Sleep Anxiety & Insomnia: Symptoms, Treatment, & Diagnosis

What Is Sleep Anxiety?

Sleep anxiety is a type of sleep disorder where your anxiety levels at night prevent you from falling asleep or staying asleep. Insomnia is the clinical term for people who have trouble falling asleep, difficulty staying asleep, waking up too early, or waking up feeling unrefreshed. Sleep anxiety can therefore cause insomnia.

Causes of Sleep Anxiety and Insomnia

Why do I get anxiety attacks in my sleep?

Lack of sleep and anxiety are closely linked and are considered ‘comorbid’ conditions. Lack of sleep can trigger anxiety, but anxiety can also cause a lack of sleep. Since the two are very intertwined, they can exacerbate one another. With anxiety, the brain is in ‘fight or flight’ mode, thinking of all the possible outcomes of whatever problem is causing the anxiety. Such an adrenaline rush from this perceived stress can make it very hard to fall asleep.

According to a survey carried out by the American Psychological Association, 43% of adults say their stress levels affect their ability to get to sleep at night.

Why am I afraid of sleeping?

There are many reasons that can cause you to be anxious at night. You may find it hard to stop your mind racing about problems in your life or you keep thinking about scenarios which make you anxious. You may be focussed on your daily worries and stressing about what you need to get done the following day. Alternatively, you may also experience sleep anxiety from a fear of recurring nightmares or the fear of sleep apnea (when your breathing repeatedly stops while you’re asleep).

Sleep anxiety can sometimes be a type of performance anxiety. You may stress about not getting enough sleep to function the next day, but this stress is precisely what can cause you to be awake for hours. If you are worried or anxious about not being able to fall asleep when you go to bed because of your experience of previous bad nights, this is called ‘anticipatory anxiety’ and can itself lead to sleep disturbance and insomnia. Such an unfortunate self-perpetuating feedback loop can worsen both your anxiety and sleep.

Sleep Anxiety Symptoms

According to the American Psychological Association, “anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.” Nevertheless, the experience of sleep anxiety may be different from person to person. The symptoms are numerous and can happen any time of the day or night. Therefore, symptoms of sleep anxiety can be similar to symptoms of anxiety during the day.

What are the symptoms of sleep anxiety?

Common symptoms of sleep anxiety include:

• Feelings of nervousness, restlessness, irritability or worry
• Intrusive thoughts or concerns
• Trouble falling asleep or staying asleep
• Gastrointestinal problems
• Sweating
• Trembling
• Dizziness
• Rapid heartbeat

Since sleep anxiety can cause insomnia, you may also suffer from symptoms of insomnia including:

• Daytime sleepiness and sluggishness
• Irritability
• Problems concentrating
• Fatigue
• Forgetfulness
• Feeling stressed
• Feeling sad or depressed

Sleep Anxiety Risk Factors

Sleep anxiety can happen to anyone, however research shows that sleep disorders, including sleep anxiety and insomnia, are common in people with a psychiatric disorder. Since we know that sleep anxiety and insomnia are comorbid conditions, it is not surprising that people with chronic insomnia are at high risk of developing an anxiety disorder. You may have an anxiety disorder if your feelings of anxiety are extreme, last for at least six months and interfere with your daily life and relationships.

How Is Sleep Anxiety Diagnosed?

When my patients come to me with trouble sleeping, I will first talk to them about their symptoms and medical history and, if necessary, encourage them to seek out a physical exam with their primary care provider. This is to see how severe the problem is and if there are any indications that your sleep anxiety and insomnia may be linked to medications you are taking or an underlying medical condition.

Your doctor may ask you to fill out a psychological questionnaire to more accurately determine the nature and seriousness of your anxiety. You may also be asked to keep a sleep journal to determine if there are any

environmental factors that may be negatively affecting your sleep.

Just to be sure, you may be asked to have some blood tests done to rule out any other medical conditions that could be causing your insomnia, such as thyroid problems. Similarly, you may be recommended to undergo a sleep study to make sure that your insomnia is not being caused by another sleep disorder such as sleep apnea or fatal familial insomnia. The latter is a rare genetic disorder which has progressive insomnia as one of its symptoms.

Some women can suffer from pregnancy insomnia, usually during the first and third trimesters. This can affect your quality of life but rest assured, it is not harmful to your baby.

Once your doctor has determined that there are no other reasons for your disturbed sleep and has established that anxiety is causing your insomnia, then you are on your way to getting the treatment you need.

Sleep Anxiety Treatment Options

If you think you may be suffering from sleep anxiety, visit your family doctor, mental health professional, or a sleep disorder clinic. Treatments may include psychotherapy and medication. Your doctor may recommend you do both for the best results.

• Psychotherapy: Psychotherapy comes in various forms to treat anxiety. One of the most used methods is cognitive-behavioral therapy, or CBT, which teaches you how you can identify and modify your thought patterns to improve your behavior and mood. According to the Anxiety and Depression Association of America, it can take 12-16 weeks to begin seeing results with CBT.

