Lily Brown hears the same thing over and over again from her patients. They’ll say, “‘All day, I’m so busy. I’ve got deadline after deadline, responsibility after responsibility. And finally, I’m exhausted, I’m so excited to get to bed—and I lie down, and that’s when my brain turns on,’” says Brown, director of the University of Pennsylvania’s Center for the Treatment and Study of Anxiety. 

It’s all too common to spiral into worry and rumination once the sun goes down. Research has long suggested that, for many people, anxiety symptoms spike and mental health otherwise suffers at night. A 2022 study labeled this phenomenon the “mind after midnight hypothesis,” noting that risks of suicidal behavior and substance misuse also rise after dark, and people’s mood plummets from roughly 1 a.m. to 4 a.m. Another study, this one published in 2024 in Psychiatry Research, found that general anxiety peaks at various times throughout the day—around 8 a.m., 4 p.m., and 1 a.m., according to the research—but the racing thoughts that plague many anxiety sufferers are at their worst in the evening.

Why is nighttime often anxiety o’clock? Here’s what to know.

Why anxiety feels worse at night

The human body has a finely tuned biological clock that influences everything from when you feel hungry to when you get sleepy. Those internal rhythms also affect the brain, says Rebecca Cox, an assistant professor of psychological and brain sciences at Washington University in St. Louis and co-author of the recent Psychiatry Research study on timing of anxiety symptoms. 

The longer you’re awake, the more your body wants to sleep. Certain biological signals keep you alert and ward off sleep throughout the day, but those signals drop off at night. If you’re awake as they drop and “sleep pressure” builds, cognitive function often suffers, Cox explains. Among other consequences, these effects seem to make it harder for your brain to regulate emotions, she says. 

These cognitive effects also help explain why people are susceptible to self-harm and substance abuse late at night, research by Brown’s colleagues suggests. “If you’re having an urge for any kind of unhealthy or unsafe behavior, chances are it’s more difficult to control that in the middle of the night,” she says.

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Making matters worse, “when we’re awake at night, usually we’re isolated. The rest of the world is asleep,” Cox says. “If I’m feeling anxious during the day, maybe I can talk to a friend or partner—but if I’m the only one awake at night and I’m feeling all these negative feelings, I don’t have an external way to regulate those.”  

Your brain also has fewer distractions at night, adds Dr. Jeffrey Strawn, director of the Anxiety Disorders Research Program at the University of Cincinnati College of Medicine. During the day, you’re likely preoccupied with work, errands, chores, family and social obligations, and the constant ping of your phone. But at night, and particularly when you get into bed, much of that falls away, creating a “perfect setup for that runaway anxiety, that ruminative thinking about ‘what if’ and ‘what about,’ and then also replaying the prior day,” Strawn says.

Will you actually feel better in the morning?

You’ve probably heard the advice to get a good night’s sleep when you’re worried or upset, because everything will feel better in the morning. There actually seems to be some truth to that adage, research suggests.

Anxiety and sleep are closely linked. Anxious people tend not to sleep well, and poor sleep may also predict future anxiety, as researchers including Cox have demonstrated. Conversely, getting a good night’s rest often seems to ease anxiety and take the edge off negative memories, studies suggest. “Sleep is medicine,” Strawn says.

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That makes good sleep habits crucial, especially for people who struggle with anxiety. In addition to the classic advice—like sleeping in a cool, dark, and quiet room; limiting caffeine intake; seeing bright light early in the day but limiting it at night; and establishing a consistent bedtime routine—Brown says it’s important to wait until you’re actually tired to get in bed. People often go to bed abnormally early when they want to get a good night’s sleep, but that can backfire. “That’s actually a known, ineffective strategy that tends to make insomnia worse and anxiety about sleep a lot worse,” she says. It gives you plenty of time to lie awake, stressing about the fact that you should be sleeping.

And be careful about self-medicating to get to sleep, Brown says. Substances including alcohol and marijuana sometimes make it easier to fall asleep initially, but may lead to poorer sleep quality overall.

What to do about nighttime anxiety

Prevention is often the best medicine, Brown says. She recommends setting aside 10 minutes during your day (well before bedtime) to have structured “worry time,” a practice supported by research. Set a timer and use those entire 10 minutes to run through everything that’s nagging at you, writing down notes or to-dos if you find it helpful.

If worries pop into your head outside of your scheduled worry time, make a conscious effort to recognize and redirect those thoughts. “Say, ‘I noticed that I’m worrying. I’m going to reserve this for worry time,’” and then get back to whatever you’re doing, Brown says. That can be hard for habitual worriers, Brown says, because many people mistakenly equate worrying with preparation or problem solving—but studies suggest the opposite is often true.

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If anxiety still comes flooding back at night, Brown recommends keeping a journal by your bed to jot down a quick note or reminder about whatever is troubling you. You’re subtly telling your brain, “‘I hear you. I’m paying attention. But I’m not going to figure that out right now,’” Brown says. Research bears that out, suggesting that people who journal end up worrying less overall. Just make sure you’re writing a quick note rather than a novel, as writing too much can “marinate the brain in those worries and those anxious thoughts,” Strawn cautions.

It’s also important to get out of bed if you find yourself spiraling into anxiety, Strawn says—otherwise, you may begin to subconsciously associate your bed with worry and wakefulness. “If folks aren’t able to fall asleep in about 15 minutes, I want them to get out of bed,” he says. Get up and do something that isn’t cognitively stimulating, like reading your dishwasher’s manual, he suggests. It can also be helpful to do a meditation or breathing exercise that brings down physiological stress levels, Cox says.

Head back to bed when you’re feeling sleepy again—and, hopefully, calmer.