Nighttime anxiety

Nighttime anxiety is the worsening of anxious symptoms at night — ruminative thoughts that intensify when lying down, worries that 'flood in' once the silence removes the day's distractions, or waking in the middle of the night with intense anxiety. It is extremely common in anxiety and has both biological components (cortisol rises in the late night and early morning) and psychological ones (fewer distractions available).

Nighttime anxiety can create a vicious cycle: anxiety → insomnia → sleep deprivation → more anxiety the next day → more anxiety the following night. And the fear of not sleeping itself contributes to more anxiety about sleep.

Specific strategies include: a 'wind-down' routine before bed (no screens, calm activity), writing worries down on paper, breathing techniques, and limiting time spent awake in bed.