Sleep anxiety is quite literally anxiety about sleep. It takes a few forms, but all have common themes. It could be fear that you won’t be able to sleep, fear that if you wake in the night, the next day will be shot, anxiety that keeps you awake worrying that your sleep isn’t going to be good. It is a self-defeating cycle of horror, with your mind creating a self-fulfilling prophecy of fatigue and sleeplessness. It is a common symptom I hear both within and outside of the MTHFR community.
Where Does Sleep Anxiety Come From?
Sleep anxiety is a sort of monstrous hybrid of anxiety and insomnia, and it can start from either of these places. I have seen clients who have trouble sleeping that then morph into sleep anxiety, and I’ve also seen clients with anxiety or anxiety-related disorders like PTSD that then affects sleep and, like a snake eating its own tail, then turns into anxiety about sleep. The two factors become intertwined, each feeding into the other.
At the end of the day, the underlying issue is that the person experiencing this knows how genuinely terrible it is not sleeping, they understand the consequences of long-term sleep deprivation and are afraid to be stuck in that place. To me, this is a reasonable fear, but ultimately unhelpful, so let’s talk about recognizing sleep anxiety and some tips and tricks to eliminate sleep anxiety for good.
Recognizing Sleep Anxiety
For many people, sleep anxiety arises out of some other issue with sleep. For example, someone who has had months of pain that keeps them awake, wore them down, and made every tiny bit of sleep fragile and precious. One day they realize the pain isn’t really a problem anymore, but sleep is still elusive. Their brain is keeping them awake, fretting about not getting enough sleep to feel well the next day. So where is the line between a sleep disorder caused by something like pain or medication changes, and sleep anxiety? Also, how do you know when you’ve crossed it?
I’m the type of person who processes on paper, so it helps me to write things down in a logical way from the beginning. When did your sleep problem start? What was the issue then? Has that issue resolved or changed? What is keeping you awake now?
I hear lots of people say, “I’m just awake. I just can’t sleep.” If this is the case for you, ask yourself if you have any of these factors that might interfere with sleep:
- Restlessness/muscle tension
- Overactive mind at night (but without anxiety)
- Difficulty breathing
- Thyroid disorders
- Recent medication changes
If any of those things are factors, then the problem might resolve if you’re able to get underneath those issues. The overactive mind at night often comes down to high histamine. As we discussed in season 4 episode ##, activated charcoal after dinner and before bed can help if it’s a histamine issue. This isn’t a long-term strategy, but it can give you an idea about where to start.
Recent medication changes is a much bigger factor than many people realize, and medication changes – especially the big “antis” – antihistamines, antidepressants, antipsychotics, and anti-seizure medications are all notorious for causing sleep weirdness that can linger for months after a dosage change. The sleep symptoms can linger far longer than most people would suspect, and sometimes it can become a pattern that then generates sleep anxiety.
Banishing Sleep Anxiety
Healing sleep anxiety is easier said than done, and sometimes it comes down to psyching yourself out, but here are a few strategies to try.
- Ritualized Sleep Routine – For some people, developing a non-negotiable sleep ritual actually soothes the anxioius mind, because you build confidence that every step in your sleep routine is bringing you closer to actual sleep. It isn’t necessarily what you are doing, particularly, but the faithful and exact doing of it every night that allows your mind to accept the inevitability of sleep. Your ritual should be built by you, of things that make you feel peaceful, safe, relaxed, and nurtured. It will most likely include self-care elements like face washing, hair brushing, night cream, and tooth brushing. Often people include prayer, meditation, breathing exercises, or other elements to quiet their mind. Some people make a list of their worries that they can write down each night so they don’t have to hold them in their head. Others journal, still others listen to relaxing music or light a candle. Whatever you would like to include in your sleep ritual, the most important factor here is the ritualization. Repeating every step in order, ever night with deliberate intent. Your ritual can become your transition time into sleep that helps ward off the anxiety.
- Vigorous Exercise – For most people, exercise is helpful to sleep. Not just doing your dutiful time on the treadmill but truly pushing your body to physical exhaustion can push you to sleep in a way that very few other things can. Physical exhaustion, as opposed to mental, will activate all the internal mechanisms like a system shut-down. Your body needs to repair muscles and tissues, rebuild, and grow stronger, and it needs sleep time to do it. This will often override even the deepest anxiety, creating sleep despite your mind.
- Igore sleep completely – It may sound counterintuitive, especially when I’ve just talked about ritualizing your sleep routine, but for some people putting more focus into the lead-up to sleep actually makes it more difficult. If you’ve been trying for years with sleep hygiene and it is increasing your dread of sleep, tossing it all out the window can be the best thing. Forget what you’re supposed to do and not supposed to do. Stay up as late as you want. If you can’t sleep, get up and watch a movie or binge-watch a series. Don’t try to encourage sleep at all – just keep doing whatever you like, and if you fall asleep in the process, well, that’s fine. For some people heaping more and more attention on sleep makes it more difficult and more stressful. These folks seem to do best when they ignore the whole thing, distract themselves with something else, and let sleep creep in and bowl them over sideways.
- CBT-I – Cognitive Behavioral Therapy – Insomnia is a set of rules and parameters around sleep. It forces you out of laying in bed thinking about sleep by creating limits. If you’re awake for more than 15 minutes, you’re to get up and do something until you feel sleepy again. You’re never just to lay there thinking about it. Many therapists and programs exist to teach this type of sleep re-training, and it is well proven to work.
- Prescription Medications – For a small handful of people with sleep anxiety, benzodiazepines at a low dose at bedtime can work and help to break the cycle of anxiety by inducing sleep well enough to allow you to stop being fearful about not sleeping. This very much depends on the person and the situation, so talk with your doctor about your options.
- Break your mental bad habits – We talked about three techniques in Season 1 Episode 34 to break mental bad habits. Sleep anxiety is pretty much the definition of a mental bad habit, and the three techniques we talked about can work well if you remember to use them.
- Thanks so much for being here today – remember to like and subscribe on youtube or leave a review on your favorite podcast player.
MTHFR is a common genetic mutation that can contribute to anxiety, depression, fatigue, chronic pain, infertility, and more serious conditions like breast implant illness, heart attack, stroke, chronic fatigue syndrome, and some types of cancer. If you know or suspect you have an MTHFR variant, schedule a free 15-minute meet-and-greet appointment with MTHFR expert Dr. Amy today.Book Your Appointment