Trying to sleep with anxiety

Falling Asleep with Anxiety

How Anxiety Affects Sleep

Sleep problems caused by anxiety aren’t limited to people with diagnosed anxiety disorders.

“The spectrum ranges from everyday kind of problems that might make us anxious and affect sleep all the way to people diagnosed with anxiety disorders who are likely to have ongoing problems,” Dr. Neubauer said.

Anxiety can affect sleep at any time, but most commonly causes difficulty in falling asleep. People with higher levels of anxiety may feel anxious all the time and have trouble staying asleep. In general, Neubauer said, the risk for awakening in the night parallels the degree of anxiety.

“People with persistent insomnia also become anxious about sleep,” he said. “The more anxious they are about sleep, that undermines the ability to sleep well, and it becomes a self-fulfilling prophecy.”

In fact, a June 2013 study in the Journal of Neuroscience suggests that sleep deprivation contributes to anxiety by heightening people’s anticipatory and stress-inducing response processes.

Easing Anxiety Improves Sleep

The good news about anxiety and insomnia being so closely related is that, if you help one problem, you also help the other.

For example, Neubauer said, if you have an anxiety disorder, then getting treatment with cognitive therapy, meditation, or medication can have the indirect effect of improving sleep.

“Short of getting treatment for an anxiety disorder,” said Neubauer, “there are ways people can, on their own, sleep better.” For instance:

Practice relaxation techniques. Many approaches, such as nighttime meditation or yoga, can combat anxiety. Neubauer recommends you start by learning new relaxation techniques earlier in the day so you’re not putting too much pressure on yourself before bedtime. Then, once you’re comfortable with it, you can do it later in the day.

Get into a regular sleep routine. Going to bed and getting up at about the same time each day lets the body’s internal circadian clock work better. Getting up at odd hours can undermine that rhythm.

Schedule some idle time before bed. “A common problem is that, when people get into bed, it’s the first time they’ve had to ponder the day,” Neubauer said. Try to sit down and think about the day before you get ready for sleep. Jot down any concerns on a piece of paper if you need to remember tasks for the next day. Don’t use the time before bed to pay bills or other anxiety-inducing activity.

Cut out screen time. “It’s not a great idea to sit in bed with a tablet or screen and then try to fall asleep,” he said, adding that research has shown that the blue light in most electronic screens has the most potential to influence and delay the body’s natural circadian rhythms, making it harder to fall asleep.

Limit alcohol and caffeine. Having a glass of wine to help you get to sleep may be counterproductive. “Sleep after alcohol tends to be lighter, more disrupted, and less refreshing,” Neubauer said. Caffeine also can stay in your system for several hours, so avoid it later in the day if you’re having trouble going to sleep.

Don’t dwell on anxiety or emotional issues that are keeping you from falling asleep. It can be self-reinforcing and put too much pressure on trying to fall asleep. If you’re feeling anxious in bed, get out of bed and do something else, like reading or yoga.

Good sleep hygiene habits, like using your bedroom only for sleep and sex — not work or TV — and sleeping in a cool, dark, and quiet room equipped with some white noise if needed, can make it easier to fall asleep. But, if you still have persistent sleep problems caused by anxiety, talk to your doctor about treatment.

Turn down the noise in your head for a more restful night

As you tuck into bed at night, do the thoughts in your brain refuse to slow down when you turn off the lights? Instead of winding down, it’s a wave of worries about everything from paying your credit card bill on time to an upcoming meeting with your boss. That non-stop chatter about what might occur tomorrow is a sign of anxiety and, for many, it’s a serious roadblock to getting a good night’s sleep.

According to the National Institute of Mental Health, the number of people struggling with anxiety is staggering. Anxiety has become the number one mental health issue in North America, affecting approximately 40 million Americans (18% of adults). Some estimates put this number higher at around 30% since many people with anxiety don’t know they have it or don’t seek treatment.

Simply put, it’s a national epidemic.

When it comes to sleep, anxiety is a key part of a toxic cycle because it makes getting to sleep and staying asleep difficult. What’s more, it becomes a source of worry itself, worsening the original anxiety – a chicken-and-egg problem. Did the anxiety cause poor sleep or did poor sleep cause anxiety? One feeds the other, experts say.

“Insomnia is often co-morbid with anxiety and depression,” explains Elika Kormeili, a Los Angeles-based licensed therapist specializing in online counseling for anxiety and insomnia and founder of the Center for Healthy and Happy Living. “This means they often occur together. It’s hard to tell which comes first, but anxiety makes it harder to sleep and lack of sleep tends to make people more anxious.”

The bad news is that even as you manage to nod off, your anxiety is still active. “While we sleep, our mind is still active and maybe processing information,” she says. “If we don’t take time throughout the day to process information and to unwind, then stress/anxiety can make it difficult to fall asleep or stay asleep.”

Fortunately, there are tried-and-true ways to tame anxiety so you can get quality rest, courtesy of these mind-soothing tips from trusted experts

1. Prep by day for nighttime calm

Kormeili says, “I recommend to all my clients (online and in-office) to take time every day to unwind. Even if you’re really busy – especially if you are really busy – you need to find simple strategies to cope with stress like practicing deep breathing while sitting in traffic.”

2. Practice gratitude for better sleep

Studies have shown the benefits of expressing gratitude, ranging from increased productivity to greater happiness and better sleep. Kormeili often recommends that her clients think of 3 or 4 things they’re grateful for every night. You can, of course, do this as often as you want.

3. Get out of bed if you can’t sleep

Don’t keep staring at the clock, tossing and turning. Abandon ship! As Kormeili says, “Your bed should be used for sleep and sex – not for worry!” She suggests going into another room to do something mundane, like folding laundry or filling up some pages in your adult coloring book.

4. Download your thoughts to allow you to fall asleep

Bedtime can turn into a time when you start to think about all the things you need to do tomorrow, creating a never-ending list of tasks swirling around in your brain. Stop the thought tornado by writing down all the things you’re trying to remember. With them safely recorded, your mind can be more at ease and you can deal with them upon waking.

5. Meditate at bedtime

“Meditation helps people relax, focus, and tune in to their innermost feelings moment-to-moment. This is extremely useful for relaxation and winding down to sleep,” says Dr. Fran Walfish, a Beverly Hills family and relationship psychotherapist and author of The Self-Aware Parent. She cites the example of a stressed-out couple she counseled who began to meditate together for 30 minutes each evening. They not only slept more deeply but also felt closer to one another. Try an app like Buddhify or Headspace for guided meditations.

6. Try a white noise machine to help you fall asleep

A low level of constant noise can be useful for distracting your anxious mind, shifting the focus away from troubling thoughts to the constant noise produced from a white noise machine. A simple fan also does the trick – as does a sleep app on your phone. Just make sure that the volume is quite low – barely audible – to keep sound in the background.

