Sleep Anxiety: Is the Fear of Insomnia Causing Your Inability to Sleep?

Is the fear of insomnia causing your inability to sleep? In some people, insomnia can begin abruptly after one bad night of sleep. From there, sleep anxiety develops and becomes a nightly pattern. Worry builds as bedtime approaches, and by the time someone gets into bed, they are so worked up, they can’t fall asleep. The fear of not being able to sleep ends up driving insomnia.

After this lousy night of sleep, a negative association develops, and sleep begins to be linked with insomnia. I like this definition of negative association:


A negative association between two variables means that when one increases, the other one usually decreases.


In other words, the more that sleep gets associated with lying in bed stressed and unable to turn the brain off, the less it’s associated with rest, comfort, relaxation, and drifting off to sleep.

Marjorie’s experience with fear of insomnia*:

The fear of not being able to sleep can create a sleep anxiety that results in an inablity to sleep. Fear of insomnia can drive sleeplessness.

Marjorie is a 36-year-old working in advertising at a busy agency. Her job is fast-paced, cutthroat, and demands top-notch performance. Three years ago, soon after she started with the company, Marjorie was anxious about a presentation she had the next day. Usually, a good sleeper, she couldn’t shut her mind off and was unable to fall asleep. She kept watching the hours tick away and calculating how much sleep she could still get. The fear of doing terribly on her presentation continued to build. She finally got a few hours of sleep, but she felt awful in the morning. 


Since this night, Marjorie has been anxious about whether she will fall asleep. She needs to be at the top of her game every day, and sleep deprivation isn’t going to get her there. Marjorie has started to think about these bedtime worries throughout the day. By the time she gets in bed, she is tense and unable to settle her brain or body. Her sleep is getting worse and worse. 

*This patient example is fictionalized but demonstrative of what happens with many patients I work with.

Inability to sleep: A common cycle of insomnia

The fear of not being able to sleep can create a sleep anxiety that results in an inablity to sleep. Fear of insomnia can drive sleeplessness.

Once sleep anxiety develops, people often begin to procrastinate getting in bed. It seems easier to stay up until collapsing from exhaustion instead of facing the possibility of not falling asleep. This sleep-delaying behavior contributes to continued sleep deprivation.


To compensate for daytime exhaustion, people then drink coffee or take naps. Both of these actions can result in an inability to sleep later.


As bedtime approaches, worries about insomnia increase, and people may drink alcohol to try to relax and help them drift off easier. Unfortunately, alcohol further interferes with the ability to get quality, restorative sleep.


The insomnia cycle goes on and on until the fear itself is dealt with.

Treatment of sleep anxiety:

It’s essential to understand the source of insomnia to decide management. Obviously, if someone is drinking caffeine late in the day, or alcohol nightly, the treatment will be focused on changing the behavior.


But if the source of insomnia is fear, sleep anxiety is what needs to be targeted. If it isn’t dealt with, people often end up on long-term sleep medication. The fear of not being able to sleep is so great that people don’t want to risk ever going off it.

Treat the fear of not being able to sleep with cognitive-behavioral therapy for insomnia:

The fear of not being able to sleep can create a sleep anxiety that results in an inablity to sleep. Fear of insomnia can drive sleeplessness.

Cognitive-behavioral therapy for insomnia (CBTi) is an effective treatment for sleep anxiety. CBTi works by challenging a person’s misconceptions about sleep and dysfunctional beliefs about their insomnia that often drive the fear. It identifies behaviors sabotaging sleep (watching the time tick away) and changes negative assumptions and “catastrophic” predictions regarding the consequences of poor sleep (i.e., “if I don’t get 8 hours of sleep I will do terribly on my presentation, humiliate myself, and my job will be at risk”).

CBTi therapy will also incorporate:



Insomnia does not need to be a chronic condition, so don’t settle for a lifetime of sleep medications. Get assistance and interrupt the cycle of insomnia and sleep anxiety that leads to an inability to sleep.


Have you experienced sleep anxiety? What have you done that has been helpful to overcome this?

Don’t miss the next post to get recommendations regarding safe and successful discontinuation of sleep medication

When sleep medications are incorrectly discontinued, people may be unable to sleep and draw an erroneous assumption that it means they cannot sleep without a sleep aid. Some medicines can have dangerous withdrawal if not appropriately tapered. This article will go over some general guidelines to consider when making a plan to discontinue sleep aids.


Related posts and book recommendations:

If you are using melatonin make sure you read this: Recommended melatonin dosage for adults: You may be surprised!


