Lying awake with racing thoughts, checking the clock, and dreading how tired you’ll be tomorrow is a familiar pattern for many people with anxiety. Anxiety and insomnia often travel together, and each makes the other worse. The good news is that the cycle can be broken, often with approaches that don’t rely on sleeping pills. This guide explains why anxiety spikes at night, how poor sleep feeds anxiety, what the evidence says about treatment, and when to get help.
How Anxiety and Insomnia Feed Each Other
Anxiety and insomnia feed each other because anxiety keeps the brain and body in a state of alertness that blocks sleep, while sleep loss makes the brain more reactive to stress the next day. A night of poor sleep can leave you more irritable and worried, which makes the following night harder still. Over time, the bed itself can become linked with frustration and worry.
Anxiety disorders are common, so this cycle is too. The National Institute of Mental Health estimates that 19.1% of U.S. adults had an anxiety disorder in the past year, and that past-year rates were higher among women (23.4%) than men (14.3%).
Share of U.S. adults with any anxiety disorder in the past year.
Why Anxiety at Night Feels Worse
Anxiety at night often feels worse because there are fewer distractions, the day’s worries surface, and the body’s stress response can stay switched on when it should be winding down. In the quiet of the night, thoughts can loop without interruption. Physical symptoms, such as a racing heart or muscle tension, can also feel more noticeable when you’re lying still.
Worry about sleep itself adds another layer. Thoughts like “If I don’t fall asleep now, tomorrow will be a disaster” raise alertness, which makes sleep less likely. Recognizing that pattern is one of the first things cognitive behavioral therapy for insomnia works on.
The harder you try to force sleep, the more awake an anxious brain becomes. Breaking the cycle starts with changing the approach.
What to Do When You Can’t Sleep Because of Anxiety
When you can’t sleep because of anxiety, the most helpful steps are to stop fighting for sleep, get out of bed if you’re wide awake, and return when you feel sleepy, while keeping a consistent wake time every day. These steps come from cognitive behavioral therapy for insomnia and help rebuild the link between bed and sleep.
- Keep a fixed wake time. Get up at the same time every day, even after a bad night.
- Use the bed only for sleep. Avoid working, scrolling, or worrying in bed.
- Get up if you’re wide awake. After about 20 minutes awake, go to another room and do something calm.
- Set aside worry time. Write worries down earlier in the evening so they’re less likely to surface at night.
- Limit caffeine and alcohol. Both can disrupt sleep, especially later in the day.
These strategies work best consistently over several weeks. They’re not a quick fix for one bad night, but they address the patterns that keep insomnia going.
Anxiety keeping you up at night?
A thorough evaluation can find what’s driving it. By telehealth across South Carolina and New York.
Effective Insomnia Treatment for People With Anxiety
Effective insomnia treatment for people with anxiety usually starts with cognitive behavioral therapy for insomnia, known as CBT-I, alongside treatment for the anxiety itself. The American College of Physicians recommends that all adults with chronic insomnia receive CBT-I as the initial treatment, a strong recommendation based on moderate-quality evidence. Medication is considered, through shared decision-making, when CBT-I alone hasn’t been enough.
| Approach | What it involves | Where it fits |
|---|---|---|
| CBT-I | Changing sleep habits, schedules, and thoughts about sleep | Recommended first-line for chronic insomnia |
| Treating the anxiety | Therapy, an SSRI or SNRI, or both | When anxiety drives the insomnia |
| Sleep medication | Short-term use chosen through shared decision-making | When CBT-I alone hasn’t been enough |
| Sleep habits | Consistent schedule, limiting caffeine and alcohol | Helpful for everyone, but rarely enough alone |
Treating the anxiety matters too. When worry, panic, or generalized anxiety drive the insomnia, treating them with therapy, an SSRI or SNRI, or both often improves sleep as well. Some sleep medications, including benzodiazepines, carry risks of dependence with regular use, so they’re generally not a long-term first choice. Our guide to benzodiazepines for anxiety explains why.
Sleep and Mental Health: When Insomnia Signals Something More
The link between sleep and mental health runs both ways, so insomnia can be a sign of an anxiety disorder, depression, bipolar disorder, or another condition that needs its own treatment. Generalized anxiety disorder, for example, often includes trouble sleeping. NIMH data show that an estimated 2.7% of U.S. adults had generalized anxiety disorder in the past year, and 32.3% of them had serious impairment.
Degree of impairment among U.S. adults with any anxiety disorder in the past year.
A sudden drop in the need for sleep without feeling tired is different from insomnia. It can be a sign of hypomania or mania and should be mentioned to a psychiatrist. Our overview of the types of bipolar disorder explains why.