7. Keep a worry journal beside your bed

Anxiety is always about “what ifs” and trying to be prepared by situations that may or may not occur – a kind of fruitless rehearsal for potential problems. It’s not an effective tactic and can compromise our wellbeing over the long term. Keep a notebook by your bed to jot down any worries. The act of recording them can zap their power. Review them in a few days when you can ask yourself, “Did the situations I was so worried about actually happen?” Over time, you may learn that the majority don’t become reality, helping to ease anxiety.

8. Don’t wait for rock bottom before asking for help

If anxiety rears its ugly head on a regular basis and disrupts your sleep, seek support and talk to your doctor (or sleep doctor) about possible solutions. It’s not something you need to just live with or to accept. Sweet dreams are within reach.

Rest well & wake up ready to go!

Better sleep gives rise to better mornings, bringing your goals into focus and dreams within reach. Hungry for more sleep info? Dig into these posts:

  • Reduce stress, sleep better
  • What the experts have to say about overcoming sleep deficit
  • 12 essential life hacks to battle stress & safeguard your sleep

By Angela Epstein

It’s been a long, tiring day and you’re feeling shattered. Finally you crawl into bed, physically exhausted and ready for a good night’s sleep… only to find your mind has other ideas. Instead of drifting off into weightless slumber, your brain fires up, your pulse quickens and your head becomes crowded with endless worries you thought had been parked for the day.

‘Around 80% of people say their worries whirlwind out of control at night,’ says Nicky Lidbetter, chief executive of support group Anxiety UK. ‘With stress, we tend to worry about a specific, tangible problem. But with anxiety, we’re less aware of what we’re worrying about, so our reaction becomes the problem and we start feeling anxious about being anxious.’

And even if we do initially drop off, those worries can still crowd in if we wake up during the night. ‘The classic time to wake up seems to be between 2am and 4am,’ adds Dr Nerina Ramlakhan, author of Fast Asleep, Wide Awake. ‘Suddenly your brain starts to became very active, and problems that may well be solvable during the day become huge worries at night – made worse by the fact you can’t sort them out there and then.’

Here’s what to do when your body says sleep but your mind’s not listening.

1. Sleep by the clock

When it comes to sleep, timing is everything, as Dr Michael Breus reveals in a new ground-breaking book. Our circadian rhythm – also known as the biological clock – affects every aspect of our life, including our ability to sleep well.

The more we understand circadian dyssynchrony – when the biological clock is out of kilter – the better we sleep, so his theory goes. In The Power Of When, Breus offers a programme for getting back in sync with our natural rhythm by making minor changes to our daily routine. This initially involves taking a simple quiz to establish what kind of chronotype we are (Lion, Bear, Dolphin or Wolf). On the basis of which category you fall into, Breus then outlines how to schedule your day for peak productivity and wellbeing by timing when it’s best to do everything – from eating and sleeping to going for a run and even having sex.

Going to bed at the correct bio time means you won’t lie awake feeling wired. Breus advises that Lions (morning-orientated optimists with a medium sleep drive) should go to bed as close to 10pm as possible, Bears (good sleepers who have a high sleep drive) at 11pm, Dolphins (neurotic light sleepers with a low sleep drive) at 11.30pm and Wolves (night-orientated extroverts with a medium sleep drive) at midnight.

MORE: 3 DIET CHANGES THAT CAN DECREASE ANXIETY

2. Wind down, not up

Sleep is a natural physiological process – but you can help it along and avoid additional anxiety by having a set wind-down routine. The goal of this is to relax your body and prime it for sleep. So if you’re going to bed at 10-11pm, set aside 30 minutes to an hour for an identical nightly pre-sleep routine. This may involve things such as taking a shower, washing your face and brushing your teeth, moisturising your face, putting on your PJs and climbing into bed with a book. Psychologist Susanna Halonen says, ‘The more identical you can make every evening, the more you train your body to prepare for sleep and the easier it will be to achieve.’

3. ​Keep a cork in it

‘Alcohol is a stimulant as well as a sedative,’ says Dr Guy Meadows of The Sleep School. ‘While many people use it to fall asleep, it is also metabolised so quickly that it can leave the body craving more.’ So when we drink alcohol close to bedtime, we are more likely to wake up in the early hours, leaving us primed for a night-time anxiety attack. As a rule of thumb, it takes an hour to process one unit of alcohol, so to be on the safe side, have a last glass of wine at 7pm if you intend to go to bed at 10pm.

4. Soak it up

Taking a relaxing bath can help de-clutter the mind. Try a few drops of Boots Therapy Relaxing Bath Essence – this contains lavender, which is a natural sleep aid. There’s an added benefit to bathtime, too: the fall in body temperature we experience when we get out of the bath is a signal for the brain to start producing sleep-inducing melatonin.

MORE: 15 THINGS PEOPLE WITH ANXIETY WANT YOU TO KNOW

5. Breathe and let go

Practising deep breathing can distract your mind from worries, explains Dr Ramlakhan. ‘Breathe in, hold for a few seconds and then breathe out – do this three times. Just follow the breathing as you do it.’ Breathing in this way instantly slows everything down, relaxes the mind and body, and helps channel your energy into the breathing action. The breathing will give way to the tiredness, which will overcome anxiety and help you fall asleep.

6. Junk the caffeine

Avoid caffeine after 2pm, suggests Will Williams. ‘Caffeine is a powerful stimulant, and it takes six hours for our body to recover from a single cup of tea or coffee. If you feel you need a hit of caffeine to get you through the afternoon, then consider learning to meditate to give you more energy throughout the day.’

7. Make your worries real

Write down what’s on your mind at least an hour before bed. By committing thoughts to paper, you control them – they no longer control you and live on paper instead of in your head. Mentally, you can tick them off. Dr Guy Meadows suggests giving each worry a nickname, too, such as The Nag. ‘We can’t help these thoughts coming in, but they’re only a problem when they start to consume us,’ he says. ‘By giving them names, you speed up the process of defusion, so when unpleasant thoughts crop up, you can just acknowledge them – oh, there’s The Nag again – and go back to what you’re doing.’

8. Get moving earlier

Strenuous exercise in the evening may cause your nervous system to be too wired to sleep, says meditation teacher Will Williams. So either restructure your day to exercise in the morning, or use meditation after exercise to calm everything down and bring you back into balance.

MORE: 7 WAYS YOU CAN HELP SOMEONE WITH ANXIETY

9. Set clear goals

Have a clear plan for the next day, says psychologist Susanna Halonen. ‘If you know what priority number one and two are, you’ll spend less time worrying because you know those are the first two things you’ll get done. The more you turn this into a habit, the more you realise that if you plan ahead and prioritise effectively, the more easily you can get the important things done. This will lower your anxiety and help you sleep better.’

