40 million adults suffer from an anxiety disorder such as generalized anxiety disorder, phobia anxiety, or social anxiety disorder. Affecting 18 percent of the population, they’re the most common mental illness in the U.S.

Anxiety disorders develop from several factors, including brain chemistry and genetics, as well as individual’s personality and life events. While anxiety itself is a normal response that can actually be helpful in certain stressful situations, people with anxiety disorders experience undue amounts of anxiety to the extent that it affects their daily lives.

One of the main symptoms of anxiety disorders is sleep problems. The feelings of fear and anxiety triggered by these disorders activate the sympathetic nervous system. From tensed muscles to a faster heart rate, individuals experience a host of physical reactions that make them feel more awake. It’s tougher to fall and stay asleep, resulting in a vicious cycle where the person has one more thing to be anxious about – not getting enough sleep.

In this article we’ll review how the most common anxiety disorders affect sleep. Then we’ll provide an overview of treatment options and suggestions for getting better sleep for each anxiety disorder.

Sleep Dread

Sleep dread, also known as sleep preoccupation, is a phobia of sleep. Sleep dread can stem from a variety of circumstances, such as:

  • Individuals who have an anxiety disorder and comorbid insomnia individuals dread the thought of lying in bed and being unable to sleep
  • Individuals with sleep disorders like sleep apnea are fearful they won’t wake up
  • Individuals who experience chronic nightmares are terrified of falling asleep

Treating sleep dread

Treating sleep dread often involves treating the underlying cause of anxiety. For instance, if the individual is fearful that their sleep apnea will stop their breathing and keep them from waking, they can treat sleep apnea by switching to sleep on their side and using anti-snoring devices or a continuous positive airway pressure (CPAP) machine.

Cognitive behavioral therapy (CBT) is effective in treating insomnia and anxiety separately, as well as cases where the anxiety and insomnia influence each other and result in sleep dread. In cases of insomnia, CBT helps an individual recognize the anxious thought patterns and behaviors keeping them up at night, and then replace them with healthier thoughts and habits that facilitate rather than inhibit sleep (such as exercising early in the day instead of late at night).

How to sleep better when you have sleep dread

Change your thoughts around sleep. Spell out your fears – if you lose a night of sleep from insomnia, what is the worst that will happen? You will be tired the next day and sleep deprived, but your body will eventually fall back asleep. Remind yourself that it’s normal to have trouble sleeping at least occasionally – 40 percent of Americans experience insomnia. Likewise, if you’re nervous about waking up from a nightmare, start expecting it instead of fearing it. Knowing that you will wake up in the night can be less scary than wondering if it will happen.

Don’t force yourself to stick to a bedtime if you end up just lying in bed awake and anxious. Some people are night owls. Go to bed when you’re tired at night. Once you start feeling less fearful, you can work on setting a regular sleep schedule. That being said, do maintain some control over your sleep. Don’t nap or sleep in whenever you want. Extra sleep during the day will make it tougher to fall asleep at night.

Find ways to relax before you fall asleep and when you wake up in the middle of the night. Practice muscle relaxation and deep breathing exercises. Rely on guided meditation or a white noise machine to calm you. If you do wake up and can’t fall back asleep after 15 minutes, get up and do something low-key in another room, such as reading by a soft lamp. You want to train your mind to view your bed as a place solely for sleeping – not one where you lay awake at night racked with anxiety.

Practice good sleep hygiene. Avoid alcohol, caffeine, heavy meals, and strenuous exercise in the hours before bed. Keep your bedroom dark and cool. Only use your bed for sleep or sex, not watching television, work, or other activities.

Additional resources for sleep dread

  • BestMattressReviews’ Bedtime Yoga guide shares the best yoga poses that calm the body and relax the mind, helping reduce anxiety and stress before bed.
  • The Meditation Vacation YouTube channel offers various videos of guided meditations to help calm bedtime anxiety and induce sleep.
  • Individuals with insomnia or anxiety disorders discuss sleep dread problems on several online forums, such as the Anxiety and Insomnia subreddits, the Mental Health Forum, and AnxietyForum.
  • Psychology Today explains causes and treatments for adults dealing with chronic nightmares, as well as guidance for giving your doctor the best information for diagnosis.
  • The book What To Do When You Dread Your Bed walks parents and children through the CBT techniques that resolve sleep dread.

