Nighttime Anxiety in Adults: Causes, Symptoms, and Solutions
Tossing and turning at night is never easy, as it can feel impossible to stop your thoughts from racing. Maybe you’ve got an interview in the morning, a busy work day ahead, or an appointment you’re nervous about the next day. Either way, we all want a good night’s rest before an important event – but too often, it ends up being quite the opposite.
Sleep is key for processing thoughts and emotions, and it’s also important for recovery, especially if you have an active lifestyle. So, without regular, adequate rest, we certainly feel the impacts the following day, whether it’s sluggishness in our jobs or being less capable of socializing.
Getting the occasional sleepless night is common and doesn’t usually have a significant impact on our day-to-day lives. But, for those of us who struggle to get restful sleep on a regular basis, this may point to an underlying anxiety disorder, history of trauma, or a sleep-related condition.
If you or a loved one finds worry or racing thoughts challenging, especially during the night, then you may have nighttime anxiety. A mental health professional can discuss your symptoms with you and provide advice about the best forms of treatment for your needs.
This page can also help you better understand the causes of and treatment for nighttime anxiety, as it explores:
- What nighttime anxiety is
- Common causes of nighttime anxiety
- Recognising the symptoms
- The link between trauma and fear of falling asleep
- Coping strategies
- Treatments for nighttime anxiety
- How Mission Connection can help
Understanding Nighttime Anxiety
Nighttime anxiety describes the moments of restlessness, physical tension, and racing thoughts at night.
For example, these racing thoughts at night can happen if you have a stressful job. This is because your day may be full of distractions and could prevent you from processing what’s happening. So, when your day is wrapped up and you’ve settled down for the night, these thoughts may naturally come to the forefront. The same may be the case for regrets from the past, worries about the future, and fears about issues such as health.
What’s more, when we become anxious about getting a good night’s rest, this can just add to nighttime nerves and make our sleep even worse. In other words, it is unfortunately easy to get caught in the cycle of nighttime anxiety and unrest.
But what exactly leads to this stress and bedtime worry? We’ll look at the common causes next.
Common Causes of Nighttime Anxiety
There’s no single cause of nighttime anxiety or fear of falling asleep. People have varying biological, social, and environmental factors that can contribute to poor sleep. However, there are some common causes of nighttime anxiety, which we cover in the following sections.
Overactive Stress Response
When considering the role of stress in anxiety, a key player is a hormone called “cortisol.” Cortisol is responsible for alertness and is a component of the body’s stress responses.
The body’s stress system is called the “hypothalamic-pituitary-adrenal (HPA) axis.” When we overstimulate the HPA axis through chronic stress, trauma, or ongoing anxiety, then cortisol levels can remain high. This means increased cortisol in the evening, causing us to find it harder to wind down and relax – typically leading to poorer sleep.1
Racing Thoughts and Cognitive Overload
Many of us experience racing thoughts at night. These intrusive thoughts often involve worrying about responsibilities, finances, or relationships, and the experience can often make it feel like sleep is impossible.
Further, the link between cognitive overload and poor sleep is well-documented. Studies on people with insomnia show that these thoughts at bedtime mean that the brain is more likely to be on high alert. This can increase tossing and turning and delays the onset of sleep.2
Trauma and Nighttime Fear
Trauma is known to have a lasting impact on sleep, regardless of whether it occurred a long time ago or more recently. It can show up as heightened fear at night, in the form of flashbacks or nightmares. In fact, trauma can also lead to fear of falling asleep.
Research shows that nighttime anxiety is closely linked to post-traumatic stress disorder (PTSD). Put simply, PTSD is a condition that some people suffer from after going through a traumatic event. For example, it’s common in war veterans. When reminders or “triggers” of these events occur in day-to-day life, they can bring about undesirable anxiety and stress responses. Plus, at bedtime, the quiet and darkness can provoke memories or sensations of past trauma. 3
Poor Sleep Hygiene and Lifestyle Factors
Modern lifestyles can often be full of distractions and stimulation. It’s well known that, in the current smartphone age, we’re constantly being barraged with notifications, news, social media posts, and so on.
With our phones constantly at arm’s reach, it’s all too easy to reach for them for easy distraction, rather than pause and take stock in the quiet moments. Quiet reflection is often necessary for processing life’s challenges. However, if we deprive ourselves of this during the day, then these thoughts can come flooding in undesirably at night – when we want to get a restful sleep.
Thankfully, the awareness around the impact of phones at bedtime is growing, as it’s widely known that nighttime scrolling isn’t a good idea for getting optimal rest. Studies show that the blue light emitted from smartphones suppresses melatonin. This is a sleep hormone responsible for sleep onset. So when considering better sleep hygiene, limiting screen time can play a big role in relaxing before bed.4
Additionally, avoiding unnecessary stimulation in the evening is generally advised, and this applies to caffeine intake and smoking. Coffee and nicotine are shown to increase nighttime awakenings and stress, even if they feel initially calming. 4 Irregular sleep schedules are a big contributor to poor sleep, too. Being disciplined with regard to a set bedtime and a regular alarm can go a long way toward restful sleep.4
Underlying Mental and Physical Health Conditions
Anxiety, panic disorder, and depression can all contribute to anxiety insomnia symptoms. But it’s not just mental health challenges that can lead to these issues either.
