Sleep anxiety arises from stress, mental health issues, and medical conditions.
Poor sleep affects physical health and mental wellbeing.
Good sleep hygiene, exposure therapy, CBT, and mindfulness can combat sleep anxiety.
The mysteries of sleep are endless.
During the subconscious state of human existence, a lot is actually happening: Human growth hormone is released, allowing our bodies to repair. Byproducts of the day are flushed out, memories are consolidated, and new neural synapses are created (Prather, 2022).
Some people love sleep and fall into it easily, while others feel it is a skill that needs to be mastered in order to survive. For this latter group, anxiety and fear related to sleep can have major physical, emotional, and social consequences.
Using a holistic approach to treating mental health, treating sleep anxiety, and improving sleep quality are common issues I see in my private counseling practice.
It is crucial to improve the ability to sleep, as it is a necessary part of life that is often taken for granted.
Before you continue, we thought you might like to download our three Positive Psychology Exercises for free. These science-based exercises will explore fundamental aspects of positive psychology, including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.
Sleep anxiety involves stress and feelings of worry about being able to fall or stay asleep (Staner, 2003). The problem with this is that anxiety over how well or how much a person sleeps can interfere with the quality and quantity of sleep, creating a vicious cycle of sleep issues.
While it is not an official diagnosis, sleep anxiety is related to general anxiety and has many common symptoms with other anxiety disorders (Staner, 2003). Sleep anxiety can involve factors such as insomnia, nightmares, panic attacks, and maladaptive stress responses.
Diagnosing underlying conditions involved with sleep anxiety, or ruling them out, is a first step in overcoming a fear of sleep and addressing the frustrating cycle.
For that purpose, a polysomnogram is a sleep study that can track data from brain waves, eye movements, breathing rhythm, heart rate, and blood pressure. This test can diagnose sleep apnea or restless legs syndrome, which are treatable conditions related to sleep anxiety (Staner, 2003).
Somniphobia
Somniphobia and sleep anxiety both involve stress and worry about falling asleep, but somniphobia is a more intense fear.
Somniphobia is an extreme fear of sleep that involves obsessive thoughts throughout the day about avoiding sleep (Goldstein et al., 2013). Unlike sleep anxiety, which is anxiety about not being able to sleep, somniphobia is a fear of what might happen while sleeping.
Parasomnias are chronic sleep-related problems that are risk factors for somniphobia. These include sleep paralysis, night terrors, and sleepwalking, which can cause an individual to fear going to sleep (Goldstein et al., 2013).
4 Somniphobia Symptoms to Recognize
There are several symptoms that may signal somniphobia. These include general symptoms associated with sleep anxiety, general anxiety, phobias, and specific symptoms expressed in children (Staner, 2003).
Symptoms associated with sleep anxiety
Struggling to concentrate throughout the day because there is an intense concern or worry about falling asleep at night
Feeling irritable or having mood swings due to lack of sleep
General anxiety symptoms
Postponing going to bed for as long as possible and procrastinating bedtime routines
Leaving the radio, television, or lights on while sleeping
Phobias
Physical symptoms of phobias such as shortness of breath or hyperventilation with discussion or thoughts of sleep
Chills, cold sweats, and night sweats
Uncontrollable shaking or tremors
Nausea and vomiting
Chest pain, increased heart rate, or heart palpitations
Symptoms expressed in children
Crying uncontrollably at bedtime
Clinging to caregivers to avoid sleep
Getting up multiple times throughout the night
Throwing tantrums when asked to go to bed and fearfully resisting bedtime
Acknowledging these symptoms rather than ignoring them can help clients take steps to decrease levels of anxiety, address fears and phobias, treat underlying conditions, and improve sleep quality.
There are many factors that contribute to sleep anxiety. These include daily stressors, underlying or other mental health issues, medical conditions, and social pressures.
1. Daily stressors
Daily stress from work, relationships, finances, and other hassles are not easily shut off at night.
Ruminating on the stressors as bedtime approaches can heighten anxiety, increase physiological arousal, and make sleep difficult. The fight-or-flight response is in direct opposition to the rest-and-digest response produced by the central nervous system.
As sleep becomes difficult, anxiety about trying to fall asleep increases, causing more stress, and the cycle continues…
As one sleep expert has stated, “We are standing in our own way of quality sleep” (Prather, 2022, p. 5).
2. Mental health issues
Mental health issues such as post-traumatic stress disorder (PTSD), generalized anxiety disorder, and depression contribute to sleep anxiety (Minjin & Suin, 2024).
