7 Anxiety Triggers You May Be Overlooking

Anxiety is one of the most common concerns I see in my practice.

Sometimes there is an obvious reason for it. You're under tremendous stress, going through a major life change, not sleeping, or juggling approximately 47 things at once.

But sometimes anxiety seems to come out of nowhere.

You may wake up feeling anxious before you've even had time to think about anything stressful. Your heart starts racing after lunch. You feel shaky in the afternoon. Or suddenly, in your 40s, you're experiencing anxiety when you've never considered yourself an anxious person before.

When that happens, I like to ask a different question:

What is making the nervous system feel like it needs to be on high alert?

Anxiety isn't always purely emotional. Your hormones, blood sugar, caffeine intake, sleep, hydration, nutrient status, thyroid function and nervous system can all influence how anxious you feel.

Here are seven anxiety triggers I commonly look at with my patients.

1. Too Much Caffeine

I know. Nobody wants me to start with coffee.

But if you're struggling with anxiety, caffeine is one of the first things worth looking at.

Caffeine is a stimulant. It can increase alertness, heart rate and sympathetic nervous system activity—the same fight-or-flight side of your nervous system that's already very active when you're feeling anxious.

Some people metabolize caffeine beautifully and can drink a cup of coffee without noticing much of anything.

Others absolutely do not.

If you're sensitive to caffeine, that morning coffee may contribute to symptoms like feeling jittery, restless, shaky, wired, or aware of your heartbeat. It can also interfere with sleep, which can create another layer of anxiety the following day.

This becomes particularly important when I hear:

"I'm exhausted, so I drink coffee all day—but then I feel anxious and can't sleep."

Now we've created a cycle.

If that sounds familiar, experiment with gradually reducing your caffeine rather than quitting abruptly and giving yourself a spectacular withdrawal headache.

Try half-caf, decaf, herbal tea or a caffeine-free coffee alternative and pay attention to what happens to your anxiety.

Your morning coffee may not be the entire problem, but sometimes it's pouring gasoline on a nervous system that's already running hot.

2. Blood Sugar Swings

This is a big one.

When blood sugar drops, the body has mechanisms designed to bring it back up. That response can involve stress hormones such as adrenaline.

And what does adrenaline feel like?

Shaky. Sweaty. Irritable. Heart pounding. Lightheaded. Nervous. Anxious.

Sound familiar?

I've seen patients assume they're having anxiety when the pattern is actually strongly connected to skipping meals, eating too little, fasting too long or eating carbohydrates without enough protein, fat and fiber.

If your anxiety predictably shows up late morning, mid-afternoon, after skipping breakfast, or several hours after eating, I would pay attention to your meals.

I generally like to see meals built around adequate protein, fiber, healthy fats and whole-food carbohydrates rather than surviving on coffee until noon and wondering why your nervous system has filed a complaint.

3. Dehydration & Electrolyte Imbalance

Hydration matters to the nervous system too.

Electrolytes—including sodium, potassium, magnesium and calcium—are involved in nerve signaling, muscle contraction and many other basic physiological processes.

That doesn't mean everyone with anxiety has an electrolyte deficiency.

But if you're dehydrated or losing significant fluids and electrolytes through sweating, vomiting or diarrhea, the resulting symptoms can include weakness, fatigue, dizziness, muscle cramping, changes in heart rhythm and other physical sensations that may feel very similar to anxiety.

This is one reason I don't look at anxiety in isolation.

If someone tells me, "I suddenly feel anxious, shaky and lightheaded," I want to know what else is happening.

Have you eaten?

Have you had enough water?

Have you been exercising outside in Florida heat?

Have you had diarrhea?

Have you been drinking alcohol?

Sometimes the nervous system is asking for something considerably less complicated than we think.

4. Poor Sleep

Sleep and anxiety can become a frustrating chicken-and-egg situation.

Anxiety makes it difficult to sleep.

Then poor sleep makes the nervous system more reactive the next day.

Then you're more anxious.

Then you sleep worse.

Repeat.

This is also why I don't automatically reach for something to “calm anxiety” without asking about sleep.

Are you falling asleep but waking at 2 or 3 a.m.? Are you waking with your heart racing? Are you getting enough hours but never feeling rested? Are you scrolling on your phone until the moment your head hits the pillow?

The pattern matters.

And if you're using caffeine to compensate for poor sleep, we may now have two anxiety triggers feeding each other.

Improving sleep is often an important part of helping the nervous system become less reactive during the day.

5. Hormone Changes in Perimenopause

If you're a woman in your late 30s, 40s or early 50s and suddenly thinking,

“Why am I anxious? I've never been like this before.”

I want you to look at your hormones.

Anxiety can become more noticeable during perimenopause, sometimes years before periods stop.

Estrogen and progesterone don't simply affect your menstrual cycle. They interact with neurotransmitter systems involved in mood, sleep and the stress response.