10. Curb your cyberenthusiasm

If we’re going to feel worry-free at night, it’s crucially important to have a mental switch-off, says Neil Shah of The Stress Management Society. ‘So have a digital blackout for an hour before bed, unplugging all devices that could stimulate the mind.’ Boots pharmacist Tom Kallis adds that browsing the latest headlines online may feel like light relief, but it actually keeps your brain stimulated. He says, ‘If checking your phone is part of your end-of-day routine, do this at least half an hour before you turn the lights out so you give your eyes and brain a break. Put any electronics out of reach or on airplane mode so you won’t be tempted to pick them up in the night – or if you can, turn them off completely.’

LCD screens emit blue light, which is the same sort as sunlight, so plays havoc with our sleep hormones. ‘Checking Facebook last thing at night is like shining a miniature sun into your eyes,’ says Dr Guy Meadows of The Sleep School. ‘Our body clock gets confused and starts thinking it’s daytime again, so it inhibits the sleep hormone melatonin and releases the waking hormone cortisol.’

11. Leave the room

If you simply can’t get back to sleep because your head is buzzing with worry, don’t look at the clock – you’ll fret even more. ‘Just get out of bed and go into another room for 10 minutes,’ says Dr Ramlakhan. ‘Leaving the environment you feel uncomfortable in breaks the association with worries. But don’t start checking your phone or scrolling through Facebook.

Go into the living room and under a dim light read a few pages of a light-hearted book, or yesterday’s newspaper. When you feel calm, return to your bed and begin some deep breathing again.’ He adds, ‘Turn your pillow over when you get back into bed. It will feel cooler on your face and creates a separation from the last time you were lying there.’

This article was originally published in the December 2016 issue of Good Housekeeping.

MORE: HOW TO COPE WITH ANXIETY IN AN AGE OF TERROR

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To Improve Your Sleep, Try Some of the Following Strategies

Create a comfortable sleep environment. If you want to have a good sleep, it helps to create a comfortable sleep environment. Make sure that you have a supportive mattress and fresh, comfortable bedding. Also, try to ensure that your room is not too hot or cold, minimize noise, and block out light.

Relax. Try doing something to relax your body and mind before going to bed. Try taking a hot bath 90 minutes before you plan to go to bed. Or try a relaxation exercise (see Calm Breathing and Progressive Muscle Relaxation), meditation, or listening to calming music.

Have a snack. Although a heavy meal late in the evening can disrupt sleep, a healthy light snack in the evening can improve sleep. Try eating light cheese and crackers, turkey, or bananas, or drink a warm glass of milk. Avoid heavy, spicy or sugary foods.

Get physical. People who exercise tend to have more restful sleep. Exercising for at least 30 minutes 3 times a week can improve your sleep. So, get moving! Go for a walk or a run. The best time to exercise is in the late afternoon or early evening. Exercising in the morning, while good for you, won’t help with sleep as it is too far off. And exercising less than 2 hours before bedtime can actually interfere with sleep as its too close. Try for something in between.

Set a bedtime routine. Having a bedtime routine cues your body that it’s time to sleep. Establish a set routine that you follow every night. For example, have a hot bath, put on your pajamas, brush your teeth, and then listen to soft music and read on the couch until you start to feel sleepy and then go to bed.

Establish a fixed awakening time. Try waking up at the same time every day (even on weekends) no matter how well or how poorly you have slept. This way your body will begin to get used to a regular sleep rhythm.

Sleep only when sleepy. Don’t force yourself into bed at a particularly time if you’re not feeling sleepy. You’ll only lie awake in bed, frustrated that you can’t sleep.

Just for sleeping. Your bed should be used strictly for sleeping (sex is the only exception). Try to avoid reading, watching television, working, or studying in bed, because these activities keep your mind active, which gets in the way of sleep.

Get out of bed. If you can’t fall asleep after 20 to 30 minutes, get out of bed and do something boring (e.g. read the manual on how to program your clock radio, read the sports section of the newspaper if you’re not a sports fan) or try relaxing (e.g. meditate, listen to calm music, have a warm de-caffeinated drink). When you start to feel sleepy, try going back to bed. This strategy can feel like you are making things worse, but if you stick with it, it can really help.

Don’t worry. Leave your worries about work, school, health, relationships, etc. out of the bedroom. Try scheduling a “worry time” earlier in the evening to deal with your worries. If you wake up in the middle of the night worrying, try writing down your worries and tell yourself that you will address them in the morning.

TIP: Worrying about not sleeping doesn’t help – it just makes it more likely that you won’t sleep. Let go of your belief that you have to get 8 hours of sleep or you can’t function. Stop looking at the clock and stop trying to make yourself fall sleep. It will happen when it happens.

Avoid caffeine. Avoid consuming caffeine at least 4 hours before bedtime. This includes coffee, some teas, soft drinks and chocolate. Caffeine is a stimulant and it can keep you awake.

Avoid alcohol. Although you may think that alcohol will help you fall asleep, it interferes with sleep later in the evening. So, try to avoid consuming alcohol at least 4 hours before bed.

Don’t smoke before bed. Try to avoid smoking at least 4 hours before bedtime as it can interfere with a good night’s sleep.

Skip the nap. Naps can interfere with normal sleep cycles. So, if you’re having trouble sleeping, avoid taking naps. That way, your body will be more tired when it’s bedtime.

Get some natural light. Try to spend some time outdoors or in natural light every day. Getting some sunlight early in the day can be helpful for setting your body’s natural wake and sleep cycle.

Keys to Success

Start small. Making small changes can have a large impact on your sleep. Don’t try to do everything all at once. Instead, pick 1 or 2 strategies and try them consistently. When you’re ready, try adding a new strategy. The goal is to slowly start increasing behaviours that can help you sleep, while reducing the things that are interfering with your sleep.

Be consistent. Pick a strategy and use it consistently. Try to do the same thing every night.

Be patient. These strategies can take time to improve your sleep. In fact, sometimes things can get worse before they get better. Hang in there and stick with it.

Chart your progress. Use the Sleep Diary form below to keep track of the strategies you’re using and your weekly progress.

I Have Anxiety-Related Insomnia—Here Are 6 Surprising Things That Help Me Fall Asleep

This writer is part of Health.com’s contributor network. Learn more about the contributor network and how to join.

If you’re anything like me, you’ve probably read many, manyarticleson how to get a better night’s sleep, and know the classic tips by heart:Avoid caffeine in the afternoon.Turn off all screens an hour or two before bed.Wake up at the same time every morning. These are good suggestions, and I’m sure they work for many people—but as someone who has struggled with anxiety-related insomnia since age 15, they’re often not enough.Over the years, I’ve collected several unconventional strategies that have helped me through my sleepless nights. Here, six tried-and-true ways I quiet my racing mind.

Write out your worries

The number-one thing that keeps me awake at night? My own thoughts.Sometimes they’re anxious thoughts, sometimes they’re negative thoughts, and other times it’s a rapid stream of consciousness that I can’t turn off.When this happens, I force myself to write down every single thing I’m thinking in a physical notebook. Not a computer or phone, but old-fashioned pen and paper.I simply write down any thoughts that come to mind, especially the negative ones. As soon as I put just one to paper, they all seem to come pouring out of me. Don’t hold back; no one has to see what you’re writing.But the result is like draining grease out of a pan. I often marvel at how this simple, five-minute exercise makes me feel instantly sleepy, as if I spent the day taking care of all my problems while running a marathon. I feel lighter, and once I’m in bed, my mind is gloriously quiet.

