Sleep Anxiety Is the Worst. Here’s How to Deal

There are few things more frustrating than sleep anxiety. It’s 10 p.m. You’re enjoying your evening skin care routine. You’re brewing a cup of chamomile tea. You’re slipping into something silky. And then all of a sudden, there it is: that creeping fear that you will not in fact be able to drift off to dreamland, that anxiety will keep you up for hours, doomscrolling in a fit of revenge bedtime procrastination. The more you think about this bedtime possibility, the more anxious you get. The vicious sleep anxiety cycle has begun.

Sleep anxiety is not an official sleep disorder, per se. “In the sleep universe, we don’t really diagnose somebody with sleep anxiety—we diagnose them with insomnia or insomnia secondary to a particular anxiety disorder, like generalized anxiety or OCD,” says clinical psychologist Michael Breus, PhD, a diplomate of the American Board of Sleep Medicine and a fellow of the American Academy of Sleep Medicine. “There’s no real formal criteria or definition, so doctors have a tendency not to use it as a diagnosis.”

That said, “every sleep doctor in the universe” knows the role anxiety can play in sleep issues, Dr. Breus confirms. “Most of the people who don’t sleep, 75% of it is due to anxiety. The other 25% is a mixture of environmental factors, medications, some type of medical condition, or in some cases, some form of depression.”

But just because sleep anxiety isn’t a formally defined condition, doesn’t mean anxiety at night isn’t impacting your health. “Mood, anxiety, and depression have a bi-directional relationship to sleep,” says Rebecca Robbins, PhD, an instructor in medicine at Harvard Medical School and sleep expert to smart-ring maker Oura. Stress and anxiety, in other words, disrupt our sleep. And when we’re sleep deprived, we’re more likely to experience “negative mood states” like anxiety and depression, Dr. Robbins explains.

So how can you prevent sleep anxiety and deal with it when it happens? We asked the top sleep experts to break it down.

What is sleep anxiety? “Sleep anxiety is stress or worry relating to your ability to fall asleep or maintain sleep,” says Dr. Robbins. It can be triggered by stress about an early alarm you’re afraid you’ll sleep through, the memory of a terrible night’s sleep earlier in the week, or maybe nothing at all. “The anxiety can manifest itself in physical, cognitive, or behavioral symptoms. You may have a fast heart or rapid breathing, as if you’re undergoing a panic attack, or you may try to avoid bed, so that you can diminish the anxiety of not being able to fall or stay sleep,” says neurologist Pedram Navab, DO, who specializes in sleep medicine and is the author of Sleep Reimagined: The Fast Track to a Revitalized Life.

You may not get a formal diagnosis for sleep anxiety, but “those who suffer from it likely know they have it,” says Sanem Hafeez, PhD, a neuropsychologist and professor at Columbia University. (Sleep disorders are diagnosed via an overnight stay in a sleep lab, where clinicians can measure your breathing, heart rate, and sleep stages. “From a mental standpoint, a psychologist will do an intake to find out what occurs before you go to sleep, the thoughts you have, and what happens if you wake during the night, in addition to pre-sleep habits,” explains Dr. Hafeez.)

Sleep anxiety is not the same as a true fear of sleep. “Somniphobia is when people think something terrible will occur while they sleep or that they must remain awake to be watchful and alert,” Dr. Hafeez says.

Who is most likely to have sleep anxiety? Since sleep deprivation and anxiety fuel one another, you’re more likely to have sleep anxiety if you have generalized anxiety. “Lack of sleep affects the frontal lobe of the brain, which is involved in executive functioning, decision making, and problem solving,” says Dr. Navab. “When that area does not work at its most optimal, one’s thought processes become irrational and allows one’s generalized anxiety to become unjustifiably full-blown and work its way into your burgeoning sleep anxiety.”

Why you need to deal with it Maybe your disrupted dreams are simply due to one of the many common mistakes that can impact your sleep. But if you’re constantly having trouble falling asleep or can’t stay asleep, it’s something you should address. “Those experiencing symptoms relating to sleep anxiety are more likely to develop a sleep disorder, such as insomnia,” says Dr. Robbins. And insomnia effects can be serious; in addition to depression and anxiety, chronic lack of sleep can increase your risk of high blood pressure and heart disease.

How to treat sleep anxiety No one likes dealing with anxiety at night (or waking up with anxiety, for that matter). Here’s what to do about it.

1. Consider therapy. When good old-fashioned sleep apps can’t do the trick, cognitive behavioral therapy (CBT) is “remarkably effective” at treating sleep anxiety, says Dr. Robbins. “Much of CBT for insomnia (CBTI) focuses on rewiring how a patient thinks about sleep and cultivating their sense of self-efficacy,” she says. In a CBT session, a licensed mental health professional will help you reframe negative thoughts into more constructive beliefs. In CBTI, “patients will learn how to avoid environmental factors that trigger anxiety prior to bed, alter negative thoughts about sleep, and perhaps learn biofeedback to learn to regulate breathing, relax muscles, lower heart rate, and focus attention,” says Dr. Hafeez.

