ORTHOSOMNIA
What to Know About Sleep Anxiety and Insomnia
Are you having a hard time falling asleep because you are anxious about the prospect of not being able to fall asleep? While this may sound counterintuitive, it is unfortunately a very real condition for many people.
If that sounds like you and your nightly struggles, you may be suffering from orthosomnia. Let’s take a closer look at this condition and give you tools to help you fall asleep faster and stress-free!
Table of Contents
What Is Orthosomnia?
Orthosomnia is a relatively new sleep disorder that has gained attention in the last decade. Unlike typical insomnia, orthosomnia is linked to anxiety about sleep itself. People with orthosomnia often worry so much about not sleeping well that the stress actually prevents them from falling or staying asleep.
The condition was first identified when researchers noticed patients reporting poor sleep even while sleep studies showed they were sleeping more than they realized. This paradox highlights the role of anxiety, self-monitoring, and sleep quality perception in orthosomnia.
For anyone who struggles with restless nights, understanding orthosomnia can provide clarity, relief, and practical steps to improve rest moving forward.
Orthosomnia vs. Insomnia: What’s the Difference?
Although orthosomnia is related to insomnia, the two conditions are not identical.
Insomnia is difficulty falling asleep, staying asleep, or getting restorative sleep, regardless of the cause. If you suffer from insomnia, check our list of natural remedies for insomnia.
Orthosomnia specifically stems from anxiety and worry about not getting enough sleep, even in people who do get enough sleep, as it can also stem from the perception of not getting enough sleep.
In other words, insomnia has many potential causes—stress, health conditions, medications, lifestyle habits, menstrual cycle, menopause, moon phases—while orthosomnia is fueled primarily by the fear of not sleeping.
This makes orthosomnia particularly challenging: the harder you try to sleep, the less likely you are to succeed.
Causes of Orthosomnia
Several factors can trigger orthosomnia, including:
1. Sleep Anxiety
Worrying about how much, or how little, you’re sleeping is the most common cause. This often worsens when people track their sleep with devices like smartwatches or apps. Read more about the impact of anxiety on sleep here.
2. Stress and Overthinking
Daily stress—work, school, relationships, finances—can spiral into nighttime anxiety. Once you link bedtime with worry, orthosomnia can develop.
3. Sleep Studies and Sleep Trackers
Paradoxically, people who undergo sleep studies often report worse sleep due to the pressure of being monitored. Similarly, obsessively checking sleep trackers can heighten worry.
4. Perfectionism
Those who strive for control and perfection in daily life may experience heightened anxiety about achieving “perfect sleep,” which fuels orthosomnia.
Symptoms of Orthosomnia
Recognizing orthosomnia is essential as a first step for getting the right help. Common symptoms include:
Trouble falling asleep despite feeling tired
Frequently waking up during the night
Feeling like sleep quality is poor, even if you get adequate hours
Racing thoughts or worry at bedtime
Physical symptoms of anxiety (elevated heart rate, restlessness)
Fatigue and irritability during the day
If you experience some, or all of those symptoms at night, and if you know you are worried about your sleep quality or sleep length, you may be dealing with orthosomnia.
How Orthosomnia Impacts Health
Sleep is foundational for health, and orthosomnia disrupts both your mental and physical well-being. You may be affected with one or more of the following:
Cognitive Impacts: Difficulty focusing, brain fog, memory lapses.
Emotional Health: Increased risk of anxiety, depression, irritability.
Physical Health: Weakened immune function, higher blood pressure, increased risk of chronic conditions like diabetes or heart disease.
Quality of Life: Lower productivity, strained relationships, and overall reduced life satisfaction.
Diagnosing Orthosomnia
Doctors typically evaluate orthosomnia through:
Sleep History – Reviewing your sleep patterns, habits, and worries.
Sleep Diaries – Tracking bedtime, wake-ups, and perceptions of rest.
Polysomnography (Sleep Study) – Monitoring actual sleep to compare with self-reported poor sleep. This typically requires a night of in-patient at a local facility.
One hallmark of orthosomnia is the mismatch between perceived poor sleep and objective data showing adequate rest.
Treatments for Orthosomnia
The good news is that orthosomnia can be managed with a combination of therapy, habits, and sometimes medical support.
1. Cognitive Behavioral Therapy for Insomnia (CBT-I)
CBT-I is considered the gold standard treatment. It helps reframe negative thought patterns, reduce bedtime anxiety, and retrain the mind to associate bed with restful sleep.