In some cases, conditions like thyroid imbalance or sleep apnea (snoring) can also make nighttime anxiety worse. 5 For these reasons, if poor sleep is persistent, consulting a doctor or mental health professional for guidance can help you get the support you need.
Recognizing Anxiety Insomnia Symptoms
Nighttime anxiety can, over time, lead to sleep deprivation, mood changes like irritability, and even anxiety during the daytime. So, it’s good to know some common signs to recognize the presence of these issues and when to seek support – especially as early recognition and treatment promote faster recovery.
Some common anxiety insomnia symptoms include:6
- Intrusive thoughts before bed
- Restlessness, muscle tension, or raised heart rate
- Shortness of breath or panic attacks when trying to sleep
- Fear of falling asleep or dread of bedtime
- Repeated waking with anxiety or nightmares
- Difficulty returning to sleep once awake
Fear of Falling Asleep: When Anxiety Turns Into Panic
For some people, bedtime can become a source of dread. For these people, sleep so often means tossing and turning with racing thoughts, increased heart rate, shallow breathing, or even panic attacks.
Fear surrounding bedtime can mean avoidance behavior. For example, staying up late to delay going to bed for as long as possible, or sleeping with the lights on.
It’s worth noting that these symptoms can reflect sleep panic disorder. This is a condition where panic attacks are triggered during sleep. Treatment for this revolves around tackling anxiety and reconditioning the sleep environment to feel safe and relaxing again.
Additionally, the fear of falling asleep is commonly linked to trauma.
The Connection Between Trauma and Nighttime Fear
We previously talked a little about PTSD and nighttime anxiety; mainly, how the stillness of the night can mean replaying distressing memories for some.
However, the symptoms of PTSD, like heightened anxiety and alertness, jumpiness, and startled reflex, can all persist into the night. In short, PTSD symptoms can persist into the evening and lead to disturbed sleep and nightmares. 7 Therefore, people with PTSD and trauma may attempt to avoid falling asleep to prevent reminders of their previous experiences. However, this can inhibit emotional processing and cognitive skills.
Fortunately, trauma-informed care goes a long way to counteracting the effects of PTSD. For example, according to studies, CBT can be transformative for people with nighttime fear. 8 We’ll go into CBT in more detail shortly.
Coping Strategies for Nighttime Anxiety
Fortunately, there are a variety of ways to keep nighttime anxiety at bay at home, and at no cost.
Here are some common ways to promote calm before bedtime:
- Create a wind-down routine: Before going to bed, make sure your bedroom is calm. For example, dim the lights, avoid screens and unnecessary stimulation, and make sure the temperature is comfortable. This can all go a long way to unwinding and a restful night.11
- Practice mindfulness: Techniques like meditation can help prevent racing thoughts later at night.11 For instance, set aside just ten minutes to sit and observe your thoughts in a non-judgmental manner.
- Write it down: Journaling worries or a to-do list before bed can prevent mental overactivity.12
- Limit stimulants: Avoiding caffeine after noon and reducing alcohol intake is proven to promote better quality, restful sleep.11
- Grounding techniques: Taking time to notice sensations around you, such as the feel of sheets or sounds in the room, can help ground you in the present and remove your focus from racing thoughts and worries.11
- Seek social and professional support: Sharing your experience with a therapist or support group reduces isolation and can validate your experiences.13
However, coping strategies may not be enough by themselves if your symptoms are persistent or severe. This is often where professional support enters the picture.
Sleep Disorder Therapy Options
The best treatment approach for people typically depends on the causes and specific symptoms of their nighttime worries. However, there are some common approaches that have been shown to be effective, which we discuss below.
CBT for Anxiety and Sleep
When participating in CBT, a qualified therapist assists in identifying unhelpful thinking habits and works towards “re-wiring” the brain to adopt healthier, more realistic thought processes. Often, an unhelpful thinking pattern for anxious people is to make absolute, negative conclusions, which in the long run can lead to a generally fearful outlook and low mood. Restoring reasonably balanced thinking helps promote positivity and overall well-being.
CBT for nighttime anxiety tackles unrealistic statements that people may tell themselves, such as I won’t be able to get to sleep tonight. It does so by reframing these to be more realistic and balanced. CBT in these cases will also work towards seeing the bedtime environment as a restful place and try to remove the anxiety and fear surrounding it. Further, it may be good to know that research confirms CBT significantly improves both anxiety and sleep outcomes, and its long-term benefits often match or exceed those of medication.9
Medication for Sleep Anxiety
When symptoms of nighttime anxiety feel intense or unmanageable, then medication may be considered. Medical supervision is recommended, especially when changing doses or stopping the medication. Some common medication for sleep anxiety options include:
- Anxiolytics: These provide short-term relief of severe symptoms but aren’t recommended long-term due to the potential for dependency10
- Antidepressants: Such as SSRIs (selective serotonin reuptake inhibitors). These prevent the breakdown of serotonin (a mood-boosting chemical), promoting emotional balance10
It’s worth noting that medications are most effective when prescribed alongside therapy and lifestyle changes. Medication should also be individualized and monitored by a clinician.
