Why Does Anxiety and Rumination Disrupt Sleep? A Clinical Psychology Podcast Episode.

There are some nights when I’m lying on my soft, warm bedsheets and my bedroom is perfectly dark and silent, but I cannot sleep. I worry how a lack of sleep will impact me the next day, and there are always other things weighing on my mind. I’m hardly the only person who experiences these challenges. We often get ourselves in anxious cycles of being stressed and worried about things outside of our sleep that negatively impact it, then because we’re worrying and anxious and can’t sleep, we start to worry about our sleep. This becomes a vicious cycle that causes further problems to our sleep patterns. This is even truer for students who tend to be stressed and anxious about assignments, readings and other university work. Therefore, in this clinical psychology podcast episode, you’ll learn why does anxiety and rumination disrupt sleep, what is the cognitive model of insomnia and more great information on the psychology of insomnia. If you enjoy learning about anxiety, sleeping problems and more, then this will be a great episode for you.

Today’s psychology podcast episode has been sponsored by CBT For Depression: A Clinical Psychology Introduction to Cognitive Behavioural Therapy for Depression. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.

Why is Sleep Important for Our Mental Health?

To kick off this episode, I want to share some extracts from my podcast episode “How Does A Consistent Sleep Schedule Improve Mental Health?” to help us have a good foundational understanding of how sleep impacts our mental health before we move onto the rest of the episode.

“Ultimately, by having a consistent sleep schedule you can stabilise your mood in the short term as well as in the long term protect yourself against mood disorders, like anxiety and depression.” As well as “having a consistent sleep schedule helps our bodies to effectively regulate our circadian rhythms, so our biological processes that impact the neurochemicals and hormones related to our stress responses and mood can occur in a healthy way. Yet when we disrupt our circadian rhythms by getting inconsistent sleep then we mess up these circadian rhythms and this has negative impacts on our mental health.”

The last extract is “I want to focus on some research that shows a person’s inconsistent sleep schedule can increase their risk of developing depression. Our first study comes from Fang et al. (2021) who looked at the impact of sleep routines on over 1,000 medical students’ day-to-day mood. Their results showed that irregular sleep routines were a big risk factor for developing depressive symptoms. Interestingly, this is even worse for medical students because they often experience an inconsistent work schedule so they can’t have a consistent sleep pattern, so the effects were easier to see in this population.”

Building upon these extracts, and I want to stress here that there are a lot of references available at the bottom of the blog post over on my website, stress and sleep disturbances are some of the most common mental health difficulties around the world. If we look at a range of mental health conditions, a large number of them include sleep disturbances. For example, if you have an anxiety disorder then you might be so anxious that you struggle to fall asleep. I know when I had my Post-Traumatic Stress Disorder after my rape, most nights I couldn’t sleep because I was so anxious, I was having too many flashbacks and I was too distressed.

If we look at depression, you have disturbed sleep because people with depression tend to sleep too much or too little. As well as mental health conditions negatively impact your ability to have a consistent sleep schedule so this reinforces and plays a developmental role in a mental health condition.

If we focus on the stress experienced by young people, because research shows that young people are very vulnerable to stress. This can be because of interpersonal factors like their relationships with peers, teachers, academic staff, family as well as academic pressures. This is even more important when we consider that the extra stress created by university and other forms of education can exacerbate pre-existing mental health difficulties.

However, if we take a systemic approach and if we view the social and societal systems that the young person lives in, then we can understand that there’s a global and cultural context that increases their stress. In turn, this increased stress can contribute to poor sleep quality, and this has a negative knock-on effect for their mental health. For example, in Europe, it isn’t uncommon for young people to face financial insecurity, mental health difficulties more often and job loss, compared to older age groups.

Personally, this is a massive problem in the UK at the moment. I’ve spoken before on the podcast about the unemployment crisis in the UK, and how the unemployment rate for young people is 10% higher than the national average. It is next to impossible to find a job as a young person and then there’s the pressure of the housing market, the increase in fuel cost because of America’s war with Iran and other factors that only makes life more expensive.

All in all, between relationships, academic pressures and society-level stressors, this has a negative impact on the mental health of young people.

What is Anxiety and Rumination in Mental Health and Sleep?

As this entire podcast episode focuses on why and how anxiety and rumination disrupts sleep, we need to make sure that we’re all on the same page about these two terms before we dive into how this negatively impacts sleep. Therefore, rumination refers to prolonged, repetitive as well as negative thinking about our distressing experiences, feelings and worries without taking any action to positively change that state. As you can imagine, rumination is a very common symptom in a range of mental health conditions. For example, I know when I had depression, I was constantly ruminating on how pointless my life was, how I was never going to get better and my life was a failure because of my mental health.

Equally, when I had my social anxiety after my rape, I constantly ruminated about how bad I didn’t want to get raped again, I was scared of everything and I thought that everyone could hurt me. And as a final example when I experienced the worst of my anorexia, I was ruminating on the distressing nature of food, how I didn’t want to gain weight and how I wanted to lose as much weight as possible.

On the other hand, anxiety and worry are a sequence of negative images and thoughts that are hard to control and they’re often accompanied by ways to mentally resolve problems with uncertain outcomes. These outcomes can be negative. For instance, when I’m lying awake late at night before a job interview and I’m worried about the interview. Then this is worry because there are negative thoughts because I am worried about failing the job interview, I’m worried about my financial situation and I’m worried about the outcome. If I don’t get the job then I won’t have money coming in and so on.

The best way to remember the difference is that rumination focuses on past failures and worries whereas worry refers to future events.

As a result, whilst rumination and worry are different, they both involve repetitive thinking about negative emotional experiences and they shift our focus away from the present to the past or future.

Building upon the differences, rumination focuses on issues related to a person’s self-worth, loss and meaning whereas worry focuses on anticipated potential threats. Also, the conscious motivation for rumination is to gain insight into a given situation whereas the motivation for worry is to predict and prepare ourselves for potential threats.

The main reason why I’m spending a section on these definitions is because we have to understand the similarities and differences between worry and rumination because they both have a separate impact on our mental health and sleep (Clancy et al., 2020; Tousignant et al., 2019).

Why is Stress Related to Sleep Quality?

Research tells us that stress is associated with a range of mental health difficulties, like depression, Post-Traumatic Stress Disorder, insomnia and anxiety, and research focuses on the relationship between stress and sleep disturbances. For instance, amongst university students, perceived stress is associated with insomnia symptoms, shorter sleep duration as well as lower sleep quality. With between 47% and 60% of university students reporting poor sleep quality.

It’s worth noting that in academia “sleep quality” is made up of the subjective aspects of sleep, like the feeling of being well-rested and the depth of the sleep, as well as the more objective aspects. Such as the latency and duration of sleep.

In addition, as I mentioned earlier, disturbed sleep is common in a range of mental health conditions because sleep relates to the neurological and cognitive functions of the brain and internalised difficulties, like depression and anxiety. And what I find really interesting about this relationship is that it can reinforce mental health difficulties because this relationship is bidirectional in the first place.

I mean if you struggle sleeping in the first place for a few nights then as my episode on the importance of a consistent sleep schedule shows, then this increases your risk of developing mental health difficulties. Therefore, you might have trouble sleeping for a few nights because of noisy neighbours, a constant party going on next door or your walls are painfully thin so you hear what your neighbours are doing in the bedroom next to you. Then because you’re sleep deprived and because of the cognitive and neurological functions that this impairs, it can lead to increased mental health difficulties.

All the references for this podcast episode are at the bottom of the blog post.

On the other hand, if you have a mental health difficulty or condition like depression, anxiety or Post-Traumatic Stress Disorder then you might struggle to sleep in the first place. I definitely experienced this during the aftermath of my rape. As a result, your mental health condition makes it difficult to sleep so you become tired, sleep-deprived and this has a negative knock-on effect for your already distressed and biased cognitive and neurological processes. Hence, the creation of the vicious cycle where your mental health difficulties cause poor sleep quality then your sleep quality causes your mental health difficulties to get worse, this leads to even poorer sleep quality and so on.

What is the Cognitive Model of Insomnia?

Now that we understand the importance of sleep and why rumination and anxiety negatively impact sleep and our mental health, we need to start looking at the why. Why exactly does rumination and anxiety impact sleep quality. As a result, a lot of research studies have shown that certain cognitive mechanisms as well as high general arousal might affect the relationship between sleep difficulties and the stress we experience. These research findings have led to the creation of several theories, including the Cognitive Model of Insomnia.

The Cognitive Model of Insomnia by Harvey (2020) proposes that individuals with insomnia are more likely to experience excessive worry about their sleep and the consequences of their disrupted sleep on their health. This is definitely something that I experience because there will be times when I’m lying in bed, I can’t sleep and then I start to get concerned about how this disrupted sleep will impact me the next day. For example, if I have a job interview, I’m out with friends or loved ones or I have something else important that I can’t be tired for. Then I get concerned about it because I don’t want to feel exhausted, tired or any other negative state of being.

In addition, this negative cognitive process that arises from worry and our rumination activates autonomic arousal and this disrupts our sleep. The Model assumes that our insomnia happens because of a combination of stressors, genetic vulnerability, learned behaviours, cognitive activities, like worry and rumination, as well as dysfunctional behaviour patterns.

Building upon this, cortical, cognitive and somatic activity results in excessive general arousal and this can lead to anxiety, worry, high levels of daytime distress, a real sleep deficit and physiological arousal. In turn, this creates a cycle where the connection between our stress and our sleep quality is bidirectional as I explained earlier.

Personally, I want to jump in here and add that I definitely agree with the theory so far. Since if I truly think about what I was experiencing during the worst of my PTSD and other negative mental health outcomes after my rape. I experienced constant cortical activity because my brain was constantly filled with thoughts, dreams and perceptions of danger because of my hypervigilance. I constantly experienced heightened somatic activity because I was shaking a lot, I felt the physical sensations of my rapist raping me over and over as well as my body was constantly tense because I was always in fight-or-flight. As well as I was always anxious, hypervigilant and other cognitive processes were going on, so all these heightened processes explained why my sleep was so bad.

On the other hand, another theory of hyperarousal by Morrin et al. (2003) suggests that it is the coping skills that we use to manage our arousal that mediates the sleep-stress relationship. For example, it is how we appraise our stressors as well as how we perceive the amount of control we have over these stressors that increases our vulnerability to sleep difficulties. Morrin et al.’s research found that both good and poor sleepers had the same number of minor life stressors, but the difference between a good sleeper and a poor sleep was that good sleepers reported less pre-sleep arousal and they perceived their lives as less stressful than the poor sleepers.

I can see where this theory is coming from because as I went for my specialist rape counselling, I learnt more skills and I was able to increase my feelings of control over my symptoms, my life and my relationships. I was able to start sleeping better, so there is no way for me to know if it was the decrease in my mental health difficulties or the increased sense of control over my stressors that led to improved sleep quality. There might be something to this theory. Personally, I believe it probably was a mixture of the two factors with the decrease of my mental health symptoms causing the most positive impact on my sleep quality.

Clinical Psychology Conclusion

Whilst this psychology podcast episode was more information-dense than usual, I really did enjoy it because it was fun to develop a deeper understanding of how our thoughts, feelings and other mental health factors can disrupt our sleep. I know from personal experience just how important having good sleep habits are, and after all my mental health struggles in the past decade, I know how disrupted our sleep can become because of excessive arousal, worry and rumination. It was really interesting to finally understand why.

Also, we’ll probably explore this in more depth in future podcast episodes but everything that we learnt today can be directly applied to clinical practice. Since these research findings and theories are applied to a wide range of psychological interventions that are used to treat insomnia. For example, Cognitive Behavioural Therapy for Insomnia, better known as CBT-I.

Therefore, to wrap up today’s episode, anxiety and rumination disrupt our sleep because they trigger physiological and cognitive hyperarousal. Since according to different psychological models, the repetitive negative thinking patterns associated with future-focused threats for worry and past-focused threats for rumination, they activate the sympathetic nervous system and heighten our cognitive, cortical and somatic arousal. This disrupts our sleep because it means we cannot turn our minds off and rumination disrupts sleep as it prolongs our emotional processing, increases pre-sleep arousal and it makes minor stressors feel more intense. Then as our arousal increases, we become more anxious because we aren’t sleeping and we’re concerned about how our disrupted sleep will impact us so this creates a vicious cycle. Ultimately, leading to decreased sleep quality and increased stress.

Finally, to truly wrap up the episode, I would unofficially recommend that when we’re struggling to get to sleep because you’re worried and/ or you’re ruminating, you might want to try some breathwork to deactivate your sympathetic nervous system, you could practise Thought Stopping from cognitive behavioural therapy so you could just “shout” stop in your mind or out loud to get the thoughts to stop and this can disrupt them so you don’t constantly ruminate. As well as please consider practising self-compassion. If you’re struggling with sleep then this is okay, it’s normal and it’s understandable given your situation, so please be kind to yourself. Beating yourself up will not help you go to sleep any faster.

Being kind to yourself is one of the best things you can do.

I hope you enjoyed today’s clinical psychology podcast episode.