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is characterized by a pervasive sense of anxiety on a regular basis for 6 months or more. Additional symptoms include irritability, problems concentrating, muscle tension, and a general sense of restlessness. GAD is different than a phobia – which is a fear tied to something specific – and the anxiety is less intense than that experienced during a panic attack, but it lasts longer and pervades every aspect of your life, making relaxation difficult to achieve. Individuals with GAD constantly worry about the future, feel like they can’t control their anxiety, and are apprehensive or fearful.

GAD affects 3 percent of people, and twice as many women than men.

Sleep issues common to generalized anxiety disorder

Up to three-quarters of people with GAD experience fatigue, insomnia, and fretful sleep. As with many anxiety disorders, the arousal caused by the anxiety heightens alertness and interferes with one’s ability to sleep. It’s difficult to fall asleep in the first place, and the sleep one does get is often fragmented and less refreshing. As a result, individuals become sleep deprived and experience fatigue during their waking hours.

Because sleep becomes associated with worry instead of rest, anxiety develops around bedtime, in addition to the other anxious thoughts one is dealing with. Add to this increased worry about how well you’ll function the following day due to being sleep deprived.

Sleep deprivation worsens mood and increases irritability for everyone, regardless of whether they’re dealing with GAD. However, research from 2013 suggests that individuals who are prone to worry – the kind of people at risk of developing an anxiety disorder like GAD – are even more susceptible to the negative effects of sleep deprivation surrounding their mood and ability to regulate their emotions. When individuals with GAD are sleep deprived, they’re even more on edge, anxious about the future and anticipating threats.

Being sleep deprived also weakens your immune system. Individuals with GAD tend to spend less time in slow-wave deep sleep, which is the stage of sleep responsible for restoring your body and muscles. Their lack of deep sleep, combined with sleep deprivation, puts individuals with GAD at greater risk of physical illness.

Treating generalized anxiety disorder

GAD doesn’t go away on its own, and is often a chronic condition that requires treatment over a period of years.

Fortunately, cognitive behavioral therapy (CBT) is extremely effective for treating both GAD and related insomnia. Individuals learn to identify the negative thought patterns and behaviors that induce anxiety and inhibit sleep. Then they learn how to replace those with positive thoughts and healthy behaviors that promote good sleep habits and minimize anxiety both during the day and around bedtime.

Because sleep is closely linked with physical and emotional health, getting better sleep is an essential part of treating GAD.

How to sleep better when you have generalized anxiety disorder

Follow the same sleep schedule every day, including weekends. Regardless of when you go to bed, wake up at the same time each day, in order to train your brain and body to get sufficiently tired at the same time each night. Don’t try to “make up” sleep on the weekend as you’ll experience a rebound effect come Monday morning and feel even more exhausted – and anxious about your work or school performance.

Only go to sleep when you’re tired. If you can’t fall asleep after 30 minutes, get out of bed, leave the bedroom, and do a calming activity in another room like reading or coloring. You don’t want your brain to associate your bedroom with anxiety and the inability to sleep.

Practice good sleep hygiene. Dedicate your bedroom to sleep and sex only. Avoid watching stimulating TV before bed – the blue light from the TV will keep you up as will the drama of the content. Avoid alcohol, caffeine, and intense exercise in the hours before bed.

Eat healthy and regularly throughout the day. Getting hungry causes low blood sugar and can cause anxiety. Eat complex carbohydrates that boost serotonin, like fruits, vegetables, and whole grains.

Try relaxation techniques before bed. Popular options include progressive muscle relaxation, deep breathing, and meditation.

