Anxiety isn’t always convenient. While it can alert and protect us from danger, it can also become problematic if it continues long after the stressor is gone. Anxiety may show up during the day for some, but for others, it can become more noticeable when they lay down for the evening. If you’re one of these people, you may find yourself asking, “Why is my anxiety worse at night?” The answer is in how your brain and body responds to stress once there are no more distractions.
Keep reading to learn what causes anxiety at night, how it affects your sleep and health, and what steps you can take to get it under control.
What is Nighttime Anxiety?
Nighttime anxiety involves feelings of worry, tension, or fear that intensify during the evening, especially around bedtime. As your external world quiets down, your internal world gets louder, making it harder to fall or stay asleep. It’s not a standalone diagnosis; however, anxiety at night is often seen in people with generalized anxiety disorder (GAD), panic disorder, or PTSD.
Symptoms of Anxiety at Night
When you have anxiety at night, it can interrupt the mind and body’s ability to rest. These symptoms may develop gradually or come on suddenly. Some of the most common symptoms include:
- Difficulty falling asleep or waking up frequently
- Thoughts that feel intrusive, repetitive, or hard to stop
- Physical restlessness that makes it hard to stay still
- Chest discomfort or a rapid heartbeat
- A general sense that something is wrong even if nothing has happened
- Replaying past events or worrying about what might go wrong
In other words, your brain doesn’t slow down, and your body doesn’t feel safe enough to sleep. This can make people feel like they’re stuck in a neverending cycle.
How Does Anxiety Affect Sleep?
Sleep is dependent on timing, routine, and a calm nervous system, but anxiety can disrupt each of these. When you’re anxious, your body stays in a state of alertness. This makes it more difficult to transition into deep, uninterrupted sleep.
Your body runs on a 24-hour circadian rhythm cycle that regulates melatonin and cortisol. Melatonin tells your body it’s time to wind down. Cortisol helps you wake up and stay focused. When anxiety keeps cortisol levels elevated at night, melatonin doesn’t increase the way it should, thus delaying sleep or causing frequent wake-ups.
Over time, sleep disturbances can become chronic and start to overlap with anxiety disorders. To cope, people may start using substances like alcohol or marijuana to force sleep. While these may help in the short-term, they can actually worsen your sleep quality, increase dependence, and make recovery more difficult.
What Causes Anxiety at Night?
Nighttime anxiety can be caused by several different factors. For some, stressful events from the day can cause anxiety at night. For others, bad sleep routines, trauma, certain medications, or co-existing disorders contribute to their anxiety at bedtime. Here’s a closer look at some common causes of anxiety at night:
Stress and Trauma
When you’re preoccupied with completing tasks or interacting with others, you may not be aware of the stress that’s building in the back of your mind. Yet, at night, this unresolved tension has nowhere else to go. The mind becomes more aware of what it didn’t fully process and proceeds to ruminate, overanalyze, and worry about things that happened during the day.
Stressful life events, like losing a job, can make this worse. In some cases, these experiences can trigger an anxiety pattern that repeats every night.
People with PTSD experience this pattern more intensely. Memories they’ve tried to avoid during the day may come back through vivid dreams or increased alertness at night. Research shows that 70% of those with PTSD have frequent and distressing nightmares. Many report feeling unsafe in silence or darkness, which can lead to sleep avoidance, physical restlessness, and waking up earlier than wanted.
Lack of Quality Sleep
Poor sleep habits can increase anxiety symptoms over time. When your sleep schedule is inconsistent or your environment isn’t restful, your brain and body don’t get the signals they need to prepare for sleep.
Habits like late-night scrolling, caffeine late in the day, or staying up past your natural sleep window can affect the body’s ability to wind down. Stimulants like caffeine increase alertness by raising heart rate and blood pressure. This can make your body feel more anxious even if your thoughts are calm. If you’ve been consuming caffeine regularly, cutting back too quickly can cause withdrawal symptoms like nervousness or irritability.
Ongoing sleep loss also affects how well you handle stress. Research shows that people who don’t get enough sleep are more emotionally reactive and more likely to develop anxiety symptoms. In other words, the worse your sleep becomes, the more vulnerable you are to anxious thoughts and feelings.
Medication Side Effects
Some prescription and over-the counter medications can make it harder to fall or stay asleep. They may also increase symptoms of anxiety, especially if you take them late in the day.
