Clinically reviewed by Dr Muhammad Najam-Ul-Arfeen, General Practitioner
Bachelor of Medicine and Bachelor of Surgery (MBBS)
AHPRA-registered
Last updated: 7 September 2026
Anxiety symptoms differ from one person to another. For many people, nighttime should be a chance to relax, unwind, and recharge. But for those dealing with nighttime anxiety, bedtime can feel like the worst part of the day. Your mind races, your chest feels tight, and even small worries can feel huge. Nighttime anxiety can make it almost impossible to fall asleep, stay asleep, or feel rested the next day.
If this sounds familiar, you are not alone. Anxiety at night is more common than you think. This article explains what nighttime anxiety is, the symptoms to watch for, why it occurs, and, most importantly, practical ways to improve sleep.
What is Nighttime Anxiety?
Nighttime anxiety happens when your mind keeps worrying or overthinking as you try to sleep. Unlike daytime anxiety, which may have distractions to take your mind off worries, the quiet of the night can make anxious thoughts louder. You might find yourself replaying events, imagining worst-case scenarios, or worrying about things you can’t control.
What Are the Symptoms of Nighttime Anxiety?
Nighttime anxiety can affect your thoughts, emotions, physical sensations and behaviour. The symptoms can vary from person to person, but common signs include racing thoughts that are difficult to slow down, a pounding or faster heartbeat, muscle tension, and a sense of dread or feeling on edge.
At bedtime, this often shows up as trouble falling asleep, waking during the night and finding it difficult to settle again, staying up later to avoid going to bed, or repeatedly checking the time.
For a full breakdown of how anxiety affects the mind and body during the day, see our [complete guide to anxiety symptoms].
Why Does Anxiety Get Worse at Night?
At night, several factors can make anxious thoughts harder to switch off and make it more difficult to fall asleep.
There Is Less to Occupy Your Mind
During the day, there are usually plenty of distractions to pull your attention elsewhere. At night, when things are quieter, the same concerns may become harder to ignore and seem more difficult to deal with while you are lying awake in bed.
Nighttime Leaves Room for Rumination
Once the day is over, you may find yourself replaying conversations, going over mistakes or worrying about what tomorrow might bring. Rumination can make a problem seem bigger than it did during the day, particularly when you are tired and have nothing else to focus on.
Physical Sensations Become Noticeable
You may barely notice your breathing or heartbeat when you are busy. In bed, these sensations can become much more noticeable because your mind isn’t occupied. If you are already tense, being aware of your sensations can keep you alert as you try to fall asleep.
Worrying About Getting Enough Sleep
After a few difficult nights, you may start worrying about whether you will sleep before you even get into bed. You might watch the clock, count the hours until you need to wake up or worry about how tired you will be the next day. The pressure to fall asleep can leave you feeling more alert, making it harder to settle down.
Your Evening Habits Can Play a Part
Caffeine late in the day, alcohol, long naps and an irregular sleep schedule can interfere with sleep. Spending the evening on stimulating activities may also make it harder to wind down before bed.
Why Do I Get Anxious When I Try to Sleep?
Several physiological processes may contribute to feeling anxious when trying to fall asleep:
- The stress response keeps the body alert: Anxiety can activate the body’s stress response, increasing physiological arousal when the body should be preparing for sleep. This can leave you feeling tense, restless or unable to settle.
- Circadian changes affect alertness: Your circadian rhythm regulates changes in sleepiness and alertness across the day. Melatonin levels rise in the evening as the body prepares for sleep, while cortisol typically follows a daily pattern and declines towards nighttime. Anxiety can make the transition into sleep more difficult when your level of alertness remains high.
- Anxiety can affect sleep architecture: Anxiety does not only interfere with falling asleep. Research has also associated higher anxiety with changes in sleep stages, including reduced REM and deep sleep. These changes may affect sleep quality even when you do manage to fall asleep
Anxiety and Insomnia: Can Anxiety Keep You Awake?
Yes. Anxiety can make it difficult to fall asleep, stay asleep or get back to sleep after waking. The relationship can work in both directions. You have a stressful night and didn’t sleep well. The next day you are tired and find normal problems harder to handle. By bedtime, you are already worried about whether you will sleep.
Then it happens again.
Anxiety → poor sleep → tiredness → more worry → poor sleep.
If this becomes a regular pattern, it is worth talking to a GP rather than assuming you simply need to try harder to sleep. For persistent insomnia, cognitive behavioural therapy for insomnia (CBT-I) may be recommended. It focuses specifically on the thoughts and behaviours that can perpetuate sleep problems.
