How do I stop waking up with anxiety?

Falling asleep when your head is whirling with anxious thoughts is hard enough. But waking up with anxiety? That can be just as difficult. If “jumping out of bed” feels more like dragging yourself out of bed, know that you’re not alone. There are things you can do to help ease those early morning (or even middle of the night) worries.

First things first, what is anxiety?

Anxiety is a feeling of physical, mental, or emotional stress. When you’re anxious or stressed, you might feel physical or mental sensations like:

• Increased heart rate
• Difficulty breathing
• Tense muscles
• Sweating
• Worry
• Digestive issues
• Repetitive worries

These sensations can feel uncomfortable and downright annoying, but any of these feelings are a completely normal, even protective, reaction to a stressful situation.

And of course, there’s some science behind it: when you encounter a stressor (environmental or psychological), your body releases chemical messengers (the stress hormonescortisol and adrenaline) that help your body prepare to face a dangerous situation. Blood flow increases; blood pressure rises; sugars are released into the bloodstream; your digestive system slows.

The result? A boost in energy, stamina, and focus—exactly what you need to face a temporary stressor like say, prepare for an exam or fend off a mountain lion. Unfortunately, some of us feel the effects of stress and experience anxiety even when the stressor isn’t there.

What’s the difference between feelings of anxiety and an anxiety disorder?

Feelings of anxiety (also known as stress) typically go away once the external cause is resolved.

Anxiety disorders, on the other hand, are characterized by persistent anxious thoughts and symptoms that happen even in the absence of a stressful event or out of proportion to the stress at hand. They are common (roughly 40 million Americans, or 18.1% of the population, will experience an anxiety disorder in a given year) and treatable.

There are five major types of anxiety disorders:

1. Generalized anxiety disorder (GAD): characterized by excessive anxiety and worry (apprehensive expectation) occurring more days than not for at least six months
2. Panic disorder (PD): characterized by recurrent, unexpected panic attacks (defined as abrupt surges of intense fear or discomfort that typically peak within a few minutes)
3. Social anxiety disorder: characterized by the intense anxiety or fear of social situations in which one may be exposed to scrutiny (e.g., conversations or interactions with unfamiliar people), observation (e.g., eating or drinking in front of others), or performance (e.g., giving a speech)
4. Agoraphobia: characterized by a fear of situations where escape may be unavailable or difficult (this fear can manifest in public transportation, open or closed spaces, lines or crowds, etc.)
5. Specific phobia: characterized by a persistent, excessive fear triggered by a specific object or situation — think heights, certain animals, seeing blood, flying, etc.

While symptoms may vary depending on the type of anxiety, they can generally be characterized as physical, mental, or behavioral:

Physical symptoms:

• Cold, sweaty hands as well as feelings of numbness/tingling
• Racing heart
• Breathing rapidly (hyperventilation) and/or trembling
• Shortness of breath
• Dry mouth

Mental symptoms:

• Repetitive worries
• Excessive worry
• Feelings of panic and fear

Behavioral symptoms:

• Difficulty concentrating
• Inability to sit still
• Difficulty sleeping

While some anxiety in daily life is to be expected—and beneficial, even, since it helps us recognize and respond to potentially threatening situations—anxiety disorders are marked by symptoms that can negatively impact one’s overall well-being, impact professional and personal relationships, and make it difficult to function and get through the day.

What causes morning anxiety?

Morning anxiety isn’t a medical term, and it can occur in people with or without an anxiety disorder. For most of us, morning anxiety is caused by an upcoming stressor like a hard day at work, a big presentation, or a social/romantic engagement.

There may also be hormonal culprits behind early-morning anxious feelings—remember the stress hormonecortisol that’s behind our fight or flight response? Scientists think there’s also a link between anxiety and cortisol levels upon waking. Cortisol levels ebb and flow over the course of a 24-hour period and seem to increase dramatically within the first 45 minutes of waking.

This morning spike in cortisol is known as the cortisol awakening response or CAR. Scientists are still figuring out exactly how CAR affects our health, but some studies have found that individuals who experience more daytime stress will see a higher spike in morning cortisol than those who have less stress.

It’s important to remember that regardless of the cause, if anxiety levels start to interfere with your daily life, it’s time to seek help from a mental health professional.

How can I stop waking up with anxiety?

Fortunately, there are various treatment options in our mental health toolkit to help ease symptoms of morning anxiety.

Lifestyle changes

Regular exercise

Exercise isn’t just good for your heart and muscles, it’s also good for your brain. Scientists have found that regular exercise is linked with positive changes in your brain and nervous system that ultimately protect against and reduce the negative effects of stress and anxiety.

How can you reap the stress-relieving benefits of exercise? Choose a routine that you can stick with. Whether it’s a high-intensity workout like running sprints, a brisk walk, or even yoga—aim for about 30 minutes of exercise a day.

Diet

While diet alone won’t cure anxiety, good nutrition can help support your energy levels and brain health, both of which are beneficial for coping with anxiety and negative thoughts (not to mention supporting your physical health, too).

