There are few things more frustrating than sleep anxiety. It’s 10 p.m. You’re enjoying your evening skin care routine. You’re brewing a cup of chamomile tea. You’re slipping into something silky. But then, all of a sudden, there it is: the creeping fear that you will not in fact be able to drift off to dreamland, that anxiety about sleep will keep you up for hours, doomscrolling in a fit of revenge bedtime procrastination. The more you think about this bedtime possibility, the more anxious you get. The vicious sleep-anxiety cycle has begun.
Sleep anxiety is very real, but it’s not an official disorder, per se. “In the sleep universe, we don’t really diagnose somebody with sleep anxiety,” says clinical psychologist Michael Breus, PhD, a diplomate of the American Board of Sleep Medicine and a fellow of the American Academy of Sleep Medicine. “We diagnose them with insomnia or insomnia secondary to a particular anxiety disorder, like generalized anxiety or OCD. There’s no real formal criteria or definition, so doctors have a tendency not to use it as a diagnosis.”
That said, “every sleep doctor in the universe” knows the role anxiety can play in sleep issues, Dr. Breus says. “Most of the people who don’t sleep, 75% of it is due to anxiety. The other 25% is a mixture of environmental factors, medications, some type of medical condition, or in some cases some form of depression.”
But just because anxiety about sleep isn’t a formally defined condition doesn’t mean anxiety at night isn’t impacting your health. “Mood, anxiety, and depression have a bidirectional relationship to sleep,” says Rebecca Robbins, PhD, an instructor in medicine at Harvard Medical School and a sleep expert for smart-ring maker Oura. Stress and anxiety, in other words, disrupt our sleep. And when we’re sleep deprived, we’re more likely to experience “negative mood states” like anxiety and depression, Dr. Robbins explains.
So how can you prevent sleep anxiety and deal with it when it happens? We asked the top sleep experts to break it down.
What is sleep anxiety?
“Sleep anxiety is stress or worry relating to your ability to fall asleep or maintain sleep,” says Dr. Robbins. It can be triggered by stress about an early alarm you’re afraid you’ll sleep through, the memory of a terrible night’s sleep earlier in the week, or maybe nothing at all. “The anxiety can manifest itself in physical, cognitive, or behavioral symptoms,” says neurologist Pedram Navab, DO, who specializes in sleep medicine and is the author of Sleep Reimagined: The Fast Track to a Revitalized Life. “You may have a fast heart or rapid breathing, as if you’re undergoing a panic attack, or you may try to avoid bed, so that you can diminish the anxiety of not being able to fall or stay sleep.”
You may not get a formal diagnosis for sleep anxiety, but “those who suffer from it likely know they have it,” says Sanem Hafeez, PhD, a neuropsychologist and professor at Columbia University. (Sleep disorders are diagnosed via an overnight stay in a sleep lab, where clinicians can measure your breathing, heart rate, and sleep stages. “From a mental standpoint, a psychologist will do an intake to find out what occurs before you go to sleep, the thoughts you have, and what happens if you wake during the night, in addition to presleep habits,” explains Dr. Hafeez.)