It’s 11PM and you're settling down to sleep. Everything is well. You turn the salt lamp off and drift. But then, suddenly, it's 3AM and you're awake again.
You should probably start getting your tax information together, you think to yourself, or else you'll be arrested for evasion. That would be shit, wouldn't it? Getting arrested. But then again you're nearly 27 – maybe it would shake things up a bit. Wow, nearly 27... what have you done with your life? You've only been to four countries and you haven't even had a threesome. Do your friends like you, or are they just pretending? You need to ring the landlord about the mould. Is now the right time to check Co-Star?
Despite all this being at least somewhat recognisable to many, there's very little research into why anxiety can feel so acute at night time (most research in this realm focuses on whether anxiety causes sleep disturbances and vice versa, rather than why some of us get so phenomenally distressed over things that don't seem that scary during daylight hours). But we do know that approximately one in four people in the UK will experience a mental health problem, such as anxiety, every year. And for a lot of us, that anxiety manifests two-fold once the sun goes down and there are no distractions from our spiralling thoughts.
Kat is 32 and lives in London. She says she'll often feel fine during the day – "relaxed, even" – but as soon as she's in bed trying to sleep, all her anxieties rise to the surface like rubbish bubbling up from the bottom of a lake. "I'll end up having pretend arguments in my head with people about things they haven't even done yet, in some imagined future," she tells me over the phone. "And it'll feel like an emotional whirlwind – I'll end up seething. I've even cried about stuff as if it's actually happened, like a break-up or someone being shitty to me at work. Then, by the time I fall asleep and wake up the next day, I can't even remember why I was so mad."
Kat isn't the only one. Gabriel, who's 27, says their anxiety has always felt particularly acute between midnight and 5AM. "I've always been an anxious person with an overactive mind, but in the daytime there are more distractions. Even if you feel it, you can work through it in a physical and mental way," they tell me. "I think when you wake up in the night and you're anxious, it's this isolated, abstract feeling. You wake up fucking confused. It makes you extra panicky, almost, because you can't contextualise in the same way you can in the day; you can't trace the root and it can take you by surprise."
Gabriel has turned to various coping mechanisms over the years, some more successful than others. "Weed has been really good in helping me with sleeping issues, because it knocks you out at first – but then you wake up fucking confused and there's this hyper-anxiety, so it's this double-edged sword," they explain. "But one thing that has really helped me, generally, has been going to therapy. To actually be able to discuss and go back to the root of these issues has been really helpful. I think also just having more of a routine and using my body during the day, like going to the gym, and actually being tired by the time I go to bed."
According to Emma Carrington, Advice and Information Manager at Rethink Mental Illness, acute anxiety at night is a problem that many clients approach them with.
"It is quite common," she says. "I think it makes perfect sense as to why anxiety can get worse at night. During the day we're usually busy with things, whether that's work, friends or family. Our thoughts aren't at the forefront of our mind. Whereas, when you're lying in bed at 3AM, you don't have those distractions. Your thoughts are going to be much louder."
Chris O'Sullivan, from the Mental Health Foundation, thinks there are a number of reasons anxiety can feel more extreme at night for some people. "There are four 'baskets' that often come up,” he tells me. “One is the tendency to reflect on the day and ruminate on things. Then there's sleep itself, and the challenges around being asleep for some people. There's the loneliness, isolation and silence that happens at night – you're less likely to WhatsApp a mate, for instance. And lastly, there's worrying about the future, and what that will be. The day is full of distractions and coping techniques – but as we wind down, we suddenly have space for our worries to bubble up.”
Chris also points out that different types of anxiety might manifest at night in different ways. "Sleep and altered consciousness can be a particular source of anxiety for those with a trauma background," he explains. "A lot of people live with trauma, and the moment of going to sleep, or the dark, can be a trigger. PTSD symptoms and complex trauma, because of childhood sexual abuse or otherwise, can make you not want to go to sleep. If you have nightmares and flashbacks and wake up because of them, going back to sleep can be an issue."
So, how can we stop anxious thoughts from churning around our brains like internal washing machines when we're alone in bed? Just like anxiety during the day, there isn't one single answer. It's about trying things out. "One thing we can do to improve anxiety at night is to actually be more aware of those anxieties during the day, and deal with it as it comes up," says Emma. "Prep for bed is also really key. Not exercising for about three hours or so before bedtime. Don't eat immediately before bed. A hot bath can help relax you. Trying to cut down on caffeine and alcohol. Turn off your phone. Keep your room well ventilated."
But if having a hot bath with some nice lavender salts cured everyone's anxiety disorders, we'd all be at it. So if none of those techniques are helping the situation, "it's always worth going to see your GP", says Emma. "Your GP can refer you to talking therapies – CBT (cognitive behavioural therapy) can be very good for anxiety. And [in the UK], people can refer themselves to their local CBT service as well. There's also a really good campaign that's gone live recently called Every Mind Matters – and that has a whole page dedicated to anxiety. It gives you a lot of CBT techniques, some of which might be helpful in managing it."
In the UK and Ireland, the Samaritans phone lines are open 24/7, at 116 123. In the US, if you're in crisis, the National Suicide Prevention Lifeline is at 1-800-273-TALK (8255). You can also contact the Crisis Text Line by texting TALK to 741741.