Sleep and aging: What happens to our sleep and how to make it better

Oh, the joys of aging and sleep!

Insomnia in the elderly is a frequent struggle. The amount of sleep people need (and the quality of sleep) changes over a lifetime.  Sleep may be affected by genetics, mental health, physical health, and medications. These changes can be part of the normal aging process and can happen independently of medical or psychiatric illness.

Sleep and Aging: What frequently happens with insomnia in the elderly?

  • Reduce total sleep time,
  • Cause daytime sleepiness,
  • Increase the number of times you wake up after you fall asleep (reduce sleep efficiency),
  • Reduce dream (REM) sleep,
  • Cause a lighter sleep,
  • Reduce the amount of slow wave sleep so there is less restorative sleep,
  • Shift your circadian rhythm so you are sleepy earlier in the evening and wake early in the morning.


Read here for an in-depth article of everything you ever wanted to know about aging and sleep.

Treatment of insomnia in elderly individuals:

There are many treatment options for sleep problems.

Aging and Sleep Hygiene

Before medication is considered it is important to optimize sleep hygiene. Older adults can be more sensitive to environmental disruptions (ie noises and light) so try to set up your sleep space as interruption-free as possible.


Learn more about sleep hygiene by reading my post full of tips to help you sleep better: Can’t sleep? Back to basics!

Cognitive Behavioral Therapy for insomnia:

If changes in sleep hygiene don’t solve the sleep issues try cognitive behavioral therapy for insomnia (CBTi).


Worries about sleep, racing thoughts, and negative emotions may cause and perpetuate issues with sleep. CBTi can teach people how to fall asleep faster, stay asleep and feel better during the day even if you don’t have the “perfect” night sleep. The goal is to establish healthy sleep patterns so falling asleep and staying asleep become automatic and natural.


Unlike sleeping pills, CBTi helps you overcome the underlying cause of your sleep problems and can help you reduce or eliminate the need for medication. Benefits from CBTi can be sustained whereas effects of a sleeping pill are often short-term.


It is important to work with a therapist who specializes in sleep therapy. If you are having trouble finding someone in your local area or if it is more convenient to find treatment online there are several online programs that can be very helpful. See my post on CBT for insomnia for a list of online options.

Insomnia in the elderly: Are Sleep Medications Safe?What changes can happen to sleep as we age? Insomnia in the elderly is a frequent struggle. Treatment of insomnia in elderly individuals must be done carefully in order to minimize risks while improving sleep. Sleep and aging no longer need to be mutually exclusive!

If medication is necessary to treat the sleep issues a careful risk/benefit analysis with your doctor should be done first. Unfortunately, as you age you may be more at risk of side effects.


It may seem quick and easy to take a medicine for sleep, and sometimes it is necessary, but be aware of the risks. Not to sound too dramatic…… but it would be terrible if you got up in the middle of the night to go to the bathroom, fell, and broke a hip because your balance was impaired from a sleep aid!


There are several medications used for sleep known to potentially affect balance. Here are a few culprits (not a complete list): Ambien (zolpidem) and benzodiazepines like Xanax (alprazolam), Ativan (lorazepam), Valium (diazepam),  and Klonopin (clonazepam).


Sometimes people are able to get away with using a tiny dose of Benadryl or melatonin or taking a small amount of a prescription medication. However, just because medications are over the counter doesn’t mean they don’t have potential risks!


Make sure you do not drink alcohol if you take a sleep aid as the extra sedation can be even more dangerous for you. To learn more about alcohol’s effects on sleep read my blog on this topic.


Use care if you do take a sleep aid and put precautions in place that can minimize fall risks.

Insomnia in the Elderly: Take precautions when you get up during the night!

Fall precautions are a good idea regardless of whether you are taking a sleep aid or not.

  • Get up slowly from bed.
  • Create a clear path to the bathroom.
  • Remove throw rugs.
  • Get a nightlight to illuminate your path.
  • Use a cane at night to help you be more steady.


Changes in sleep quality and quantity frequently happen with aging. Make sure to take common-sense preventative steps and precautions when trying to improve your sleep.  Eliminate behaviors that could be making it worse such as drinking coffee, soda, or caffeinated tea during the day. Improve sleep hygiene and try to treat insomnia with cognitive behavioral therapy. If your sleep is still a problem discuss the risk and benefits of sleep aids with your doctor to see if a medication trial is right for you.


