Can stress and anxiety affect sleep?

In the UK, 1 in 4 people experience a mental health issue of some kind every year¹. For many individuals, this means navigating an anxiety disorder.

Like depression, anxiety and stress are often associated with poor sleep. Anxiety and sleep have a complex, bidirectional relationship: a lack of sleep can exacerbate or even lead to anxiety disorders, and anxiety can contribute to or cause sleep issues.

Understanding how stress and anxiety affect sleep is an important step in supporting your physical and emotional health. Here, we take a look at the link between anxiety, stress and sleep, as well as helpful ways to manage nocturnal anxiety.

What is anxiety?

Everyone will experience anxiety at some point in their life; it’s the body’s natural response to stress. You may, for instance, feel anxious during a job interview, before an exam, or delivering a speech. And that’s very normal.

An anxiety disorder, however, is characterised by chronic and excessive feelings of unease, worry, or fear that interferes with daily life, occurring on most days over six months or more².

Living with anxiety can stop you from doing the activities you enjoy; it can prevent you from going to social events, entering lifts, or even leaving the house.

What causes anxiety?

Anxiety is a complicated condition – and its exact cause remains unknown. Experts believe there’s no single trigger; rather, it stems from a combination of environmental factors, family history, genetics, and adverse life events. In some instances, drug use and health problems may also contribute to anxiety.

How does anxiety make you feel?

In the face of perceived stress, the amygdala – the brain’s fear centre – stimulates the sympathetic nervous system, responsible for the fight, flight or flee response³. The sympathetic nervous system then primes the adrenal glands to release the stress hormones noradrenaline, adrenaline, and cortisol, which cause a cascade of emotional and physical reactions⁴.

Emotionally, chronic anxiety can make you feel tense, on-edge, and restless; physically, it can make you feel dizzy, nauseous, fatigued, and breathless.

Often, people with anxiety disorders develop avoidance behaviours to manage their anxiety symptoms. However, this can indirectly exacerbate the fear, as well as disrupt personal and professional life.

Can anxiety cause sleep problems?

Anxiety and sleep issues often go hand in hand. At night, many people with anxiety can find themselves in a state of mental hyperarousal – identified as a key causal factor of insomnia – catastrophising about the future or ruminating about worries of the past⁵.

What makes nocturnal anxiety so disruptive is that it throws your biological clock or circadian rhythm out of whack. The body naturally secretes the stress hormone cortisol throughout the day, with levels surging shortly after waking up and gradually decreasing at night.

However, feelings of anxiety at night increase cortisol levels when they should naturally be declining to make way for melatonin, your sleep hormone. This, in turn, keeps you alert and stimulated, which is unfavourable for sleep.

People prone to sleep problems and anxiety may also develop negative associations around their bed or bedtime. This form of anticipatory anxiety can perpetuate sleep issues and make it harder to follow good sleep hygiene⁶.

Does a lack of sleep affect your mental health?

Since sleep – and REM sleep, in particular – is such an important form of overnight therapy, a lack of it can adversely affect your mental health⁷. That’s why many doctors use sleeping patterns to inform their diagnosis of a mental health condition.

Evidence suggests sleep deprivation reverts the brain to more primitive ways of thinking⁸. Without the positive emotional and physiological regenerating effects of sleep, you can become more emotionally reactive to stimuli.

Research has also reported that anxious individuals are especially sensitive to the challenges posed by poor sleep, which can worsen mental health and exacerbate sleep deprivation⁹.

Sleep and mental issues are multi-layered and complex since they tend to operate in a vicious cycle. The reciprocal relationship means anxiety and sleep issues can be self-augmenting: anxiety causes sleep deprivation, leading to more anxiety and further sleep problems. Depression and sleep issues have a similar bidirectional connection.

How does stress affect your sleep cycle?

The terms ‘anxiety’ and ‘stress’ are often used interchangeably. And while they exist on the same continuum and both affect sleep, there are some notable differences.

Anxiety manifests from chronic, unresolved, excessive stress and worry that doesn’t improve even in the absence of the stressor. Its origin is internal. Stress, on the other hand, occurs in response to a stressor. Its origin is external.

Like anxiety, feeling stressed at night leads to a surge in cortisol when it should be falling, inhibiting sleep. Stress and sleep also have a reciprocal relationship: stress can lead to sleep deprivation, and sleep deprivation can lead to stress.

Stress is generally categorised as acute – short-term – or chronic – long-term. Acute stress can arise for several reasons: interpersonal relationship issues, financial loss, work-related problems, grief or bereavement, or recent changes to your sleeping environment – sharing a bedroom with a newborn, for instance.

In the throes of acute stress, it’s not uncommon to experience insomnia symptoms, such as delayed sleep onset and reduced sleep quantity and quality. Fortunately, short-term insomnia usually dissipates once the stressor begins to subside.