Put them in a box

If I’m feeling particularly anxious, I go through the extra step of writing down my thoughts and then physically placing the paper into a little box, jar, or container before I go to bed. This might sound silly, but I find that literally putting away my worries at night tricks my brain into settling down. The process reminds me that those problems are for tomorrow morning, and I can take them out and deal with them then.

RELATED: 8 Things That Could Be Keeping You Awake at Night

Force yourself to get out of bed

Many sleep experts will tell you to get up when you can’t sleep, and I think there’s some truth to this.In my experience, lying awake at night for a long time causes my brain to associate my bed with not sleeping, creating even more anxiety. When I can’t fall asleep after 20 minutes of lying in bed, I get up, walk around the house, and do an activity that doesn’t require much brain power. My go-to: coloring in adult coloring books with gel pens. It’s soothing, mindless, and better than lying awake feeling anxious and frustrated.

Try to stay awake

Stay with me here: You know how actively trying to fall asleep can sometimes make falling asleep more difficult? It’s like your brain is determined to do the exact opposite of what you want it to do. When this happens to me, I try to use reverse-psychology on myself by thinking, Stay awake! I open my eyes and think about something interesting or exciting, and tell myself not to fall asleep. And before you know it, I’m out. It might sound strange, but I’m not about to argue with the results.

RELATED: The Best Pillows for Side Sleepers

Sleep upside-down

No, I don’t mean hanging from the ceiling like a bat. During periods of severe, ongoing insomnia, I’ve saved myself by simply putting my pillow at the foot of the bed and sleeping in reverse. Sometimes a small change in perspective is all you need to break that bad association between your bed and not being able to fall asleep.

Have a good cry

Remember that first tip about getting your thoughts out? I find this also works on pent-up emotions.I don’t cry very often and tend to ignore or repress unpleasant feelings, especially when I’m stressed. So when none of my other strategies are working, I’ll think to myself, How long has it been since you’ve cried? Crying is a natural and healthy way of expressing emotion.If you’ve been going through a tough time and can’t sleep, consider whether you need nature’s most effective emotional release. Then, do what you need to do: Listen to a sad song. Watch one of those Sarah McLachlan ASPCA commercials.Cry it out, then sleep like a log.

Bookshelf

3. Short-term treatment with benzodiazepines

3.1.

Health care providers should initially consider non-pharmacological treatment strategies. Empathic listening, reassurance and guidance should always be offered. Additionally, specific psychotherapeutic techniques, such as cognitive-behavioural therapy, are effective measures to reduce anxiety and insomnia, and non specific supportive therapy may initially be offered to patients with uncomplicated generalized anxiety or sleep disorders. Relaxation techniques may additionally be offered.

3.2.

Benzodiazepines are a group of structurally-related compounds that reduce anxiety when given at low doses and induce sleep at higher doses. Clinical guidelines generally recommend to prescribe benzodiazepines to treat anxiety or insomnia that is severe, disabling and causing extreme distress. Health care providers should consider that benzodiazepine use is associated with dependence liability and withdrawal symptoms, and should therefore be used at the lowest effective dose for the shortest period of time (maximum 4 weeks).

3.3.

The use of benzodiazepines is under international control. These agents are internationally regulated by the Convention on Psychotropic Substances, 1971 (United Nations).

3.4.

Health care providers should consider that, in addition to international control, benzodiazepine use may be under national control. Health care providers must therefore comply with national, regional and local regulations.

3.5.

Benzodiazepines can be grouped, according to their elimination half-life, into short/intermediate and long half-life agents. Short/intermediate half-life agents include alprazolam (intermediate), lorazepam (short), oxazepam (short), temazepam (intermediate) and triazolam (ultra-short); long half-life agents include diazepam, chlordiazepoxide, flurazepam and nitrazepam. Benzodiazepines with short elimination half-life are preferred to minimise daytime sedation, but they can cause rebound symptomatology more often than agents with longer elimination half-life.

3.6.

Ultra-short benzodiazepines are generally not recommended due to the possibility of rebound symptomatology.

3.7.

Benzodiazepines hasten sleep onset, decrease nocturnal awakenings, increase total sleeping time, and reduce pathological anxiety, agitation and tension.

3.8.

According to the WHO EML, essential medicine for anxiety and sleep disorders is diazepam. Diazepam is indicated as an example of the class for which there is the best evidence for effectiveness and safety. Thus diazepam represents benzodiazepines.

3.9.

In individuals with insomnia, if short-acting agents such as lorazepam are available, these are generally used when residual sedation is undesirable, if falling asleep is a problem, or, when necessary, in elderly patients. Longer-acting benzodiazepines such as diazepam are indicated when early waking is a problem and possibly when an anxiolytic effect is needed during the day or when some impairment of psychomotor function is acceptable.

3.10.

Health care providers should consider that in recent years non-benzodiazepine hypnotics such as zopiclone and zolpidem have progressively become widely used in individuals with insomnia. However, these agents may be as likely as the benzodiazepines to cause rebound symptoms, dependence and other adverse reactions.

3.11.

In individuals with generalized anxiety disorder health care providers may consider using a benzodiazepine only for a limited course of time. The main objective may be to reduce symptoms enough to allow the patient to engage in treatments based on cognitive-behavioural techniques. A short course (maximum 4 weeks) started at the lowest possible dose for a pre-defined duration of treatment may be used for initial management. Diazepam may be indicated when an anxiolytic effect is needed during the day and an hypnotic effect is required at night.

3.12.

Considering that major depression often complicates anxiety symptoms, health care providers should consider using antidepressants. Some tricyclic antidepressants (imipramine, clomipramine) and selective serotonin reuptake inhibitors have been shown to be effective for treating patients with generalized anxiety alone or in association with depression. Antidepressants may be prescribed at low doses initially, and then treatment may be up-titrated into the normal antidepressant dosage. Treatment response should be assessed after six weeks.

In the pharmacological treatment of insomnia that is severe and disabling a benzodiazepine may be considered only for a short period of time (maximum 4 weeks)

In patients with generalized anxiety, health care providers may prescribe a benzodiazepine to rapidly relieve symptoms, and consider antidepressants when depression is present or when a long-term therapy is needed

Sleep Disorders

Many of us toss and turn or watch the clock when we can’t sleep for a night or two. But for some, a restless night is routine.

More than 40 million Americans suffer from chronic, long-term sleep disorders, and an additional 20 million report sleeping problems occasionally, according to the National Institutes of Health.

Stress and anxiety may cause sleeping problems or make existing problems worse. And having an anxiety disorder exacerbates the problem.

Sleep disorders are characterized by abnormal sleep patterns that interfere with physical, mental, and emotional functioning. Stress or anxiety can cause a serious night without sleep, as do a variety of other problems.