2. Relaxation Techniques
Deep breathing
Meditation
Progressive muscle relaxation
Guided imagery
These can calm the body and mind before sleep. If you are looking for free resources, our favorite app has thousands of tracks to help you tackle sleep, anxiety, stress, and other ailments that could be impacting your sleep and daily life.
3. Limiting Sleep Trackers
If you constantly check your sleep data, consider taking a break. This removes a source of performance anxiety and allows sleep to happen naturally. You should know, in the morning, whether you have gotten sufficient sleep, and/or high-quality sleep.
4. Healthy Sleep Hygiene
Go to bed and wake up at the same time daily.
- Put in place a bedtime routine that works for you.
Avoid screens 1–2 hours before bed to limit your exposure to blue light.
Keep your bedroom cool, dark, and quiet.
5. Medical Treatment
In severe cases, a doctor may recommend short-term use of sleep aids. However, these are not a long-term solution and should be used sparingly. Only start a new treatment after consulting a medical professional.
Orthosomnia and the Role of Sleep Environment
Your sleep environment has a powerful effect on orthosomnia. A comfortable, relaxing setup can reduce anxiety and promote better rest.
Choosing the Right Mattress
If your mattress is uncomfortable, too firm, or too soft, it can worsen sleep anxiety. A high-quality mattress with good support and temperature regulation helps reduce tossing and turning. Check out our list of Best Mattresses, updated yearly.
Breathable Bedding
Cooling sheets and comforters prevent overheating, a common disruptor for anxious sleepers. Natural materials like bamboo or cotton are excellent choices.
Weighted Blankets
For some, a weighted blanket provides calming pressure that reduces anxiety and helps the body relax into sleep. We have created a list of Best Weighted Blankets for Anxiety – they can make a world of difference and remain a natural way to cope with anxiety and orthosomnia.
Lifestyle Changes to Manage Orthosomnia
Orthosomnia often improves when paired with healthy daytime habits:
Exercise Regularly – Morning or afternoon workouts help regulate sleep cycles. Not sure when is best to exercise before sleep? Check out our guide by sport!
Limit Caffeine and Alcohol – Both can interfere with deep sleep. Here’s a list of more foods to avoid before bedtime.
Create a Wind-Down Routine – Reading, journaling, or gentle yoga signal to the body it’s time to rest. Having an established bedtime routine helps in signaling to your brain that it is time to wind down.
Set Boundaries with Work – Avoid bringing work-related stress into bedtime.
When to Seek Professional Help
Occasional restless nights are normal, but if you consistently struggle with orthosomnia symptoms for weeks or months, it is time to seek help. A sleep specialist or therapist can guide you toward treatment strategies that restore healthy sleep.
Orthosomnia - Final Thoughts
Orthosomnia is a unique sleep disorder rooted in anxiety and worry about rest. While it can be frustrating and exhausting, it is highly treatable with the right combination of therapy, habits, and lifestyle changes. By creating a supportive sleep environment and breaking the cycle of worry, you can retrain your mind and body to rest more naturally.
If you suspect you may have orthosomnia, consult with a sleep specialist to explore treatment options tailored to your needs.
References
- Mayo Clinic. (2023). Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills. Retrieved from https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/insomnia-treatment/art-20046677
- National Library of Medecine. (2003). The Tale of Orthosomnia: I Am so Good at Sleeping that I Can Do It with My Eyes Closed and My Fitness Tracker on Me. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC9875581/
- Compassion Behavioral Health. (2024). The Link Between Anxiety Disorder and Sleep Problems. Retrieved from https://compassionbehavioralhealth.com/the-link-between-anxiety-disorder-and-sleep-problems/
FAQ
Most frequent questions and answers
Orthosomnia is a sleep disorder caused by anxiety about not sleeping, making it harder to fall or stay asleep.
Orthosomnia is often triggered by sleep anxiety, stress, perfectionism, or over-monitoring sleep with trackers.
Unlike general insomnia, orthosomnia specifically results from worry about not getting enough sleep.
Yes, with cognitive behavioral therapy, relaxation techniques, and better sleep habits, orthosomnia can be managed effectively.
If you struggle to sleep due to anxiety about rest and feel like your sleep is worse than it actually is, you may have orthosomnia.
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Laura Georgieff
Laura is a mother of three who did not sleep through the night for the first 5.5 years of her kids' lives. She is passionate about sleep quality and loves sharing her experience and knowledge of all thing bedding! It is her mission to help you make the best decisions when it comes to sleep and help you get the best deal on the market!
