This week a woman (I’ll call her Gina) wrote to Ask The Savvy Insomniac with questions about sleep anxiety and sleep restriction.
I have had chronic insomnia since September. I honestly didn’t have any major life event that caused it. Just a few bad nights of sleep—and the anxiety started setting in. The worst part of it for me is that as soon as it nears “bedtime” my heart starts racing and I feel extremely anxious.
I am doing sleep restriction therapy (I’ve been averaging 5 hours per night) but I’ve had a few “slips” along the way. I tend to drift off to sleep on the couch (for about 5 or 10 minutes). How long does this take? I’ve been doing it for over a week and I haven’t seen any great improvements. I’m losing hope.
Anxiety About Sleep: How It Develops
Anxiety about sleep can develop during a stressful life event when sleep is difficult. It can also develop following several nights of bad sleep, regardless of what triggered them.
Being unable to sleep when you want to sleep is frustrating. Frustration may give rise to symptoms of physiological arousal: increased heart rate, blood pressure, respiratory rate, and body temperature. If you’re prone to developing chronic insomnia you may be particularly sensitive to what’s going on inside your body. Merely noticing signs of arousal at a time when the brain and body are supposed to be shutting down can cause anxiety.
It’s important to note when and where these unpleasant sensations are occurring. They’re not happening as you drive your 3-year-old to daycare or participate in a staff meeting. They’re happening at night when you’re in bed in the bedroom—where you’re supposed to be asleep.
After a few bad nights you may also begin to notice unpleasant symptoms during the daytime: lethargy, low mood, trouble thinking. Consciously or unconsciously, you might start to connect these these symptoms to your struggle for sleep at night. This, too, can give rise to anxiety or exacerbate existing anxiety.
Activities and projects may claim your attention during the daytime. But when nighttime rolls around and your physical and mental stamina are at low ebb, boom! The mere thought of going to bed makes you anxious, ramping up physiological arousal and increasing your anxiety still further.
Forget about sleep when you finally go to bed. Your odds of an easy send-off are nil.
If You’re Anxious About Sleep
Keep these things in mind. Sleep-related anxiety:
- Is learned. It doesn’t just materialize out of nowhere but is rather conditioned through a process similar to the one described above (and likely predisposed by constitutional factors as yet unknown).
- Is not your fault. Conditioned learning takes place at an unconscious level; you are not aware that it is occurring. So don’t play the blame game—it hurts rather than helps.
- Can be unlearned. That’s where we’re heading now.
Some insomniacs who are anxious about their sleep respond to treatment with cognitive therapies. Cognitive restructuring, offered as part of cognitive behavioral therapy for insomnia (CBT-I), may help by dismantling some of the attitudes and beliefs that keep sleep anxiety alive. Other insomniacs have found that mindfulness meditation helps to alleviate sleep anxiety. Acceptance and commitment therapy is worth checking into as well.
Stimulus Control Therapy
For me personally, the two behavioral strategies I learned during CBT-I had the biggest impact on my sleep anxiety. By regularizing and solidifying my sleep, they helped to make fear of sleeplessness a thing of the past.
You’ve heard advice to the sleepless that counsels avoiding the bed except for sleep and sex? Well, this rather parsimonious view of how to use the bed has grown out of studies showing that stimulus control therapy (SCT) for insomnia works. The protocol is simple:
- Go to bed only when sleepy.
- Use the bed only for sleeping (and sex). Do not read, watch TV, eat, or do anything else in bed.
- If within 15 minutes you’re unable to sleep (estimate the 15 minutes; do not watch the clock), move to another room. Do a quiet activity—reading, knitting, watching TV—until you feel really sleepy. Then return to bed. The goal is to break the association between the bed and wakefulness and instead learn to associate the bed with falling asleep quickly.
- Repeat the above instruction as often as necessary.
- Get up at the same time every morning regardless of how much or how little you’ve slept.
- Do not take naps.
Sleep Restriction Therapy
The aim of sleep restriction therapy (SRT)—the treatment Gina is undergoing—is to restrict your time in bed so that most of your time there is spent sleeping rather than lying awake and worrying about sleep. The SRT process is somewhat involved and I’ve blogged about it elsewhere. Find out more by typing “sleep restriction” in the site search box above.
In response to Gina’s concerns about sleep restriction: avoid drifting off too early by engaging in evening activities that are not completely sedentary. And don’t lose hope because you’re failing to see improvements right away. It may take two or even three weeks before you notice appreciable benefits.
Take it from one who’s been there and done that: it’s worth the wait.