And during perimenopause, hormone levels don't decline in a nice, orderly straight line.

They fluctuate.

This is one reason anxiety may appear alongside other symptoms such as disrupted sleep, shorter or irregular cycles, heavier periods, hot flashes, night sweats, heart palpitations, irritability or brain fog.

When several of those symptoms start clustering together, I want to look at the whole hormonal picture rather than treating anxiety as an isolated symptom.

6. Not Moving Your Body Enough

Movement is one of the simplest tools we have for supporting both physical and mental health.

Exercise can influence mood, sleep, stress regulation and overall nervous system function. Research continues to support exercise as a useful complementary strategy for anxiety, although there isn't one perfect exercise prescription for everyone.

The important part is finding movement your body responds well to.

That could be:

• Walking

• Strength training

• Pilates

• Yoga

• Cycling

• Swimming

• Dancing

• Hiking

You don't have to annihilate yourself with a workout for it to count.

In fact, if you're already exhausted, sleeping poorly and feeling completely wired, I don't necessarily want you adding an extreme exercise routine simply because someone on Instagram told you harder is always better.

I want appropriate movement and consistency.

Start where your body is.

7. Your Nervous System Is Stuck in High Alert

This is the piece that connects many of the others.

Your autonomic nervous system constantly helps regulate functions you don't consciously think about—heart rate, digestion, blood pressure, breathing and your response to perceived threats.

The sympathetic branch helps mobilize you when action is needed.

That's useful when you're actually in danger.

It's less useful when your body behaves as though an unanswered email is a tiger.

When stress becomes chronic, some people begin spending far too much time in that high-alert state.

You may notice:

• Difficulty relaxing even when nothing is wrong

• Shallow breathing

• Muscle tension

• Digestive problems

• Trouble falling or staying asleep

• Heart pounding or palpitations

• Feeling “tired but wired”

• Being easily startled

• Feeling constantly on edge

This is why simply telling someone to “relax” isn't particularly useful.

We need to understand why the nervous system keeps receiving—or interpreting—signals that tell it to stay alert.

What Else Can Contribute to Anxiety?

These seven triggers aren't the entire list.

Depending on the person, I may also consider thyroid function, iron status, B vitamins and other nutrients, medications and supplements, alcohol, digestive health, chronic pain, inflammation and other physiological stressors.

This doesn't mean every case of anxiety requires a giant panel of laboratory tests.

It means the pattern matters.

Someone whose anxiety began suddenly during perimenopause may need a different approach than someone who feels shaky every afternoon after skipping lunch.

And someone drinking four cups of coffee while sleeping five hours a night gives me another set of clues entirely.

That's why I don't like treating symptoms in isolation.

Anxiety Through a Chinese Medicine Lens

Chinese medicine also looks for patterns rather than treating every person with anxiety exactly the same way.

Anxiety may present with patterns involving the Heart, Liver, Spleen or Kidneys, depending on the accompanying symptoms.

One person may experience anxiety with irritability, tension and feeling emotionally “stuck.”

Another may have anxiety accompanied by insomnia and heart palpitations.

Someone else may be exhausted, overthinking everything and struggling with digestion.

Those aren't necessarily the same Chinese medicine pattern—and they shouldn't automatically receive the same acupuncture points or herbal formula.

This individualized approach is one of the reasons I find acupuncture and Chinese herbal medicine so valuable when working with anxiety.

Dr. Stephanie's Tip: If your anxiety seems random, start tracking when it happens.

Not just that you were anxious.

Write down what was happening in the several hours beforehand:

What did you eat? When did you last eat? How much caffeine did you have? How did you sleep? Where are you in your menstrual cycle? Did you exercise? Were you dehydrated? Did your anxiety start before or after a meal?

Patterns often become much easier to see when they're written down.

Your 3 p.m. anxiety may feel completely random until you realize it happens every day you have coffee for breakfast and don't eat lunch until 2.

That's useful information.

Finding the Root Cause of Anxiety

When someone comes into my office with anxiety, my goal isn't simply to make them feel calmer for an hour.

I want to understand why their system is having difficulty feeling calm in the first place.

At New Direction Natural Medicine in Altamonte Springs, I combine acupuncture, Chinese medicine and functional medicine to look at anxiety from multiple angles.

Depending on the person, that may mean looking at the nervous system, hormones, sleep, nutrition, blood sugar patterns, digestive health, stress physiology and other pieces of the picture.

Because sometimes anxiety is telling us you're stressed.

And sometimes it's telling us we need to look deeper.

If you're experiencing anxiety and want to explore what may be contributing to it, schedule a consultation with me at New Direction Natural Medicine in Altamonte Springs, Florida. I work with patients throughout the Orlando, Winter Park, Maitland, Longwood, Lake Mary and Central Florida area.