Q&A: Will Regular Rest Curb Sleep Anxiety?

“I have nights when I can’t sleep at all and other nights when I sleep a lot,” Philippa wrote last week. “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 first I want to look at sleep that’s inconsistent and unpredictable and how anxious it can make you feel.

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.

Insomnia at the Pinnacle of Power

We don’t hear much about the sleep of presidents and prime ministers except for the hours they get: President Obama, 6; George W. Bush, 8: Margaret Thatcher, 4. Their personal habits matter little compared with the decisions they make and the work they do in office.

But Dr. Li Zhisui wrote about insomnia at length in his biography of Mao Zedong, The Private Life of Chairman Mao, suggesting that our leaders’ sleep (or sleeplessness) may affect their decisions and behavior more than we think.

Insomnia was a problem for Mao ZedongWe don’t hear much about the sleep of presidents and prime ministers except for the hours they get: President Obama, 6; George W. Bush, 8: Margaret Thatcher, 4. Their personal habits matter little compared with the decisions they make and the work they do in office.

But Dr. Li Zhisui wrote about insomnia at length in his biography of Mao Zedong, The Private Life of Chairman Mao, suggesting that our leaders’ sleep (or sleeplessness) may affect their decisions and behavior more than we think.

Mao’s Stress-Related Insomnia

As Mao’s personal physician, Li was expected to give up all other duties to see to the chairman’s health and wellbeing. So he worked and lived in the ruler’s compound, observing him at close range and eventually becoming Mao’s confidant.

Li noted right away that Mao’s sleep was erratic. Anticipatory anxiety would keep him awake on nights before public events where he was to address the masses.

“Often he would get no sleep at all the night before the festivities,” Li wrote. “He was exhilarated by the crowds and their adulation, and his energy always carried him through the event, but he often caught cold afterward. Sometimes the cold would become bronchitis, and he would be miserable for weeks.”

A Possible Circadian Rhythm Disorder

But Li observed that Mao’s erratic sleep patterns seemed to be driven by internal as well as external factors. Mao was a night owl who tended to be awake when most other people were sleeping.

“His body refused to be set to the 24-hour day,” Li wrote. “He stayed awake longer than others, and much of his activity took place at night. If he went to bed one day at midnight, the next night he might not sleep until 3 in the morning, and the day after that he would not sleep until 6. His waking hours grew longer and longer until he would stay awake for 24, or even 36 or 48, hours at a stretch. Then he could sleep 10 or 12 hours continuously, and no amount of noise or commotion would wake him.”

This erratic sleep pattern would probably be classified as a circadian rhythm disorder today. It might be delayed sleep phase disorder, a diagnosis often given to night owls who prefer to be up at night and sleep in late in the morning. It might also be non-24-hour sleep-wake disorder, a problem often seen in people who are blind, who cannot detect daylight and whose body clocks—as a result—are not set to the 24-hour day.

Whatever the diagnosis, the problem may have been amplified by Mao’s unusual lifestyle. He spent most of his time indoors—in his bedroom, according to Li, where thick dark curtains blocked out the sunlight. Without exposure to sunlight, his circadian rhythms may have become desynchronized, a situation that could easily give rise to insomnia.

But Li felt Mao’s problem was partly organic, and that he’d simply been born with a wayward body clock predisposed to run on its own time.

Insomnia Affected Mao’s Behavior

People with sleep problems like Mao’s don’t usually have easy lives. Perennial lateness and poor performance interfere with relationships and jobs.

But Mao rose to a leadership position despite his strange sleep habits and, as Chairman of the Communist Party, he called the shots. Without regard for the sleep needs of his associates, he would call impromptu staff meetings at 3 a.m. On the spur of the moment he would order his whole staff to get up early to prepare for a 4 a.m. departure by train.

As disruptive as his strange sleep habits were to others, they were a source of great anxiety to Mao himself, Li said. Mao tried swimming, dancing, and walking to wear himself out, and he took up to 4 times the recommended dosage of powerful sleeping pills. But often, Li said, nothing worked.

Could there be a relationship between the tight-fisted control Mao insisted on exerting over his country and the lack of control he seemingly had over his sleep? What do you think?