• Medications: Your doctor may prescribe various medications for your anxiety and you will need to find the one that best suits you. If your anxiety is long-term, you may be prescribed antidepressants.

• Relaxation techniques: Your doctor may recommend various relaxation techniques to reduce your anxiety and help you sleep. These can include meditation, breathing exercises, imagery or visualizations, and others. These can be a beneficial therapy in addition to CBT and medication.

The above treatments will help with your sleep anxiety and in turn are also insomnia treatments.

Prevention: What You Can Do at Home

To prevent sleep anxiety and insomnia, you can take some simple steps to reduce your anxiety levels and create an environment that is optimal for quality sleep. Since anxiety and insomnia are linked to one another, the best way to help yourself is to make sure you do not neglect treating one or the other.

To reduce anxiety and stress:

• Meditate: The simplest form of meditation and a great relaxation technique needs no fancy gimmicks or expensive classes. Simply focus on your breath and breathe in and out slowly and deeply. You may find it helpful to visualize a scene which you find relaxing such as a deserted beach or grassy hill.

• Exercise: As we all know, regular exercise has many benefits for our physical and mental health. Find an exercise that you can enjoy to release those mood-enhancing endorphins. Try kick-boxing or other cardio exercises as an outlet for your frustrations. Alternatively give yoga a go; it has been shown to be particularly effective at reducing anxiety and stress.

• Prioritize and delegate: Life is busy and you may have what seems like a never ending to-do list that is causing you a lot of anxiety and stress. Use an app or old-fashioned pen and paper to prioritize what is truly important and spend your time and energy on those tasks. Delegate where you can and allow yourself to let others help. Breaking up large projects into smaller, more easily manageable tasks may also help you to reduce anxiety.

• Take up a hobby: Find something that you enjoy and take some ‘me time’ to give yourself a break from the stresses of your day. For example, you can try to relax your mind and body by playing some music.

• Volunteer: Volunteering in your local community is a great way to take your mind off your own problems and anxiety while benefiting others.

• Talk to someone: Letting a family member or friend know that you’re anxious can reduce the burden of anxiety and any feelings of being alone. Don’t be afraid to ask for professional help from your doctor or a therapist.

• Be realistic: Notice what you are saying to yourself about sleep and ensure you are being realistic. Negative and unhelpful thoughts about sleep make insomnia worse. For example, some suffering from sleep anxiety have thoughts like "I won't be able to function tomorrow" or "I have to get 8 hours of sleep." Restructuring these types of thoughts will reduce worry and allow you to sleep better.

How can I stay asleep all night?

While it can be very difficult to stay asleep through the night with sleep anxiety, here are a few tips that you can try immediately that may help you sleep more soundly:

• Establish a regular sleep routine: Since sleep anxiety can harm your sleep and in turn make your anxiety worse, it is vital to make getting a good night’s sleep a priority. Stick to the same times to go to bed and to wake up every day, even on weekends, and make sure that you have blocked out seven to nine hours for a full night of uninterrupted sleep. It is also important that you have an evening bedtime routine that is conducive to getting yourself relaxed and ready to sleep. Avoid stimulants like coffee, chocolate, and nicotine before going to sleep, and don’t watch TV or use your phone or computer before going to bed. Read a book, listen to soft music, or meditate instead.

• Make your bedroom a good environment for sleep: Make sure that your bedroom is at a comfortable temperature, is totally dark and quiet, and that you have clean and comfortable bedding. Use your bedroom only for sleeping and get into bed only when you are tired. These steps will make your mind and body associate your bedroom as a place for long quality sleep.

• Exercise regularly: Just as with reducing stress, exercise also benefits your sleep. However, avoid working out in the evenings.

• Avoid the clock and technology: Avoid looking at the clock or looking at your cell phone during the night. This can make you anxious. Try facing the clock away from you and putting your phone out of reach before going to bed.

When to See a Doctor

If you have taken all possible steps to reduce your anxiety and improve your sleep, and you still have problems falling asleep, it is time to see your doctor. Your doctor will discuss your symptoms and lifestyle and see if there are any further steps you can take to help yourself sleep. If needed, your doctor may prescribe you psychotherapy and/or medications to help you.

Sleep Anxiety Complications and Related Conditions

Sleep anxiety goes hand-in-hand with trouble sleeping. If you are finding it hard to sleep or stay asleep, your insomnia can cause you further complications through a lack of sufficient quality sleep. This goes beyond tiredness. Sleeplessness can lead to difficulties in concentrating and performing at work, an increased risk of injury and motor vehicle crashes, and various health problems.

The Centers for Disease Control and Prevention (CDC) classifies a short sleep duration as adults getting less than seven hours of sleep in a 24-hour cycle. In fact, a third of American adults are not getting the recommended amount of sleep. If you are getting insufficient sleep long-term, the CDC has shown that this can be associated with the development of chronic diseases and moreover difficulty in managing these chronic diseases.

Conditions related to long-term sleep anxiety/insomnia include:

• Type 2 diabetes

• Cardiovascular disease

• Depression

• High blood pressure

• Obesity

• Other anxiety disorders