Sleep Disorders and Anxiety: A Two-Way Street

Many people struggle with getting a good night’s sleep, and this can be worsened by anxiety. But the relationship goes both ways – sleep disorders themselves can also contribute to anxiety symptoms. In this article, we’ll go over some of the most common sleep disorders that affect Americans today, and how they can interact with anxiety.

Common sleep disorders and their relationship with anxiety

We often hear about how insomnia and mental health conditions like anxiety are related, but insomnia is far from the only sleep disorder out there. There are many kinds of sleep disorders, and all of them are connected with anxiety in some way. Most have a bidirectional relationship with anxiety, meaning each affects the other.

Here are some of the most common sleep disorders, and how they affect (and are affected by) anxiety.

Insomnia and anxiety

Insomnia is the most common and well-known sleep disorder; it causes people to have difficulty falling or staying asleep. Insomnia affects around 25 million Americans each year^[1]. Some reports show up to 30% of Americans show some signs of insomnia^[2].

The symptoms of insomnia include:

• Difficulty falling asleep at night
• Difficulty staying asleep; waking up several times during the night
• Having a hard time getting back to sleep after waking up in the night or too early in the morning

This difficulty sleeping is one of the most commonly reported symptoms of anxiety disorders. In fact, sleep disturbances are listed in the Diagnostic and Statistical Manual (DSM) as one of the core symptoms of generalized anxiety disorder.

Restless leg syndrome and anxiety

You may have heard of restless leg syndrome (RLS), a condition that causes an overwhelming urge to move your legs^[3]. The sensation gets worse at night or during periods when you’re trying to rest. The sensations caused by RLS aren’t typically painful, but they’re extremely uncomfortable to the point they interrupt sleep.

The exact causes of restless leg syndrome are still not very well understood. Scientists have found RLS can be at least partly genetic. Other factors can also contribute, including low iron, certain medications, and some health conditions like peripheral neuropathy.

Research has also found a strong link between anxiety and RLS, although we don’t yet know if one causes the other^[4]. High stress and anxiety can trigger episodes of RLS for many people, but the opposite can also be true; RLS makes it difficult to get restful sleep every night, and being sleep-deprived can make existing anxiety symptoms worse.

Narcolepsy and anxiety

In many ways, narcolepsy causes the opposite problem of insomnia. People who live with narcolepsy have trouble staying awake and can fall asleep at any time. This can make daily life stressful and even dangerous for them, and they may not be able to engage in normal daily activities like driving and working because of their disorder.

Over half of those with narcolepsy also live with anxiety symptoms, including social anxiety^[5]. A lot of this has to do with the way narcolepsy affects your life. People with narcolepsy live with the constant fear their disorder will interrupt day-to-day activities. They may worry about how narcolepsy symptoms will affect their relationships or how they’ll be perceived by other people. This, understandably, can lead to anxiety.

Narcolepsy is a genetic neurological disorder. Although its exact causes are still unknown, anxiety alone does not typically cause it. For many people, it’s thought to be caused by the lack of a brain chemical called hypocretin, which helps us stay awake^[6]. However, severe psychological stress can trigger narcolepsy for some people.

Sleep apnea and anxiety

Obstructive sleep apnea is a common medical condition that causes people to periodically stop breathing while asleep. It affects around 30 million people in the United States alone^[7]. Sleep apnea can be very dangerous when left untreated, and can even lead to death.

Anyone can develop obstructive sleep apnea, and there’s no single cause. But several factors can heighten your risk of developing it. These include obesity, being middle-aged or older, high blood pressure, enlarged tonsils, a naturally narrow airway, chronic nasal congestion, asthma, diabetes, smoking, and being male. In addition, research has found people with direct family members with sleep apnea are at higher risk.

Research has demonstrated a strong link between obstructive sleep apnea and anxiety disorders. A 2022 study found people with anxiety were significantly more likely to live with obstructive sleep apnea, especially if they also lived with a co-occurring depressive disorder^[8]. In another older study, more than 60% of participants with anxiety suffered from severe obstructive sleep apnea^[9].

This isn’t to say anxiety causes sleep apnea. Researchers are still trying to understand the exact causes behind sleep apnea, but it’s generally thought anxiety is not a direct cause. The disrupted sleep caused by sleep apnea is more likely the culprit for worsening anxiety symptoms in most people. Sleep apnea can leave people feeling exhausted even after a night’s sleep, and sleep deprivation is widely known to worsen anxiety.

In addition, people with sleep apnea may have fears about their health or even dying during the night. This can also, understandably, worsen anxiety.

