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Anxiety and Sleep Loss: How to Unravel This Tangled Web

Anxiety can cause sleep loss and sleep loss can cause anxiety. Lowering your sleep debt and removing the source anxiety are the keys unlocking the cycle.
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Jeff Kahn, M.S., Rise Science Co-Founder
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Person in bed with anxiety and trying to sleep

Staring into the semi-darkness of your bedroom, your brain is mentally tracking every minute you aren't asleep. You know you will pay for it when your alarm rings in the morning and you have to drag your too-tired body out of bed. It will likely be another day of intense drowsiness, in which you don't have the energy and mental capacity to do things you need to do. But the irony is, the harder you will yourself to fall asleep, the more anxious you become and can't doze off. If this endless cycle of rising anxiety and sleep loss sounds familiar, rest assured that you aren't alone.

We know that anxiety is one of the primary contributors to sleep loss, but what about the other way round? Can lack of sleep cause anxiety, too? The answer is yes. Ahead, you will discover the two-way relationship between anxiety and sleep loss, as well as the exact mechanisms behind their bidirectional nature. Most importantly, you'll learn how to get a handle on your anxiety to sleep better tonight.

Please note: This post is meant for informational purposes only and should not be used as a substitute for medical advice from a healthcare professional. The RISE app is designed to support natural sleep and good sleep hygiene, but it does not treat health problems like anxiety disorders.

What Is Anxiety Exactly?

We often say things like "I'm worried" and "I feel stressed out" when describing anxiety. But, here's the thing: Anxiety is distinct from worry, fear, and stress.

The Diagnostic and Statistical Manual of Mental Disorders defines anxiety, fear, and worry in the following ways:

  • Anxiety is “the anticipation of future threat.” The American Psychological Association (APA) further spells it out as “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.”
  • Fear is “the emotional response to real or perceived imminent threat.”
  • Worry is “the cognitive aspects of apprehensive expectation.”

Anxiety is also closely linked to stress, as both emotions often elicit similar responses. In the next section, we delineate the differences between anxiety and stress.

The Distinction Between Anxiety and Stress

Anxiety and stress are both emotional responses to physical and psychological triggers. Common examples include a near-fatal car accident or the threat of financial instability. But exactly how are they different?

First, stress is your body's short-term response to identifiable external threats called stressors. Hans Selye, the father of stress research, defined it as the “nonspecific response of the body to any demand." For example, you automatically tense up when an oncoming car heads toward you.

Meanwhile, anxiety is triggered by your body's stress response. Whereas stress dissipates the moment you are out of a threatening situation, anxiety lingers like a guest that has overstayed its welcome. 

Using the same example, you may continue to feel anxious even after you've swerved your car in time to avoid a crash. Perhaps you're fretting over potential what-ifs, like, "What if my reflexes aren't quick enough the next time?" or "What if I hadn't been paying attention just now?" As you can see, anxiety sets off persistent, obsessive thoughts about possible threats that may or may not happen.

The Different Faces of Anxiety

Anxiety and sleep: woman with her hands covering her mouth and nose

All of us experience anxiety from time to time. When in moderation and for the right reasons, anxiety can be a timely alarm system, alerting you to potential hazards.

Let's say you're feeling anxious about a challenging work project. That spurs you to put in extra time to go over the details, conduct relevant research, and draft up proposals. In this case, anxiety is useful in helping you produce exceptional work and knock the socks off your managers and clients. What's not so useful is when you constantly worry about the project to the point that you have mild panic attacks and sleepless nights.

As you can see, once you give anxiety free rein, it quickly develops into something unmanageable. If you're anxious most of the time — if not all of the time — and have been feeling this way for at least six months, you may be dealing with an anxiety disorder.

Anxiety disorders come in various forms that react to different triggers. Here are some of the most common ones:

  • Generalized anxiety disorder (GAD): GAD involves constant, excessive worry that affects your day-to-day functioning. Triggers can be anything from work demands to household chores.
  • Panic disorder: It features a series of panic attacks, in which the physical and psychological sensations are so overwhelming you think you're having a heart attack or something similar. Panic attacks that occur during the night are known as nocturnal panic attacks.
  • Social anxiety disorder: You feel uncomfortable, anxious, or distressed during social interactions. You assume people are watching and/or judging you, making it difficult for you to socialize.

