Anxiety at night is common, especially among people who fixate on upsetting events of the day or who worry about every noise in the dark.

People who feel anxiety at night may struggle to sleep, making the day feel more stressful and intensifying the anxiety over time.

With the right help, anxiety at night is treatable.

What causes anxiety at night? 

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Nighttime anxiety is not a special class of anxiety. People become anxious at night for the same reasons they do during the day. However, the following factors may make anxiety more noticeable at night:

  • Fewer distractions at night mean a person is more likely to think about the things that make them anxious.
  • Consuming caffeine during the day can make a person jittery and anxious and less able to sleep during the night.
  • Nightmares.
  • Fear about the coming day.
  • Anxiety about insomnia, particularly if a person worries about the effects of their sleep deprivation the next day.
  • Health anxiety, since people might notice aches and pains more when they are falling asleep.

People with pre-existing anxiety disorders or anxiety risk factors may have a predisposition to nighttime anxiety. Examples include post-traumatic stress disorder (PTSD) or a recent trauma.

Certain medical conditions or hormonal states may also contribute to anxiety. For example, a 2019 study suggests that nighttime anxiety may be a sign of menopause in some cases.

Symptoms

Some symptoms of nighttime anxiety include:

  • Physical anxiety: A person with anxiety may experience the following physical symptoms:
    • heart palpitations
    • breathing difficulties
    • sweating
    • feeling lightheaded
  • Panic attacks: For some people, severe anxiety may trigger a panic attack. A person may feel out of control, or may fear they are about to die.
  • Rumination: Rumination is when a person fixates on things that worry or upset them. Possible triggering factors include:
    • worries about money
    • a recent dispute or argument
    • reliving trauma
  • Aches and pains: Some people experience aches and pains from tense muscles. These pains may manifest as:
    • headaches
    • jaw pain
    • tightness in the chest
  • Nightmares: Some people feel anxious about going to sleep because they worry they will have nightmares. People who experience a nightmare may wake up in a state of anxiety and have difficulty getting back to sleep.
  • Uncontrolled thoughts: An anxious person may feel that they have no control over their thoughts. This can trigger further anxiety.

Treatment

The following treatment options can help a person manage nighttime anxiety:

Therapy

Therapy focuses on addressing the source of anxiety and helping a person develop effective coping skills.

The American Psychological Association reports that therapy is often more effective than medication. This may be because therapy helps a person identify the cause of the problem and address it in a constructive way.

Therapy often works best alongside medication, as medication can offer some immediate relief, allowing a person to focus on the therapy.

Several different therapies can be effective for anxiety, including cognitive behavioral therapy (CBT) and exposure therapy.

Medication to manage anxiety

Anxiety medications can change the body’s physical response to anxiety, helping a person feel less anxious.

Antidepressants

Antidepressants affect chemical messengers, or neurotransmitters, in the brain. They can help stabilize a person’s mood or alleviate stress.

Antidepressants can take some time to begin working. A person should give the medication a chance before deciding whether it is effective.

Benzodiazepines

Benzodizaepines are the most common type of anti-anxiety medication. These drugs tend to begin working almost immediately.

Benzodiazepines bind to the neurotransmitter gamma aminobutyric acid (GABA). This helps slow down activity in the brain, thereby helping a person feel less anxious. However, these drugs come with risks that a person should discuss with their doctor first.

Beta blockers

Beta-blockers are medications that people ordinarily use to treat high blood pressure. However, doctors sometimes prescribe these drugs to help alleviate the physical symptoms of anxiety.

Sleep medications

Sleeping pills may help people fall asleep faster, thereby reducing nighttime restlessness. However, the American Academy of Sleep Medicine states that sleeping pills only reduce the length of time it takes to fall asleep by 8 to 20 minutes.

Sleeping pills can also be addictive, so it’s safest to try other interventions first. People who do use sleeping pills should:

  • take the pills only when needed
  • take the pills for the shortest possible time
  • avoid combining the pills with any other drugs, including alcohol

Sleeping positions

There is no scientific evidence suggesting that a specific sleep position might help a person sleep.

However, if a person finds that their sleep position is related to their anxiety, they can try out alternative sleep positions. For example, a person who fears a home intruder may be less anxious if they sleep with their back against the wall.

Additionally, evidence suggests that people with obstructive sleep apnea may wake up anxious or experience anxiety and depression throughout the day. Sleeping on the side or stomach may reduce the risk of sleep apnea events at night, thereby reducing the risk of anxiety.

Other remedies and management strategies

Some other strategies that may alleviate nighttime anxiety include:

  • Reducing caffeine: People should avoid caffeine before bed and reduce their caffeine intake in the afternoon.
  • Dietary changes: Certain foods wake some people up at night. People can identify and avoid problematic foods by keeping a log of what they eat and any nighttime anxiety symptoms they experience.
  • Exercise: Exercise can ease symptoms of anxiety and depression. A 2018 meta-analysis found that high-intensity exercise programs may be more effective than low-intensity regimens.
  • Relaxation exercises: Effective relaxation strategies can depend on the type of anxiety a person has. Some examples include:
    • box breathing
    • progressive relaxation
    • guided meditation
  • Alternative and complementary medicine: The following interventions may help to alleviate chronic pain due to anxiety:
    • acupuncture
    • massage
    • chiropractic therapy
  • Stress management: Adopting strategies to manage daily stress may help to ease nighttime anxiety. Examples include:
    • developing new time management strategies
    • seeking help with housework
    • seeking professional help to manage financial or legal issues

When to contact a doctor

Occasional anxiety is common, especially during times of stress. However, chronic anxiety is a medical condition that often does not get better on its own. Delaying treatment gives the anxiety time to spiral out of control, potentially affecting other aspects of a person’s life.

A person should see a doctor if they experience any of the following:

  • anxiety that causes physical health problems
  • anxiety that does not respond to home remedies like exercise
  • anxiety that is so severe that the person is unable to sleep

People should also contact their doctor if they experience a recurrence of anxiety while undergoing treatment for anxiety. The doctor may recommend adjusting or adding to the treatment plan.

Summary

Nighttime anxiety can feel overwhelming and can significantly affect a person’s quality of life.

Thankfully, there are a number of treatments for night-time anxiety. Examples include medications, talking therapies, and relaxation therapies.

A person who experiences nighttime anxiety should seek treatment as soon as possible. Prompt treatment can help prevent the anxiety from escalating and causing further problems. A person can seek help from their regular doctor or from a qualified therapist.