Possible causes of waking up with anxiety

Anxiety is a natural emotion designed to get us on our toes when we perceive a threat. If anxiety is persistent and interferes with your daily life, however, it may be a sign of an anxiety disorder.

Physical symptoms of anxiety may include:

• heart palpitations
• shortness of breath
• sweating and chills
• nausea
• lightheadedness
• stomachache
• twitching
• dry mouth
• overall aches and pains
• muscular tension

Cognitive and emotional symptoms of anxiety may include:

• negative self-talk
• feelings of doom or impending danger
• feeling something is wrong, but you’re not sure what
• difficulty concentrating
• challenged memory
• irritability
• being on edge

If you’re experiencing a personal challenge, you may wake up with anxiety while you face or resolve the situation. However, if anxiety becomes recurrent or you have symptoms repeatedly at different times of the day, you may be living with an anxiety disorder.

Only a mental health professional may accurately give a diagnosis and explore the best management tools for you.

Causes of waking up with anxiety

If you occasionally wake up with anxiety in the morning, after a nap, or throughout the night, you may be experiencing common life stressors like:

• a personal challenge, like an argument with your partner or a new health diagnosis
• a professional challenge, like a busy week, an upcoming project, burnout, or a job loss
• a financial challenge, like an increasing cost of life or a pending debt payment
• an episode of gastrointestinal upset, like acid reflux
• a side effect of caffeine or high sugar intake
• hypoglycemia (low blood sugar)
• sleep disturbances, like sleep paralysis, nightmares, or insomnia

Your cortisol levels may also be higher during the first 2 hours after waking up.

Cortisol is known as the “stress hormone,” and it regulates your alertness.

If you experience chronic psychological or physical stress, you may be more likely to experience high levels of cortisol in the morning, leading you to wake up with anxiety symptoms.

If you persistently experience anxiety after waking up, but also have high anxiety episodes at other times of the day, you may be living with:

• generalized anxiety disorder, if you have many sources and times of anxiety
• social anxiety disorder, if your symptoms increase in anticipation of or during social situations
• separation anxiety disorder, if you fear being separated or losing a loved one
• panic disorder, if you have experienced panic attacks

Anxiety disorders involve persistent, repetitive, and intense episodes of fear and worry related to one or more events in your life. These are mental health diagnoses that respond well to treatment and self-care strategies.

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Management of anxiety after waking up

Occasional anxiety and anxiety disorders can be managed through a variety of strategies. A formal diagnosis may sometimes require medications depending on the severity of your symptoms.

Self management of morning anxiety

If you are waking up with anxiety, these strategies may help:

• limit caffeine and sugar intake, particularly before bed or nap time
• build optimal sleep hygiene to increase your chances of sleeping through the night
• focus on positive thoughts before going to bed
• work with positive affirmations throughout the day, especially before sleeping
• engage in regular physical activity every day but at least 4 hours before sleeping
• have a soothing drink before bedtime
• practice breathing exercises for anxiety relief

Grounding exercises may also help you reduce anxiety quickly after waking up. These may include showering with cold water until you calm down, focusing on colors, textures, and noises around you as you wake up, and breathing in and out to the count of four.

If you experience persistent sleep disturbances, hypoglycemia, or chronic conditions, consider consulting a health professional for a tailored management program. Addressing the root cause of anxiety may help you decrease the number of episodes.

Psychotherapy

Talk therapy with a mental health professional can help you manage all instances of anxiety.

Cognitive behavioral therapy (CBT) is the first line of treatment for anxiety disorders. It will focus on your thoughts and help you reframe them, so you gain a new perspective on the things that worry you.

Even if you have not received a formal anxiety disorder, psychotherapy may become an effective tool to reduce anxiety in the moment and long term.

Medications

If your anxiety symptoms persist or worsen, a healthcare professional may recommend anti-anxiety medications. These may include:

• serotonin-norepinephrine reuptake inhibitors (SNRIs), like venlafaxine (Effexor XR)
• selective serotonin reuptake inhibitors (SSRIs), like escitalopram (Lexapro), citalopram (Celexa), and sertraline (Zoloft)
• tricyclic antidepressants (TCAs), like imipramine (Tofranil)
• short-term benzodiazepines, such as alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan)

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Summary

If you are waking up with anxiety every now and then, it may be related to what you ate the night before, blood sugar levels, or current worries like relationship conflicts and job-related challenges.

If you wake up with anxiety often and also experience it at other times of the day, you may be living with an anxiety disorder.

Occasional and persistent anxiety may be managed with talk therapy, relaxation techniques, grounding exercises, and regular activity. In severe anxiety cases, you may need to take anti-anxiety medications.