Morning Anxiety

What to do in the first 10 minutes

Get your body upright before you let your mind start on the day. Here are the same steps as in the tool, for a morning without a screen.

1. Sit up and put both feet on the floor (about a minute). Leave the phone where it is.
2. Breathe out slowly for one minute. The NHS, the UK's health service, describes a calming breath for stress, anxiety and panic: breathe in gently, then let the air flow out gently, counting to 5 each way ^[1]. We make the out-breath a little longer, in for 4 and out for 6.
3. Do 5-4-3-2-1 (about 2 minutes): 5 things you see, 4 you can feel, 3 you hear, 2 you smell, 1 you taste. If the anxiety is in your body, start with what you feel, such as the floor under your feet.
4. Choose one task for today, the smallest one you can finish today. Say it out loud or write it down.
5. Then get up and start with something physical, such as washing your face or opening a window.

The order and the 10 minutes are our suggestion, not a tested program. The full grounding steps are on 5-4-3-2-1 grounding.

Why is anxiety worse in the morning?

Several things may add up in the morning: the normal rise in a stress hormone, the stress you went to bed with, and the day ahead.

Cortisol, often called the stress hormone, rises sharply in the first 30 to 45 minutes after waking. Brain imaging studies suggest it helps prepare the brain for the day ^[2]. That rise is larger, on average, in people under more stress at work or in life ^[3]. It also depends on the evening before. In a 5-day study of 42 young adults, the rise was bigger on mornings after evenings when they expected more stress than usual the next day ^[4]. In 156 older adults, feeling lonely, sad, threatened or out of control one day went with a larger rise the next morning ^[5].

None of these studies measured morning anxiety itself, so they don't show that cortisol causes it, or that changing your evening would help. We still think the evening is worth trying: it is the part of the cycle you can change.

Then there is timing. You wake up with the whole day ahead and nothing yet to keep your mind busy. Bethany Teachman, a psychologist at the University of Virginia, describes morning anxiety as mostly a "false alarm," and says treating it as just an emotion you can ride out tends to keep it from spiraling ^[6].

Waking up with a panic attack

Waking up in a state of panic is common in panic disorder: in the studies reviewed by Craske and Tsao, 44% to 71% of patients reported at least one such attack. Such an attack starts out of non-dream sleep, so it is different from a nightmare ^[7]. Cleveland Clinic says symptoms of a nighttime panic attack usually peak in under 10 minutes ^[8], and NIMH says panic attacks themselves are not life-threatening ^[9].

• If you wake up with your heart pounding, turn on a light and sit up with your feet on the floor. Breathe out slowly. Remind yourself where you are, and that symptoms like these usually peak within about 10 minutes.
• If it is the first time, or there is chest pain, call 911 rather than wait it out (see below).
• If it keeps happening, tell your doctor. Repeated attacks that wake you are worth checking, like any repeated symptom.

The full steps for an attack, including what not to do, are on panic attack: what to do.

Is it anxiety or my heart?

You can't tell for sure on your own, and a panic attack can feel just like heart trouble. The American Heart Association says to call 911 for any of these ^[10]:

• discomfort in the center of the chest that lasts more than a few minutes, or goes away and comes back: pressure, squeezing, fullness or pain;
• pain or discomfort in one or both arms, the back, neck, jaw or stomach;
• shortness of breath, with or without chest discomfort;
• a cold sweat, nausea or lightheadedness along with any of the above.

Call 911 instead of driving yourself. If it turns out to be anxiety, you have lost nothing by checking.

The evening before: what makes the morning easier

It's 10 p.m. and tomorrow's meeting is already playing in your head. Deal with it now, before bed. Write tomorrow's first task on paper and leave it where you will see it when you wake up, so the morning starts with a decision already made.

In a 6-week diary study of 50 people, stress and worries at bedtime were the main predictors of how well people slept that night ^[11]. If the worries keep going once you are in bed, try the routine in how to stop overthinking at night.

If you wake up anxious in the middle of the night rather than in the morning, see what to do when you wake up at night.

Coffee, phone and news in the first hour

Very large amounts of caffeine can trigger anxiety. In lab studies, a dose of caffeine roughly equal to 5 cups of coffee set off panic attacks in about half of people with panic disorder and in very few healthy adults; smaller doses were not tested ^[12]. If your mornings are bad, try a week with less coffee, or coffee later in the morning, and notice any difference.

Checking email, news or social media in bed puts the whole day in front of you before you're out of bed. We suggest keeping the phone out of reach until after the first 10 minutes.

Frequently asked questions