Sleep and Anxiety

Poor sleep and high anxiety work in tandem to undermine your health and well-being. You don’t need me to tell you that your relentless worrying and uncontrollable anxiety are keeping you awake. Night after night you toss and turn, your mind racing with endless lists of tasks that you have no hope of ever completing, fears about worst possible outcomes, and generalized anxiety about past, current, and future scenarios.

You’re not alone. More than a third of Americans report getting less than their recommended seven to nine hours of sleep, many of them losing sleep to stress and anxiety.

The Connection Between Sleep and Anxiety

Even undiagnosed stress and worry can disrupt your sleep, but if you have a diagnosed anxiety disorder, your chances of having disordered sleep go way up. According to the National Institutes of Health, about half of the 40 million Americans who suffer from a chronic anxiety disorder also report sleep problems at least occasionally. In fact, about 50% to 75% of people diagnosed with Generalized Anxiety Disorder (GAD) also have trouble sleeping.

Other anxiety disorders that can interfere with sleep include:

• Panic disorder, panic attacks, and nocturnal (nighttime) panic attacks
• Social anxiety disorder
• Separation anxiety
• Phobias
• Post-traumatic Stress Disorder (PTSD)

What you may not know is that your lack of sleep contributes to increased anxiety levels, which initiates a vicious cycle that has serious consequences for your physical and mental health.

It goes like this:

You lose sleep (for whatever reason) >> you feel tired and anxious during the day >> your anxiety keeps you from sleeping at night >> you feel tired and anxious during the day > >and so on in an endless, exhausting loop.

That means that simply improving your sleep can go a long way toward reducing or even eliminating your anxiety.

How Your Brain Responds to Sleep Loss

In a recent study, sleep experts Matthew Walker and Eti Ben Simon from the University of Berkeley’s Sleep and Neuroimaging Laboratory found a positive link between sleep deprivation and increased anxiety that they could actually see using MRI.

Brain scans of participants after a night with no sleep showed increased activity in the brain’s “fight-or-flight” control center, putting them in a state of high alert as if they were encountering an imminent threat. At the same time that their brains were activating their fight-or-flight mechanism, the area that helps to regulate emotional responses was almost totally shut down. Without this regulation from the brain’s medial frontal cortex, emotional responses become disproportionate to their provocation.

Participants could feel the difference. They reported a 30% increase in their anxiety levels after a sleepless night as compared to when they enjoyed a full night’s sleep.

Ben Simon concluded that “the more time you spend in non-REM sleep, the less anxious you are in the morning.”  Since this new research shows that sleep deprivation can lead to increased anxiety and increased risk of depression, sleep disorders and lifestyle choices that prevent you from getting the sleep you need can have a devastating effect not just on your physical health but your mental health as well.

Some Causes of Sleep Loss and Its Consequences

It’s no mystery why so many Americans are chronically sleep deprived. Career and educational ambitions, addictions to digital devices, substance abuse, medications, and medical conditions can all cause sleep problems. But some people suffer from actual sleep disorders that make falling asleep and staying asleep challenging if not impossible.

Some sleep disorders that can lead to sleep deprivation include:

• Obstructive Sleep Apnea, the most common sleep disorder
• Advanced Sleep Phase Disorder (ASPD) and Delayed Sleep Phase Disorder (DSPD)
• Parasomnias like exploding head syndrome, REM sleep behavior disorder, and night terrors
• Shift Work Sleep Disorder
• Restless Leg Syndrome

Crankiness and fatigue may be the most obvious consequences of sleep loss, but they are certainly not the most serious. You may think you can push through the fatigue and ask forgiveness for your crankiness, but the fact is that sleep loss can lead to automobile accidents, loss of productivity in the workplace, and mental health issues like anxiety and depression.

