Nighttime anxiety: Why it gets worse at night–and what you can do about it

What Is Nighttime Anxiety?

Nighttime anxiety refers to anxiety symptoms that feel more intense or distressing right before or during bedtime, making it hard to fall asleep or stay asleep.

It is not a specific diagnosis in the DSM-5, the official manual clinicians use to diagnose mental health conditions. Instead, “nighttime anxiety” describes when anxiety or panic symptoms tend to spike for certain individuals. “It’s a way to describe this pattern of symptoms,” says Kate Hanselman, a board-certified psychiatric mental health nurse practitioner at Thriveworks.

Everyone experiences racing thoughts before sleep occasionally or feels so stressed that they toss and turn. One night of poor sleep can throw you off, but you usually bounce back once the stress eases. There’s science behind this: “We have a biological predisposition to not necessarily feel more anxious, but be a little more keyed up in the evening,” Hanselman says. This heightened alertness is “advantageous from an evolutionary perspective.” Early humans needed sharp eyesight and hearing around the fire at night to stay safe from any lurking predators.

Today, you don’t need the threat of a saber-toothed tiger to feel anxious as darkness falls. And when nighttime anxiety becomes your norm, it’s a problem because it disrupts your sleep. For those who also experience panic attacks in the evening or during sleep, this can lead to a fear of going to bed, says Thomas Uhde, MD, chair of the department of psychiatry and behavioral sciences at the Medical University of South Carolina.

Are Nighttime Panic Attacks More Serious Than Daytime Panic Attacks?

Yes, nighttime panic attacks can potentially be more serious if you’re experiencing sleep panic attacks, which is a more precise term for panic attacks that jolt you awake, Dr. Uhde says. (The broader term “nocturnal panic attack” can refer to any panic attack occurring at night, even if you’re awake.)

Dr. Uhde explains that nocturnal panic attacks become more concerning when they cause excessive daytime sleepiness. “Not everybody who has sleep deprivation has a cognitive awareness of how it impairs their thinking and ability to function,” he says. This impairment can lead to serious consequences, such as car crashes or work-related accidents.

To understand this better, it’s important to know what panic disorder involves. According to the National Institute of Mental Health (NIMH), people with panic disorder experience sudden, unexpected waves of intense anxiety and fear, often lasting several minutes. Physical symptoms—like a racing heart, trembling, sweating, difficulty breathing, chest pain, and dizziness—can feel very similar to a heart attack.

The symptoms of daytime and nighttime panic attacks are largely the same. Dr. Uhde notes that most people who have sleep panic attacks also experience them during the day. In fact, some studies suggest that up to 71% of people with panic disorder have nocturnal symptoms at least once. However, research on isolated sleep panic attacks is limited, so we don’t yet know if the timing makes one type more dangerous than the other.

Another key point: Sleep panic attacks are often confused with nightmare disorders or trauma-related nightmares, but they are different, Dr. Uhde says. Recurring nightmares usually occur during REM sleep, which is associated with vivid dreaming. In contrast, sleep panic attacks typically happen during the first two to three hours of sleep, when the body transitions from lighter to deeper sleep stages.

“It’s occurring during a transition toward increased relaxation,” Dr. Uhde explains. “So just like people with wake panic attacks develop a conditioned fear of the situations in which [the attacks] occur, the person with sleep panic attacks develops the same conditioned fear. They become frightened of going to sleep, particularly the deeper levels of sleep.”

What Causes Nighttime Anxiety and Panic Attacks?

Nighttime anxiety and nocturnal panic attacks can be triggered by a combination of genetics, lifestyle, environment, and underlying health conditions. Here are the most prominent causes:

1. Family History

A family history of panic disorder or anxiety increases your risk, though scientists don’t fully understand why some relatives develop these conditions while others don’t. Experts have identified several genes that may contribute to susceptibility, but clear genetic markers remain elusive. Still, having a first-degree relative, like a parent or a sibling, with panic disorder raises your risk by about 40%.

2. Stress

Chronic or unresolved stress is a major contributor to nighttime anxiety. If you don’t release some steam during the day, it’ll screech like a kettle at night. Many people distract themselves from worry during the day, only to have anxious thoughts surface at night when things quiet down, Hanselman says. 

3. Trauma

While trauma-related nightmares (when a person relives aspects of a traumatic experience while sleeping) and sleep panic attacks are distinct, the aftermath of trauma can heighten nighttime anxiety, Dr. Uhde says. Experiencing emotionally or physically distressing events, such as a life-threatening accident, abuse, or natural disasters, can keep your body on high alert—especially at night. “People say, ‘You’re scared of the dark.’ That’s not accurate,” Hanselman says. “It’s that you’re scared in the dark.”

4. Poor Sleep Habits and Sleep Disorders

Disrupted sleep patterns, insomnia, or conditions like sleep apnea can increase the risk of nocturnal panic attacks. These disorders can cause awakenings that trigger anxiety or panic, creating a cycle where poor sleep and anxiety feed into each other.

5. Doomscrolling and Screen Time

If you know you’re prone to feeling anxious or panicky before bed, staying glued to your phone up until the second your eyes close isn’t doing you any favors, Hanselman says. For starters, our devices emit blue light that disrupts sleep.

On top of that, “screens are addictive,” Hanselman says. “Your brain is so tired at the end of the day. It doesn’t have a lot of energy left.” Meaning, consuming stressful headlines or scrolling through TikTok videos that trigger FOMO may make your anxious brain feel substantially worse.

