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Anxiety is typically caused by a reaction to stress. According to ADAA, the primary symptoms are feelings of tension, thoughts of worry, and physical changes such as increased heart rate and elevated blood pressure. Feeling anxious from time to time is entirely normal, and doesn’t indicate you have a mental disorder. Similar to physical pain, feeling anxious in certain situations indicates something is wrong and draws attention to particular causes of stress.
Anxiety disorders manifest differently – the affected person constantly worries and fears for the future. If the stressors are identified (often the patient feels anxious without a specific reason), even when they are addressed, worried thoughts don’t go away. Over time, the condition gets worse.
According to the National Institute of Mental Health, anxiety disorders, phobias, and neuroses like obsessive-compulsive disorder and PTSD are the most common mental disorders in the USA. Researchers estimate that around 18% of the population (roughly speaking, approximately 40 million adults), suffers from the mentioned mental illnesses.
Anxiety can negatively affect sleep, and inadequate sleep negatively affects anxiety. Like in case of depression, anxiety and insomnia are comorbid and connected via a self-reinforcing feedback loop. Simply explained anxiety can keep us up at night, and insomnia further feeds anxiety. It is proven that a good night’s sleep can alleviate the symptoms of anxiety and other mental illnesses like depression.
In this guide, you will learn more about the vicious connection between anxiety and sleep. We will discuss several anxiety disorders, and offer some solutions for better sleep when suffering from these disorders, starting form treatment options to implementing healthier sleeping habits into your lifestyle.
Sleep Deprivation and Anxiety
People who tend to worry too much by nature are logically more prone to anxiety disorders. However, the same people will suffer most from the effects of sleep deprivation. Anxiety causes sleep loss, and lack of sleep can provoke further worried thoughts in patients. This mechanism is also known as anticipatory anxiety. People who are prone to sleep deprivation may worry about not being able to sleep, based on their past experience. The worries stress out the body and the brain and act as a stimulant that prevents our mind from shutting down and preparing for slumber. Before learning how to sleep better with anxiety, let’s take a closer look at some of the most common anxiety disorders.
Generalized Anxiety Disorder
GAD manifests as free-floating anxiety or exaggerated worrying without any particular reason. The worry persists no matter what the affected person does, and it typically lasts at least six months. If a person has an object of concern, he or she is obsessed with the potential consequences worst case scenarios. Other symptoms include restlessness, difficulty concentrating, difficulty making decisions, continually changing your mind.
50% of patients with anxiety also have a sleep disorder. Common effects of GAD on sleep are difficulties falling and staying asleep, waking up too early in the morning or waking up to panic attacks. Those panic attacks are characterized by intense anxiety, increased heart rate, shortness of breath, sweating or chills and irrational fears.
When it comes to treatment, physicians recommend psychotherapy and drugs. CBT or mindfulness therapy helps patients to learn how to distract themselves or detach from negative thoughts, while drugs like antidepressants increase the activity of mood balance hormones and neurotransmitters such as serotonin, dopamine, and norepinephrine. For acute attacks, tranquilizers (benzodiazepines) such as Xanax and Ativan may be recommended.
Social Anxiety Disorder
SAD is characterized by a fear of being judged, negatively evaluated, or rejected in a social or performance situation. A socially anxious individual fears acting in some way that may be embarrassing in a social situation. People who suffer from this disorder avoid social activities and may experience panic or anxiety attacks in public. The affected individual recognizes that the fear is excessive and irrational. A person can be diagnosed with SAD when social anxiety affects the person’s normal routine and relationships, and when it lasts for at least six months.
When it comes to treatment, physicians also recommend psychotherapy and medications. Cognitive behavioral therapy helps patients to prepare for social situations that challenge them. Talk therapy is usually equally or even more effective than drugs. Antidepressants help with mood management, while benzodiazepines like Xanax and Ativan may be used to prevent panic attacks. In case the person needs to alleviate physical symptoms such as elevated heart rate and blood pressure, excessive sweating, and shaking voice, beta-blockers (that block adrenaline) may be recommended.
