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Inspiration

How to Sleep When Anxious: 3 Practical Body-Scan Tips

Jud Brewer, MD PhD
Jud Brewer, MD PhD
Mar 24, 2020
10 min read
Watch · 8

Jud Brewer, a neuroscientist who specializes in anxiety and habit change, opens his March 2020 video with a scene most people living through that spring will recognize: he and his wife set an alarm for 5:00 a.m. and cheered, because for a week they had been waking between 3:00 and 4:00 a.m. with no alarm at all, their minds filling with thought after thought. Now they were getting a normal night's rest again. From there, the six-minute video becomes a clear-eyed explanation of how anxiety and sleep trap each other, a short list of questions he uses in his clinic to diagnose the trap, three practical tips for the bedtime hours, and a guided body scan he walks viewers through on camera. It is a short video, but it carries a lot of useful clinical logic, and it holds up well as a practical guide for anyone whose nights have gotten worse.

Read · 9 sections

Why does anxiety and bad sleep become a loop?

Brewer's core framing is blunt. In the video at 0:44 he describes the problem this way: "anxiety is a double whammy it can get in your head and mess with your sleep and then the lack of sleep can make you more prone to anxiety." That is a feedback loop, not a single cause. Worry keeps you awake; being awake makes you more worried the next day; and the next night starts with a head already primed for threat.

He also says that the two forms of interrupted sleep he sees most often in his clinic are difficulty falling asleep and early-morning awakening, in which a person wakes too early and cannot get back under. Those patterns map closely onto the lived experience in his opening anecdote, and they are useful categories for self-diagnosis. If you lie awake at the start of the night, or you surface at 3:30 a.m. and your mind starts running, you are describing the two patterns he treats.

How can you tell whether anxiety is what's disrupting your sleep?

To make the point concrete, Brewer reads from a set of standardized questions the National Institutes of Health developed for researchers studying the links between anxiety and sleep. Respondents rate, on a scale from 1 (not at all) to 5 (very much), how much statements apply to them over the past seven days. The items he reads include feeling physically tense at bedtime, worrying about not being able to fall asleep, feeling worried at bedtime, having trouble stopping thoughts at bedtime, and stress disturbing sleep. A high total, he says, is a sign that anxiety is interfering with your nights.

The joke he makes about the results is worth taking seriously. A high score, he suggests at around 1:53, means you are playing the same game everyone else is playing that spring. The questionnaire is less a diagnostic instrument for a viewer at home than a mirror: it helps you name what your nights have been like, which is the first step toward changing them.

What do Brewer's three first questions reveal?

When patients come into his addiction clinic with sleep trouble, Brewer says he asks a first set of questions. The reason for the visit varies, he notes, but almost all of his patients have trouble sleeping. He asks whether, when their head hits the pillow, they have trouble shutting their brain off; whether their brain starts spinning with worried thoughts about the future; and whether, when they can't sleep, looking at the clock makes them more anxious because they begin to worry they won't get enough rest.

The third question is the most revealing, because it shows how the anxiety compounds itself. The clock becomes a threat. Each glance reminds you how little time remains before morning and how badly you need the sleep, and that worry is itself the thing keeping you up. Answering yes to all three is a strong signal that the problem is less about the hours and more about what your mind does with them.

Why does worry keep the body awake?

Brewer grounds the discussion in a definition: anxiety, in medical terms, is "a feeling of worry nervousness or unease typically about an imminent event or something with an uncertain outcome." He then points to the obvious candidate for the current situation. The outcome of the pandemic is uncertain, and that uncertainty produces a feeling of nervousness that, in his telling, energizes the body for action. In his words, anxiety "says dangers ahead be ready to run, which is the opposite of what you need to help you sleep."

Sleep, by contrast, requires settling. That is why, as Brewer notes at around 3:36, common advice to reduce or eliminate caffeine after a certain time of day exists: the goal is to calm the system, not to rev it. He says he will not go deep into the physiology in a six-minute video, but he points viewers to a classic 1990s paper showing how generalized anxiety disorder, and its central feature of worry, affects the autonomic nervous system. The video's own summary of that research is plain: worry is not good for you, and it shows up in your physiology. The paper itself is linked in the video's description if you want to read the primary source.

What are the three tips to try tonight?

Brewer offers three simple tips for the bedtime hours. Two are laid out in detail in the video, and they are the ones worth building a routine around.