There are also anxiety-related disorders such as:

  • Post-traumatic stress disorder (PTSD): Personal experience or observation of a traumatic event can give rise to this psychiatric disorder.
  • Obsessive-compulsive disorder (OCD): Repetitive, unwelcome thoughts, ideas, or feelings drive the need to do a specific behavior repeatedly.

More often than not, anxiety disorders coexist with sleep disorders like chronic insomnia and sleep apnea. But you don't need to be clinically diagnosed with an anxiety disorder to feel its negative effects, particularly in terms of lost sleep.

This Is Your Body in Anxious Mode

Anxiety and sleep: Stress Response infographic

When you're stuck in anxious mode, chances are your heart races, your underarms sweat, and your muscles tense up. But these are just the tip of the iceberg when detailing symptoms of anxiety. Other common examples include:

  • Breathlessness or rapid breathing
  • Feelings of nervousness, fear, agitation, and worry
  • A sense of hyperawareness
  • Restlessness or difficulty concentrating
  • Trouble sleeping

In more serious cases of anxiety, you may even encounter sensations like:

  • Chest pain or pressure
  • Dizziness or feeling faint
  • Tingling or numbness in the arms and legs

To understand why you're feeling these physical effects, we need to dive down to the biological level.

When you're stressed, the hypothalamus in your brain releases corticotropin-releasing factor (CRF). This hormone is the main driver of the hypothalamic-pituitary-adrenal (HPA) axis. CRF prompts the pituitary gland (below the hypothalamus) to release the adrenocorticotropic hormone into the bloodstream. When the adrenocorticotropic hormone reaches the adrenal glands, stress hormones, like cortisol and adrenaline, are released into your system.

But CRF's realm of control also extends to emotional regulation and cognitive functioning. Specifically, CRF downplays serotonin secretion, a neurotransmitter that controls your moods and is also known as your body's feel-good chemical. Low serotonin levels, courtesy of an anxious mind, allow negative emotions to breed, like depression, frustration, and fear.

Research also suggests a bidirectional relationship between CRF and norepinephrine (noradrenaline), which is a hormone and neurotransmitter. As part of the fight-or-flight response during a stressful situation, CRF triggers the release of norepinephrine in the prefrontal cortex and hypothalamus. Noradrenaline also activates the CRF-containing cells to stimulate the HPA axis. The result is higher-than-normal norepinephrine levels, which bring about biological reactions such as:

  • Dilated pupils
  • Increased blood pressure
  • A faster heart rate
  • Increased production of blood glucose and fatty acids for energy metabolism
  • Increased cognitive activity

All of these internal changes give you an edge during times of actual threats. But prolonged anxiety puts you in a constant arousal state that makes it hard for you to relax, much less fall asleep.

The Two-Way Interaction of Anxiety and Sleep Loss

According to the Anxiety & Depression Association of America (ADAA), deciding whether anxiety or sleep disorders come first is akin to the chicken and egg dilemma. After all, it's a well-known fact that anxiety is responsible for most sleep problems and that sleep loss is a hallmark in many mental health conditions.

Indeed, the two-way relationship of anxiety and sleep loss feeding into each other makes untangling the web even more difficult. To complicate matters, you may also encounter sleep anxiety, in which you worry about your lack of sleep. This does not bode well for your already high levels of anxiety and sleep debt (the amount of sleep you've missed out on over the past 14 days relative to your sleep need).

Anxiety Brings About Sleep Deprivation

Anxiety and sleep: woman lying awake in bed

It's easy to see how being in an anxious state for longer than necessary leads to sleep problems. Below, we look behind the scenes to see how feelings of anxiety bring about sleep deprivation.


Rumination is a classic symptom of how anxiety repels sleep. When you're trapped in a cycle of repetitive, worried thoughts about an upcoming performance review or your kid's poor grades, it's much harder to drift off to sleep. Predictably, rumination prolongs sleep latency (you take longer to fall asleep), cutting into your sleep duration and building up sleep debt.

