Why do I wake up anxious?
Part of it may be timing. A stress hormone climbs for 30 to 45 minutes after waking, nearly three times as much on work days in one UK study. Yesterday may count too.
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Why do I wake up with anxiety?
Part of the answer is timing. Cortisol is one of the stress hormones your body releases when you’re anxious. The NHS says these hormones might cause a faster heartbeat and more sweating.
Cortisol also follows a daily rhythm. It rises sharply over the first 30 to 45 minutes after waking. Experts call this the cortisol awakening response.
Source: Kunz-Ebrecht 2004
Those figures come from 196 British civil servants aged 47 to 59. The researchers linked the bigger rise to looking ahead to the working day.
Other researchers think what you expect from the day shapes the size of the rise. That’s a link, not proof the rise causes the anxious feeling.
For a week, jot down how you feel on waking and what’s on that day. The NHS says a diary may help you see why you’re anxious.
Morning anxiety symptoms
| Where you feel it | Signs |
|---|---|
| Heart and chest | A faster, irregular or more noticeable heartbeat, chest pains, breathlessness |
| Stomach | Loss of appetite, indigestion, stomach cramps, bloating, feeling sick |
| Head and body | Feeling light-headed and dizzy, headaches, sweating, feeling hot, shaking |
| Mind | Feeling tense or nervous, being unable to relax, worrying about the past or future, fear of the worst happening, not being able to sleep, difficulty concentrating |
| What you do | Finding it hard to look after yourself, avoiding places and situations that make you anxious |
Source: NHS: anxiety, fear and panic
Can’t face breakfast? Loss of appetite and feeling sick are both on the NHS list.
A sudden wave of intense fear may be a panic attack. It usually lasts 5 to 20 minutes. They can be frightening, but the NHS says they’re not dangerous and should not harm you.
If panic wakes you in the night, see panic attacks at night.
Chest pain that matches the 999 signs below needs a 999 call, not a breathing exercise.
What makes morning anxiety worse?
That’s where yesterday comes in. In 156 older US adults, feeling lonely, sad, threatened or out of control was linked to a bigger cortisol rise next morning. The study measured cortisol, not anxiety.
Caffeine matters too. The NHS says lots of coffee, tea, cola or energy drinks can disrupt your sleep and make anxiety harder to control. See when to stop caffeine.
Short on sleep most nights? You may feel tired, irritable or less able to cope. Waking early and not getting back to sleep is a sign of insomnia.
An overactive thyroid can cause nervousness, anxiety and irritability and trouble sleeping. A blood test can often check for it. See blood tests for anxiety.
How to stop morning anxiety
Six NHS steps for anxious mornings
- Before you go to sleep, write a list of the things you need to do the next day.
- On waking, breathe in through your nose and out through your mouth, counting to 5 each way, for at least 5 minutes.
- Set small targets for the morning that you can easily achieve.
- Don’t drink lots of coffee, tea, cola or energy drinks.
- Get active: running, walking, swimming and yoga can reduce anxiety and stress.
- Set a daily worry time, at the same time each day, to go through your concerns.
Sources: NHS: breathing exercises; NHS: GAD; NHS: anxiety, fear and panic; Every Mind Matters; Every Mind Matters: sleep
The breathing works best if you do it regularly, not only on bad days.
Dreading one thing, like a meeting? The NHS says not to avoid situations that make you anxious. Instead, slowly build up time in them to gradually reduce anxiety.
Eat regular meals, too. The NHS says they keep your energy levels stable. For more ideas, see overthinking and natural remedies for anxiety.
Could it be GAD or depression?
Most people feel anxious sometimes. It’s more likely to be generalised anxiety disorder (GAD) if you feel anxious most of the time and it affects your everyday life.
A GP may diagnose GAD if you often worry about lots of things, it affects your daily life and you find it hard to control. You’ll also have felt anxious a lot of the time for at least 6 months.
Depression can show up in the morning too. Its signs include waking up very early, feeling anxious or worried, and continuous low mood.
How the NHS usually treats ongoing anxiety
- 1
Refer yourself
To NHS talking therapies, if you’re 18 or over (16 in some areas) and registered with a GP.
- 2
Talking therapy
Usually cognitive behavioural therapy (CBT), which changes unhelpful thoughts and habits.
- 3
Medicine
Usually an SSRI, a type of antidepressant. A GP will usually suggest talking therapy first.
- 4
Specialist team
A GP may refer you to a community mental health team.
Sources: NHS: GAD; NHS talking therapies
Treatment can help you manage symptoms, but it may take time. Never stop or change a prescribed medicine without your prescriber.
When to speak to a GP
Book an appointment if:
- You’re struggling to cope with anxiety, or the things you try are not helping.
- You think you might have GAD: you feel anxious most of the time and it affects your everyday life.
- You have signs of depression, like waking very early or low mood, most of the day, every day, for more than 2 weeks.
- You have signs of an overactive thyroid, like nervousness, a fast or irregular heartbeat, trembling or weight loss despite eating more.
- You can’t tell if shortness of breath is from anxiety.
Call 999 if you get sudden pain or discomfort in your chest that does not go away. It can feel like squeezing, pressure, burning or indigestion. Call too if it spreads to your arm, neck, jaw, stomach or back, or comes with feeling sweaty, sick, light-headed or short of breath.
Need urgent help for your mental health? Call 111 and choose the mental health option. Call 999 or go to A&E if you do not feel you can keep yourself or someone else safe.
Samaritans answer on 116 123, day or night.
See also cortisol and sleep and anticipatory anxiety.