Anxiety And Insomnia - A Dangerous Duo?

Anxiety disorders are among the most common mental health conditions in the United States, affecting 40 million adults¹ aged 18 or older every year. 

Defined as an uncontrollable sensation of fear and worry, anxiety can come with associated conditions, such as an increased risk of developing depression, obesity, diabetes, and even heart disease.

Sleep disturbances are another issue frequently observed in individuals with anxiety. Sleep is vital in maintaining healthy brain function and other bodily functions. Without proper sleep, your physical and psychological well-being can be impacted.

How are insomnia and anxiety linked?

Insomnia is common among adults, with this condition affecting approximately 6–10% of the population worldwide.²

People with anxiety are more likely to experience severe sleep disruptions when experiencing stress, which can worsen existing anxiety symptoms. 

Increasing evidence suggests that sleep problems are both a risk factor and a key symptom for several anxiety disorders, such as generalized anxiety disorder, post-traumatic stress disorder, and panic disorder. 

Missing one night of sleep can lead to short-term problems such as reduced concentration and irritability. However, the long-term effects of sleep deprivation impact more than just focus and mood.³ 

Sleeplessness can affect several aspects of your mental clarity, increase stress levels, and even increase your risk of injury. 

The good news is there are many ways to manage and treat anxiety-related insomnia. 

What is insomnia?

Insomnia is a sleep disorder where a person has trouble falling asleep or staying asleep. 

If you struggle to sleep, you’re not alone. Insomnia is one of the most common sleep disorders.

According to the American Academy of Sleep Medicine:⁴

• 30–35% of the US population experiences brief insomnia symptoms.

• 15–20% suffer from short-term insomnia that could last anywhere from a few days to up to 3 months.

• 10% suffer from chronic insomnia, which occurs at least three times a week over three months. 

A combination of several factors usually causes insomnia. Together, these factors may lead to hyperarousal, meaning your body’s stress response is always switched on, making you feel like you’re living in constant fear and tension. 

Common risk factors for insomnia include: 

• Stress

• Existing medical conditions 

• Mental health conditions

• Lifestyle habits such as poor diet, lack of exercise, and too much time spent looking at your phone

• Medications.

How do I know if I have insomnia? 

You may have insomnia if you regularly: 

• Have difficulty falling sleeping

• Have difficulty staying asleep 

• Feel poorly rested after sleep 

• Wake up early but are unable to go back to sleep

• Find it difficult to concentrate or remember things.

Anxiety-induced insomnia: overview, causes, symptoms

Anxiety is frequently linked to sleep problems, and while it’s a necessary response to stress, it can do more harm than good, especially before sleep. This is because anxiety triggers the fight-or-flight response in your body, flooding your body with energy to deal with perceived threats. 

This response releases two hormones, adrenaline, and noradrenaline, along with cortisol. Cortisol increases your heart rate and contraction of muscles to help you escape, which will make it much harder to relax and sleep. 

Insomnia and anxiety are closely linked. Because of this, it can be hard to tell whether you’re having trouble sleeping because you’re anxious or if you’re feeling anxious because you can’t sleep. 

However, research has suggested that either condition can precede the other. According to the Anxiety and Depression Association of America,⁵ anxiety can cause sleeping problems, further worsening anxiety severity. 

Likewise, sleep deprivation can increase the risk of developing anxiety as trying to force sleep can generate hyperarousal and make you more alert. You also begin thinking about the impact your inability to sleep may have on your performance the next day, which incites a vicious cycle that worsens the effect of insomnia and anxiety. 

What does the research show?

An experimental study⁶ observing the sleep patterns of 15 adults with anxiety found that the brain activity of those who had poor sleep quality resembled brain activity seen in anxiety disorders. 

This suggests that insomnia and anxiety activate the same stress mechanisms in the brain. 

Using brain imaging techniques, researchers observed that those who experience insomnia showed increased activity in the amygdala when shown sleep-related stimuli. 

A separate study⁷ found that when a person is sleep-deprived, there was reduced connectivity between the amygdala and medial prefrontal cortex, which work together to regulate emotional responses like fear and anxiety. 

These findings are important as the amygdala is considered to be responsible for regulating emotion, and under sleep-deprived conditions, it may be more sensitive towards negative emotional triggers. 

Common causes of anxiety 

The causes of anxiety-induced insomnia are similar to the causes of insomnia. Things that cause you to worry may indirectly impact sleep. 

Common causes of anxiety include: 

• Caffeine - Consuming caffeine before sleeping or late in the day stimulates your brain, which can lead to difficulties in sleeping.

• Significant life changes - Problems at work, school, or home can impact your ability to sleep as lying in bed without distractions allows you to think about the issues.

• Other medical conditions - Existing health conditions may lead you to feel more anxious about sleeping in fear that the condition may disrupt your sleep. 

