Why Do I Feel More Anxious at Night?

The quiet hours can bring a lot of internal chatter. Here’s how to deal.

Q: Whenever I’m trying to fall asleep at night, a bunch of anxious thoughts and embarrassing memories come racing into my mind, preventing me from drifting off. Why does this happen and is there anything I can do about it?

Whether you’re ticking through tomorrow’s to-do list or dwelling on past regrets, it’s normal for worries and fears to surface at night, experts say.

According to an October 2022 survey of 3,192 of adults in the United States, for instance, 34 percent of respondents reported feeling anxious or nervous within the past month. And 32 percent said that their stress had led to changes in their sleeping habits, including difficulties with falling asleep.

There’s an evolutionary purpose to evening anxiety, said Dr. Rafael Pelayo, a clinical professor of psychiatry and behavioral sciences in sleep medicine at Stanford Medicine and author of the book, “How to Sleep.” “Sleep is the most dangerous thing we can do,” he said, and being hyper-aware of our surroundings allowed our ancestors to spot any incoming threats.

But when your anxiety keeps you awake, you not only miss out on the health benefits of sleep, you might kick off a vicious cycle of poor sleep and increased anxiety that can be hard to break.

“Sleep loss is often a precursor for anxiety disorders, and anxiety leads to sleep loss,” said Dr. Sarah Chellappa, a neuroscientist at the University of Cologne in Germany.

Here’s what the experts say you can do if your overactive mind is keeping you awake.

The cruel connection between anxiety and sleep

Anxiety can surface at any time, but there are a few reasons it may feel more intense at bedtime, said Candice Alfano, director of the Sleep and Anxiety Center of Houston at the University of Houston. “Most of us are incredibly busy during the waking hours; our attention is pulled in many different directions, so we have limited time to think about our worries,” she said. “But at night, while we lie in bed, there are few distractions from the thoughts that make us anxious.”

This can lead to a frustrating conundrum: We can’t sleep because those anxious thoughts are making us think we are unsafe, which makes us more alert by raising our heart rates and tightening our muscles.

Essentially, the body can’t quite tell if the source of our troubles is a physical threat, like a tiger about to pounce, or an upcoming presentation you’re nervous about making at work — it just gets the memo to stay awake.

“At a basic level,” Dr. Pelayo said, “feeling in danger or under stress are the same to the brain.”

Worse, sleep loss has been shown to beget more anxious thoughts. In a 2019 review of 13 studies published in the journal Sleep Medicine Reviews, researchers concluded that insomnia was a significant predictor of anxiety, among other mental health conditions. The researchers explained that sleep helps us distinguish between what’s threatening and what’s safe, so without adequate shut-eye, we aren’t as good at responding to stress, fear and anxiety. This could, in turn, mean more negative thoughts that can interfere with sleep.

The good news is that solid sleep can also make your anxiety better over time, experts say.

How to slow anxious thoughts at night

Since better sleep helps decrease anxiety, general good sleep hygiene practices — like going to bed and waking up at the same times every day and avoiding screens before bedtime — can help on both fronts, Dr. Alfano said.

The tips below, however, might help you reduce anxious bedtime thinking.

Establish a caffeine cut-off. Caffeine’s half-life is approximately five hours, meaning if you have an eight-ounce cup of coffee at 4 p.m., you’ll still have half that cup’s caffeine in your system by 9 p.m. That’s a problem because caffeine not only keeps you awake, it’s also known for making anxiety symptoms worse, Dr. Chellappa said. Instead, consider sipping your last cup of coffee at least 10 hours before your bedtime.

Put your worries onto paper. If you’re prone to overthinking at night, both Dr. Alfano and Dr. Pelayo recommended writing in a journal at the end of the day.

If your ballooning to-do list is making you stressed, Dr. Pelayo said, try writing down all of your competing thoughts and tasks, like: “I need to buy milk.” “I need a new job.” “I never thanked Uncle Joe for a birthday present five years ago.” Doing so can keep the thoughts from creeping up later and, if they do pop up at night, you now have a calming response: Everything important is already captured in the journal.

Just focusing on your responsibilities might help make sleep a little easier. In a 2019 study, researchers found that those without clinical anxiety who spent five minutes writing to-do lists before going to sleep, fell asleep faster than those who wrote in their journals about completed tasks.

Give yourself something to look forward to. “If you lie in bed thinking, I hate my job, I hate my commute, then of course you’re not going to sleep well,” Dr. Pelayo said. But if you can give yourself something to look forward to in the morning — a nice breakfast, a walk, your favorite podcast — you have positive thoughts to draw on, he explained, which can replace some of the more negative ones keeping you awake.

Optimism in general has been linked with better sleeping. In a 2019 study of 3,548 young adults, for instance, researchers found that people who scored higher on a questionnaire that measured optimism were more likely to report better sleep quality than those with lower scores.

Incorporating a few of these suggestions might help quiet your bedtime thoughts, experts explained, but if you’re consistently waking up tired, ask your doctor to refer you to a sleep medicine specialist who can help you explore potential causes. And, if your sleeplessness is stressing you out, Dr. Pelayo had some words of comfort: “I want people to know that they don’t have to feel this way,” he said. “I tell my patients all the time, ‘If you’ve ever slept well, you can sleep well again.’”

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