Anxiety at night: why worries get louder at bedtime

Anxiety often feels worse at night because the distractions of the day fall away, leaving your mind with space to replay and rehearse worries. When you are anxious, the NHS explains, your body can stay more alert and your mind can fill with worrying thoughts, which makes it harder to drop off. Lying awake can then become a worry of its own. The good news is that there are practical steps that can help, and support is available if night-time anxiety is affecting your life.

Key points

• Stress, anxiety and depression are among the common causes of poor sleep listed by the NHS.
• Worrying about not sleeping can keep sleep disturbed even after the original stress has passed.
• The NHS suggests getting up if you are still awake after about 20 minutes, and returning to bed when sleepy.
• Writing down worries or tomorrow’s tasks before bed can help clear your mind.
• See your GP if sleep problems have lasted months or are affecting your daily life. In England you can also self-refer to NHS Talking Therapies.

Why does anxiety get worse at night?

During the day, work, conversation and simply being busy take up a lot of your attention. At bedtime there is nothing else to focus on, and your mind may use the quiet to go over what happened today and what might go wrong tomorrow. Worries that seemed manageable at lunchtime can feel bigger and more urgent in the dark, when you cannot do anything about them.

There is also a physical side. Anxiety switches on the body’s alarm system, which is designed to keep you alert to danger. That is the opposite of the relaxed state you need to fall asleep. The NHS describes how, when you are stressed or anxious, your body may feel more alert and your mind full of worrying thoughts.

Some people notice their anxiety is not about anything specific at night. Instead they feel restless, tense or wired, with a racing heart or churning stomach. The NHS lists difficulty sleeping, restlessness and a noticeable heartbeat among the possible symptoms of generalised anxiety disorder (GAD). If you have physical symptoms that worry you, it is always sensible to check them with your GP.

How do worry and poor sleep feed each other?

Anxiety and sleep can get caught in a loop. You worry, so you sleep badly. You sleep badly, so the next day feels harder and you have less in reserve. Then, as bedtime approaches, you start to worry about whether you will sleep tonight.

The Royal College of Psychiatrists points out that the way you think about poor sleep can make it worse, and that worrying about sleep can keep disturbing it even once the original stress has eased. It also notes that lying in bed worrying can strengthen the link in your mind between bed and being awake. The NHS adds that long-term sleep problems can affect your mood, appetite and relationships, which can then add to the worry.

Common signs that this loop has set in include:

• Dreading bedtime or feeling a jolt of alertness as soon as your head hits the pillow.
• Checking the clock and calculating how many hours of sleep you have left.
• Waking in the early hours with your mind already racing.
• Going to bed earlier and earlier to “catch up”, then lying awake for longer.
• Feeling tired all day but wide awake at night.

What can I do when I can’t sleep because of anxiety?

These suggestions come from NHS and Royal College of Psychiatrists guidance. Not all of them will suit everyone, so it may help to try one or two at a time.

Before bed

• Give yourself a wind-down period. The NHS suggests relaxing for at least an hour before bed, for example with a bath or a book.
• Put worries on paper. The NHS and the Royal College of Psychiatrists both suggest writing down worries or a list of tasks for the next day, so you can let them go and come back to them in the morning.
• Try a regular worry time. NHS Every Mind Matters describes setting aside 10 to 15 minutes most days to write worries down and look for solutions. When a worry pops up at other times, you remind yourself you will deal with it later.
• Put screens away. The NHS suggests avoiding phones, tablets and computers for an hour before bed. The Royal College of Psychiatrists suggests leaving your phone outside the bedroom.
• Watch caffeine and alcohol. The NHS advises avoiding tea, coffee and alcohol in the hours before bed, as they can disrupt sleep.

In bed

• Don’t try to force sleep. If you are comfortable and resting, sleep may come on its own.
• Get up if you are still awake. The NHS suggests that if you are still awake after about 20 minutes, you get up, sit somewhere comfortable and do something calming, then go back to bed when you feel sleepy.
• Turn the clock away. The NHS includes keeping clocks out of view among its tips for a restful bedroom.
• Use your breath. A slow breathing exercise or a short grounding exercise may help your body settle. The aim is to rest, not to make sleep happen.

During the day

• Keep regular times. The NHS recommends getting up at the same time every day, even after a bad night, and going to bed only when you feel sleepy.
• Move your body. Regular activity can help you sleep better, though some people find exercising close to bedtime keeps them awake.
• Skip daytime naps. The NHS includes avoiding naps among its tips for insomnia.

What about sleeping tablets?

The NHS says GPs rarely prescribe sleeping pills for insomnia because of side effects and the risk of dependence, and only for short periods when other approaches have not helped. If you are thinking about medication, or already taking something to help you sleep, the best person to talk to is your GP.

When should I see a GP about anxiety and sleep?

The NHS suggests seeing your GP if changing your sleep habits has not helped, if you have had trouble sleeping for months, or if it is affecting your daily life and ability to cope. The Royal College of Psychiatrists also suggests speaking to your GP if persistent worry or low mood is affecting your sleep. A GP will try to find out what is causing the problem. The NHS says they may offer cognitive behavioural therapy (CBT), which helps change the thoughts and behaviours that get in the way of sleep.

In England you can also refer yourself to NHS Talking Therapies for help with anxiety, without seeing your GP first. If night-time worry is part of a broader pattern of stress or burnout, our guide to burnout vs stress may also help.

How therapy can help

Night-time anxiety is often a sign of what the mind has not had a chance to process during the day. As an integrative psychotherapist registered with the BACP, I offer a space to slow down and look at what your worries are really about, alongside practical CBT-informed ideas for loosening their hold. Drawing on person-centred and psychodynamic ideas too, we can explore patterns such as perfectionism, a busy inner critic or a sense of always needing to be prepared. You can read more about how I work with anxiety. Sessions are available in Farringdon, Central London, or online, in English or Turkish.

If you are in crisis, call 999, go to A&E, call NHS 111, or contact Samaritans on 116 123 (free, 24/7).

If worries are keeping you awake, you are welcome to get in touch to arrange an initial consultation. We can go at a pace that feels manageable for you.