Morning anxiety

Several things make anxiety stronger in the first hour of the day. Cortisol rises sharply in the 30 to 45 minutes after you wake, and short sleep, caffeine habits and alcohol the night before can each add to how you feel.

This guide goes through each cause, what the research shows, and what you can change. It covers the first hour after you get up. If your anxiety wakes you in the middle of the night, that has its own guide.

For waking in the night with a racing mind, see anxiety at night.

If you have new, severe or crushing chest pain, especially pain that spreads to your arm, jaw, neck or back, or comes with sweating or breathlessness, call 911 even if you are not sure it is your heart. If you are in crisis or thinking about suicide, call or text 988, the Suicide & Crisis Lifeline.

1)Why do I wake up with anxiety?

The best-studied reason is a normal hormone pattern called the cortisol awakening response. Cortisol is a stress hormone, and its level climbs steeply over the first 30 to 45 minutes after waking. This rise sits on top of the normal daily cortisol cycle.

Researchers still debate what the rise is for. One idea is that it prepares the body for the day ahead, so the size of the rise may reflect what you expect that day to bring. The evidence for that idea is mixed, but some findings are consistent:

• A meta-analysis of 147 studies found that a larger morning rise went with higher job stress and general life stress.
• In a study of 219 people, those who reported chronic work overload and worry had a bigger rise on weekdays, and no bigger rise on weekends.
• A smaller study of 23 people did not find a link between the rise and how stressful people expected their day to be. It did find that people with a larger rise coped better with that day's stress.

So the morning cortisol rise is a normal part of waking, and it tends to be larger when life is under strain. The research has not shown that the rise itself creates the anxious feeling. A reasonable reading is that it is one reason your body starts the day more activated, which can make any worries on your mind feel louder in the first hour.

2)Why is morning anxiety worse on workdays?

In the weekday study mentioned above, 219 participants took saliva samples when they woke and again 30, 45 and 60 minutes later, over six days starting on a Saturday. People who reported ongoing work overload and worry had a larger cortisol rise on weekdays, and the difference held after accounting for what time they woke and how long they slept. On weekend mornings, their rise was no larger than anyone else's.

If your mornings are calmer on days off and harder on workdays, that fits this pattern, and it points to workload and worry as the things to work on. Note which days are worst for two or three weeks.

The large review also found a smaller morning rise in people reporting fatigue, burnout or exhaustion. If your mornings feel flat and drained for weeks, mention it to a doctor.

3)Can poor sleep cause morning anxiety?

Yes, and the effect shows up the next day. A 2020 study from the University of California, Berkeley, found that a night of lost sleep raised next-day anxiety, and linked this to reduced activity in the medial prefrontal cortex, a brain area that helps regulate emotion. Deep non-REM sleep, the slow-wave stage, had the opposite effect and was followed by lower anxiety.

The same study found that small night-to-night drops in sleep, of the kind most people have, predicted day-to-day rises in anxiety.

The NHS suggests these steps for better sleep:

• Wake up and get out of bed at the same time every day.
• Go to bed only when you are sleepy.
• Keep the bedroom dark and quiet.
• Avoid alcohol, tea and coffee for at least 6 hours before bed.
• Do not eat a big meal late at night.
• Skip daytime naps.

If sleep problems go on for weeks, the NHS says cognitive behavioral therapy for insomnia (CBT-I) is the usual treatment, delivered by a therapist or through an online programme.

4)Does coffee make morning anxiety worse?

It can, in two ways. The first is the caffeine itself. In a 2022 meta-analysis of lab studies, high doses of caffeine, around five cups of coffee, brought on panic attacks in about half of people with panic disorder and raised anxiety in healthy adults too. Less is known about smaller doses.

The second is withdrawal. A review of 66 studies found that caffeine withdrawal symptoms usually begin 12 to 24 hours after the last dose, and can appear in people who take as little as 100 mg a day. The confirmed symptoms include headache, tiredness, low mood, irritability, trouble concentrating and a foggy head. Anxiety is not on that list. Still, if your last coffee was the afternoon before, you may wake up already partway into withdrawal, and irritability plus a foggy head can make a tense morning feel worse.