Here’s what’s recommended:

• Eat a high-protein breakfast to keep energy and blood sugar levels steady throughout the day. Symptoms of low blood sugar or hypoglycemia can mimic those of anxiety.
• Fill up on complex carbs (beans, oatmeal, sweet potatoes, whole wheat bread) to support the brain’s serotonin levels (AKA your ‘happy hormone’).
• Drink water to stay hydrated and limit or avoid alcohol which can interfere with sleep.
• Limit or avoid caffeine, especially on an empty stomach since this can cause feelings of jitteriness and nervousness that may interfere with quality sleep and make it difficult to get up in the morning.

Mindfulness and self-care

There are various mindfulness tactics that can help support healthy cortisol production. And remember, there’s no need to commit to them all.

In fact, we recommend starting small—try just one item from the list below for a few weeks and see how you feel.

• Minimize screen time before bed and upon waking up. You’ve probably heard this one before, but excessive use of screens is linked with poor stress regulation. What does that mean exactly? When faced with everyday stressors, your body may have a heightened response which can have negative impacts on your health.
• Spend time outside in nature. Spending time outdoors has been found to help ease stress and reduce cortisol levels.
• Cultivate a mindfulness meditation practice. This time-tested calming technique aims to settle racing thoughts with two basic steps: attention and acceptance. There are several ways to practice, but the most straightforward is focused on the way you observe your thoughts:
• Focus your attention on the present moment. Notice any emotions you’re feeling, as well as any physical sensations. Don't pass judgment on these observations (i.e. “I can’t believe I’m shaking again! This is so embarrassing!”) Simply observe.
• If you find your mind wandering or fixating on future worry, try to center your observations on your breath. Notice each inhale and exhale.
• You can try widening your focus out to your entire body again, noticing how your feelings and emotions change from moment to moment.

Anxiety treatment

Therapy

The idea that there are better ways to think about our feelings is the core concept behind cognitive behavioral therapy (CBT), which focuses on how thoughts, feelings, and behaviors influence each other.

The goal: recognize when thoughts might become troublesome and be able to employ techniques to effectively redirect those thoughts.

Medication

If diagnosed with an anxiety condition, your healthcare professional will perform bloodwork to rule out any other medical conditions (e.g., hypothyroidism) that may be contributing to your symptoms. You’ll also receive a psychological evaluation from a mental health specialist to discuss family history of anxiety or depression, symptom severity/frequency, and other social stressors.

If diagnosed, your psychiatrist may prescribe anxiety medications to help manage your symptoms.

At Talkiatry, our psychiatrists focus on long-term treatment success, which is why anti-anxiety medications that provide temporary relief are only recommended as a short-term measure to alleviate symptoms when starting the treatment process. We instead utilize medications that have demonstrated long-term success in treating anxiety symptoms, including SSRIs, SNRIs, and tricyclic antidepressants.

Not all of these medications will be appropriate for everyone with anxiety. Some people may require just one medication, while others may manage their symptoms best with two complementary medications. If you don’t respond to one medication, it’s possible you’ll respond to another, which is why it’s important to work with a provider, like a psychiatrist, who can tailor your treatment to your specific needs.

Struggling with anxiety and not sure where to start?

The first step in treating anxiety is getting a proper anxiety disorder diagnosis from a qualified mental health professional, like a psychiatrist. Unfortunately, many people with anxiety disorders don’t take this critical first step. They don’t realize that they have a medical condition for which many treatment options exist.

With Talkiatry, you can see a psychiatrist from the comfort of your home and you can schedule your first appointment in a matter of days.

If you believe you have an anxiety condition (or are not sure), start by taking our free, easy assessment and see if Talkiatry is a good fit and get matched with a psychiatrist that meets your needs and takes your insurance.

The information in this article is for informational and educational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.

Sources:

NIMH » I’m So Stressed Out! Fact Sheet | NIMH

Table 3.15, DSM-IV to DSM-5 Generalized Anxiety Disorder Comparison - Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health | NCBI

Table 3.10, Panic Disorder and Agoraphobia Criteria Changes from DSM-IV to DSM-5 | NCBI

Table 16, DSM-IV to DSM-5 Social Phobia/Social Anxiety Disorder Comparison - DSM-5 Changes | NCBI Bookshelf

Table 3.10, Panic Disorder and Agoraphobia Criteria Changes from DSM-IV to DSM-5 | NCBI

Table 3.11, DSM-IV to DSM-5 Specific Phobia Comparison - Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health | NCBI

Anxiety Disorders: Types, Causes, Symptoms & Treatments | Cleveland Clinic

Prospective Associations Between the Cortisol Awakening Response and First Onsets of Anxiety Disorders Over a Six-Year Follow-up – 2013 Curt Richter Award Winner | PMC

Cortisol on Circadian Rhythm and Its Effect on Cardiovascular System | PMC.

Effects of Exercise and Physical Activity on Anxiety | PMC

Coping with anxiety: Can diet make a difference? | Mayo Clinic

Generalized Anxiety Disorder and Hypoglycemia Symptoms Improved with Diet Modification | PMC

Associations between Nature Exposure and Health: A Review of the Evidence | PMC