• Work schedule - Longer working hours are associated with increasing anxiety symptoms, which in turn increased the risk of sleep disturbances.

Is it anxiety or insomnia? 

Although both anxiety and insomnia share similarities, some differences do exist between the conditions. Below is a side-by-side comparison of the two conditions:

If you suspect that you have both anxiety and insomnia, it’s important to mention both conditions to your doctor. 

Sleep and anxiety have a strong relationship, so it may take more than one doctor’s visit to diagnose the disorders. It’s essential to express any concerns about how anxiety and sleeplessness may affect your day-to-day performance and quality of life. 

Treating sleep problems without taking steps to manage anxiety and reduce stress and vice versa is unlikely to have any significant impact.

Treatments for anxiety-induced insomnia

The treatments for insomnia and anxiety are often the same. As such, it is possible to find a suitable treatment that can treat both conditions simultaneously. 

Treatments can involve talk therapy, lifestyle changes (e.g., starting a yoga class), medication, natural remedies, or a combination of these. 

Cognitive behavioral therapy 

Cognitive behavioral therapy (CBT) for insomnia⁸ is an evidence-based therapy that helps people identify negative thoughts and replace them with positive thoughts so they can resume normal sleeping behavior. 

Typically, this involves a structured program with a therapist or trained counselor who helps you identify underlying thoughts and behaviors that may be worsening your sleep problems. 

Many people respond to this treatment quite quickly, with significant changes observed in as little as two therapy sessions. This can be done through techniques such as: 

• Stimulus control

• Sleep restriction

• Sleep interfering arousal/activation

• Food and substance management

• Biological clock regulation.

Exercise

Exercise is recommended for almost every mental health condition, making it an effective treatment for insomnia.

Most researchers agree that moderate-intensity workouts are the best type of exercise to help you fall asleep faster. 

Research⁹ has shown that even just one exercise session can increase sleep time and sleep efficiency by 18% and 13%, respectively. 

In addition, exercise helped prolong the time spent in slow-wave sleep (also known as deep sleep), which allows our body and mind to refresh for the next day. 

Despite the overwhelming support for exercise, avoid exercising too close to bedtime as this might stimulate your mind instead of relaxing it. 

Relaxation techniques

Relaxation techniques such as yoga, meditation, mindfulness, and deep breathing exercises can help calm your mind throughout the day, ideally making it easier to fall asleep at night. 

A review¹⁰ of 112 studies related to relaxation techniques and sleep quality found that mindfulness meditation was one of the most frequently used relaxation exercises and the most effective. 

By maintaining awareness of our body and surroundings, researchers¹¹ agree that mindfulness meditation is a good technique to combat insomnia, with significant improvements in sleep quality. 

Journaling

It’s common for your thoughts to keep you on high alert. Regardless of the thoughts occupying your mind, it’s often hard to switch them off. 

It’s recommended to keep a notebook and pen near your bed to log everything and anything: thoughts before bed, amount of time spent awake, and thoughts on the quality of sleep. 

Writing your thoughts can help slow your mind, which may help you to fall asleep faster. 

Medications

A doctor may recommend over-the-counter medications, and they can work with or without other interventions (e.g., CBT or exercise). However, caution is advised as some sleep medications have long-term side effects,¹² potential drug interactions, and can become addictive. 

Make sure to tell your doctor about all existing medications and supplements that you’re taking before you consider sleep-related medication. 

Medications such as Ambien, Lunesta, and benzodiazepines have been used for insomnia; however, they should only be used short-term to avoid physical dependency. 

You can also use sleep aids containing chemicals found in our bodies, such as melatonin. This hormone is naturally produced to signal our brain to prepare for sleep and regulates our body’s sleep-wake cycle. 

Other effective treatment options include: 

• Practicing good sleep hygiene

• Creating a good sleep environment

• Avoiding alcohol and caffeine

• Avoiding screens before bed

• Creating an optimal environment for sleep.

When to see a doctor

If you find that your anxiety and insomnia are getting worse, or if you’re still experiencing significant difficulty in falling/staying asleep, then it’s important to make time to see your doctor. They may ask you about your sleeping history, lifestyle, and habits. 

Your doctor may also check for other medical conditions that could affect your sleep and anxiety to rule out other possibilities. 

Depending on the outcome, your doctor may refer you for a sleep study, prescribe sleep aids, or suggest you keep a sleep diary to note any changes in your sleeping patterns. 

The lowdown

Although anxiety and insomnia go hand in hand, it doesn’t mean that you have to suffer through them. 

From CBT to lifestyle changes, a range of treatments are available for everyone, and finding what’s best for you can be done through experimenting and trial-and-error. 

Insomnia can be treated, and with the right support from your doctor and therapist, it can help you get a good night’s sleep again.