When was the last time you had a good night’s sleep? If you have anxiety, chances are it’s been awhile. Anxiety is notoriously known for disrupting sleep, which can start a vicious cycle of more anxiety about not sleeping leading to even more difficulty with sleep.
Many anxiety disorders are connected to insomnia and other sleep difficulties. A few statistics demonstrate the severity of this problem.
- Among people diagnosed with panic disorder, 68% report “difficulties falling asleep” and 77% report “restless and disturbed sleep.”
- “60% to 70% of patients with GAD [generalized anxiety disorder] have insomnia complaints.”
- Individuals with PTSD “estimate being awake more than half of the time in bed during the night.”1
The treatment of anxiety and the treatment of insomnia have an interesting relationship. Research shows that when you find treatments that improve your insomnia, this also leads to a decrease in anxiety.2 On the flip side, when you find treatments that improve your anxiety, this leads to better sleep.3 Both anxiety and insomnia affect each other, in such a way that if you find help for one, you also help the other.
Although insomnia due to anxiety can be a tricky problem to have, it is possible to find help and a better quality of life. Our counselors would love to work with you on this. No matter what form of anxiety you have, therapy is an effective means of discovering the “why” behind your anxiety, the reason for your insomnia, and the tools to find help for both.
As you work towards recovery, here are some steps you might need to take.
Rule out Medical Causes for Your Insomnia
Your first step is to ensure that you are correct in assuming anxiety as the cause of your insomnia. If your insomnia is long-term and having a significant impact on your ability to sleep every night, it would be worth seeing a doctor to rule out medical causes.
The National Sleep Association provides the following list of “medical conditions that can cause insomnia.”
Gastrointestinal problems such as reflux
Endocrine problems such as hyperthyroidism
Neurological conditions such as Parkinson’s disease
Low back pain
These, among other medical conditions, could be the main cause of your insomnia. It’s possible you are assuming that your insomnia is caused by anxiety when a co-existing medical condition is the actual problem. Or, perhaps your anxiety is one factor in insomnia, but a medical condition is a part of it as well.
Finally, insomnia can be a side effect of some medications. Check with your prescribing practitioner or your pharmacist to see if any of your medications are known for this side effect.
Address the Root of Your Anxiety in Therapy
We already know that improvement for your anxiety leads to improvement in your sleep. So, naturally, we can assume that therapy to treat your anxiety is a good place to start once you have ruled out medical causes.
What is causing your anxiety? A therapist or an online counselor can help you get to the bottom of your anxiety and help you take steps to manage the root cause, which over time, can lead to a reduction in your symptoms. Is your anxiety caused by relational issues? Something that happened in your past? A lack of confidence? Stressors at work? Health issues?
Whatever the reason may be, it is likely that you have the power to take specific steps and take back control. A therapist can help you determine what these steps may be. As you learn to manage your stressors and think differently about events in your life, over time, you will find yourself spending less and less time ruminating on these things in the evening when you are trying to sleep.
Manage the Physical Symptoms of Your Anxiety
Working through the underlying cause of your anxiety can take time. In the meantime, you may need some tools to tide you over, particularly in the area of managing the physical symptoms of anxiety. It is possible to have anxiety without experiencing thoughts racing through your head. Oftentimes, people will say they do not feel anxious, when in reality, they are merely unaware that feelings of anxiety can take many forms.
For example, some people experience anxiety more in their physical bodies than in their thoughts. They may experience headaches, stomachaches, a racing pulse, muscle tension, chest pain, or dizziness. It can take some time to connect these physical symptoms to the experience of anxiety.
You might consider practicing a simple relaxation technique in the evening to help these physical symptoms. Examples of relaxation techniques include deep breathing, progressive muscle relaxation, and guided imagery. You can learn more about these techniques at the National Center for Complementary and Integrative Health. It may also be helpful to ask your therapist to explain what techniques he or she finds most helpful and ask for resources that teach how to develop a relaxation practice.
Manage the Cognitive Symptoms of Your Anxiety
When it comes to patterns of thinking, there are three main differences between individuals with insomnia and individuals who sleep normally. Each of these patterns provides insight into how people who struggle with insomnia can manage the cognitive symptoms of their anxiety which prevent good sleep.4
- Individuals with insomnia have more negative beliefs related to sleep. For example, they might more strongly agree with the following statements than normal sleepers: “I am worried that I may lose control over my abilities to sleep” or “I have little ability to manage the negative consequences of disturbed sleep.”
