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Insomnia, Depression, and Anxiety: How They’re Connected

Insomnia, Depression, and Anxiety: How They’re Connected
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Updated on March 11, 2025
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Do you have trouble sleeping when you’re feeling stressed, worried, or down in the dumps? You’re not alone. Research shows that insomnia, depression, and anxiety are linked, meaning sleep problems can contribute to mental health issues and vice versa.

“There does appear to be a circular relationship between sleep health and mental health,” says David Neubauer, MD, an associate professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine in Baltimore. “Worse sleep or mental health can have a negative impact on the other.”

Learn more about how having a mental health condition that causes constant worry or stress — like anxiety or depression — can trigger persistent problems with sleep, and the other way around.

Can Insomnia Cause Anxiety or Depression?

The relationship between insomnia and mental health is bidirectional, meaning one can worsen the other and vice versa.

As with the proverbial chicken and egg, it’s not always easy to tell which came first. “Some start off with insomnia that develops into depression, while others start off with depression that leads to insomnia,” Dr. Neubauer says.

Trouble sleeping can go on to affect your mental health because it elevates your levels of the stress hormone cortisol and makes it harder to regulate emotions, according to Mirela Loftus, MD, PhD, medical director of Newport Academy, a division of Newport Healthcare that offers treatment to teenagers, young adults, and families struggling with mental health and co-occurring disorders.

“Insomnia disrupts neurotransmitters like serotonin, dopamine, and norepinephrine, increasing vulnerability to anxiety and depression,” adds Jasmine Sawhne, MD, a board-certified psychiatrist in private practice in Los Angeles.

However, just because you’re having trouble sleeping doesn’t mean you have a clinical diagnosis of depression, anxiety, or any other mental illness, nor does it mean you’ll develop one. In some cases, simply not sleeping well (in contrast to clinical insomnia) can foster rumination and worry, leading to temporary anxious or depressive thinking, according to Dr. Sawhne.

“[Not sleeping] exacerbates feelings of frustration, agitation, and tiredness,” adds Rostislav Ignatov, MD, board-certified psychiatrist and chief medical officer at the Haven Detox in West Palm Beach, Florida. “The absence of sleep also increases the body’s response to stress.”

Sleep problems also increase your risk of developing conditions like depression, anxiety, or bipolar disorder.

 In fact, about 40 to 50 percent of people with insomnia also have a mental health disorder.

If you have insomnia, you may notice additional symptoms that could be early warning signs of compromised mental health:

  • Feeling sad or depressed
  • Lack of interest in usual activities
  • Lack of appetite or overeating
  • Fatigue
  • Stress and anxiety
  • Feelings of worthlessness
  • Difficulty concentrating
  • Irritability
  • Recurrent thoughts of death

“Early consultation may prevent significant future impairment,” says Neubauer. “A healthcare professional will help with education about good sleep habits and may recommend cognitive behavioral therapy for insomnia or possibly the use of medication.”

Can Anxiety or Depression Cause Insomnia?

Everyday symptoms of stress and anxiety can cause sleep problems for anyone, even if it’s not clinical insomnia. That’s because they trigger hyperarousal — think elevated heart rate, tense muscles, and racing thoughts — which can make it difficult to fall and stay asleep, says Sawhne.

“Ideally, stressful situations resolve quickly and the associated anxiety and sleep disturbance rapidly improve,” says Neubauer.

Clinical depression, anxiety, bipolar disorder, and post-traumatic stress disorder have all been linked to sleep disturbances, including insomnia.

 In fact, about 50 percent of insomnia cases are related to depression, anxiety, or stress.

 Sometimes, though, you may still have trouble sleeping even after you’ve addressed the underlying cause, Neubauer says. Worrying about sleep difficulties can become a self-fulfilling prophecy that leads to more insomnia, he explains.

In any of these cases, it’s best to speak with your doctor to address any underlying mood disorders or symptoms that could be contributing to your sleep difficulties, says Dr. Ignatov.

4 Tips for Breaking the Insomnia-Depression-Anxiety Cycle

Whether insomnia is causing a mental health problem or vice versa, either can make the other worse. That means if you had trouble sleeping, it persisted, became insomnia, and as a result you developed a problem with depression, that depression can in turn worsen your sleep problems.

Similarly, while anxiety can cause sleeping problems, sleeping problems can also worsen anxiety, leading to a negative cycle.

The flip side is that addressing one of the problems (likely the one you started experiencing first) can help the other one go away, too.

To help, here are expert-recommended tips for breaking the insomnia-depression-anxiety cycle:

1. Optimize Your Sleep Environment

Practicing good sleep hygiene (healthy sleep habits) is crucial for getting quality rest, which helps mitigate your risk of developing sleep problems, says Sawhne.