The Role of Mental Health Residential Care
In some severe cases, the combination of medication, therapy, and coping strategies doesn’t provide enough relief for people – especially if they have pre-existing complex mental health difficulties. In such cases, mental health residential care may be considered.
It’s particularly beneficial as it involves staying in a facility with a higher level of support. Plus, it typically includes programs that combine therapy, medication management, and holistic approaches like yoga and mindfulness to aid recovery in a supervised and focused setting.
Nighttime Anxiety in Teens: How It Differs from Adults
It may be good to note that nighttime anxiety doesn’t just affect adults – it often begins in adolescence. It’s perhaps easy to see why: academic pressures, social fears, and moving from the family home to campus. The teenage years are often full of change and stress. So, nighttime worry isn’t uncommon in teens.
If this goes unrecognized and untreated, nighttime anxiety in teens can eventually evolve into adult sleep anxiety patterns. This is why early intervention is important; therapy, healthy routines, and parental support are confirmed by studies to ease insomnia and emotional distress in later life.14
Recovery from nighttime anxiety is possible, whether you’re in your teens or in adulthood. Well-researched therapies like CBT, medication, and coping strategies are all effective means of achieving more restful sleep and better well-being. What’s more, the experienced team at Mission Connection are here to help.
Mission Connection: Where Expert Care Meets Restful Recovery
Even when anxiety lingers, healthy coping mechanisms, therapy, and medication can all help reduce its intensity and impact. The journey toward peaceful sleep can be deeply personal, but it’s entirely possible with the right support.
Mission Connection provides comprehensive, compassionate treatment for adults experiencing anxiety, trauma, and sleep disturbances. Our team specializes in evidence-based therapies that rebuild confidence and calm – helping clients rediscover the peace that comes with a good night’s rest.
We provide a variety of evidence-based treatment options that can be tailored to your specific needs, whether you require immediate support or more long-term continued help. Our telehealth services also mean that you can fit therapy for nighttime anxiety into your schedule flexibly, allowing you to receive care from the comfort of your home.
By also offering comprehensive medication monitoring alongside various therapies, Mission Connection can be a guiding light toward overcoming nighttime anxiety. If you’re ready to explore our treatment options, contact us today or complete our confidential contact form for more information.
References
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- Harvey, A. G. (2002). A cognitive model of insomnia. Behaviour Research and Therapy, 40(8), 869–893. https://doi.org/10.1016/S0005-7967(01)00061-4
- Germain, A. (2013). Sleep disturbances as the hallmark of PTSD: Where are we now? American Journal of Psychiatry, 170(4), 372–382. https://doi.org/10.1176/appi.ajp.2012.12040432
- Watson, N. F., et al. (2020). Behavioral and environmental influences on sleep. Sleep Health, 6(5), 671–681. https://doi.org/10.1016/j.sleh.2020.04.004
- Ohayon, M. M. (2011). Epidemiology of insomnia: What we know and what we still need to learn. Sleep Medicine Reviews, 16(1), 77–84. https://doi.org/10.1016/j.smrv.2010.02.002
- Craske, M. G., Stein, M. B., Eley, T. C., Milad, M. R., Holmes, E. A., Rapee, R. M., & Wittchen, H. U. (2017). Anxiety disorders. Nature Reviews Disease Primers, 3(1), 17024. https://doi.org/10.1038/nrdp.2017.24
- Kobayashi, I., et al. (2012). Sleep and PTSD: The role of trauma-related hyperarousal. Sleep Medicine Reviews, 16(1), 97–107. https://doi.org/10.1016/j.smrv.2011.01.002
- Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures. Guilford Press.
- Trauer, J. M., et al. (2015). Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis. Annals of Internal Medicine, 163(3), 191–204. https://doi.org/10.7326/M14-2841
- Wichniak, A., et al. (2017). Sleep and antidepressant treatment. Current Pharmaceutical Design, 23(32), 4882–4890. https://doi.org/10.2174/1381612823666170728153256
- 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. https://doi.org/10.1016/j.smrv.2014.10.001
- Smyth, J. M. (1998). Written emotional expression: Effect sizes, outcome types, and moderating variables. Journal of Consulting and Clinical Psychology, 66(1), 174–184. https://doi.org/10.1037/0022-006X.66.1.174
- Garland, E. L., et al. (2015). Mindfulness-oriented recovery enhancement for anxiety and sleep disturbance. Journal of Behavioral Medicine, 38(2), 327–341. https://doi.org/10.1007/s10865-014-9603-7
- Alfano, C. A., & Gamble, A. L. (2009). The role of sleep in childhood psychiatric disorders. Child and Adolescent Psychiatric Clinics of North America, 18(4), 817–828. https://doi.org/10.1016/j.chc.2009.04.007
