How to Break the Vicious Cycle of Anxiety and Sleep Deprivation
Anxiety and sleep deprivation are cruel bedfellows, but there are solutions to help you settle your mind and sleep better.
Do you sleep poorly because you’re anxious? Or are you anxious because you sleep poorly?
The answer is both, and here’s why. Research tells us that the relationship between anxiety and poor sleep is bidirectional: Anxiety tends to peak at night, and it sets off a cascade of effects in the nervous system that can make it hard to get enough, high-quality sleep. Meanwhile, losing sleep can lower our threshold for stress and activate our brain’s fear network, resulting in worse anxiety.
Statistics bear this out: Anxiety is the most common mental health issue worldwide, and somewhere between 45% and 75% of people with anxiety also deal with sleep problems.
Either issue can be the chicken or the egg, kicking off a vicious cycle that’s hard to break. But not impossible. There are expert-backed treatment methods and strategies to help you move past challenges with bad sleep and anxiety, the couple no one wants to hang out with.
What happens inside your body when you’re anxious
Anxiety is a state of hypervigilance — your nervous system goes into overdrive assessing environmental threats.
When you find yourself in a dicey situation, the emotional-processing center of your brain activates your fear response. That means it tells your nervous system to release stress hormones, which trigger neurophysiological changes that prepare you to run away, hide or fight. (“Fight-flight-or-freeze” and fear response are the same thing.) These changes include:
- Heightened alertness
- A faster heartbeat to increase blood supply to your brain and muscles
- Heavier breathing to increase oxygen supply to your muscles
- Sweating, which brings down body temperature driven up by worrying
Fear response is a critical adaptive mechanism — in an emergency, you need to be on your toes, both physically and mentally. But anxiety happens when your brain perceives threats that don’t exist and activates your fear response when you’re not really in danger.
Does anxiety get worse at night?
Anxiety fluctuates throughout the day, says Rebecca Cox, PhD, an assistant professor of psychological and brain sciences and a clinical psychologist at Washington University in St. Louis who studies sleep and circadian rhythm disruption in anxiety-related disorders. Cox and colleagues recently published a paper showing that anxiety peaks at three times of day — the morning, late afternoon and late evening.
One reason anxiety tends to bubble up late at night, Cox says, is that anxious thoughts become the only thing to focus on. You’re too busy during the day to go down a worry spiral. But, by bedtime, you’ve finished working, working out, and catching up on group chats, and your mind is free to wander.
A complementary explanation comes from a recently developed theory called “Mind After Midnight.” The gist is: Late at night is the time when you’re most likely to be in a bad mood and have trouble thinking logically about your emotions. This is due to the “combined effects of circadian timing and sleep loss on systems that support emotion,” Cox says.
Research shows that positive emotions tend to be lowest at night, while negative ones peak.
In this case, we’re not talking about specific feelings, but rather a general tendency to either interpret information in a positive or negative light. Both positive and negative moods are tied to the circadian clock — they ebb and flow on a 24-hour schedule, and each one has its own distinct rhythm.
Additionally, there’s also a nighttime dip in activity between brain regions involved in regulating emotions. The presumed result is that you’re more likely to assume the worst at night and also less able to quash paranoid, pessimistic thoughts.
“To paraphrase one of the theory’s authors,” Cox says, ‘it’s a bad thing to be awake when reason sleeps.”
The team behind Mind After Midnight still has a lot to learn about the phenomenon. The next step is a lab study, set to begin in the fall, to flesh out its neurophysiological underpinnings.
How does anxiety disturb sleep?
Anxiety is stimulating — it makes you more mentally alert and physically energized. On any given night that can disrupt sleep, and it also makes sense that anxiety is usually linked with insomnia.
Some studies frame anxiety as a risk factor for subsequent insomnia, while others have found that insomnia often emerges at the same time an anxiety disorder does. Anxiety is also linked to sub-clinical insomnia symptoms, in people who don’t meet the criteria for a diagnosis.
