Insomnia and Anxiety: Navigating the Vicious Cycle

Anxiety and insomnia are two of the most prevalent mental health problems affecting Americans today. Reports show millions of Americans live with anxiety and don’t get enough restful sleep each night.

Unfortunately, the hardest part about living with anxiety and insomnia is they can get locked in a vicious cycle – each makes the other worse.

Here, we’ll go into the cycle of insomnia and anxiety and provide practical tips to help you deal with both.

Understanding the connection between insomnia and anxiety

Anxiety and insomnia have a bidirectional relationship, meaning they can each make the other worse. It’s difficult to say which comes first: anxiety or insomnia. For some people, anxiety comes first and causes sleeplessness. Others may become anxious due to the fact they can’t sleep at night.

Regardless of which comes first, anxiety and insomnia can get locked in a vicious cycle that’s difficult to break out of without treatment.

How anxiety can lead to insomnia

Sleep disturbances, including insomnia and other problems like nightmares, are very common for people who live with an anxiety disorder. Changes in sleeping patterns, including problems falling and staying asleep, are a core symptom of generalized anxiety disorder as listed in the Diagnostic and Statistical Manual (DSM)^[1]. Additionally, other common symptoms of anxiety disorders can come together to make it even more difficult to sleep.

For example, one common symptom of anxiety is restlessness. People with anxiety often feel like they can’t sit still and feel constantly wound up or on edge. This feeling often continues even when it’s time to go to bed, and may cause people to toss and turn throughout the night.

People with anxiety disorder also commonly have racing thoughts and excessive worries. If you live with anxiety, you may find yourself staying wide awake at night ruminating on things that cause you anxiety and fear. For example, you may stay up worrying about finances or your relationships. These constant worry cycles through your mind can make it incredibly difficult to rest and in some cases can cause insomnia.

People with anxiety can also live with a chronic stress response. The stress response, also known as the fight-flight-or-freeze reflex, is a biological response that helps us get ready to cope with threats and dangers. It causes certain changes in the body, such as your heart starting to beat faster and more blood flowing into your muscles. Your body also gets flooded with stress hormones, like cortisol, during the fight-or-flight response.

Although the stress response is not inherently a problem, the hormones that are released are meant to keep you more alert. This means experiencing chronic stress can significantly interfere with your sleep cycles and cause insomnia. This is another way in which living with an anxiety disorder can cause insomnia in many people^[2].

Lastly, many mental health conditions closely linked to anxiety disorders, like post-traumatic stress disorder (PTSD), cause nightmares. Up to 90% of people with PTSD experience nightmares^[3]. People with nightmares may develop insomnia because they avoid going to sleep in an effort to stop the nightmares.

How insomnia can worsen anxiety

While anxiety often leads to insomnia, the reverse is also true. Living with insomnia can make anxiety significantly worse.

This is primarily due to the way sleep deprivation affects your mood and mental health. Research shows people who are sleep deprived are more likely to experience symptoms like irritability, excessive worrying, lack of focus, and low mood. All of these symptoms are associated with anxiety; when you don’t sleep well, these symptoms can get worse.

Some people also experience anxiety about insomnia itself. They may have anxious thoughts like, “I’m only going to get 5 hours of sleep. I’ll be so tired and stressed for the exam tomorrow,” or “What if I struggle with insomnia for the rest of my life? I can’t live like this any longer.”
These metacognitions, or worries about the insomnia itself, can make it even harder to fall asleep at night. Many treatments for insomnia are targeted towards dealing with these specific thoughts, rather than the symptoms of general anxiety.

This makes anxiety and insomnia get locked in a vicious cycle. The more anxious you feel, the less likely you are to be able to get restful sleep. But the less you sleep, the more anxious you tend to feel, and so on.

Coping mechanisms for managing insomnia and anxiety

Luckily, there are ways to break out of the self-perpetuating cycle of anxiety and insomnia, get restful sleep, and reduce anxiety..

Sleep hygiene

It’s essential to make healthy lifestyle changes to better manage insomnia and anxiety, whether or not you also receive professional treatment. These habits can make it easier to quiet your mind and fall asleep at night, as well as reduce excessive worrying throughout the day.