If, however, you’re under chronic stress – often the result of long-term stressors, like poverty, trauma or abuse – it can precipitate chronic insomnia, where symptoms occur at least three times per week for at least three months.

How can I calm my anxiety at night?

Although anxiety and stress can take a sizeable toll on your sleep, there are many ways to manage the conditions. And since anxiety disorders have such a complex, multifaceted relationship with sleep, improving your sleep may, in fact, reduce your anxiety¹⁰.

Build a healthier sleep hygiene practice

Good sleep always starts with good sleep hygiene. Cultivating healthy daily practices – getting enough morning light, avoiding caffeine after midday, and limiting screen-use 90-minutes before bed – and optimising your sleep environment – ensuring it’s dark, temperate, comfortable, and quiet – will help lay a foundation for quality sleep every night.

Try relaxation techniques

To calm anxiety and help you fall asleep quickly and peacefully, you could try using a range of mindfulness and relaxation techniques before bed. Many people with anxiety find meditation, visualisation, gratitude journaling, deep breathing, or aromatherapy effective and practical tools to add to their pre-bed, wind-down routine.

Practice gentle yoga

The ancient practice of yoga combines movement with meditation and conscious breathing. It’s widely recognised for its positive effects on physical and emotional wellbeing and is often used for stress relief, anxiety management, and sleep¹¹. To reduce nocturnal anxiety, we recommend slower, gentler styles of yoga, like restorative yin.

Get support

If your anxiety or stress persists and severely disrupts your quality of life, don’t be afraid to reach out to your GP or another healthcare professional. There’s plenty of support out there.

Consider natural support

Alongside lifestyle changes, supplements are another helpful way to manage anxiety and improve your sleep hygiene.

• Magnesium

  Magnesium contributes to normal muscle and psychological function, making it a useful addition to your sleep hygiene and emotional health.

• Valerian

  Valerian root is a traditional herbal remedy used for the temporary relief of night-time disturbances and mild anxiety.

• Theanine and Lemon Balm

  The soothing blend of Theanine and Lemon Balm is always a popular choice for those who want to support their sleep and mental health.

• St John’s Wort

  St John’s Wort is a traditional herbal medicinal product used to relieve the symptoms of slightly low mood and mild anxiety.

• Epsom salts

  Soaking in a relaxing Epsom salt bath can prepare your body and mind for rest at night.

Navigating anxiety disorders can be incredibly challenging, especially since they almost always affect sleep. But since anxiety, stress and sleep issues have such a reciprocal relationship, addressing one of these issues will often improve the other.

To learn more about supporting your sleep hygiene, as well as common conditions that may affect your sleep, feel free to explore the rest of our sleep health hub.

 

References:

1. McManus, S., Meltzer, H., Brugha, T. S., Bebbington, P. E., & Jenkins, R. (2009). Adult psychiatric morbidity in England, 2007: results of a household survey.
2. nhs.uk. 2021. Overview - Generalised anxiety disorder in adults. [ONLINE] Available at:  https://www.nhs.uk/mental-health/conditions/generalised-anxiety-disorder/overview/  
3. Barlow DH. (2002) Anxiety and its disorders. 2. New York: Guilford Press.
4. Ranabir, S., & Reetu, K. (2011). Stress and hormones. Indian journal of endocrinology and metabolism, 15(1), 18–22. https://doi.org/10.4103/2230-8210.7757
5. Kalmbach DA, Cuamatzi-Castelan AS, Tonnu CV, Tran KM, Anderson JR, Roth T, Drake CL.(2018) Hyperarousal and sleep reactivity in insomnia: current insights. Nat Sci Sleep, 10:193-201. 
6. Grupe DW, Nitschke JB. (2013) Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nat Rev Neurosci. 14(7): 488-501.
7. Kalmbach DA, Fang Y, Arnedt JT, Cochran AL, Deldin PJ, Kaplin AI, Sen S. (2018) Effects of Sleep, Physical Activity, and Shift Work on Daily Mood: a Prospective Mobile Monitoring Study of Medical Interns. J Gen Intern Med. 33(6) :914-920.
8. Yoo. S., Gujar. N., Hu. P., Jolesz. F.A., Jolesz. F.A. (2007). The human emotional brain without sleep: A prefrontal amygdala disconnect. Current Biology. 17: 877-878.
9. Goldstein AN, Greer SM, Saletin JM, Harvey AG, Nitschke JB, Walker MP. (2013) Tired and apprehensive: anxiety amplifies the impact of sleep loss on aversive brain anticipation. J Neurosci, 33(26):10607-15.
10. Neckelmann D, Mykletun A, Dahl AA. (2007) Chronic insomnia as a risk factor for developing anxiety and depression. Sleep. 30 (7): 873-80.
11. Nccih.nih.gov. 2021. [ONLINE] Available at: https://www.nccih.nih.gov/health/yoga-what-you-need-to-know

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