The first is practicing good sleep hygiene. He points to a downloadable tip sheet from the CDC, and he is specific about one habit that matters a great deal for anxious people: no screens in bed, and do not check the news before going to sleep. His reasoning is that news-checking gets you more anxious and revs up your autonomic nervous system, which is exactly the wrong direction for sleep. If the pandemic is driving your scrolling, a hard stop before bed is the most concrete adjustment on the list.

The third tip, and the one Brewer spends the most time on, is a body scan done in bed. He describes it as a technique that calms the nervous system and helps you fall asleep, and notes that it is so easy that he has all his clinic patients use it.

How do you do a body scan in bed?

Brewer demonstrates the practice on camera, and the instructions are simple enough to follow without a script. Start by bringing your awareness to the physical sensations in the toes of your left foot. If you can't feel anything there, wiggle them for a moment. Then notice what you feel: are they warm or cold, moist or dry? Be curious about what your toes feel like right now. Next, move your attention to the bottom of your left foot and notice what it feels like. From there, keep moving your awareness through the body: up the left leg, then down and through the right leg, then through the rest of the body.

He suggests the full pass can take about ten minutes, or longer if you want. If you need support at first, he has posted a guided version on his YouTube channel, linked in the video's description. Most people pick up the rhythm quickly. Brewer also recommends doing the scan not only at the start of the night but whenever you wake in the middle of it and struggle to return to sleep. His instruction for that moment is pointed: don't worry about getting back to sleep. Simply practice the body scan and see what happens.

That instruction is the heart of the method. The scan is not a sleep aid in the sense of a target you have to hit. It is a task that gives your attention a place to go other than the worry.

Why does a body scan work when trying to force sleep doesn't?

Brewer's explanation is the most useful part of the segment for anyone who has tried to fall asleep by sheer willpower. At around 5:17 he says: "the body scan works well because you're not trying to force your mind not to think and you're not trying to force your body to calm down." Both of those efforts tend to backfire. Telling yourself to stop thinking is itself a thought, and trying to relax on command adds a new job to the list of things your body is failing to do.

The body scan sidesteps both traps. As Brewer puts it, it naturally draws your attention and energy away from worried thinking and grounds you in the body. You are not fighting the mind. You are giving it a concrete, physical, low-stakes object to notice, and the worry loses some of its grip because it is no longer the only thing in the room.

What happened when Brewer taught the body scan to a golf team?

Brewer offers one anecdote about applying the practice outside his clinic. He taught the body scan to the women's golf team at Yale, and in his telling "they were all sleeping like babies within a couple of weeks." He is careful to frame this as an observation rather than a controlled result. His clinic evidence is similarly informal: he says many patients liked the body scan more than medications, that they don't need a prescription for it, that it does not leave them groggy in the morning, and that it is free.

He also mentions that his lab had just finished a study using the Unwinding Anxiety app to test how well mindfulness training can improve sleep, and that the data were still being analyzed at the time of the video. Since this is a March 2020 recording, readers should treat that study as something he was reporting on in progress; the video itself does not present its findings.

Where should you go from here?

The most direct next step is to try the body scan tonight, starting with the toes of your left foot and working through the body at whatever pace feels right. If you want guidance, Brewer's guided body scan is available on his YouTube channel at https://youtu.be/ANZfVnjCmXk. For sleep hygiene basics, the CDC tip sheet he links is the reference to download and keep by the bed. For the physiology, the 1990s paper on anxiety, worry, and autonomic function is the primary source he points to.

The video closes on a personal note. Brewer and his wife are reading a book together, The Boy, the Mole, the Fox and the Horse, as a way to calm their nervous systems before bed. His final suggestion is to watch for the loop: if you are feeding worry about the pandemic and then adding fuel by worrying about sleep, see whether you can reverse the process. His term for it is unlearning. Use the body scan and other mindfulness practices to unlearn worry habit loops, one night at a time, so that the alarm, when it rings, is one you are glad to hear.

