Waking up with anxiety in the middle of the night can disrupt your sleep. When you’re lying awake with anxiety, you may have trouble drifting back to sleep.
Anxiety and sleep are closely linked. Anxiety can worsen a sleep disorder, such as insomnia—the inability to fall and stay asleep. But difficulty sleeping can also worsen anxiety.1 In either case, taking steps to manage those nighttime worries could help you go back to sleep and improve your overall health.
Why Would Anxiety Cause Someone to Wake Up in the Middle of the Night
Stressful life events and anxiety can make your mind more active than usual and trigger a heightened mental and emotional state called hyperarousal.2 As a result, your fight-or-flight response—or how your body automatically reacts to stressful events—can be thrown off balance.3
Usually when you wake up in the morning, your brain releases more noradrenaline (also called norepinephrine). This is a hormone involved in your fight-or-flight response and is linked to certain brain functions that keep you awake.3,4
But being stressed during the day is associated with disrupted sleep at night. That’s more likely for people whose sleep is particularly vulnerable to stress.2 Losing sleep during the night can cause an unusual increase of noradrenaline levels.3 In turn, you might suddenly wake up with feelings of anxiety at night and also find it difficult to fall back asleep.
Several mental disorders related to anxiety or stress can provoke or worsen sleep difficulties. These include:
- Generalized anxiety disorder: This condition involves a constant feeling of dread or anxiety that can last for months or more. Symptoms include restlessness, agitation, difficulty concentrating, and excessive or irrational worry.5 It can affect daily life and disrupt sleep.1,5
- Post-traumatic stress disorder (PTSD): People who experienced a traumatic event, such as one related to death or physical harm, may develop this stress disorder. Symptoms include flashbacks, frightening thoughts, or avoidance of the traumatic event, along with disrupted sleep and nightmares.6
- Nocturnal panic attacks: People with panic disorder have frequent panic attacks—sudden periods of intense panic with symptoms such as elevated heart rate, chest pains, trembling, and feelings of being out of control. But even if you don’t have panic disorder, you can still experience a panic attack, though less frequently.5 This includes nocturnal panic attacks that can jolt you awake at night.7
The Vicious Cycle of Anxiety During Sleep
Since anxiety and sleep are so closely related, a vicious cycle can emerge. Waking up with stress, worry, and anxiety can make it harder to fall back asleep. And this inability to relax the mind and drift off, in turn, causes even more anxiety as you wonder if you’ll ever get the rest you need.
When you sleep, you go through different sleep stages, including REM (rapid-eye movement) sleep. This stage can help process your emotions and adapt to fearful or stressful events. REM sleep can affect how you remember certain details and help you reduce your emotional responses when recalling a stressful event over time.3 This includes how your body responds autonomically—your breathing, heart rate, and other essential functions of your autonomic nervous system.2
For example, if your dog just died, you could be overwhelmed with stress and grief in the first few days. You may shed tears and be short of breath. Over time, sleeping can help you process that grief. After a year, your emotions won’t be as intense as you first experienced them and you might cry less when thinking back on it.
Having anxiety, a stress disorder like PTSD, or a sleep disorder can disrupt your sleep. You might be getting less REM sleep, meaning you are spending less time recovering from emotional events.3
The result? A vicious cycle of lost sleep and worsening anxiety and stress.
The CDC recommends adults get at least seven hours of sleep each night.8 Signs you’re not getting enough sleep include:9
- Difficulty staying awake during the day
- Inability to concentrate or focus
- Difficulty managing emotions
- Slower reaction time
- Difficulty making decisions or solving problems
How to Avoid Anxiety at Night
Reducing anxiety can improve your sleep. Several strategies can help manage anxiety and stress:
- Meditation: Deep breathing and visualization exercises can help you relax. This typically involves inhaling and exhaling slowly while focusing on your breath and imagining a peaceful, calm place.1
- Exercise: Studies show that physical activity can reduce symptoms of anxiety disorders.10 Regular exercise in the mornings and afternoons can also improve sleep.1
- Manage your tasks: It might help to write down what you have to do during the day. Break down those extra stressful tasks into smaller, more manageable steps. Try to prioritize your time with the important stuff.1
- Relaxing activities: Unwind from the day and get ready for sleep with a bedtime routine of relaxing activities. Try listening to music, reading, journaling, or taking a bath.1
- Redirect your anxiety: Being more engaged in your community, such as volunteering or simply lending your neighbor a hand, can help take your mind off your stress and anxiety.1
- Seek professional help: If you have an anxiety or stress disorder or suspect you do, it’s worth talking to a psychiatrist or therapist. They can provide treatments, such as medications and therapy.11 Even just having someone to talk to can be a big boost for your mental health.1
How to Go Back to Sleep Once You Wake Up
Nighttime panic attacks can jolt you awake. But how can you tell if anxiety is waking and keeping you up? Typical signs of a panic attack can include:12
- Racing, unwanted worries (intrusive thoughts)
- Feelings of fear and loss of control
- Elevated, racing heartbeat
- Chills or hot flashes
- Shortness of breath, chest pain, or difficulty breathing
- Nausea or abdominal pain
- Dizziness, feeling faint
- Numb or tingling sensations in the body
Even if you aren’t having a panic attack, you may still experience anxiety symptoms, such as persistent worry or muscle tension, that keep you up at night. You may also feel restless and fatigued but have trouble falling back asleep because you are fixated on your worries.12
These symptoms can wake you up and keep you tossing and turning in bed. However, there are some techniques that can help you reset and go back to sleep.
If you have difficulty sleeping, try turning any clock faces away from your view. If you’ve woken up with anxiety, knowing what time it is may only add to your worries. This can contribute to the vicious cycle of anxiety and sleep.1
Establish a screen-free bed
If you are trying to go back to sleep, avoid checking your phone in bed, don’t watch TV, and keep your laptop packed up.1 When children and teens use these devices before bed, they are more likely to stay up later and sleep less.13
Get up and do something relaxing
If you can’t fall back asleep and 15 minutes have passed, go into another room for a moment. Sit in a comfortable chair and read or do some breathing exercises. After relaxing, try going to bed again.1
When to See a Healthcare Provider
Since sleep difficulties can make anxiety worse and anxiety can interfere with your sleep, it’s important to know when to get help. Anxiety disorders are very common; about 30% of adults experience them at some point in their lives.12
If you are having anxiety and sleep loss, talk to a healthcare provider for diagnosis and treatment. They will be able to provide ways to manage your condition, such as therapy or medication.1,12
Anxiety upon waking up can make falling back asleep difficult, and as you toss and turn, the worries and fears may only get worse. Whether from a mental health disorder or periodic stress, managing anxiety—and learning ways to fall back asleep—can be a critical part of maintaining your overall health. Keep an eye on how much rest you’re getting, and if you suspect you have a mental health disorder, seek help from a healthcare professional.
- Anxiety and Depression Association of America. Sleep disorders.
- Kalmbach D, Anderson J, Drake C. The impact of stress on sleep: pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders. J Sleep Res. 2018;27(6):e12710. doi:10.1111/jsr.12710
- Goldstein AN, Walker MP. The role of sleep in emotional brain function. Annu Rev Clin Psychol. 2014;10:679-708. doi: 10.1146/annurev-clinpsy-032813-153716
- National Institute of Neurological Disorders and Stroke. Brain basics: understanding sleep.
- National Institute of Mental Health. Anxiety disorders.
- National Institute of Mental Health. Post-traumatic stress disorder.
- Nakamura M, Sugiura T, Nishida S, Komada Y, Inoue Y. Is nocturnal panic a distinct disease category? Comparison of clinical characteristics among patients with primary nocturnal panic, daytime panic, and coexistence of nocturnal and daytime panic. J Clin Sleep Med. 2013;09(05):461-467. doi:10.5664/jcsm.2666
- Centers for Disease Control and Prevention. Data statistics: short sleep duration among adults.
- National Heart, Lung, and Blood Institute. How sleep affects your health.
- Kandola A, Stubbs B. Exercise and anxiety. Adv Exp Med Biol. 2020;1228:345-352. doi:10.1007/978-981-15-1792-1_23
- American Psychological Association. Beyond worry: how psychologists help with anxiety disorders.
- American Psychological Association. Anxiety disorders.
- Hale L, Guan S. Screen time and sleep among school-aged children and adolescents: a systematic literature review. Sleep Med Rev. 2015;21:50-58. doi:10.1016/j.smrv.2014.07.007