Easing Worry and Anxiety about Sleep

Insomnia sufferers write to me often with complaints about sleep-related worry and anxiety.

“The more important the next day is to me, the harder it is for me to sleep,” Jessica says. “So I worry about not sleeping and then it turns into a self-fulfilling prophecy.”

Finding a solution to this problem can be tricky. It may require experimentation before you home in on a strategy that works.

Insomnia characterized by worry and anxiety about sleep can be alleviated using psychological and physiological strategiesInsomnia sufferers write to me often with complaints about sleep-related worry and anxiety.

“The more important the next day is to me, the harder it is for me to sleep,” Jessica says. “So I worry about not sleeping and then it turns into a self-fulfilling prophecy.”

“I finally had about 4 good nights after starting sleep restriction (about 11 days ago) but had a horrible night of anxiety last night,” Stacy says. “I was anxious about not being able to continue my good nights of sleeping. I find it hard to practice relaxation exercises when I’m that anxious.”

Achieving a relaxed state conducive to sleep can seem impossible with a mind that’s racing from one fraught thought to another. Likewise, the physiological changes that accompany worry and anxiety—the release of stress hormones, a faster heart rate, bodily warming, tensing muscles—are a better preparation for fight and flight than for relaxation and disengagement.

How to stop obsessing about sleep and sleeplessness is the main concern of many insomniacs, yet finding a solution can be tricky. It may require experimentation before you home in on a strategy that works.

Different Schools of Thought

Research backs a handful of approaches to managing the problem, but even among sleep experts there is no consensus as to which works best. It may depend on the nature of your insomnia and which approach you find more appealing.

Some experts promote a type of talk therapy–called “cognitive restructuring–as effective in reducing worry and anxiety related to sleep. The idea behind it is that sleep-related anxieties develop in part due to the misconceptions people have about sleep and catastrophic thinking about insomnia. Replacing these ways of thinking with attitudes that are more realistic and sleep-supportive should help.

Cognitive restructuring is normally presented as part of cognitive-behavioral therapy for insomnia (CBT-I). It usually involves work with a therapist, who helps you learn to talk yourself out of worries and anxieties about sleep and sleeplessness.

Mind/Body Approaches to Curbing Arousal

Other experts suggest that psychological treatments for sleep-related anxieties may not be as effective as treatments that simply help insomniacs learn to relax. Physiological hyperarousal is the main cause of poor sleep, they say, with sleep-related anxiety and worry developing as a result. Treatment should focus on tamping down arousal that gives rise to these sleep-related worries, enabling a stronger and more dependable relaxation response.

  • Relaxation training is recommended as helpful to sleep by the American Academy of Sleep Medicine. It may involve progressive muscle relaxation and/or autogenic training (guided visualization).
  • Mindfulness-based therapies enable people to become more accepting of unpleasant feelings and sensations and, in so doing, alleviate them. Mindfulness meditation has been shown in a handful of studies to help insomnia sufferers by cutting down on pre-sleep arousal, reducing wake time at night, and enhancing sleep quality.
  • Yoga has now been shown in several studies to help insomnia sufferers learn to manage stress and get more sleep. Not only does yoga practice effectively deactivate the stress system. Yoga postures, breathing, and meditation exercises also help people develop more resilience to stress.

Exercise, Anxiety, and Sleep

Still other experts advocate exercise as the best way to relieve the anxious arousal that sabotages sleep. There’s now solid evidence that regular exercise promotes sounder sleep and preliminary evidence that exercise is effective in reducing anxiety. A meta-analysis published in April shows that even a single bout of exercise has a small but significant anxiety-alleviating effect.

Strenuous exercise is the way I calm myself down in times of stress, especially when my old fear of sleeplessness threatens to stage a comeback. The minute I feel that happening, I push myself to work out longer and harder and, most of the time, it helps.