Insomnia is the clinical term for people who have trouble falling asleep, difficulty staying asleep, waking too early in the morning, or waking up feeling unrefreshed.

Other common sleep disorders include sleep apnea (loud snoring caused by an obstructed airway), sleepwalking, and narcolepsy (falling asleep spontaneously). Restless leg syndrome and bruxism (grinding of the teeth while sleeping) are conditions that also may contribute to sleep disorders.

Anxiety Disorder or Sleep Disorder: Which Comes First?

Either one. Anxiety causes sleeping problems, and new research suggests sleep deprivation can cause an anxiety disorder.

Research also shows that some form of sleep disruption is present in nearly all psychiatric disorders. Studies also show that people with chronic insomnia are at high risk of developing an anxiety disorder.

Health Risks

The risks of inadequate sleep extend way beyond tiredness. Sleeplessness can lead to poor performance at work or school, increased risk of injury, and health problems.

In addition to anxiety and mood disorders, those with sleep disorders are risk for heart disease, heart failure, irregular heartbeat, heart attack, high blood pressure, stroke, diabetes, and obesity.

Treatment

If you suspect you have a sleep disorder, visit a primary care physician, mental health professional, or sleep disorders clinic. Treatment options include sleep medicine and cognitive-behavior therapy, which teaches how to identify and modify behaviors that perpetuate sleeping problems.

Treatment options for an anxiety disorder also include cognitive-behavior therapy, as well as relaxation techniques, and medication. Your doctor or therapist may recommend one or a combination of these treatments. Learn more about treatment options.

Reduce Anxiety, Sleep Soundly

To reduce anxiety and stress:

  • Meditate. Focus on your breath — breathe in and out slowly and deeply — and visualize a serene environment such as a deserted beach or grassy hill.
  • Exercise. Regular exercise is good for your physical and mental health. It provides an outlet for frustrations and releases mood-enhancing endorphins. Yoga can be particularly effective at reducing anxiety and stress.
  • Prioritize your to-do list. Spend your time and energy on the tasks that are truly important, and break up large projects into smaller, more easily managed tasks. Delegate when you can.
  • Play music. Soft, calming music can lower your blood pressure and relax your mind and body.
  • Get an adequate amount of sleep. Sleeping recharges your brain and improves your focus, concentration, and mood.
  • Direct stress and anxiety elsewhere. Lend a hand to a relative or neighbor, or volunteer in your community. Helping others will take your mind off of your own anxiety and fears.
  • Talk to someone. Let friends and family know how they can help, and consider seeing a doctor or therapist.

To sleep more soundly:

  • Make getting a good night’s sleep a priority. Block out seven to nine hours for a full night of uninterrupted sleep, and try to wake up at the same time every day, including weekends.
  • Establish a regular, relaxing bedtime routine. Avoid stimulants like coffee, chocolate, and nicotine before going to sleep, and never watch TV, use the computer, or pay bills before going to bed. Read a book, listen to soft music, or meditate instead.
  • Make sure your bedroom is cool, dark, and quiet. Consider using a fan to drown out excess noise, and make sure your mattress and pillows are comfortable.
  • Use your bedroom as a bedroom — not for watching TV or doing work — and get into bed only when you are tired. If you don’t fall asleep within 15 minutes, go to another room and do something relaxing.
  • Regular exercise will help you sleep better, but limit your workouts to mornings and afternoons.
  • Avoid looking at the clock. This can make you anxious in the middle of the night. Turn the clock away from you.
  • Talk to your doctor if you still have problems falling asleep. You may need a prescription or herbal sleep remedy.

Get Help

Find a Therapist who treats anxiety disorders.
Find a sleep disorders clinic.

Find Out More

American Sleep Association
Sleep Apnea
Sleep Disorders Health Center (WebMD)
Can’t Sleep? Sleep Expert Has the Answers
ADAA Member Philip Muskin Discusses Sleep (CBS News)
Sleepdex website

Other Resources

For more information about sleep disorders, BetterHelp has more information on the subject.

Tips for beating anxiety to get a better night’s sleep

Many people with anxiety disorders have trouble sleeping. That’s a problem. Too little sleep affects mood, contributing to irritability and sometimes depression. Vital functions occur during different stages of sleep that leave you feeling rested and energized or help you learn and forge memories. Sleep usually improves when an anxiety disorder is treated. Practicing good “sleep hygiene” helps, too. Here are some steps to take:

  • Go to bed and wake up at the same time every day, even on weekends.
  • Daylight helps set sleep patterns, so try to be outdoors while it’s light out for 30 minutes a day.
  • Exercise regularly (but not too close to bedtime). An afternoon workout is ideal.
  • Keep naps short — less than an hour — and forgo napping after 3 p.m.
  • Avoid caffeine (found in coffee, many teas, chocolate, and many soft drinks), which can take up to eight hours to wear off. You may need to avoid caffeine entirely if you have panic attacks; many people who experience panic attacks are extra-sensitive to caffeine.
  • Review your medications with a doctor to see if you are taking any stimulants, which are a common culprit in keeping people up at night. Sometimes it’s possible to switch medicines.
  • Avoid alcohol, large meals, foods that induce heartburn, and drinking a lot of fluid for several hours before bedtime.
  • If you smoke, quit. Smoking causes many health problems, including compromising sleep in a variety of ways.
  • Keep your bedroom cool, dark, and quiet, without distractions like TV or a computer. Avoid using an electronic device to read in bed; the light from the screen can trick your brain into thinking it is daytime. If your mattress is uncomfortable, replace it.
  • Reading, listening to music, or relaxing before bed with a hot bath or deep breathing can help you get to sleep.
  • If you don’t fall asleep within 20 minutes of turning in (or if you wake up and can’t fall back to sleep in 20 minutes), get out of bed and do something relaxing until you feel sleepy.

For additional tips and strategies for living with anxiety, buy Coping with Anxiety and Stress Disorders, a Special Health Report from Harvard Medical School.

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Create a comfortable sleep environment. If you want to have a good sleep, it helps to create a comfortable sleep environment. Make sure that you have a supportive mattress and fresh, comfortable bedding. Also, try to ensure that your room is not too hot or cold, minimize noise, and block out light.

Relax. Try doing something to relax your body and mind before going to bed. Try taking a hot bath 90 minutes before you plan to go to bed. Or try a relaxation exercise (see Calm Breathing and Progressive Muscle Relaxation), meditation, or listening to calming music.

Have a snack. Although a heavy meal late in the evening can disrupt sleep, a healthy light snack in the evening can improve sleep. Try eating light cheese and crackers, turkey, or bananas, or drink a warm glass of milk. Avoid heavy, spicy or sugary foods.

Get physical. People who exercise tend to have more restful sleep. Exercising for at least 30 minutes 3 times a week can improve your sleep. So, get moving! Go for a walk or a run. The best time to exercise is in the late afternoon or early evening. Exercising in the morning, while good for you, won’t help with sleep as it is too far off. And exercising less than 2 hours before bedtime can actually interfere with sleep as its too close. Try for something in between.

