Sleep Anxiety Therapy in California

Sleep anxiety occurs when the fear of not sleeping becomes part of the problem itself. Instead of sleep arriving naturally, bedtime starts to feel tense, effortful, and uncertain. Over time, this anxiety can keep the nervous system on high alert—even when exhaustion is present.

Many people with sleep anxiety describe feeling “tired but wired,” lying awake scanning their body, watching the clock, or worrying about how poor sleep will affect their health, mood, or functioning the next day.

Sleep anxiety is common, treatable, and often reversible with the right approach.

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What Is Sleep Anxiety?

Sleep anxiety refers to worry, fear, or anticipatory stress related to sleep. It often develops after a period of disrupted sleep—such as insomnia during a stressful life event, illness, travel, or a change in routine.

When sleep becomes inconsistent, confidence in the body’s natural ability to sleep begins to erode. Bedtime shifts from something automatic to something that feels fragile or unreliable.

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Common signs of sleep anxiety include:

• Fear of not falling asleep or waking too early

• Racing thoughts or mental “monitoring” at night

• Clock-watching or calculating hours of sleep

• Increased tension or alertness when getting into bed

• Worry about how poor sleep will affect work, mood, or health

Sleep anxiety frequently overlaps with insomnia symptoms
 

How Sleep Anxiety Develops

Sleep anxiety doesn’t usually start as anxiety.

It often begins with a real sleep disruption.

A few nights of poor sleep can lead to concern. That concern leads to effort—trying harder to sleep, controlling sleep, or preventing another bad night. Over time, sleep becomes something to manage rather than something that happens.

As this cycle continues:

1. Confidence in the body’s ability to sleep decreases

2. Bedtime becomes associated with vigilance rather than rest

3. The nervous system stays activated “just in case”

4. Sleep becomes more inconsistent, reinforcing the fear

Eventually, the problem is no longer just sleep—it’s the relationship with sleep.

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When Sleep Anxiety Turns Into Health Anxiety

As confidence in sleep declines, many people begin to worry about the consequences of not sleeping.

This is where health anxiety often enters the picture.

Thoughts may include:

• “What is this doing to my brain?”

• “Am I damaging my health?”

• “What if this never gets better?”

• “What if I can’t function tomorrow?”

At night, when distractions are minimal, these worries tend to intensify. The body is monitored more closely. Normal sensations feel threatening. Reassurance-seeking increases.

For some people, sleep anxiety and health anxiety begin to reinforce one another.

You can learn more about this overlap here

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How Sleep Anxiety Is Treated

Treatment for sleep anxiety focuses on reducing struggle, restoring trust in the body, and breaking the fear–arousal–insomnia cycle.

My work is grounded in sleep therapy, using CBT-I as the foundation while integrating other evidence-based approaches when anxiety is a central driver.

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Approaches commonly include:

• CBT-I to rebuild consistent sleep patterns and reduce behaviors that maintain insomnia

• ACT-I strategies to reduce fear, control, and preoccupation with sleep

• Mindfulness-informed techniques to calm the nervous system and shift attention away from monitoring

• Cognitive and behavioral tools to address reassurance-seeking, perfectionism, and anticipatory anxiety

Rather than forcing sleep, treatment focuses on helping sleep return as confidence and safety are restored.

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Short-Term or Ongoing Work

Some clients work with me short-term, focusing specifically on sleep anxiety and insomnia over a structured course of treatment.

Others begin with sleep and choose to continue working together as related patterns become clearer, such as:

• Generalized anxiety

• Health anxiety

• Perfectionism or high self-pressure

• Work-related stress or burnout

• Relationship stress affecting sleep

In some cases, clients work with me specifically on sleep while continuing with an established primary therapist. In others, therapy naturally evolves beyond sleep.

We decide together what approach fits best.

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Related Reading

You may find these articles helpful:

• Racing Thoughts That Keep You Awake 

• Sunday Night Anxiety and Sleep 

• Revenge Bedtime Procrastination

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Getting Started

If sleep anxiety is keeping you stuck in a cycle of worry and exhaustion, help is available. A brief consultation allows us to discuss what’s happening with your sleep and whether this approach is a good fit.

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