For something that seems like such a natural part of life, getting adequate sleep isn't always as easy as laying your head on your pillow, closing your eyes, and drifting off to dreamland. And there are nearly 70 million Americans who suffer from sleep disorders to prove it. Many of whom struggle specifically with sleep anxiety.

"[Sleep anxiety] is a lay term that most closely fits a diagnosis referred to as psychophysiological insomnia," says Virginia Runko, PhD, a behavioral sleep medicine specialist and psychologist in Washington, D.C. "It's characterized by physical and cognitive manifestations of anxiety that are caused by and can cause trouble sleeping." In other words, it's characterized by common anxiety symptoms that interfere with you getting sleep, including racing thoughts, worrying specifically about sleep, and dreading going to bed, fearing it will be an unpleasant experience.

While most cases revolve around a fear of not being able to sleep well, Runko says that sometimes "someone has the reverse type of sleep anxiety, where they fear going to sleep, which might be because of how sleep reminds them of death or they might feel more vulnerable when they sleep." 

Considering how important sleep is for both your mind and body, getting to the root of why you aren't getting any (or enough) is key. Here we explore what triggers sleep anxiety, how it can affect your health, and what you can do to combat it.

Common Sources of Sleep Anxiety

Sleep anxiety can often find its way into your life, thanks to genetics. "If many people in your family have anxiety and sleep problems, that can place you at a higher risk of developing it," Runko says. 

But really anyone can feel an overwhelming pressure to make sure they get good sleep—sometimes to a fault. For example, buying all the latest products on the market promising to cure insomnia; or being very rigid with your sleep habits. The irony is that these efforts or beliefs can sometimes sabotage our shut-eye. You're so worried about sleeping well, that you worry yourself into not sleeping well. "That pressure, stress, hypervigilance, and effort can ramp up anxiety," explains Runko. 

Another reason might be, "if something particularly bad happened after a poor night of sleep—that can ramp up sleep anxiety even more," she adds. And unfortunately, once your bed has been associated with things like worry and a quickened heart rate, which are essentially forms of conditioned arousal, Runko says "the bed itself can start to be a cue to automatically elicit those physical symptoms and worrisome thoughts to some degree." In other words, you might start to associate your bed and bedtime with feelings of anxiety.

Typically, the thoughts that come into your head when you lie down at night are the ones that are "unfinished business" for your mind, explains Aeva Gaymon Doomes, MD, a licensed psychiatrist in Washington, D.C. "If you cannot stop yourself from thinking about them in detail before bed, they're likely going to keep you up at night." 

While Dr. Doomes says that some pillow thoughts can be about an upcoming exciting or milestone event (think a big vacation or a reunion with a loved one), "the thoughts that are not so easy to sort out are the ones that generally lead to increased feelings of restlessness and anxiety, and the result can be insomnia." 

The Repercussions of Not Resting

The obvious: You're not getting enough sleep thanks to sleep anxiety. But that comes with more than just a morning of grogginess. "Sleep anxiety or insomnia can have devastating effects on your wellness," says Dr. Doomes, which leads to health concerns such as obesity, heart disease, increased irritability, risk of depression, trouble focusing, decreased motivation, lower energy, and suppressed immune function. "In the end, a lack of sleep can shorten your overall life expectancy."

Being anxious and unable to sleep can also lead to increased anxiety, and thus cause even less sleep—a cycle that's not only frustrating, but overwhelming. It exacerbates an already decreased ability to deal with stress in general, as well as causes feelings of "losing control" over even the simplest parts of your life, like bedtime, Dr. Doomes adds.

Strategies for Less Anxiety—and More Sleep

Pinpoint what's triggering your sleep anxiety

To counter these worrisome thoughts and feelings that inhibit your ability to snooze, Dr. Doomes says it's useful to understand the source of ongoing or recent anxiety and to employ tools that may reduce this anxiety. "Processing and thinking [objectively] about the thoughts that are keeping you up during the night, [especially] with the assistance of a therapist or counselor, may be helpful as well," Dr. Doomes says. 

Replace worry with positivity and gratitude

For example, training your mind to focus on positive thoughts and expressions of gratitude, which, she says, research has shown reduces sleeplessness. In fact, one study in the Journal of Psychosomatic Research—that included about 400 men and women, 40 percent of whom experienced sleep disorders—found that those who practiced gratitude had fewer negative thoughts at bedtime, and more positive ones, which was associated with not only falling asleep faster, but better sleep quality and duration. 

Practice healthy, stress-busting habits during the day

According to Runko, more formal treatments for anxiety include medication and psychotherapy but someone can always start with basic stress management on their own. They can brush up on better self-care, such as regular exercise, good nutrition, and good work-life balance, she says. 

Try cognitive behavioral therapy

Runko also says that first-line treatment for insomnia—before sleeping pills—is Cognitive Behavioral Therapy for Insomnia (CBT-I). "CBT-I includes some basic anxiety management techniques such as cognitive therapy and relaxation, and it also provides behavioral strategies specifically targeting how to retrain the body to sleep better, as well as a review of sleep hygiene," she says. "If someone's anxiety is mostly contained to just sleep, CBT-I alone might be sufficient. If the anxiety, however, is more pervasive and extends beyond sleep, separate treatment—CBT-I in conjunction with anxiety treatment via psychotherapy and/or medications—would probably be a better approach."

Talk to your doctor and/or a sleep specialist

At some point, if anxiety-induced insomnia is severe enough, you should seek the counsel of a medical professional who can advise you about treatments that can help you get more rest, Dr. Doomes says. Her recommendation: If you're consistently having trouble with sleep more than one or two nights a week, you should discuss medication options with your physician.

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