Breathing for Anxiety at Night: What to Do When Worry Keeps You Awake

If worry keeps you awake, try 4 seconds in and 6 seconds out, for 5 to 10 minutes, lying down with your eyes open or closed. Keep it gentle and skip breath holds. It may help you settle, though it does not work for everyone every night.

This article gives you a bedtime routine, a plan for waking in a panic, what the research says, and the signs that you need more than breathing.

Can breathing help with anxiety at night?

It may help you settle, and it is safe for most people. A 30-day trial of 64 adults had them practice 15 minutes of slow-paced breathing each evening. Their subjective sleep quality improved, and a measure of calm heart activity during sleep rose compared with the control group (Laborde et al., 2019). In a small study of 14 people with insomnia, 20 minutes of paced breathing before bed shortened the time to fall asleep (Tsai et al., 2015).

Both studies were small, and results on measured sleep, as opposed to how rested people feel, are less clear. Breathing is a way to quiet the body, and it does not guarantee sleep.

Why anxiety gets louder at night

During the day, work and people give your mind something to do. At night that stops, and worries have room. Your body is quiet, so a thumping heart or tight chest is easier to notice, and noticing can feel like danger.

A longer exhale gives your attention a small, steady job and is linked to the calming side of the nervous system. In a 2014 study of 30 adults, a longer exhale felt more relaxing than a longer inhale (Van Diest et al., 2014). The aim at night is not to force sleep, which backfires. It is to let your body settle so sleep can arrive on its own.

A gentle routine for the bed

1. Lie on your back or side. Let your belly go soft. Put a hand on it if that helps.
2. Breathe in through your nose for 4 seconds. Quiet and easy.
3. Breathe out slowly for 6 seconds. As if you were slowly fogging a window. No holds at the bottom or the top.
4. Continue for 5 to 10 minutes. Do not count the minutes. Let the count loosen on its own.
5. When your mind wanders, return to the exhale. There is nothing to win.
6. Let an app help you. If counting in bed keeps you alert, try an app like Breath Interval. Set your inhale and exhale once, press start, and let it guide you, so there is nothing left to think about. Soft music underneath can make it even easier to drift.

New to this? Try 3 in and 4 or 5 out. If counting keeps you alert, skip the numbers and just make each out-breath a little slower than the last.

If you wake up in a panic

Nocturnal panic means waking from sleep in a state of panic. A review notes that 44 to 71% of people with panic disorder report at least one such attack, and that it is distinct from nightmares and sleep apnea (Craske and Tsao, 2005).

1. Sit up and open your eyes. Look at something fixed in the room.
2. Remind yourself: "This is panic. It will pass."
3. Breathe in gently for 4 seconds and out for 6. No holds, no big breaths.
4. Name five things you can see. This anchors you to the room.
5. Stay up until the wave settles, then go back to bed.

If this happens more than occasionally, see a doctor or therapist. Cognitive behavioral therapy targets the fear of body sensations that feeds these attacks (Craske and Tsao, 2005).

What the research shows

• 30 days of slow breathing before bed, 64 adults: better self-reported sleep quality and higher calm heart activity during sleep versus a control group (Laborde et al., 2019).
• Paced breathing for insomnia, 14 people: 20 minutes before bed shortened sleep onset in a small study (Tsai et al., 2015).
• Longer exhale versus longer inhale, 30 adults: the longer exhale felt more relaxing (Van Diest et al., 2014).
• Nocturnal panic: 44 to 71% of people with panic disorder have had at least one attack, and CBT is the usual approach (Craske and Tsao, 2005).
• Breathing training for panic, 37 patients: a feedback-guided program, with a carbon dioxide sensor, reduced panic severity, and gains held at 12 months (Meuret et al., 2008).

The takeaway: slow breathing is a sensible wind-down, with small studies behind it, and it is not a stand-in for treating panic or a sleep disorder.

Common mistakes

• Trying to force sleep. Pressure keeps you awake. Aim for rest, not sleep.
• Checking the clock. It adds stress. Turn it away.
• Holding your breath to relax. Holds can feel uncomfortable in the dark.
• Lying awake for hours. If you are still alert after about 20 minutes, get up for a short while.
• Practicing only at 3 a.m. Try it earlier in the evening so it is familiar.

Who should be careful

• People with panic disorder: skip breath holds and fast, deep breathing, which can trigger or worsen symptoms. Use gentle long-exhale breathing.
• People who snore loudly, wake gasping or feel very sleepy in the day: these can be signs of sleep apnea, which breathing exercises do not address. See a doctor.
• People with asthma or another lung condition: keep every breath easy and unforced.
• Anyone who feels dizzy, tingling or short of breath: stop and breathe normally.
• Anyone with weeks of poor sleep or repeated night panic: please talk to a doctor or therapist. Effective help exists.