Norepinephrine, Dopamine, and Melatonin

Aside from the psychological impacts of anxiety on sleep, there are also biological consequences to contend with. To illustrate, norepinephrine (the organic chemical in your fight-or-flight response) has enormous ramifications on sleep due to its role in your sleep-wake cycle. As an arousal-promoting hormone, norepinephrine is highly active during wakefulness, slow-firing during non-REM (rapid eye movement) sleep, and almost completely quiet during REM sleep.

Norepinephrine also triggers the release of dopamine, a neurotransmitter that promotes wakefulness. Dopamine operates in the pineal gland, which is essential to your circadian rhythm (your body’s internal clock), as it translates light signals to regulate your sleep-wake cycle. Scientific evidence explains that norepinephrine and dopamine interact to control your body's natural melatonin production (a sleep-promoting hormone). In the absence of dopamine, norepinephrine stimulates melatonin synthesis.

When dopamine is thrown into the mix, it neutralizes norepinephrine, subsequently lowering your body's melatonin content. Dopamine receptors naturally appear in the pineal gland in the early morning hours when darkness subsides to signal it's time to wake up.

Under anxiety-induced circumstances, though, dopamine makes its appearance regardless of whether it's light or dark outside to dampen melatonin production. As you can imagine, an anxious state of mind at bedtime sparks dopamine production and inhibits melatonin synthesis, all of which is detrimental to your sleep.

High Sleep Reactivity

As if your anxious thoughts aren't already rebuffing sleep, science shows that anxiety is linked to high sleep reactivity. High sleep reactivity means your sleep is drastically disrupted by stress. So you're much less likely to get a good night's sleep (meet your sleep need) when you're stressed out.

In fact, the Journal of Sleep reports highly anxious individuals show altered sleep patterns as they:

  • Took longer to fall asleep
  • Had less deep sleep and REM sleep
  • Had more light sleep (non-REM sleep)
  • Experienced more frequent short awakenings (micro-arousals), which incidentally double as minor sleep disruptions

In essence, anxiety incites sleep disturbances that prevent you from meeting your sleep need (the genetically determined amount of sleep your body needs). 

You should also know that reduced deep sleep and REM sleep spells disaster for your emotional wellness. Research suggests that during these sleep phases, the prefrontal cortex reconnects and regains control over the amygdala, the part of the emotional brain that regulates our perception of negative emotions. As a result, poor sleep not only leads to next-day tiredness but also increased reactivity and anxiety.

Lack of Sleep Triggers Anxiety, Too

Tired woman sitting on her bed

On the other side of the coin, not getting enough sleep can trigger anxiety in two ways.

First, sleep deprivation, even in minute amounts, is potent enough to hike up your anxiety levels. Ample research suggests that chronic insomnia isn't just a solid marker for anxiety disorder but also a risk factor. The National Sleep Foundation backs this up by highlighting that severe insomniacs are “17 times as likely to have clinical anxiety.”

Yet, what is the exact mechanism behind sleep loss contributing to anxiety? According to one study, the answer is unnaturally high levels of cortisol, an alertness-boosting hormone. For context, cortisol naturally declines throughout the day when you've had sufficient sleep. Alas, partial or total sleep deprivation leads to a jump in daytime cortisol levels by as much as 37-45%. It's no wonder then that your mind is still active when it's time for bed. 

To make matters worse, poor sleep handicaps your coping mechanisms, particularly in stressful situations. Consequently, your anxiety levels intensify rather than decline.

Second, lack of sleep adds an additional layer of anxiety around sleep loss itself, also known as "sleep anxiety." You've probably experienced it firsthand when you lie in bed thinking about how you're losing more sleep as the minutes tick by. This ongoing cycle of anxious thoughts surrounding the inability to fall asleep and stay asleep throughout the night entangles the already complicated ties of anxiety and sleep loss. 

You may even start dreading sleep during the day and become increasingly anxious the nearer your bedtime draws. The more anxious you get about not meeting your sleep need, the more you can't fall asleep. It's an endless loop of sleep loss, anxiety, and more sleep loss again.

Get a Handle on Anxiety to Sleep Better Tonight

As you can see, a small amount of anxiety and sleep deprivation quickly snowballs into more anxiety and sleep deprivation that saps your daytime energy. Predictably, you aren't feeling and functioning at your best when you need to. So how do you step off the hamster wheel and get a handle on your anxiety levels throughout the day and at night to drift off to sleep?

