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What is the link between anxiety and sleep?

Anxiety is our body’s natural response to stress[1]. All, if not most of us will experience periods of anxiety when we may be apprehensive or fearful. This can often be spurred on by an upcoming event (like an exam or interview) or even during conflict.

When we experience prolonged periods of anxiety, it can impact our quality of life and in particular our quality of sleep[2]. Here, we look at the link between anxiety and sleep while also discussing the phenomenon of sleep anxiety.

Mental health and sleep

Anxiety is perhaps the most obvious example of how a mental health condition can affect sleep. Many of us have experienced sleepless nights where falling asleep seems almost impossible because you’re worrying so much.

In fact, a survey of more than 20,000 people in the UK[3] revealed that a racing mind is the main cause of sleeplessness. The top 5 persistent thoughts that were reported during the study were:

  1. What happened today & what I’ve got on tomorrow? (82%)
  2. How long have I been lying awake? (79%)
  3. Trivial things of no importance (76%)
  4. What the future might hold (71%
  5. Things that happened in the past (71%)

Sound familiar?

Anxiety or insomnia, which came first?

The relationship between anxiety and insomnia is a little like a chicken and egg scenario. It can be tough to tell whether you’re having trouble sleeping because you’re anxious, or you’re suffering from anxiety because you can’t sleep.

It’s very much a two-way street with anxiety and insomnia. Stress and anxiety have been shown to cause or worsen sleeping problems[4]. Having said that, a lack of sleep through conditions like chronic insomnia have also been shown to cause or worsen anxiety disorders[5].

What’s the difference between anxiety and an anxiety disorder?

There are so many different factors that can cause feelings of stress, anxiety, fear and panic. These triggers are different for everyone but can include:

  • Conflict – can generate feelings of tension, stress and nervousness
  • Work – workload pressures, long hours, redundancy, unemployment and retirement
  • Finance – unexpected bills, redundancy and debt can all have an impact on your mental health[6]
  • Family – divorce, new baby, relationship difficulties, buying/moving house, caring for someone with a disability
  • Health – chronic illness or injury
  • Traumatic experiences – bullying, bereavement, abuse, neglect, accident

When we become anxious or fearful, our body naturally releases stress hormones to help you manage the situation, such as adrenaline[7] and cortisol[8]. These stress hormones can be helpful when we’re in real situations of danger where we employ a freeze, fight or flight response.

Despite the above, experiencing anxious thoughts without any ‘real’ danger present can lead to an excess of these hormones in your body. This subsequently has a negative effect on how you feel mentally, physically and even how you behave[9].

Physical symptoms of anxiety

Here are some of the physical symptoms of the anxiety response[10]:

  • Faster, irregular or more noticeable heartbeat
  • Feeling lightheaded and dizzy
  • Headaches
  • Feeling sick
  • Feeling restless and unable to sit still
  • Not being able to sleep

Mental symptoms of anxiety

These are some of the mental symptoms associated with the anxiety response[10]:

  • Feeling on edge, tense or nervous
  • Being unable to relax
  • Worrying and a feeling of dread
  • Worrying about the past, present or future

Behavioural changes from anxiety

Here, we list some of the behavioural changes which come with an anxiety response[10]:

  • Not being able to enjoy leisure time
  • Difficulty looking after yourself
  • Struggling to concentrate at work
  • Difficulty forming or maintaining relationships
  • Worried about trying new things

If you find yourself experiencing symptoms of anxiety over a long period of time, you may find that you have an anxiety disorder[11].

The different types of anxiety disorder

Many people discuss anxiety in general terms, but there are actually a number of anxiety disorders. Here, we explain each type.

Generalised Anxiety Disorder

General Anxiety Disorder (GAD) is a long-term mental illness that causes the sufferer to feel anxious about a wide range of situations and issues, as opposed to a single event[12]. The main symptom of GAD is overwhelming feelings of anxiety and worry. People with GAD experience physical and psychological symptoms of anxiety more days than not for 6 months or more[13].

Physical symptoms include[14]:

  • Headaches
  • Muscle tension
  • Palpitations
  • Stomach pains
  • Trouble staying sleeping

Psychological symptoms include[14]:

  • Feeling on edge
  • A sense of dread
  • Irritability
  • Restlessness

Panic disorder

A person with panic disorder has frequent, recurring panic attacks and is afraid that a panic attack might occur[15].

Symptoms include[15]:

  • A racing heartbeat
  • Feeling dizzy or faint
  • Chest pain and/or shortness of breath
  • A feeling of dread or fear of dying

Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder caused by very stressful, frightening or distressing events. Someone with PTSD often relives the traumatic event through nightmares and flashbacks. This is often coupled with feelings of isolation, irritability and guilt[16].

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) is a mental disorder where a person feels the need to perform certain routines repeatedly (compulsions) or has certain thoughts repeatedly (obsessions). The person is unable to control either the thoughts or activities for more than a short period of time[17].

