What the evidence says about Anxiety and Sleep

Anxiety and sleep problems are closely linked, and the relationship runs in both directions. Insomnia is one of the most common symptoms reported in anxiety disorders. At the same time, poor sleep predicts the later development and worsening of anxiety. This two-way pattern appears in cohort studies that follow people over time, where sleep problems at one point predict anxiety later, and anxiety predicts sleep problems later.

The treatment with the strongest evidence for chronic insomnia is cognitive behavioral therapy for insomnia, known as CBT-I. Major sleep guidelines, including those from the American Academy of Sleep Medicine, recommend CBT-I as the first-line treatment for chronic insomnia. Trials show CBT-I improves sleep, and a growing body of evidence finds it also reduces anxiety symptoms when the two conditions occur together. Treating sleep directly, rather than assuming it will resolve once anxiety is treated, appears to help.

Medication for sleep alone, such as sedative-hypnotics, can produce short-term sleep improvement but doesn't reliably address the underlying anxiety, and some sleep medications carry their own dependence and next-day-impairment concerns.