Set a bedtime routine. Having a bedtime routine cues your body that it’s time to sleep. Establish a set routine that you follow every night. For example, have a hot bath, put on your pajamas, brush your teeth, and then listen to soft music and read on the couch until you start to feel sleepy and then go to bed.

Establish a fixed awakening time. Try waking up at the same time every day (even on weekends) no matter how well or how poorly you have slept. This way your body will begin to get used to a regular sleep rhythm.

Sleep only when sleepy. Don’t force yourself into bed at a particularly time if you’re not feeling sleepy. You’ll only lie awake in bed, frustrated that you can’t sleep.

Just for sleeping. Your bed should be used strictly for sleeping (sex is the only exception). Try to avoid reading, watching television, working, or studying in bed, because these activities keep your mind active, which gets in the way of sleep.

Get out of bed. If you can’t fall asleep after 20 to 30 minutes, get out of bed and do something boring (e.g. read the manual on how to program your clock radio, read the sports section of the newspaper if you’re not a sports fan) or try relaxing (e.g. meditate, listen to calm music, have a warm de-caffeinated drink). When you start to feel sleepy, try going back to bed. This strategy can feel like you are making things worse, but if you stick with it, it can really help.

Don’t worry. Leave your worries about work, school, health, relationships, etc. out of the bedroom. Try scheduling a “worry time” earlier in the evening to deal with your worries. If you wake up in the middle of the night worrying, try writing down your worries and tell yourself that you will address them in the morning.

TIP: Worrying about not sleeping doesn’t help – it just makes it more likely that you won’t sleep. Let go of your belief that you have to get 8 hours of sleep or you can’t function. Stop looking at the clock and stop trying to make yourself fall sleep. It will happen when it happens.

Avoid caffeine. Avoid consuming caffeine at least 4 hours before bedtime. This includes coffee, some teas, soft drinks and chocolate. Caffeine is a stimulant and it can keep you awake.

Avoid alcohol. Although you may think that alcohol will help you fall asleep, it interferes with sleep later in the evening. So, try to avoid consuming alcohol at least 4 hours before bed.

Don’t smoke before bed. Try to avoid smoking at least 4 hours before bedtime as it can interfere with a good night’s sleep.

Skip the nap. Naps can interfere with normal sleep cycles. So, if you’re having trouble sleeping, avoid taking naps. That way, your body will be more tired when it’s bedtime.

Get some natural light. Try to spend some time outdoors or in natural light every day. Getting some sunlight early in the day can be helpful for setting your body’s natural wake and sleep cycle.

Start small. Making small changes can have a large impact on your sleep. Don’t try to do everything all at once. Instead, pick 1 or 2 strategies and try them consistently. When you’re ready, try adding a new strategy. The goal is to slowly start increasing behaviours that can help you sleep, while reducing the things that are interfering with your sleep.

Be consistent. Pick a strategy and use it consistently. Try to do the same thing every night.

Be patient. These strategies can take time to improve your sleep. In fact, sometimes things can get worse before they get better. Hang in there and stick with it.

Chart your progress. Use the Sleep Diary form below to keep track of the strategies you’re using and your weekly progress.

No matter how tired you are, sleep anxiety can prevent you from falling asleep and getting the valuable shut-eye you need to be happy and full of beans in the morning.

The more your mind races the more restless and agitated you feel, as the monkey mind spins thought trail after trail of random worries, predictions, fears and contemplations about all manner of things.

Before long, you inherit the added worry of worrying how late it’s getting and how tired you’ll feel in the morning.

It’s annoying, frustrating and makes you feel groggy the next day.

Not only do you end up physically exhausted the following day, but also mentally out of steam having wasted your resources on those unnecessary but uncontrollable nighttime demons in your head.

But worry not, because a natural solution is at hand…

We already know that using the breath to still the mind is a common practice in meditation, but few people know that it’s also used medically to calm a person having an anxiety attack.

I was actually told this by a guy who had been rushed to hospital once while having an attack. He said the nurse who treated him used this technique to bring his heart rate down and enable him to catch regain control.

The technique is to breath in deeply and hold for a count of 6, and then breath out again, slowly.

The NHS (National Health Service) in the UK actually recommends the following:

  • Fill up the whole of your lungs with air, without forcing. Imagine you’re filling up a bottle, so that your lungs fill from the bottom.
  • Breathe in through your nose and out through your mouth.
  • Breathe in slowly and regularly counting from one to five (don’t worry if you can’t reach five at first).
  • Then let the breath escape slowly, counting from one to five.

So that’s 5 and not 6, but very similar to what I was taught.

Breathing in this way instantly begins to slow everything down and relax the mind and body in synchronisation.

And so a few years ago I began using this simple technique when my mind wouldn’t stop racing in bed at night.

Instead of getting caught in that cycle of tossing and turning, I would simply lay on my back and deep breathe in this way until I woke up having no recollection of when I’d dropped off.

Of course, the duration which it takes to fall asleep varies depending on how anxious/worried you are about the day ahead or whatever problems you may be dealing with at the time, but this really does work and goes to show again just how powerful the breath is.

And it’s no surprise really, considering it is our life force, the supporting mechanism that keeps us finely straddled between life and death.

So try it…slowly breathe in and hold for 5 or 6 seconds, and then release slowly until your lungs are deflated. Focus intently on what you are doing. Feel the breath come in and out of your body and channel your focus on that action.

What you’ll quickly feel is that it actually takes quite some effort and concentration to do, especially because your body is already tired – it’s just your mind that won’t settle – and I think this is why it is so effective.

To really focus on breathing in this way takes your mind off the swirling thoughts and channels your energy into the breathing action, which helps the tiredness overcome the anxiety and ultimately helps you fall asleep.

This isn’t just useful for bouts of sleep anxiety but for anytime when you need to calm down and recenter quickly.

One last little tip. If this doesn’t help first time, or you are still awake after 15 minutes of trying, get out of bed and go into another room for 10 minutes. The reason for this is that leaving the environment you feel uncomfortable in breaks the association; you essentially release yourself and take yourself out of the situation.

Go into the living room or kitchen. Sit quietly, and if you have to put a light on make it a dim one. Do some light stretching exercises or yoga poses, or read a few pages of a light-hearted book or magazine.

When you feel calm, return to your bed and begin your breathing again.

What to Do When Worrying Keeps You Awake

Insomnia can become a vicious self-perpetuating cycle. The more tormented sleepless nights you have, the more you come to dread going to bed, and the harder falling asleep becomes. How are you supposed to slip into a calm, blissful slumber when you’re anxious about not sleeping—or about anything else, for that matter?

