Sleep anxiety: when worry keeps you awake

The short answer: yes, worrying about not sleeping can keep you awake, and poor sleep makes anxiety worse, so the two feed each other. Trying harder to sleep backfires, because sleep is an involuntary process that can't be forced. What helps is taking the pressure off, using techniques from cognitive behavioural therapy: giving worries a set time, not watching the clock, getting up when you can't sleep, and letting go of the effort to sleep. If anxiety is affecting more than your nights, it deserves help in its own right.

It starts in the afternoon. You're tired, and you catch yourself thinking about tonight. Will I sleep? What if I don't? What will tomorrow be like?

By the evening the thought is louder. You put off going to bed, or you go early "just in case". When you finally lie down, your body is tense, your heart is going, and your mind is wide awake. The one thing you want most has become the thing you're most anxious about.

If that sounds familiar, you're not imagining it and you're far from alone. This guide explains why worrying about sleep keeps you awake, and what breaks the cycle.

What is sleep anxiety?

"Sleep anxiety" isn't a formal diagnosis. It's the name people give to anxiety that centres on sleep itself: dread of bedtime, fear of another bad night, worry about how you'll cope tomorrow.

It can show up at different points:

at bedtime, when worry stops you falling asleep
in the night, when you wake and the worry about getting back to sleep keeps you up, as in waking at 3am
during the day, when you're preoccupied with how you slept or how tonight will go

None of this is a sign of overreacting. Researchers describe lying in bed worrying, including about not being able to get to sleep, as part of how insomnia works.

What it feels like

It isn't only in your head. When you're anxious, your body is more alert and your mind fills with worrying thoughts: racing thoughts, tense muscles, a faster heartbeat. Your body is doing the opposite of preparing for sleep.

People with sleep anxiety often describe:

dreading bedtime from the afternoon onwards
feeling sleepy on the sofa, then wide awake in bed
a mind that races, especially over tomorrow
a pounding or racing heart when trying to sleep
checking the time repeatedly and calculating what's left
feeling "tired but wired"

Does anxiety cause insomnia, or the other way round?

Both. A study that followed people over time found that anxiety predicted new cases of insomnia, and insomnia predicted new episodes of anxiety. A later systematic review reached the same conclusion: insomnia and anxiety are bidirectionally related.

That's why sleep anxiety feels like a trap. A bad night makes you more anxious. More anxiety makes the next night worse. Neither side of the loop needs the other to have started it.

How the cycle keeps going

Understanding the mechanics is the first step to breaking them.

Your brain starts scanning for threats

Once sleep becomes a worry, attention narrows onto it. People with insomnia monitor for sleep-related threats: every noise, every twitch, how awake they feel, what the time is. All that monitoring is itself alerting.

The clock becomes a countdown

In one study, people with insomnia found watching a clock more worry-provoking and more disruptive to sleep than a comparison task. Each glance restarts the arithmetic.

You try harder to sleep

This is the cruel part. Sleep is an involuntary physiological process that cannot be placed under full voluntary control, yet people with insomnia strive to control it anyway. Forcing sleep is like forcing yourself to relax. The effort gets in the way.

Bed becomes a place for being awake

Night after night of lying there anxiously teaches your brain that bed means alertness. Together with the heightened arousal, that learned association is what keeps insomnia going after whatever started it has passed.

What helps: taking the pressure off

None of the approaches below try to force sleep. They lower the stakes so sleep can arrive on its own.

In the evening

Give your worries their own slot. Set aside "worry time", 10 or 15 minutes earlier in the evening, to write down what's on your mind and look for next steps. When a worry surfaces later, tell yourself it's already on tomorrow's list. Even simply writing worries down before bed stops them circling.

Wind down for an hour. Give yourself a buffer of at least an hour between the day and bed: dim lights, screens away, something calm. A bath, a book, gentle stretching, a relaxation audio.

Don't go to bed to try. Going early "just in case" hands worry more time to build. It's better to stay up until you're ready to sleep than to lie there bracing for failure.

In bed

Turn the clock around. Put the phone out of reach. Anxiety about the time only makes insomnia worse.

Get up if you can't sleep. Lying in bed getting more anxious teaches your brain the wrong lesson. Get up, go to another room, do something calm until you feel sleepy, then go back. In CBT for insomnia this is stimulus control, and it works by breaking the link between bed and wakefulness.

Stop fighting it. A CBT-I technique called paradoxical intention asks you to give up any effort to fall asleep, and any concern about still being awake. It's built on the idea that because sleep is involuntary, trying to control it makes things worse. It sounds strange, and it goes straight at the pressure that keeps you up. It's best done with guidance.

Let rest be enough. Instead of "I must sleep now", try letting your body rest without a goal. When sleep stops being a test, it tends to arrive more easily.

During the day

Keep the same wake-up time, even after a bad night. Consistency steadies your body clock more than anything else you can do.

Skip naps. They spend the sleepiness you need at night.

Move earlier rather than later. Be active in the morning or early afternoon, not in the four hours before bed.

Watch the caffeine. It can sharpen anxiety as well as delay sleep. Nothing with caffeine in the six hours before bed.

