Anxiety and the racing mind

Not everyone gets hot flashes, but a great many women describe a rise in anxiety they did not expect and were not warned about. Sometimes it is a general unease; sometimes it is a racing, catastrophising mind that spins up in the small hours. It can feel like a personality change. It is better understood as a nervous system running hot.

Why anxiety rises now

The same hormonal swings that affect mood affect the systems that regulate the stress response, so the baseline can shift toward more easily triggered. Perimenopause is recognised as a window of vulnerability for mood and anxiety, not a coincidence of timing. And it feeds on poor sleep: a short night leaves the brain’s threat alarm more reactive, which is the mechanism behind mood, anger, and tears. Anxiety and the 3 a.m. wake tend to keep each other company.

The fastest lever is your breath — used precisely

“Just breathe” is easy to dismiss until you see how specific the useful version is. A 2023 randomized trial by Balban and colleagues, published in Cell Reports Medicine, compared brief daily breathing practices with mindfulness meditation. The standout was cyclic sighing: a double inhale through the nose, then a long, slow exhale through the mouth, for about five minutes. That pattern — a longer out-breath than in-breath — lowered physiological arousal and lifted mood more than meditation did. The long exhale is the part that signals the body to stand down.

When the mind is spiralling, come back to the room

Breath calms the body; a different tool is better when thoughts are racing. Grounding techniques from dialectical behaviour therapy — Marsha Linehan’s work — use the senses to pull attention out of the spiral and into the present: the 5-4-3-2-1 practice of naming five things you can see, four you can hear, and so on. It is deliberately boring, and that is the point. It gives the mind a simple, external task instead of the loop.

• For the body: cyclic sighing, a double inhale and a long exhale, a few minutes.
• For the thoughts: 5-4-3-2-1, naming what your senses can actually detect right now.
• For the pattern: notice whether the worst anxiety follows the worst sleep, and treat sleep as part of the treatment.

How Still Me helps

Both of these are built into Still Me’s Right now page. There is a guided cyclic-sighing breath for when the body is buzzing, and a “Spiralling” tool that walks you through 5-4-3-2-1 when the thoughts will not stop. They are there for the exact moment you need them, not as homework for later. And in the daily conversation, saying the dread out loud is itself a way of taking its charge down — the coach helps you name it, which is where anxiety usually starts to loosen. If it is heavy and constant rather than wave-like, that is worth a clinician’s time.

Grounded in Balban et al. (Cell Reports Medicine, 2023) on cyclic sighing; Marsha Linehan, DBT Skills Training Manual (2015), on distress tolerance and grounding; and research on perimenopause as a window of vulnerability for mood and anxiety.