Additional resources for generalized anxiety disorder

Social Anxiety Disorder

Social anxiety disorder (SAD) affects almost 7 percent of Americans, or 15 million adults. It often begins with adolescence and is equally reported among men and women.

The disorder describes pervasive fear, worry, and anxiety about an individual’s performance in social situations where they’re with unfamiliar people or subject to scrutiny from others. Even though they recognize their anxiety is disproportionate to the event, people with SAD can become so fearful of the event that it can even trigger a panic attack. Their fear of judgment from others and public humiliation is so intense that they end up either avoiding social situations altogether or enduring them under extreme duress.

Sleep issues common to social anxiety disorder

When people have social anxiety disorder, they often develop insomnia. They lie in bed, worrying about how they performed socially that day and whether they embarrassed themselves, as well as dreading their social performance the following day. Their thoughts are often cyclical and feel uncontrollable, preventing sleep and making bedtime a restless experience. Worse, the chronic lack of sleep from anxiety-induced insomnia worsens their anticipatory anxiety of upcoming social events.

Besides having a tougher time falling asleep, people with social anxiety disorder also worry that others will perceive their lack of sleep and judge them for it. This increases their distress during social situations and adds to the anxiety that keeps them up at night.

Studies show that individuals with SAD have a tougher time falling asleep, experience more interruptions during sleep, and lower sleep quality overall. As a result, their daytime functioning is impaired.

Treating social anxiety disorder

Psychotherapy is the recommended treatment for SAD.

In particular, cognitive behavioral therapy (CBT) is extremely effective in treating SAD and related insomnia. Individuals work with a therapist over a series of sessions to recognize the anxious thought patterns that are keeping them up at night, as well as any behaviors that prevent sleep, such as drinking excessive alcohol late at night. Then they learn to recognize those thoughts and stop them in their tracks, instead replacing them with positive thoughts that minimize the anxiety and calm them down so they can fall asleep.

The techniques individuals learn in CBT help them manage their anxiety in social situations, and calm their thoughts at night.

How to sleep better when you have social anxiety disorder

Set and follow a consistent sleep and wake schedule. Wake up at the same time every day, regardless of how much sleep you got the night before, even on weekends.

Follow a bedtime routine that calms you down and helps you relax before bed. Take a warm bath, listen to soothing music, or consider aromatherapy. Stop using electronics like your phone, TV, and computer in the hour before bed.

Don’t lie awake in bed. If you don’t fall asleep within 15 minutes of going to bed, get up out of bed and do something relaxing. You don’t want your mind to associate your bed with lying awake and worrying about social situations the following day. Distract yourself with a calming activity in another room until you feel tired enough to fall asleep.

Keep a sleep diary. Note when you go to bed, when you wake up, and how long it takes you to fall asleep. Consider using a sleep tracking device or smartphone app. These will help you determine the extent of your insomnia and get properly diagnosed when you see your doctor.

Additional resources for social anxiety disorder

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) affects over 2 million adults and 1 million children in the U.S., or about 1 percent of the population. The disorder usually appears sometime between childhood and early adulthood, with 19 being the average age of onset.

People with OCD are consumed by endless cycles of distressing thoughts or fears they cannot control (the obsessions), and the resulting anxiety compels them to perform certain ritualistic behaviors (the compulsions) in an attempt to alleviate the thoughts or make them go away. Unfortunately, the compulsion only relieves the obsession for a period of time, and when it returns, they must repeat the behavior. These thoughts and rituals significantly interfere with their daily life and take time to complete.

Common obsessions include a need for precision or symmetry, and being fearful of dirt, making a mistake, or acting in a way that hurts others or is considered socially unacceptable. Common compulsions include repeatedly bathing or washing hands to stay clean, refusing to shake hands or touch potentially contaminated surfaces, constantly arranging things in a certain way, repeating words or talking aloud while performing a task, needing to perform tasks a certain number of times, and hoarding items.

People with OCD are aware of the unreasonableness of their thoughts and behaviors, but feel they have no power to stop them.

