Could Sleep Anxiety Be to Blame for Your Tiredness?
Sleep and anxiety are two topics that are likely on your mind as of late. Over the past year — due in part to both politics and the pandemic — anxiety has been on the rise while sleep has been on the decline. And if you've ever struggled to score some shut-eye several nights in a row thanks to stress, then you likely know how easy it can be to spiral into stressing about not getting sleep thanks to stress — notice the pattern?
While there's no formal definition or diagnosis for "sleep anxiety," "it's quite common to experience increased anxiety later in the evening when you attempt to fall asleep," says Michael G. Wetter, Psy.D., director of psychology at UCLA Medical Center, Division of Adolescent and Young Adult Medicine, Medical Stabilization Program. "In many ways, it's as if all the distractions of the day are removed and your mind can now be flooded with any and all thoughts that have otherwise been suppressed." (Related: How to Sleep Better When Stress Is Ruining Your Zzz's)
But couldn't that just be describing common restlessness? Depends. If you're feeling as if you "can't turn your brain off" night after night, then it might be time to consider whether or not you're dealing with sleep anxiety, according to Wetter.
What Is Sleep Anxiety?
Sleep anxiety isn't an official medical diagnosis recognized by the Diagnostic and Statistical Manual of Mental Disorder (DSM), the catalog of psychological conditions widely used by clinicians to diagnose patients. But it's still worthy of attention — after all, "not all problems have an official diagnosis," says clinical psychologist Kevin Gilliland, Psy.D., executive director at Innovation 360 in Dallas. If you regularly have trouble sleeping, you can start to worry about not getting enough zzz's — or any for that matter — and/or staying asleep before you even get into bed, explains Gilliland. "You know you need to sleep, so you can start to develop some dread about it," especially if you've struggled with healthy sleep in the past. And yes, sleep anxiety is generally considered different than clinical insomnia, which is an official medical diagnosis or condition — but more on that later.
You can think of sleep anxiety as a kind of performance-based anxiety, in which sleep is the performance, and the anxious thoughts and feelings surrounding it can begin to interfere with your everyday life and functions, according to the American Institute of Stress."This often shows up as worry about being able to fall asleep, or fall back asleep, or a generalized unease about sleep," explains Cassandra Carlopio, a licensed psychologist in Australia, sleep coach, and partner at The Breathe Institute.
"There is a clear bidirectional relationship between insomnia and anxiety," says Carlopio. "Anxiety makes it more difficult to fall asleep or stay asleep, and not getting enough sleep (sleep deprivation) can exacerbate anxiety. It's really easy for people to fall into a vicious cycle, with sleep becoming more and more stressful." And the more nerve-wracking it becomes, the worse your sleep can become, which, in turn, can also exacerbate anxiety. Vicious cycle, indeed.
That being said, "it's important for people to know they will not fall apart the next day if their sleep was mixed in quality," explains sleep medicine doctor and psychiatrist Alex Dimitriu, M.D., founder of Menlo Park Psychiatry & Sleep Medicine. "Even resting (and not stressing) in bed, can still be restorative."
Now, if you're diagnosed with an anxiety disorder, you're more likely to experience sleep anxiety. "Generally speaking, people with anxiety disorders tend to be more prone to trouble falling asleep," says Wetter. "But just about anyone can experience this, especially in times of high stress and worry." (See also: How and Why the Coronavirus Pandemic Is Messing with Your Sleep)
The Difference Between Sleep Anxiety and Insomnia?
Insomnia disorder is its own beast, according to Dr, Dimitriu. "Insomnia disorder (or psychophysiological insomnia ) is not a result of depression, anxiety, medical issues, or substances including alcohol, caffeine, or stimulants." Rather it's defined as trouble initiating or maintaining sleep or waking too early, three days per week or more over a period of at least three months, he explains.
Insomnia disorder, aka chronic insomnia, is a long-term pattern of sleep difficulties that, as Dr. Dimitriu explains, aren't necessarily a direct byproduct of anxiety. Then there's acute or short-term insomnia, which is a brief episode (less than three months) of sleep loss brought on by factors such as sleep anxiety, grief, or job loss and typically improves as the patient copes with the stressors that originally brought on the sleep issues, according to SleepFoundation.org. Just as you can feel depressed but not have a clinical depressive disorder, you could experience insomnia symptoms, but not have chronic insomnia disorder.
That said, insomnia could very well leave you feeling anxious, and all of this can be confusing without the help of a professional, which is just another reason why seeking out a physician and therapist is essential for getting to the root of your sleep issue. (Related: Why Everyone Should Try Therapy at Least Once)
How to Treat Sleep Anxiety
When it comes to handling sleep anxiety, Gilliland suggests having "a short-term memory" for a bad night's rest. "Focus on things to improve sleep, and don't allow worry and agitation [about poor past experiences] to creep into thoughts about sleep. You don't need to add that kind of pressure, and it won't help."
"Treating sleep anxiety is similar to how you treat more generalized anxiety and worry, but with a few differentiators," says Carlopio. She emphasizes that seeing a doctor first is the most important step, especially to rule out any medical conditions that "might be mimicking anxiety or insomnia." You'll also want to make sure you aren't suffering from breathing difficulty at night from conditions such as snoring or sleep apnea, as these can also cause sleep disturbances, including sleep anxiety, if not treated.
Whatever the outcome of your doctor visit — be it a diagnosis of a specific, perhaps more chronic, sleep disorder or an acute issue brought on by specific stressors — turn to these tips if you catch yourself slipping into sleep anxiety-territory.
See a therapist. As noted, getting a professional evaluation from a physician is crucial. "Then getting professional support from a therapist trained in dealing with anxiety and stress is recommended," says Carlopio. (Related: How Cognitive Behavioral Therapy "Cured" My Insomnia)
Cut caffeine. Curbing your caffeine intake "can help decrease overall feelings of anxiety and stress and help you fall asleep easier," explains Carlopio. Caffeine has a half-life of about five hours, meaning it takes five hours for your body to eliminate half of the caffeine ingested, according to the Academy of Sleep Medicine. So if you reduce the overall amount and stop drinking caffeine earlier in the day, you're less likely to be restless and have difficulty falling asleep.
Meditate. Yes, you've likely heard about the distressing benefits of mediation already, but "there is a lot of research demonstrating the effectiveness of guided meditation and mindfulness practices to help activate the relaxation response and counter the effects of sleep anxiety," says Carlopio, who offers guided meditations for sleep on Spotify and YouTube, as well as meditation apps, such Aura, Calm, and Headspace. Aim to practice 10 or more minutes a day, suggests Dr. Dimitriu. (See also: How to Use Sleep Meditation to Fight Insomnia)
Breathe. If you find yourself in a neverending panic cycle about not being able to fall asleep (or fall back asleep), experts point to deep breathing as a way to calm yourself into a slumber, as the practice can slow the nervous system — just know it might take some practice. There is a range of breathing techniques, but deliberate, slow diaphragmatic breathwork and deep belly breathing have been shown to help shift you into a state of relaxation, lowering cortisol and switching on the parasympathetic nervous system (which is responsible for your body's rest and digest responses).
Keep your sleep space sacred. "Sticking to a regular sleep-wake schedule helps a lot, and having a cool, dark, and quiet bedroom helps too," says Dr. Dimitriu. "No screens around bedtime, or waking — this tends to 'jar' you awake." If you're struggling with falling asleep and you've tried everything, get out of bed and read a book by a dim light, only returning to bed when sleepy, suggests Dr. Dimitriu. He says it's important to ensure that you don't stress out while physically in bed because this will turn your sleep space into a stressful zone when you want the opposite.