“Whenever someone is experiencing anxiety, the sympathetic nervous system responsible for the fight/flight response is activated, and in this state, you can’t sleep,” says neuropsychologist Amy Serin, co-founder and chief science officer of The TouchPoint Solution, a healthcare tech company. “This is why many people lay in bed night after night with racing thoughts going through their minds, watching the clock time progress.” They know they are desperate for sleep, they truly want to sleep, but it’s just not happening. But sleep requires calm and, unfortunately, trying to outwit anxiety by the many so-called sleep solutions—positive thinking, essential oils, counting backward—isn’t always effective, Serin tells me, because the brain just won’t shut off the stress switch.

The cruel thing is, the more you worry, the less you sleep—and the less you sleep, the more you worry. “Insomnia can be one of the most devastating outcomes of anxiety, seeing that a lack of restful sleep contributes directly to an increase in anxiety as well as other mood disturbances,” says Marissa Long, a Southern California-based clinical psychologist. “Fortunately, an effective combination of practices, behavioral changes, and at times medication or other physiological support can get the body back on track for most.”

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We asked experts how to push away those anxiety-inducing thoughts that have a way of becoming self-fulfilling prophecies.

Do a “brain dump” before bed.

Jotting down all your worries will get them out of your head so that they won’t interrupt your sleep, Long says. She suggests spending five minutes before bed writing down every thought that’s been eating away at you. You can also underline or circle the items you need to worry about the next day so your brain won’t feel the need to remind you of them while you’re trying to turn it off.

Don’t keep checking the time.

If your issue is worrying about lack of sleep, don’t even let your mind go there. Helen Odessky, a Chicago-based psychologist and author of Stop Anxiety From Stopping You, suggests reducing stress over how disgruntled you’ll be the next morning by removing all clocks from sight and turning your cell phone face down (which you should be doing anyway so that the light doesn’t wake you up).

Leave the room if you can’t sleep.

It might seem counterintuitive, but there comes a point where trying to sleep actually hurts your chances of sleeping. “The longer you lie in bed, trying unsuccessfully to sleep, the greater anxiety you will feel,” says Kimberly Fenn, associate professor of psychology at Michigan State University. “Furthermore, this has compounding effects because the next time you go to sleep, you will be reminded of the stressful situation you had the prior night.” So by staying in bed, what you’re essentially doing is creating an association between your bed and anxiety. Once you’ve made 20 minutes of futile effort, Fenn recommends leaving the room and doing something else until you feel like you can sleep.

Don’t climb into bed unless you’re actually ready to sleep.

For the same reason, you’ll want to avoid getting into bed before you actually have a good shot at sleeping, Fenn says. Going to bed early will probably just mean more hours of inner turmoil, since your body gets used to falling asleep and waking up at specific times. If you wake up early one day and can’t make it until your usual bedtime, Fenn recommends going to bed half an hour early at most. The more tired you can get, the greater your chances of falling asleep, and the more you’ll come to associate your bed with sleeping instead of worrying.

Try a meditation app.

Establishing a relaxing nighttime routine will cue your brain to go to sleep whenever that routine takes place, Fenn says. You could try one of the usual things like taking a bath and reading a book, but Odessky recommends enlisting the help of a meditation app with guided relaxation exercises like Calm or Headspace. “Meditation works by activating the body’s parasympathetic nervous system, our built-in calming mechanism,” she explains. “When we are stressed, our bodies produce cortisol, which suppresses melatonin production. Melatonin helps us go to sleep. Meditation, therefore, can help us relax so that our natural sleep can happen.”

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ADHD-Fueled Anxiety Is Keeping Me Up at Night

Waking up in the middle of the night is so frustrating! You know you need to sleep. You want to sleep. But your mind just won’t cooperate.
Here are some things you can do to prevent these R.E.M.-busting awakenings:

  • Address the source of any anxieties that are likely to come up. Try to make peace with unresolved issues before bedtime. Either hash them out with someone, or write in your journal.
  • Send positive messages to your subconscious before you go to sleep. Think about what you’re grateful, or what’s going well in your life, as you’re falling asleep.
  • Have a Reiki session. The calming effects of Reiki (a form of energy healing) last long after the session is over.
  • Avoid alcohol late in the evening. It might make it easier to get to sleep, but it makes it hard to stay asleep. Similarly, avoid caffeine, nicotine and strenuous exercise at night.
  • Keep the room dark. Light inhibits the secretion of melatonin in the brain, which is a hormone that enables the body to stay asleep.
  • Don’t do anything in your bedroom that causes anxiety — no fighting, confrontations, or watching scary movies.
  • Don’t take naps. Napping during the day can throw off your sleep cycle.

Here are some ideas for relaxing your mind if prevention doesn’t do the trick:

  • Reiki self-treatment. This is my personal favorite method for getting back to sleep. Unlike massage, Reiki can just as easily be done on yourself as it can be done by another person. Take a Level 1 Reiki course from your local Reiki Master to learn how to do it.
  • Keep a tablet by your bed. If you find yourself reviewing your To-Do list or rehashing some drama, write it down. That way your subconscious mind knows it’ll be there in the morning and can let go.
  • Don’t fight it. Sometimes lying in bed, insisting that your mind must be calm and you must go to sleep immediately, can be counterproductive. Get up and walk around. Make some warm milk. Look at the stars. Don’t look at the TV or electronics, though — the light can make it harder to sleep. Just stay up long enough to ease the anxiety, and try again.
  • Breathing exercises. Inhale slowly and deeply through your nose. Visualize the fresh, clean air filling your lungs from top to bottom. Feel your stomach rise as you do so. Then exhale slowly, picturing the tension escaping with the stale air. “In with the butterflies, out with the bees!”
  • Progressive muscle relaxation. Tense the muscles in your face for five seconds, then relax for ten seconds. Then tense the muscles in your neck and throat for five seconds and relax for a count of ten. Continue this pattern with your shoulders, arms, hands, chest, etc., working your way down to your toes.
  • Go to your happy place. Think of a place that makes you feel calm, safe, and at peace. Imagine you’re there. Visualize all the details, really feel the ambience. What do you see? What do you hear? What do you smell? How do you feel?

Everyone experiences sleeplessness from time to time. The ideas presented above should help. But if it’s happening regularly, and nothing works, you might want to look into other causes with the help of a doctor, therapist, or sleep clinic.

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Updated on January 12, 2020

7 Steps to Stop Anxiety before Sleep

If you are anxious all the time or suffer from an anxiety condition, chances are you don’t find it very easy to fall asleep. Relaxing your mind at the end of a full day is challenging at the best of times, but when you also have anxiety to contend with, you may find yourself physically and mentally challenged when trying to convince your body to sleep.

Being anxious during the day is tiring, which makes it all the more important to make sure you don’t have to deal with it at night when your body is trying to recover. This article will cover the causes and effects of pre-sleep anxiety, as well as tips for effectively shutting down your anxiety at the end of the day.

Falling Asleep and Anxiety

The time before you go to sleep is a difficult one for anxiety sufferers. This is because all the worries you have accumulated over the course of the day choose now to float through your mind. Being alone in a dark room doing nothing but lying there with your worries allows you no distractions from them, which often allow them to seem to grow bigger and bigger and spiral out of control.

