When worry keeps you awake

If you've ever found yourself replaying conversations, worrying about tomorrow's to-do list, or feeling unable to quiet your thoughts at bedtime, you're not alone. Anxiety is one of the most common causes of sleep difficulties, and a lack of sleep can, in turn, make anxiety feel even worse.

According to Jeremiah Vrudny, PsyD, clinical health psychology fellow with Baptist Behavioral Health, and Maria Anastasiades, PsyD, a clinical health psychologist with Baptist Behavioral Health and chief of Psychology at Baptist Medical Center Jacksonville, anxiety and worry are among the most common psychological factors that interfere with quality sleep.

"Additionally, physical conditions like chronic pain can impact mood, ability to relax and comfort when sleeping," Dr. Vrudny said. "Physical and mental symptoms can make it harder to relax, get comfortable and return to sleep after waking."

Why stress can keep you awake

Stress is a normal part of life, but when worries linger long after the day is over, sleep can suffer. Whether concerns center around work, finances, family responsibilities or health issues, anxious thoughts often become more noticeable once the distractions of the day are gone.

"Life stress commonly makes it challenging to quiet the mind for sleep,” Dr. Vrudny said. "Stress can often lead to worrying over and over about certain thoughts or upcoming tasks, which can impact falling asleep."

Over time, the brain can begin to associate being in bed with worrying rather than resting. Fortunately, Dr. Vrudny noted that the brain is adaptable and can be retrained to develop healthier sleep patterns.

Healthy sleep habits to try

One effective way to manage anxiety-related sleep difficulties is by creating a consistent wind-down routine before bed. This may include relaxation exercises and mindful meditation.

"It may also be helpful to write a list of pending tasks and worries before getting in bed, so the brain can let those things go more easily during the wind-down routine," Dr. Anastasiades explained.

She emphasized the importance of maintaining a healthy sleep routine and recommended these evidence-based habits:

• Aim for seven to nine hours of sleep each night.
• Wake up at the same time every day, including weekends.
• Get bright light exposure in the morning and reduce light exposure in the evening.
• Exercise regularly.
• Keep your bedroom cool, dark and quiet.
• Limit screen time before bed.
• Avoid heavy meals close to bedtime.

What to do when you can’t sleep

Dr. Vrudny often recommends a technique known as stimulus control, which helps strengthen the connection between bed and sleep.

"If you're lying awake and becoming frustrated, get out of bed and do something relaxing in low light until you feel sleepy, then return to bed," he said. "This helps the brain associate the bed with sleep rather than wakefulness."

He added, “If you tend to fall asleep and then wake in the night, avoid clock-watching and checking your phone, as both can increase anxiety and alertness. Another strategy, known as paradoxical intention, involves letting go of the pressure to force sleep. Resting quietly and allowing sleep to come naturally can reduce the anxiety that keeps people awake.”

When to seek help for insomnia

While healthy sleep habits can be very effective, they may not fully resolve chronic insomnia.

For people with ongoing sleep difficulties, the American Academy of Sleep Medicine recommends cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment. This structured approach combines education and behavioral techniques, including stimulus control and sleep restriction therapy (limiting the amount of time spent in bed to the actual time spent sleeping), to improve sleep over time.

Dr. Vrudny encouraged people to seek professional help if sleep problems occur three or more nights a week for at least three months, interfere with daily functioning, cause excessive daytime sleepiness or continue despite consistent self-help efforts.

In general, if poor sleep is affecting your health, safety or quality of life, it's worth talking with a health care provider.

Better sleep takes time

"These changes take time, so give yourself some grace as you work toward making change," Dr. Vrudny said. "Including your support network can be very beneficial for staying motivated."

Quality sleep is essential for both mental and physical health. By addressing anxiety, developing healthy routines and seeking support when needed, many people can improve their sleep and wake up feeling more rested and resilient.