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Relationship between Anxiety, Mental Health, and Quality of Sleep

by Purple(more info)

listed in sleep and insomnia, originally published in issue 254 - May 2019


Republished from


Anxiety comes in many forms, from the general worry that comes from everyday life to the intense fear caused by major psychiatric disorders. As debilitating as anxiety can be to our mental and physical health, it’s also corrosive to our quality of sleep – whether you’re a college student pulling an all-nighter or a veteran jolted awake from a nightmare caused by PTSD. This guide covers how anxiety and sleep are interrelated, change with age, and what you can do to improve both.

Anxiety and Sleep

Nearly 40 million people in the US experience an anxiety disorder in any given year. More than 40 million Americans also suffer from chronic, long-term sleep disorders. Those numbers aren’t a coincidence. Anxiety and sleep are intimately connected: The less sleep you get, the more anxious you feel. The more anxious you feel, the less sleep you get. It’s a cycle many insomnia and anxiety sufferers find hard to break.

sleep and anxiety

Common anxiety symptoms like restlessness, increased heart rate, rapid breathing, and gastrointestinal (GI) problems make it difficult to fall asleep.

Because insomnia and anxiety are so closely linked, one of the first steps in treatment is to determine which is causing the other – that is, which is the primary cause and which is the secondary symptom. “Sometimes, insomnia is secondary,” says psychotherapist Brooke Sprowl, “in that it is caused by another primary disorder such as depression, anxiety, or a medical condition. In this case, usually treating the primary disorder [improves] the insomnia.”

Whether insomnia is the primary or secondary cause, natural remedies like magnesium glycinate and melatonin have been shown to help with sleep, says Sprowl. Non-medication treatments like cognitive behaviour therapy along with good sleep hygiene are also effective at combating insomnia and anxiety.

Health Risks of Insomnia

Insomnia affects cognitive functions and cripples school and work performance. According to one study, 70% of college students with lower GPAs also had difficulty falling asleep. Insomnia also slows reaction times, raising the risks of driving a car or operating heavy machinery.

Sleep deprivation is also bad for your physical health, increasing your risk for developing high blood pressure and heart disease. And long-term sleep disruptions may even raise the risk of some forms of cancer.

Common Sleep Disorders

There are many forms of sleep disorder besides insomnia. All interrupt sleep, threaten our health, and increase nervousness and stress. Here are a few common ones:

Delayed Sleep Phase Syndrome

Anyone who has changed time zones or experienced ‘jet lag’ understands the effects of delayed sleep phase syndrome (DSPS). When your sleep and wake cycles don’t align with the current time zone, you feel groggy when you shouldn’t.

While these symptoms are temporary for most, people with DSPS stay out of sync for long stretches of time, negatively affecting their work and activities. Because people with DSPS are forced to conform to the external clock rather than their internal one, they suffer from lack of sleep and increased anxiety.

Obstructive Sleep Apnea

Obstructive sleep apnea is when a sleeper’s relaxed airways close and obstruct breathing. Interrupted breathing episodes occur numerous times during sleep and are usually accompanied by snoring.

sleep and anxiety

Obstructed airways result in lowered oxygen levels and increased carbon dioxide in the blood. Sufferers are often unaware they have the condition. Sleep apnea increases the risk of heart disease, stroke, diabetes, and cancer. Sleep studies are required to diagnose obstructive sleep apnea.

Forms of Anxiety

How do you know if you have garden-variety nervousness or a more serious anxiety disorder? Usually, the difference is how significantly your anxiety affects your life.

For someone at a party who doesn’t know anyone, a certain level of anxiety is normal. However, if their anxiety is interfering with daily activities (e.g. making friends, school work, job performance), they may have a serious anxiety disorder.

sleep and anxiety

Whether social nervousness or a serious phobia, every form of anxiety will affect your quality of sleep if it goes on long enough. Below are descriptions of the five major anxiety disorders. If you think you may have one, consult your physician or therapist about diagnosis and treatment.

Generalized Anxiety Disorder

People with generalized anxiety disorder (GAD) display excessive anxiety and worry most of the time. Instead of one source of anxiety, sufferers tend to worry about multiple things simultaneously. GAD symptoms will last at least six months and begin to negatively affect social interactions like school, work, and family life. GAD affects 6.8 million adults (3.1 percent of the U.S. population), yet only 43 percent of sufferers receive treatment.

Social Anxiety Disorder

The fear of public speaking (glassophobia) is still ranked alongside death as a the number one fear among 20 percent of Americans. Social phobias like public speaking apply to formal situations, but for people with social anxiety disorder, their fear extends into informal interactions like eating and drinking in front of others. People with social anxiety disorder struggle when meeting new people, making friends, interacting with teachers, or buying items at a checkout counter.

