Why Can’t I Sleep?! Understanding Sleep Anxiety and What Actually Helps

By Anissa Bell, Sleep Therapist | www.sleep-anxiety.com

Here we go again.

It’s the middle of the night and you’re staring at the ceiling (again) doing the math: “Okay, if I fall asleep right now I’ll get… four hours. That’s still decent, right?” Meanwhile your brain is doing its best impression of a late night talk show—cue the running list of things to do tomorrow, that weird thing you said at brunch three days ago and the all-time favorite: “Why am I still awake?” Sound familiar? Yeah you’re not the only one stuck in this nightly rerun.

If this sounds familiar you’re not alone. Millions of people suffer from sleep anxiety—a common sleep disorder that’s a special blend of stress and overthinking that kicks in exactly when you want your brain to shut down.

Here’s the good news: you’re not broken. And this doesn’t have to be permanent. Let’s break down what sleep anxiety is, why it shows up at bedtime and what actually helps calm your mind so you can finally rest.

Sleep Disorders

Sleep disorders are conditions that disrupt your normal sleep patterns and affect millions of people worldwide. These disorders can significantly impact your quality of life, mental health and physical health. There are over 80 different sleep disorders including insomnia, sleep apnea, restless leg syndrome and narcolepsy. Understanding these disorders is key to proper diagnosis, treatment and prevention. A sleep medicine physician can help diagnose and treat sleep disorders and improve your sleep quality and overall health. Whether it’s trouble falling asleep, staying asleep or feeling tired during the day addressing sleep disorders can lead to better rest and a healthier life.

What Is Sleep Anxiety, Really?

Sleep anxiety isn’t just “having a lot on your mind.” It’s performance anxiety—your brain gets hyper focused on the actof falling asleep because it’s been hard in the past. Bedtime becomes a test you can’t pass and that alone can trigger stress.

Your nervous system starts sounding the alarm at the exact moment you’re trying to wind down. Engaging in relaxation techniques can help individuals feel sleepy and reduce sleep anxiety.

Common signs of sleep anxiety:

• Dreading bedtime even when you’re tired

• Worrying that you won’t fall asleep (especially if it’s happened before)

• Clock-watching and feeling panicked about the time* Physical symptoms like a racing heart, stomach upset or muscle tension

• Delaying bedtime or creating rituals that feel urgent or necessary to “make sleep happen”

And the kicker? The more you want sleep the more elusive it becomes. Not because you’re doing something wrong—but because your brain is trying to protect you. (A bit too enthusiastically.)

Insomnia

Insomnia is one of the most common sleep disorders characterized by trouble sleeping, difficulty falling asleep or staying asleep. It can be short-term (acute) or long-term (chronic) with chronic insomnia lasting three months or more. Insomnia symptoms often include difficulty concentrating, memory problems and mood swings. Treating insomnia requires a comprehensive approach including lifestyle changes, cognitive behavioral therapy and relaxation techniques. Your sleep wake cycle is regulated by an internal clock and disruptions to this cycle can lead to insomnia. Insomnia can also be a symptom of underlying medical conditions such as sleep apnea, chronic pain or mental health conditions. Addressing these underlying issues is key to treating insomnia effectively.

Why Anxiety Shows Up at Night

During the day distractions help muffle your thoughts. Work, errands, TikTok rabbit holes—they all keep your brain busy. But when night falls? Your mind starts sorting through everything you didn’t have time to process earlier.

Anxiety tends to thrive in quiet spaces because there’s no competition for your attention. That means those anxiety thoughts and worries get louder and feel more urgent. Big life events can contribute to nighttime anxiety by leaving unresolved stressors that resurface at bedtime.

Physiologically if you’ve been stressed all day your stress hormones (like cortisol) are still circulating at bedtime. That leaves your nervous system in a “tired but wired” state—physically exhausted but mentally on high alert.