Nights that feed the worry
Anxiety keeps you awake, and exhaustion makes the next day’s anxiety harder to manage.
Treating both together
CBT-I for sleep plus treatment for the anxiety driving it, chosen after a careful evaluation.
Rest and calmer days
More consistent sleep and anxiety that feels manageable again.
Dr. Gabriella Farkas, MD PhD
Board-certified adult psychiatrist with a PhD in neuroscience. Dr. Farkas looks at sleep and anxiety together and favors approaches that treat the cause, not just the symptom.
About Dr. Farkas →When to Get Help for Anxiety and Insomnia
Get help for anxiety and insomnia when poor sleep lasts more than a few weeks, affects your work, mood, or safety, or when anxiety is hard to manage during the day. Chronic insomnia is generally defined as trouble sleeping at least three nights a week for at least three months, but you don’t need to wait that long to ask for help.
A comprehensive adult psychiatric evaluation can sort out what’s driving the problem and whether therapy, medication, or both fit. Our guide to panic disorder vs panic attacks covers night-time panic, and our walkthrough of how telepsychiatry works explains video visits. If you’re having thoughts of suicide, call or text 988 in the US.
Key Terms
- Insomnia
- Persistent difficulty falling asleep, staying asleep, or getting restful sleep that affects daytime functioning.
- CBT-I
- Cognitive behavioral therapy for insomnia, a structured program that changes sleep habits and thoughts about sleep.
- Hyperarousal
- A state of heightened physical and mental alertness that makes it hard to relax or fall asleep.
- Sleep restriction
- A CBT-I technique that temporarily limits time in bed to strengthen the drive to sleep.
Common Questions About Anxiety and Insomnia
Why does anxiety make it hard to sleep?
Anxiety makes it hard to sleep because it keeps the brain and body alert, with racing thoughts, tension, and a stress response that blocks the natural wind-down needed for sleep. Worry about sleep adds to it. The bed can become linked with frustration. This pattern is treatable. CBT-I targets it directly.
Can poor sleep make anxiety worse?
Yes, poor sleep can make anxiety worse, because sleep loss makes the brain more reactive to stress and harder to regulate emotionally the next day. That feeds the cycle. Better sleep often eases anxiety. Treating both works best. Small changes can help early. A consistent wake time is a good first step.
What is the best treatment for insomnia with anxiety?
The American College of Physicians recommends cognitive behavioral therapy for insomnia as the first treatment for chronic insomnia, and treating the anxiety itself with therapy or medication often improves sleep too. Medication may be added if needed. Shared decisions matter. Benzodiazepines aren't usually a long-term first choice. An evaluation helps tailor the plan.
Should I take a sleeping pill for anxiety-related insomnia?
Sleeping pills can help in some situations, but they're generally not the first choice for chronic insomnia, and some carry risks of dependence with regular use. CBT-I is recommended first. Short-term medication may be considered. Discuss benefits and risks. Your psychiatrist can guide the choice. Many people improve without long-term medication.
What should I do if I wake up anxious at night?
If you wake up anxious at night and can't settle, get out of bed after about 20 minutes, go somewhere calm and dim, and return when you feel sleepy, rather than lying there worrying. Keep your wake time fixed. Avoid screens. Write worries down earlier in the evening. Consistency helps over weeks.
When is insomnia considered chronic?
Insomnia is generally considered chronic when sleep problems happen at least three nights a week for at least three months and affect daytime functioning. Shorter episodes are common too. You don't need to wait to get help. Early care can prevent it from becoming chronic. An evaluation can clarify the cause.
Can I get help for anxiety and insomnia by telehealth?
Yes, Dr. Farkas evaluates and treats anxiety and related insomnia by secure telehealth for adults in South Carolina and New York, coordinating with therapists who provide CBT-I when helpful. You'll need a private space. A device with a camera works well. Follow-ups use the same platform. Prescriptions can be sent to your pharmacy.
Better sleep and calmer days can go together.
An evaluation that looks at both.
Sources
- Qaseem A, Kansagara D, Forciea MA, et al. “Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians.” Annals of Internal Medicine, 2016;165(2):125–133. https://pubmed.ncbi.nlm.nih.gov/27136449/
- National Institute of Mental Health. “Any Anxiety Disorder.” NIMH Statistics. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder
- National Institute of Mental Health. “Generalized Anxiety Disorder.” NIMH Statistics. https://www.nimh.nih.gov/health/statistics/generalized-anxiety-disorder
Educational content only. This article does not constitute medical advice and does not establish a doctor-patient relationship. If you are in crisis, call or text 988 (Suicide & Crisis Lifeline) or call 911. Treatment decisions should be made with a qualified clinician familiar with your circumstances. Last reviewed: August 2026.