Is Your Worry Keeping You Up at Night?

What to do if anxiety is interfering with your sleep.

Woman hugging pillow on bed
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Anxiety is known to be associated with a number of physical symptoms including disturbances in sleep. In fact, a key feature of generalized anxiety disorder (GAD) is difficulty sleeping due either to trouble falling asleep or staying asleep, nighttime restlessness, or unsatisfying (i.e., “light” sleep).

Insomnia based on tension or anxiety often starts during an acute period of stress or a few months thereafter.

If worry is keeping you up at night, it may help to determine when the onset of the sleep problem occurred, what current stressors are maintaining the problem, and whether or not your worry is excessive in relation to the actual problem.  Beyond uncovering why you’re having difficulty sleeping, what can you do about it? Here a number of ways to begin to address the problem:

Step 1. Know what’s what. Keep a sleep diary (such as this version, available through the National Sleep Foundation). Often, though we have a sense of a problem, we have no actual data to help us pick up on clear, problematic patterns. Self-monitoring certain aspects of your sleep (e.g., how frequently you nap and for how long, if or when you take medication to help with sleep, what time you turn the lights out and roughly how long it takes you to feel asleep, how many times you wake up during the night) may offer some clues for obvious changes to make.

For example, if you find that you have the most difficulty sleeping on days when you’ve exercised in the evening, you might aim to move your workout to the morning. Or, your log may reveal that on nights when you try to manage your worry with a few glasses of wine, you actually have a poorer quality of sleep.

If this is the case, changing your pattern of alcohol use (as well as your pattern of nicotine or caffeine use) may positively impact your sleep.

Step 2. Evaluate your sleep environment, and set yourself up for success. Are your sheets fresh? Is your bed comfortable? How is the temperature in your room? Is your sleeping space noisy or quiet? Light or dark? Make any adjustments necessary to achieve maximal comfort in your sleeping space.

Is there a digital clock staring you in the face all night? Perhaps it taunts you when you have difficulty falling asleep, or speaks to you when you wake up in the middle of the night and tells you that it’ll be impossible to get back to sleep. If this is the case, try turning the clock away from you or moving it to a different place in the bedroom (ideally, further from the bed) for a week or two; see if this makes a difference.

Step 3. Get into a helpful mindset.  Here are a couple of common, counter-productive beliefs about sleep that can fuel insomnia.

“If I cannot fall asleep, I must try harder and harder until it happens.”

The truth is that if your worry is preventing you from falling asleep, you are likely to benefit from putting your energy into relaxation and distraction (as well as working to contain the worry in designated periods of time well before bedtime) rather than attempting to force yourself to sleep.

“If I don’t get X hours of sleep, I will not be able to function at all tomorrow.”

This is a cognitive distortion, a fairly rigid prediction of catastrophe. In reality, whether or not you sleep on any one given night probably won’t make much a difference on how you perform tomorrow. 

If you notice yourself falling into these thought traps at night, then take some time during the day to challenge these beliefs and devise an alternate action plan when they arise.

Step 4. Wind up with a good wind-down plan. Feel free to rely on rituals, as many people do when they go to bed. This might include reading or listening to the radio, showering or washing up and brushing teeth, changing into pajamas. Assess your current rituals – keep the behaviors that feel organizing, relaxing or soothing and change any aspects of the routine that are overly stimulating.

Step 5. Even if you’re evening isn’t sleep-full, it can be restful. Even (and especially) when it’s hard to fall or stay asleep due to anxiety, remember you will benefit from making nighttime as restful as possible. Soothing exercises for the evening can include stretching, progressive muscle relaxation or meditation, as well as abdominal breathing. There are also a variety of smartphone or tablet applications that offer easy access and guidance to these exercises.

If sleep problems occur more nights than not, or persist for weeks on end, speak with your physician to rule out medical problems associated with sleep disturbance. For anxiety-related sleep difficulty, consider seeking out the help of a mental health professional, to talk about your worries, learn strategies for coping during the daytime, or to receive specialized treatment for insomnia.

For more resources on healthy sleep (and sleep disorders), there are a variety of brief informational handouts online via The National Center on Sleep Disorders Research (a part of The National Heart, Lung, and Blood Institute). Additional information about the relationship between anxiety and sleep is also available through The Anxiety and Depression Association of America.


Hauri, P, Linde, S. No More Sleepless Nights: A Proven Program to Conquer Insomnia. New York: John Wiley & Sons, 1996.

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