe symptoms. This goes back to the vicious cycle mentioned earlier. Not sleeping can cause you to worry more, increasing your anxiety and making it less likely that you’ll sleep the next night.

How to calm anxiety at night

Though the outlook seems grim if you have anxiety and difficulty sleeping, the good news is that the situation can be addressed with any number of self-help techniques. However, note that these are not cures for anxiety - they are simple strategies that might help you fall asleep faster and stay asleep longer.

Establish a sleep routine

Try to go to bed and wake up at the same time each day, even on the weekends. This helps get your body in “sleep mode” and can facilitate a longer, deeper sleep at night.^[6] As part of your routine, avoid napping too late in the day, as it can throw your “sleep mode” off.

Create a quality sleeping environment

Your ability to get a good night’s sleep depends partly on the sleep environment. By making your bedroom dark, cool, and quiet, you’re more likely to get a good night’s sleep. Consider using a white noise machine to drown out the noise from other parts of your home or neighborhood.

Engage in sleep-inducing activities

Relaxation techniques like meditation and mindfulness training not only help induce sleep but can also relax you and help lower your anxiety levels. Listening to soothing music or taking a hot bath are other relaxing activities that can be useful in helping turn your brain off and prepare you for bed.

Consider the substances you intake

Many different substances can make sleep less likely, from spicy foods to nicotine to caffeine. What’s more, medications (e.g., stimulants) and illicit drugs (e.g., amphetamines) reduce the likelihood that you will sleep.

Get outside and exercise

Sunshine, fresh air, and exercise can all reduce anxiety. But they also have a positive effect on your ability to sleep. For example, working out in the afternoon can help calibrate your body with reduced stress and increased relaxation for bedtime.^[6]

Additionally, exposure to daylight helps calibrate your circadian rhythm - the mechanism that enables you to be alert during the day and sleep at night.^[7] By spending time outside during the daylight hours (and minimizing your exposure to bright light in the hours before bedtime), you remind your body when to be alert and when to rest.

Why does my anxiety get worse at night?

As noted earlier, anxiety peaks at night because you have fewer distractions to take your attention away from it. Moreover, going to bed concerned about your ability to sleep only exacerbates your already elevated anxiety levels. The self-help techniques outlined above can help address this issue, as can the tips for professional help outlined below.

When to seek professional help

If your anxiety is unmanageable and is causing significant distress in your daily life, it’s time to seek professional help. This typically involves therapy, medication, or both. Some of the most common methods a therapist might utilize to treat your anxiety are listed below.

Therapies

The most common and effective type of therapy for anxiety is cognitive-behavioral therapy or CBT. CBT aims to identify the reasons for your anxiety and teach you how to manage your symptoms. This occurs in two parts: a cognitive component, in which you learn how your negative thoughts contribute to your anxiety, and a behavioral component, in which you learn how to minimize behaviors associated with your anxiety.^[8]

Exposure therapy, a type of CBT, is also used to treat anxiety.^[8] Exposure therapy aims to expose you to anxiety-inducing stimuli in a controlled, supportive environment. Doing so gradually reduces anxiety and fear and minimizes your sensitivity to once anxiety-inducing stimuli.

In some cases, group therapy is a worthwhile treatment for anxiety disorders. For example, if you have a specific phobia, a supportive therapeutic group setting is valuable for sharing your experiences, feeling understood and supported, and building confidence in your ability to manage your anxiety.

Family therapy can also be advantageous for treating anxiety, particularly for children and adolescents.^[8] Family therapy aims to train family members to interact with their loved one in a way that doesn’t exacerbate anxiety. With a greater understanding of anxiety and its effect on their loved one, families can be more supportive and participatory in the treatment process.

Medications

The following are among the most commonly prescribed medications for anxiety disorders:^[9]

• Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that increase serotonin (which is associated with mood regulation) in the brain. SSRIs are effective and have fewer side effects than other medications. Common options include citalopram, fluoxetine, and paroxetine.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another form of antidepressants that boost levels of serotonin and norepinephrine in the brain. SNRIs are popular because they have relatively few side effects. Examples include venlafaxine and duloxetine.
• Benzodiazepines are a secondary option for treating anxiety when SSRIs and SNRIs are ineffective. Benzodiazepines, like lorazepam, alprazolam, and clonazepam, are sedatives that calm anxiety symptoms. However, benzodiazepines come with various side effects and are only effective for short-term use.
• Buspirone, which is an anxiolytic, provides long-term treatment for anxiety. Unlike benzodiazepines, buspirone must be taken daily for an extended period to achieve its full effect.