Anxiety and Sleep: A Checklist for a Healthy Mind and Body
Getting a good night’s sleep can do wonders for your energy and mood. Poor sleep can contribute to anxiety and depression, so a healthy rest can improve your mental as well as physical health.
Use this checklist to find new strategies to improve your sleep.
Set up your environment for good sleep
- Set the thermostat between 60-67°F. Temperature may be even more important than light in natural sleep rhythms. One study of non-industrial rainforest tribes found that they went to sleep and woke up not when it got dark or light, but rather when the temperature reached a certain point.
- Wear socks to bed. Having warm feet triggers vasodilation (expansion of the blood vessels), which releases the heat in the feet to the rest of the body, and is a natural cue to the body to go to sleep.
- Limit lights, including from electronics. The best sleep often comes when the room is dark. This includes small lights from electronics.
- Remove sounds entirely, or use a quiet, constant soundscape. Even if noise doesn’t wake you up, it can decrease the quality of your sleep. Silence or turn off your phone. You can also try using looping rain soundtracks, waves soundtracks, white noise, pink noise, and brown noise. These kinds of soundtracks can be found on many websites, including MyNoise.net and Youtube.com.
- Put away visible clocks. Watching the clock when you can’t sleep only leads to heightened emotions that disrupt sleep even more.
Strategies that improve both sleep and anxiety
- Try an app that helps with anxiety. An app such as UpLift helps users relieve anxiety that can interfere with sleep. For example, UpLift helps you tackle Thinking Errors that can keep you up at night (e.g., “I’m going to be up all night and have a horrible day tomorrow”) or keep you in bed longer than is helpful (e.g., “I can’t deal with today. I’m going to bed”).
- Set some worry time. If you’re prone to worry at night, set aside some time earlier in the evening to do your worrying. Then, do your best to keep your problems out of your bed by refocusing your attention on a non-worry topic. If you cannot refocus your mind, leave your bedroom and write down a list of things to attend to in the morning. Then, return to bed.
- Increase your exercise. Exercise regularly to help deepen your sleep and make it easier for you to fall asleep. Exercise is also helpful for improving low mood. Aim to do at least 15 minutes of aerobic activity, or whatever feels comfortable to you, such as jogging, brisk walking, or playing an outdoor sport game. Do be sure to exercise no later than 4 hours before bedtime.
- Cut down on all caffeine. Caffeine can worsen anxiety as well as wake you up at night or lead to more shallow sleep, even if you have it earlier in the day. Stop consuming caffeine at least 6 hours before bedtime. Some studies have shown that even drinks labeled as “decaf” may have some remaining caffeine that could interfere with sleep. If you’re especially sensitive to caffeine, you may also want to abstain from decaf.
- Avoid alcohol within the 4 hours leading up to bed. Alcohol may help you relax and fall asleep, but it can decrease sleep quality, worsen sleep apnea, worsen anxiety, and even lead you to wake up very early or in the middle of the night. That’s because when the sedative effects wear off, there is often a rebound of activity in the brain that can cause you to wake up well before you’ve gotten enough rest.
- Avoid nicotine. Nicotine is a stimulant and promotes wakefulness and can worsen anxiety, so avoid smoking altogether, or at least more than you typically would in the 4 hours leading up to bed.
More before-bed strategies to improve sleep
- Have a light snack before bed. Avoid going to bed hungry. Have a light snack before bed if necessary. Avoid chocolate, as it has a small amount of caffeine.
- Limit drinks before bed. Avoid any more than small quantities of liquid before bed to cut down on nighttime bathroom trips. Of course, don’t put yourself in discomfort. You may find that you need to increase your water intake during the day, so as not to be thirsty at night.
- Avoid electronic media for 2+ hours before bed. Using things like phones or computers can cause sleep disturbances. This is because the blue-spectrum light in screens, which mimics the spectrum of the sun, can fool your brain into thinking the sun’s out, and disrupt the release of a chemical called melatonin in your brain, which helps to regulate your sleep cycle. One study found that reading an E-book within four hours of going to bed caused a significant delay in sleep, less restful sleep, and reduced alertness the next morning.
- Download f.lux or use night mode for your device. If you must use your computer near bedtime, turn on night mode on your device or use a free program like f.lux, which adjusts the blue-light level emitted by your screen to cue the brain that it’s nighttime. Some research suggests blue light may not affect sleep as much as previously thought, but users of these programs say they help.
Control how much you sleep
- Sleep the proper amount. Sleep only as much as you need to feel refreshed the next day. Sleeping only this much helps you sleep more deeply when you are asleep. It you’re tempted to oversleep, start stretching and get yourself out of bed.
- Try to wake up at the same time each day. Get up at the same time everyday, no matter how much you have slept. This helps set and regulate your sleep cycle.
- Nap with caution. Staying awake during the day helps you fall asleep at night, so it may be best to avoid naps, especially if you’re experiencing sleep difficulties.
When you wake up at night
- If you can’t sleep, get up and do something else. Avoid trying to fall asleep. If you can’t sleep for 15 minutes or you wake up and find yourself annoyed you are awake, get up and do something else in another room. Return when you are sleepy. Over time, this will train your body and mind to be tired when you are in your bed, instead of anxious, annoyed, and awake.
- Surprisingly, waking up a few times during the night may not be a sign of poor sleep. Recent research has shown that, until modern times, sleep was commonly thought of as occurring in two separate blocks during the night, between which people might do a variety of small tasks, such as tend the fire or write letters. Waking up once or twice during the night is probably normal, and shouldn’t prevent you from feeling rested in the morning.
- If you wake up multiple times, and have trouble falling back asleep, it’s probably a sign that something’s wrong. Repeated waking and trouble falling back asleep can be caused by a large variety of problems. It may be a bad mattress or leg cramps. It could also be caused by something in your environment, such as irregular noises or lights, or any of the sleep disturbances listed earlier. Or, it could be caused by a health problem such as nocturnal asthma or sleep apnea.
If you’re still having difficulty with sleep…
- Discuss getting a sleep study with your doctor. A sleep study is the most complete way for your doctor to learn about what’s happening when you sleep. In a sleep study, you’ll go to a sleep center and sleep there. A variety of monitoring devices will record all aspects of your body function while you sleep, so doctors can see exactly what’s happening. Sleep studies can discover medical sources of insomnia, like sleep apnea, which may not be treatable by lifestyle change alone.
- Consider seeing a CBT-I professional. Cognitive Behavioral Therapy for Insomnia (CBT-I) is recommended by the American College of Physicians and the American Academy of Sleep Sciences as the first-line treatment for insomnia, and many studies have demonstrated its effectiveness. Ask your doctor for a referral, or check out this directory of CBT-I professionals
- Consider talking to your physician about medication. There are several medications that can provide relief. While this relief can be very helpful in the short term, sleep medications have some drawbacks. Sleep issues tend to come back or even worsen when you go off medication and some decrease the quality of your sleep. Discuss your options with your doctor or a board-certified psychiatrist, who can help you determine the medication that would maximize benefits and minimize drawbacks.
If you have persistent sleep problems that don’t respond to lifestyle change and are disrupting your life, it’s a good idea to talk to your doctor about them. Tell your doctor about your symptoms, and discuss with them whether a sleep study might be warranted.