Sleep issues common to obsessive-compulsive disorder

OCD sufferers experience certain sleep problems at a higher rate than the general population, such as insomnia and delayed sleep phase disorder.

A growing body of research links OCD with insomnia, although researchers still aren’t sure how the two are related. One study found a link between the insomnia and obsessive thoughts, but not with compulsive behavior. However, a different study found severe compulsive behavior was correlated with lack of sleep in pediatric patients, and that children with OCD on the whole experienced about 1 hour less of sleep and more fragmented sleep. Depression is often comorbid with both insomnia and OCD, but researchers believe the OCD-insomnia connection is distinct.

Some hypothesize the insomnia is caused by individuals obsessing over thoughts and worrying about not performing the necessary tasks, thus causing anxiety and delaying bedtime.

Treating obsessive-compulsive disorder

OCD is a chronic condition that won’t go away on its own. The recommended treatment involves a combination of medication such as antidepressants with cognitive behavioral therapy (CBT).

CBT is also an extremely effective treatment for insomnia. For insomnia, CBT focuses on recognizing and replacing the problematic thoughts and behaviors that put off sleep with healthy ones. For OCD, CBT helps individuals learn to recognize and manage the catastrophic and obsessive thinking associated with OCD. Then, through exposure therapy, they practice dealing with the anxieties without performing the associated compulsive behavior.

While sleep problems are a secondary issue with OCD, researchers believe treating comorbid sleep conditions will facilitate treatment of OCD as a whole.

How to sleep better when you have OCD

A calm bedroom environment is helpful for anyone with an anxiety disorder, but for those with OCD, keeping the bedroom free of distractions or anything that can reminds them of unfinished tasks is especially important. Clear the bedroom of clutter. Use blackout curtains to keep it dark and cool. Remove electronics from the bedroom, including your clock, so you don’t obsess about the time.

Follow a bedtime routine that calms you. Include relaxing tasks such as a warm bath, smelling lavender, or turning off all the electronics.

Guided meditation and progressive muscle relaxation can give individuals with OCD something positive and calming to focus on while they lie in bed.

Exercise in the early morning or during the day. This will also help you expend excess energy, so you’re tired by the time it’s nighttime.

Additional resources for OCD

Phobia Anxiety

Phobias are intense, irrational fears about a thing, situation, or place that are disproportionate to the threat posed.

People with phobias are extremely fearful, anxious, and uncomfortable when confronted with their phobia, and may experience panic attacks. They often experience anticipatory anxiety before coming into contact with the phobia, and they take care to avoid the phobia, which can interfere with their ability to lead a normal life. People with phobias know their fears are irrational, but they still can’t control them.

Phobias like claustrophobia (fear of small spaces) and arachnophobia (fear of spiders) are considered specific phobias under the DSM-5. Specific phobias affect 19 million Americans and twice as many women as men.

Sleep issues common to phobia anxiety

Like other anxiety disorders, phobias are so activating to the nervous system that they make it difficult to let go of fears and fall asleep. This is especially the case for people with a phobia of sleep itself, known as hypnophobia or somniphobia (see sleep dread above).

Individuals with phobia anxiety may lie awake at night in fear of their phobia, leading to insomnia. Unfortunately, because of their underlying disorder, this inability to sleep puts the at risk of developing a phobia of the insomnia as well.

Treating phobia anxiety

There are several types of psychotherapy to address phobia. Flooding, systematic desensitization, virtual reality immersion, biofeedback, and hypnotherapy are all types of exposure therapy where the individual is exposed to the phobia and over time, learns to deal with it.

However, because exposure therapy can be extremely anxiety-producing and stressful in the beginning, researchers are exploring other alternative to treat phobias. One study found a solution with sleep therapy. Individuals were trained to be afraid of images of certain male faces by receiving a shock whenever they saw them, and the stimulus was paired with an odor. Then, while they slept, they were exposed to the odor and showed physiological signs of reacting to the trigger, although they stayed asleep. Over time, and the longer they were exposed and the more they slept, the less their fear of the faces when they were awake.

