For a long time, I’ve considered myself a reformed bad sleeper. I quit alcohol almost five years ago and it revolutionized my sleep — gone were the 3 a.m. wake ups, inconsistent sleep schedules and mornings dogged by exhaustion after a night of poor quality sleep.
Recently though, I’ve noticed that my sleep is suffering again, thanks (or not!) to nighttime anxiety. Instead of drifting off easily after climbing into bed, I’ve been left lying awake, often for hours, anxious and restless.
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Key take-aways: At a glance
- Nighttime anxiety can cause racing thoughts, elevated heart rate and increased temperatures, making it difficult to fall asleep and stay asleep
- This poor sleep then leads to more anxiety, which in turn leads to worse sleep
- The 4-7-8 breathing technique uses even, deep breathing to slow the heart and respiratory rate, calming the body and mind
- You count your breath in for four seconds, hold for seven seconds and breathe out for eight seconds
- It’s an effective way to soothe nighttime anxiety, although it does require some practice
- Other techniques to calm nighttime anxiety include a structured sleep routine, cooler bedroom, and the 15-minute sleep rule
What is nighttime anxiety?
It appears I’m not alone in experiencing nighttime anxiety. In a survey from the American Academy of Sleep Medicine (AASM) 68% of Americans reported losing sleep as a result of anxiety, while a UK survey found that 79% of people struggle to switch off at bedtime.
When anxiety kicks off, the brain boots up the alarm system… the precise opposite of what sleep needs
Darwall-Smith
For myself, I’ve found that when I get into bed, my mind begins to race with worries. I’m hyper-alert, almost nauseous, and can feel my heart rate rising. And it’s an ongoing cycle. No sooner have I finished ruminating over one problem when another takes its place.
I’ve tried everything: adjusting my sleep position, snuggling under the covers, lying half out of the covers, repeating calming mantras and even box breathing. All to no effect.
“When anxiety kicks off, the brain boots up the alarm system,” Heather Darwall-Smith, UKCP psychotherapist specializing in sleep, tells me. “Stress hormones cortisol and adrenaline flood the body, heart rate ratchets up, core temperature rises, and the brain shifts into high alert, all of which is the precise opposite of what sleep needs.”
Dr. Carleara Weiss, PhD, sleep science advisor at Aeroflow Sleep, adds that nighttime anxiety “delays sleep onset, increases sleep fragmentation, and worsens sleep quality.”
And though I do eventually drop off at some stage (I assume my brain exhausts itself), I typically wake up groggy after a night of fragmented sleep.
Darwall-Smith explains this creates a feedback loop: “Poor sleep makes anxiety worse and then anxiety makes sleep worse.”
Dr. Weiss adds that nighttime anxiety is not a standalone medical diagnosis. “[It] is often part of other disorders such as insomnia and may present in people with anxiety disorders, depression, and PTSD,” she notes.
What I tried and why it worked
One night while stuck in a loop of anxiety, I remembered the 4-7-8 breathing technique. It’s a deep breathing exercise, like the tried-and-abandoned box breathing method, except in this case you count your breath in for four seconds, hold for seven seconds and breathe out for eight seconds.
I decided to give it a go during a particularly bad bout of nighttime anxiety and, while it seemed unnatural at first, after a few rounds I could feel the benefits of the technique. The tension in my body eased and a feeling of calm began to emerge.
In fact, I fell asleep quickly after using the 4-7-8 method for just a few minutes.
Buoyed by this, I’ve used this technique on subsequent nights when nighttime anxiety has hit, and been surprised by how effective it is at helping me get to sleep.
Every time I’ve tried it, I’ve woken up to the pleasant realization that 4-7-8 breathing eased my nighttime anxiety so I could switch off and fall asleep.
What is the 4-7-8 breathing technique and how to do it
I was surprised at how well the 4-7-8 breathing method eased my nighttime anxiety, so I asked the experts what was happening.
It helps manage intrusive thoughts and overthinking, which often accompany nighttime anxiety
Dr. Weiss
The technique, Darwall-Smith explains, is rooted in “yogic breathing traditions.”
“It’s a structured breathwork practice designed to activate the parasympathetic nervous system, the body’s rest and recovery mode, which switches you out of the sympathetic nervous system, the stress response,” she says.
It was popularized by Dr. Andrew Weil and, according to Dr. Weil himself the 4-7-8 technique is “the most powerful anti-anxiety measure [he’s] ever come across.”
Dr. Weiss explains that “[it aids] sleep onset by helping the body transition from the high-stress, hypervigilant fight-or-flight state into a resting, relaxing state” and points out the breathing method has been cited in recent studies as effective.
As well as a physical response — lowering heart and respiratory rates — Dr. Weiss notes that 4-7-8 breathing manages the “intrusive thoughts and overthinking which often accompany nighttime anxiety.”
If you want to try it for yourself, Darwall-Smith has advice on using the method at home.
To begin with, she says she “always recommend[s] that someone learns and practices how to do it during the day so that they feel confident they can use it more effectively when they need it.”
Here’s her recommended approach to 4-7-8 breathing:
- Sit or lie comfortably.
- Place your tongue just behind your upper front teeth and breathe out fully through your mouth.
- Next, inhale through the nose for a count of 4, hold for 7, then exhale through your mouth for 8. That’s one cycle.
- See if you can do four cycles. The ratio matters more than the speed – if the counts feel too long, go a little faster but keep the 4-7-8 relationship.
