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Mind & Wellbeing

When Worry Keeps You Awake: Understanding Anxiety and Sleep

4 hours ago

You are exhausted. But as soon as the lights go out, your mind replays the day and rehearses tomorrow’s problems. This is not a failure of willpower. Anxiety and poor sleep feed each other in a well-documented loop. Longitudinal research suggests that improving sleep may matter more in breaking that loop than many people realise.

A study published in the Journal of Anxiety Disorders followed 3,294 adults over 18 years. It found that poor sleep was more than a symptom alongside anxiety: it helped keep the cycle going. Higher anxiety predicted worse sleep years later, and that worse sleep then predicted higher anxiety and depression further down the line.

Key Takeaways

  • Anxiety and sleep problems form a genuine two-way loop: anxiety disrupts sleep, and poor sleep worsens anxiety, according to an 18-year study of 3,294 adults.
  • In that study, poor sleep quality explained 41% of the link between earlier generalised anxiety disorder and later depression, and 11% of the reverse pathway.
  • A 2025 Institute of Mental Health study found insomnia affecting roughly 1 in 12 Singapore residents, and it was significantly linked to anxiety, psychological distress and perceived stress.
  • Cognitive behavioural therapy for insomnia (CBT-I) is recommended as first-line treatment by major sleep medicine bodies, with 70% to 80% of people with insomnia seeing improvement.
  • When anxiety itself is the main driver of sleeplessness, treating the anxiety disorder directly, alongside or instead of sleep-specific therapy, is often necessary.

The Bidirectional Trap: How Anxiety and Poor Sleep Feed Each Other

Illustration of a distressed person transforming into a calm, sleeping person through rest

The 18-year study, led by researchers including Michelle Newman at Penn State, assessed generalised anxiety disorder (GAD), major depressive disorder and sleep quality in the same adults at three points, nine years apart. Higher anxiety and depression severity at the first assessment predicted worse sleep quality nine years later. Poor sleep, in turn, predicted higher anxiety and depression a further nine years on. The researchers explained this through the “hyperarousal model” of sleep. In simple terms, chronic anxiety keeps your nervous system on high alert, making it harder to fall asleep and stay asleep. Poor sleep then makes it harder to manage mood and worry the next day.

That is why “just relax, and your sleep will sort itself out” misses half the picture. Poor sleep does not simply accompany anxiety; it can help keep it going. The researchers therefore highlighted sleep as a priority within cognitive behavioural treatment, rather than something to address only after anxiety improves.

Why This Matters in Singapore

The issue is close to home in Singapore. A 2025 study by Singapore’s Institute of Mental Health followed 597 residents through and after the pandemic. Insomnia prevalence rose from 8.24% to 8.83% between the two assessments: roughly 1 in 12 people. Mild anxiety symptoms, or severe levels of depression, anxiety or stress, were significantly associated with insomnia at both assessments. Separately, Singapore’s second national Mental Health Study (2016) found that the lifetime prevalence of generalised anxiety disorder had risen compared with the first study in 2010. It also found that up to three-quarters of people experiencing a mental health condition had not sought professional help.

What Actually Helps

Person drinking a hot beverage beside a bed, plant, cat, and open book

For ongoing insomnia, the best-supported starting point is cognitive behavioural therapy for insomnia (CBT-I). The American Academy of Sleep Medicine and American College of Physicians both recommend it as first-line treatment, ahead of sleep medication. CBT-I targets the thoughts and habits that disrupt sleep, including anxiety about sleep itself. Roughly 70% to 80% of people with insomnia see meaningful improvement. If anxiety is the main driver of your sleeplessness, treating the anxiety disorder directly may also be necessary. A qualified mental health professional can help assess whether you need anxiety treatment, such as cognitive behavioural therapy, alongside or instead of sleep-specific therapy.

What can you do in the meantime? A slow, unhurried breathing practice before bed may help calm an overactive nervous system; our guide to settling after stress explores this in more detail. Trying to force yourself to sleep, on the other hand, can heighten the very alertness keeping you awake. If sleep isn’t coming, getting out of bed briefly rather than staring at the ceiling broadly aligns with CBT-I recommendations.

Frequently Asked Questions

Does anxiety cause insomnia, or does insomnia cause anxiety?

Both. Over time, each can worsen the other. The 18-year study found that anxiety predicted worse sleep years later, and worse sleep then predicted higher anxiety. It is a two-way loop, not a one-way cause.

Is it normal to feel anxious specifically about not being able to sleep?

Yes, this is common enough that standard CBT-I protocols specifically target anxious beliefs about sleep as one of their core components, alongside sleep-schedule and behavioural changes.

Should I try melatonin or other supplements first?

Sleep medicine bodies recommend CBT-I as the first-line approach for ongoing insomnia, ahead of medication or supplements. It targets the thoughts and habits that keep sleep disrupted, rather than focusing only on symptom relief.

When should I see a professional instead of managing this myself?

If sleeplessness or worry has lasted most nights for a month or more, or is affecting your daily functioning, it is worth speaking to a doctor or mental health professional, who can assess whether CBT-I, treatment for an anxiety disorder, or both, would help most.

The Bottom Line

Anxiety and poor sleep reinforce each other, so addressing just one may not be enough. If worry keeps you awake, you don’t have to rely on willpower alone. Cognitive behavioural approaches offer evidence-based help, whether that means CBT-I for insomnia, therapy for anxiety or both.

Editorial Note

This article is intended for general educational purposes only and does not constitute medical or psychological advice. Whether CBT-I, anxiety treatment, or both are appropriate depends on individual circumstances, so consult a doctor or qualified mental health professional for an assessment. Seek prompt support if anxiety or sleeplessness is severe or affecting your safety.

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