Obsessive-Compulsive Disorder (OCD)

Those with obsessive-compulsive disorder (OCD) have recurrent, unwanted thoughts (obsessions) and/or repetitive behaviours (compulsions). OCD sufferers often perform repetitive ‘rituals’ like washing their hands, checking, counting, or cleaning. The rituals are intended to lower anxiety levels, but the result is temporary. Obsessive-compulsive disorder is often associated with poor sleep, especially if repetitive behaviours involve getting out of bed.

Panic Disorder

Panic attacks are unexpected episodes of intense fear followed by physical symptoms like chest pain, heart palpitations, and shortness of breath. These episodes of intense anxiety are the major result of panic disorder. Because panic attacks manifest without warning, the fear of having another one is a major source of fear itself.

Panic disorder makes insomnia worse for many sufferers. Most people will experience only one or two panic attacks in their lifetime. But anyone who has panic attacks frequently enough that they live in fear of having another one, probably has panic disorder.

Post-Traumatic Stress Disorder (PTSD)

Everyone who experiences a traumatic event feels a certain level of anxiety. Our fight-or-flight responses help protect us, whether from a physical attack or a natural disaster. Once the event is over, some residual anxiety is normal – but, eventually, anxiety levels return to normal.

For some people, however, this never happens. Instead, they develop post-traumatic stress disorder (PTSD) – an anxiety disorder where sufferers continually re-experience the fear of a traumatic event(s) long after it has passed. One of the most common symptoms of PTSD is intense nightmares, which are major sleep disruptors.

Although PTSD causes sleep disorders, the disorder also contributes to acquiring PTSD. One sleep study of National Guard members showed this causal relationship. The National Guard members were screened for sleep disturbances a few months before deployment to Iraq. A year later, they came back and were tested for PTSD. Researchers found that soldiers who had sleep disorders before they were deployed were more likely to have PTSD afterward.

sleep and anxiety

While PTSD is often associated with military veterans, anyone experiencing a traumatic event can develop symptoms. For example, one in eight heart attack survivors develop PTSD.

Sleep and Anxiety as We Age

In general, our anxiety levels lower as we get older – ramping up during our adolescence and slowly abating with old age. The difference in anxiety disorder rates for adolescents (32 percent) and adults (19 percent) is significant.


But while anxiety in general improves with age, our quality of sleep gets worse. One cause of this is that our sleep patterns change as we get older. We tend to sleep less – 28 minutes per decade according to one sleep study of men.

Another cause comes from chronic age-related aches and pains that rouse us from sleep. Our brain chemistry also changes as we age. Levels of melatonin, the chemical responsible for beginning the sleep cycle, decline as we get older.

If we don’t take the steps to improve our sleep as we age, we can counteract the positive gains we get from lowered levels of anxiety. To do that, we need to understand how anxiety and sleep affect us at critical points in our life.

Children and Adolescents

For the first few decades of our lives, our sleep patterns change dramatically. Our bodies and brains grow, and our sleep needs change along with the sources of anxiety.

Infants need the most sleep and have frequent sleep-wake episodes throughout the day. Around six months, children begin sleeping through the night. By adolescence, they achieve the average adult sleep requirement of 7 to 10 hours per day. Sleep deprivation symptoms for children and adolescents include:

  • Irritability;
  • Behaviour problems;
  • Poor academic performance;
  • Automobile accidents;
  • Napping (teenagers).


Sleep Disorders

Sleep disorders like snoring and sleep apnea are rare in children and adolescents, while others like delayed sleep phase syndrome (DSPS) or behaviour insomnia are more common.

Anxiety Disorders

The sleepless night after watching a scary movie is a familiar experience for most of us. But children with anxiety disorders feel an intense nervousness and fear during everyday activities.

One in eight children has an anxiety disorder, which is often accompanied by depression. Here are some common symptoms of childhood and adolescent anxiety that are possible sleep disruptors:

  • Change in eating habits;
  • Anger or irritable mood;
  • Clinginess;
  • Nightmares;
  • Substance abuse.

College Students

The college years mark a time when we’re the most anxious and most sleep deprived. All-night cram sessions, midnight social gatherings, and 8:30 a.m. classes take their toll on the health and mental well-being of college-aged students. Sleep studies of college-aged students show up to 60 percent suffer from poor sleep quality, while almost 8 percent have insomnia disorder.

sleep and anxiety

Poor sleep quality affects grades too. One study of student sleep patterns showed those who got more than 9 hours sleep tend to have higher average GPAs (3.24) than those who got less than 6 hours sleep (2.74). Just getting 10 or 15 minutes less sleep every night can add up quickly over four years – making a significant dent in overall academic performance.

College students show high rates of anxiety disorders. In fact, anxiety for college students has surpassed depression as the most common mental health diagnosis – affecting about 1 in 5 students.

Navigating new surroundings, strange faces, and responsibilities during college are a necessary part of becoming an adult, but the transition comes with a healthy dose of anxiety. Much of that worry comes from performing well on exams.

Test Anxiety

Test anxiety is something most college students bring with them from primary and secondary school. But in college, the stakes are even higher for students who’ve taken on the responsibility for policing their own grades.

Test anxiety is particularly pernicious because it affects a large portion of students (around 17 percent) and is a common way for students to slip into bad sleeping habits.

Students with test anxiety are more susceptible to bad sleep hygiene from staying up late to cram for tests. And the general anxiety they feel weighs on their ability to fall asleep.

Test anxiety and fear of failure often set off a series of what-if hypotheticals. “What if I don’t pass this test? I’ll flunk this class. What if I flunk this class? I won’t graduate. What if …”. Students can lower their stress by following some common guidelines to overcome test anxiety, which include getting enough sleep.

Sleep Disorders

College students suffer from sleep disorders at about the same rate as older adults. It’s a statistic at odds with society’s view that a group of young, healthy people are vulnerable to “older” maladies. But sleep disorders like delayed sleep phase syndrome (DSPS) and sleep apnea affect up to 27 percent of students.

sleep and anxiety

College students may be more likely to develop DSPS given their penchant for late-night study sessions and other activities. They’re awake more during the night time and may nap to ‘catch up’ during the day.

Over time, their internal clocks (circadian rhythms) begin to slip out of sync with the regular day-and-night cycle. What results is a type of ‘academic jet lag’ that can last for semesters and cause long-lasting physical and mental harm.

Getting Better Sleep in College

Here are some tips for changing your daily college routine to improve your quality of sleep and lower your anxiety levels.

  • Get out of your head. If you can’t fall asleep because you can’t turn off your thoughts, get out of bed and do something ‘mindless’. Go for a walk. Do push-ups. Doodle on paper. Try yoga. Turn your focus to your body and not your mind;
  • Get into the sunlight. Your circadian rhythm is sensitive to light and darkness. Get a good dose of sunlight every day. Walk around campus. Eat lunch on the lawn;
  • Don’t ‘catch up’ on weekends. Keep a consistent sleep schedule. Don’t sleep in more than an hour on weekends;
  • Save your bed for sleeping. Don’t do anything else in bed but sleep. Watch TV and do homework somewhere else. Train your brain and body to expect sleep when you lay down. And don’t make a habit of sleeping anywhere else besides your bed (e.g. couch, recliners);
  • Don’t drink alcohol before bed. You may think alcohol helps you sleep, but it actually disrupts your sleep cycle throughout the night. Avoid alcohol at least 4 hours before bed.


Diagnosing anxiety disorders in seniors is notoriously difficult. Factors like changes in medication and age-onset dementia make it hard to diagnose older folks, and social stigma around mental illness make seniors hesitant to report issues. A mental health screening is a quick and easy way to find out if anxiety symptoms are impacting your life enough to warrant medical attention.

Although ageing usually involves a drop in anxiety levels, the stress and fears of adult life still pose a real barrier to getting a good night’s sleep. Over half of seniors report some problems with their sleep.

The elderly tend to have more interruptions during sleep and sleep fewer hours. The aches and pains of age-related physical problems like chronic pain, arthritis, and diabetes cut into our sleep quality. Fewer hours means the amount of quality sleep they get becomes even more important. Follow these sleep guidelines for seniors to make sure you’re getting a good night’s rest.

Tips for Sleeping  with Anxiety

Tips for Sleeping With Anxiety

The nightly rituals and sleep habits you use make up your sleep hygiene. Having good sleep hygiene increases your chances of getting quality sleep and relieving anxiety. Bad sleep hygiene includes eating too late, sleeping on a bad mattress, or living near a noisy interstate.

Some changes to your sleep habits are relatively easy to make, others not so much. But each one you can address is another step towards getting a good night’s sleep and reducing anxiety.

Keep a Tight Sleep Schedule

The more you stick to a sleep routine, the faster you’ll fall asleep. Like any other habit, sleep is highly sensitive to change. Sleeping only in your bed (not the recliner) or waking up at the same time on weekends are both effective sleep rituals. They send strong signals to your brain when it’s time to sleep and wake. Alter your routine, and your sleep will suffer.

Sleep schedule consistency also helps lower anxiety levels. Anxiety is about the fear of the unknown. Adhering to a strict sleep schedule reinforces a strong sense of control and predictability into your life.

