Why Anxiety Gets Worse at Night
- Phoebe Walsh
- 1 hour ago
- 7 min read
Many people find that anxiety intensifies at night. Even if the day has passed without significant stress, the moment your head hits the pillow, a flood of racing thoughts and tension may take over. This is not just anecdotal — there are psychological and physiological reasons why anxiety tends to feel worse in the evening and overnight.
Key Takeaways
Night-time anxiety is often worsened by a lack of distractions and elevated cortisol levels.
Poor sleep and disrupted circadian rhythms create a feedback loop with anxiety.
There are proven strategies to manage night-time anxiety, including CBT, mindfulness, and reducing stimulants.
Why do you get more anxious at night?
Fewer Distractions, More Rumination
"As a sleep expert, I have worked with hundreds of patients to improve their sleep through cognitive behavioral therapy. Through my research, I've discovered that the number one killer of sleep isn't social media or an uncomfortable mattress — it's thinking"
During the day, distractions are everywhere. Work, chores, errands, social interactions — they all help keep the mind occupied. At night, when external stimulation drops, the brain turns inward. For those with anxiety, this often leads to rumination: overthinking, catastrophising, and mentally replaying events or future worries.
With nothing else demanding your attention, anxious thoughts can feel louder and more pressing. In psychology, this is linked to something known as the default mode network — a brain system that becomes more active during rest and mind-wandering, which is often more negative in anxious individuals.
Cortisol and the Body’s Stress Response
Cortisol, the body’s main stress hormone, follows a daily rhythm. It typically begins rising in the early morning and peaks shortly after waking. However, for those with chronic stress or anxiety disorders, cortisol patterns can become dysregulated, leading to elevated levels in the evening, precisely when the body should be winding down.
Research published in the journal Biological Psychiatry has shown that people with anxiety disorders may have higher evening cortisol levels, which can lead to racing thoughts, shallow breathing, and increased heart rate — all of which make sleep harder.
The Link Between Anxiety and Insomnia
Anxiety and sleep disturbances are closely intertwined. The Sleep Foundation reports that individuals with anxiety are more likely to experience insomnia, fragmented sleep, and lower sleep quality overall. In turn, poor sleep contributes to increased emotional reactivity and reduced resilience to stress the next day, creating a vicious cycle.
A study in Behaviour Research and Therapy found that people with insomnia are significantly more likely to experience night-time anxiety due to their preoccupation with not sleeping — the harder they try to fall asleep, the more anxious they become.
Night Sweats and Physical Symptoms
Night-time anxiety often comes with physical symptoms, including:
Sweating or hot flushes
Restlessness or tossing and turning
Racing heart or palpitations
Muscle tension
Shallow breathing
Gastrointestinal discomfort
These are caused by the activation of the sympathetic nervous system, also known as the fight-or-flight response. When the brain senses a perceived threat — even if it's imagined or future-based — the body prepares to take action, even if you’re lying in bed.
Dreams
Many people find that nighttime anxiety doesn't just disrupt sleep — it can also influence the nature of their dreams. Heightened stress levels are often linked to more vivid, emotionally charged dreams, including common experiences like dreaming about teeth falling out, which is widely associated with feelings of loss of control or vulnerability.
Similarly, dreaming about being pregnant can symbolise underlying anxieties about change, responsibility, or uncertainty. Understanding how anxiety and dreaming patterns connect can offer valuable insights into managing both.
Hormonal Shifts and Menopause
For women, especially those over 40, night-time anxiety may also be linked to hormonal changes. As oestrogen and progesterone levels fluctuate during perimenopause and menopause, many experience new or worsening anxiety, including anxiety night sweating and panic-like symptoms.
According to The British Menopause Society, hormonal changes can disrupt the body’s thermoregulation and emotional processing, contributing to feelings of anxiety, especially during the night.
Blue Light and Sleep Interference
Exposure to blue light in the evening — from phones, laptops, or LED lighting — suppresses melatonin production, the hormone that helps regulate your sleep cycle. This can delay sleep onset and increase alertness when the body should be winding down.
Reduced melatonin not only makes it harder to fall asleep but has also been shown to reduce the quality of REM sleep, which is vital for emotional regulation. A poor night’s sleep often results in elevated anxiety levels the next day.
Overthinking, Perfectionism and Hyperarousal
For some, night-time anxiety is rooted in high-functioning anxiety or perfectionist tendencies. The quiet of night allows space for harsh self-criticism or worries about performance, social interactions, or future events.
This state of hyperarousal — where the body is alert and overstimulated — can make it impossible to transition into a relaxed state suitable for sleep.
How to Reduce Night-Time Anxiety
Managing anxiety at night often requires a multi-pronged approach. While each person’s triggers and responses may vary, the following strategies are backed by research and clinical practice:
CBT-i is a gold-standard, evidence-based treatment that targets the thoughts and behaviours disrupting sleep. Studies published in The Lancet Psychiatry (Freeman et al., 2017) have shown that CBT-i can significantly reduce both insomnia and anxiety symptoms by helping retrain the brain’s associations with sleep.
Mindfulness and Meditation
Mindfulness practices, including body scans and breathing exercises, help anchor the mind in the present. They lower activity in the amygdala (the brain’s fear centre) and reduce physiological arousal.
Apps like Headspace, Calm, and Insight Timer offer free guided meditations tailored for nighttime anxiety and sleep preparation.
Reduce Evening Stimulation
Avoid caffeine, alcohol, heavy meals, and intense exercise within three hours of bedtime. These can all spike alertness, affect cortisol levels, or disrupt digestion, all contributing to restlessness at night.
