Sleep anxiety: when worry stops you sleeping and what helps

Sleep anxiety is not a formal diagnosis in itself. People use the phrase for two overlapping experiences. The first is lying awake with anxious thoughts about work, money, health or the future. The second is anxiety about sleep itself: dreading bedtime, watching the clock, and worrying about how you will cope tomorrow if you do not sleep tonight.

The second pattern can keep going long after the original stress has passed. The bed, the bedroom and the evening routine become cues for tension, so the body is alert at exactly the time it should be winding down. Clinicians often call this conditioned or psychophysiological insomnia, and it is treatable.

The NHS lists what insomnia looks like: finding it hard to go to sleep, waking up several times in the night, lying awake, waking early and not getting back to sleep, still feeling tired after waking, feeling tired and irritable in the day and finding it difficult to concentrate. Every Mind Matters adds that anxiety can bring restlessness, trouble sleeping, worrying about the past or future, shakiness, sweating, headaches, tummy aches, muscle pain, and a heartbeat that is stronger, faster or irregular.

• Mind racing as soon as the lights go off.

• Dread or tension as bedtime approaches.

• Checking the time repeatedly through the night.

• A pounding heart, shallow breathing or sweating when trying to settle.

• Waking in the early hours with worries and being unable to switch off.

• Fear of the effects of poor sleep, which in turn increases wakefulness.

The NHS names stress, anxiety or depression first among the most common causes of insomnia, followed by noise, a room that is too hot or cold, an uncomfortable bed, alcohol, caffeine or nicotine, recreational drugs, jet lag and shift work. Other conditions can also interfere with sleep, including an overactive thyroid, menopause, restless legs syndrome, long-term pain and sleep apnoea.

Every Mind Matters explains that there is often no single obvious trigger for anxiety, and that possible causes include upbringing, environment, things that happen to us and temperament. For many people the real picture is a mixture: a stressful period, a few poor nights, then a learned habit of lying awake worrying.

NHS advice on insomnia is practical. It suggests going to bed only when sleepy, getting up at the same time each day, relaxing for at least an hour before bed, keeping the bedroom dark and quiet, exercising regularly in the day and making sure the mattress, pillows and covers are comfortable.

It also lists things to avoid: smoking or drinking alcohol, tea or coffee at least 6 hours before bed, a big meal late at night, exercise within 4 hours of bed, screens right before bed because blue light makes you more awake, napping in the day and sleeping in after a bad night.

For the anxious part, Every Mind Matters suggests mindfulness, breathing and relaxation exercises, keeping a diary of what you are doing and how you feel, setting aside a daily "worry time" so concerns have a place other than bedtime, and facing fears gradually rather than avoiding them. Its self-help CBT techniques are free online.

The NHS says to see a GP if changing your sleeping habits has not helped, if you have had trouble sleeping for months, or if insomnia is affecting your daily life so that you cannot cope. A GP will try to find out what is causing it, and sometimes you will be offered CBT, which can help change thoughts and behaviours that keep you from sleeping. You may be referred to a sleep clinic if you have symptoms of another sleep disorder such as sleep apnoea.

The NHS adds that GPs now rarely prescribe sleeping pills for insomnia because they can have serious side effects and you can become dependent. They are only prescribed for a few days, or weeks at most, if insomnia is very bad and other treatments have not worked. Pharmacy sleep aids containing valerian, lavender or an antihistamine may help for 1 to 2 weeks and should not be taken for longer; check with a doctor before using one.

If anxiety is the main problem during the day as well as at night, the GP may discuss anxiety-specific talking therapy. In England, many people can refer themselves to NHS Talking Therapies without seeing a GP first.

Poor sleep with anxiety is common and usually not an emergency. Seek prompt help if you have thoughts of harming yourself, feel unable to keep yourself safe, or are having panic attacks you cannot manage. In an emergency call 999; for urgent mental health support in England you can call NHS 111 and choose the mental health option.

See a GP if you cannot tell whether shortness of breath or palpitations are due to anxiety, as Every Mind Matters advises, or if you also have loud snoring with pauses in breathing, because sleep apnoea needs a different approach.

For most people sleep anxiety improves when the vicious circle is broken. NHS guidance emphasises that insomnia usually gets better by changing sleeping habits, and CBT-based approaches target the learned worry about sleep directly. Progress is rarely a straight line, and a few bad nights during a stressful week do not mean the pattern has returned.

It can help to accept that one poor night is not harmful in itself, to keep a regular rise time even when tired, and to keep the bed for sleep. If the cause is another condition, such as an overactive thyroid or menopause, treating that often improves sleep too.

NHS support runs from self-help websites and online CBT programmes through GP review to talking therapies and, where needed, a sleep clinic. Many services accept self-referral for talking therapy.

Some people choose a private therapist trained in CBT for insomnia or a private sleep specialist for a faster appointment. Ask any provider about their training and about evidence-based methods, and be cautious about products that promise to cure sleep problems quickly.