Phobias

A phobia is an overwhelming and debilitating fear of an object, place, situation, feeling, or animal. Phobias are more severe than fears and are often an exaggerated or unrealistic sense of danger about a situation or object[18].

Agoraphobia

Sometimes people believe this to be a fear of going outside. Agoraphobia is actually a fear of being in situations where escape might be difficult or that help wouldn’t be available if things went wrong[19].

What is sleep anxiety?

Sleep anxiety is a form of performance anxiety. People experiencing sleep anxiety often feel sleepy but stress about not getting enough sleep to function. In this situation, the stress and conscious effort to attempt to sleep can lead to sufferers lying awake for hours[20].

Ever found yourself clockwatching? This is a common feeling for those who suffer from insomnia and the clock becomes a gauge used to monitor sleep performance. The pressure to ‘perform’ makes it more difficult to sleep.

An alternative interpretation of sleep anxiety comes from those who suffer from conditions like night terrors, sleep paralysis, sleep apnoea and other disturbances. These can cause a ‘scared to sleep’ reaction[21].

Simple ways to help relax your body and mind

If you find yourself struggling from any of the issues mentioned earlier on in this piece, you might find some solace in these simple strategies to help relax. Remember though, these aren’t silver bullets. If you’re struggling from a serious sleep disorder or mental health condition, it’s always best to speak to your GP for professional medical advice. There are a number of treatment options which they can recommend, including Cognitive Behavioral Therapy (CBT) or similar[22].

Meditation

Mindfulness and meditation can help soften feelings on anxiousness, reduce stress and calm a panic attack[23]. There are several helpful websites and apps (like Headspace) that can teach you how to meditate for both anxiety and sleep.

Exercise

Exercise has been shown to improve sleep quality and quantity, as well as reduce stress and relieve anxiety[24].

Wind down

A quiet mind is essential to a good night’s sleep and reducing stress[25]. So, it’s important to allow yourself enough time to relax, wind down and release all those persistent thoughts[25]. Do what relaxes you and make these into new sleep habits. Everyone is different. Some people prefer a bath, others read a book or even write a diary.

Breathing techniques

There are lots of different deep breathing techniques[26], such as diaphragmatic breathing and box breathing. These have been shown to help both sleep and stress.

Bedtime routine

A consistent bedtime routine can relax the mind and the body, preparing you for a better night’s sleep[27].

Avoid stimulation

Avoiding both stimulating activities (like vigorous exercise) and stimulating products (like coffee or nicotine) before bed is beneficial for a relaxed body and mind[28].

Due to the fact a lack of sleep can lead to anxiety, and anxiety leads to trouble sleeping[29], it’s vital to attempt to break away from this vicious cycle. Anxiety and poor sleep health are interlinked, so don’t attempt to self-diagnose this. Speak to a pharmacist or GP about your concerns and they should be able to help you. If you want to give your circadian rhythm a little push in the right direction, Nytol can help.

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[1] Everything you need to know about anxiety – Healthline

[2] Relationship of anxiety disorders, sleep quality, and functional impairment in a community sample – Journal of Psychiatric Research

[3] The Great British Sleep Survery – Sleepio

[4] Sleep and psychopathology – Applied and Preventive Psychology

[5] Sleep and anxiety disorders – Psychiatric Clinics of North America

[6] Debt and mental health – Mental Health Foundation

[7] Adrenaline rush: Everything you should know – Healthline

[8] Cortisol: Why the “stress hormone” is public enemy No.1 – Psychology Today

[9] Anxiety, fear and panic – NHS

[10] Anxiety and panic attacks – Mind

[11] Do I have an anxiety disorder? – NHS

[12] Generalised anxiety disorder in adult (Overview) – NHS

[13] Generalised anxiety disorder in adults (Diagnosis) – NHS

[14] Generalised anxiety disorder (Symptoms) – NHS

[15] Panic disorder – NHS

[16] Post-traumatic stress disorder – NHS

[17] Obsessive compulsive disorder – NHS

[18] Phobias – NHS

[19] Agoraphobia – NHS

[20] Get rid of sleep anxiety and insomnia: Your guide to a better night’s rest – The American Institute of Stress

[21] Scared to sleep – WebMD

[22] Anxiety in adults: Treatment – NHS

[23] Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders – Kabat-Zinn et al

[24] The benefits of exercise for sleep – The Sleep Doctor

[25] Meditation for sleep – Headspace

[26] The 9 best breathing techniques for sleep – Healthline

[27] Sleep hygiene – Tuck

[28] 10 tips to beat insomnia – NHS

[29] Sleep disorders – Anxiety and Depression Association of America

Nytol One-A-Night Tablets contain diphenhydramine. An aid to the relief of temporary sleep disturbance. Always read the leaflet.

Nytol Herbal Tablets. A traditional herbal medicinal product for use in the temporary relief of sleep disturbances exclusively based upon long-standing use as a traditional remedy. Always read the leaflet.