Racing mind at night: anxiety & sleep

Anxiety can show up in the body as tension, headaches, stomach aches, sweating or feeling out of breath. These are the same signals your body uses to keep you ready for danger, so they work against sleep.

During the day, tasks and people keep your mind busy. At bedtime, there is nothing else to hold your attention, so worrying thoughts can take over.

People who find it hard to control their worries during the day often notice it most at night.

Worrying about getting enough sleep, and watching the clock, can raise the risk of insomnia or make it worse.

A well-known model of insomnia describes how worry about sleep and about the next day triggers arousal and distress, which then makes sleep harder still.

In a Berkeley study, a sleepless night raised anxiety levels by up to 30%. Brain scans showed that a part of the brain that helps keep anxiety in check (the medial prefrontal cortex) was less active after sleep loss.

The researchers found that deep sleep seemed to calm and reset the anxious brain. People who got more deep sleep felt less anxious the next day.

When you’re anxious, attention narrows onto possible threats, inside and outside the body. At night that can mean noticing every sound, every heartbeat and every minute awake.

This close watching can trick you into thinking you slept less, or are coping worse, than you really are.

In two experiments, people asked to watch a clock while trying to sleep worried more and took longer to fall asleep. People with insomnia who watched the clock also overestimated how long it took them to drop off.

Pushing thoughts away, trying to control images in your mind, or holding feelings in are all things people do to try to sleep. Research suggests these efforts can actually keep the worry going.

Sleep comes more easily when you stop chasing it. Aim to rest, not to “make” yourself sleep.

Some people believe worry helps them prepare or stay safe. Unhelpful beliefs like this, about worry and about sleep, are named as things that keep insomnia going.

Planning helps. Going over the same worry again and again at 2 a.m. usually doesn’t. The next section has a way to plan earlier in the evening instead.

Researchers developed a simple method sometimes called “constructive worry.” Well before bed, you write down what’s on your mind and a next step for each worry. In a study of students with insomnia, this lowered mental busyness before sleep.

Try it

1. Pick a time early in the evening, well before bed.
2. Set a timer for about 15 minutes.
3. In one column, write each worry.
4. In the next column, write one small next step, or “not mine to solve tonight.”
5. Fold the page and put it away.

In a sleep-lab study, people who spent five minutes writing a detailed to-do list before bed fell asleep faster than those who wrote about tasks they had already done.

The “Insomnia & trouble sleeping” guide has a “Worry dump” worksheet you can use for this.

Healthy sleep habits include putting screens away at least half an hour before bed, keeping the bedroom quiet and cool, and avoiding big meals and alcohol close to bedtime.

Use the buffer for something soothing: a shower, stretching, a paper book or quiet music. The “Screens, sleep & your brain” guide has a full screen wind-down plan.

Some worries have no next step right now, like waiting for test results. For these, it can help to write them down and tell yourself, “I’ve noted this. I’ll come back to it tomorrow.”

You are not ignoring the worry. You are choosing a better time to give it your attention.

Instead of arguing with a worry, try noticing it: “There’s the work worry again.” Then gently bring your attention back to your breath or the feel of the sheets.

A review of 18 trials found early evidence that mindfulness meditation may help with some sleep problems.

Relaxation therapy is one of the approaches sleep experts suggest for long-term insomnia.

Try it

1. Start with your feet. Squeeze the muscles for about five seconds.
2. Let go and notice the difference for a few breaths.
3. Move up to your legs, belly, hands, arms, shoulders and face.
4. Finish with a few slow breaths.

Imagine a calm place in detail: a beach, a forest path, a favourite room. What can you see, hear and smell? A detailed, gentle scene gives your mind something to rest on besides worry.

Stimulus control means keeping the bed linked with sleep, not with worry. If you can’t sleep, get up, do something calm in dim light, and come back when you feel sleepy.

The “Insomnia & trouble sleeping” guide has a “My can’t-sleep plan” worksheet to plan this ahead.

Slow breathing is one of the simplest ways to settle a body on alert. The “Breathing for sleep & rest” guide walks you through several bedtime breathing routines.

Clock-watching has been shown to raise worry and slow sleep. Trust your alarm to do its job.

If a worry or task wakes you, jot down a few words in dim light. Then tell yourself you’ll deal with it in the morning.

Writing things down is part of the constructive worry approach that helped lower mental busyness before sleep.

Night-time news or social media can feed worry and keep your mind busy. The “Screens, sleep & your brain” guide has ideas for night-time worry scrolling.

Try saying: “This feels huge right now because I’m tired. I’ll look at it in daylight.” Being kind to yourself works better than telling yourself off for being awake.

Anxiety can make you think you slept less, or will cope worse, than you really will.

Once a panic attack starts, the feelings need to run their course. Slow, steady breathing or relaxing your muscles may make it less intense.

Try this

1. Sit up and put your feet on the floor.
2. Turn on a soft light.
3. Breathe in gently, then breathe out slowly, longer than the in-breath.
4. Tell yourself: “This is panic. It will pass.”
5. When it settles, do something calm before going back to bed.

Some health conditions, such as heart or thyroid problems, can cause similar feelings. Call a provider if you have chest pain, breathing problems, or panic that lasts more than 15 minutes.

Loud snoring or gasping for breath can also be a sign of sleep apnea, which is worth mentioning. See the “Sleep apnea & your mental health” guide.

CBT helps you spot triggers and change how you think about and respond to panic. Over time, panic attacks often decrease and may stop completely.

For any other treatment options, please consult your clinical provider.

A consistent schedule for going to bed and waking up is one of the main healthy sleep habits.

Sleeping in after a rough night can make it harder to fall asleep the next night, which can feed the worry loop.

Exercise, mindfulness and meditation can reduce anxiety symptoms and add to the benefits of therapy.

Staying physically active is also one of the CDC’s healthy sleep habits.

Reducing caffeine is one of the habits that can help with anxiety. For sleep, limit caffeine in the afternoon and evening.

Moving worry to a set time earlier in the day, instead of at bedtime, is the idea behind constructive worry.

When a worry pops up at other times, jot it down and save it for your worry slot.

Talking to a friend, family member, faith leader or support group gives worries somewhere to go before bedtime. Feeling understood can make the night feel less lonely.

Ask open questions like “What’s been on your mind lately?” Listen without rushing to solve. A daytime chat can take some weight off bedtime.

Pressure to sleep can add to worry about sleep. Try “Rest is still good for you” instead.

Agree ahead of time that it’s fine to leave the bed for a while if they can’t sleep. Keep a soft lamp and a blanket ready in another room.

Spend a few minutes before lights out talking through the day. Help them write or draw a worry and “put it away” in a box until morning.

If worries are keeping them up most nights, talk to their pediatrician or school counselor.