Stress-Related Insomnia: Why Anxiety Keeps You Awake

In the evening the body asks for rest, but the head keeps going over conversations, tasks, and worries, and falling asleep only happens toward morning. Many people know this state, and it rarely says anything about weakness of character. Below — about how worries are connected to sleep and at what point talking to a doctor stops being something to put off.

How stress and worries affect sleep

Stress, anxiety, and depression are the most common causes of insomnia. Besides them, sleep is disrupted by noise, a room that is too hot or too cold, an uncomfortable bed, alcohol, caffeine and nicotine, changing time zones, and shift work.

Insomnia is spoken of when sleep problems recur regularly. It can look different:

• it is hard to fall asleep, and the person lies awake for a long time;
• sleep is interrupted several times a night;
• waking comes earlier than desired, and returning to sleep does not work;
• after waking there is a feeling of being worn out, and during the day it is hard to concentrate and irritability builds up.

If this lasts less than three months, insomnia is called short-term; three months or longer — long-term. Acute insomnia against the background of worries at work, family difficulties, or a severe event usually lasts days or weeks.

Insomnia and anxiety: why thoughts won't let go before bedtime

Anxious doubts — whether it will be possible to fall asleep — as well as worry about a possible decline in work performance or health problems due to disrupted sleep often contribute to the chronification of insomnia. Psychologists call such persistent beliefs dysfunctional beliefs.

They maintain "fear of sleep" — fear of not falling asleep in one's own bedroom: the place for sleep and the expectation of problems falling asleep become linked, and the room's setting itself triggers excessive brain activation. Insomnia based on such psychological mechanisms without a serious illness is called psychophysiological.

Insomnia in depression and anxiety disorders

Mental disorders, primarily depression and anxiety disorders, are among the causes of insomnia. The connection between sleep and depression is complex: sometimes sleep disturbances turn out to be a symptom of a depressive episode, and sometimes a factor that pushes toward its development.

A separate difficulty is that insomnia itself changes the state: against its background a person more often feels anxiety, low mood, and irritability.

Psychosomatic insomnia: how to distinguish it from other causes

The word "psychosomatics" in conversations about sleep usually means that the cause is in the psyche, not in the body. It is more accurate to speak of psychophysiological insomnia: it rests on psychological factors, without a serious illness.

Analyzing the causes helps distinguish it from other variants. Besides stress and anxiety, sleep is disrupted by chronic pain, snoring and breathing pauses during sleep, restless legs syndrome, increased thyroid function, menopause, some illnesses, and medications.

For diagnosis, a doctor takes a sleep history and medical history, asks the patient to keep a sleep diary, and if necessary orders polysomnography — it shows how a person sleeps and how the body responds to disturbances.

Shift work and changing time zones

Shift work and travel with time zone changes shift the usual rhythm of sleep and wakefulness. Caffeine, alcohol, and nicotine also interfere with sleep.

Sleep needs vary from person to person. On average, adults need 7–9 hours, children — 9–13, toddlers — 12–17, but a sign of insufficient sleep is constant fatigue during the day. Another notable risk is drowsiness while driving.

When insomnia requires seeing a doctor

A reason for a visit is a situation when changes in habits have not helped, sleep problems last for months, or insomnia affects daily life so much that coping becomes difficult.

At the appointment, the doctor looks for the cause of the disturbances. Cognitive behavioral therapy is also discussed: it helps change the thoughts and behaviors that interfere with sleep and can be delivered as in-person sessions or an online program. Doctors prescribe sleeping pills rarely and only for a few days or weeks — because of side effects and the risk of dependence.

Insomnia by itself is not a reason to call an ambulance. The numbers 103 and 112 are for life-threatening situations — for example, signs of a stroke or heart attack.

This text is for reference: it helps to navigate the topic and does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer