It's almost bedtime, and just the thought of it kicks off your stress. You really need a good night's sleep, but when you get in bed your mind goes wild, thinking of yesterday, today, tomorrow, a year from now … somehow you do drift off, but wake up several times throughout the night. Before you know it, it's morning, and time to start another day ― exhausted and frustrated.
This is what sleep ― or lack of it ― can be like for the 40 million U.S. adults with anxiety. According to Jason Ong, a Northwestern Memorial Hospital psychologist specializing in sleep disorders, roughly two-thirds to three-quarters of those seeking sleep-disorder treatment have a form of anxiety associated with their sleep loss. And yet despite more awareness about anxiety disorders and the importance of a good night's sleep, most people don't understand how closely tied anxiety and sleep can be. We partnered with Sleep Number to share four things that people with anxiety want you to know about their experience trying to catch some Zs ― and what the experts say may be able to help.
1. Simply Falling Asleep Can Be A Battle
“The whole process of falling asleep can take anywhere from 30 minutes to four or five hours,” says Nick Miller, 24. “I've had nights where I didn't fall asleep until 6 or 7 a.m.”
A typical experience for those with clinical anxiety, this insomnia is often rooted in the fact that anxiety tends to be more pronounced when things quiet down and people are left to ruminate on their thoughts, explains Moe Gelbart, a psychologist and sleep expert with Torrance Memorial Medical Center in California.
“Basically, the moment I lay down, I have nothing to distract me from my thoughts,” Miller says. “I'll find myself running through things that upset me that day, or old things I still feel guilty about. Sometimes, I will freak out about my breathing ― I'll feel like my breaths are too shallow, and start getting really nervous I'm not getting enough air.”
Thoughts then spiral into what psychologists call “catastrophizing” ― imagining the worst imaginable outcome of a scenario, then the worst imaginable outcome of that scenario, and so on.
“Once that stream of thoughts starts, I can generally spin things pretty quickly into a list of completely unreasonable consequences that are 99 percent unlikely to ever occur,” explains Carrie Dowling, 31, who has had generalized anxiety disorder most of her life.
Aside from the mental strain, common physical symptoms of anxiety include a pounding heart, dry mouth, nausea, dizziness, shortness of breath and an inability to sit still, according to New York-based psychotherapist Kathryn Smerling, who notes that many of these symptoms are due to stress- and anxiety-induced adrenaline and cortisol secretions.
What begins as runaway thoughts, Dowling says, “can quickly escalate into a full-blown panic attack with shaking and hyperventilating.”
To combat these symptoms, sleep experts recommend breathing and meditation techniques. And generally, good 'sleep hygiene,' from turning off gadgets an hour before bed to soaking in a pre-bed bath, can help to mitigate sleep issues even in those with clinical anxiety, says Ong.
2. Just Thinking Of Bedtime Is Stressful
If tossing, turning, and ― in some cases ― hyperventilating occur frequently at bedtime, they can quickly spiral into an even bigger issue: fear of sleep. People with these symptoms can become so anxious that they will relive those past, negative experiences, and sometimes are already dreading sleep as early as lunchtime, according to Gelbart.
“The anxiety starts the moment I put my book down at night and try to fall asleep,” says Miller Shor, 19, who has been diagnosed with dysthymia, a form of depression that's often accompanied by anxiety. “I feel my heart racing and sometimes even feel palpitations. I feel very nervous that I will never be able to get to sleep.” Meanwhile, Miller notes that while falling asleep in bed can take hours, it's easy for him to doze off on the couch.
For this reason, experts actually recommend to certain patients that they start sleeping in a new room, like a spare bedroom or living room ― spaces the mind hasn't learned to associate with anxiety and sleepless nights, says Dr. W. Christopher Winter, medical director of the Sentara Martha Jefferson Sleep Medicine Center in Charlottesville, Va.
Alternatively, Winter recommends making your bedroom an oasis. Switching things up can make the room feel like a different space ― one that your brain doesn't associate with past sleepless nights. Try making some creative changes to the environment, such as rearranging furniture or using new bed sheets.
3. Sleeping Through The Night Can Feel Like An Unreachable Goal
As much as falling asleep is an issue for those with anxiety, actually staying asleep can be even more challenging.
“Sometimes, I wake up and then am unable to fall asleep for hours,” says Brooke Wanser, 22. “I think about everything happening in my life and obsess over hypothetical situations. I wish I could shut my brain down, but it seems to run extra fast when I wake up like this. Once, I woke up at 1:30 a.m. and couldn't sleep, so I finally went outside to watch the sun rise. Recently, I went to the gym at 3 a.m.”
These awakenings, which can occur up to every couple of hours for those with generalized anxiety disorder, are a result of the brain being in a state of hyperarousal, Ong, the Northwestern psychologist, says. “The body's fight-or-flight system is running all night long, and when our body thinks that we need to prepare for action, it doesn't want to be sleeping.”
Even if they don't wake up, this arousal causes people with anxiety to miss out on much of the deep or slow-wave sleep that is vital to rejuvenating the body, says Dr. Robert S. Rosenberg, medical director of the Sleep Disorders Center of Prescott Valley, Ariz., and author of The Doctor's Guide to Sleep Solutions for Stress and Anxiety. Additionally, when in the deeper stages of sleep, the anxious brain shows increased levels of alpha and beta brainwaves, both of which are associated with consciousness, Ong says.
Research consistently shows that cognitive behavioral therapy, which centers around identifying thought patterns and working to change them, is an effective method of easing anxiety disorders. Cognitive behavioral therapy is also often recommended as a first-line form of treatment in those with sleep disorders, according to Gelbart.
4. Anxiety And Sleeplessness Feed Each Other
Lack of sleep is not just a symptom of anxiety disorders ― it can also be part of the cause. Because sleep deprivation activates brain regions that contribute to excessive worrying, it can actually contribute to the development of anxiety disorders, according to 2013 research published in the Journal of Neuroscience.
In fact, according to the National Sleep Foundation, people with insomnia are 10 times more likely to face clinical depression and 17 times more likely to deal with clinical anxiety when compared to sound sleepers.
“The marriage of anxiety and sleep makes for an incredibly destructive union,” explains Manhattan-based therapist Paul Hokemeyer. “The more we are denied sleep, the more stress our bodies must contend with. This stress robs our bodies of serotonin, a hormone that calms our central nervous system; makes us irritable in our daily lives; interferes with relationships; and can cause us to self-medicate, whether with unhealthy foods or even alcohol.” Miller admits that in the past, he's used the latter to try to get himself to sleep. (“It just led to more anxiety,” he says.)
“The anxious 'sleep' takes a dramatic toll on my physical and emotional states,” Dowling says. “The physical effects are ... muscle aches and extreme exhaustion. I usually end up requiring a nap the next day, or I go to bed really early, both of which negatively affect my sleep cycle. Emotionally, I find myself slipping into depression more easily as the exhaustion tends to make me more anxious during the upcoming day.”
For Dowling, trial and error has led him to a more lasting solution. “I have tried acupuncture, traditional 'couch' therapy, meditation, medications, as well as basic things like exercise and changes in diet,” he says. “Cognitive behavioral therapy has, so far, been the most helpful for me. It has allowed me to identify potential triggers and either avoid them or re-frame them so that they don't cause me the same anxiety.”
Dowling acknowledges that the sleep-anxiety cycle can feel like a never-ending carousel, and getting off isn't easy ― but it is possible. The important thing to remember is that the way off is different for everyone.
“There is hope for people who haven't found their beach yet, and I would encourage them to keep trying and find what works for them,” Dowling says. “It's worth the effort.”
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