Good sleep hygiene is about implementing lifestyle habits that set your brain and body up for a good night’s rest. Research shows these habits are proven to reduce insomnia and improve sleep quality. Here are some evidence-based sleep hygiene tips to consider implementing:

• Go to bed and wake up at the same time every day, even on weekends.
• Avoid doing anything but sleeping and having sex in bed; for example, don’t work from your laptop in bed and avoid scrolling social media.
• Put your digital devices away at least an hour before your bedtime; the blue light that’s emitted from electronic screens can trick your brain into thinking it’s not yet time to sleep.
• Make your sleeping area as comfortable as possible for sleep; research shows humans sleep best in dark, cool, and quiet places. If you live in an urban area, consider getting blackout curtains or a white noise machine.
• At the same time every day, implement a bedtime routine. This can involve common activities like having a warm non-caffeinated beverage, taking a shower or bath, and listening to relaxing music.
• Avoid alcohol and caffeine, especially in the afternoon and evening. Many people mistakenly believe alcohol helps them to sleep, but studies show alcohol actually worsens your quality of sleep over the long term.

Relaxation strategies

On top of these healthy habits to help you sleep better, you can also implement some lifestyle changes and relaxation strategies to cope better with your anxiety. Try these tips:

• Practice relaxation techniques: There are many relaxation techniques that can help reduce anxiety and improve sleep quality, including:
  1 – Deep breathing exercises: Focus on slow, controlled breaths to calm your mind and body.
  2 – Progressive muscle relaxation: Tense and relax different muscle groups in your body to release tension.
  3 – Meditation: Mindfulness meditation techniques can help you focus on the present moment and let go of worries.
  4 – Guided imagery: Visualize calming scenes or experiences to promote relaxation.
• Spend time in nature: Spending time outdoors in nature has been shown to reduce stress and anxiety. Take walks in the park, hike in the woods, or simply sit outside and enjoy the fresh air.
• Listen to calming music: Soothing music can help quiet your mind and promote relaxation.
• Practice mindfulness throughout the day: Mindfulness involves paying attention to the present moment without judgment. This can help you become more aware of your thoughts and feelings and detach from negative thought patterns.
• Engage in activities you enjoy: Make time for hobbies and leisure activities that bring you joy and relaxation.

The importance of exercise

Lastly, it’s important to mention one lifestyle habit that can help you cope better with both insomnia and anxiety: physical exercise. Research studies show getting regular exercise is one of the best ways to lessen anxiety and helps you sleep better at night. Find ways to move your body that are fun and sustainable for you. Just make sure you don’t exercise too strenuously before going to bed, as this can sometimes make insomnia worse^[4].

Cognitive behavioral therapy (CBT) techniques

Cognitive behavioral therapy (CBT) is a first-line treatment for both anxiety and insomnia. This treatment method is based on the idea that our thoughts, feelings, and behaviors are interconnected. By reframing negative thoughts or changing your behaviors, you can start to feel better.

While receiving CBT from a licensed mental health professional is ideal, there are some helpful concepts you can use on your own.

An important part of CBT for insomnia (CBT-I) involves making behavioral changes to improve sleep, like the sleep hygiene and relaxation tips mentioned earlier. There is also a technique called sleep restriction that’s often used. This involves initially reducing the amount of time you spend in bed, even though it might seem counterintuitive. The goal is to decrease the time you lie awake in bed. Over time, by only staying in bed during the hours you’re actually asleep, you can train yourself to sleep more efficiently^[5].

In addition, you can use cognitive techniques to reframe the thoughts and worries that keep you awake at night, especially thoughts about insomnia itself. For example, you might have a thought: “What if I don’t sleep all night and because of that I can’t function at work tomorrow?” Instead of ruminating on this thought, you might reframe it to think about how rational the thought is.

For example, you might remind yourself that, in the past, even if you haven’t gotten a perfect night’s sleep, you were able to function relatively well at work. Or you might recall another instance in which a colleague didn’t sleep well the night before, and remind yourself that you and your other colleagues were understanding of their situation — even if your sleepless colleague wasn’t at 100% that day.

By reframing these worries about insomnia into more rational thoughts, you can lessen anxiety and break the cycle of anxiety and insomnia.

Get help for anxiety and insomnia

If you live with an anxiety disorder or insomnia, then these self-help strategies can help, but you may also require professional treatment. A therapist can help you explore the root causes behind your insomnia and anxiety and learn new ways to manage your symptoms.

At The Center • A Place of HOPE, we use a proven Whole Person Care approach to mental health treatment. This means that we address every aspect of your well-being, and understand that mental health doesn’t happen in a vacuum. Rather than treating individual mental health conditions, we look at your overall wellness and habits, including sleep.

Are you ready to get out of the cycle of anxiety and insomnia? Get in touch with us for more information about admissions.

1 – https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t15/
2 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688585/
3 – https://my.clevelandclinic.org/health/diseases/24464-nightmare-disorder
4 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503965/
5 – https://pubmed.ncbi.nlm.nih.gov/24629826/