I recommend these products and books to help improve your sleep:

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Can’t sleep? Back to basics!

Is your sleep suffering? Can’t sleep at all? Let’s talk about sleep problems, some basic information about sleep and sleep hygiene, and how to sleep better. We often don’t make the connection between poor sleep and habits we have that interfere with it. Quality sleep is essential to feeling well. We feel lousy when we have a lack of sleep! Chronic lack of sleep can have medical consequences and make it hard to recover from an illness like depression.

How to Sleep Better: Sleep Hygiene

You may be able to improve sleep by practicing better sleep hygiene. Sleep hygiene is really about getting back to basics: minimizing disruptions while sleeping, maximizing comfort, and identifying things interfering with sleep while adding in things to improve sleep. Here is a link to a great review of sleep hygiene that will help you figure out how to improve your sleep problems.

Is your sleep suffering? You can't sleep? Let’s talk about sleep problems, information about sleep and sleep hygiene, and how to sleep better. Many of us have habits that can interfere with sleep. Quality sleep is essential to feeling well. Lack of sleep causes us to feel lousy.


How many people do you know who drink coffee later in the day or drink alcohol before bed? Read my previous posts on caffeine and alcohol’s effects on sleep to see what happens to sleep when we drink these.


There are often a lot of things we can do on our own to help get a better nights sleep.


Dr. Steph, MD is a sleep specialist and writes all about sleep.  She has a post related to sleep hygiene with great recommendations on how to sleep better: 6 Ways to Optimize your Sleep Environment.


It’s not just us adults that can use some help with our sleep. Dr. Kristen Stuppy, pediatrician, writes about sleep-deprived teens. Teens have habits (excessive cell phone use is a big one) and activities (sports, early school hours, lots of homework) that interfere with any chance of getting enough sleep. There are consequences to this sleep deprivation. “Teens are at the highest risk for falling asleep at the wheel”. She includes good sleep hygiene suggestions specifically geared towards this age group.

Sleep Problems and Sleep Cycle

There are different stages of sleep:

Is your sleep suffering? You can't sleep? Let’s talk about sleep problems, information about sleep and sleep hygiene, and how to sleep better. Many of us have habits that can interfere with sleep. Quality sleep is essential to feeling well. Lack of sleep causes us to feel lousy.
Stages of Sleep

Insomnia can involve difficulty falling asleep, difficulty staying asleep, non-restorative sleep or some combination of all of these. We need to get into a deep sleep to feel restored and rested.


There are many medical conditions (think sleep apnea) and substances that can interfere with the sleep cycle. An important part of treating insomnia is figuring out what the source of it is.

Suffering from Lack of Sleep? What are Your Sleep Requirements?

Different people require different amounts of sleep to feel well. I would LOVE it if I felt great with 5 hours of sleep but I just don’t. I know some people who feel their best at 9 hours and lousy at 8. What is your optimum amount? To understand more about your sleep need and the effects of sleep deprivation visit:

Can’t Sleep? Sleep Debt Happens

Is your sleep suffering? You can't sleep? Let’s talk about sleep problems, information about sleep and sleep hygiene, and how to sleep better. Many of us have habits that can interfere with sleep. Quality sleep is essential to feeling well. Lack of sleep causes us to feel lousy.Unfortunately, when we don’t sleep enough we accumulate a SLEEP DEBT! There are a lot of consequences to chronic sleep debt including obesity, diabetes, heart disease, memory impairment, and stroke.


Insulin resistance can be caused by not sleeping enough and is a common reason why people with sleep apnea gain weight. Untreated sleep problems can increase the risk of obesity, insulin resistance, and type 2 diabetes.


Luckily research has shown these changes in our body can be reversed by repaying sleep debt. Here is a great summary which includes suggestions on how to repay your debt.

Evaluating Sleep Problems: Epworth Sleepiness Scale

If you find yourself dragging during the day, the Epworth Sleepiness Scale is a rating scale that can determine your level of sleepiness. If you score 10 or above it is recommended you have an evaluation for a possible sleep disorder or an underlying condition affecting your sleep. Here is a link to take the test.


For other general sleep information, I recommend the Ohio Sleep Medicine Institute which maintains a fantastic website. It includes information on a plethora of sleep topics pertaining to both children and adults. Go check it out and then get to sleep!


Want more information on how to sleep better?

8 Great Options to Treat Insomnia (Without Medication)

Sleep and Aging: What happens to our sleep and how to make it better



I recommend these products and books to help improve your sleep and treat insomnia: