Anxiety at Night: Why It Happens and How to Handle It

By Jill Kapil, Psy.D.
Medically reviewed checkmarkMedically reviewed
July 25, 2022

It’s normal to feel nervous or worried from time to time, and certain lifestyle factors and stressful events can contribute to this. 

However, if you regularly experience anxiety at night, something more serious may be going on.

In this article, I’ll explain why nighttime anxiety happens, as well as its symptoms, causes, and treatment options. 

I’ll also discuss coping strategies you can try and when to see a healthcare provider.

Why Does Anxiety Happen at Night?

Anxiety may occur at night for several reasons:

  • For many people, the lack of distractions in the evening means it is easy to ruminate on negative or unhelpful thoughts, or to worry about things happening the next day.
  • If you have insomnia, you might feel anxious about not being able to fall asleep. You may also worry about the short- or long-term effects of inadequate sleep.
  • Some people experience anxiety related to health concerns. For example, when you sit or lay for extended periods of time—which is common at night—you’re more likely to notice aches and pains, and this can trigger health anxiety.
  • People with certain conditions are more likely to experience anxiety at night. For example, research has found that people with post-traumatic stress disorder (PTSD) often experience rumination and anxious thoughts at night.
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Symptoms 

Symptoms of anxiety include:

  • Irritability
  • Trouble concentrating
  • Restlessness
  • Feeling worried
  • Fatigue
  • Sleep problems
  • Headaches 

If you have anxiety at night, you might also experience:

  • Rumination
  • Nightmares
  • Panic attacks
  • Insomnia 

Causes

It’s unclear exactly what causes anxiety disorders. 

Anxiety may be related to underlying medical conditions, and it can be a side effect of some medications. 

There also may be a genetic component to anxiety, and of course life events may also  trigger anxiety. 

All of these things can also contribute to nighttime anxiety.

Potential medical conditions 

While they don’t appear to be the sole cause of anxiety at night, the following medical conditions may be a factor: 

Treatments

If you have nighttime anxiety, medications, therapy, lifestyle changes, or a combination of these may help. 

Talk to a healthcare provider, who can help you determine the best treatment plan for you.

Medication

Medications to treat anxiety include: 

  • Selective serotonin reuptake inhibitors (SSRIs): SSRIs treat depression and anxiety. Examples include fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft).
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs): These medications treat depression, anxiety, OCD, and other mood disorders. Examples include desvenlafaxine (Pristiq), duloxetine (Cymbalta), and levomilnacipran (Fetzima).
  • Benzodiazepines: These are sedative medications used to treat anxiety, seizures, and insomnia. Examples include alprazolam (Xanax), clonazepam (Klonopin), and diazepam (Valium).
  • Antipsychotics: These medications are used to treat schizophrenia, psychosis, and anxiety. Examples include aripiprazole (Abilify), asenapine (Saphris), and cariprazine (Vraylar). 

If anxiety at night makes it hard for you to sleep, your provider may also prescribe a sleep aid. 

While these may help you fall asleep, they won’t treat the root cause of the anxiety. 

You may need to take anti-anxiety medication as well. 

Therapy

Talk therapy can help you understand nighttime anxiety and learn coping strategies to manage your symptoms.

Common forms of therapy include psychotherapy and cognitive behavioral therapy (CBT). 

CBT has been shown to be particularly effective. It helps you understand your thoughts and learn how to manage them by reframing into healthier beliefs.

Other Remedies

If your nighttime anxiety is mild, you may be able to manage it with natural remedies

The following can also be useful additions to a medication and therapy treatment protocol:

  • Dietary changes: Reduce the amount of caffeine you drink, especially after noon. Also avoid foods that make you jittery in the evenings, such as sugary and highly processed foods.
  • Exercise: Getting a bit of physical activity every day may help you sleep better at night, and a 2018 study found that aerobic exercise and high intensity exercise may reduce anxiety levels.
  • Routine: Creating a daily evening routine can help your brain recognize that it’s time for bed. Try eliminating screens an hour or two before bed, drinking a cup of tea, and taking a warm shower or bath. It really doesn’t matter what you do—it just matters that you do it consistently.
  • Relaxation: Guided breathing exercises, journaling, meditation, and progressive relaxation exercises may help reduce stress and anxiety. 
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When to See a Medical Provider

If you have persistent anxiety symptoms at night that impact your functioning, contact your medical provider. 

They can evaluate your symptoms and suggest treatment methods that can help.

How K Health Can Help 

Want mental health support?

K Health offers anxiety medication for the right candidates.

Get connected to care in minutes.

K Therapy offers free smart chats, which are dynamic, pre-written conversations designed by experts that cover a number of common mental health topics such as depression, anxiety, stress, relationships, and more. Access them for free by downloading the K Therapy app.

Online therapists are also available in select states for individualized care.

Connect with a licensed mental health therapist for unlimited asynchronous text-based therapy. Therapists respond Monday through Friday between 9am-5pm, within 24-hours.

Frequently Asked Questions

Why do I get anxiety at night?
Some people experience nighttime anxiety because the lack of distractions makes it easy to ruminate on negative thoughts and worry about the next day’s tasks. This can make it hard to sleep, which in turn can cause more anxiety.
How can I overcome night anxiety?
Coping strategies such as avoiding caffeine after noon, relaxation techniques, and having an evening routine may help reduce nighttime anxiety. If your symptoms persist, talk to a medical provider.
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Jill Kapil, Psy.D.

Dr. Jill Sorathia Kapil is a Licensed Clinical Psychologist in California. She completed her undergraduate degree in Psychology with a minor in Education from the University of California, Irvine; and received her Doctorate in Clinical Psychology from CSPP, San Diego (California School of Professional Psychology). Dr. Kapil completed her predoctoral and postdoctoral training at various College/University Health Centers across California, and has been licensed as a Psychologist since 2016.

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