Why Nighttime Anxiety Worsens “`
Lily Brown, director of the University of Pennsylvania’s Center for the Treatment and Study of Anxiety, frequently hears from patients that their anxiety intensifies at night despite feeling exhausted from a busy day.
Evening anxiety and its negative impact on mental health are widespread. Researchers have observed a correlation between nighttime hours and increased anxiety, suicidal thoughts, and substance misuse, particularly between 1 a.m. and 4 a.m. A 2024 study in *Psychiatry Research* revealed anxiety peaks at various times daily (8 a.m., 4 p.m., and 1 a.m.), with evening hours exhibiting the most intense racing thoughts.
Why does anxiety worsen at night? Let’s explore the reasons.
The nighttime anxiety link
Our internal biological clock regulates various bodily functions, including sleep and brain activity, explains Rebecca Cox, an assistant professor at Washington University in St. Louis.
As wakefulness extends, sleep pressure increases, impacting cognitive function and emotional regulation, according to Cox. This impaired regulation contributes to increased vulnerability to self-harm and substance abuse during nighttime hours.
Isolation further exacerbates nighttime anxiety. The lack of social interaction during evening hours hinders emotional regulation, explains Cox.
Reduced distractions at night also contribute to anxiety, notes Dr. Jeffrey Strawn, director of the Anxiety Disorders Research Program at the University of Cincinnati College of Medicine. Daytime activities and responsibilities diminish at night, creating an environment conducive to worry and overthinking.
Morning relief?
The notion that a good night’s sleep improves anxiety appears supported by research.
Anxiety and sleep are interconnected; poor sleep can predict future anxiety, and adequate sleep is often associated with reduced anxiety, according to studies. “Sleep is medicine,” says Strawn.
Good sleep habits are crucial for anxiety management. This includes creating a conducive sleep environment (cool, dark, quiet), limiting caffeine, managing light exposure, establishing a regular sleep schedule, and waiting until tired before bed, advises Brown. Avoid self-medicating with alcohol or other substances.
Managing nighttime anxiety
Proactive strategies are key, according to Brown. Scheduling a short “worry time” each day allows for structured time for addressing concerns. Redirect worries outside of this designated time.
For persistent nighttime anxiety, Brown recommends keeping a bedside journal for quick notes about worries, signaling acknowledgment without immediate problem-solving. However, Strawn cautions against lengthy writing, which could prolong anxious thoughts.
Leaving the bed if anxiety persists is important to avoid associating the bed with worry, suggests Strawn. Engage in calming, non-stimulating activities like reading or meditation.
Return to bed when feeling sleepy and calmer.