Why does anxiety get worse at night?

Many people with anxiety notice their symptoms get worse at night, especially when trying to fall asleep. There are both physiological and psychological reasons for this:

Physiological: cortisol (the stress hormone) normally peaks in the morning and drops at night. For people with a dysregulated cortisol-HPA axis (common in anxiety), this pattern can be reversed or irregular. There is also a drop in other mood-regulating neurotransmitters during the transition to sleep.

Psychological: during the day, tasks, conversations, and external stimuli keep attention occupied. At night, without distractions, the brain "processes" what is left unresolved — worries that were not addressed, problems left unsolved, conflicts that get replayed.

Strategies that help: "scheduled worry time" — setting aside 15-20 minutes at the end of the day specifically to worry (and not at other times). Journaling before bed to "offload" worries from the brain. A relaxing pre-sleep routine (a warm bath, reading, meditation). Avoiding screens for an hour before bed. Breathing techniques right before lying down.