Parasomnias and anxiety

Parasomnias are a group of sleep disorders that cause unwanted behaviors or symptoms while asleep. Some of the most commonly known types of parasomnias are sleeptalking, sleepwalking, sleep terrors, nightmares, and sleep paralysis.

Many parasomnias are highly linked with anxiety. For example, some reports show up to 90% of people with PTSD experience nightmares. And in one older systematic review, around 35% of psychiatric patients with panic disorder reported experiencing sleep paralysis^[10].

Many different things can trigger parasomnia behaviors, including genetics and family history. But stress and anxiety commonly trigger symptoms like sleepwalking, sleep talking, and sleep paralysis for many people. You may have experienced this yourself, even if you don’t live with a diagnosable sleep disorder. For example, maybe you’ve had a big event coming up and found yourself having nightmares about it during the nights leading up to it.

Not only can heightened stress and anxiety trigger episodes of parasomnias, but experiencing these symptoms can also make you feel more anxious than you already do. Many of these parasomnia behaviors are frightening and upsetting. For example, people who experience sleep paralysis often experience disturbing hallucinations which can cause anxiety even after waking.
On top of that, these symptoms often get in the way of adequate restful sleep, which can also make anxiety symptoms worse.

Hypersomnia and anxiety

Hypersomnia, or hypersomnolence disorder, is a sleep disorder that causes extreme sleepiness, even when you’ve gotten the recommended 7 to 9 hours of sleep at night. You may find it difficult to stay awake through the day, or wake up after a period of 9 or more hours of sleep still feeling unrested.

Hypersomnolence disorder is not the same thing as narcolepsy. Narcolepsy is a neurological disorder that causes people to uncontrollably lapse into sleep and experience sudden lapses in muscle strength. People with hypersomnolence don’t lose control in the same way.

However, hypersomnolence disorder is still disruptive. Experiencing symptoms of hypersomnia can be very anxiety-provoking for many people. Excessive daytime sleepiness can get in the way of reaching your potential in life, including at work and in your relationships. This can understandably increase stress. In addition, people with hypersomnia don’t feel rested even after sleeping long hours. This can be upsetting and lead to symptoms of anxiety as well.

Anxiety doesn’t directly cause hypersomnia — people with anxiety tend to sleep less, not more. However, anxiety can sometimes indirectly lead to hypersomnia. For example, some people with anxiety may use drugs or alcohol as a way to cope. Certain drugs, like sedatives, can cause you to sleep more and feel excessively sleepy.

In addition, anxiety and depression often co-occur. Reports show up to 70 percent of people who live with an anxiety disorder also show symptoms of depression^[11]. Depression and hypersomnia are highly linked, and fatigue and low energy are some of the core symptoms of most depressive disorders.

How to cope when you live with a sleep disorder and anxiety

Regardless of what came first, leaving sleep disorders or anxiety untreated is only likely to make them worse. These are serious health conditions that require treatment. Luckily, there is effective treatment out there for both sleep disorders like insomnia and anxiety. Some treatments may be able to address both problems at the same time.

If you’re having trouble with sleep and anxiety – whether you’re not sleeping enough or are sleeping too much and anxiety symptoms are making this problem worse, then tell a healthcare provider right away. They can recommend the right interventions, including behavior therapy, psychotherapy (talk therapy), and holistic interventions like nutritional counseling, expressive therapies, mindfulness, and more. For some sleep disorders, medication may be necessary.

In addition, keep in mind that lifestyle habits make a big difference for both sleep disorders and anxiety. It’s unlikely lifestyle changes by themselves will make symptoms go away altogether, but they can help. Regular physical exercise, in particular, is a lifestyle habit shown to be very effective in reducing symptoms of both anxiety and several different sleep disorders.

Anxiety treatment in Washington state

At The Center • A Place of HOPE, our team has decades of experience helping people heal from anxiety and its related sleep disorders. We use a proven Whole Person Approach to mental health care, which means we don’t believe in simply giving you a pill to “fix” your anxiety and sleep problems. We’ll work together with you to find an individualized holistic treatment method that works for you.

To learn more about our admissions process and how you can start your treatment journey, get in touch with us today.

1 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10094753/
2 – https://www.ncoa.org/adviser/sleep/sleep-statistics/
3 – https://www.ninds.nih.gov/health-information/disorders/restless-legs-syndrome
4 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10982394/
5 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872173/
6 – https://karger.com/Article/Abstract/514959
7 – https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-sleep-apnea
8 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9021543/
9 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061640/
10 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156892
11 – https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.20030305