OCD is characterized by a chronic pattern of unwanted, irrational, and repetitive thoughts that drive people to repetitive behaviors, also known as compulsions. According to studies, more than 2 million Americans struggle with OCD. Obsessive-compulsive disorder may coexist with eating disorders and depression.
Common symptoms include fear of germs or uncleanliness, unwanted aggressive thoughts, unwanted taboo thoughts or preoccupation with order, symmetry, or counting things. Symptoms of compulsions also include various rituals, such as obsessive cleaning, organizing and arranging things in exact ways, repeatedly checking on various things (for example, if the doors are locked or if the iron is off when leaving the house), and frequent counting. People with obsessive-compulsive disorder don’t necessarily have sleep issues, but some reported struggling to fall asleep at night due to the inability to control their thoughts.
OCD-afflicted persons recognize that their behavior is irrational. The rituals and compulsive behavior provides relief from anxiety, but not with pleasure. If you love to collect things and take pleasure in organizing them, you don’t have OCD.
When it comes to treatment, CBT has shown excellent results, especially a type of CBT-ERP therapy called Exposure and Response Prevention Therapy. The treatment consists of exposing the patient to the situation that triggers OCD behaviors and helping them how to refrain from compulsive behaviors. Antidepressants are also considered effective.
Phobias are characterized by intense and irrational feel regarding an object, place or situation. The fear can be paralyzing and may cause discomfort, anticipatory anxiety, and panic attacks. The affected person also typically avoids his or her triggers. Most common phobias include acrophobia (fear of heights), arachnophobia (fear of spiders), ophidiophobia (fear of snakes), agoraphobia (fear of open spaces often experienced by people with social anxiety), and claustrophobia (fear of small spaces).
All phobias can also be divided into three categories – agoraphobia, social phobias, and specific phobias. Specific phobias affect almost 20 million of US citizens.
Although rarely, some people can suffer from somniphobia and hypnophobia which is the irrational fear of sleep. These patients are advised to practice healthy sleep hygiene, challenge negative thoughts and feelings, meditate, and practice relaxing deep breathing exercises.
Diagnosing phobias is not always easy, because sometimes it’s difficult to differentiate them from other disorders with fears of objects or situations such as OCD, schizophrenia, and paranoia. For example, paranoia causes avoidance, much like in case of social phobias. However, the difference is that paranoid people believe other individuals have ill intentions and want to hurt them. Similarly, in schizophrenia are present different types of hallucinations. People suffering from paranoia or schizophrenia don’t realize they have a mental illness and rationalize their fears. The phobic knows his fear is irrational, but he or she cannot control it. Unlike people living with OCD, phobias do not obsess on them or act compulsively.
When it comes to treatment, CBT-ERP, progressive relaxation, hypnotherapy, and counter-conditioning have been proven to be effective. Rarely, medications such as sedatives may be used in situations that trigger the phobia. For example, if a person is air traveling and has a fear of heights. Beta blockers may be recommended to help with increased heart rate, sweating, and shaking voice.
Post-Traumatic Stress Disorder (PTSD)
PTSD develops as a result of a shocking, terrifying, or dangerous event or series of events. People affected by this condition have troubles recovering from trauma and often re-experience the shocking event over and over. Each time they remember the trauma, they feel very stressed and frightened. More than seven millions of Americans suffer from PTSD. This disorder is common among war veterans and people exposed to mass violence. Rape is also one of the biggest causes of PTSD.
Common symptoms include recurring memories, flashbacks, and nightmares. Certain triggers provoke reliving the trauma, and once the patient identifies the triggers, he or she will avoid entering situations that remind them of trauma. People suffering from PTSD often experience negative changes in thinking and mood, and frequently change their emotional reactions (emotional numbness, hopelessness, angry outbursts, self-destructive behaviors, suicidal thoughts, guilt or shame). People with PTSD often have trouble with insomnia or develop a sleep phobia due to nightmares.
