Guide to Anxiety and Sleep

An article from Tuck Sleep – A Community for Advancing Better Sleep


According to Anxiety and Depression Association of America (ADAA), anxiety is a reaction to stress. Its key markers are feelings of tension, worried thoughts, and physical changes such as elevated blood pressure.

Just like physical pain, in and of itself anxiety is not a bad thing: it signals that something is wrong. Temporary anxiety is normal and can count as healthy, because it draws our attention to causes of stress that might need correcting. But anxiety disorders–the excessive and chronic reactions to stress–are mental illnesses. Anxiety disorders are, in other words, worry that sticks way past its usefulness to us; it does not go away and often gets worse with time. According to National Institute of Mental Health, anxiety disorders–from post-traumatic stress disorder, through obsessive compulsive disorder, to a variety of phobias–are the most common mental disorders experienced by Americans. They affect 40 million adults over 18 in the United States, or 18 percent of the population. Many anxiety disorders negatively affect sleep–and vice versa. Doctors call them comorbid: they go hand-in-hand. In other words, anxiety and sleep are connected via a self-reinforcing feedback loop. Feeling rested has been proved to combat anxiety and feeling less anxious leads to sounder sleep. The converse is also true: insomnia feeds anxiety and anxiety keeps us up at night. According to The Cleveland Clinic, two-thirds of patients referred to sleep disorders centers have a psychiatric disorder. “Anxiety is an emotion that actually wakes us up,” Dr. Steve Orma, author of Stop Worrying and Go to Sleep: How to Put Insomnia to Bed for Good, told The Huffington Post. “There are all kinds of physical changes happening that ramp you up, which is the exact opposite state of what you need to be in when you’re trying to fall asleep.”

This guide gets at the link between anxiety and sleep and covers several anxiety disorders that interfere with sleep and which can be alleviated with sleep: generalized anxiety disorder (GAD); social anxiety; obsessive-compulsive disorder (OCD); phobias; post-traumatic stress disorder (PTSD); and panic disorder. It offers solutions to the sleep deprived anxiety sufferers, from treatment options, through online forums, tips regarding healthy sleep hygiene and banishing anxious thoughts, to medical associations that can help.

Anxiety and lack of sleep

Anyone who lost a night to insomnia on account of troubling thoughts has been where many chronic anxiety sufferers find themselves all too frequently. According to UC Berkeley researchers, lack of sleep plays a role in ramping up brain regions that trigger excessive worry. Additionally, those who tend to worry too much are more vulnerable to sleep disorders. “These findings help us realize that those people who are anxious by nature are the same people who will suffer the greatest harm from sleep deprivation,” said Matthew Walker, a professor of psychology and neuroscience at UC Berkeley and senior author of the study. Worry about lack of sleep becomes a self-fulfilling prophecy at times. Anxiety causes sleep loss, which in turn can provoke further anxiety in sufferers. The mechanism behind this phenomenon has to do with what researchers call anticipatory anxiety. People prone to sleep deprivation worry that they might not be able to sleep, perhaps based on past experience. That worry fires up the brain’s amygdala and insular cortex, mimicking the neural activity seen in anxiety disorders. And now, indeed, because of the anticipatory anxiety, sleep becomes elusive. Researchers at University of California Berkeley’s Sleep and Neuroimaging Laboratory found that when deprived of sleep, the brain reverts back to more primitive patterns of activity. What this means is that subjects kept awake were less likely to put emotionally-charged information in context. The good news is found in the reverse. Doing the opposite–finding ways to get better sleep–presents us with a tried-and-true solution to alleviate anxiety. “By restoring good quality sleep in people suffering from anxiety, we may be able to help ameliorate their excessive worry and disabling fearful expectations,” says Dr. Allison Harvey, one of the authors of the study published in the Journal of Neuroscience.

Generalized Anxiety Disorder


People living with generalized anxiety disorder (GAD), also known as free-floating anxiety, are prone to an exaggerated sense of worry regarding everyday events. The worry tends to persist no matter the circumstances. According to DSM-5, which is short for the fifth and the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, if the excessive anxiety and worry about events or activities goes on for most days of the week for at least six months, it points to GAD.


  • Persistent obsession that is disproportionate to the concerns and the potential consequences of the object of worry
  • Restlessness
  • Inability to set the worry aside and relax
  • Difficulty maintaining focus and concentration
  • Frequent decision-making paralysis
  • Worrying about worst-case scenarios

The persistent chatter of generalized anxiety is a voice that’s difficult to quiet at bedtime. Fifty percent of patients diagnosed with generalized anxiety disorder have sleep disorders. Difficulty falling and staying asleep as well as walking up to panic attacks (sudden awakenings to intense anxiety, heart palpitations, shortness of breath, sweating or chills, and often the irrational fear of impending death) are common effects of GAD on sleep.


Determining that a patient has generalized anxiety disorder can be tricky because it often mimics and coexists with mental health illnesses such as phobias, depression, and PTSD. The persistence of excessive worry and the inability to control it for most days during the period of six months is a key marker of the GAD diagnosis. The absence of a particular trigger or trauma is also a distinguishing marker. For more features used by doctors to diagnose GAD, the questionnaire provided by the ADAA can be of help.

Getting better rest at night can do wonders for the symptoms of free-floating anxiety. Sleep researchers at Harvard have found that consolidated slumber throughout a whole night, in all its stages, helps people learn and make memories while impaired sleep reduces the ability to focus and acquire new information.

