Anxiety and Sleep

Anxiety and Sleep

A Brief Overview

Ever found yourself lying awake at 2 a.m., your mind racing through to-do lists, worst-case scenarios, or awkward conversations from three years ago?

You’re not alone. Millions of people experience this exhausting loop where anxious thoughts keep them up at night, and a lack of sleep only makes things worse the next day.
Anxiety and sleep are closely connected—and not in a good way. Poor sleep makes us more emotionally vulnerable, and when we’re anxious, winding down at night becomes even harder. Understanding how these two feed into each other is key for improving both mental health and quality of life.

The Vicious Cycle

Research shows that people with insomnia are nearly twice as likely to develop an anxiety disorder later on (Baglioni et al., 2011). At the same time, those with high anxiety levels are much more likely to struggle with falling or staying asleep (Taylor et al., 2005). And it’s not just about tossing and turning—repeated poor sleep can raise stress hormones like cortisol, leaving us feeling wired during the day and restless at night (McEwen, 1998).

What’s Going On in the Brain?

So why does this happen? Scientists have uncovered a few core reasons:

• Biological changes: When we’re sleep-deprived, the brain’s stress systems go into overdrive. Cortisol increases, and calming brain chemicals like GABA and serotonin drop (Winkelman, 2008). This creates a perfect storm for anxiety.
• Thought patterns: People with insomnia often develop scary or hopeless beliefs about sleep—like, “If I don’t sleep tonight, I’ll fail tomorrow.” These thoughts trigger worry, which only makes it harder to relax (Espie, 2009).
• Behavioral habits: Trying to “fix” sleep with things like daytime naps or going to bed too early can backfire. These habits confuse the body’s natural rhythm and make sleep even more fragmented (Spielman et al., 1987).

How Researchers Study the Link

To figure out which comes first—anxiety or sleep issues—researchers use different study designs. Some track people’s sleep and mental health over months or years (Baglioni et al., 2011), while others look at short-term interactions between anxiety and sleep over time (Taylor et al., 2005). Meta-analyses help by summarizing data from dozens of studies to reveal overall patterns (Trauer et al., 2015).

What Actually Helps?

The good news is: improving sleep can actually reduce anxiety. One of the best tools for this is Cognitive Behavioral Therapy for Insomnia (CBT-I)—a short-term, skills-based therapy that targets the thoughts and habits that fuel poor sleep.

1. Sleep restriction – Limiting time in bed so sleep becomes deeper and more efficient (Kyle et al., 2014).
2. Stimulus control – Training your brain to associate the bed only with sleep (and intimacy) (Spielman et al., 1987).
3. Cognitive restructuring – Challenging unhelpful beliefs about sleep (Espie, 2009).
4. Sleep hygiene – Building healthy habits around light, caffeine, and routine (Irish et al., 2015).

What’s even better? Online CBT-I programs work just as well as in-person therapy, and many also reduce anxiety symptoms as a bonus (Cheng et al., 2012).

Where We’re Headed

The future of sleep therapy is already here: think wearables that monitor your sleep, apps that learn your habits, and digital coaching that adapts to your needs (de Zambotti et al., 2019). These tools are helping make evidence-based care more accessible than ever.

Final Takeaway

If you’re stuck in the loop of anxious nights and groggy mornings, you don’t have to tackle anxiety or insomnia on their own. Sleep and mental health go hand in hand, and treating one often improves the other. Whether through therapy, apps, or small lifestyle changes, better sleep is within reach—and it could be the key to a calmer, more balanced life.

Written By: Natasha Joseph, BSc.
Support Approach Consultant

References

• Baglioni, C., Battagliese, G., Feige, B., Spiegelhalder, K., Nissen, C., Voderholzer, U., … & Riemann, D. (2011). Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies. Journal of Affective Disorders, 135(1–3), 10–19.
• Cheng, S. K., Dizon, J., & Wong, J. (2012). Efficacy of cognitive behavioral therapy for insomnia: A meta-analytic review. Sleep Medicine Reviews, 16(6), 511–520.
• de Zambotti, M., Cellini, N., Goldstone, A., Colrain, I. M., & Baker, F. C. (2019). Wearable sleep technology in clinical and research applications. Sleep, 42(6), zsz078.
• Espie, C. A. (2009). “Stepped care”: A health technology solution for delivering cognitive behavioral therapy as a public health service. Behaviour Research and Therapy, 47(11), 921–927.
• Irish, L. A., Kline, C. E., Gunn, H. E., Buysse, D. J., & Hall, M. H. (2015). The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep Medicine Reviews, 22, 23–36.
• Kyle, S. D., Beattie, L., Spiegelhalder, K., Rogers, Z., & Espie, C. A. (2014). Sleep restriction therapy for insomnia is associated with reduced amygdala reactivity to negative stimuli: Preliminary support for an emotional regulatory role. Sleep, 37(8), 1405–1411.
• McEwen, B. S. (1998). Stress, adaptation, and disease: Allostasis and allostatic load. Annals of the New York Academy of Sciences, 840, 33–44.
• Spielman, A. J., Saskin, P., & Thorpy, M. J. (1987). A behavioral perspective on insomnia treatment. Psychiatric Clinics of North America, 10(4), 541–553.
• Taylor, D. J., Lichstein, K. L., Durrence, H. H., Reidel, B. W., & Bush, A. J. (2005). Epidemiology of insomnia, depression, and anxiety. Sleep, 28(11), 1457–1464.
• Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M. W., & Cunnington, D. (2015). Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Annals of Internal Medicine, 163(3), 191–204.
• Winkelman, J. W. (2008). Neurobiology of insomnia. Psychiatric Clinics of North America, 31(2), 259–269.