But falling asleep isn’t always the pain point, says Philip Cheng, PhD, an associate professor and sleep researcher at Henry Ford Health. Biological differences can influence precisely how anxiety interferes with sleep. “Someone could have a strong sleep homeostat that builds and dissipates easily,” says Cheng. “This means they’re able to fall asleep despite anxiety. But as soon as their sleep drive (their need for sleep) has been partially dissipated, the anxiety is now strong enough to interfere with sleep maintenance.”
An example of this: After nodding off promptly at 11, you wake up at 2 a.m. and spend the next hour worrying.
Sleep maintenance is part of sleep continuity, a metric that assesses how well you sleep through the night on a consistent basis. Continuity is an aspect of sleep where experts see sizable differences between anxious and non-anxious people, Cox says.
Why does sleep deprivation lead to anxiety?
Just as anxiety can rob you of sleep, a lack of shuteye can bring on or exacerbate anxiety.
In one study, people who stayed up for 24 hours rated minor stressors as very stressful. This suggests that acute sleep deprivation “lowers the bar for experiencing an event as stressful,” Cox says, “and makes us more vulnerable to experiencing anxiety, even in response to relatively mild events.”
According to some studies, acute deprivation affects anxiety in a pronounced or even unique way. But others have found comparable effects from chronic partial sleep restriction (when you repeatedly get less than a full night’s sleep).
And, when it comes to partial restriction, one study suggests sleeping less than usual is what makes anxiety more likely, whereas the average amount of sleep you get is less relevant. In other words, someone averaging six hours of sleep isn’t necessarily more prone to anxiety than someone who gets seven. And if both people reduce their sleep by two hours for six nights in a row, that restriction would have a similar impact on their anxiety risk.
This happens because of changes that occur inside the sleep-deprived brain. Broadly speaking, sleep loss alters activity in the brain’s “fear network,” the series of neural circuits that help you identify threats in the environment and respond to them appropriately. Remember: Anxiety disorders involve a hyperactive fear response — where the brain misinterprets innocuous things as dangerous and struggles to control outsized negative emotions.
In one heavily cited 2007 study, participants either slept normally or stayed up for 35 hours, before having their brains scanned while they viewed various images. All participants showed similar neural responses to pleasant and neutral images, but differences emerged for frightening ones: The sleep-deprived group showed enhanced activity in the amygdala, a small structure that acts like the fear network’s alarm bell. There was also reduced connectivity between the amygdala and the medial-prefrontal cortex (MPFC), a region within the brain’s rational-thought hub involved in “top-down” control. That means it regulates negative emotional responses. An overzealous amygdala that’s not reined in by the MFPC is a recipe for emotions to run wild.
Sleep deprivation affects other parts of the brain too. For example, changes have also been observed in the hippocampus, a fear-network region that’s chatty with the amygdala. After the amygdala detects a threat, it sends information about it to the hippocampus, which converts that newly acquired information into a longer-term memory. This process is called memory consolidation. Consolidation of fear-related memories mainly happens during deeper stages of sleep. The hippocampus is also involved in two other memory processes, called retrieval and differentiation.
One hippocampus-centric theory blames sleep-fueled anxiety on increased fear generalization.
Fear generalization is a phenomenon where you sense danger in a situation you’ve never encountered before, because you subconsciously realize it’s similar to a dangerous situation you have been in. Some level of fear generalization is key for survival. But over-generalization entails perceiving too many situations as dangerous when they aren’t, and is a hallmark feature of multiple anxiety disorders.
The proposed neural explanation is that reduced connectivity between the prefrontal cortex and the amygdala and hippocampus, plus enhanced activity throughout the emotion-processing system, might impair the hippocampus’s “pattern separation ability.” This function is needed to distinguish between true threats and things that somehow resemble those threats but are harmless.
And here’s another idea that implicates the hippocampus: Impaired memory consolidation from sleep loss leads to increased threat anticipation, not fear over-generalization. This means people who haven’t slept expect to encounter threats, so they’re biased toward detecting them — like a self-fulfilling prophecy. The authors of one review paper framed this as a maladaptive version of the “better safe than sorry” principle. When you’re unsure about something, assuming it’s dangerous can feel protective. This dovetails with the finding that uncertainty is extremely stressful for underslept people.
Either direction can start a vicious cycle
Anxiety can interfere with sleep, which spurs more anxiety, which only makes it harder to sleep. Or bad sleep can whip up anxiety, and then more bad sleep. Or both problems can emerge around the same time. Regardless of which emerges first, bad sleep and anxiety can become a vicious cycle.
“Sleep anxiety” can help fuel this negative feedback loop: If you can’t sleep one night, you might get anxious about not being able to sleep the next night, on top of generally feeling more anxious from sleep loss. This is a common pattern with insomnia.
Also, if you regularly experience anxiety when you’re in bed, being in bed can itself become an anxiety trigger. “Repeatedly pairing anxiety with the bed or bedroom can create a learned association,” Cox says, “such that the bed or bedroom becomes a conditioned stimulus for anxiety.”
Treatments for anxiety and sleep deprivation
If you’re dealing with anxiety and insomnia, a doctor might suggest cognitive behavior therapy for insomnia (CBT-I). CBT-I would likely be helpful whether insomnia is clinical or subclinical, says Cox. On top of that, it could help prevent subclinical insomnia symptoms from turning clinical.
CBT is a goal-oriented form of therapy that entails identifying and challenging destructive thought and behavior patterns, and then replacing them with healthier habits. In one study, people with generalized anxiety disorder received CBT for anxiety, and researchers measured changes in both their anxiety and sleep symptoms. The CBT program didn’t specifically address sleep, but participants whose anxiety improved also reported sleeping better. When participants’ anxiety didn’t improve, neither did their sleep. So, the two issues seemed to go hand in hand.
CBT-I is an insomnia-specific version of CBT and the first-line recommended treatment for the disorder.
The Tone Take: You can break the cycle
It’s absolutely possible to overcome poor sleep and anxiety, and the right solution depends on the nature and severity of what’s going on. If you’re experiencing sleeplessness for a month or longer, talk to your doctor. In the short-term, start with these strategies, many of which are drawn from the CBT-I playbook.
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Schedule “worry time” during the day: “Set aside a specific block of time each day and write down everything you’re currently worried about,” says Cox. This technique can “help you problem-solve ongoing issues during the day, when your brain is more capable of logic and reduces the likelihood of worries emerging in the pre-sleep period.”
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Pay attention to light exposure, day and night. Light plays a big role in telling your biological clock when it’s time to sleep. Exposure to bright light suppresses melatonin, a hormone heavily involved in regulating circadian rhythms, while darkness triggers its release. Misalignment between your biological clock and preferred sleep schedule can contribute to insomnia, but you can use light to nudge your biological clock earlier. Cox recommends dimming indoor lights after sunset and heading outside for a morning walk, because natural sunlight is the strongest circadian cue.
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Don’t go to bed until you feel sleepy. Lying in bed awake strengthens the association between wakefulness and bed, and is practically an invitation for anxious thoughts. So don’t get cozy unless you’re actually tired, even if that means going to bed later than you want. “Letting pressure or need for sleep build up helps you fall asleep quicker and stay asleep longer,” Cox says.
- Optimize your sleep soundscape. Your bedroom should be quiet, but absolute silence doesn’t work for everyone. Background noise can help distract you from anxious thoughts. If you have a noise machine, turn it on. Or find a white or pink noise app. Or put on “sleep stories,” which are intended to be too dull to capture your attention. Just don’t listen to something stimulating, like the next episode of your current binge-watch.
- Don’t try to fall asleep. It might seem counterintuitive, but “trying to sleep” works against you. “It’s more about creating the physical, psychological and physiological conditions for sleep to occur,” says Cheng.
- Get out of bed. If you find yourself tossing and turning, unable to sleep, one thing that might help in the moment is leaving your bed. Once you’ve been lying awake for 15 to 20 minutes, or as soon as you start worrying, Cox says to get up and do a relaxing activity, like reading, in dim light.
- Avoid common errors. Alcohol might initially relax you, but it won’t help you achieve or stay in deep sleep. And most DIY fixes you see online, like essential oils and special pillows, are useless, Cox says. “They don’t address the core issue in insomnia — the learned association between wakefulness and the bed.”