Anxiety and Sleep

Things you should know:

• If you are a "worrier", you are at greater risk of having insomnia.
• Worrying about your sleep can make it worse. This may create a vicious cycle of poor sleep and worrying.
• Worrying may disturb your sleep even you if you are not an anxious person.
• If you have a regular pattern of poor sleep and feeling tired during the day, you may feel less sure of your ability to ever sleep well again.
• Insomnia that began in a time of high stress might not go away, even after the stress has been dealt with.
• To treat insomnia, one of the main things you should focus on is being more relaxed and drowsier before going to bed.
• Using alcohol for relaxation may lead to worse sleep. It is a popular myth that alcohol improves sleep.

How do I stop feeling anxious about my sleep?

It is important to understand that waking up at night is normal. Everyone does it to a greater or lesser extent. Some people remember waking up and may worry about it. Others do not remember waking up. Worrying about sleep usually makes the sleep worse. Do not think “I won’t be able to function tomorrow unless I get back to sleep”. Instead try: “I’ve been able to function on less sleep before and I will get by OK again tomorrow”. Relaxation exercises before going to bed may help. If sleep anxiety continues, a doctor should be consulted. A referral to a specialist sleep psychologist may also be needed.

I haven’t slept well for years but don’t think I have anxiety.

You do not need to have general anxiety for an overactive mind to get in the way of a good night's sleep. It is true that some people do not sleep well due to stress in their lives. But others have mostly stress-free lives, except that they worry about their sleep. By itself, this can disrupt the quality of sleep. You must aim to lower overall levels of worry or ‘stress’. Being fit and having a healthy diet also play a part in how well you sleep.

Can alcohol help with sleep? Should I give up caffeine altogether?

Caffeine and alcohol can be bad for sleep. It is important to only have caffeine and alcohol in moderation. This will result in better sleep quality. Caffeine should be avoided for at least 3 to 7 hours before going to bed. Using alcohol to relax and de-stress before going to bed will not help your sleep. It may help to get you off to sleep but will interrupt your sleep during the night. Too much caffeine will make you too alert to sleep well.

Can medication help make me worry less about sleep?

Medicines (e.g., sleeping tablets or anti-anxiety drugs) will not always work. Their effectiveness decreases with time, and they can be habit forming which makes it difficult to stop taking them. The best way to lower anxiety about sleep is to try to alter how you think about sleep. For instance, you can learn new ways of dealing with being awake or with being nervous about the night falling. There are many methods to learn new ways to think about your sleep, or lack of it. These include Cognitive Behavioural Therapy (CBT) and Mindfulness. These have been proven to be effective.

What can be done about a mind that doesn’t seem to shut down?

“I’m not worrying, just thinking a lot, often about mundane things.”‍

There are many things you can try if your mind seems overactive e.g., CBT for insomnia and Mindfulness. If you learn to notice when your mind is racing you can use methods to relax and aim not to feel too alert or worried. These can work across the whole day. Most importantly, don’t do the thinking or worrying in bed. Many people find that setting aside a ‘worry time’ during the day is helpful. Choose a time during the day when you are usually free and do your worrying, thinking and planning at that time. Bed is for sleep, so if you are not asleep or likely to fall asleep, it’s not where you should be. Aim to gently let go of the thoughts and not let them distract you. This is just like people living next to railway lines learn to not notice the train noise after a while. It takes time and practice but can be done.

Can some people suffer from anxiety but sleep well?

Yes. If you suffer from anxiety, it does not mean you won’t sleep well. Very anxious people can still sleep well and not feel too tired or sleepy. But if the person with anxiety starts to sleep poorly, this will make them feel tired. They can then start to worry about lost sleep. This can set up a vicious cycle resulting in chronic sleep problems.

I am having problems with my sleep. What should I do?

Talk to your GP. There are also sleep specialists that can help. There are psychologists who are trained to help people sleep better. They can explain to you about the mental factors involved. In the meantime:

• Do not try too hard to sleep.
• Let sleep come to you when the timing is right.
• Keep a regular daily routine, when possible, with consistent times for eating, sleeping and doing other things.
• Make sure you can learn or get taught some methods to relax.
• Realise that part of the reason why you don't sleep well might be that you worry about sleep too much.
• Don’t blame every little thing that goes wrong on your poor sleep.
• Do not lie in bed awake for a long time. Give yourself about 20 minutes, then get up and go and sit in a quiet, dark room somewhere, not doing anything, until you feel sleepy again.
• Know that sleeping tablets are not as helpful as you might think.
• Also know that there is a chance that you might actually be getting more sleep than you think you are.
• Make sure you don't have too much alcohol and caffeine.
• See also Sleep Hygiene: Good Sleep Habits.

Where can I find out more?

http://www.cci.health.wa.gov.au/docs/ACF1174.pdf

Review article: Harvey, A. (2011) Sleep and Circadian Functioning: Critical Mechanisms in the Mood Disorders? Annual Review of Clinical Psychology, Vol. 7: 297-319 

Download a PDF of this Fact Sheet

Other useful links:

• Insomnia
• Preventing Chronic Insomnia
• Caffeine, Food, Alcohol, Smoking and Sleep
• Sleep Hygiene: Good Sleep Habits
• Mindfulness and Sleep
• Mental Health and Sleep
• Bushfire Threat and Sleep Health: Coping with Uncertainty and Anxiety
• Depression and Sleep
• Post-Traumatic Stress Disorder (PTSD)
• Cognitive Behavioural Therapy for Insomnia (CBT-I)