Cognitive behavioral therapy (CBT) is also effective for treating phobia anxiety. Individuals learn how to stop their thought processes regarding their phobias so they can react differently when they confront them instead of having a panic attack.

If people developed somniphobia due to another condition, such as sleepwalking or sleep apnea, the underlying conditions need to be treated first, much like the case with sleep dread.

How to sleep better when you have phobia anxiety

Progressive muscle relaxation, deep breathing exercises, and meditation calm the nervous system and train the brain to feel safe and relaxed, helping induce sleep.

Gradually reduce the coping behaviors you use to allow your phobia to continue. For example, if you’re fearful of not being able to sleep so you spend more time in bed, limit your time in bed to 8 or 9 hours, regardless of how much sleep you got. The more you take control over your coping behaviors, you’ll feel more in control overall, giving you the confidence to face your fears and anxiety.

Reframe how you view your bedroom and establish a bedtime routine. Only use your bedroom for sleep and sex, and keep it cool and dark. Try a warm bath and aromatherapy to train your mind to shut off each night. Taking control of your life through a bedtime routine and managing your sleep environment will help you feel better equipped to face your fears.

Practice good sleep hygiene and follow a consistent sleep schedule. Go to sleep and wake up at the same time every day so you know what to expect. Avoid stimulants like caffeine that activate your nervous system and make you more on edge and awake.

Additional resources for phobia anxiety

  • Healthline reviews a long list of specific phobias as well as risk factors, symptoms, and treatment options for each.
  • The government’s MedlinePlus resource page on phobias shares links to booklets, recent research, and directories to find local psychologists and therapists.
  • Individuals can share their experience with others and lean on peers for support in online forums such as the Phobia subreddit and Phobia Support Groups.
  • MedicineNet offers a local resource directory for phobia support groups and health professionals.
  • Self-Treatment for Phobias is an online booklet prepared by Anxiety Care UK as a self-help treatment plan for phobias.

Panic Disorder

Panic disorder affects 2 to 3 percent of Americans and is twice as common among women than men. It usually begins in adulthood although children can have it, too.

People with panic disorder experience panic attacks that happen spontaneously and out-of-the blue, causing them fear, anxiety, and worry about when the next one may happen. Occasionally panic attacks occur upon waking up. Panic disorder significantly interferes with daily life, since individuals fear when the next one will occur and may avoid work and social situations out of fear an attack will happen there. This is especially true for people who have both panic disorder and agoraphobia.

Panic attacks are a main symptom of panic disorder but have also been linked with other anxiety disorders, including OCD, PTSD, and specific phobias. They are also associated with irritable bowel syndrome and gastroesophageal reflux disease.

Sleep issues common to panic disorder

People with panic disorder often wake up due to breathing complaints, and sleep disturbances are worse for those with comorbid depression.

Nocturnal panic attacks are common for individuals with panic disorder. Nighttime panic attacks rouse individuals from sleep with an alarming combination of sweating, increased heart rate, dizziness, chest pain, hyperventilation, alternating sensations of hot flashes or chills, and shortness of breath. They’re terrifying and don’t appear to have an obvious trigger.

Nighttime panic attacks are similar to daytime panic attacks, but even more fear-inducing because they interrupt a person when they’re most vulnerable, while they’re asleep. The attack itself will last only a few minutes, but it takes a significant amount of time for the individual to calm down again to return to sleep. As a result, people with nocturnal panic attacks often experience less sleep overall and more disturbed sleep, leading to sleep deprivation.