2. Give yourself a pep talk. Depending on how severe your sleep anxiety is, you might be able to do a version of this yourself whenever you feel the anxiety chills approaching. “Recognize how you are talking to yourself about sleep,” says Dr. Robbins. Are you telling yourself you’ll never be able to figure out how to calm anxiety at night? “If so, try to reverse that, and as bedtime approaches, tell yourself, ‘Hey, I got this!’ when it comes to your ability to fall asleep and get good, restorative sleep,” Dr. Robbins says.

3. Put your phone in another room. Yes. Really. For real this time. “Keeping all electronics out of the room is a great way to not only reduce stimulation from digital media but also the light that emits from that electronic equipment, which can decrease melatonin levels and lead to a fitful sleep,” says Dr. Navab.

Be honest with yourself: Was the 45 minutes you spent on TikTok or trolling for the perfect holiday gift really worth it? “Looking at your phone tethers you to the reality of today, which is not all that helpful,” says Dr. Navab. “Instead, keep a novel at hand to transport you to another place that allows you think of someone else’s dilemma and not your anxious sleep.”

4. Create a bedtime routine. If you can’t talk yourself into a calmer mindset before bed, the right bedtime routine might get you there. “It is not possible to go from our energetic, productivity-focused days to sleep in the blink of an eye,” says Dr. Robbins. “Sleep takes time.” She recommends setting aside at least 30 minutes to wind down.

“My favorite way to unwind is to take a shower, do my skin care routine, meditate for 10 minutes, then read a book until I’m ready to sleep,” says Kelly Smith, yoga and meditation teacher and host of the Mindful in Minutes podcast.

5. Meditate. Meditation is admittedly not for everyone. If you’re into it, or at least into the idea of trying to be into it, sleep meditations are remarkably effective. “With a regular meditation practice—about 10 minutes per day for at least eight weeks—the amygdala, which is the pain, stress, and worry center of the brain, begins to shrink,” explains Smith. That means your response to stressors and anxiety triggers also shrinks. “At the same time, meditation helps to strengthen the hypothalamus, which is one of the key centers of the brain for sleep,” Smith says.

Smith suggests starting with a guided sleep meditation. “Listening to a meditation can give you something to focus on other than your anxiety and can lull you to sleep,” she says. There are dozens of great meditation apps to help you get started.

6. Try a breathing exercise. Breathing exercises are also surprisingly effective at getting you off to dream land. “If you awaken in the middle of the night, the 4-7-8 breathing method is a fantastic way to pull your body out of fight-or-flight mode, as it will bring about a relaxed, parasympathetic response,” says Dr. Navab. To do it: Breathe in for four seconds, hold for seven, and exhale slowly for eight seconds.

7. Practice muscle relaxation. Another powerful technique: progressive muscle relaxation. “Definitely one of my favorites,” says Dr. Breus. “It’s good because it teaches people the difference between when they’re tense and when they’re relaxed.”

The premise is simple. Starting at the top of your head and moving toward the tip of your toes, progressively tense and relax your muscles while you’re lying in bed. “It’s very relaxing and has a tendency to put people to sleep,” Dr. Breus says.

8. Go for a walk. If all this zen stuff isn’t for you, consider exercise. “There’s almost no better way to reduce levels of stress than exercise,” says Dr. Breus. It doesn’t have to be intense—a 25-minute walk an hour before bedtime can help you calm those anxious thoughts.

9. Stick to a schedule. There’s a reason sleep experts recommend sticking to a consistent bedtime and wakeup time to maintain good sleep hygiene. Not only does it keep your internal clock from getting confused, “having a habit over which you have control will create stability and willpower that can dampen anxiety,” says Dr. Navab. “Anxiety is often related to a sense of control, so creating a routine of waking up at the same time each morning will bolster that command.”

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10. Don’t check the clock. If you find yourself lying awake at night, avoid the temptation to look at the clock. Nothing good can come of it. I’ve been lying awake how long? I have to get up that soon? “If you can avoid looking at the clock, you will avoid the additional anxiety,” says Dr. Breus. Seeing the clock is likely to make you panic and try even harder to fall asleep. “Nobody in the history of time has ever thought their way back to sleep—trying really hard is the opposite of what we want your brain to do,” Dr. Breus points out.

11. Stay in bed. It’s perfectly normal to wake up in the middle of the night (usually somewhere between 1 and 3 a.m. as your core body temperature begins to rise after falling all night). Most people fall back asleep within a few moments. If you don’t, don’t panic. Unless you’re dying to go to the bathroom, stay in bed, says Dr. Breus. “In order to get you back into a state of unconsciousness, your heart rate needs to be at 60 or below,” he explains. Going from lying to standing to walking will raise your heart rate, so avoid it if you can.

Even if you can’t fall back to sleep for awhile, just lying there, eyes closed, is useful. This is called nonsleep deep rest. “It is not as rejuvenating as sleep, but if you do that for an hour, it’s worth about 20 minutes of sleep,” Dr. Breus says. Understanding this can help lower your anxiety and allow the natural sleep process to take back over.