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Clinical Psychology References and Further Reading

Clancy, F., Prestwich, A., Caperon, L., Tsipa, A., & O’connor, D. B. (2020). The association between worry and rumination with sleep in non-clinical populations: a systematic review and meta-analysis. Health Psychology Review, 14(4), 427-448.

Davey, G. C., Meeten, F., & Field, A. P. (2022). What’s worrying our students? Increasing worry levels over two decades and a new measure of student worry frequency and domains. Cognitive Therapy and Research, 46(2), 406-419.

Emran, M. G. I., Mahmud, S., Khan, A. H., Bristy, N. N., Das, A. K., Barma, R., ... & Roy, M. (2024). Factors influencing stress levels among students: A virtual exploration. European Journal of Medical and Health Sciences, 6(6), 67-75.

Harvey, A. G. (2002). A cognitive model of insomnia. Behaviour research and therapy, 40(8), 869-893.

https://pmc.ncbi.nlm.nih.gov/articles/PMC12294785/#sec1-ijerph-22-01001

Iqbal, N., & Dar, K. A. (2015). Negative affectivity, depression, and anxiety: Does rumination mediate the links?. Journal of affective disorders, 181, 18-23.

Jansson-Fröjmark, M., Sunnhed, R., Carney, C. E., & Rosendahl, I. (2024). Conceptual overlap of negative thought processes in insomnia: A focus on catastrophizing, worry, and rumination in a student sample. Behavioral Sleep Medicine, 22(6), 857-872.

Joubert, A. E., Moulds, M. L., Werner‐Seidler, A., Sharrock, M., Popovic, B., & Newby, J. M. (2022). Understanding the experience of rumination and worry: A descriptive qualitative survey study. British journal of clinical psychology, 61(4), 929-946.

Lancet, T. (2022). An age of uncertainty: mental health in young people. Lancet (London, England), 400(10352), 539.

Liu, Z., Xie, Y., Sun, Z., Liu, D., Yin, H., & Shi, L. (2023). Factors associated with academic burnout and its prevalence among university students: a cross-sectional study. BMC medical education, 23(1), 317.

Manzar, M. D., Salahuddin, M., Pandi-Perumal, S. R., & Bahammam, A. S. (2021). Insomnia may mediate the relationship between stress and anxiety: a cross-sectional study in university students. Nature and Science of Sleep, 31-38.

Morin, C. M., Rodrigue, S., & Ivers, H. (2003). Role of stress, arousal, and coping skills in primary insomnia. Biopsychosocial Science and Medicine, 65(2), 259-267.

Nolen-Hoeksema, S., & Watkins, E. R. (2011). A heuristic for developing transdiagnostic models of psychopathology: Explaining multifinality and divergent trajectories. Perspectives on psychological science, 6(6), 589-609.

Petak, A., & Maričić, J. (2025). The role of rumination and worry in the bidirectional relationship between stress and sleep quality in students. International journal of environmental research and public health, 22(7), 1001.

Riemann, D., Spiegelhalder, K., Feige, B., Voderholzer, U., Berger, M., Perlis, M., & Nissen, C. (2010). The hyperarousal model of insomnia: a review of the concept and its evidence. Sleep medicine reviews, 14(1), 19-31.

Schmickler, J. M., Blaschke, S., Robbins, R., & Mess, F. (2023). Determinants of sleep quality: a cross-sectional study in university students. International journal of environmental research and public health, 20(3), 2019.

Segerstrom, S. C., Tsao, J. C., Alden, L. E., & Craske, M. G. (2000). Worry and rumination: Repetitive thought as a concomitant and predictor of negative mood. Cognitive therapy and Research, 24(6), 671-688.

Thomsen, D. K., Mehlsen, M. Y., Christensen, S., & Zachariae, R. (2003). Rumination—relationship with negative mood and sleep quality. Personality and Individual Differences, 34(7), 1293-1301.

Tousignant, O. H., Taylor, N. D., Suvak, M. K., & Fireman, G. D. (2019). Effects of rumination and worry on sleep. Behavior therapy, 50(3), 558-570.

Watkins, E. R. (2008). Constructive and unconstructive repetitive thought. Psychological bulletin, 134(2), 163.

Zhang, J., Li, X., Tang, Z., Xiang, S., Tang, Y., Hu, W., ... & Wang, X. (2024). Effects of stress on sleep quality: multiple mediating effects of rumination and social anxiety. Psicologia: Reflexão e Crítica, 37(1), 10.

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