Insomnia is a sleep disorder; anxiety is a feeling of worry and unease that becomes an anxiety disorder when it does not go away and gets in the way of daily life. The clearest clue to which one is driving your sleepless nights is what you worry about. If your worries are mostly about sleep itself (not sleeping, the clock, how you will cope tomorrow), insomnia is the more likely root problem. If you feel anxious about many parts of your life beyond sleep, talk to a doctor about an anxiety disorder (Sleep Foundation). Often it is both: each one can make the other worse, and treating one often helps the other.
Not a diagnosis. This guide explains the difference in general terms. Insomnia and anxiety share many symptoms, they often occur together, and other conditions such as depression, sleep apnea or thyroid problems can look like either. Only a doctor or mental health professional can tell what is going on for you.
What Is Insomnia?
With insomnia you have trouble falling asleep, staying asleep or getting good-quality sleep, even when you have the time and the right setting to sleep well (NHLBI). It involves both a sleep problem and daytime symptoms such as fatigue, poor concentration, moodiness, low energy and concern or frustration about your sleep (AASM Sleep Education).
Short-term insomnia is often caused by stress and lasts days or weeks. Chronic insomnia happens 3 or more nights a week, lasts more than 3 months and cannot be fully explained by another health problem (NHLBI). About 10 percent of people have chronic insomnia (AASM).
What Is An Anxiety Disorder?
Anxiety is a feeling of fear, dread and uneasiness, and it can be a normal reaction to stress. In an anxiety disorder the anxiety does not go away, can get worse over time and interferes with work, school and relationships (MedlinePlus). About a third of U.S. adolescents and adults have an anxiety disorder at some point in their lives (NIMH).
The type most often confused with insomnia is generalized anxiety disorder (GAD). People with GAD worry excessively about everyday things such as work, health, money and family, and trouble falling or staying asleep is one of its listed symptoms. To be diagnosed, a person must find worry hard to control on most days for at least 6 months, with at least three symptoms such as restlessness, fatigue, poor concentration, irritability, muscle tension or sleep problems (NIMH).
How Insomnia And Anxiety Feed Each Other
The link runs both ways. People with anxiety disorders often have trouble falling and staying asleep, and people with insomnia often become more anxious, which creates a cycle of sleeplessness (Sleep Foundation).
- Anxiety to insomnia. When you feel anxious, your stress response releases hormones such as cortisol and adrenaline that raise your heart rate and keep the brain alert. This state, called hyperarousal, is one of the main reasons the two occur together (Sleep Foundation).
- Insomnia to anxiety. Strong evidence shows that sleep loss can trigger or worsen anxiety disorders, and people prone to anxiety are especially sensitive to the effects of too little sleep on mood (Sleep Foundation). Insomnia itself can make you feel anxious, depressed or easily annoyed (NHLBI).
A doctor assessing insomnia will ask about stress and major life events and may test your mental and emotional wellbeing (AASM). For more on how short sleep changes mood, see how sleep affects emotional regulation.
Signs That Point More To Insomnia Or To Anxiety
No single sign settles it, and many people have features of both. Use this table as a starting point for a conversation with a doctor, not as a test.
| Question | Points more to insomnia | Points more to an anxiety disorder such as GAD |
|---|---|---|
| What do you worry about? | Mostly sleep: whether you will sleep, the clock, coping tomorrow | Many things: work, health, money, family, often out of proportion |
| When is it worst? | Builds as bedtime approaches | Present during the day as well as at night |
| Daytime symptoms | Tiredness, poor focus and irritability that follow bad nights | Feeling on edge, restless, tense or shaky even after a decent night |
| Body symptoms | Mainly sleepiness and fatigue | Racing heart, sweating, muscle aches, headaches, stomach upsets |
| How long and how often | 3 or more nights a week for 3 months or more for chronic insomnia | Hard-to-control worry on most days for 6 months or more for GAD |
| What tends to help first | CBT-I and a steady sleep schedule | CBT or other therapy, sometimes medicine |
Sources: Sleep Foundation, NHLBI, NIMH.
Want to put a number on your sleep problem before you see someone? The insomnia severity calculator scores how much your symptoms affect your nights and days.
Why Your Mind Races When Your Head Hits The Pillow
Many people with insomnia but no anxiety disorder still feel wired at bedtime. Part of this is learned. People with insomnia often start to dread the bedroom and link it with being awake and frustrated (Sleep Foundation). Worrying about whether you will get enough sleep and watching the clock can raise your risk of insomnia or make it worse (NHLBI).
Trying harder makes it worse: spending extra time in bed to force sleep makes falling asleep harder and sets up a nightly cycle (Sleep Foundation). This bed-equals-alertness link is what the behavioral parts of CBT-I are designed to undo.
Why Treating One Often Helps The Other
Better sleep can improve mental health and reduce anxiety, and treating anxiety may improve insomnia symptoms (Sleep Foundation). Healthy habits such as cutting back on caffeine and getting enough sleep can reduce anxiety symptoms when they are paired with standard care, though they do not replace treatment (NIMH).