“Sleep hygiene — in addition to addressing any mental health issues — is key to breaking the cycle,” says Dr. Loftus. “This may include creating a sleep-friendly environment and limiting stimulants and disruptive habits like caffeine and screen time before bed.”

2. Maintain a Regular Sleep Schedule

Good sleep hygiene means keeping regular bedtime and wake-up hours, getting an adequate amount of sleep, developing a relaxing evening routine, avoiding caffeine in the afternoon and evening, and refraining from alcohol.

 This routine can cue your brain that it’s time for bed, says Sawhne.
But if you find yourself tossing and turning in bed, don’t lie there for hours. Instead, get up and do something soothing like meditating, yoga, or listening to calm music.

“Avoid extended time in bed while [you’re feeling] frustrated and worrying,” adds Neubauer. He suggests writing down your worries so you don’t have to think about them in bed.

3. Consider Therapy

Cognitive behavioral therapy for insomnia (CBT-I) specifically targets the behaviors and thoughts that make it hard for you to fall or stay asleep, according to Ignatov.

“It is the most recommended and researched treatment for improving sleep quality by addressing sleep deprivation related to anxiety or depression,” he says.

Counterintuitively, CBT-I often involves sleep restriction, which is when you stay in bed for only the amount of time you can sleep, says Sawhne. This can eventually increase your drive to sleep and reduce the amount of time it takes to fall asleep.

4. Try Relaxation Techniques

Practicing mindfulness can help relax your body and brain before bed to support better rest. Effective techniques can include:

  • Deep breathing
  • Meditation
  • Progressive muscle relaxation, where you alternately tense and relax your muscles from one end of your body to the other

The Takeaway

  • Experiencing a mental health problem like depression or anxiety can lead to sleep problems like insomnia, and vice versa.
  • Good sleep habits — like a regular bedtime, dark bedroom, and avoiding screens — support better rest.
  • CBT-I is an effective, research-backed type of therapy that can help ease insomnia.
  • See your doctor if insomnia, anxiety, or depression disrupts your everyday life to determine the best course of treatment.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Fang H et al. Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment. Journal of Cellular and Molecular Medicine. February 2019.
  2. What Are Sleep Disorders? American Psychiatric Association. March 2024.
  3. Mood Disorders. Cleveland Clinic. August 4, 2022.
  4. Oakes DJ et al. Associations between comorbid anxiety and sleep disturbance in people with bipolar disorder: Findings from actigraphy and subjective sleep measures. Journal of Affective Disorders. July 2022.
  5. Sleep Disorders. National Alliance on Mental Illness.
  6. Sleep disorders and problems (insomnia): Learn More – What can you do if you have trouble sleeping? InformedHealth.org. July 31, 2024.
  7. Eric Suni. Anxiety and Sleep. Sleep Foundation . April 23, 2024.
  8. Insomnia. Cleveland Clinic. February 13, 2023.
  9. Walker J et al. Cognitive Behavioral Therapy for Insomnia (CBT-I): A Primer. Klinicheskaia i spetsial'naia psikhologiia. March 10, 2023.
  10. Everything You Need To Know About Progressive Muscle Relaxation. Cleveland Clinic . November 10, 2022.
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Angela D. Harper, MD

Medical Reviewer

Angela D. Harper, MD, is in private practice at Columbia Psychiatric Associates in South Carolina, where she provides evaluations, medication management, and psychotherapy for adults.  

A distinguished fellow of the American Psychiatric Association, Dr. Harper has worked as a psychiatrist throughout her career, serving a large number of patients in various settings, including a psychiatric hospital on the inpatient psychiatric and addiction units, a community mental health center, and a 350-bed nursing home and rehab facility. She has provided legal case consultation for a number of attorneys.

Harper graduated magna cum laude from Furman University with a bachelor's degree and cum laude from the University of South Carolina School of Medicine, where she also completed her residency in adult psychiatry. During residency, she won numerous awards, including the Laughlin Fellowship from the American College of Psychiatrists, the Ginsberg Fellowship from the American Association of Directors of Psychiatric Residency Training, and resident of the year and resident medical student teacher of the year. She was also the member-in-training trustee to the American Psychiatric Association board of trustees during her last two years of residency training.

Harper volunteered for a five-year term on her medical school's admission committee, has given numerous presentations, and has taught medical students and residents. She currently supervises a nurse practitioner. She is passionate about volunteering for the state medical board's medical disciplinary commission, on which she has served since 2015.

She and her husband are avid travelers and have been to over 55 countries and territories.

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Katherine Lee

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Katherine Lee is a writer and editor who specializes in health, science, and parenting content. She has written for Verywell, where she covered school-age parenting, and worked as an editor at Parenting and Working Mother magazines. She has written and edited numerous articles and essays on science, parenting, and children's health and development for What to Expect, the American Association for the Advancement of Sciences, the American Psychological Association, and Newsweek, among others

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