Establish a Wind-Down Routine
A structured evening routine — such as taking a warm bath, using calming scents like lavender, or journaling — signals to the brain that sleep is approaching. Avoid screens in the hour before bed or enable “night mode” to reduce blue light exposure.
Try a Natural Supplement (Cautiously)
Some individuals benefit from natural sleep supplements such as magnesium, valerian root, or L-theanine. However, always consult a GP if you’re considering supplements, especially if you're on medication or managing a mental health condition.
Create a Calm Sleep Environment
A cool, dark, and quiet bedroom promotes melatonin production and eases anxiety. White noise or nature sounds can help mask environmental disturbances, and weighted blankets have shown promise in reducing anxiety symptoms.
Seek Professional Support
If nighttime anxiety is chronic, overwhelming, or affecting your quality of life, speak to your GP. Cognitive therapy, medication, or further assessment for conditions such as Generalised Anxiety Disorder (GAD), ADHD, or depression may be necessary.
Final Thoughts
Anxiety getting worse at night is a shared experience for many. While the silence and darkness should bring calm, they often allow anxious thoughts and sensations to come to the surface. From overthinking to hormonal imbalances and disrupted sleep cycles, the reasons are complex but manageable.
With the right combination of routine, environment, and support, it’s possible to reclaim your nights and get the rest your body and mind need.
FAQ: Anxiety at Night
Why does anxiety feel worse at night?
Anxiety often intensifies at night because distractions fade and the brain has more space to focus inward. Without work, conversation, or tasks to occupy attention, rumination and overthinking become more prominent. This mental quiet allows anxious thoughts to surface more forcefully, especially in people prone to worry or catastrophising.
Can cortisol levels make anxiety worse in the evening?
Yes. Cortisol, the body’s primary stress hormone, should fall in the evening. In people with chronic stress or anxiety disorders, cortisol rhythms can become disrupted, leading to elevated evening levels. This keeps the nervous system alert and makes relaxation and sleep more difficult.
Is nighttime anxiety linked to insomnia?
Very closely. Anxiety increases the likelihood of insomnia, and insomnia in turn increases anxiety. Difficulty falling asleep or staying asleep can heighten emotional reactivity the next day, reinforcing a cycle where fear of poor sleep causes further nighttime anxiety.
Why do anxious thoughts become louder when trying to sleep?
When lying in bed, the brain’s default mode network becomes more active. This network is associated with mind wandering and self-referential thinking. In anxious individuals, this activity tends to skew negative, leading to intrusive thoughts, worry about the future, or replaying past events.
Can anxiety cause night sweats or physical symptoms?
Yes. Night-time anxiety can trigger physical symptoms such as sweating, hot flushes, a racing heart, muscle tension, shallow breathing, and gastrointestinal discomfort. These symptoms occur when the sympathetic nervous system activates the fight-or-flight response, even in the absence of real danger.
Does anxiety affect dreams?
Heightened anxiety can influence dream content, often leading to vivid or emotionally charged dreams. Stress is commonly linked to recurring anxiety-related dreams, including themes of loss of control, vulnerability, or major life changes.
Why is nighttime anxiety common during menopause?
Hormonal fluctuations during perimenopause and menopause can disrupt emotional regulation and temperature control. Changes in oestrogen and progesterone may contribute to increased anxiety, night sweats, and panic-like symptoms that are more noticeable during the night.
Can blue light exposure make night anxiety worse?
Yes. Blue light from phones, tablets, and LED lighting suppresses melatonin production, delaying sleep onset and increasing alertness. Poor melatonin regulation can reduce REM sleep quality, which is important for emotional processing, potentially worsening anxiety.
Is overthinking at night linked to perfectionism?
Often. People with high-functioning anxiety or perfectionist traits may use night-time quiet to mentally review performance, social interactions, or future responsibilities. This state of hyperarousal keeps the brain alert when it should be transitioning toward rest.
What is the most effective treatment for nighttime anxiety and sleep issues?
Cognitive Behavioural Therapy for Insomnia (CBT-i) is considered the gold standard. It addresses unhelpful thought patterns and behaviours around sleep and has strong evidence for reducing both insomnia and anxiety symptoms.
Do mindfulness and meditation help with nighttime anxiety?
Yes. Mindfulness practices can reduce activity in the brain’s fear centres and calm physiological arousal. Regular use of breathing exercises, body scans, or guided meditations can make it easier to disengage from anxious thought loops at night.
Should caffeine or alcohol be avoided in the evening?
Yes. Caffeine increases alertness and cortisol, while alcohol disrupts sleep architecture and can worsen nighttime awakenings. Both can contribute to increased anxiety and restless sleep when consumed too close to bedtime.
Are natural supplements safe for nighttime anxiety?
Some people find supplements like magnesium, valerian root, or L-theanine helpful. However, supplements should be used cautiously and discussed with a GP, particularly when taking other medications or managing mental health conditions.
When should professional help be sought?
Professional support should be considered if nighttime anxiety is persistent, severe, or interfering with daily life. A GP can assess whether therapy, medication, or further evaluation for conditions such as generalised anxiety disorder, ADHD, or depression is appropriate.
Is nighttime anxiety normal?
It is common, but that does not mean it should be ignored. Many people experience increased anxiety at night due to biological rhythms, thought patterns, and lifestyle factors. With appropriate strategies and support, nighttime anxiety can be significantly reduced.
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