Many people with anxiety report feeling worse in the morning. Recently, llrrbb asked this question:
'I still experience morning anxiety upon awakening.
Should I try taking my med in the evening instead of morning?'
It's a good question and an opportunity to discuss some of the possible reasons why anxiety often feels worse in the morning and seems to lighten towards the evening.
Now, as everyone with long-term anxiety knows, there is an intimate relationship between the way we think and the way our bodies react. This is something that follows the person throughout the day and night and partly influences the intensity of
anxiety felt in the morning. So, let's start the journey as you go to bed.
Let's assume you are a person with a generalized anxiety problem. Your average day has been one of muddling along. Maybe you've managed to avoid some of the moments or situations that give rise to the worst sensations of anxiety and maybe you've struggled with some pretty nasty moments. Towards the end of the day you start to feel a little better in yourself. The variety of stressful or unpredictable situations you have to encounter have all but passed and it's likely that your evening will be predictable and pretty much within your control. Maybe you'll relax in front of the television and then it's off to bed.
You'll go to bed quite possibly after a day of feeling overwhelmed and anxious. Although you may feel your body and mind are starting to wind down, your body is actually gearing up to prepare you for another difficult day. There is evidence to suggest that people in such situations have elevated levels of cortisol in their body when they wake the following morning. Cortisol levels are normally high immediately upon waking and continue to increase for about 30 minutes. Normally, these levels diminish over the day, but following a day of anxiety or anger they may be elevated in the evening. The stress hormone cortisol not only responds to your daily experiences it also influences them. For example, people with low morning cortisol levels experience greater fatigue throughout the day.
At the start of the waking cycle several things start to happen. The heart rate increases, blood pressure goes up, hormones surge around the body and there is a general state of arousal that accompanies the transition from a sleep state to that of waking. For the person who suffers with anxiety this physical state of arousal can feel quite uncomfortable, partly because they are so sensitized to associating this arousal state with anxiety. In turn it can trigger an immediate emotional response where the prospect of a whole day of anxiety can cause an almost immediate slump in mood.
There are some things you can do to help peg back the worst effects of morning anxiety and it is worth experimenting with a few until you find one that works for you. Some people find exercising early in the morning burns up adrenaline and offers a useful distraction from ruminating and worrying. As the workout finishes both heart rate and blood pressure come down and a sense of wellbeing starts to take over from the natural endorphins produced. Others prefer to meditate or go through some other form of relaxation technique. Whatever your preference it is important to allow yourself time and not be rushed to work without first having breakfast. Low blood-sugar levels can contribute to anxiety, as can caffeine, so think about what you eat and drink in the morning and maybe prepare what you can the night before.
Finally, llrrbb asks whether she should try taking her medication in the evening instead of the morning. If, like llrrbb, you are taking medication for anxiety there is no harm in speaking to your doctor about the time of day you take it. If new to anti-anxiety medication it's worth knowing that it takes time for some drugs to build towards a clinically therapeutic effect. If long established, it may not make a great deal of difference whether you take meds in the morning or the evening, although some people do have a personal preference.