To test it, spend two weeks writing down how much caffeine you had and when, next to a 1 to 10 rating of how anxious each morning felt.

5)Can low blood sugar feel like anxiety in the morning?

The symptoms overlap. The NHS lists feeling anxious or irritable, shaking, sweating, a pounding heart, hunger and dizziness as signs of low blood sugar.

Low blood sugar mostly affects people with diabetes who take insulin or certain other diabetes medicines, and the NHS says it is rare in people without diabetes. If you take those medicines and wake up shaky and anxious, talk to your diabetes team about it. If you do not have diabetes and keep getting these symptoms, see a doctor so they can look for the cause.

6)Why is anxiety worse the morning after drinking?

The US National Institute on Alcohol Abuse and Alcoholism lists anxiety and irritability among hangover symptoms and gives two reasons for it.

• Rebound. While you drink, the brain adjusts to alcohol's calming effect. When the alcohol wears off, that adjustment is still in place, and people can feel more restless and anxious than before they drank.
• Broken sleep. Alcohol helps you fall asleep faster, but sleep later in the night is more fragmented, and people tend to wake earlier.

A review of sleep lab studies found the same pattern at every dose tested: deeper sleep in the first half of the night, and more disrupted sleep in the second half. That puts the worst of the disruption in the hours just before you wake. The NHS advice for anyone with ongoing anxiety is to cut down on alcohol and avoid using it to cope.

7)How do you stop waking up with anxiety?

The morning cortisol rise is a normal part of waking. What you can change are the other things that add to it. These are the steps with evidence behind them:

• Keep the same wake-up time every day, weekends included, and get out of bed when you wake instead of lying there.
• Protect your sleep, using the NHS list above.
• Look at caffeine and alcohol, using the two-week log to see whether they track with your worst mornings.
• Move your body. A review in American Family Physician notes that physical activity reduces anxiety symptoms. A short walk in the first hour is an easy place to start.
• Do five minutes of structured breathing.

On breathing, a month-long randomized study at Stanford compared five minutes a day of breathing exercises, including box breathing and the cyclic sigh, with five minutes of mindfulness meditation. All groups had less anxiety after their daily practice. The breathing groups had a larger improvement in mood, and the cyclic sigh, which uses a long slow breath out, did best.

Our box breathing timer counts the rounds for you, so you can do it before you pick up your phone.

8)Can you wake up in a panic attack?

Yes. Some panic attacks start during sleep and wake you up with a pounding heart, sweating, shaking or a feeling of dread. The same symptoms from the DSM-5 panic attack list apply, and the fear peaks within minutes. A review in American Family Physician notes that night-time attacks are not uncommon in people with panic disorder, and that attacks at night call for a more thorough medical check.

Our guide to panic attacks and anxiety attacks explains how to tell a slow build of anxiety from a panic attack.

9)Is morning anxiety a sign of something else?

A few patterns are worth a closer look:

• Worry that is hard to control, present on most days for six months or more. This is the time frame for generalized anxiety disorder. Other signs include restlessness, irritability, trouble concentrating and difficulty sleeping.
• Waking very early and feeling low. The NHS lists waking very early in the morning and feeling anxious or worried among the symptoms of depression.
• Waking up in a panic attack, with a sudden surge of fear and a pounding heart. Panic attacks at night are not uncommon in panic disorder, which is treatable.
• Shakiness, a racing heart and anxiety that do not fit any worry. An overactive thyroid is one of the medical conditions doctors rule out when anxiety symptoms appear.

The free GAD-7 anxiety test has seven questions and shows whether ongoing anxiety is at a level worth raising with a professional.

10)When should you get help for morning anxiety?

See a doctor or a mental health professional if:

• You wake up anxious on most days and it has been going on for weeks.
• It is making it hard to get to work, look after your family or leave the house.
• You feel low as well as anxious.
• You have physical symptoms with no clear cause, such as shaking or a racing heart.
• You are relying on alcohol or other substances to get through the morning or to get to sleep.

