Specialist Dr. Yaprak Arslan Psychiatrist & Psychotherapist

Whilst for some people anxiety increases as the day progresses, others may wake up feeling anxious even before the day has begun.

From time to time, you may find that as soon as you open your eyes in the morning, your mind starts racing; you might start thinking about what you have to do that day, worry about events that haven’t happened yet, or feel a sense of unease for no apparent reason.

However, if waking up with anxiety in the mornings is a frequent occurrence and is affecting a person’s ability to start the day, their sleep or their daily life, it may be important to assess the underlying causes.

What is morning anxiety?

Morning anxiety is not a psychiatric diagnosis in its own right. It is more of a term used to describe symptoms of anxiety that become apparent upon waking or in the first few hours after waking.

These symptoms can vary from person to person:

• Internal restlessness or unease
• Feeling that one’s heart is racing
• A feeling of pressure or tightness in the chest
• Nausea or gastrointestinal discomfort
• Muscle tension
• Difficulty getting started in the morning
• The mind turning to tasks or problems as soon as one wakes up
• A feeling that something bad is going to happen
• Intense thoughts beginning even before getting out of bed

The fact that these symptoms occur in the morning does not necessarily mean that you have an anxiety disorder. What matters is how often the symptoms occur, how long they last, and to what extent they affect your life.

Why might we feel more anxious in the mornings?

There is no single cause of morning anxiety. Biological rhythms, sleep patterns, the individual’s stress levels, thoughts and daily habits can all play a role.

The morning rhythm of cortisol

Although cortisol is mostly known as the stress hormone, its function in the body is not limited to stress alone.

Cortisol secretion follows a natural rhythm throughout the day. Levels are low in the early hours of the night, begin to rise towards morning, and following waking, a marked increase—known as the ‘wake-up response’—is observed. This increase is usually noticeable within approximately 30–45 minutes of waking and is a normal part of physiology.

It is thought that this morning rise helps the body prepare for the day’s demands. However, it is not correct to explain morning anxiety solely in terms of cortisol levels. The findings of studies examining the relationship between the cortisol arousal response and stress and psychological factors are also inconsistent on this point.

The influence of thoughts on morning anxiety

In morning anxiety, it is not only physical processes but also mental processes that are important.

As soon as a person wakes up, they may begin to think about what needs to be done that day, tasks they need to complete, unresolved problems or uncertainties.

Particularly in people who have been experiencing stress for a long time or who are prone to anxiety, the mind may begin to assess situations that have not yet occurred and prepare for potential problems:

“What will happen today?”

“Will I be able to manage it?”

“What if a problem arises?”

“What if I feel bad again?”

Whilst these thoughts are sometimes recognised as distinct sentences, at other times a person may simply feel a sense of unease that they cannot fully explain.

Sleep and anxiety can influence one another

How we feel in the morning is not independent of how we slept at night.

There is a two-way relationship between sleep problems and anxiety. Whilst anxiety can make it difficult to fall asleep or stay asleep, sleep problems can also lead to an increase in anxiety and depressive symptoms.

Frequent waking during the night, not getting enough rest, or having irregular sleep patterns can contribute to some people experiencing more pronounced morning restlessness.

For this reason, when assessing morning anxiety, it is necessary to consider not only the morning hours but also the person’s overall sleep pattern.

What conditions might morning anxiety be associated with?

Waking up feeling anxious in the mornings can occur at different times and in conjunction with various psychological conditions.

Intense or prolonged stress, generalised anxiety disorder, panic symptoms, depressive episodes and sleep disorders are just some of these.

For example, in generalised anxiety disorder, a person may experience worries not just about a single issue, but about many areas – such as work, health, family, financial matters or daily responsibilities – over which they feel they have little control. These worries may begin as early as the morning.

In depression, some people may experience more pronounced distress, listlessness or low mood in the morning. For this reason, not every feeling of distress experienced in the morning should be interpreted solely as anxiety.

Furthermore, in cases where physical symptoms such as palpitations, trembling, sweating or marked restlessness are prominent, it is necessary to assess the impact of medication, caffeine and other stimulants, as well as certain medical conditions.

Daily habits that may influence morning anxiety

Alongside psychological processes, certain daily habits can also influence how we feel in the morning.

Irregular or insufficient sleep, being confronted with an intense flow of information and notifications as soon as you wake up, starting the day by thinking about numerous responsibilities all at once, or consuming excessive amounts of caffeine can increase feelings of restlessness and physical arousal in some people.

For this reason, when assessing morning anxiety, it is necessary to look not only at thoughts but also at sleep patterns and how the day begins.

What can be done to cope with morning anxiety?

Just as the causes of morning anxiety can vary, so too can the ways of coping with it, and certain lifestyle adjustments may help make the symptoms more manageable.

Some of these include trying to establish regular sleep and wake-up times, allowing yourself a short transition period after waking up, not starting the day with an immediate flood of news or notifications, reviewing caffeine intake, and incorporating physical activity into your daily routine.

Rather than trying to eliminate anxious thoughts entirely, it is also important to simply acknowledge them.

Sometimes, the thought ‘Why did I wake up feeling like this again today?’ may be added to the anxiety a person experiences in the morning. Worrying about the anxiety itself can cause a person to focus more on their physical symptoms and thoughts, which may contribute to the anxiety persisting.

When should you seek support?

Waking up feeling anxious from time to time is not, in itself, a sign of a mental health condition.

However, if morning anxiety persists for weeks, is gradually increasing, is disrupting sleep patterns, is affecting work or daily responsibilities, or has become part of intense anxiety that lasts for a significant part of the day, a psychiatric assessment may be helpful.

During the assessment, the focus is not solely on the anxiety itself, but also on how long it has been present, its pattern throughout the day, sleep patterns, any accompanying physical symptoms, any medication or supplements being taken, and stressors in the person’s life.

Where necessary, it is also important to assess the medical causes of any physical symptoms.

Waking up with anxiety in the mornings can sometimes be a temporary reflection of a particularly stressful period. At other times, it may be one of the symptoms of a longer-standing anxiety, sleep or mood disorder.

A holistic approach to assessment is crucial for resolving the issue.