Anxiety Keeping You Awake? Here’s How to Fix It

April 24, 2023

A man suffering from insomnia lying in bed

If stress or anxiety keeps you up at night, you’re not alone. These feelings are a common cause of the sleep disturbance known as insomnia.

Everyone has a poor night’s sleep sometimes. You might toss and turn for what seems like an eternity or wake up at 3 a.m. with racing thoughts that make it difficult to fall back asleep. You may be diagnosed with insomnia if you have difficulty falling or staying asleep at least three nights a week.

Anxiety and insomnia can become a vicious cycle, says Brittany Loomis, CNP, a University Hospitals nurse practitioner specialist in sleep medicine. “Often, it’s a feedback loop causing the issue,” Loomis says. “You have insomnia and it leads to anxiety, or you have anxiety and it causes insomnia. The loop can worsen both conditions.”

Loomis says most patients she sees with anxiety-related insomnia have trouble sleeping through the night. “A lot of middle-of-the-night wakings are very much anxiety related. We see that most commonly,” she says. “In other patients, the anxiety makes it hard for them to fall asleep at bedtime.”

How to Manage Anxiety-Related Insomnia

“One of most important strategies we teach is relaxation,” Loomis says. “If your mind is relaxed before you go to bed, there’s less chance that anxiety and stress will wake you up in the middle of the night.”

Some tips to improve relaxation include:

Keep a sleep schedule. Go to bed and wake up around the same time every day, including on weekends.
Start relaxing an hour before bedtime. Turn off electronics, create a quiet space. Ease your mind by reading, thinking of something pleasant or listening to soft music.
If worrisome thoughts are present, try deep breathing exercises or progressive muscle relaxation.
There are different types of stress-reducing, breathing exercises. They focus on slow and deliberate inhaling and exhaling for 5 minutes or so.
Progressive muscle relaxation involves tensing groups of muscles one at a time, breathing in gently as you tense the muscles and relaxing as you exhale.

“These practices before bedtime can help you sleep through the night,” Loomis says. Her patients often try different methods. “No one approach fits every person. Once they find the right approach, say a hot shower and music, they fall asleep easier and notice they aren’t waking up as much.”

Stay in Bed or Get Up?

If you’re up in the middle of the night and awake for more than 20 minutes, Loomis suggests getting out of bed and going to another room. Do something relaxing, such as reading or listening to calming music until you get sleepy.

You may be inclined to turn on a TV, but don’t. “No TV. No electronics,” she says.

Treatment Options

For patients who need clinical intervention, the best evidence-based therapy is cognitive behavioral therapy (CBT), Loomis says. The therapy teaches you to recognize thoughts that keep you awake and to redirect your thinking.

Therapy may be paired with medications such as anti-anxiety drugs. “We can manage a lot of it in clinic with learning new coping mechanisms such as mindfulness, journaling and progressive muscle relaxation. But sometimes we refer patients for mental health treatment,” Loomis says. Patients can be referred to a mental health provider if they have underlying depression, which often accompanies anxiety.

Patients are also encouraged to keep a journal to write about daily worries and stresses. Writing helps you process emotions and put them in perspective. For example, if a work deadline gives you anxiety, journaling about it can remind you that you’ve addressed the challenge the best you can and there’s nothing more to be done today.

Lifestyle Changes Can Help

Proper nutrition, routine exercise and other healthy habits can also help improve sleep quality. These include:

Avoid caffeine at least four hours before bedtime.
Don’t drink alcohol, which diminishes sleep quality and duration.
Avoid heavy meals and spicy food within two or three hours of bedtime.
Exercise regularly, but not before bedtime because the stimulation can keep you up.