Anxiety and Insomnia: Understanding the Connection

January 1, 2021

Anxiety and insomnia are two incredibly common health conditions in the United States. 

While everyone feels anxious from time to time and struggles to fall asleep occasionally, anxiety disorders and insomnia are more intense, prolonged versions of these common experiences. 

With millions of American adults experiencing anxiety, insomnia, or both, it is important to understand how the two conditions are connected and how they can contribute to one another. 

What is anxiety and what are anxiety disorders?

Everyone feels anxious sometimes — it’s perfectly natural. Anxiety is how the body responds to stress, fear, or apprehension about what is to come. 

Although feelings of anxiety are normal from time to time, they can be considered an anxiety disorder when they start to become extreme, are felt consistently for six months or more, or begin to interfere with your daily activities and relationships. 

Anxiety can cause both physical and mental symptoms. Physical symptoms can include rapid heart rate, sweating, tense muscles, rapid or shallow breathing, gastrointestinal distress, shaking, and fatigue. Mental symptoms can include difficulty concentrating, feelings of irritability and restlessness, and a feeling of impending doom. 

There are also a number of different kinds of anxiety disorders, including:

  • Generalized Anxiety Disorder (GAD)
  • Panic Disorder
  • Social Anxiety Disorder
  • Obsessive – Compulsive Disorder (OCD)
  • Post-Traumatic Stress Disorder (PTSD)
  • Specific phobias

Generalized anxiety disorder is marked by significant feelings of doom or worry that often do not have an identifiable source. The condition is estimated to affect approximately 6.8 million adults in the United States, or about 3.1% of the population. 

Panic disorder is characterized by intense episodes of extreme fear that may come on suddenly for no apparent reason and usually last several minutes. These episodes, called panic attacks, affect approximately 6 million adults in the United States, or 2.7% of the population. 

Social anxiety disorder is pervasive anxiety that involves a fear of engaging in social settings and potentially being embarrassed in front of other people. It is one of the most common anxiety disorders, affecting 15 million adults in the United States, or 6.8% of the population. 

Obsessive-compulsive disorder, or OCD, is characterized by obsessive thoughts, such as worrying about the death of a loved one, as well as compulsive behaviors that attempt to control the anxiety and are often done in a ritual or repetitive manner, such as repeatedly locking the door. Approximately 1.2% of adults in the U.S. have OCD. 

Post-traumatic stress disorder, or PTSD, is a type of anxiety disorder that stems from experiencing a traumatic event, such as the death of a loved one, time spent in combat, or sexual assault. An estimated 7.7 million adults in the United States, or 3.5% of the population, suffer from PTSD. 

Specific phobias are intense fears of specific situations or objects, such as a fear of enclosed spaces (claustrophobia) or separation anxiety. Approximately 2.2 million adults in the United States, or 1% of the population, deals with specific phobias.

What is insomnia?

Put simply, insomnia is the medical term used to describe difficulty sleeping. While many people associate insomnia with difficulty falling asleep, insomnia is actually an umbrella term. 

In addition to having difficulty falling asleep, insomnia can also include difficulty staying asleep, waking up feeling tired or like you haven’t gotten enough rest, or waking up too early. Insomnia can occur for many different reasons, but one of the most common reasons is anxiety. 

What is the connection between anxiety and insomnia?

According to the Anxiety and Depression Association of America, approximately 40 million Americans struggle with long term sleep disorders, and an additional 20 million occasionally experience trouble sleeping. 

When it comes to anxiety and insomnia, there is no question that the two are related. 

Studies have established that one of the key factors associated with insomnia is a mental state of hyperarousal, which is often marked by worry or anxiety. Many of us have laid awake in bed at night worrying about a big presentation the next day or perhaps wondering how to make ends meet on this month’s bills. This type of occasional stress can certainly prevent people from falling asleep. However, people with anxiety disorders are even more likely to experience difficulty sleeping.