It does not always work out evenly. CBT for anxiety can reduce anxiety even in people who have insomnia, but severe insomnia may continue afterwards, and CBT-I may then be a useful next step (Sleep Foundation). Some anxiety medicines can also affect sleep: SSRI and SNRI antidepressants may cause difficulty sleeping as a side effect (NIMH), so tell your doctor if your sleep changes after starting one.
Treatments For Insomnia And For Anxiety
Insomnia: CBT-I Comes First
Cognitive behavioral therapy for insomnia (CBT-I) is a 6- to 8-week plan that is usually recommended as the first treatment for long-term insomnia and can be very effective. It can be done in person, by phone or online (NHLBI). It includes:
- Cognitive therapy to help you feel less nervous about not being able to sleep;
- Relaxation or meditation to help you fall asleep faster;
- Sleep education about good sleep habits;
- Sleep restriction, which sets a specific time in bed and lengthens it as sleep improves;
- Stimulus control: going to bed only when sleepy, getting up if you cannot sleep and using the bed only for sleep and sex (NHLBI).
The AASM also recommends CBT-I for chronic insomnia in adults, and says sleeping pills should only be taken under medical supervision (AASM). Research has not proven that melatonin is an effective treatment for insomnia (NHLBI).
Anxiety: Therapy, Medicine Or Both
Treatment for GAD typically involves psychotherapy, medicine or both. Cognitive behavioral therapy (CBT) is commonly used and well studied: it helps you question harmful automatic thoughts and change patterns that keep worry going. Acceptance and commitment therapy (ACT) is another option. Medicines can include SSRI and SNRI antidepressants, buspirone, and sometimes benzodiazepines for short periods only (NIMH).
If you have both, CBT can address both: CBT-I targets the habits that cost you sleep, and CBT for anxiety targets worry in the rest of your life (Sleep Foundation).
What To Try Tonight
These low-risk steps are not a substitute for treatment. For a structured program, see our step-by-step plan to fix insomnia.
- Write your worries down earlier in the evening. Getting thoughts onto paper can reduce rumination, and some people set aside a fixed worry time so bedtime is not the time to worry (Sleep Foundation).
- Try a slow-breathing or muscle-relaxation exercise. Slow, controlled breathing can calm the nervous system, and tensing and releasing each muscle group in turn can ease physical tension (Sleep Foundation).
- Do not lie there fighting it. If you do not fall asleep after 20 minutes, get up and do something quiet in low light, away from screens, and go back to bed when sleepy (AASM).
- Turn the clock away. Clock-watching can make insomnia worse (NHLBI).
- Keep the bed for sleep and sex, and turn off electronic devices at least 30 minutes before bed (AASM).
- Skip afternoon caffeine and evening alcohol. Caffeine can make anxiety symptoms worse (MedlinePlus), and alcohol makes sleep lighter and wakings more likely (NHLBI).
- Get up at the same time tomorrow, even after a bad night and at weekends (AASM).
Keeping a sleep diary for 1 to 2 weeks, noting bedtimes, wake times, naps, caffeine, alcohol and exercise, helps a doctor see the pattern (NHLBI). If you use a wearable, our guide to sleep tracking and insomnia explains when a nightly sleep score can turn into one more thing to worry about.
When To Seek Help
- You struggle to fall or stay asleep at least three nights a week, or sleep problems or worry last for weeks and affect your daily life (Sleep Foundation).
- Your worry feels hard to control, or you have panic attacks, frequent nightmares or rely on alcohol, medicines or sleep aids to sleep (Sleep Foundation).
- Anxiety starts to cause problems at school, at work or with friends and family (NIMH).
- You snore loudly or wake up gasping, which a doctor may want to check for sleep apnea (NHLBI).
Start with your regular doctor or a mental health professional such as a psychologist, psychiatrist or clinical social worker (NIMH). For chronic insomnia, a sleep doctor at an accredited sleep center can help (AASM).
If you are in crisis: if you or someone you know is struggling or having thoughts of suicide, in the U.S. call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org. In a life-threatening situation, call 911 (NIMH). Outside the U.S., contact your local emergency number.
Insomnia vs Anxiety FAQs
Can Anxiety Cause Insomnia?
Yes. Anxiety keeps the brain in an alert state that makes it hard to fall and stay asleep.
Can Insomnia Cause Anxiety?
Yes. Ongoing sleep loss can trigger or worsen anxiety, and worry about not sleeping becomes its own bedtime stress.
How Do I Know If It Is Insomnia Or Anxiety?
Look at what you worry about. Worry focused on sleep points more to insomnia; worry about many areas of life points more to an anxiety disorder.
Does CBT-I Work If I Also Have Anxiety?
It can help, as it includes work on worry about sleep. Anxiety that goes beyond sleep usually needs its own treatment too.
Will Treating My Anxiety Fix My Sleep?
Often it helps, but not always. Severe insomnia can continue after anxiety improves, in which case CBT-I is a useful next step.
Should I Take Sleeping Pills For Anxiety-Related Insomnia?
Only under a doctor’s supervision. CBT-I is usually tried first, and some sleep and anxiety medicines can be habit-forming.