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Transcript

[0:00] I'm dr. Judd brewer addictions like hiya

[0:03] Tristan neuroscientist specializing in

[0:05] anxiety and habit change my wife and I

[0:07] woke up this morning at 5:00 a.m. to the

[0:09] sound of our alarm and we cheered all

[0:12] last week we'd been waking up regularly

[0:14] between 3:00 and 4:00 a.m. without an

[0:16] alarm our minds filled with thought

[0:18] after thought after remarking on how

[0:21] good it felt to get a normal amount of

[0:23] sleep my wife told me about a dream she

[0:25] just had that she was flying on an

[0:27] airplane and for some reason leaked a

[0:29] dust pan and then she started worrying

[0:31] that she would come down with the

[0:32] coronavirus you don't have to be a

[0:35] psychiatrist to be able to interpret

[0:36] this one I'm guessing that you like me

[0:40] and my wife might be having some

[0:42] interrupted sleep right now

[0:44] in my clinic I often see patients with

[0:46] two main forms of this either difficulty

[0:48] falling asleep or early morning

[0:50] awakening in which someone wakes up

[0:52] early and has difficulty falling back

[0:54] asleep anxiety is a double whammy it can

[0:58] get in your head and mess with your

[0:59] sleep and then the lack of sleep can

[1:00] make you more prone to anxiety anxiety

[1:03] interfering with sleep is such a big

[1:05] problem that the National Institutes of

[1:07] Health created a number of standardized

[1:08] questions for researchers to use to

[1:11] study the links between the two I'll

[1:13] read a couple of them to you now and you

[1:15] can see if they apply to your

[1:16] coronavirus anxiety ready answer on a

[1:20] scale of 1 to 5 how much the following

[1:23] statements apply to you 1 being not at

[1:25] all

[1:26] and 5 being very much during the past 7

[1:30] days

[1:30] 1 I felt physically tense at bedtime

[1:34] 2 I worried about not being able to fall

[1:37] asleep 3 I felt worried at bedtime 4 I

[1:43] had trouble stopping my thoughts at

[1:45] bedtime 5 stressed disturbed my sleep if

[1:50] you got a high score congratulations you

[1:52] just won the same game that everyone

[1:54] else seems to be playing right now

[1:56] coronavirus anxiety is definitely

[1:58] messing up your sleep you probably

[2:01] didn't need to take a test to know this

[2:02] so what's going on here well here's the

[2:05] science there's a fair amount of

[2:07] research linking anxiety to sleep

[2:09] problems I see this all the time in my

[2:11] addiction clinic no matter what there

[2:13] may

[2:14] reason for coming in is almost all of my

[2:16] patients have trouble sleeping the first

[2:18] set of questions I asked them is when

[2:21] your head is the pillow do you have

[2:22] trouble shutting your brain off does

[2:24] your brain start spinning with worried

[2:26] thoughts about the future and when you

[2:28] can't sleep does looking at the clock

[2:30] make you more anxious because you start

[2:33] to worry that you won't get enough sleep

[2:35] can you relate to these questions the

[2:38] medical definition of anxiety is a

[2:40] feeling of worry nervousness or unease

[2:42] typically about an imminent event or

[2:44] something with an uncertain outcome the

[2:47] outcome of this pandemic is certainly

[2:49] uncertain and that feeling of

[2:51] nervousness energizes your body for

[2:53] action anxiety says dangers ahead be

[2:56] ready to run which is the opposite of

[2:59] what you need to help you sleep to get

[3:01] to slink you need things that relax you

[3:03] and calm your nervous system which is

[3:05] why you hear advice like reducing or

[3:07] eliminating caffeine after a certain

[3:09] time of day to keep this video short I

[3:12] won't go into all of the physiologic

[3:14] details but I will post a link in the

[3:16] comment section below to a classic paper

[3:18] from the 1990s that shows how

[3:21] generalized anxiety disorder and its

[3:23] Cardinal feature worried affect your

[3:25] nervous system the headlines simple

[3:27] worry ain't good for you and this shows

[3:29] up in your physiology but you probably

[3:31] already knew that so what can you do

[3:34] tonight when you go to bed here are

[3:36] three simple tips 1 practice good sleep

[3:40] hygiene I'll post a link to a

[3:42] downloadable tip sheet from the CDC for

[3:44] you below but this includes things like

[3:46] no screens in bed - don't check the news

[3:50] before going to bed really it just gets

[3:53] you more anxious King up your autonomic

[3:54] nervous system so you can't sleep 3

[3:57] practice doing a body scan in bed this

[4:00] simple technique helps calm your nervous

[4:02] system and put you to sleep it's so easy

[4:05] to do that I have all my clinic patients

[4:07] use it lots of them liked it more than

[4:09] medications they don't need a

[4:11] prescription it doesn't leave them

[4:12] feeling groggy in the morning and it's

[4:14] free I'll demonstrate how to do it now

[4:17] you can follow along yourself bring your

[4:21] awareness to the physical sensations of

[4:23] the toes in your left foot if you can't

[4:25] feel anything wiggle your

[4:26] for a moment then notice what you feel

[4:29] are they warm or cold

