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How to manage anxiety at night

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CausesSymptomsEffects on sleepMedicationsNatural remediesSeeking helpSummary
Many people feel more anxious at night. Your options for managing nighttime anxiety include relaxation techniques, lifestyle changes, medication, and talk therapy. 
Medically reviewed by Ifeanyi Olele, DO, MBA, MS
Written by Uxshely Carcamo
Updated on

As you lie in bed trying to sleep, you may find yourself feeling anxious. For many, the quiet period before sleep allows for racing thoughts and amplifies the worries of the day. 

It is common to feel slightly anxious at night from time to time. However, some people may feel anxious at night regularly or find that anxiety gets in the way of their sleep.

Experiencing high levels of anxiety at night may be a sign of an anxiety disorder. Anxiety disorders are mental health conditions that people usually treat with a combination of medication, lifestyle changes, and talk therapy. 

What causes anxiety at night? 

Adult laying in bed with a night light on and yawning looking at a mobile device wondering how to manage anxiety at night
Corinna Kern/Getty Images

Anxiety describes a state of being hyper-alert to perceived threats. At night, when the room is dark and quiet, your brain and body can be even more alert to these perceptions. You may notice worries about intruders or noises that you can hear. The stillness of the night may cause you to worry about your to-do list and things that may not go to plan in the days ahead. 

There are many causes of anxiety, including at night. According to the National Institute of Mental Health, causes of anxiety include: 

  • Genetics: You may be more likely to have an anxiety disorder if a blood relative also has one. 
  • Stressful events: Having negative or stressful things in your life can make you more likely to have high anxiety levels. 
  • Distress in childhood: If you felt distressed or nervous in new situations in childhood, you may be more likely to have an anxiety disorder. 
  • Physical issues: Conditions like heart arrhythmia or thyroid disorders can lead to high anxiety levels. 
  • Caffeine and other medications or substances: These can stimulate the autonomic nervous system, making a person feel anxious.  

Other conditions that can become triggered at night may also cause high levels of nighttime anxiety. These include:

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What are the symptoms of anxiety at night? 

Everyone will experience different anxiety symptoms. The National Alliance on Mental Illness (NAMI) reports that symptoms of anxiety can include: 

  • feeling jumpy or tense 
  • feeling irritable or restless 
  • expecting the worst to happen and looking out for danger or threats
  • feeling dread 
  • a racing or pounding heart 
  • shortness of breath 
  • headaches, tiredness, or difficulty sleeping 
  • an upset tummy, frequent urination, or diarrhea 
  • twitches, tremors, and sweating

You may notice some of these symptoms if you’re feeling anxious at night. 

Some people may also experience nocturnal panic attacks. Research from 2022 suggests that the majority of people with panic disorder have panic attacks at night. NAMI notes that panic attacks — including those that happen at night — can cause:

  • dizziness
  • chest pain
  • shortness of breath
  • heart palpitations
  • sudden feelings of terror

How anxiety can affect sleep

Research from 2022 suggests that sleep problems affect around 50% of people with anxiety. Nighttime anxiety can make it more difficult to get a good night’s sleep. Anxiety causes your body to go into a stress mode where it releases stress hormones like cortisol. This stress mode may prevent you from sleeping or getting good-quality sleep. 

Nighttime anxiety can affect your sleep negatively. However, 2021 research suggests that sleep deprivation can also increase anxiety levels. This can create a problematic cycle if you have nighttime anxiety. Your anxiety may be getting in the way of your sleep but sleep deprivation may then worsen your anxiety. 

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Managing anxiety at night with medication 

There are lots of treatment options available to help with nighttime anxiety.

Your doctor may suggest medications, including: 

  • selective serotonin reuptake inhibitors (SSRIs), like sertraline (Zoloft) and fluoxetine (Prozac)
  • serotonin norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta) and venlafaxine (Effexor)
  • benzodiazepines like lorazepam (Ativan), which are usually short-term options

If you need help covering the cost of medications, the free Optum Perks Discount Card could help you save up to 80% on prescription drugs. Follow the links on drug names for savings on that medication, or search for a specific drug here.

Natural remedies for anxiety at night 

Optimizing your sleep and lifestyle can also help you improve anxiety at night. According to the National Sleep Foundation, you can improve your sleep and your mental health by: 

  • getting regular exercise 
  • eating meals at regular times every day 
  • spending some time in natural light during the day 
  • avoiding nicotine, caffeine, alcohol, and heavy meals close to bedtime 
  • creating a routine to relax and wind down at the end of the day 
  • putting devices away at least an hour before bedtime and sleeping in a cool, dark, and quiet room

Talk therapy can also help you manage and improve anxiety symptoms. A form of therapy called cognitive behavioral therapy for insomnia (CBT-I) aims to help you improve your sleep and anxious thoughts at night. 

If you wake up feeling anxious, you may find it helpful to use some techniques suggested by the National Center for Complementary and Integrative Health to help you get back to sleep. You can try things like:

  • listening to some hypnosis or a hypnotherapy recording 
  • relaxation techniques, such as breathing exercises or progressive muscle relaxation 
  • meditation
  • listening to music

Contacting a doctor  

Even though it is natural for us all to feel anxious sometimes, contact your doctor if you’re experiencing anxiety at night regularly or if it is affecting your sleep quality.  

Anxiety is treatable. A doctor can help you put a plan in place to help manage your anxiety and get a good night’s sleep again. 


Most people will experience anxiety at night sometimes. However, if it is stopping you from sleeping well or affecting your quality of life, there are things you can do to manage nighttime anxiety.  

Your doctor may suggest taking medication or seeking talk therapy. Making some lifestyle changes like getting regular exercise can also help improve your sleep and mental well-being. 

Download the free Optum Perks Discount Card to save up to 80% on some prescription medications.

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