Can’t Sleep Because of Anxiety? What May Help

If anxiety is keeping you awake, what tends to help is calming your body first, parking your worries before bed, and not lying in bed fighting it. If it’s happening most nights for weeks, the most effective long-term help is usually treating the sleep problem and the anxiety directly, often with cognitive behavioral therapy.

Lying awake anxious is miserable, and it’s very common, especially during stressful periods. A few rough nights don’t mean something is wrong with you. But it helps to understand why anxiety and sleep get tangled up, because that points to what actually loosens them.

Why anxiety and sleep feed each other

Anxiety puts your body on alert: faster heart, shallow breathing, tense muscles, a mind scanning for problems. That state is the opposite of what sleep needs. Then, after a poor night, you’re more emotionally reactive the next day, and anxiety finds it easier to take hold.

A systematic review of studies on this concluded that the relationship runs both ways: poor sleep can raise the risk of later anxiety, and anxiety can raise the risk of later sleep problems.

What may help tonight

Calm your body before your thoughts

When your body is in alarm, arguing with your thoughts rarely works. Start with the physical side.

• Lengthen your exhale. Breathe in through your nose, then out slowly through your mouth, making the out-breath longer than the in-breath. In one study, a few minutes a day of exhale-focused breathing improved mood and lowered breathing rate more than the same time spent on mindfulness meditation.
• Release muscle tension. Tense and release each muscle group from your feet up, pausing on your jaw and shoulders.
• Cool down. A slightly cool room, lighter covers, or a cool cloth on your face can take the edge off a racing body.

Get the worries out of bed

Before bed, write down what’s worrying you and one next step for each. If there’s nothing to do yet, write that too. It doesn’t solve the problems; it tells your mind they’ve been recorded somewhere other than your head.

If a new worry arrives in bed, jot one line on a notepad and leave it there.

Don’t lie there battling it

If you’re lying awake and getting more anxious, get up for a while. Sit somewhere dim, do something quiet and familiar, and return to bed when you feel sleepy. It helps keep your bed linked with sleep rather than with anxiety.

If you feel panic at night

Sudden surges of intense fear with a pounding heart, shaking or breathlessness can happen at night. Slow breathing, feeling your feet on the floor and reminding yourself the wave will pass can help in the moment. If you’ve never had this before, or have chest pain, seek medical advice to rule out other causes.

An anxious night, step by step

1. Early evening: write the worries and next steps
2. Wind-down hour: dim, calm, no news or work
3. In bed: long exhales and muscle release
4. Anxious and wide awake? Get up for a while
5. Next day: same wake time, a walk outside, less caffeine

What helps over weeks

Treat the sleep problem directly

If you have trouble sleeping three or more nights a week for several months, it may be chronic insomnia. Insomnia can continue even after the original stress fades, because the sleeplessness and worry about sleep keep it going.

Guidelines from the American College of Physicians recommend cognitive behavioral therapy for insomnia (CBT-I) as the first treatment for chronic insomnia. It focuses on sleep habits and timing, and on the anxious thoughts about sleep that keep insomnia going. It’s available with clinicians and in structured digital programs.

What CBT-I involves

People are sometimes surprised by how practical CBT-I is. Over around four to eight sessions (in person, by video or in a digital program), it typically includes:

• Stimulus control: using the bed only for sleep, and getting up when you can’t sleep, to rebuild the link between bed and sleeping.
• Sleep restriction or compression: temporarily limiting time in bed to roughly the time you actually sleep, then gradually extending it. This builds sleep pressure. It can be tiring at first, so it’s best done with guidance, and it isn’t suitable for everyone (for example people with bipolar disorder, seizures or jobs where sleepiness is dangerous).
• Cognitive work: examining worries about sleep (“if I don’t sleep, tomorrow will be a disaster”) that keep you alert at night.
• Relaxation skills and practical sleep habits.

For people whose insomnia is tangled up with anxiety, the cognitive part is often especially helpful, because it targets the worry about sleep itself.

What about sleeping pills?

Sleep medication can be useful for some people in the short term, but it doesn’t treat the underlying anxiety or the patterns that keep insomnia going, and some types carry risks with longer use. Guidelines favor CBT-I first. If you’re considering medication, or already take it, talk it through with a doctor.

Treat the anxiety directly

If you feel anxious most days, not just at night, and it’s hard to control, it may be an anxiety disorder such as generalized anxiety disorder. These are common and very treatable, usually with talking therapies like CBT and sometimes with medication. A doctor is a good place to start.

Protect the basics

• Keep a regular wake-up time, even after a poor night.
• Move during the day, ideally outside in daylight.
• Watch caffeine and alcohol. Caffeine can increase anxiety and keep you alert; alcohol can make you drowsy but tends to worsen sleep later in the night and can increase anxiety the next day.
• Limit late-night news and doom-scrolling. It feeds the alarm.

When to get help soon

Please speak to a doctor if:

• poor sleep and anxiety are affecting your work, relationships or safety
• you’re having frequent panic attacks
• you’re relying on alcohol, cannabis or non-prescribed pills to sleep
• you feel hopeless, or have thoughts of harming yourself

If you’re in crisis, contact emergency services or a crisis line. In the US you can call or text 988. In the UK, Samaritans are available on 116 123.

Don’t stop or start sleep or anxiety medication without talking to your doctor.

A calmer body at bedtime, on repeat

A sleep hypnosis session does the “tonight” steps for you: it slows your breathing, loosens your shoulders and jaw, and gives your attention one voice to follow while the worries wait outside. Across controlled trials, hypnosis lowered anxiety on average, though the trials were mixed in quality. The sleep research is smaller and earlier; here’s what it shows.

If you have chronic insomnia or an anxiety disorder, use it next to CBT-I or medical care, not in place of them. For calming down during the day, see how to calm down when your mind won’t stop racing, and for the whole evening plan, how to stop overthinking at night.