Why Anxiety Feels Worse at Night

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Why Anxiety Feels Worse at Night
Dr Nikki Ramskill
6 Aug 2026 | 6 minutes read

clock on bedside table under nightlight and a disrupted bed

Why Anxiety Feels Worse at Night: Understanding the Link Between Hormones, Sleep and Your Mind

It's been a busy day. You've finally climbed into bed, the house is quiet and there's nothing left on your to-do list.

Yet instead of switching off, your mind seems to speed up. You replay conversations. Think about tomorrow's meeting. Worry about your family. Wonder why you're awake again. Before long, your heart feels like it's racing and sleep seems further away than ever.

If this sounds familiar, you're far from alone.

Many women notice that anxiety feels more intense during the evening or in the early hours of the morning, particularly during perimenopause and menopause. While it can feel frustrating, or even frightening, there's a reason this happens.

The good news is that understanding what's happening inside your body can help you approach those difficult nights with more confidence and self-compassion.

Is anxiety a symptom of menopause?

Anxiety and sleep have a two-way relationship.

Poor sleep can increase feelings of anxiety. At the same time, anxiety can make it harder to fall asleep or stay asleep. It becomes a cycle that can be difficult to break.

For example:

You wake during the night.
Your mind starts racing.
You become worried about not sleeping.
Feeling anxious makes it harder to fall back asleep.
The following day feels more exhausting, making stress harder to manage.

These experiences are real, and they're more common than many women realise.

Doctor's Insight

"Sleep is influenced by neurotransmitters such as serotonin and GABA (gamma-aminobutyric acid), both of which are affected by hormonal change. This helps explain why sleep disruption, anxiety, mood changes and brain fog often occur together rather than as isolated symptoms.

Dr Nikki Ramskill

Women's Health GP & Menopause Specialist

Why does anxiety feel worse at night?

During the day, life keeps us busy.
Work, conversations, family responsibilities and everyday routines give our minds something to focus on.

At night, those distractions disappear. When everything becomes quieter, our thoughts often become louder.

If you're already feeling stressed or emotionally stretched, bedtime can become the first opportunity your brain has had to process everything you've been carrying throughout the day. This doesn't necessarily mean your anxiety has suddenly become worse. It may simply feel more noticeable because there are fewer distractions competing for your attention.

Hormones play a role too

Hormonal changes during perimenopause don't just affect your reproductive system. Oestrogen also influences important neurotransmitters including serotonin and GABA, which help regulate mood, emotional wellbeing and relaxation.

As hormone levels fluctuate, some women notice they feel less emotionally resilient than they once did. This can mean everyday worries feel bigger than they normally would.
Small stresses that you might once have brushed aside can suddenly seem much harder to ignore.

Why do anxious thoughts often appear around 2am?

Many women say they wake around the same time each night, often between 2am and 4am. There's no single "anxiety hormone" that suddenly switches on.

Instead, several normal physiological processes overlap.

During the second half of the night:

Sleep naturally becomes lighter
Cortisol begins its gradual rise in preparation for waking
Hormonal fluctuations may have already fragmented sleep
You're more likely to wake from small disturbances

Once you're awake, your brain has the opportunity to latch onto worries that may have been sitting quietly in the background all day.

Serenova's Hormone Hour research also found that online searches relating to anxiety, insomnia and menopause peak during the early hours, highlighting just how many women are looking for reassurance while awake at night.

Doctor's Insight

"It's rarely one single hormone that's responsible for disrupted sleep or anxiety. Instead, it's usually several physiological changes happening together, alongside everyday life and stress."

Dr Nikki Ramskill

Women's Health GP & Menopause Specialist

Small habits that can help

While there's no instant solution, small, consistent habits can help support both emotional wellbeing and healthier sleep.

Create a wind-down routine

Your brain benefits from a clear signal that the day is coming to an end.

Reading, gentle stretching, journalling or listening to calming music may help you transition into sleep more peacefully.

Try not to watch the clock

If you wake during the night, constantly checking the time can increase anxiety.

Turning your clock away may help reduce the pressure you place on yourself to fall asleep.

Limit stimulating activities before bed

Bright screens, work emails and stressful conversations can make it harder for your mind to switch off.

Giving yourself time away from these activities can help create a calmer bedtime environment.

Move your body during the day

Regular physical activity supports both emotional wellbeing and healthy sleep patterns.

The goal isn't intense exercise. Even a daily walk can be beneficial.

Talk to someone

If anxiety is becoming overwhelming or affecting your daily life, it's important to seek support from a healthcare professional.

You don't have to navigate these changes alone.

Supporting your evening routine

Supporting better sleep isn't only about what happens once your head reaches the pillow. Creating a calming evening ritual can help signal to your mind and body that it's time to slow down.

Many women find that consistency is key.

Serenova's Rest & Renew has been developed to complement an evening wellbeing routine.

Featuring over 250mg of magnesium alongside carefully selected ingredients traditionally used in evening rituals, it's designed to fit naturally into your nightly routine as part of a balanced diet and healthy lifestyle.

Because sometimes the smallest habits become the ones that make the biggest difference over time.

Frequently asked questions

Can low oestrogen cause poor sleep?

Changing oestrogen levels are one of several factors that can influence sleep during perimenopause and menopause. They can affect temperature regulation, mood and the quality of sleep, although other hormones and lifestyle factors also play a role.

Why do I wake up feeling too hot?

Fluctuating oestrogen levels can make the brain's temperature regulation system more sensitive, meaning even small changes in body temperature may trigger a hot flush or night sweat.

Is poor sleep always caused by menopause?

No. Sleep problems can have many different causes. If your symptoms are persistent or affecting your quality of life, it's important to discuss them with a healthcare professional.

Can improving sleep help other menopause symptoms?

According to Dr Nikki Ramskill, sleep is one of the foundations of good health. Better sleep can have a positive impact on mood, concentration, emotional wellbeing and overall quality of life.

Dr Nikki Ramskill
Dr Nikki Ramskill is a Women's Health GP and British Menopause Society Accredited Menopause Specialist with a passion for helping women better understand and navigate hormonal health. She is the founder of The Female Health Doctor Clinic, where she provides evidence-based care for women experiencing perimenopause, menopause and other complex hormonal health concerns.
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