This can include:
- Antidepressants
- Decongestants
- Smoking-cessation drugs
- Steroids
- Beta blockers
Beta blockers, for example, are known to reduce melatonin production by 50%. These lower melatonin levels can contribute to insomnia or shallow sleep.
If you’ve recently started a new medication and noticed changes in your anxiety or sleep patterns, bring it up with your doctor. Changing the time you take the medication or how much medicine you’re prescribed, or switching to a new medication, may help improve your sleep without compromising your treatment.
Sleep Disorders
Sometimes, an undiagnosed or mismanaged sleep disorder may be part of the problem if you’re experiencing nighttime anxiety. Insomnia, sleep apnea, restless leg syndrome, or narcolepsy can all interfere with the brain’s attempts to enter restorative sleep cycles.
These interruptions can leave you feeling wired or overtired at night. Studies show that almost half of people with anxiety also experience chronic sleep disturbances. Either the anxiety comes first or it appears as a response to repeated nights of poor sleep. When left untreated, sleep disorders can make anxiety harder to manage and easier to trigger.
How Does Nighttime Anxiety Affect Your Health?
When anxiety keeps you from getting quality sleep night after night, it can begin affecting how well you function during the day. Sleep is important for emotional regulation, concentration, memory, and decision-making. Without it, the brain and body can’t recover properly, which makes you more vulnerable to stress and less equipped to manage it.
According to the American Psychiatric Association, 10 to 15% of adults with insomnia report daytime impairments that affect their ability to work, socialize, or stay productive. Some of the common effects of sleep loss tied to anxiety at night include:
- Difficulty focusing or retaining information
- Low energy and mental fatigue
- Increased irritability or emotional reactivity
- Poor stress tolerance and lack of resilience
- Withdrawal from responsibilities or social engagements
Sleep deprivation caused by anxiety can also cause workplace accidents. In fact, sleepy employees are 70% more likely to be involved in an accident at work. These preventable errors or injuries are due to slower reaction times, poor judgment, and impaired decision-making.
How Can You Manage Anxiety at Night?
To manage your nighttime anxiety, you’ll need to adopt healthier habits and thought patterns that’ll help your brain wind down. Essentially, you want your body to feel safe so that it can get the rest it needs. Strategies to consider include:
- Grounding exercises, like deep breathing, guided meditation, or journaling
- Limiting social media, stimulants, or doomscrolling leading up to bedtime
- Going to bed and waking up at the same time everyday
- Releasing built-up tension through progressive muscle relaxation
- Participating in regular physical activity or exercise
- Joining support groups with others who understand what you’re going through
In addition to these lifestyle changes, you might also want to consider therapy. Cognitive Behavioral Therapy for Insomnia (CBT-I) is one option that addresses the thoughts and behaviors that may be contributing to your nighttime anxiety. Researchers discovered that CBT-I improves insomnia symptoms in up to 80% of people who attend regular sessions. Many people find that once they improve their sleep, their anxiety is easier to manage.
Get Support For Nighttime Anxiety
If your anxiety is keeping you from getting quality sleep every night and it’s affecting your ability to function during the day, it’s time to reach out for help. Working with a licensed therapist can help you get down to the cause of your anxiety and learn healthier routines that support rest and recovery.
At Cura Behavioral Health, we offer evidence-based therapeutic interventions and medication management for nighttime anxiety and other related conditions that may be contributing to your stress. Contact us today to schedule an appointment and start building a plan that helps you sleep, think, and live more clearly.
Sources:
- Cortisol and sleep: Do cortisol levels affect sleep? – everlywell
- Understanding the relationship between sleep deprivation and addiction – American Academy of Sleep Medicine
- The phenomenology of nightmares in post-traumatic stress disorder and complex post-traumatic stress disorder – European Journal of Trauma & Dissociation
- What doctors wish patients knew about the impact of caffeine – AMA
- Sleep deprivation makes us less happy, more anxious – American Psychological Association
- Effects of Prolonged Use of β-Adrenoblockers on Melatonin Secretion, Sleep Quality, and Vascular Brain Damage – Neuroscience and Behavioral Physiology
- Sleep and anxiety: From mechanisms to interventions – Sleep Medicine Reviews
- What are Sleep Disorders? – American Psychiatric Association
- Excessive Sleepiness and Workplace Accidents – Sleep Foundation
- Cognitive Behavioural Therapy for Insomnia (CBT-I) – Sleep Health Foundation
