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What to Do When Insomnia Makes You Afraid of Sleep

Is anxiety about sleeping keeping you awake at night? Here are 5 expert tips to reduce the stress

Sleep Anxiety
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“I live in fear of going to bed,” says Jenny Verdery, 55. She’s not afraid of the usual suspects like nightmares, critters or prowlers. She’s afraid of what often won’t visit her at night: sleep.

For the past few years, Verdery has frequently awakened in the middle of the night after dozing for two or three hours. Then she can’t fall back to sleep.

“It’s been devastating,” says Verdery, a yoga teacher in Washington, D.C. “It’s definitely kept me from feeling good.”

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Her doctor thinks it might be related to menopause, but that hasn’t been confirmed. Meditation hasn’t helped, nor have yoga and breathing exercises.

About a third of Americans suffer from at least periodic insomnia, according to the American Academy of Sleep Medicine (AASM). In most cases, the sleep issues resolve on their own. But when insomnia lasts for a month or more, it’s considered a chronic condition that affects about 1 in 10 of us. For Verdery and others who sometimes struggle at night, the stress can create a sleep-disrupting cycle: Lying awake night after night creates anxiety about falling asleep, which exacerbates insomnia.

“This is something I see in almost all my patients with insomnia,” says Joshua Tal, a clinical sleep and health psychologist in New York City. Poor sleep is often a reaction to stress, he explains, and then the problem starts to spiral.

“If you have a couple of bad nights, then the first thing that happens is you start to worry, Will I sleep tonight? But if you’re worrying, then your body is going to keep you awake,” he says. “It’s thinking, Where’s the bear? But the bear is sleep itself. And so it becomes self-perpetuating.”

How age can trigger sleep anxiety

Just the simple fact of aging itself can start the wheels of anxiety in motion. “As you get older, you get multiple awakenings throughout the night,” which can lead to the anxiety-insomnia spiral, says Raj Dasgupta, M.D., an AASM fellow and spokesperson.

Age-related reasons for sleep disruptions can include menopausal hormone shifts associated with discomfort or restlessness; prostate issues for men that lead to more frequent trips to the bathroom; pain from chronic conditions, which can be more common in our later years; and certain medications that can cause sleep problems, such as high-blood-pressure meds (including beta-blockers) and antidepressants. Your health provider will also want to rule out apnea, a condition in which breathing stops or is constricted briefly as you sleep.

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Our circadian rhythms also shift as we get older, especially past age 60, when our bodies tend to want to go to bed and wake up earlier; those new bodily rhythms can conflict with our established lifestyles.

Another culprit: caffeine. It can take up to 10 hours to completely clear caffeine from your bloodstream, and half of what you drank in that coffee is often still circulating six hours after consumption, according to the Cleveland Clinic. And we metabolize food more slowly as we age, says Michael Breus, a sleep specialist and clinical psychologist based in Manhattan Beach, California. To make sure caffeine isn’t affecting your sleep, avoid caffeinated drinks after noon, Breus suggests.

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Many of us turn to a glass of wine or beer in the evening for its sedative effect, but alcohol backfires, too, says Jennifer Mundt, assistant professor of neurology at Northwestern University Feinberg School of Medicine.

“While it may help you feel sleepy at first,” she notes, “it will result in poor-quality, disrupted sleep as the alcohol is metabolized.” According to the Sleep Foundation, two drinks for men or one drink for women can decrease sleep quality by 24 percent.

Breaking the cycle of insomnia

The cornerstone treatment for sleep anxiety is cognitive behavioral therapy for insomnia (CBT-I), which addresses a patient’s habits and thought patterns. With the cognitive part of CBT-I, the therapist — one who specializes in sleep — explores your sleep-related anxieties. When clients tell Tal they’re afraid they’ll never sleep well again, for example, he challenges their assumptions and helps them reframe their fears.

“I ask clients, ‘Is it true that, after a bad night, you won’t sleep well the next night?’” Then he points out what science says: “You’re actually more likely to sleep well the next night. But it’s the anxiety that makes it worse.”

Elaine Harris has experienced this phenomenon. A retired French teacher in Chicago, Harris, 86, struggled with sleep for decades. She would often wake up in the middle of the night and grow increasingly anxious, thinking, How am I going to get through the day on four or five hours of sleep?

Last year, Harris started working with Mundt, who begins by asking her patients to keep a sleep log and to record sleeping times. Over a period of seven or eight months, she talked with Harris about her sleep-related anxieties and stressors, while gradually helping her develop a healthy sleep routine — the behavioral part of the CBT-I program.

It sounds counterintuitive, but sleep therapists often improve your sleep by restricting it. The object is to create so much sleep deprivation that you conk out and sleep through the night without awakening. Once you start sleeping for a solid block of time, say midnight to 6 a.m., the next step is to hit the sack earlier, in 15-minute increments, until you reach a schedule where you are tired enough to fall asleep — and stay asleep — but are not exhausted when you wake up, Breus says. (Forget about melatonin supplements: They don’t usually help with sleep anxiety, Tal says.)

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One big thing you can do if you’re anxious about sleep is to simply stop trying. “If you can’t fall asleep within a ballpark of 15 to 20 minutes,” Dasgupta says, “then you should leave the bed and do things that are non-stimulating in dim light, and only come back to bed when you’re ready to sleep.” That helps to strengthen the cues that the bedroom is for sleeping.

Despite some setbacks, Harris now gets about seven hours of sleep a night. She goes to bed at the same time every night, and if she wakes up, she goes to another room to read. This allows her to “get away from the anxious thoughts” associated with her bedroom, she says. She’s also learned not to check the time when she gets up with her book, to avoid triggering her anxiety.

“It’s not always a great night’s sleep,” she notes, “but I’m not nervous about waking up anymore.”

Do-It-yourself ways to address sleep Anxiety

When Elaine Harris underwent CBT-I, Medicare and a supplemental insurance plan covered her treatment. Medicare may cover sleep therapy (it’s typically billed the same as any cognitive behavior therapy), but there’s a catch: Many mental health providers don’t accept Medicare. Private health care plans may cover CBT-I, but it can be tough to find a specialist in-network, and a high deductible can make going out of network too expensive. To find out how much sleep therapy will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several factors. If insurance won’t cover CBT-I, try these strategies:

1. Get a guidebook. Two thorough options for CBT-I guidebooks include End the Insomnia Struggle: A Step-by-Step Guide to Help You Get to Sleep and Stay Asleep, by Colleen Ehrnstrom and Alisha L. Brosse, and The Insomnia Workbook: A Comprehensive Guide to Getting the Sleep You Need, by Stephanie Silberman.

2. Skip the sleeping pills. Sedatives such as benzodiazepines (Xanax, Valium) and Z drugs (Ambien, Lunesta) are meant to be used short-term, Tal says. Benzodiazepines are addictive when used long-term, and improper use of sleeping meds has been associated with more frequent falls, confusion and other complications.

3. Try simple stress-busting tricks. Common steps for reducing sleep anxiety include moving your clock so you can’t check the time, and turning off TVs, computers, cellphones and other devices about 30 minutes before bedtime in order to reduce exposure to blue light (and prevent you from reading stressful headlines).

4. Add weight. In a study of 120 insomnia patients study of 120 insomnia patients with major depression, anxiety or bipolar disorder, those who used a weighted blanket for four weeks reported significantly reduced insomnia. Pressure from the blanket may help lower your heart rate and slow your breathing; the weight also helps reduce tossing and turning.

5. Try online tools. Explore online guides like Path to Better Sleep: A free CBT-for-insomnia program developed by the U.S. Department of Veterans Affairs; or Go! To Sleep: A six-week course from the Cleveland Clinic that uses CBT principles to address anxiety and insomnia ($40).   

 

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