It is really common for me in clinic to work with people who are really struggling with sleep. There are a huge number of things that can affect sleep so in this blog I am going to talk about how anxiety affects sleep and then give you some suggestions as to how you can help yourself if sleep is an issue for you.
This is quite a personal blog for me because I have struggled with sleep throughout most of my life, especially when I have been experiencing mental health problems. Many of the suggestions that I am going to talk about here are things that I still use or have found to be really helpful.
Anxiety is frequently connected to sleeping problems. Excess worry and fear make it harder to fall asleep and stay asleep through the night. Sleep deprivation can then make anxiety worse resulting in a negative cycle involving insomnia and anxiety disorders.
Anxiety is a feeling of worry and unease. It’s normal to experience anxiety occasionally in response to fearful or stressful situations.
In anxiety disorders, this distress becomes excessive. Fears are not proportional to the situation and worrying interferes with everyday life. When these feelings become persistent, occurring most days for a period of six months or more we are then talking about Generalised Anxiety Disorder (GAD).
People with anxiety may feel extremely nervous and on-edge. This can affect their concentration and mood, leading to irritability and restlessness. Their fear or sense of impending doom can feel overwhelming and out-of-control.
Physically, anxiety disorders can provoke tense muscles, rapid breathing and heartbeat, sweating, trembling, gastrointestinal distress, and fatigue.
Serious sleep disturbances, including insomnia, are a common symptom of anxiety disorders. People who are struggling with anxiety often ruminate about their concerns in bed, and this anxiety at night can keep them from falling asleep.
Worrying about falling asleep can itself complicate matters, creating a sleep anxiety that reinforces a person’s sense of dread and preoccupation. These negative thoughts about going to bed, can then create challenges to healthy sleep schedules and routines.
Even after falling asleep, people may wake up with anxiety in the middle of the night. Getting back to bed can be a challenge if their mind again starts racing with worry. This can lead to sleep fragmentation, reducing both the quantity and quality of their sleep.
Connections have been found between anxiety disorders and changes in a person’s sleep cycles. Research indicates that anxiety and pre-sleep rumination may affect rapid eye movement (REM) sleep, which involves the most vivid dreaming. Anxiety may provoke more disturbing dreams and make it more likely that a person will experience sleep disruptions. Nightmares can then cause further fears around going to sleep.
Sleep deprivation can also worsen anxiety disorders, meaning that it is not just a symptom of anxiety but can go on to be a cause of anxiety. Researchers have found that people who are prone to anxiety are especially sensitive to the effects of insufficient sleep, which can provoke symptoms of anxiety.
Lack of sleep is known to affect both mood and mental health, which make the challenges we face with anxiety disorders worse. This means that anxiety and sleep deprivation can be self-reinforcing, so worrying causes poor sleep, leading to greater anxiety and even more sleep difficulties.
This can be a huge challenge as it can be very difficult to control a racing mind in general but even more difficult when you are exhausted too.
In an ideal world, learning to control this is a great idea. You can do this through learning self-hypnosis or using breathing techniques.
My personal favourite self-hypnosis technique is what we call a progressive muscle relaxation where you go from head to toe in your mind, relaxing all of the muscles as you do. Allow yourself to really take your time with this and imagine each muscle becoming completely loose and relaxed. It can also help to notice how comfortable you are as you allow each and every muscle to relax deeply into your bed.
My personal favourite breathing exercise is the balloon exercise. Here you imagine that there is a balloon in your stomach and as you breathe in you imagine the balloon inflating, and as you breathe out it deflates.
If you are too exhausted for these techniques, which is OK by the way and does happen, then I would recommend some from of distraction. Ideally nothing that produces light or anything too engaging, just something that will occupy your mind enough to distract from worrying but won’t keep you up. Things that work for me are podcasts, music, nature sounds and relaxation mp3s. I sometimes buy mp3s from other practitioners, mostly because it is weird listening to my own voice, but my clients get a new one after every session. If you wanted to work on sleep with me then we would build up a bank of mp3s that you can use whenever you wanted.
This is also a common complaint and one that can be very tricky as whatever causes you to feel panicked happened while you were asleep. This makes controlling it or even understanding it very difficult.
From a biological point of view it is thought to be caused by excess levels of cortisol in the body, this is a “stress hormone” that is released by the adrenal glands when we feel threatened. Reducing this stress hormone is a long term solution to resolving this issue so I would recommend seeking help with any ongoing anxiety or stress that you may be experiencing.
More short-term solutions are to deal with the panic episode or panic attack at the time and try and get back to sleep. All of the suggestions above will be helpful in this situation so I would recommend trying those but there are also a couple of other things to be aware of.
Make sure you are aware of thoughts that can creep into your mind that will make the panic situation worse. Clients have told me, and I have experienced, thoughts like:
“I’ve got to be up in a few hours”
“great, now I am going to be tired for work”
“this is going to screw me over for my big meeting tomorrow, or actually later today!”
These thoughts are likely to make anxiety worse in the moment and make it harder for you to get to sleep again.
Alternative thoughts are quite personal but if you can find something that makes sense to you then you can use these thoughts instead to help calm yourself and get back to sleep.
Examples could include:
“I still have a couple of hours to get some more sleep”
“I can be kind to myself tomorrow to help me through the day”
“I am prepared for my meeting and I won’t let lack of sleep get in my way”
As I said though, alternative thoughts are really personal so you will need to find thoughts that work for you and fit with how you think and feel to be truly authentic and beneficial.
Sleep hygiene is a really important part of making sure that you are able to get the best night’s sleep possible. In order to practice good sleep hygiene you need to think about the environment you sleep in as well as your behaviours before you go to bed and your routine or habits around sleeping.
Here are some things you may wish to consider:
By keeping a regular bedtime and alarm time, you are getting your body into the routine of going to sleep. Our bodies love routine and they can adapt to new routines surprisingly quickly. Try and keep to regular hours even on days off as your body will then get comfortable with the idea that at this time, it goes to sleep.
By not keeping a regular sleep schedule you are essentially causing jet lag in your body as it struggles to know when is the right time to feel tired and when is the right time to get up again. The occasional late night wont cause too much of a problem as long as you get back into your routine as quickly as you can.
Your bedroom should be a peaceful place for rest and sleep. Temperature, lighting and noise should be controlled so that your bedroom environment helps you to fall (and stay) asleep. Don’t be afraid to use things like sleeping masks or ear plugs if you need to. Most of the foam ear plugs still let some noise in so you will notice if something happens like a fire alarm still, they just reduce background noise.
It's difficult to get restful sleep on a mattress that's too soft or too hard, or a bed that's too small or old. Consider investing in mattresses and pillows that suit you and be OK with experimenting a little.
Something that I found incredibly helpful was investing in decent cotton bed clothes that allow for better temperature regulation.
The health and mental health benefits of exercise are wide ranging and very well documented, but exercise is also beneficial for helping you sleep well.
Try and engage in exercise that you enjoy and raises your heart rate as this will encourage your body to release endorphins that can be great for calming stress hormones and also lets your body know that it needs to rest and recuperate.
The most common culprits are caffeine and nicotine when it comes to impacting on sleep. Try and reduce your consumption of those to an absolute minimum. I have to say that from a personal point of view, reducing caffeine completely has had a huge impact on my sleep quality.
I know that giving up both nicotine and caffeine can be really hard and, depending on how much you are consuming now, often quite uncomfortable. If you need help with either of those then consider talking to your GP.
Especially before bed!!
This can be tricky, both myself and my husband work late into the evenings and so it can sometimes be the case that we are eating dinner later than would be ideal for sleep.
What has worked for us here is to have lighter meals on the days we will be eating late and have a larger lunch to make up any calorie requirements.
Alcohol is another common culprit that, in an ideal world, would be kept to an absolute minimum for the best sleep. Often people use alcohol to get to sleep, especially if they are dealing with stress. Unfortunately alcohol also disrupts how well we regulate our body temperature and our hydration levels, even in small doses and so it can cause us to wake up frequently instead.
As it is often used to help us get to sleep, I would suggest looking back at my suggestions for how to get to sleep if your mind is racing.
Bright lights can hinder the production of melatonin which is a hormone our body produces to help us sleep. Consider using lamps instead of bright overhead lights in the evenings and in the summer thing about drawing blinds and curtains and hour or so before you go to sleep. It can also be useful to install night lights in places like the bathroom so that when you brush your teeth before bed, you aren’t doing it in a bright white room.
This also covers electronics too, consider using night mode on phones and turning down the brightness on the TV. If it fits with you and your lifestyle, maybe consider which electronics you could do without in the hour or so before bed.
The key thing with all advice is to find what works for you, your lifestyle and your family. I have never been a fan of the word “should” and I think it is perfectly OK for different people to have different needs with their anxiety and their sleep.
All I can suggest is that you get really curious and experimental about what might work for you and build a routine that fits with your unique set of circumstances and pressures.
The way we think has a huge impact on our mental health. If you are looking to overcome your anxiety or just improve your mental health then first you need to know what thoughts are making things worse.
This download gives you a list of the most common ways we think negatively. All you need to do is see which ones you do most.
Also, keep an eye on your emails! I will be sending you a really useful video that goes with this exercise.