Studies have shown that people with diagnosed anxiety disorders, such as those outlined above, are more likely to have higher sleep reactivity

Sleep reactivity is a term used to describe the degree to which a person’s stress level impacts their sleep, resulting in difficulties falling asleep or staying asleep. People with anxiety disorders are more likely to have stress impact their ability to get a good night’s sleep, which is problematic because they tend to be in a constant state of worry. Over time, insomnia can lead to anxiety about falling asleep, which reinforces the difficulties and continues the cycle. 

Anxiety disorders may even cause changes in a person’s sleep cycles. Studies have shown that feelings of anxiety, worry, or hyperarousal before falling asleep can impact rapid eye movement (REM) sleep, which is the deep sleep associated with vivid dreams. Feelings of anxiety can cause disturbing dreams and cause people to experience disrupted sleep, which is less restful and can lead to feelings of fatigue upon waking. Nightmares are common and can increase the feelings of anxiety people experience about falling asleep.

Although we’ve discussed how anxiety can cause or contribute to insomnia and sleep disorders, there is also evidence that poor sleep can exacerbate the symptoms of anxiety disorders and can even trigger anxiety disorders in some people. 

People with anxiety disorders have been found to be more sensitive to the impacts of sleep deprivation, and not getting enough sleep can cause symptoms of anxiety to worsen. 

While it’s not clear which comes first, what is apparent is that anxiety and insomnia are closely related and can exacerbate each other’s effects. 

How can you combat anxiety-induced insomnia?

While anxiety disorders and insomnia are both extremely common, both conditions can be treated with help from mental health professionals

Prescription medications, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are available for the long term treatment of anxiety disorders. Benzodiazepines like Xanax and Ativan can be used to manage severe anxiety for short periods of time. 

Working with a licensed therapist to receive talk therapy treatment in the form of cognitive behavioral therapy (CBT) or another type of therapy can also reduce feelings of anxiety, and in turn, improve symptoms of insomnia. 

Cognitive behavioral therapy can also be used to treat insomnia itself. In fact, the Mayo Clinic reports that CBT for insomnia is just as effective as prescription medication.

While treating your anxiety is certainly important, another key component of improving your insomnia symptoms (and by proxy, your anxiety) is building a healthy sleep hygiene routine. 

Believe it or not, the environment and routine surrounding your sleep patterns can make a huge difference in the rest you receive. 

Some of the key elements of a healthy sleep routine include:

  • Ensuring that your bed is as comfortable as possible
  • Eliminating sources of sleep disruption such as light and noise
  • Keeping the temperature in your bedroom cool or cold
  • Avoiding caffeine or alcohol in the afternoon and evening
  • Practicing deep breathing or mindfulness techniques, such as meditation
  • Avoiding exposure to screens, such as computer, television, or cell phone screens, for at least one hour before bed 
  • Going to bed at the same time every night
  • Avoiding taking naps during the day
  • Using your bedroom only for sleeping and sex and avoiding doing other activities in your room, such as watching tv, working, or exercising

Summary

Anxiety disorders can contribute to insomnia by making it more difficult to fall asleep and stay asleep, and insomnia can also worsen symptoms of anxiety disorders. 

Fortunately, there are lots of different treatment options for both anxiety and insomnia, including prescription medications, talk therapy, and lifestyle changes. 

Finding a mental health provider has never been simpler with telehealth services like YANA

YANA is an online mental healthcare service that can match you to an expert doctor from the comfort of your own home, meaning no missed time off work or school to get to appointments, no waiting rooms, and no co-pays. Best of all, YANA’s services are affordable at a low monthly fee, and beats co-pays and drug prices by 75% by cutting out the middleman. 

Mental healthcare is more accessible than ever before, and you can get started with YANA today in just a few minutes. 

Sources:

https://www.sleepfoundation.org/mental-health/anxiety-and-sleep

https://www.healthline.com/health/anxiety-insomnia

https://adaa.org/understanding-anxiety/related-illnesses/sleep-disorders

https://pubmed.ncbi.nlm.nih.gov/30046255/

https://pubmed.ncbi.nlm.nih.gov/29797753/

https://pubmed.ncbi.nlm.nih.gov/23804084/

https://www.mayoclinic.org/diseases-conditions/insomnia/diagnosis-treatment/drc-20355173