How to sleep with anxiety

A wind-down you can actually keep

Ninety minutes, roughly, and none of it requires equipment or willpower you do not have at 10pm.

1. Ninety minutes before bed: dump the worries. Ten minutes with a notebook. Everything that is on your mind, plus the next physical action for each item. This is not journalling and it does not have to be honest or well written — it is emptying a queue.
2. Sixty minutes before bed: lower the input. Dim the lights, put the phone somewhere it is not a decision. Not because screens are evil, but because news, messages and email are activating and you are trying to be less alert, not more.
3. Thirty minutes before bed: the same boring routine. Same order, same steps, every night. NHS advice on sleep is precisely this unspectacular: go to bed and wake up at around the same time each day and “give yourself time to relax before bed”^[1].
4. In bed: a long exhale. Four counts in, eight out — or without the hold if that is easier. Use the 4-7-8 timer before you get in rather than reaching for your phone once you are there.
5. If you are still awake after about twenty minutes: get up. Somewhere dim, something dull, no screens. Go back when you feel sleepy. Lying in bed being frustrated teaches your brain that bed is where frustration lives.

Why the worry dump does the heavy lifting

Lying down removes every distraction you have been using all day. That is why the thoughts arrive at 11pm — not because they are worse then, but because nothing else is competing for the space.

Writing them down earlier gives them somewhere else to be. The research tradition here is expressive writing: the standard protocol described in a 2005 review is 15–20 minutes on three to five occasions, writing about your deepest thoughts and feelings without worrying about spelling or grammar^[2]. You do not need the full protocol to get the practical benefit at bedtime; ten unstructured minutes and a next-action for each worry is usually enough to stop the mental rehearsing.

The trick that makes it work is specificity. “Worried about work” stays live. “Email Sam about the deadline, first thing” is finished business until tomorrow.

Why the long exhale, not deep breathing

“Take deep breaths” is the most common and least useful piece of sleep advice. Big breaths are effortful. What the evidence points to is slow ones. The 2018 systematic review of slow breathing associated breathing under about ten breaths a minute with increased heart-rate variability, parasympathetic activation and reduced reported arousal and anxiety^[3], and the 2023 randomised trial of five-minute daily breathwork found the extended-exhale practice improved mood more than mindfulness meditation and produced the largest fall in breathing rate^[4].

Practically: make the out-breath longer than the in-breath and stop trying to make it big. And be honest about what this does — it may help you feel settled enough for sleep to happen. It is not a sleep switch, and the NIH’s complementary-health centre is clear that much of the relaxation evidence base is rated low quality^[6].

The trap: trying to sleep

Sleep is not a task you can complete by working harder. The more you monitor whether it is happening, the more alert you become, and checking the clock converts a bad night into a maths problem — five hours left, four and a half, four.

Two things reduce that pressure:

• Turn the clock around. Nothing you learn from it helps.
• Aim for rest, not sleep. Lying still in the dark, breathing slowly, is genuinely restorative even when sleep does not arrive. It also, paradoxically, makes sleep more likely.

What to keep and what to drop

Worth doing

• The same wake time every day, including weekends. It is the single most effective lever and the least popular.
• Caffeine before about 2pm only; it hangs around for many hours.
• A cool, dark room.
• Getting outside in daylight early — it anchors the clock that decides when you get sleepy.

Not worth doing

• A nightcap. It gets you to sleep faster and wrecks the second half of the night.
• Making up for a bad night with a long lie-in. It moves the problem to tomorrow.
• Sleep-tracking when you are anxious about sleep. You end up anxious about the data too.
• Reading anxiously about insomnia in bed, including this page.

When to get help

If you are struggling most nights for more than a few weeks, ask about cognitive behavioural therapy for insomnia (CBT-I). It is the first-line recommendation in most guidelines and is delivered in a handful of sessions. CBT more broadly has the strongest evidence base of any psychological approach for anxiety problems, with large or medium effect sizes reported across the anxiety disorders^[5].

Try it in relif

relif has the wind-down pieces in one place: paced breathing with haptic pacing so you can run it with the screen dark, and journalling to get worries out of your head before you get in. Liam, the in-app AI companion, is there at 2am if writing to something helps — it is an AI, not a therapist, and not a crisis service.

Related guides and tools

• 4-7-8 breathing timerA wind-down pattern with a long exhale
• How to stop overthinking at nightWhen the loop starts after lights out
• Morning anxietyWhy the worst of it is often at 6am
• 5-4-3-2-1 groundingFor when you cannot look around

How this page was written: by the relif team, not by a clinician. We do not publish a “medically reviewed” badge we cannot stand behind. Instead we name and date every source, prefer systematic reviews and randomised trials over single studies, and match the strength of the wording to the strength of the evidence — “may help” and “research suggests”, never “cures” or “treats”.

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