Sleep Disturbances

Sleep disturbances can significantly impact your daily life causing fatigue, decreased productivity and an increased risk of accidents. These disturbances can be caused by various factors including lifestyle habits, medical conditions and neurological disorders. Establishing a consistent sleep schedule, creating a sleep-conducive environment and avoiding stimulating activities before bedtime can help prevent sleep disturbances. Techniques like progressive muscle relaxation, deep breathing and mindfulness meditation are effective for improving sleep quality. Getting enough quality sleep is essential for both physical and mental health and sleep deprivation can have severe consequences. Prioritizing good sleep hygiene can make a big difference in your overall well-being.

The Sleep-Anxiety Loop (And Why It’s So Familiar)

Let’s break it down:

1. You feel anxious →

2. You can’t sleep →

3. You get anxious about not sleeping →

4. You fall asleep at 3 AM →

5. Anxiety makes it hard to get back to sleep after waking up in the middle of the night →

6. You wake up groggy and stressed →

7. Repeat tomorrow night.

This is what sleep researchers call the sleep-anxiety loop, and once it gets going it’s hard to stop.

But it can be broken and you don’t have to do a total life overhaul to start. Just small, intentional steps.

“Do I Have Sleep Anxiety?” – A Quick Quiz

If any of these sound familiar you might be stuck in the sleep-anxiety loop:

😰 You hate going to bed

🧠 Your mind goes into overdrive when your head hits the pillow

⏰ You watch the clock and freak out about how little time is left

🛎️ You delay bedtime or avoid your bed altogether

😓 You feel physical tension, like a tight chest or racing heart

🔄 You try new “sleep hacks” and nothing sticks

You’re not alone—and this isn’t all in your head. Well, it is in your head, technically, but your brain is just trying to help.

Risk Factors

Several risk factors can contribute to sleep disorders including genetics, lifestyle habits and medical conditions. Certain medications, like prescription drugs and sleeping pills, can also cause sleep disorders. Drinking alcohol and consuming caffeine in the late afternoon or evening can disrupt your sleep patterns. Electronic devices like smartphones and tablets can also interfere with sleep quality. Eating a healthy diet and exercising regularly can reduce the risk of sleep disorders. Resources from the National Institute of Health and the National Heart, Lung, and Blood Institute can provide more information on sleep disorders.

Sleep

Sleep is important for physical and mental health and getting quality sleep is key to overall well-being. During sleep your body repairs and regenerates tissues, builds bone and muscle and strengthens the immune system. Sleep also plays a big role in brain function with sleep deprivation linked to an increased risk of chronic diseases like heart disease, high blood pressure and diabetes. A good night’s sleep can improve concentration, memory and mood and reduce the risk of accidents and errors. Establishing a consistent sleep schedule, avoiding stimulating activities before bedtime and creating a sleep-conducive environment can help improve sleep quality and reduce the risk of sleep disorders. Almost everyone experiences trouble sleeping at some point but persistent sleep problems can be a sign of an underlying condition and seeking medical attention is essential for diagnosis and treatment.

What Actually Help You Sleep

Let’s move past the unhelpful advice (looking at you, “just relax”) and focus on real tools that support your nervous system and sleep cycles.

Various methods including lifestyle changes and cognitive behavioral therapy can be used to treat insomnia.

🌊 1. Rethink Your Relationship with Sleep

Think of sleep like surfing. You don’t force a wave—you learn to wait for one and ride it when it comes. Same goes for sleep. If you don’t catch one wave just hang out and enjoy floating in the water. Be curious “maybe I will catch the next wave, let’s see what happens.” Getting enough sleep is key to overall well-being and can help reduce sleep anxiety.

Here’s how to be a better sleep surfer:

• Notice drowsiness cues (heaviness, eye fatigue, mental fog)

• Don’t panic if you miss a wave—another one will come

• Let go of the pressure to sleep at a specific time and instead get curious about when your body starts inviting sleep in

🪨 2. Anchor Your Mind With Thought Diffusion

Borrowed from Acceptance and Commitment Therapy (ACT), thought diffusion helps reduce the power of racing thoughts.

Try this:

Imagine your thoughts are cars passing by on a highway. You’re on the sidewalk, just watching them. You don’t have to hop in and ride along. Just observe them go.

Reducing nighttime anxiety with these techniques can lead to more energy during the day.