Symptoms of PTSD such as hypervigilance, feeling alert, nightmares, and flashbacks can make falling and staying asleep difficult (Minjin & Suin, 2024).
Mental health issues like anxiety and depression are often characterized by ruminating, catastrophizing, and negative thinking patterns that do not shut off before bed. The inability to shut off thoughts can create more anxiety as individuals try to fall asleep.
3. Medical conditions
Medical conditions such as insomnia and sleep apnea can make the sleeping environment one that individuals often dread. Insomnia is the inability to fall and stay asleep, while sleep apnea is a sleep disorder that causes one to stop breathing (or have very shallow breathing) while asleep (Papadimitriou & Linkowski, 2005).
4. Social pressures
Social pressure from the bombardment of media and screens can create an unhealthy environment for sleep. Increased screen time and use of social media have been linked to poor sleep quality (Irish et al., 2015).
Additionally, what individuals consume on social media can create pressure to have a perfect life, perfect health, and even perfect sleep habits. The unrealistic pressure and addiction to screens can lead to poor sleep habits and routines, negatively impact sleep quality, and initiate the brutal cycle of sleep anxiety (Irish et al., 2015).
Implications for Wellbeing & Mental Health
Much of our physical and mental health depends on the quality and quantity of sleep we get.
Quality sleep helps the body produce necessary hormones for physical health and emotional wellbeing. For example, levels of ghrelin and leptin (hormones that regulate hunger) are regulated with sleep patterns (Nathaniel & Watson, 2015).
Sleep also impacts how the body uses and reacts to insulin, which controls blood glucose and is related to diabetes. Sleep is also when the body releases hormones that heal, repair, and help with growth, puberty, and fertility (Nathaniel & Watson, 2015).
Individuals who struggle with sleep anxiety or fear of falling asleep not only experience physical health consequences; there are mental health issues as well. Most people know that getting enough sleep helps with focus, productivity, and the ability to concentrate. A loss of just one to two hours per night is enough to impair cognitive function and attention throughout the day (Nathaniel & Watson, 2015).
Sleep deprivation has been related to diabetes, a weakened immune system, cardiovascular issues, weight gain, depression, anxiety, an increased risk of accidents, and accelerated aging (Nathaniel & Watson, 2015).
It is crucially important to address anxiety and fear of sleep to improve and promote optimal rest for overall mental and emotional wellbeing.
Preventing Sleep Anxiety: 4 Strategies
One way to try to prevent sleep anxiety and somniphobia is to adopt healthy lifestyle habits. Additionally, adopting good sleep hygiene can help prevent sleep anxiety and issues with sleep.
Sleep hygiene was developed in the 1970s and refers to the environment and behaviors around sleep that impact its quality and quantity (Irish et al., 2015). Strategies involved in sleep hygiene can promote better sleep and help prevent sleep anxiety.
1. Have a set sleep schedule
Having a set bedtime and wake-up time creates a healthy circadian rhythm so the body knows what to do. Avoiding naps and keeping a sleep schedule can help prevent sleep anxiety by regulating hormones involved in the sleep/wake cycle (Irish et al., 2015).
2. Create a nighttime routine
Healthy nighttime routines can involve a wide range of calming things. Take a hot bath or shower, dim lights, read a book before bed, and try different methods of relaxation such as yoga, mindfulness, or meditation.
Avoid eating right before bed so the body can properly digest, and try to find a consistent routine that can be kept each night (Irish, et al., 2015).
3. Create healthy daytime habits
Healthy lifestyle habits during the day can help decrease anxiety that comes at night. Exercising, getting outdoors, cutting down on caffeine in the evening, and eating a nutritious diet are all part of a healthy life that leads to better sleep (Prather, 2022).
4. Adjust the bedroom environment
Creating a calm, inviting bedroom is an excellent way to decrease anxiety around sleep. A cool (65°F to 68°F), dark room with little noise is an ideal environment for sleeping (Irish et al., 2015). Calming smells like lavender and having a comfortable pillow and mattress can also help with sleep anxiety.
Optimal sleep hygiene can be different for everyone, so testing out these strategies or having clients try some of their own can be a helpful way to individualize restful sleep.
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4 Tips on How to Sleep Better Despite Anxiety
Sometimes anxiety is an unavoidable part of life. There are ways to combat anxiety and learn to find restful sleep despite stress and worry.