For ongoing anxiety, the NHS says a GP will usually suggest a talking therapy such as cognitive behavioral therapy (CBT) first, with medication as another option.

The Canadian anxiety guidelines rate CBT as a first-line treatment for generalized anxiety that works as well as medication, and online CBT programmes have also been shown to help.

If you have new, severe or crushing chest pain, especially pain that spreads to your arm, jaw, neck or back, or comes with sweating or breathlessness, call 911 even if you are not sure it is your heart. If you are in crisis or thinking about suicide, call or text 988, the Suicide & Crisis Lifeline.

11)Sources

Definition and timing of the cortisol awakening response: Stalder, T., Kirschbaum, C., Kudielka, B. M., et al. (2016). Assessment of the cortisol awakening response: expert consensus guidelines. Psychoneuroendocrinology, 63, 414-432.

The anticipation idea behind the morning cortisol rise: Fries, E., Dettenborn, L., & Kirschbaum, C. (2009). The cortisol awakening response (CAR): facts and future directions. International Journal of Psychophysiology, 72(1), 67-73.

Morning cortisol rise and job and life stress: Chida, Y., & Steptoe, A. (2009). Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis. Biological Psychology, 80(3), 265-278.

Weekday rise linked to work overload and worry: Schlotz, W., Hellhammer, J., Schulz, P., & Stone, A. A. (2004). Perceived work overload and chronic worrying predict weekend-weekday differences in the cortisol awakening response. Psychosomatic Medicine, 66(2), 207-214.

Morning cortisol rise and coping with same-day stress: Powell, D. J., & Schlotz, W. (2012). Daily life stress and the cortisol awakening response: testing the anticipation hypothesis. PLoS One, 7(12), e52067.

Sleep loss and next-day anxiety: Ben Simon, E., Rossi, A., Harvey, A. G., & Walker, M. P. (2020). Overanxious and underslept. Nature Human Behaviour, 4(1), 100-110.

Sleep advice and CBT for insomnia: NHS. Insomnia.

Caffeine and anxiety: Klevebrant, L., & Frick, A. (2022). Effects of caffeine on anxiety and panic attacks in patients with panic disorder: a systematic review and meta-analysis. General Hospital Psychiatry, 74, 22-31.

Caffeine withdrawal symptoms and timing: Juliano, L. M., & Griffiths, R. R. (2004). A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. Psychopharmacology, 176(1), 1-29.

Low blood sugar symptoms and who it affects: NHS. Low blood sugar (hypoglycaemia).

Hangover anxiety and sleep after drinking: National Institute on Alcohol Abuse and Alcoholism (2025). Hangovers.

Alcohol and the second half of the night: Ebrahim, I. O., Shapiro, C. M., Williams, A. J., & Fenwick, P. B. (2013). Alcohol and sleep I: effects on normal sleep. Alcoholism: Clinical and Experimental Research, 37(4), 539-549.

Breathing exercises and mood: Balban, M. Y., Neri, E., Kogon, M. M., et al. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), 100895.

Generalized anxiety time frame, physical activity, nocturnal panic and medical causes: DeGeorge, K. C., Grover, M., & Streeter, G. S. (2022). Generalized anxiety disorder and panic disorder in adults. American Family Physician, 106(2), 157-164.

Generalized anxiety symptoms, self-help and treatment: NHS. Generalised anxiety disorder in adults.

CBT and online CBT for generalized anxiety: Katzman, M. A., Bleau, P., Blier, P., et al. (2014). Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry, 14(Suppl 1), S1.

Depression symptoms, including early waking: NHS. Symptoms of depression in adults.

The 988 Suicide & Crisis Lifeline: National Institute of Mental Health (2025). Panic Disorder: What You Need to Know.

Heart attack warning signs and when to call 911: National Heart, Lung, and Blood Institute. Heart attack symptoms.