Anxiety & sleep cycle: How to get a good night’s rest

The vicious cycle of anxiety & poor sleep: Good sleep hygiene, home remedies, and what to do when all else fails

Advice

The link between anxiety and sleep is well-established. You probably already realized that stress and anxiety can lead to sleep deprivation. But research from The Anxiety and Depression Association of America (ADAA) indicates that it can also work the other way around - sleep deprivation can also cause anxiety. This can lead to a vicious cycle where you don’t sleep because you’re anxious, which then makes the anxiety worse, which makes it even harder to sleep. Chronic insomnia can greatly impact mood regulation - when you’re tired, things that might usually roll off your back can seem intolerable, sparking anger, anxiety, or depression, which can also make it more difficult to sleep. But don’t worry - there are a few things you can try at home.

Sleep Hygiene

No, we’re not talking about brushing your teeth - though that’s important too. Sleep hygiene includes:

  • Regular Bedtime Routine: You should be going to bed at about the same time every day - even on the weekends. This helps your brain’s internal clock to know when to start creating melatonin and other sleep-inducing hormones.
  • Reduce screen time. The blue light from your TV, tablet, phone, and other devices can throw off your circadian rhythm - the timer in your head that says it’s time to sleep or wake up - and decrease the amount of melatonin your brain produces.
  • Environmental Factors: make sure your room is cool, dark, and quiet. Additionally, use your bed only for sleep and sex. Using the bed for work, or just “chilling” while you scroll on your phone, will create an association in your brain between bed and wakefulness.
  • Avoid eating & exercise too close to bedtime. The increase in body heat, metabolism, and endorphins which come from exercise and food will keep your brain alert for the next couple of hours.
  • Avoid or reduce alcohol and caffeine intake - even for those of us who feel sleepy after drinking alcohol or caffeine. We may be able to fall asleep okay, but the quality of sleep will be much poorer, so we wake up exhausted.
  • Keep your eyes off the clock. Watching the clock when you’re trying to sleep will just cause frustration, which is an energizing emotion.
  • Take a break. If you can’t fall asleep within 20 minutes, get up and do something relaxing for 10-15minutes, then try again. Lying there awake can lead your brain to associate your sleeping environment with wakefulness - and probably a fair amount of frustration and anxiety, too.

Home Remedies for the Racing Mind

Once you have your bedtime routine and sleep hygiene figured out, you can try some of the following mental tricks:

  1. Mindfulness: There are a lot of different ways to practice mindfulness. For sleep, it might be helpful to practice mindfulness of your breath or body. To practice mindfulness, the goal is NOT to ‘empty your mind,’ or prevent other thoughts from coming up. Instead, the goal is to notice when thoughts arise, and intentionally turn your attention back to your breath or body. Each time you notice and re-direct your thoughts, you’re successfully being mindful!
  2. Worry Time: This one is pretty self-explanatory. Before bed, schedule in 5-10 minutes of time specifically for worrying. You can use this time to vent in a journal, or create a to-do list for tomorrow, or anything else that’s on your mind. Once you set it aside, any time those worries pop back into your head, remind your brain that you’ve already had worry time, and this is bed time. In short - practice mindfulness!The worries will almost certainly pop up many times, since that’s what your brain is used to doing while you’re in bed. But the more you practice turning your attention to bed, instead of worrying, the easier it will become, and the less frequent the thoughts will pop up.
  3. Paradoxical Intention: This is basically reverse psychology. If you could forget about the desire to fall asleep, it would probably come easier, right? You’d forget about the anxiety and frustration that comes from lying there awake.
  4. ~So, since this is reverse psychology, you practice Paradoxical Intention by doing the opposite. Get in bed, keep your eyes open, and focus on staying awake (without the aid of screens, or any other distraction). Directly facing the fear of not sleeping will lessen its intensity over time. Without the pressure to fall asleep, sleep will come more easily.
  5. Cognitive Shuffle: Sometimes racing thoughts are just too strong for other techniques to work well. This technique give your brain a distraction strong enough to (hopefully) keep you out of worry world, but it’s also a neutral, less-stimulating activity.
  6. ~To practice Cognitive Shuffling, first think of a word - any word - that’s five letters or longer. For example, you might think of the word ‘dolphin.’ Then, spell it out in your head. For each letter, think of as many other words as you can that start with that letter, and visualize it as much as you can. So in this case you’d start with ‘d’ and think up as many words that start with ‘d’ as you can, visualizing dogs, donuts, dust, etc. Once you run out of ‘d’ words, you’d move on to ‘o’ words, ‘l’ words, and so on.
  7. ~If you manage to get through the whole word without falling asleep - or if you forget the original word, like I do - just pick a new one and start over.

When At-Home Strategies Aren’t Working

Anxiety is, of course, only one of several challenges that lead to sleeping problems. Other sleep disorders, mental health disorders such as depression, ADHD, or anxiety disorders, and physical health conditions can cause trouble sleeping - both falling asleep, and staying asleep. Sleep apnea, insomnia, panic attacks, sleep walking, narcolepsy, and restless leg syndrome are some of the most common. So, if you’re having trouble sleeping, again, it’s important to talk to your doctor, or even a sleep specialist. They can help give you an accurate diagnosis and treatment, and medical advice. If an anxiety disorder is the culprit, here are a few of the things they might suggest:

  • Cognitive Behavioral Therapy (CBT). CBT is by far one of the most effective and well-researched behavioral therapies for anxiety and stress disorders - and, by extension, it can also work wonders for sleep. There are several different techniques and therapies that fall under the CBT umbrella, but in general CBT is used to identify unhealthy patterns of thinking and behavior, and substitute healthier, more effective behaviors. Try to find  a therapist trained in CBT-I, which is a CBT program specifically for insomnia.
  • ~CBT is usually very structured, and often you’ll be assigned “homework” to practice the skills you learn in therapy in your everyday life. It’s often quicker than traditional psychotherapy - aka “talk therapy,” and most insurance companies are often more willing to cover it.
  • Medications. Often, combining mental health therapy with medication leads to even better results than just one or the other alone. There are a TON of different medications that can help with sleep, and pros and cons to each. For example, benzodiazepines like Xanax, Klonopin, and Valium tend to work quickly, with fewer side effects; but they can also be addicting, and your body can get used to them quickly, so that you need more and more for it to work. These are usually only prescribed as a short-term fix, and sometimes require a trip to a specialist, like a psychiatrist, as primary care doctors sometimes can’t prescribe them.
  • ~Antidepressants, like Prozac, Zoloft, Celexa, and numerous others, can have more side effects in some people, and take longer to work - sometimes 60 - 90 days. On the plus side, they can often be taken long-term, and since they’re not addictive, doctors are more willing to prescribe them - and most primary care doctors, and even nurse practitioners, can prescribe these.
  • ~Beta-blockers, & Alpha blockers, often used to treat high blood pressure, can also sometimes help with anxiety as they help with some of the physical symptoms - rapid heartbeat, shaking/trembling, and blushing. Prazosin, for example,

Your doctor will be able to help you decide which medication is best for you by considering any other medications you’re on, your health history, and other health issues.

As you can see, getting a good night’s rest can be trickier than it sounds - especially when anxiety rears its head, or tries to join you in bed. It’s especially important to determine the root cause of the sleep issues; for example, ADHD, depression, and other mental and physical health conditions can also impact sleep. But anxiety disorders and sleep disorders are treatable, and there are so many options you and your doctor can choose from. Sleep is so important to keep yourself both mentally and physically healthy. Don’t let anxiety stand in your way.

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