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. But 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 about sleep 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 very real but it’s not an official 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 says. “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 anxiety about sleep 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 anxiety about sleep
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.