Causes of Anxiety Before Sleep

Everyone experiences anxiety differently. Those that have anxiety when falling asleep may have that problem for their own unique reason. Some of the causes include:

  • Focus on the Day — For some people, anxiety while falling asleep is caused by over-focusing on the stress caused by anxiety due to events occurring throughout the day. There also may be an anxious focus on what is to come the next day.
  • Feeling Scared or Afraid — Some people feel scared or afraid for no apparent reason, although it may be linked to the dark. Those that have a fear of death or mortality may also have moments where they just feel scared, afraid, or sad in some ways. The act of falling asleep can sometimes feel scary for those with anxiety.
  • Falling — Known as Hypnic Jerks, these muscle sensations that occur in the arms, legs, or whole body can create the sensation of falling or “not breathing”. Often occurring during the first stage of sleep it can cause someone with anxiety to awaken in a panic. That anxiety can sometimes stick around.
  • Rapid Thought Patterns — Those with anxiety tend to have thoughts that keep them awake and are difficult to calm. The longer those thoughts go on, the more anxious they may become.
  • Poor Sleep Cycle — If you have had anxiety or trouble falling asleep for a long time then a pattern of poor sleep may have developed. Anxiety can cause you to not sleep well. Lack of sleep makes your more susceptible to stress. Stress causes anxiety and then anxiety leads to a lack of sleep and possibly insomnia. This cycle may leave you feeling as if you may never sleep, making sleep that much more difficult to attain.

These are only an introduction to the different issues that may cause anxiety when falling asleep. There are a variety of other reasons why a person with anxiety may struggle to fall asleep including something as simple as what you ate or drank before going to bed.

Effects and Symptoms of Nighttime Anxiousness

Anxiousness, when you are trying to get to sleep, causes both mental and physical struggles. See if these descriptions of the types of problems encountered by anxiety sufferers trying to get to sleep match up to your own experiences.

  • Restlessness – You may find yourself tossing and turning as you try and get to sleep because your body refuses to relax, and must continue trying to find a comfortable position. You may find yourself too hot or too cold, the blankets or pillows are uncomfortable, blood circulation isn’t feeling right, and so on. The discomfort keeping you awake will give you more of a chance to think about the negative, anxious thoughts that can keep you up at night.
  • Panic Attacks – A panic attack before sleep may be characterized by sweating, a rapid heart rate, rapid breathing, and chest pain. These symptoms can be alarming because they mimic some of the symptoms of a heart attack, and may trigger the panicked belief that you are about to die (imagining that you are in physical danger or about to die is common during panic attacks). Panic attacks can also awaken you from sleep and then, due to a heightened state of arousal and anxious thoughts, make it difficult to fall back asleep, causing insomnia.
  • Nightmares and Night Terrors – Nightmares and night terrors are two separate experiences however are so common that one out of every two adults experiences them on occasion. Night terrors happen in the first few hours after falling asleep and are not typically associated with dreams but rather with feelings, leaving the person unsure of why they woke up in terror. Nightmares are most often linked to REM sleep and dreams. As night goes on your REM sleep get longer meaning that nightmares typically occur in the early morning hours when REM sleep is at its longest.
  • Falling/Twitching – You may also find that you experience anxiety as a result of weird sensations you get while trying to fall asleep. Those with stress, for example, are more prone to this feeling as though their body is jolting them awake right before they’re about to fall asleep. Scientists are not clear what causes this but know for a fact it’s harmless. Known as hypnic jerks these involuntary muscle sensations occur during the first stage of sleep, when you are in the lightest stage of sleep. You are suddenly jerked awake which can cause anxiety, making it harder to fall asleep in the future.
  • Limited REM – All these effects add up to a very limited REM cycle. Most people get 80% non-REM and 20% REM sleep in a night. REM sleep only occurs after some non-REM sleep has taken place. Therefore, if it takes you a long time to get to sleep or you wake up soon after you do, you don’t have as much time in the night to achieve that REM stage. Regular REM sleep is required to maintain a healthy mind and body.

If you are experiencing any of these symptoms when trying to sleep, you should take the steps outlined below to help you escape the torture of being too anxious to get a good night’s sleep.

How to Minimize Anxiety and Maximize Sleep

To get to sleep more easily, you can try changing some of your pre-sleep habits to decrease your mental and physical stress levels. Habit-changing takes time and persistence, but if you stick to these changes, you will find yourself adapting and feeling less anxious overall in no time.

  • Time Travel – This is a fancy way of saying that at least an hour before you want to get to bed, you should try to turn everything off and do something that engages more of your mind than, for example, gazing at your computer or the television screen. Dimming the lights helps alert your brain to the idea that it should be sleeping soon. Doing something casual that still forces your mind to engage, such as reading, drawing, or playing cards will help occupy your brain with something other than the worries of the day when it is time to lay down your head.
  • Pick a Bedtime – Deciding on a particular hour that you want to be in bed by will relax your body by providing it with a comforting, familiar routine to follow. It will also train your brain to get tired at a certain time of night, which will help you fall asleep sooner after you lay down to do so.
  • Keep a Journal – Writing in a journal is another routine you can follow (and a good one to incorporate into your pre-bedtime time travel, as it doesn’t involve any technology). Sometime before bed, jot down some thoughts about your day. If any worries or problems come up, be sure to write them down with possible solutions to accompany them. Once you do this, shut the book and imagine you are symbolically shutting away all the cares and thoughts from the day until you next want to open the journal and look at them.
  • Consciously Relax Your Body – Once you are lying down in bed, try relaxing your body one piece at a time. Start at your toes, relaxing each toe individually. Then move up to your ankles, your calves, your thighs, and so on. Make sure each part is thoroughly relaxed before moving on to the next. You may start to feel tingly and almost numb. This is good: it means your body is getting ready to sleep. Once you are completely relaxed, focus on breathing comfortably and slowly until you fall asleep.
  • Reserve Your Bed For Sleep – Avoid doing non-bed-related things on your bed: for instance, texting, going online or doing homework. The more you reserve your bed for sleep, the more your mind will associate it with sleep, and the easier it will be to fall asleep on.
  • Get Up and Walk Around – If you find that your anxiety is too strong, don’t keep trying to sleep. Distract yourself for a while by cleaning the house or reading a book. Falling asleep when your anxiety is that strong is very difficult, so giving yourself a distraction and then trying again later may prove helpful.
  • White Noise – Some type of white noise, calming music, or easy to ignore radio may also be helpful. Often these things can distract your senses, making it harder for you to focus on your anxious thoughts. Try something like talk radio, with a volume so low that you can only hear what they’re saying if you try extremely hard. The noise and talking will make it much more difficult to focus on your anxious thoughts.

Avoiding the anxiety that keeps you from getting the sleep you need can be difficult, but following the above all-natural and healthy techniques may be all that you require taking back control over your sleep schedule.

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