1. Exposure therapy
Exposure therapy is a form of therapy where clients face their fear of sleep systematically while using safe and relaxing methods to decrease anxiety (Papadimitriou & Linkowski, 2005).
The first step involves identifying the physical symptoms of anxiety and what specifically triggers them as the client prepares for sleep. Coping skills such as breathing techniques are used to reduce symptoms of anxiety. The client is assisted in facing the least fearful experience of going to bed to the most fearful.
Exposure therapy has been helpful for approximately 90% of individuals with phobias (Papadimitriou & Linkowski, 2005). Facing fears and anxiety about going to bed helps shift thoughts and beliefs about sleep, making it something desirable rather than something to dread.
2. Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is an effective way to learn how to sleep despite anxiety (Goldstein et al., 2013). CBT can help clients identify specific thoughts and behaviors that cause sleep anxiety. Once identified, they can be replaced with thoughts and habits that will support sleep.
Often, simply becoming aware of the anxious thoughts and realizing that they are either irrational or outside our control can be helpful.
3. Sleep diary
A sleep diary can help track sleep patterns and the habits that promote sleep or create sleep anxiety. By identifying patterns in daily routines, clients can learn to shift behaviors to get more restful sleep. This sleep diary can help clients start tracking behaviors and sleep patterns to make connections and create effective change.
4. Mindfulness training and techniques
Taking five to 10 minutes before bed to practice mindfulness can help calm the mind and prepare the body for a good night’s sleep.
Mindfulness encourages clients to focus attention inward with gentle acceptance. Instead of fighting worrying thoughts, they can notice them and visualize them floating by. Practicing mindfulness shifts thoughts into acceptance. The less effort that is expended trying to force sleep, the easier it will become.
Despite the negative impact anxiety can have, sleep is not impossible. Implementing strategies and techniques can help clients find deep rest no matter how stressful sleep and life can be.
7 Relaxation Techniques That Can Help
Relaxation techniques can be very helpful for nighttime anxiety and calming a racing mind in order to promote restful sleep.
1. Soft music
Soft and relaxing music has a restorative impact on the central nervous system that can help calm anxiety at night (Baccarani et al., 2023).
Listening to music before bed or as part of a bedtime routine can promote better sleep (Baccarani et al., 2023). Creating a playlist with clients specific for sleep might be an effective activity to do with them in sessions.
2. Journaling
Journaling before bed can help clients express anxiety, worry, and concerns about the day, which can alleviate unnecessary stress before sleep. These journaling prompts provide ideas for clients to start a bedtime journaling habit for better sleep.
3. Progressive muscle relaxation
Progressive muscle relaxation is a technique that can help quiet the mind and release tension in the body before sleep, particularly because it is best done lying down.
It is an excellent exercise that implements deep breathing and systematic tensing and releasing muscles. This video provides one example of a script that could be used.
A guided meditation for sleep
4. Bedtime yoga
Yoga can help individuals get better sleep. One survey reported that over 55% of people who did yoga before bed were able to get better sleep, and 85% said that it helped reduce stress (Wang et al., 2014).
Restorative or gentle yoga that focuses on slow stretches and deep breathing could be ideal for decreasing sleep anxiety and improving restful sleep. Mindful yoga is also a great option for clients to try.
5. Sleep meditations
Our article discussing the best sleep meditations provides specific meditations for better sleep, some of which include:
– Guided imagery
Guided imagery invites clients to use all five senses to imagine relaxing places or experiences, such as resting on the beach while hearing the ocean or feeling the soft sand and warm sun.
Guided imagery should be tailored to what is particularly calming for the individual client.
– Sleep meditation videos
There are a plethora of meditations designed specifically for better sleep and helping clients with sleep anxiety. This example involves a 20-minute guided meditation to help calm the mind and relax the body before bed.
Guided 20 minute sleep meditation - Great Meditation
– Guided sleep meditation apps
From the convenience of a mobile phone, you can access sleep meditations that include soothing music, deep breathing, physical relaxation, and calming imagery. These are useful to help clients learn how to fall asleep with anxiety.
InsightTimer is a free resource that offers over 200,000 meditations for sleep.
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PositivePsychology.com offers a variety of resources that can help clients navigate nighttime anxiety or fear of falling asleep.
Deep breathing is an excellent way to decrease anxiety, regulate the central nervous system, and prepare the mind and body for deep sleep. Teaching clients deep-breathing techniques and ways to improve their breathwork is one way to address issues with sleep anxiety.