In turn, treating the symptoms of GAD can lead to better sleep because an effective treatment diminishes restlessness and helps gain control of worry.


The two common ways of treating GAD’s symptoms are psychotherapy and drugs. They are often used in conjunction. Both have the power to alter brain chemistry.

Psychotherapy, such as cognitive behavioral therapy or mindfulness therapy, helps patients learn skills (such as distraction, detachment from negative thoughts, cognitive restructuring, exposure therapy) with which they can learn to abort obsessive worry.

Antidepressants (particularly SSRIs) can help, over time, to influence the activity of neurotransmitters in the brain—serotonin, dopamine, and norepinephrine–by increasing their presence. These neurotransmitters are responsible for maintaining mood balance and helping people put concerns in context. It takes a few weeks of well-tuned and consistent use for antidepressants to render effective results. Tranquilizers known as benzodiazepines–for example, Xanax and Ativan–can in the meantime be used occasionally to prevent acute attacks of anxiety, such as panic attacks.

Some studies have found that, depending on the individual, talk therapy can be as effective as antidepressants.

Online Resources


Social Anxiety Disorder


DSM-5 defines social anxiety disorder as a “persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others.”

The socially anxious person fears acting in a way that might be embarrassing or humiliating. The fear of judgment by others often leads to avoidance of social situations or attacks of anxiety in social contexts, interfering with the socially anxious person’s normal routine, relationships, and professional goals for the period of at least six months. Fifteen million American adults live with social anxiety disorder.


  • A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others
  • Exposure to the feared situation almost invariably provokes anxiety (which can manifest in panic attacks)
  • The sufferer recognizes that this fear is unreasonable or excessive
  • The feared situations are avoided or else are endured with intense anxiety and distress
  • The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s normal routine and functioning
  • The fear, anxiety, or avoidance is persistent, typically lasting 6 or more months

Because a good night’s rest is proven to stabilize people’s moods and emotional regulation, it is important for social anxiety sufferers to get enough sleep. Not enough sleep boosts anticipatory anxiety, which troubles the socially anxious in the lead-up to social situations, often preventing their ability to sleep at night. According to UC Berkeley researchers, “By restoring good quality sleep in people suffering from anxiety, we may be able to help ameliorate their excessive worry and disabling fearful expectations.”


To be diagnosed with the disorder, persons must have persistent fear, anxiety, or avoidance that last for six months and interfere with their usual routine, occupational tasks, and relationships.

When diagnosing a patient, doctors sometimes confuse social anxiety disorder with panic disorders. The difference between the two is found in the fears that underlie them, explains psychologist Thomas A. Richards. People with a panic disorder interpret their sudden, discombobulating anxiety attacks as something being physically wrong with them. They might, for example, believe that the tightness in their chest means that they’re having a heart attack or that they are about to suffocate to death.

Not so in the case of social anxiety sufferers, who do not see their heightened anxiety as a primarily physical issue. They see their anxiety, provoked by social interactions, is the underlying fear.

“The socially-anxious person has extremely high anxiety when they’re put into a position where they must make small talk to a stranger or interact with others in a group,” Richards writes. “Their anxiety becomes worse when the person fears that they are going to be singled out, ridiculed, criticized, embarrassed, or belittled.”

It is important to note that people living with social anxiety are not deluded: they recognize this fear as unreasonable and excessive. Yet, they act on this fear they know to be irrational by avoiding social situations or becoming very anxious when socializing.


Like in cases of other anxiety disorders, both talk therapy and medications have been found helpful to the socially anxious.

Cognitive behavioral therapy has been proven effective in many cases. Often therapists will try to get at deeply seated roots of the problem (which, for example, may have to do with family background or history of having been bullied). In practical terms, they can conduct exposure therapy, in which patients prepare for and are put in social situations that challenge them. Some studies have found that, depending on the individual, talk therapy can be as effective as antidepressants.

Antidepressants (particularly SSRIs) can help, too, by increasing the presence of neurotransmitters (serotonin, dopamine, and norepinephrine) in the brain, which in turn allows for mood management; people treated with antidepressants are then better able to internalize the rational arguments against social anxiety disorder–for example, that few people take the time to scrutinize us when we make a comment at a cocktail party. It takes of a few weeks of well-tuned and consistent use for antidepressants to render effective results. Tranquilizers known as benzodiazepines–for example, Xanax and Ativan–can in the meantime be used occasionally to prevent acute attacks of anxiety, such as panic attacks.

The socially anxious patient who has a speaking engagement can benefit from taking a benzodiazepine prior to that occasion. Beta blockers block adrenaline, which can reduce the physical symptoms of social anxiety such as shaking voice, elevated heart rate and blood pressure, excessive sweating, and the pounding of the heart.

Online resources

  • The National Institute for Mental Health’s online social anxiety section contains explanation of the disorder, symptoms, and treatment information
  • The ADAA offers 10 tips to reduce stage fright
  • A social phobia forum
  • Social Anxiety Disorder forum at the Anxiety Community website
  • This ADAA offers ways to treat anxiety and depression (which often coexist), including both conventional and complementary treatments
  • A list of 10 feelings that social anxiety causes from The Social Anxiety Institute
  • Stories and tips concerning what it’s like to live with social anxiety can be found at Social Anxiety Institute’s website, The Huffington Post, and The Mighty
  • To find a local, national, or online social anxiety support group check out the links provided by the ADAA, Anxiety Social Net,, Anxiety Community, or ask a therapist.
Jessica JonesGuide to Anxiety and Sleep

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