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Sleep and Anxiety

Anxiety and insomnia feed each other: worry keeps you awake, and the bad night feeds the worry. Breaking that loop is a large part of what CBT-I does.

Written by George Wang
3articles
5 minper article
Oct 2026last reviewed article

What to know first

  • If you dread bedtime, that isn't you overreacting to a sleep problem. Being worried or unhappy about your sleep is one of the symptoms doctors look for when they diagnose chronic insomnia.
  • It is also a driver. Hyperarousal is named among the factors that perpetuate chronic insomnia, and anticipatory dread from early evening is an efficient way to produce it.
  • The loop is self-confirming: worry raises arousal, arousal delays sleep, the bad night confirms the worry.
  • Cognitive therapy — a component of CBT-I — targets this directly, and multicomponent CBT-I is the only strong recommendation in the AASM's 2021 behavioral guideline.
  • Relaxation exercises are worth a try — the guideline suggests them, though without much conviction. Mindfulness by itself hasn't been tested enough for the guideline to say either way, which is a gap in the research rather than a verdict.

CBT-I = cognitive behavioral therapy for insomnia · AASM = American Academy of Sleep Medicine

For education only, and not a substitute for advice from your own doctor or prescriber.

Read in this order

  1. Sleep Anxiety: Why It Happens and How to Treat ItStart here

    Fear of not sleeping often keeps the struggle alive. The good news is that fear can be addressed and reduced with treatment.

    6 min

  2. How to Quiet Racing Thoughts at Night

    It can feel like your mind is working against you at 11pm. It's likely that this is the first time all day that nothing is standing between you and everything you have been carrying in your mind.

    5 min

  3. How Revenge Bedtime Procrastination Messes With Your Sleep

    It is the trendy behavior all over social media with a catchy name. It may seem light and funny, but be careful this behavior doesn't creep into a permanent habit and a new normal for your sleeping pattern.

    4 min

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Common questions

Is sleep anxiety a real condition?
Not a separate diagnosis, but not imaginary either. The criteria for chronic insomnia disorder list "concerns about or dissatisfaction with sleep" among the qualifying daytime symptoms, so worry about sleep is part of how the condition is defined.
How do I stop worrying about sleep?
Not by trying to stop, which requires monitoring the thought you are suppressing. Cognitive therapy within CBT-I works on the specific beliefs driving it — that a bad night ruins tomorrow, that you need a fixed number of hours — by testing them against what actually happens.
Does meditation help?
It depends on exactly what is being tested. The AASM's 2021 guideline said there was not enough evidence to make a recommendation on using mindfulness by itself for insomnia, and the 2025 VA/DoD guideline reached the same conclusion about mindfulness meditation. Relaxation therapy — a more structured and specific method — did get a conditional recommendation from the AASM.

References

  1. Insomnia chapter, International Classification of Sleep Disorders, Third Edition, Text Revision (ICSD-3-TR). American Academy of Sleep Medicine; 2023.
  2. Chronic Insomnia. StatPearls, NCBI Bookshelf.
  3. Edinger JD, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine. 2021;17(2):255-262. doi:10.5664/jcsm.8986
  4. Psychological and Physical Approaches for Sleep Disorders: What the Science Says. NCCIH Clinical Digest.