In addition to increased anxiety levels and risk of depression, sleep deprivation has many serious physical consequences including:

• Heart disease and hypertension that can lead to heart attacks and stroke
• Diabetes
• Obesity
• Immune impairment
• Alcoholism
• Shortened life expectancy

What You Can Do to Break the Cycle of Anxiety and Sleep Loss

If your sleep loss is not due to a diagnosed sleep disorder, committing yourself to improving your sleep should be your first recourse in breaking the cycle of high anxiety and poor sleep. If you suspect or know you have a sleep disorder, consult with your primary care physician who will likely refer you to a sleep specialist. Many sleep disorders like sleep apnea are treatable, allowing you to get the sleep you need and reduce your anxiety levels. 

How to sleep well every night

• Exercise regularly but not before bedtime. Daily morning or afternoon exercise has a host of health benefits including promoting sound sleep and relieving stress. Exercising near bedtime will raise your body temperature and heart rate too much for you to feel drowsy and fall asleep.
• Be consistent with bedtime and wake time. Going to bed and waking up at the same time, even on the weekends, helps to maintain your regular circadian rhythm that controls your sleep.
• Limit light exposure and screen time. Dim your lights an hour before bedtime, and stay away from screens that emit blue light at least an hour before bedtime. Dim lights trigger the production of melatonin, which promotes sleep. Blue light interferes with melatonin production and makes your brain think that it’s daytime. You may think you’re winding down when you check your Instagram feed before you go to bed, but you are inadvertently telling your brain to stay awake.
• Turn down your thermostat. The ideal bedroom temperature is around 67° because your brain and your body need to lower their core temperatures by about 2 degrees in order to initiate sleep.
• Limit caffeine and alcohol. Since the effects of caffeine persist for about 4 to 6 hours, put the brakes on your caffeine intake by mid-afternoon. Alcohol consumption may initially have a relaxing effect, but as it is metabolized, it will disrupt your normal distribution of non-REM sleep and REM sleep making your overall sleep lighter and less restorative. No night caps for the sleep deprived.
• Calm your mind naturally. Meditation, prayer, light stretching, or yoga are excellent ways to slow down your mind and prepare for sleep.
• Make a “to-do” list if your mind is stuck in a downward spiral into the bottomless well of needs that is your life. Prioritize and make a plan for how you will tackle the list. Once you write it all down, you can more easily let it go until morning.
• Don’t lie in bed if you can’t sleep. If getting to sleep or going back to sleep takes longer than 20 minutes or so, get up and go into a different room. With the lights dimmed, do something relaxing like reading a book (a real book with paper pages) or meditating. Go back to bed only when you feel sleepy again.
• Talk to the experts for the help you need. Start with your primary care physician. You may need help from a sleep doctor for help with sleep apnea or other disorders that are disrupting your sleep. Or you may need to address the anxiety and/or depression that is causing you to lose sleep by consulting with a psychiatrist or therapist.

Treatment Options for Anxiety

If improving your sleep has not reduced your anxiety, you may have an anxiety disorder. The good news is that anxiety disorders are treatable.

• Mindfulness, meditation, yoga. Mindfulness exercises are simple tricks you can use throughout your day to stop and allow your brain to unclench its hold on stress. Taking a short walk, steering clear of social media, and journaling are just some of the ways you can power down your brain and take notice of each moment as it passes. Guided meditation apps are easily accessible on your device day or night. Learn a few yoga poses that you can do at home to relieve anxiety.
• Cognitive Behavior Therapy (CBT). This well-established, highly effective, and long-lasting treatment option involves identifying, understanding and modifying thinking and behavior patterns. Patients are actively involved in their treatment through reading about their issues, keeping records between sessions, and practicing skills learned in therapy sessions. Benefits are usually seen in 12 to 16 weeks.
• Medications. Your primary care provider or psychiatrist may prescribe from four major classes of medications that target anxiety disorders.

1. 1. 1. Selective Serotonin Reuptake Inhibitors (SSRIs)
      2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
      3. Benzodiazepines
      4. Tricyclic Antidepressants

• Combination treatments.

Not all fear is a bad thing. Our fear often warns us of a potential threat or that something is not right. That feeling puts us on alert and helps us to avoid, escape, or otherwise cope with threatening situations. But when fear and anxiety begin to affect daily activities like eating and sleeping, or if it has no apparent cause, it’s time to take action.