But which kinds of exercise will give you the most bang for the buck? University of Pennsylvania researchers, analyzing data from a huge survey of behaviors affecting health, have found that while walking is associated with better sleep compared with getting no exercise at all, aerobics, calisthenics, biking, gardening, golf, running, weight-lifting, yoga and Pilates are associated with even better sleep.

Consider these strategies if worry and anxiety are feeding your insomnia. Continuing to obsess about sleep and sleeplessness is surely worse than making a good-faith effort to try some of these practices out.

Insomniacs Weigh In on Mindful Stress Reduction

A lot of people with insomnia say the main barrier to sleep is an unquiet mind. The minute they lie down, the mind starts racing over the events of the day or sprints ahead to the next day, chewing over problems and unable to stop.

If you could put a lid on the chatter and improve your sleep by dedicating 20 minutes a day to meditation, focused breathing, and simple yoga poses, would you do it?

Here’s what you could expect to gain, in the words of those who are doing it.

Insomnia is less bothersome if you practice meditation, focused breathing and yogaA lot of people with insomnia say the main barrier to sleep is an unquiet mind. The minute they lie down, the mind starts racing over the events of the day or sprints ahead to the next day, chewing over problems and unable to stop.

If you could put a lid on the chatter and improve your sleep by dedicating 20 minutes a day to meditation, focused breathing, and simple yoga poses, would you do it?

This is the commitment a group of insomnia sufferers made after participating in an 8-week study comparing the effects of mindfulness-based stress reduction (MBSR) to treatment with the sleeping pill eszopiclone (Lunesta). The MBSR and the Lunesta groups experienced similar improvements in their sleep. But the MBSR group reported a lot more treatment satisfaction. Five months later, 9 participants gathered at the University of Minnesota in focus groups to discuss the effects of MBSR on their sleep and waking hours. Here are some of their comments.

Improved Sleep

Mine [my sleep] was almost immediately, positively impacted . . . I didn’t sleep longer, but I slept better. So I woke up more refreshed even though I wasn’t sleeping more, and that happened for me very quickly.

Sleep quality improved with MBSR practice. Specifically, people reported (1) getting to sleep more quickly, (2) having shorter nighttime awakenings and fewer early-morning wake-ups, and (3) waking up feeling more rested and refreshed.

Benefits of the Body Scan

The body scan is a guided meditation that several people in the group found was especially effective in halting mental chatter and helping them relax. (The body scan involves focusing your attention on body parts one by one, starting, for example, with the left big toe. With acceptance rather than judgment, you’re to notice any sensations you’re experiencing there, and continue doing the same thing through the rest of the body.)

The body scan helped keep my mind from racing, so that I could just decompress and fall asleep.

If I wake up in the middle of the night it [the body scan] seems to help me relax and get back to sleep. And a lot of times I’m back to sleep before I get past the left leg.

Better Sleep Habits

While undergoing the MBSR training, participants also learned the rules of good sleep hygiene: avoid caffeine late in the day, get up at the same time every morning, and so forth (you know the drill!).

MBSR helped in

making it a priority to do the things that we all know we are supposed to do, but we don’t necessarily do. Like not watching TV in bed, not eating chocolate at 7 o’clock at night.

Overall, MBSR training made it easier to shy away from behaviors that interfered with sleep and adopt habits that were helpful.

Benefits Beyond Sleep

Sleep wasn’t the only that improved with training in MBSR. People also reported feeling better emotionally and physically in the daytime.

I feel as though instead of getting worked up about things throughout the day and then having it be difficult to come down to relax and sleep, I feel that when I started doing the body scan [in the morning] I was at a stable emotional level throughout the day.

The yoga component of the training was helpful in increasing physical flexibility and reducing aches and pains.

It’s low impact and I don’t get stiff like I used to sitting working long hours.

Use It or Lose It

Like many techniques and skills, though, MBSR requires ongoing practice. One group member couldn’t do her customary meditation while on vacation and backslid as a result:

I noticed that the benefits left me. . . . I came back home and here was the chatter all back again. ‘I shouldn’t have said that. Shouldn’t have done that.’. . . It was all back. And . . . I couldn’t go to sleep. And when I do the meditation that chatter goes away. . . . I lay down at night and I’m not chattery.

The Take-Away

A maintenance routine of 20 minutes a day does not sound like a big investment if the potential gains are as great as these comments would suggest. As alternative treatments for insomnia go, this one is not so demanding.

But the initial 8-week training requires a bigger time commitment. To learn MBSR techniques, group members participated in a 2½-hour class every week and a daylong silent retreat. They were also asked to do 40 minutes of home practice 6 days a week. This is the standard MBSR training program recommended by Full Catastrophe Living author Jon Kabat-Zinn.

But a 20-minute maintenance regimen that can be done at home with no special equipment and no special clothes? Especially if mental chatter and/or conditioned arousal keep you from sleeping at night, MBSR is worth a serious look.

Managing Anxious Thoughts at Night

Whether the mind’s runaway chatter actually causes insomnia is an open question, but there’s no doubt but that rumination and worry go hand in hand with anxiety and make it harder to sleep.

Here are three ways to keep intrusive thoughts from creating anxiety and ruining the night.

Awake-at-NightNine out of ten insomnia sufferers blame their sleep problems on a racing mind. Here are some comments I heard as I was interviewing people for my book:

“When I’m trying to fall asleep all my brain wants to do is think about all the things I have to do the next day.”

“If something unpleasant happened at work, I’ll review it on and on.”

“If I go out socially I won’t be able to sleep that night. Everything that’s done or said just keeps rattling around in my mind. Not that anything bad happened, it’s just that I can’t turn it off.”

Whether the mind’s runaway chatter actually causes insomnia is an open question, but there’s no doubt but that rumination and worry go hand in hand with anxiety and make it harder to sleep. Insomnia, said the authors of a study on sleep and worry conducted in 1983, is associated with “an inability to turn off intrusive, affectively-laden thoughts and images at bedtime.” Follow-up studies in the 1990s showed that the more emotion-laden thoughts a person experienced at bedtime, the longer it took to fall asleep.

What to Avoid

Investigator Allison Harvey has written a lot about the management of thoughts that get in the way of sleep. According to Harvey, insomniacs plagued by a racing mind at bedtime will sometimes try to stop or suppress the thoughts they think are keeping them awake. This is usually counterproductive. Thought suppression causes a rebound in the unwanted thought, she says, making it even harder to fall asleep and diminishing sleep quality as well.

Another tactic insomniacs sometimes fall back on is trying to sleep, says investigator Colin Espie. But making an effort to sleep is also counterproductive. Sleep is an involuntary and automatic process. “Direct sleep effort (trying to force sleep to come) is likely to increase cognitive and emotional arousal,” Espie says, making it harder, rather than easier, to sleep.

Better Strategies

There are more effective ways to keep intrusive thoughts from creating anxiety and ruining the night.

  1. If your thoughts have to do with planning and rehearsing for events in the future, try setting those plans down in writing well before you head to bed. This may make you less inclined to plan and rehearse when you turn out the lights.
  2. If your thoughts are emotionally charged and you’re willing to consider a long-term solution, mindfulness meditation shows promise as a way to reduce the arousal associated with anxious thinking that interferes with sleep. Some insomniacs find that relaxation techniques work as well.
  3. Finally, research shows that thought management via distraction can help people with insomnia get to sleep more quickly and reduce the discomfort associated with intrusive thoughts. For me personally, distraction is the only thing that works if anything will. A novel with interesting characters or a good movie will often divert my attention away from the stressors causing my arousal. And if at lights-out my mind drifts toward the unsettling, mentally I re-enter the world of the novel or movie, and with luck that’s the last memory I have.

What helps you manage intrusive thoughts at night? Does it always work?