Good Sleep Hygiene + Professional Help

First, identify if you’re trapped in a vicious cycle of anxiety and sleep loss or not. If your sleepless night is just a one-off occurrence, focus on lowering your sleep debt. Start with practicing good sleep hygiene using Rise’s step-by-step Sleep Guide. It covers everything you need to know, from preparing the ideal sleep environment to structuring your day for better sleep on top of good sleep habits. Pair these sleep-promoting behaviors with the sleep debt-tracking function in our RISE app to ensure you're consistently meeting your sleep need.

On the other hand, if you’re trapped in a constant cycle of never-ending anxiety and sleep deprivation, good sleep hygiene can only take you so far. You will have to tackle the crux of the problem by removing the root cause(s) of your anxiety so you can fall asleep more easily at night. Yet, as much as we would like to eradicate all sources of anxiety, it might not be possible, much less practical. For some of us, anxiety triggers like work stress or a chronic illness are out of our control and we can’t run away from them.

In such cases, focus on mitigating anxiety throughout the day and evening to keep it at bay. This way, you will likely have much better odds of meeting your sleep need when it's time for bed. As always, good sleep hygiene should be at the core of your anxiety-reducing blueprint.

But anxiety can be difficult to work through on your own. If you need to, seek medical advice from a qualified mental health professional. They will work with you to pinpoint the root causes of your anxiety to help improve your mental well-being. They may also provide treatment options specifically related to anxiety and sleep, such as:

  • Cognitive-behavioral therapy for insomnia (CBT-I)
  • Relaxation techniques, like mindfulness meditation
  • Sleep medicine and anti-anxiety drugs

For more details, view other treatment options at adaa.org.

Practice Anxiety Management on Your Own

RISE app screenshot showing how to personalize your evening wind-down activities
The RISE app lets you customize your ideal evening wind-down routine to help you fall asleep more easily once your bedtime arrives.

Whether you're working with a therapist or not, there are some anxiety-reducing techniques you can perform on your own. These tactics are easy to follow and help curtail sleep-related anxiety.

  • Take time to wind down before bed: An active mind is an anxious mind just waiting to sabotage sleep. This is why a wind-down routine is non-negotiable in the 1-2 hours before your target bedtime. Give yourself sufficient time to slow down and let go of the day's stressors. Sliding into the right frame of mind for sleep means less tossing and turning in bed later. (In the RISE app, add the "Evening routine" habit to your Energy Schedule for a timely reminder.)
  • Do a brain dump: To break the bad habit of rumination, pen down your fretful thoughts on a piece of paper. Add the "Brain dump" habit to your Energy Schedule to jot down your worries or be productive by planning your next-day to-do list. What you're essentially doing is taking a load off your mind, making it easier for you to doze off.
  • Engage in relaxation techniques: Relaxation techniques help nip your body's stress response in the bud before it progresses to full-blown anxiety. The RISE app offers four types of relaxation techniques — progressive muscle relaxation, autogenic training, diaphragmatic breathing, and relaxing sounds. You can perform them at any time of the day and at night. Experiment and see which one(s) work best for you.

If you'd like to learn more about how to dial down your nighttime anxiety levels, check out our in-depth guide to "How to calm anxiety at night."

Don’t Let Anxiety and Sleep Loss Control Your Life

It's scarily easy to slide into a vicious cycle of anxiety and sleep loss. Even one night of sleeplessness takes a significant hit to your daytime energy levels. Understanding how anxiety perpetuates sleep deprivation (and vice versa) can help you break up the cycle and avoid the gnarly issue of sleep anxiety altogether.

Given how much effort it can take to navigate the thorny terrain of anxiety and sleep loss, don't hesitate to seek professional help if you need to. Pair your therapy sessions with anxiety-reducing techniques on your own.

And remember, good sleep hygiene is always your first line of defense. The RISE app can give you a heads up on when you should perform sleep-promoting activities based on your unique chronobiology. This way, you're less likely to be trapped in the endless loop of anxiety and sleep loss. And we all know what that means — better energy for better days ahead.

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