Why Anxiety and Trauma Keep You Awake: Sleep Struggles and the Nervous System
By Ellen Ottman, LMFT, and founder of Stillpoint Therapy Collective, and Nicole Woolf, LCSW, and founder of Wolf Den Therapy
The Cycle of Anxiety and Sleepless Nights
It’s really common to get into bed absolutely exhausted, expecting to fall asleep easily—only for your mind to start racing. Suddenly, you’re replaying the day, planning tomorrow, or worrying about why you’re not asleep yet. In fact, this experience is so universal that it’s practically become a meme.
Anxiety and sleep problems often go hand in hand. The relationship can feel frustrating: you can’t sleep because you’re anxious, and you’re anxious because you can’t sleep. Fortunately, this cycle can be broken.
There’s a lot of biology behind both anxiety and sleep—and they don’t always cooperate. Sleep is regulated by two main processes: your circadian rhythm, which tells your body when it’s time to sleep and wake, and your sleep drive, which builds pressure to sleep the longer you’re awake. When functioning together, they create balanced, restorative sleep.
Anxiety, however, activates stress hormones like adrenaline and cortisol, which override these systems by keeping the body alert and the mind active. Over time, this weakens the natural sleep drive and can lead to insomnia or restless sleep. The less you sleep, the more stressed and anxious you become—and many people understandably try to “fix” it by going to bed earlier, staying in bed longer, or turning to sleep aids. Unfortunately, these well-intentioned efforts can actually make things worse by further disrupting the circadian rhythm and reducing natural sleep pressure.
If you’ve tried sleep hygiene, sleep aids, or medication and haven’t found lasting relief—or they stopped working over time—you’re not alone. There are practical, research-supported approaches that target the root of anxiety-related sleep issues.
Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold standard for treating insomnia. It helps identify and change unhelpful sleep habits, reduce nighttime anxiety, and rebuild a healthy sleep–wake rhythm. Techniques like stimulus control, sleep scheduling, and cognitive restructuring quiet the mind and strengthen your natural sleep drive.
Mindfulness-Based Stress Reduction (MBSR) and Acceptance and Commitment Therapy for Insomnia (ACT-I) have also shown promising results in improving sleep and reducing anxiety. These practices help you observe thoughts without judgment, lower physiological arousal, and let go of the struggle to “force” sleep.
For those whose anxiety shows up in the form of distressing dreams, Cognitive Behavioral Therapy for Nightmares (also known as Imagery Rehearsal Therapy) helps change the narrative of recurrent nightmares and reduce nighttime fear responses, improving both sleep quality and emotional well-being.
When Trauma Enters the Night
If you’ve ever felt tired but “too wired” to fall asleep, you’ve experienced what happens when the nervous system doesn’t yet feel safe enough to rest. For people who live with anxiety, trauma, or chronic stress, nighttime can stir up sensations of vulnerability—the body may still be scanning for threat, even long after the day has ended.
From a nervous system perspective, sleep requires the parasympathetic state—the part of our system responsible for rest, digestion, and repair. Trauma, however, often leaves the body stuck in fight, flight, or freeze, primed for danger even when no danger is present. In this state, the body interprets stillness as unsafe, and what looks like insomnia can actually be the body’s attempt to protect you.
“Insomnia is often the body’s way of saying, ‘I’m still on guard.’ Through somatic work, we help the nervous system realize it no longer needs to stand watch.” — Ellen Ottman, LMFT
Nightmares can also be part of this protective cycle. They’re not just random images; they’re sometimes the body’s way of processing unintegrated fear. While distressing, they’re often a sign that something in the system is trying to move toward healing.
Somatic Therapy and Restoring Safety for Restful Sleep
Working with sleep through a somatic therapy lens means helping the body learn that it’s safe enough to soften. This doesn’t happen by forcing sleep but by creating conditions that cue safety and connection.
A few gentle ways to begin:
Orienting: Before bed, look slowly around your space. Let your eyes land on objects that feel comforting or safe. This reminds your nervous system, “I’m here, and I’m safe.”
Visualization: Imagine a place where you feel calm and protected — maybe a forest path, a sunlit room, or the sound of the ocean. Picture the textures, colors, and sensations around you. Let your body register that sense of safety and warmth, even for a few moments. Search “safe space visualizations” online for guided options.
Movement before rest: Light stretching, shaking out the arms, or placing a hand over your heart can help discharge leftover activation.
Ritual: Repetition can signal safety. A consistent wind-down routine—dimming lights, journaling, or a few slow breaths—can cue the body to shift toward rest.
Learning to sleep again after trauma or chronic stress isn’t about willpower; it’s about re-establishing trust between your body and safety. With practice and support, the nervous system can remember what it’s like to rest.
When to Seek Support
If sleep challenges have persisted for months or years, or if anxiety and trauma symptoms feel overwhelming, support from a therapist can make a real difference.
At Wolf Den Therapy, Nicole offers evidence-based approaches like CBT-I and ACT-I for insomnia and anxiety.
At Stillpoint Therapy Collective, a team of skilled therapists provides somatic and trauma-informed therapy to help the nervous system regulate and restore safety in the body.
You don’t have to choose between treating anxiety and improving sleep—healing both is possible, and often they improve together.
FAQs About Anxiety, Trauma, & Sleep:
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Anxiety activates the body’s stress response, releasing adrenaline and cortisol, which keep you alert and make it difficult to relax. Even when you’re tired, your body may interpret stillness as unsafe, keeping your mind busy and your body tense. Over time, this can disrupt your natural sleep rhythm.
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Trauma can leave the nervous system stuck in “fight, flight, or freeze.” At night, this can look like being tired but wired, waking often, or feeling unsafe when things are quiet. From a somatic perspective, the body hasn’t yet learned that it’s safe enough to rest.
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Somatic therapy works with the connection between the body and mind. When anxiety or trauma keeps your body on alert, somatic techniques—like grounding, gentle movement, and breathwork—help the nervous system relax so that rest becomes possible again.
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something still feels unresolved or unsafe. Somatic therapy helps you gently process those sensations through awareness, grounding, and movement so your nervous system can recognize that it’s safe to rest. Over time, this can reduce distressing dreams, ease nighttime anxiety, and restore a deeper sense of calm in the body.
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Try orienting to your space, gentle stretching, or visualizing a safe place before bed. Consistent rituals like dimming lights, journaling, or slow breathing can cue the body that it’s time to rest and help regulate your circadian rhythm.
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If sleep struggles have lasted for more than three months, or if anxiety and trauma symptoms are disrupting daily life, therapy can help. Many people benefit from combining CBT-I with somatic or trauma-informed approaches to address both mind and body.