Why do I overthink, feel anxious, and can't sleep? What should I do?
Nov 14, 2025
Source: Cainiu Health
Dr. Zhang Baohua
Introduction
Overthinking, anxiety, and difficulty sleeping may be caused by factors such as neuronal hyperexcitability, disrupted melatonin secretion, neurasthenia, generalized anxiety disorder, or comorbid depression. It is recommended to seek medical attention promptly, identify the underlying cause, and follow a treatment plan under medical guidance, which may include general interventions and medication. In daily life, avoid drinking coffee or strong tea before bedtime, and refrain from eating a heavy or greasy dinner.
Generally, overthinking and anxiety that lead to difficulty sleeping may be caused by imbalances in neural excitation, disrupted melatonin secretion, neurasthenia, generalized anxiety disorder, or comorbid depressive disorders. It is recommended to seek medical attention promptly, identify the underlying cause, and then improve symptoms under a doctor's guidance through non-pharmacological and pharmacological treatments. Specific causes are analyzed as follows:
1. Neural Excitation Imbalance: Excessive thinking before sleep leads to sustained brain nerve excitation, inhibiting the activity of the sleep center and making it difficult to fall asleep. Immediately turn off electronic devices and shift your focus to deep breathing, using the 4-7-8 breathing technique—inhale for 4 seconds, hold your breath for 7 seconds, and exhale slowly for 8 seconds—to gradually calm neural overactivity.
2. Disrupted Melatonin Secretion: Prolonged anxiety disrupts the biological clock and interferes with normal melatonin production, reducing sleep quality. Go to bed every night before 10:30 PM, draw curtains tightly to create a dark environment, and consume sleep-promoting foods such as bananas and oats in moderation to help regulate melatonin levels.
3. Neurasthenia: Chronic mental stress can cause nervous system dysfunction, manifesting as racing thoughts and difficulty falling asleep. Follow medical advice when taking medications such as oryzanol tablets, vitamin B1 tablets, or diazepam tablets. Avoid engaging in complex thinking one hour before bedtime; instead, listen to soothing white noise to relax both body and mind.
4. Generalized Anxiety Disorder (GAD): Excessive worry about daily matters results in uncontrollable thoughts, with heightened anxiety at night leading to insomnia. Under medical supervision, medications such as buspirone hydrochloride tablets, tandospirone citrate capsules, or lorazepam tablets may be prescribed, along with cognitive behavioral therapy to alleviate anxiety.
5. Comorbid Depressive Disorder: Interwoven anxiety and depression cause a surge of negative thoughts before sleep, severely disrupting rest. Medications such as sertraline hydrochloride tablets, fluoxetine hydrochloride capsules, or fluvoxamine maleate tablets may be used as directed by a physician. Additionally, writing a "worry list" before bedtime can help organize thoughts and reduce psychological burden.
Avoid consuming coffee or strong tea before bedtime, and do not eat dinner too late, too much, or too greasily. Engage in moderate daytime activities such as jogging or yoga to relieve psychological stress. Keep the bedroom quiet and comfortable, and use it exclusively for sleeping.