Stop grading your nights. Replaying how badly you slept, and predicting how awful the day will be, is part of the loop. You've probably got through more bad nights than you give yourself credit for.

"My heart races when I try to sleep. Is that dangerous?"

A racing or pounding heart at bedtime is a common and frightening part of sleep anxiety, and a lot of people search whether it's dangerous.

Palpitations are common and not usually a sign of anything serious. Stress, anxiety, lack of sleep, caffeine, alcohol and nicotine are the usual triggers. See a GP if they keep coming back, happen more often, or last longer than a few minutes, or if you have a heart condition or a family history of heart problems.

Call 999 or go to A&E if palpitations come with chest pain, shortness of breath, or feeling faint or fainting. Don't drive yourself; ask someone to take you, or call 999.

Does sleep anxiety go away?

It can. Breaking the loop means working on both halves: the anxious thoughts about sleep, and the habits that have built up around them.

CBT for insomnia is designed to do exactly that, and UK guidance recommends it as the first-line treatment for insomnia. Alongside the practical techniques above, it includes cognitive work: identifying the automatic negative thoughts about sleep, then learning to catch and test them.

Treating the insomnia also helps the anxiety. A 2023 review of digital CBT-I trials found a small to moderate reduction in anxiety symptoms alongside better sleep. Our chronic insomnia guide explains how to get CBT-I in the UK.

When anxiety needs help in its own right

Sometimes sleep anxiety is one part of a wider anxiety problem. If worry is following you through the day as well as the night, or you're feeling low, get support for that directly.

In England you can refer yourself to NHS Talking Therapies for anxiety and depression without seeing a GP, as long as you're registered with a GP and aged 18 or over (16 in some areas). There's a service finder online. In Scotland, Wales and Northern Ireland, your GP is the starting point.

When to see your GP about sleep

See your GP if changing your sleep habits hasn't helped, you've had trouble sleeping for months, or it's affecting your daily life. If sleep anxiety has been part of your life for months, that counts.

If it's been months

If bedtime has become something you dread, you don't have to face it alone.

Seona is a regulated UK online clinical service for chronic insomnia. We start by looking at what's really driving your sleep problems, including the part worry and stress are playing. Every case is reviewed by a UK-registered prescriber, and treatment is only prescribed where clinically appropriate. You can read how we assess chronic insomnia first.

Start your consultation

Can't sleep? You're not alone, and it's not your fault.

Frequently asked questions

Can sleep anxiety cause insomnia? Yes. Anxiety and insomnia are linked in both directions. Worrying about sleep keeps your mind and body alert, which makes it harder to sleep, and poor sleep makes anxiety worse.

Does sleep anxiety go away? It can. Techniques from CBT for insomnia work on both the anxious thoughts about sleep and the habits that keep insomnia going, and digital CBT-I has been shown to ease anxiety symptoms too.

Why do I get anxious at bedtime? Bedtime is often the first quiet moment of the day, so worries surface. After a run of bad nights, sleep itself becomes something to worry about, and your brain starts watching for signs you're not sleeping.

What should I do if I'm anxious and can't sleep? Don't watch the clock. If you can't sleep, get up, go to another room and do something calm until you feel sleepy. Setting aside worry time earlier in the evening helps too.

Is it dangerous if my heart races when I'm trying to sleep? Palpitations are common and usually not serious; stress, anxiety and lack of sleep are common triggers. See a GP if they keep happening or last more than a few minutes. Call 999 if they come with chest pain, shortness of breath or fainting.

Can I get help for anxiety without seeing a GP? In England, yes. You can refer yourself to NHS Talking Therapies if you're registered with a GP and aged 18 or over (16 in some areas).

This article is general information, not medical advice. If you need to talk to someone now, call Samaritans free on 116 123, any time. For urgent mental health help, use 111 online or call 111 and select the mental health option. If a life is at risk, call 999.

References

Harvey AG. A cognitive theory and therapy for chronic insomnia. J Cogn Psychother, 2005
NHS Every Mind Matters. Sleep; Tackling your worries
The Sleep Charity. Sleep anxiety: tips to manage anxiety and improve sleep
Jansson-Fröjmark M, Lindblom K. A bidirectional relationship between anxiety and depression, and insomnia? J Psychosom Res, 2008
Alvaro PK, Roberts RM, Harris JK. Bidirectionality between sleep disturbances, anxiety and depression. SLEEP, 2013
Tang NKY, Schmidt DA, Harvey AG. Clock monitoring in the maintenance of insomnia. 2007
Broomfield NM, Espie CA. Towards a valid, reliable measure of sleep effort. J Sleep Res, 2005
McNamara S, Spurling BC, Bollu PC. Chronic Insomnia. StatPearls, 2025
NHS inform. Insomnia
NHS. Insomnia; Heart palpitations
Walker J et al. CBT-I: a primer. 2022
Espie CA. Paradoxical intention therapy. 2011
Lee S et al. Effects of digital CBT-I on depression and anxiety. npj Digital Medicine, 2023
NHS. NHS Talking Therapies