What causes nighttime anxiety?
The experts explained that there are a wide variety of possible causes for nighttime anxiety.
Dr. Weiss says that these include “previous episodes of poor sleep, accumulated worries and stress, rumination, overthinking, feeling mentally wired and unable to relax, and chronic insomnia.”
Darwall-Smith explains that the causes of nighttime anxiety can be psychological (including generalized anxiety disorder and depression), behavioral (such as inconsistent sleep schedules, caffeine/alcohol consumption and work/relationship stress), environmental (bedroom noise and temperature) and physiological (such as hormonal shifts, chronic pain and sleep apnea).
As such, if nighttime anxiety is having a serious impact on your sleep, it’s important to always consult a doctor to understand the cause.
“I would highlight that you should consult with your primary care provider to rule out a medical diagnose and seek further guidance,” advises Dr. Weiss.
Expert tips to help combat nighttime anxiety — and fall asleep fast
While the 4-7-8 method has been effective for me, it’s useful to have set of skills in your arsenal to keep nighttime anxiety at bay. So, I asked the experts for their tips…
1. Have a nighttime routine or ‘brain reset’ before bed
At Tom’s Guide we’ve written extensively about the benefits of a nighttime routine. This expert-recommended tip involves practicing a series of relaxing activities in the lead up to bedtime to cue your brain for sleep.
Our brain… accumulates and processes a lot of information throughout the day, which drains our brain capacity, increases anxiety, and worsens sleep quality
Dr, Weiss
Dr. Weiss often recommends a “brain reset” before bed. And though she points out that this isn’t a medical term, she explains that it is guidance based on behavioral sleep medicine.
“Think about a laptop with multiple tabs open – the battery will drain out, even if you close it,” she says. “Our brain is affected by anxiety in a similar way: it accumulates and processes a lot of information throughout the day, which drains our brain capacity, increases anxiety, and worsens sleep quality and duration.”
She describes a ‘brain reset’ as time to close those metaphorical ‘tabs’ and allow our brain and body to reach the physiological changes needed for sleep, including lowering heart and respiratory rates.
Just as with a nighttime routine, Dr. Weiss says that for a ‘brain reset’ you should practice relaxation techniques for 30-60 minutes before bed. This can include the likes of breathing techniques, meditation, yoga, listening to relaxing music, journaling, or progressive muscle relaxation.
She adds that you should do this in conjunction with “reduced light exposure, no screens,” and warns you should avoid emails and work notifications during a ‘brain reset.'”
2. Use your bed wisely
Darwall-Smith explains that when you’re lying awake your bed becomes a cue for wakefulness and anxiety. It’s important to break that association, “so the brain learns bed = sleep.”
So how do you do this? The first step is to use your bed “only for sleep, sickness and sex,” the psychotherapist advises.
If nighttime anxiety is keeping you awake, get up sooner rather than later (advice that I definitely need to take.)
Similar to the 15 minute sleep rule, she says that; “if you can’t sleep after around 20 minutes, get up, go to another room and do something quiet in dim light until you feel genuinely sleepy, then return. Repeat as needed.”
“It can feel worse before it feels better, but the evidence behind it is very strong. Know that getting up doesn’t mean game over for the night.”
3. Keep the bedroom cool
Our core temperature naturally drops at night, which Darwall-Smith says is “both a prerequisite for and a signal of sleep onset.”
However, she adds that anxiety can increase body temperature.
When the sympathetic nervous system, or ‘fight or flight’ response, is activated, our increased heart rate and blood flow can cause a rise in our core temperature.
A way to help combat this, Darwall-Smith advises, is to “keep your bedroom cool.”
One 2020 study found that the ideal temperature for sleeping is in the range of 65 to 70 F (18 to 21 °C), while Darwall-Smith says that slightly cooler, approximately 61 to 65 F (16 to 18 °C), can be effective for many people struggling to sleep with nighttime anxiety.
It’s also worth considering other ways you can keep cool at bedtime.
“A warm bath or shower 1–2 hours before bed is one of the most evidence-backed sleep interventions available: it draws blood to the skin, heat dissipates rapidly, and core temperature drops as a result. Lightweight, breathable bedding helps too, particularly for those who tend to overheat,” the sleep expert suggests.
4. Be mindful of caffeine and alcohol consumption
If you’ve slept badly because nighttime anxiety has kept you awake, it’s tempting to use caffeine to help you through the day.
If nighttime anxiety is the problem, alcohol will make it worse
Darwall-Smith
But be aware that, as Darwall-Smith explains, “caffeine blocks adenosine – the chemical that builds sleep pressure throughout the day. With a half-life of 5–7 hours, afternoon caffeine is still active at bedtime for many people.”
She advises a midday cut-off as a starting point for those with sleep difficulties.
And if racing thoughts from stress are keeping you awake, don’t be fooled by the initial sedative effect of alcohol.
“Alcohol feels like a sleep aid but isn’t,” says Darwall-Smith.
“It suppresses REM sleep, fragments sleep architecture, and reliably produces anxious early-morning waking — delivering, in the second half of the night, exactly the kind of arousal it was recruited to prevent. If nighttime anxiety is the problem, alcohol will make it worse,” she emphasizes.
Instead, try a herbal tea as part of your nighttime routine.
The psychotherapist cautions they’re not a “magic solution,” but suggests that “as part of a consistent wind-down ritual, chamomile, passionflower, or valerian can serve a useful function as well as providing a moment of soothing.”
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