General wellbeing and self-care are related to better sleep. This Self-Care Checkup worksheet helps clients identify areas of life where they are practicing self-care and where to improve. This understanding can help lead to decreased stress and anxiety around sleep.
CBT is a treatment for both general anxiety and sleep anxiety. Teaching clients to identify anxious thoughts around bedtime and sleep and helping them replace thoughts with positive affirmations and statements is one of the first steps. This worksheet, Replacing “What if” Statements, may help to change the thought “What if I can’t sleep?” to “It will feel so great to get a good night’s sleep.”
Sleep hygiene is a crucial aspect to improving sleep and helping clients overcome sleep anxiety. This article provides sleep hygiene tips specifically for teens and children who may struggle with sleep issues. Many of the recommendations can be helpful for adults and parents as well.
For most people, sleep is not something they focus on until it’s not happening.
Sleep anxiety can become a vicious cycle that affects mental, physical, and emotional wellbeing.
The fortunate thing is that there are ways to address issues with sleep and sleep anxiety. There are many areas of our lives and health that are not in our control, but sleep is one area where small changes can make a big difference.
Improving sleep quantity and quality can, in turn, improve many other areas of life, such as the ability to focus, how we feel, our immune system, and our mental health.
Unfortunately, there is a vicious cycle between sleep and anxiety. Often people will be anxious about sleep, which interferes with sleep and then leads to more anxiety. Dealing with both quality of sleep and general anxiety is needed to address the issue.
Can sleep apnea cause anxiety?
Sleep apnea is a disorder characterized by snoring, gasping, dry mouth, headaches, and tiredness during the day (Papadimitriou & Linkowski, 2005). Sleep apnea can lead to other anxiety disorders because exhaustion from lack of sleep leads to feelings of stress and overwhelm during the day.
How common is sleep anxiety?
It is unknown how common sleep anxiety is. However, the prevalence of anxiety disorders increases the likelihood that individuals will develop sleep disorders such as insomnia (Prather, 2022). About 24% to 36% of individuals with sleep complaints experience anxiety.
References
Baccarani, A., Donnadieu, S., Pellissier, S., & Brochard, R. (2023). Relaxing effects of music on physiological recovery after cognitive stress and unexpected absence of multisensory benefit. Psychophysiology, 60, Article e14251. https://doi.org/10.1111/psyp.14251
Goldstein, A., Greer, S., Saletin, J. Harvey, A., & Nitschke, J. (2013). Tired and apprehensive: Anxiety amplifies the impact of sleep loss on aversive brain anticipation. Journal of Neuroscience, 33(26), 607–632. https://doi.org/10.1523/jneurosci.5578-12.2013
Irish, L., Kline, C., Gunn, H., Buysse, D., & Hall, M. (2015). The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep Medicine Reviews, 22, 23–36. https://doi.org/10.1016/j.smrv.2014.10.001
Minjin, K., & Suin, P. (2024). The influence of depression, sleep quality and mental health on quality of life in breast cancer patients. Asian Oncology Nursing, 24, 73–81. http://doi.org/10.5388/aon.2024.24.2.73
Nathaniel, F., & Watson, E. (2015). Recommended amount of sleep for a healthy adult: A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep, 38(6), 843–848. http://doi.org/10.5664/jcsm.4758
Papadimitriou, G., & Linkowski, P. (2005). Sleep disturbance in anxiety disorders. Internal Review of Psychiatry, 17(4), 229–236. https://doi.org/10.1080/09540260500104524
Prather, A. (2022). The sleep prescription. Penguin Random House.
Wang, Y., Chang, H., & Lin, C. (2014). Systematic review of yoga for depression and quality of sleep in the elderly. Journal of Nursing, 61(1), 85–92. https://doi.org/10.6224/jn.61.1.85
About the author
Dr. Melissa Madeson, Ph.D., believes in a holistic approach to mental health and wellness and uses a person-centered approach when working with clients.
Currently in full-time private practice, she uses her experience with performance psychology, teaching, and designing collegiate wellness courses and yoga therapy to address a range of specific client needs.
The mysteries of sleep are endless.
There are several symptoms that may signal somniphobia. These include general symptoms associated with sleep anxiety, general anxiety, 
Much of our physical and mental health depends on the quality and quantity of sleep we get.
Relaxation techniques can be very helpful for nighttime anxiety and calming a racing mind in order to promote restful sleep.
