Anxiety about sleep is treatable with CBT for insomniaMy sleep used to be erratic. Really, really erratic. The Sandman could come as early as 10 p.m. . . . but he might not show up till daybreak.

Occasionally I hear another insomnia sufferer voice a variation on the same complaint. Here’s what Philippa wrote last week:

 

 

I have nights when I can’t sleep at all and other nights when I sleep a lot. I don’t have a problem waking up at night and, if I do, I can go back to sleep. However, if I don’t fall asleep straight away I find I often don’t sleep the whole night! Do you think sleep restriction would work for me?

My answer to Philippa’s question is an unqualified yes. But before I talk about making sleep more regular, I want to look at sleep that’s inconsistent and unpredictable and how anxious it can make you feel.

Night-to-Night Sleep Variability

Actually, there’s not much talk about night-to-night variability in people’s sleep. We hear a lot about sleep need, but that’s always stated as an average, as in “most people need about 7 hours of sleep a night.”

But plenty of research shows there’s night-to-night variability in when, how long, and how well each person sleeps. Unsurprisingly, some people’s sleep is more variable than others’. According to a new paper published in Sleep Medicine Reviews, from night to night, your sleep is more likely to vary in duration, timing, or quality if

  • you’re young
  • you live alone
  • you’re a person of color
  • you’re a night owl
  • you’re overweight or obese
  • you have physical health conditions
  • you have bipolar or depressive symptoms
  • you’ve had lots of stressful life events
  • you have insomnia.

Insomnia and Sleep Variability

The word insomnia means “the condition of not being able to sleep.” Yet even if your insomnia is chronic, chances are you don’t sleep poorly every night. In fact, like Philippa, on some nights you probably sleep passably or even quite well. But good sleep is not dependable, and that’s a problem.

There may be certain situations you’ve identified that typically give rise to bad nights. For example, you may know your sleep will suffer after a bad day at work or if you have to give a speech the next day.

But the good and bad nights may not necessarily correspond to stressors you can put your finger on. And this lack of predictability can cause big-time anxiety. It certainly did for me.

A Pattern of Good and Bad Nights?

Is there an underlying pattern to insomniacs’ poor sleep and, if so, would discerning that pattern be reassuring? Maybe it would for some people with insomnia.

Researchers in Scotland looked at the sleep diaries of over 100 insomniacs and found a predictable pattern of good and bad nights in about two-thirds of the study participants. Most of these participants could count on a good night’s sleep after 1 to 3 bad nights.

It could be reassuring to know that a better night’s sleep is just a day or two away, the authors wrote. A predictable pattern of good and bad nights might alleviate some anxiety about sleep.

In a study conducted at the University of Pennsylvania, investigators concluded that insomniacs can expect a “better-than-average” night’s sleep within 3 days—but that “good” sleep may come only 1 night in 6. This doesn’t sound very predictable or reassuring to me.

Take the Bull by the Horns

It might be helpful to keep a sleep diary and see if you can identify a pattern of good and bad nights. Seeing method in the madness might allow you to dispense with some of the uncertainty that’s probably contributing to your anxiety about sleep at night (and driving your insomnia).

But getting rid of erratic sleep—and making sleep predictable—is a more effective approach to curtailing anxiety about sleep. Undergoing CBT for insomnia, which includes sleep restriction therapy, is a good way to do that, research shows. And both this blog and my book, The Savvy Insomniac, are a testimonial to what CBT for insomnia—combined with regular exercise—has done for my sleep.

I’ve written more about sleep restriction therapy because it’s the part of treatment that helped me the most. To read more about it, just click on “Blog” at the top of this page, type “sleep restriction” in the site search box, and start browsing.

Posted by Lois Maharg, The Savvy Insomniac

Lois Maharg has worked with language for many years. She taught ESL, coauthored two textbooks, and then became a reporter, writing about health, education, government, Latino affairs, and food. Her lifelong struggle with insomnia and interest in investigative reporting motivated her to write a book, The Savvy Insomniac: A Personal Journey through Science to Better Sleep. She now freelances as an editor and copy writer at On the Mark Editing.

5 Comments

  1. I totally agree with CBT and sleep restrictions. It works but you have to be patient. It may take weeks but you must not give up. I experienced some good and bad nights for at least 3 weeks, but now I seldom have any bad nights. Please in order for this to work, you must avoid naps and do exercise regularly.

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  2. Hello Kamal,

    I’m glad to know you’ve finally had some success in improving your sleep! Thank you for writing in to share how you did it. I promote the things you mention—CBT for insomnia (including sleep restriction) and exercise—in part because these therapies are evidence based and in part because they helped me (and continue to help me) improve my sleep.

    Variable nights of good and bad sleep for 3 or even 4 weeks during the sleep restriction process may sound like a steep price to pay for stable, consolidated sleep. Yet a mix of good and bad nights is standard fare for most insomniacs. Looked at this way, sleep restriction doesn’t sound so bad.

    Thanks again for writing in!

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  3. Hi lois
    I had my blood test results come back yesterday. My doctor explained i have slightly elevated levels of blood sugar and cholesterol, which to me sounds like I’ve got hypoglycemia or pre diabetes which is why wake up every night around 3am-4am. Do you think this could be a possible cause for my sleep issue? I have no problems falling asleep but i wake up too early

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    1. Hello Moe,

      I haven’t heard of any correlation between slightly elevated cholesterol and waking up too early in the morning. There is research suggesting that short sleepers (people who sleep 5 hours or less) have a higher risk of developing diabetes than normal sleepers. But I’m not aware of any research suggesting that slightly elevated levels of blood sugar could actually cause early morning wake-ups. It’s good you and your doctor are keeping tabs on the blood sugar and cholesterol, though.

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  4. What my doctor was said was while sleeping when the sugar levels drop below normal (hypoglycemia)the brain alerts the liver to release glucose for energy production, this is done by the brain by signalling the adrenal glands to release cortisol, when this happens we wake up too early find it hard to fall asleep again because of the elevated levels of cortisol. My doctor thinks its important to stabilise blood sugar levels and to exercise regularly

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