Why Your Anxiety Feels Worse at Night: The Neuroscience Behind It

June 16, 2025

You are finally in bed. The house is quiet. The lights are off. The day is done, and suddenly, your brain comes alive. Thoughts start racing. Worries you managed to hold off all day now scream for attention. Your heart picks up its pace. Sleep feels impossible.

If this sounds familiar, you are not alone. Many people with anxiety find that nighttime is the hardest part of the day. But why does anxiety seem to get louder when the world quiets down? It turns out, the answer lies deep in how our brains and bodies are wired.

Let us explore what is happening behind the scenes and how you can start to calm your mind when the lights go out.

The Science Behind Nighttime Anxiety

During the day, our brains are occupied. Work, conversations, errands, screens, there is always something to focus on. These distractions act like background noise that keeps anxiety at bay, at least temporarily.

But at night, all of that disappears. The world slows down, and suddenly, there is space. That space can feel overwhelming for an anxious mind.

This is partly due to the brain’s default mode network. This network becomes more active when we are resting or not focused on a task. It is responsible for self-reflection, memory processing, and, unfortunately, worry. When the brain is not busy, it often turns inward. And if you are prone to anxiety, that inward turn can mean spiraling into fear or overthinking.

Additionally, levels of cortisol, the stress hormone, follow a daily rhythm. Cortisol is usually lower at night to help prepare the body for sleep. But in people with anxiety, this rhythm can get disrupted. If your cortisol levels remain high or spike in the evening, it can leave you feeling restless or wired when you should be winding down.

And let us not forget about the role of fatigue. After a long day, both the body and the brain are tired. This exhaustion lowers your emotional defenses. Your ability to cope with anxious thoughts weakens, and everything feels heavier and more intense than it did in the afternoon.

The Mind Loves Patterns, Even Unhelpful Ones

Anxiety loves a routine, even if it is a painful one. If your brain has gotten into the habit of spiraling at night, it may start to expect it. This creates a loop. You start dreading bedtime because you associate it with anxiety. That dread becomes part of the pattern, and the anxiety shows up again. The loop continues night after night.

Breaking this pattern takes intention, but it is possible.

How to Calm Nighttime Anxiety

You cannot force your brain to stop being anxious. But you can help it feel safer and more supported. Here are some gentle ways to reduce nighttime anxiety and make rest more accessible:

Create a winding-down routine

Give your brain signals that it is time to relax. This could be reading a book, stretching, taking a warm shower, or listening to calming music. The key is consistency and calm.

Avoid overstimulation before bed

Bright screens, intense shows, or scrolling through social media can activate your nervous system. Try setting a screen cutoff time an hour before sleep.

Journal your worries

If your mind feels full, put it on paper. Writing down your thoughts can help get them out of your head and into a place where they feel more manageable.

Focus on your senses

Ground yourself with what you can feel, hear, or smell. Notice the texture of your sheets, the rhythm of your breath, or the scent of essential oils. These bring your focus away from thoughts and into the present moment.

Practice self-kindness

It is okay if anxiety shows up. Fighting it can make it worse. Try to greet it with curiosity instead of fear. Remind yourself that it will pass, it always does.

Final Thought

Anxiety often feels louder at night, not because there is something wrong with you, but because your brain is doing exactly what it is wired to do. It is searching for safety and trying to process a busy world in stillness. With gentle structure, awareness, and compassion, you can start to shift that pattern.

Sleep does not have to be a battle. With time and care, it can become a place of rest again.

smoking

Smoking Addiction

BrainsWay Deep TMS is a noninvasive, FDA-cleared, outpatient brain stimulation procedure with proven clinical results to help patients to quit smoking.  Known as the addiction coil, the H4 coil was specifically designed for targeting the deep areas of the brain involved in addictions.

A large study in 14 centers examined adults who had been long-term heavy smokers, all having failed prior quit attempts using medication, therapy, or other methods. Of those that completed Deep TMS treatment, 28% achieved four consecutive weeks without smoking, most of them not smoking for at least three months after treatment.  Among all participants in the study, the average number of cigarettes smoked per week over the course of treatment was reduced by 75%.  

TMS has none of the side effects commonly found in medication to treat smoking cessation. TMS is well-tolerated with years of safety data supporting Deep TMS. Patients may initially experience minor headaches or pain at the site of treatment which typically subside after the first few sessions. There is no preparation, no anesthesia, and patients are able to resume daily activities immediately after each treatment session. Treatments are done in our office. Each treatment session lasts 25-30 minutes. They are done daily on weekdays for 3 weeks followed by a weekly session for another 3 weeks.

BrainsWay Deep TMS offers a fresh approach that may help to quit smoking using cutting-edge neuroscience. Clinically proven and well-tolerated, Deep TMS is the first non-invasive technology that is FDA-cleared to treat smoking addiction.

addiction

OCD

Deep TMS has recently be approved by the FDA for treatment of obsessive-compulsive disorder (OCD).  OCD traditionally has been treated primarily with exposure psychotherapy, and while it is also treated with medication such as fluvoxamine, OCD does not respond well to medication management.  Medication improves symtpoms greater than 30% in only 50% of patients, and half of OCD patients stop taking their medication due to side effects.  And while exposure therapy might improve OCD, as many as 80% of patients continue to have symptoms after psychotherapy, according to some studies.

BrainsWay Deep TMS is a noninvasive, FDA-cleared, outpatient brain stimulation procedure with proven clinical results for improving the symptoms of OCD.  The technology stimulates the brain using its patented H-coil, known as the H7 coil, resulting in a deep and broad penetration of the magnetic field into areas of the brain that are affected in OCD. Deep TMS is safe and well-tolerated, has a very low rate of side effects, and does not require anesthesia.  

