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.
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 behavior 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.
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.
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 behaviors (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 behaviors involve getting out of bed.
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.
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:
- Behavior problems
- Poor academic performance
- Automobile accidents
- Napping (teenagers)
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
- Substance abuse
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.
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 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.
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.
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