How to Calm Anxiety at Night
When anxiety is keeping you awake, the aim is not to force yourself to sleep. Instead, focus on helping your mind and body settle.
Create a Relaxing Bedtime Routine
Give yourself some time to transition from the day to sleep. Dim the lights, put work aside, take a warm shower or bath, read a book, or listen to something calming. Going to bed and getting up at roughly the same times each day can also help keep your sleep routine consistent.
Reduce Screen Time Before Bed
Phones, computers and televisions can keep your mind stimulated when you are trying to wind down. Where possible, put screens aside before bed. If you need to use a device, reducing the brightness or using a night-mode setting may make it less stimulating.
Try Breathing or Relaxation Techniques
Slow and comfortable breathing can help you focus on something other than anxious thoughts. You can also try progressive muscle relaxation, gentle stretching or mindfulness.
Write Down What Is on Your Mind
If you’re getting worried over the same things again and again, write them down rather than continuing to work through them in bed. You can note what needs your attention and get back to it the following day.
Get Out of Bed If You Are Wide Awake
If you have been lying awake and becoming increasingly frustrated, get out of bed for a while. Do something quiet in low light, such as reading, and return to bed when you feel sleepy again.
What Is the Difference Between Nighttime Anxiety and a Panic Attack?
Nighttime anxiety often builds around worry. Your thoughts become busy, your body feels tense, and you gradually become more alert.
A nocturnal panic attack is usually much more sudden. It can wake you from sleep with an intense rush of fear and physical symptoms such as a racing heart, sweating, trembling, dizziness, nausea or difficulty breathing.
Someone can wake up in a panic without remembering any worrying thoughts before falling asleep. Not every episode of waking with a racing heart or breathlessness is a panic attack, since similar symptoms can occur for other reasons, including some medical and sleep-related conditions.
Concerned about anxiety at night? Speak with a GP online.
When Should I See a GP About Nighttime Anxiety?
Everyone has the occasional night when stress gets in the way of sleep. You do not necessarily need medical help after one difficult evening. A GP visit makes more sense when it has become a pattern.
For example, make an appointment if:
- Anxiety regularly stops you from sleeping
- You often wake feeling anxious or panicked
- You are tired during the day because of disrupted sleep
- You have started to dread going to bed
- You are using alcohol or other substances to help you sleep
- You are not sure whether your symptoms are actually anxiety
Your GP can ask about what happens before, during and after your episodes, as well as your sleep routine, general health, medications and lifestyle.
If you would like to discuss your symptoms with a GP without travelling to a clinic, HelloGP offers online GP appointments where you can speak with a doctor from home.
When Does Nighttime Anxiety Become an Emergency?
Anxiety can cause physical symptoms such as a racing heartbeat, chest tightness and shortness of breath. However, these symptoms can also occur with other medical conditions, so it is important not to assume they are caused by anxiety.
FAQs
Why Do I Wake Up With Anxiety?
You can wake feeling anxious for several reasons, including disrupted sleep, a stressful dream or worries that become noticeable once you wake. Sometimes there is no obvious trigger. If it happens regularly or affects your sleep, speak with your GP.
Can You Have a Panic Attack While Sleeping?
Yes. A panic attack can occur during sleep and wake you suddenly with symptoms such as a pounding heart, sweating, shaking or intense fear. These episodes are sometimes called nocturnal panic attacks. If they happen repeatedly, speak with your GP so the symptoms can be properly assessed.
Is It Normal to Feel Anxious at Bedtime?
Feeling anxious at bedtime can happen occasionally, particularly during periods of stress or disrupted sleep. It becomes more concerning when it happens regularly, makes it difficult to sleep or starts affecting how you function during the day.
How Long Does Nighttime Anxiety Last?
The duration can vary. Some episodes may settle once you relax or fall asleep, while anxiety may continue or return throughout the night. If nighttime anxiety is persistent or regularly interferes with your sleep, a GP can help assess what may be contributing to it.
Can nighttime anxiety cause insomnia?
Yes. Nighttime anxiety is a common cause of insomnia. Racing thoughts, tension, and worry can make it difficult to fall asleep or stay asleep. Over time, this can lead to poor sleep quality and daytime fatigue.
Are there professional treatments for nighttime anxiety?
Yes. Healthcare professionals can help with anxiety that affects sleep. Treatments may include:
- Cognitive behavioural therapy (CBT) for anxiety
- Relaxation and coping techniques
- Medication for severe cases
- Lifestyle and sleep hygiene guidance
Disclaimer:
This article is for general information only and does not replace professional medical advice. Telehealth is not suitable for emergencies. If you are in an emergency or at immediate risk, call 000 or visit your nearest emergency department.