Research has proven a higher level of improvement using Deep TMS.  Almost 68% of OCD patients were able to reduce symptoms by more than 30%, and 87% of those who responded saw sustained improvement for at least a year.

depression

Depression

Major depression was the diagnosis first approved for treatment with TMS, and it is still the most commonly treated condition. Most patients are treated with TMS after failures of medications and psychotherapy, as insurance companies will pay for TMS treatment only after medication failures.  However, TMS treats depression much better than medication, and some would argue that TMS should be the first treatment instead of the last.  

When patients have not improved with medication, they are considered to be “treatment-resistant”. And in treatment-resistant depression, TMS treatment results in significant improvement, defined as more than a 50% reduction in symptoms, in more than 80% of patients.  And more than 60% of patients achieve remission.  That is a very high and a very impressive number of people who are happy for the first time in many years after TMS treatment.

TMS treatments for depression are done in a series of 36 treatments.  Patients have a 20-minute treatment 5 days a week for six weeks followed by 6 more treatments in a tapering schedule over three more weeks. No preparation is needed, and there is no recovery time.  After each treatment, patients are able to leave and go about their day.  Except for a rare seizure, which occurs in 1 of 1000 patients, TMS has only minor side effects of mild headache or scalp soreness in the first few days. 

It is said that after successful TMS treatment, that there is a 50% chance of relapse of depression within the first year.  However, at Hagan Health we consider that statistic to be too high, and our relapse rate is lower.  While treatments are done by certified and experienced treaters, Dr. Hagan is closely involved in determining the location and strengths of settings to provide the most accurate treatment.  In addition, Dr. Hagan meets with patients every week or two before and during treatment, and periodically after treatment, in order to insure the best possible results.  Depression varies from patient to patient, and it is important to get the know the patient and the thoughts, feelings, and circumstances that might lead to relapse.  Using cognitive therapy techniques, patients are taught to be aware of triggers and to be prepared with the cognitive tools used to reduce the chances of relapsing. 

TMS for Anxious Depression

Recently TMS has been cleared by the FDA for treatment of Anxious Depression.  This condition is one in which anxious distress is a major part of the clinical picture while depression remains the predominant diagnosis.  Anxiety which is treated along with depression is also significantly improved, while TMS is not currently considered appropriate for the treatment of anxiety without depression.

Dr. Hagan Bio

So the lesson Al taught me was about my lack of happiness related to feelings of inadequacy. Even though I had become a brain surgeon, I did not have a healthy self-regard. Al explained to me that my father, in his drive to succeed and to push me to succeed, would never let me savor a victory, that whenever I achieved something important, he would ask, . “How could you have done it better?” Or “what is next?”. He was setting the bar at perfection, such that nothing less than perfection was going to be good enough. Al said, “Nobody is perfect”, and that I would be much happier deciding what degree of imperfection I was going to settle for. When one sets the bar at perfection, then every effort falls short of perfection and is therefore a relative failure, it becomes yet more evidence of one’s belief that he is fundamentally flawed and inadequate. He said that we are all always doing our best, and that is not fair for my father or for me myself to tell myself that I am not good enough. It was the single most important piece of wisdom that I would learn for the next several decades, and I have told this story many times to those who, like me, grew up to have similar issues.

After seeing Al for a year, another year or two went by. One day at church I was listening to a talk from a psychotherapist who had grown up in a family in which his mother was an alcoholic and his father was a workaholic. His story sounded so much like mine that I decided to see him professionally to “learn more about this garbage in my head”. I saw Paul for two years.

A few years later, life had become quite stressful. I was married with three small children, practicing neurosurgery full time and doing some farming on the side. It was at this time that I started seeing my third therapist, the one that I would see for most of the next 10 years. Keith was a psychiatrist, an MD like me, who did only psychotherapy. A few months after starting my therapy with Keith, I realized that I liked what he did better than what I did. The process of therapy is that of developing an increasing awareness of how one got to be the way he or she is, starting with childhood issues. Specifically, this type of therapy is called “psychodynamic psychotherapy”.

Dr_Hagan
Terry

Three years into my experience with Keith, I made the final decision that I would rather be a psychiatrist, because I came to love the process of developing insight into one’s own psychology. As I closed my neurosurgery practice and completed a residency in psychiatry, I was so grateful the entire time for the opportunity to turn myself into a psychiatrist. “Who gets to do that?!” Years later a patient was looking at the books on my bookshelf and asked, “So you were a neurosurgeon; did you like it?” I had been asked many times why I decided to give up neurosurgery to become a psychiatrist, but no one had ever asked if I liked neurosurgery. The answer had to be that no, I did not. I did not like who I was. But I have loved psychiatry from the very beginning, and I really appreciate the contribution it has had in my own personal development.

But because of my heavy early experience in psychotherapy, I also became proficient and experienced in both psychodynamic psychotherapy and in cognitive behavioral therapy (CBT). And I attended the Cincinnati Psychoanalytic Institute for a year to take my psychotherapy skills to a higher level.

During the 17 years that I have been practicing psychiatry, I have continued to grow. The most gratifying experiences I have had have been when I have settled into a psychotherapy relationship with a patient, while there have been many, others with whom I have combined psychiatry with psychodynamic therapy, practicing psychodynamic psychiatry.

Terry
Dr. Hagan Bio

During these same years, I have also been on several mission trips, which have given me perspectives that I would never have learned otherwise. The concepts of loving your neighbor, giving of your time and resources, being kind and gentle and gracious, have come to define me.

I have always been at the head of my own practice, managing my own business. I have experience with other businesses as well, such as being a successful alpaca breeder for 10 years. “They do not teach business in medical school.” In a growing psychiatry practice, running the business is something you learn from necessity.