PTSD is in most cases easily diagnosed. The patients typically report the symptoms in conjunction with the history of having experienced or witnessed a traumatizing event such as death, serious injury, or sexual abuse. When it comes to treatment, talk therapy and medications have been proven to be effective. Exposure therapy, reprocessing (EMDR), group therapy, and family therapy is the most effective. When it comes to drugs, doctors may recommend SSRI antidepressants and tranquilizers. Prazosin (Minipress) is a drug often used to decrease nightmares and reduce daytime symptoms of PTSD.
Panic disorder is a mental illness characterized by severe anxiety and panic attacks. When attacks occur, the person also experiences physical symptoms such as chest pain, shortness of breath, dizziness, or abdominal distress, elevated blood pressure, increased heart rate, heart palpations and similar. Although some of these symptoms seem scary, they are not life-threatening and occur as a physical and hormonal response to severe stress. The person experiencing these symptoms often believes he or she has a heart attack and may think he or she is going to die. The attacks occur suddenly and typically last at least 10 minutes. People with panic disorders may experience several attacks per day or only several per year. Around 2.7% of US population (or 6 million people) suffers from panic disorder.
Panic attacks can also occur during the night, and wake up the affected person. At least 50% of people with panic disorder occasionally experience nocturnal panic attacks. As the daytime attacks, the nocturnal ones cause the same symptoms and don’t have a specific trigger.
Panic disorders are not easily diagnosed and can be often confused with paranoia, hysteria, and hypochondria. Panic disorder is diagnosed when panic attacks do not result from substance use (intoxication or withdrawal), other medical conditions, or another mental disorder. The condition often coexists with agoraphobia or fear of open space. When the disorder is diagnosed with agoraphobia, it means patients avoid ordinary activities or situations because they worry about having panic attacks.
When it comes to treatment, cognitive behavioral therapy can help to identify the triggers and restructure them in a way to respond differently. The therapy can focus on desensitization of physical symptoms the individual with a panic attack experiences. CBT-ERP can help patients gain control of the panic attack. In most cases, physicians use vivo exposure technique where the threatening situation is broken into tiny manageable steps, and the patient learn to take control of each one.
Tips for Sleeping with Anxiety
As mentioned in the beginning, people with anxiety also often suffer from sleep deprivation. Lack of sleep makes anxiety disorders even worse, which as a consequence, further prevent a good night’s rest. On the flip side, quality sleep can alleviate the symptoms of anxiety, stabilize mood, and improve cognitive functioning which further helps to promote rational thinking we need to put fears, worries, and concerns in context. If you suffer from anxiety, the following tips will help you sleep better.
- Create a sleeping schedule: Regardless of other obligations, go to bed and wake up at the same time every day, even on weekends. Sticking to a specific sleep schedule will help your brain associate a particular time of the day with sleeping or waking up.
- Create a bedtime routine: A bedtime routine is not only beneficial for kids, but also to adults. For example, before going to bed, take a hot bath, disconnect from social media, and read a relaxing book. Do this in the same exact order every evening. The bedtime routine should be simple and shouldn’t last longer than half an hour or 45 minutes.
- Limit caffeine intake: Avoid coffee and caffeinated beverages several hours before bedtime
- Limit napping: If you need to nap, limit naps to 20 minutes
- Avoid exercising close to bedtime: Exercising before bed usually doesn’t negatively affect sleep, but since you are already having troubles to calm the mind in the evening, you don’t need something that will additionally stimulate it.
- Turn your bedroom into a sleep sanctuary: An ideal sleeping environment should be clean, dark, quiet and reasonably cool. This means you should eliminate clutter and distractions such as TV and other electronic devices. The room should always be filled with fresh air and comfortably cool. Lastly, your mattress should provide you proper support and prevent you from sleeping hot.
- Don’t stay in bed for too long: If you cannot fall asleep within 30 minutes, get out of bed and do something else until you feel sleepy.
- Seek help: If you have sleep problems, talk with your doctor and try to identify the cause of the issue.
- Try natural supplements: Valerian and chamomile tea or melatonin supplements may help you to sleep better. However, it is best to consult your doctor before purchasing any of these over-the-counter.
- Try a worry journal: To alleviate anxious thoughts, keep a worry journal on your nightstand, and whenever you are feeling worries, write those thoughts down and release them from your mind.