Exercise Regularly

Regular exercise is often touted as one of the best ways to get a good night’s sleep, relieve tension and eliminate stress. However, if you want to get the most benefit from exercise, do it at the right times.

Exercise releases endorphins and revs up your body and brain. Doing it too late in the evening or just before bedtime makes it harder to fall asleep. Plan your exercise regimen for morning or afternoon. Give your body time to come down and soak in the relaxing effects of physical exercise.


Meditation is a treatment for insomnia that helps lower anxiety.

Mindfulness meditation brings your attention to the present experience by eliminating thoughts about the past and future. It helps you focus on the now by eliminating backward, revisionary thoughts and forward-looking worries. Since the past and future are the subject of most worries, mindfulness helps eliminate those anxiety-producing thoughts.

One study of middle-aged adults showed that six weeks of mindfulness awareness meditation resulted in less insomnia, fatigue, and depression compared to a control group. Get started with meditation by choosing a mindfulness program that’s right for you.

Mindfulness meditation is only one technique in a larger sleep treatment strategy called cognitive behaviour therapy, which helps you identify and change thoughts and behaviours that cause sleep problems.

Dampen Distracting Noises

We still have the high levels of alertness our early ancestors employed to stay alive for thousands of years. That’s why even sounds slightly above a whisper (30 decibels) can still disrupt our sleep. With sleep disruptors this quiet, you may not even know they’re affecting you. Here are a few ways to tamp down unwanted nightly noise:

  • Use a white noise machine to cover random sounds within your sleep space;
  • Try earplugs designed for sleeping;
  • Soften hard surfaces like floors and walls with rugs or acoustic foam;
  • Soundproof curtains for windows;
  • Don’t run dishwashers and washing machines at night;
  • Plant thick hedges outside your bedroom window to block exterior noises.

Turn Off Bad Lighting

Different lighting colours and intensities affect our circadian rhythms. Bright blue sunlight tells our brains it’s time to get up, dim amber-coloured lighting signal that it’s almost time for sleep. That bright street lamp outside your bedroom window may be counteracting your brain’s signal to go to bed. But you can fight light pollution by following these tips:

Improve Sleep-Space Lighting

Use thick window covering to block out external light. Adjust your alarm clock to a lower intensity setting. Unplug non-essential electronics that contain bright LED indicator lights. Keep your sleep environment as dark as possible, and use strategically placed night lights for safe travels to the bathroom.

Block Blue Lighting Before Bed

There are also lights that disrupt your sleep before you lay down. Laptops, tablets, and cell phone screens all emit a blue light that tricks your brain into thinking the sun is still up. They also inhibit the release of melatonin.

Avoid staring into screens an hour or two before bedtime. If digital device abstinence isn’t an option, set your displays to ‘night mode’. This automatically changes screen colours from blue to amber at sunset – the longer wavelength light won’t disrupt your circadian rhythm. Also, try wearing blue light blocking glasses in the evening.

Get a Mattress and Pillow That Fits You

When we lay on an unsupportive mattress or overly stuffed pillow, pressure points build on our sides, back, and neck. These pressure points cause us to literally toss and turn in an attempt to find a comfortable position all night.

Relieve pressure points by getting a mattress and pillow that conforms to your body. Most modern memory foam, latex, and elastic polymer mattresses are designed to conform to your body while also supporting it – but tests show mixed results.

Your pillow should support the curves of your head and neck while keeping your head cool. Good air circulation keeps your head cool and comfortable. Look into getting a pillow that offers proper airflow.

Why Sleeping Well Is Getting More Difficult

The connection between sleep and anxiety is deep – primordial even. Our bodies and minds have evolved to be a search light for dangers. It’s a major reason humans still exist. But those ancient hazards that plagued the sleep of our ancestors – those predatory howls and snaps of twigs – are now the stresses and worries of a modern life. Our anxiety triggers are the same; it’s the environment that’s changed.

Our technological devices do more than emit a blue light that disrupts our circadian rhythms. They bombard us with sources of anxiety from every corner of the world every hour of the day.

Every war, famine, or natural disaster we hear about pushes our anxiety levels higher. And our sleep suffers. Night-time rituals and blackout curtains help, but how we handle those stressors during the day may be the key to staying calm and well rested.

Recent studies are already looking into the effects of social media use and stress in adolescents, and news fatigue is a commonly reported phenomenon among Americans.

Being constantly ‘plugged in’ to current events or monitoring the lives of family and friends keeps our fight or flight responses turned on. In a modern, technological world, turning inward for self-maintenance and tranquillity is no longer a self-obsessed, ‘new age’ idea; it’s a prerequisite to getting through life.

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