Nighttime panic attacks are linked with other sleep disorders, including sleep apnea, sleep paralysis, nightmares, and night terrors:

  • With sleep apnea, an individual literally stops breathing momentarily during sleep, and the resulting sensation of suffocating or losing one’s breath can coincide with a panic attack. The amygdala (the “fear center” in the brain) is activated during apneic episodes just as it is during a panic attack. Studies have found that sleep apnea can increase one’s risk of developing a panic disorder.
  • Sleep paralysis occurs in the transition between waking and sleeping, when one’s mind is awake but the body hasn’t quite caught up. This disconnect causes the individual to feel paralyzed, unable to move, or suffocating – terrifying sensations which can induce a panic attack.
  • If an individual wakes from a nightmare, their fear may develop into a panic attack upon waking. Night terrors are less common in adults but share many of the physical symptoms common with panic attacks such as fear, sweating, shaking.

Treating panic disorder

Psychotherapy is highly effective for panic disorder and can resolve symptoms in a short amount of time. Unfortunately, people with panic disorder are often too ashamed or embarrassed to seek it out, since they feel that their fear is unreasonable.

Often, therapists use a combination of cognitive therapy and exposure therapy. The cognitive therapy helps patients recognize the triggers of their panic attacks and how they’re prone to respond, so they can retrain their mind to think about the triggers in a healthier way. Exposure therapy helps individuals become desensitized to the physical sensations they feel during the panic attack through repeated exposure.

If the panic attacks are connected to a sleep disorder such as sleep apnea, that condition should be treated first. CPAP machines and anti-snoring devices prevent or reduce the severity of apneic episodes during sleep.

How to sleep better when you have panic disorder

Make the bedroom calm, cool, and dark. Remove electronics and clocks from the room so you don’t become anxious about how long it’s taking you to fall asleep. Avoid using the bedroom for anything other than sleep and sex, so your mind doesn’t associate it with daytime activities that keep it awake.

Follow a bedtime routine that primes your body for a calm transition to sleep. Practice relaxation and visualization techniques to distract your mind from anxiety-producing thoughts. Try journaling to put words to your fears and release them from your mind.

If you wake up from a nocturnal panic attack, fully wake up. Your body is so aroused that you won’t be able to fall back asleep immediately, and you don’t want to induce anxiety over losing sleep. Leave the bed and splash some cool water on your face. Don’t focus on distracting yourself from the panic, as this may cause you even more anxiety. Instead, accept that it occurred, and focus on relaxing with deep breathing exercises or reading. Return to bed once you feel relaxed again and tired.

Additional resources for panic disorder

Top Recommendations for Sleeping with Anxiety

Getting good sleep makes you better equipped to manage your anxiety during the day time. Here are our top tips for sleeping better with anxiety.

  1. Practice good sleep hygiene. Go to sleep and wake up at the same time every day, even weekends. Only use your bedroom for sleep and sex.
  2. Set and follow a calming bedtime routine. Activities might include taking a warm bath, reading, journaling, and listening to soothing music.
  3. Keep the bedroom dark, cool, and relaxing. Get rid of clutter. Remove electronics from the room and consider using blackout curtains. Use a lavender-scented diffuser. Sleep on a comfortable mattress.
  4. Practice relaxation techniques when you’re ready to fall asleep, including meditation, deep breathing, progressive muscle relaxation, or yoga.
  5. Avoid caffeine and nicotine. These stimulants keep you awake and also trigger many of the same physical responses your body has to anxiety.
  6. Exercise early in the day and outside if possible. The sunlight will boost your mood, and the activity early on will make you tired later at night. Plus, exercising too close to bedtime will mimic the feeling of adrenaline you experience with anxiety or panic attacks.
  7. Explore CBT and other psychotherapy options to help address your anxiety. Make sure to tell your doctor about your sleep problems so they can include it as part of your treatment.
  8. Also ask your doctor about melatonin. It’s generally considered a safe sleep aid, but it may interact negatively with any medication you’re taking for anxiety.
  9. Eat healthy. Avoid sugary and fatty junk food, especially late at night. Instead, eat foods rich in healthy carbohydrates, melatonin, and tryptophan to promote good sleep.
  10. Keep a sleep diary. Noting when you fall asleep, when you wake up, and any sleep disturbances will help you feel more in control of your sleep and less anxious.

For more in-depth information on the relationship between sleep and mental health, check out our our other guides here: