FIRST PUBLISHED HERE: https://www.tuck.com/anxiety-guide-sleep/
According to Anxiety and Depression Association of America (ADAA), anxiety is a reaction to stress. Its key markers are feelings of tension, worried thoughts, and physical changes such as elevated blood pressure.
Just like physical pain, in and of itself anxiety is not a bad thing: it signals that something is wrong. Temporary anxiety is normal and can count as healthy, because it draws our attention to causes of stress that might need correcting. But anxiety disorders–the excessive and chronic reactions to stress–are mental illnesses. Anxiety disorders are, in other words, worry that sticks way past its usefulness to us; it does not go away and often gets worse with time. According to National Institute of Mental Health, anxiety disorders–from post-traumatic stress disorder, through obsessive compulsive disorder, to a variety of phobias–are the most common mental disorders experienced by Americans. They affect 40 million adults over 18 in the United States, or 18 percent of the population. Many anxiety disorders negatively affect sleep–and vice versa. Doctors call them comorbid: they go hand-in-hand. In other words, anxiety and sleep are connected via a self-reinforcing feedback loop. Feeling rested has been proved to combat anxiety and feeling less anxious leads to sounder sleep. The converse is also true: insomnia feeds anxiety and anxiety keeps us up at night. According to The Cleveland Clinic, two-thirdsof patients referred to sleep disorders centers have a psychiatric disorder. “Anxiety is an emotion that actually wakes us up,” Dr. Steve Orma, author of Stop Worrying and Go to Sleep: How to Put Insomnia to Bed for Good, told The Huffington Post. “There are all kinds of physical changes happening that ramp you up, which is the exact opposite state of what you need to be in when you’re trying to fall asleep.”
This guide gets at the link between anxiety and sleep and covers several anxiety disorders that interfere with sleep and which can be alleviated with sleep: generalized anxiety disorder (GAD); social anxiety; obsessive-compulsive disorder (OCD); phobias; post-traumatic stress disorder (PTSD); and panic disorder. It offers solutions to the sleep deprived anxiety sufferers, from treatment options, through online forums, tips regarding healthy sleep hygiene and banishing anxious thoughts, to medical associations that can help.
Anxiety and lack of sleep
Anyone who lost a night to insomnia on account of troubling thoughts has been where many chronic anxiety sufferers find themselves all too frequently. According to UC Berkeley researchers, lack of sleep plays a role in ramping up brain regions that trigger excessive worry. Additionally, those who tend to worry too much are more vulnerable to sleep disorders. “These findings help us realize that those people who are anxious by nature are the same people who will suffer the greatest harm from sleep deprivation,” said Matthew Walker, a professor of psychology and neuroscience at UC Berkeley and senior author of the study. Worry about lack of sleep becomes a self-fulfilling prophecy at times. Anxiety causes sleep loss, which in turn can provoke further anxiety in sufferers. The mechanism behind this phenomenon has to do with what researchers call anticipatory anxiety. People prone to sleep deprivation worry that they might not be able to sleep, perhaps based on past experience. That worry fires up the brain’s amygdala and insular cortex, mimicking the neural activity seen in anxiety disorders. And now, indeed, because of the anticipatory anxiety, sleep becomes elusive. Researchers at University of California Berkeley’s Sleep and Neuroimaging Laboratory found that when deprived of sleep, the brain reverts back to more primitive patterns of activity. What this means is that subjects kept awake were less likely to put emotionally-charged information in context. The good news is found in the reverse. Doing the opposite–finding ways to get better sleep–presents us with a tried-and-true solution to alleviate anxiety. “By restoring good quality sleep in people suffering from anxiety, we may be able to help ameliorate their excessive worry and disabling fearful expectations,” says Dr. Allison Harvey, one of the authors of the study published in the Journal of Neuroscience.
Generalized Anxiety Disorder
People living with generalized anxiety disorder (GAD), also known as free-floating anxiety, are prone to an exaggerated sense of worry regarding everyday events. The worry tends to persist no matter the circumstances. According to DSM-5, which is short for the fifth and the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, if the excessive anxiety and worry about events or activities goes on for most days of the week for at least six months, it points to GAD.
- Persistent obsession that is disproportionate to the concerns and the potential consequences of the object of worry
- Inability to set the worry aside and relax
- Difficulty maintaining focus and concentration
- Frequent decision-making paralysis
- Worrying about worst-case scenarios
The persistent chatter of generalized anxiety is a voice that’s difficult to quiet at bedtime. Fifty percentof patients diagnosed with generalized anxiety disorder have sleep disorders. Difficulty falling and staying asleep as well as walking up to panic attacks (sudden awakenings to intense anxiety, heart palpitations, shortness of breath, sweating or chills, and often the irrational fear of impending death) are common effects of GAD on sleep.
Determining that a patient has generalized anxiety disorder can be tricky because it often mimics and coexists with mental health illnesses such as phobias, depression, and PTSD. The persistence of excessive worry and the inability to control it for most days during the period of six months is a key marker of the GAD diagnosis. The absence of a particular trigger or trauma is also a distinguishing marker. For more features used by doctors to diagnose GAD, the questionnaire provided by the ADAA can be of help.
Getting better rest at night can do wonders for the symptoms of free-floating anxiety. Sleep researchers at Harvard have found that consolidated slumber throughout a whole night, in all its stages, helps people learn and make memories while impaired sleep reduces the ability to focus and acquire new information.
In turn, treating the symptoms of GAD can lead to better sleep because an effective treatment diminishes restlessness and helps gain control of worry.
Psychotherapy, such as cognitive behavioral therapy or mindfulness therapy, helps patients learn skills (such as distraction, detachment from negative thoughts, cognitive restructuring, exposure therapy) with which they can learn to abort obsessive worry.
Antidepressants (particularly SSRIs) can help, over time, to influence the activity of neurotransmitters in the brain—serotonin, dopamine, and norepinephrine–by increasing their presence. These neurotransmitters are responsible for maintaining mood balance and helping people put concerns in context. It takes a few weeks of well-tuned and consistent use for antidepressants to render effective results. Tranquilizers known as benzodiazepines–for example, Xanax and Ativan–can in the meantime be used occasionally to prevent acute attacks of anxiety, such as panic attacks.
Some studies have found that, depending on the individual, talk therapy can be as effective as antidepressants.
- The Mayo Clinic discusses treatments available for generalized anxiety
- ADAA offers ways to treat anxiety and depression, which often coexist
- Huffington Post and ADAA feature stories and tips concerning what it’s like to live with GAD
- To find a local, national, or online GAD support group check out the links provided by the ADAA,Anxiety Social Net, Drugs.com,Anxiety Community, or ask a therapist