[4:31] are they moist or dry simply be curious

[4:34] about what your toes feel like right now

[4:36] then invite your awareness to the bottom

[4:39] of your left foot and notice what it

[4:40] feels like so you can keep repeating

[4:43] this practice by moving your awareness

[4:44] through your body as you scan up your

[4:47] left and then your right leg and then

[4:49] through your entire body you can do this

[4:51] in about 10 minutes or longer if you'd

[4:53] like I'll post a guided body scan on my

[4:56] youtube channel if you need some support

[4:57] at first but you'll get the hang of it

[4:59] pretty quickly do a body scan not only

[5:02] when you go to sleep but also if you

[5:05] wake up in the middle of the night and

[5:06] have trouble getting back to sleep don't

[5:09] worry about getting back to sleep simply

[5:11] practice the body scan and see what

[5:13] happens

[5:14] the body scan works well because you're

[5:17] not trying to force your mind not to

[5:19] think and you're not trying to force

[5:21] your body to calm down

[5:22] what you can't do anyway but instead

[5:24] this naturally draws your attention and

[5:27] energy away from your worried thinking

[5:28] and ground you in your body I taught

[5:32] this to the women's golf team at Yale

[5:34] and they were all sleeping like babies

[5:36] within a couple of weeks and my lab is

[5:39] just finished a study with our unwinding

[5:41] anxiety app specifically looking to see

[5:43] how well mindfulness training can help

[5:45] people improve their sleep we're

[5:47] analyzing the data now so stay tuned for

[5:50] what we find out I'll end on a personal

[5:53] note with a page from the book my wife

[5:55] and I are reading together to calm our

[5:57] nervous systems before going to bed it's

[5:59] called the Boyd the mole the Fox and the

[6:01] horse if you're feeding any anxiety or

[6:04] getting into habits of worrying about

[6:06] the pandemic and you're adding fuel to

[6:08] that fire by worrying about sleeping see

[6:11] if you can start to reverse that process

[6:13] now I wonder if there is a school of

[6:17] unlearning yes see if you can use the

[6:22] body scan and other mindfulness

[6:23] practices to help you unlearn any worry

[6:26] habit loops so that you can sleep better

[6:28] onward together see you tomorrow

[6:32] if there are topics you'd like me to

[6:35] cover post them in the comment section

[6:36] below or tag me on Twitter at Judd

[6:38] brewer subscribe to this

[6:40] to get updated when I post new videos

[6:42] and please share this video with anyone

[6:44] who you think might benefit thank you

Jud Brewer, MD PhD
ArtistJud Brewer, MD PhD

Psychiatrist, neuroscientist and best-selling author at Brown University's Mindfulness Center, Dr. Jud Brewer studies how habits and addictions form and teaches mindfulness-based w…

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Sleep-anxietyBody-scan-meditationSleep-hygieneNervous-systemWorry-loops

Got Questions?

Frequently Asked Questions

Jud Brewer describes anxiety as a feeling of worry or unease about an uncertain outcome, which energizes the body for action. That state is the opposite of what sleep requires, so a racing mind at bedtime makes it hard to settle. He also notes that lack of sleep makes you more prone to anxiety, creating a loop.
A body scan is a mindfulness practice where you move your attention through the body, noticing physical sensations without trying to change them. Brewer starts with the toes of the left foot, asks you to notice whether they feel warm or cold and moist or dry, then moves up the left leg, down the right leg, and through the rest of the body, taking about ten minutes or longer.
Brewer says the body scan works because you are not trying to force your mind to stop thinking or force your body to calm down. It naturally draws attention and energy away from worried thoughts and grounds you in the body. Trying to relax on command often adds pressure, while the scan gives your attention a neutral physical focus.
Brewer reads from a set of standardized questions the National Institutes of Health created for researchers studying anxiety and sleep. Respondents rate statements from 1 (not at all) to 5 (very much) over the past seven days, covering bedtime tension, worry about falling asleep, trouble stopping thoughts, and stress disturbing sleep. A high total suggests anxiety is interfering with sleep.
Brewer advises against it. He says checking the news before going to bed gets you more anxious and revs up your autonomic nervous system, which keeps you from sleeping. He recommends no screens in bed as part of general sleep hygiene, also referencing a CDC tip sheet.
Brewer says he most often sees two patterns in his clinic: difficulty falling asleep, and early-morning awakening in which someone wakes early and has trouble getting back to sleep. He describes anxiety as a double whammy that can disrupt sleep and then make the person more prone to anxiety.
Brewer suggests practicing the body scan rather than worrying about falling back asleep. Let go of the goal of sleep and simply move your attention through your body, then see what happens. He says this is useful whenever you wake during the night.

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