6. The Vicious Cycle of Anxiety and Sleep

Nighttime anxiety and poor sleep are often locked in a cycle that’s hard to break. As Dr. Uhde describes, this is a positive feedback loop: Anxiety makes it difficult to fall or stay asleep, and lack of sleep, in turn, intensifies anxiety.

Over time, you may start to associate your bed with worry and restlessness rather than relaxation and rest. “Lying in bed becomes anxiety-provoking because you’re worrying about what’s going to happen tomorrow while you’re exhausted instead of sleeping,” Hanselman says.

This cycle can leave you feeling more anxious each night and more fatigued each day, making it even harder to break free and get the restorative sleep your mind and body need.

How to Ease a Panic Attack at Night

There’s no instant off-switch for a nocturnal panic attack, especially when you’re jolted awake. The good news: Even though it feels overwhelming, it will end—most panic attacks peak within 10 minutes.

Here are steps you can take to help calm yourself as the symptoms gradually fade:

Step 1: Get out of bed.

If you can do so safely, stand up and walk around slowly. Since your body is flooded with adrenaline during a panic attack, gentle movement can help those levels subside.

Step 2: Distract yourself.

Try the 333 rule: name three things you can see, three things you can hear, and three things you can touch. This helps shift your focus to your surroundings instead of your symptoms. Other grounding techniques include counting backward from 100 or reciting the alphabet backward (not an especially easy one). The goal isn’t perfection; it’s simply to get neutral information into your head.

Step 3: Take 3 slow, deep breaths.

Practice box breathing: Inhale for 4 seconds, hold for 4 seconds, exhale for 4 seconds, and hold again for 4 seconds. Focus on your breath and repeat three to five times, or until you feel steadier. For extra support, follow along with a visual guide like this video.

Step 4: Give yourself a pep talk.

Remind yourself that you will get through this. Use affirmations such as, “I’ve survived similar situations and I will be okay,” or “This will pass.”

Step 5: Don’t rush getting back in bed.

Your bed should be a place of rest. Wait until you feel calmer and sleepier before returning to bed.

How to Prevent Nighttime Anxiety and Panic Attacks

The most effective way to keep nighttime anxiety in check is to proactively manage your mental health. This means making realistic (truly) lifestyle changes, prioritizing sleep hygiene, and connecting with your healthcare provider or a therapist for extra support, if needed. More specifically:

1. Set yourself up well during the day (i.e., stick to the basics you already know)

There’s a reason you’ve heard these healthy habits a hundred times: They’re proven to work. If you’re struggling with regular nighttime anxiety, try to incorporate these practical steps into your daily routine as much as you realistically can:

• Move your body in a way that feels good for at least 15 minutes. Bonus points if you can get outside, enjoy nature, and breathe in some fresh air.
• Eat balanced, nutritious meals to help keep your energy and mood stable.
• Take breaks when you feel overwhelmed. Step away from stressful situations when you can, and give yourself permission to reset, even if it’s just for a few minutes.
• Commit to one relaxing activity each day. This could be playing your favorite music while you cook, focusing on your breath in a warm shower, or reading a book instead of scrolling on your phone. Choose something that helps you unwind and feel more present.
• Talk to someone you trust when you need support. Sharing your thoughts with a spouse, parent, friend, or sibling can ease worries and help you see things from a new perspective.

No routine is perfect, and some days will be harder than others. The key is to keep coming back to these basics—they’re the foundation for better nights and brighter mornings.

2. Dissect your sleep routine.

Take a close look at the habits that might be making your nighttime anxiety worse. “Sleep hygiene is a great place to start,” Hanselman says. Dr. Uhde agrees, noting that people with panic disorder and a fear of sleep often have “extraordinarily poor” sleep hygiene—like keeping the TV or lights on to feel safer. “They’re trying to prevent themselves from having sleep panic attacks, and they do that by increasing their level of arousal,” he explains.

To get a clearer picture, Hanselman recommends keeping a sleep diary. Track:

• What time you get into bed
• When you actually fall asleep and wake up
• How much exercise you got that day
• How much caffeine you consumed (and when)
• How much time you spent outside

You can also find templates online here and here. Over time, you’ll start to notice patterns that could be affecting your sleep and anxiety—like maybe you didn’t realize you were slamming coffee at 3 p.m. or only getting outdoors once a week. Use what you learn to make small, realistic changes that support better rest.

3. Seek professional support.

Both Dr. Uhde and Hanselman emphasize that you shouldn’t wait to seek help for nighttime anxiety—especially if it’s leaving you exhausted or interfering with your daily life. “Don’tt wait for it to get ‘bad enough.’ It is bad enough if you’re thinking about it and it’s bothering you,” Hanselman says. “You should be able to fall into bed and feel good about that.”

A healthcare provider can help determine if you’re experiencing panic disorder, which is diagnosed when you have recurring, unexpected panic attacks and spend at least a month worrying about more attacks or changing your behavior to avoid them—like altering your sleep routine.

Start by talking to your primary care provider, who may refer you to a sleep specialist if a sleep disorder is suspected. Working with a licensed therapist can also help you identify your triggers and develop coping strategies—your sleep diary can be a valuable tool here. Research shows that cognitive behavioral therapy (CBT), sometimes combined with medications like selective serotonin reuptake inhibitors (SSRIs), is highly effective for both daytime and nocturnal panic attacks. Your provider may discuss other medications, such as benzodiazepines, but these are not always the first choice since they can cause sedation and may make you feel less in control, which isn’t ideal for many people with anxiety.

If your nighttime anxiety is persistent or worsening, reaching out for professional support is a practical and proven step toward relief.

“Your body knows how to sleep,” Hanselman stresses. “So if you’re feeling tense or anxious, come talk to us, because it doesn’t have to be this way.”