Or, use a gentle script like:> “This is just my nighttime anxiety talking. It’s loud right now but it’s not dangerous. I can let it pass.”

📓 3. Create a Worry Buffer

Your brain doesn’t love problem-solving at midnight. Help it shift earlier.

Each evening (ideally 1–2 hours before bed) try this short journal ritual:

• What am I worried about?

• Is there anything I can do tonight?

• Can it wait until tomorrow?

• What do I want to let go of today before I get into bed?

Insomnia makes it hard to manage daily activities and can impact overall well-being.

This teaches your brain: We’ve already handled this. We’re done for today.

🧠 4. Rebuild the Bed = Sleep Association

When your bed becomes a battleground your brain forgets it’s meant for rest. A CBT-I technique called stimulus control helps rewire this connection.

If you’re awake for more than 20 minutes in bed:

• Get up

• Do something quiet and non-stimulating (read, breathe, stretch)

• Return to bed after what feels like about 20 minutes and see what happens

Over time this rebuilds the positive relationship with your bed. We want to take the anxiety and alertness out of the bed and keep it a place of relaxation. Maintaining a positive bed-sleep association can help you stay asleep throughout the night.

🌙 5. Make a Wind-Down Bridge

Think of bedtime as a transition not an on/off switch. Create a short nightly ritual to signal to your brain: “We’re shifting gears now.” A consistent bedtime routine can signal to your brain that it’s time to go to bed.

Try 30–60 minutes of:

• Dimmed lighting

• Screens off

• Gentle activities like reading, stretching, showering or listening to calming music

Sleep doesn’t respond to pressure—but it does respond to consistency.

🧰 Quick Start Toolkit – Tools You Can Try Tonight

Here’s a no-stress, no-perfection starter list to try:

✅ Do a 10-minute “worry dump” on paper

✅ Flip your clock around (no more time math)

✅ Name the thought: “Ah, just sleep anxiety again”

✅ Get up and reset if you’re stuck in bed

✅ Choose one small wind-down ritual to try tonight

Small changes add up to better nights over time. No need to do them all. Proactive measures like a consistent sleep routine can prevent insomnia.

When to Get Extra Help

If anxiety and sleep issues are impacting your mood, focus, relationships or overall wellbeing – it might be time to reach out for more support. You don’t need to wait until you’ve “tried everything.” A healthcare provider will consider your medical history when diagnosing sleep issues.

CBT-I (Cognitive Behavioral Therapy for Insomnia) is the gold standard treatment for insomnia and sleep anxiety and is research backed. Whether you explore it through self-help, books, courses or working with a provider – it’s worth looking into.

You Deserve Rest

Sleep is essential but if you’re struggling – it’s not a sign of personal failure. It’s your brain doing its job, trying to keep you safe by pointing out potential threats. The problem is – anxiety can get a little off track and start overreacting. The good news – you have tools to help reset your brain and get back to better rest. Long term insomnia can have significant impacts on overall wellbeing and requires management.

💤 Want More Tools Like This?

I share evidence based strategies for managing sleep anxiety, nighttime overthinking and insomnia in my Sleep Matters Blog. Getting the sleep you need is key to managing sleep anxiety and overall wellbeing.

You don’t have to fight your brain every night. Let’s help it wind down.

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FAQs

Can anxiety make me wake up in the middle of the night?

Yes. Anxiety can trigger waking during the night by keeping your nervous system on high alert even during sleep. It’s often described as being “tired but wired.”

Is sleep anxiety a real condition?

Yes. Sleep anxiety is recognized by mental health and sleep professionals. It often overlaps with insomnia and can be managed with supportive tools and approaches. Sleep anxiety often overlaps with both short term and long term insomnia.

Do I need medication?

Not necessarily. Many people treat insomnia through CBT-I and consistent routines. Medication may be helpful in some cases but therapy using cognitive and behavioral strategies is often effective on its own.

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Sources & Further Reading:

• National Sleep Foundation – sleepfoundation.org

• Harvard Health: Anxiety & Sleep

• APA – ap.org

• AASM – aasm.org

• U.S. Department of Veterans Affairs: Managing Sleep Issues – va.gov