Sleep Anxiety

Perhaps one of the most common and difficult to treat conditions associated with poor sleep is sleep anxiety.  This occurs when you begin to associate anxious thoughts and feelings with the process of falling asleep.  It can be compounded by a conditioned response whereby you associate your bed with an anxious feeling.  Some of our patients even describe a feeling that they could never imagine falling asleep in their bed because the minute that they lie down, their mind starts racing and they begin to ruminate about how difficult it will be to fall asleep.  The problem here is that the more that you try to fall asleep, the worse things get.  This is often the situation where people will turn to sleeping pills.  This is not recommended, and we spend much of our time in the office trying to wean people from dependence on sleeping pills.  The pills will sedate you and make it seem easier to fall asleep, but they massively disrupt the sleep cycle and nearly always result in very low-quality sleep.  A much better way to get over sleep anxiety is to do 2 things:  First, you need to change your associations with the bedroom environment.  In other words, you need to reassociate your bedroom and your bed itself with positive feelings and create confidence that you will be able to fall asleep.  Second, you need to learn some simple relaxation techniques that will help calm the mind while you are attempting to fall off to sleep.

a.      Re-Wire Your Associations:  If you have associated your bed and bedroom environment with fear and anxiety, you need to undo that.  The bed needs to feel like a cozy nest that is the ideal place for you to fall asleep.  We often tell our patients that they need to feel like that bed is the best place on the planet to fall asleep.  It needs to feel warm (but not too warm!), snug and safe.  If you have gotten into bad habits like watching TV in bed, looking at your iPad or doom scrolling on your mobile phone, you need to stop doing those things.  The bed is to be used for sleep and the only exception is sex.  Finally, you need to avoid getting into bed when you are not tired and then staring at the ceiling hoping for sleep to come.  If you are not sleepy, you should stay out of bed in a chair quietly reading a book or doing some other low key, non-stressful activity.  Then, when you are sleepy, you should slide into your warm, snug nest and drift off to sleep.

b.      Relaxation Techniques:  You will want to go to bed when you feel sleepy and not before.  But if you are overcoming negative associations with your bed, then you may also need a relaxation technique to help you drift off.  Use this simple technique below:

a.      Start by focusing on the rhythmic nature of your breath.

b.      Bring your attention to the slow rise and fall of that breath and start to slow the breathing down and take long deep breaths in and out.

c.       Then bring your attention to the top of your head. 

d.      Scan down from the top of your head to your shoulders, arms, chest, back, stomach, legs and feet.

e.      As you scan from top to bottom, search for areas of tension in your muscles.

f.        If you find tension in any of your muscles, gently release the tension.

g.      Then return your attention to your breath.

h.      Take 5-10 slow deep breaths and then start the scanning process again.

Sleep anxiety has its greatest impact on sleep latency and restlessness.  Record your sleep latency and restlessness scores in your notes.  Then record your Epworth score for the following day as well.  Use the relaxation techniques and the process described above to re-wire your associations to diminish your sleep anxiety.  Do this for not less than 2 weeks to see if you get any improvement.  If you do, incorporate your new associations and your relaxation techniques into your program.