Think through your own negative beliefs about sleep. Write them down and consider discussing them with your therapist at your next session.
- Individuals with insomnia experience greater levels of mental arousal before times when they would like to sleep.
Individuals with insomnia often feel like they cannot turn their mind off. They focus hard on trying to sleep and feel worked up when they cannot. Finding ways to turn of this mental arousal can be essential to making progress.
One technique that can turn down levels of mental arousal is to journal in the evening before going to bed. Talking through your thoughts with a friend can also help. Alternatively, research has shown some support that sleep is improved when individuals schedule times to worry. For example, a person might schedule a time to worry between 6:30 PM and 7:00 PM and then not allow themselves to worry until the next evening at that same time.
- Individuals with insomnia use less effective thought control strategies while trying to fall asleep.
One common trait of individuals with insomnia is a tendency to use the following strategies for thought control: trying to suppress their thoughts, worrying about their thoughts, and punishing themselves for their thoughts. On the other hand, normal sleepers find ways to replace and reappraise their thoughts.
This process of learning to replace and reappraise your thoughts can be difficult to do on your own. This is another area to bring up with your therapist.
Consider General Sleep Hygiene Advice
Remember how improved sleep also leads to improvement in your anxiety? Now it’s time to look at sleep hygiene strategies that can have a direct improvement on your sleep. When completed consistently, these steps will hopefully lead to an improvement in your anxiety as well. Empirical research supports each of the following sleep hygiene strategies as a means of alleviating insomnia.5
- Abstain from alcohol, caffeine, and nicotine. Consider if you are ingesting any foods, drinks, or substances that may be exacerbating sleep problems. You may consider stopping ingestion of all caffeine, nicotine, and alcohol. Caffeine and nicotine are stimulants that can keep people awake. And alcohol is a sedative that can deceptively feel like it is helping you sleep, but actually, leads to sleep disruptions later in the night.
- Create a comfortable bedroom environment. How do you feel about your bedroom? Is it a room you love that you look forward to sleeping in each night? If not, how can you make it more comfortable and inviting? Make sure your bedroom is a good temperature. Consider a different mattress if needed. Adjust lighting so it isn’t so harsh. Fill the room with pillows and blankets and other forms of comfort.
- Eliminate light and noise. You can make your bedroom even more comfortable by eliminating light and noise. Consider getting ear plugs to wear while you sleep. Invest in some blackout shades that will allow you to sleep in the dark. Limit your use of tablets and electronics at bedtime, as the harsh light can be a deterrent to falling asleep.
- Create a bedtime routine. Research supports the benefits of sleep timing regularity in the treatment of insomnia. All this means is that you go to bed at the same time each night and wake up at the same time each morning. Create a bedtime routine that will help you stay consistent in your sleep times.
- Exercise. Consistent exercise has been shown to reduce insomnia and other sleep difficulties. For best results, exercise earlier in the day instead of in the evening.
What Steps Will You Take Today?
Insomnia can be a complex problem. It often requires people to take multiple steps as listed above and persistently carry those steps out for a long period of time. Let us know if we can help you with this process. Our counselors are ready to provide guidance, encouragement, and advice as you work towards recovery.
1Staner, L. (2003). Sleep and anxiety disorders. Dialogues in Clinical Neuroscience, 5(3), 249-258.
2Luik, A. I., Bostock, S., Chisnall, L., & Kyle, S. D. (2017) Treating depression and anxiety with digital cognitive behavioral therapy for insomnia: A real world NHS evaluation using standardized outcome measures. Behavioral and Cognitive Psychotherapy, 45(1), 91-96.
3McGowen, S. K., Espejo, E. P., Balliet, N., & Werdowatz, E. A. (2016) The effects of transdiagnostic group CBT for anxiety on insomnia symptoms. Cognitive Behaviour Therapy, 42(2), 163-175
4Zwi, R., Shawe-Taylor, M., & Murray, J. (2005). Cognitive processes in the maintenance of insomnia and comorbid anxiety. Behavioral and Cognitive Psychotherapy, 33(3), 333-342.
5Irish, L. A., Kline, C. E., Gunn, H. E., Buysse, D. J., Hall, M. G. (2014).The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep Medicine Reviews, 22 23-36