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  • Writer's pictureAnissa Bell, LMFT

Spotlight On Insomnia: Is the Sleep Anxiety Actually the Problem?

Updated: 25 minutes ago


Sleep Anxiety
Is sleep anxiety the real problem?

Ahh, the pressure to sleep!

Over the last several years there has been more information and education regarding the importance of sleep. We receive a lot of messages that tell us good sleep is necessary to maintain optimal wellbeing. This information highlights the importance of prioritizing sleep, but it has also created more pressure.

 It’s not uncommon for adults to have acute insomnia throughout the life cycle. Acute insomnia is a brief bout with insomnia, and it’s frequently triggered by a stressful life event. Often this will resolve on its own without the need for treatment. But the stress about having the sleep disruption can trigger chronic insomnia.

 

Hi, I’m anxiety and I have lots of ideas!

Sleep anxiety is about fear related to falling asleep and staying asleep. You ruminate all day about your ability to sleep! In turn, it leads to feelings of dread as the hours of the day go by. Sleep anxiety makes you consumed with negative thoughts about what may happen at bedtime.

 

At the core, your anxiety is trying to protect you. Anxiety comes up with a lot of ideas to pile on to your stress about sleep.

 

Something is very wrong with me.

Sleeping is supposed to come naturally so I must be broken.

I am going to get sick if I lose sleep tonight.

I am going to feel awful tomorrow.

I cannot function at work if I do not sleep well.

 

Listen, don’t get mad at your anxiety! It wants to do its job and keep you safe. Sometimes it can also be misguided. We can improve this with a little redirection (more on that later).

  

But I’m an insomniac.

There is a term called insomnia identity, which occurs when one self-labels as an insomniac. Research shows that perception of poor sleep carries more weight than reality. Perceived sleep disruption can pose a health risk, even when you’re getting good sleep. What many people observe as symptoms of insomnia are actually a result of sleep anxiety. Impaired concentration, “brain fog”, irritability, fatigue, muscle tension, and digestive issues are common symptoms of both anxiety and insomnia. Think about this the next time you are feeling rough after a challenging night of sleep. Are you feeling bad because of the sleep issue or are you feeling bad because you are anxious about the sleep issue?

 

Wait, so you mean I am doing this to myself??

You’re not consciously doing this to yourself. It’s not your fault and there are ways to address the issue. One of the worst things you can hear when you have anxiety is “just stop worrying about it”, so I hope that is not your takeaway here. It’s an intuitive response to worry when your slumber is interrupted. It might be hard to hear that you may be suffering from your sleep anxiety as opposed to the actual lack of sleep. Tap into your self-compassion and circle back to the first paragraph…the pressure to sleep!


There is help that you may not know about!

Cognitive Behavioral Therapy for Insomnia (CBT-I) is a clinically recommended treatment program for chronic insomnia. This is a treatment plan specific to insomnia and has different interventions than general Cognitive Behavioral Thearpy (CBT). When the techniques in this protocol are implemented, as many as 70%-80% of patients with primary insomnia experience improvements*. Benefits include less time to fall asleep, more time spent asleep, and waking up less during sleep.  

 

About the “C” in CBT-I…

Cognitive Behavioral Therapy for Insomnia (CBT-I) can help to improve the sleep anxiety-sleep disruption cycle. The cognitive aspect that needs to be addressed are the negative thoughts, feelings, and beliefs we develop about the ability to sleep. There is a loss of sleep confidence! Sleep therapy addresses these worries, providing tools to balance out the negative thoughts that anxiety likes to feed us. Start dialoging with your anxiety to change the relationship with this part of you. Acknowledge the concern that anxiety brings up, but don't automatically accept those negative thoughts as truth. A thought is just a thought, and you can choose what you do with that thought. Try to shift to a place of curiousity, kind of a "let's just see what happens" aproach. Anxiety really likes to look for what may go wrong. After all, that is anxiety's job. The negative thoughts come automatically without any effort required. What does take more effort is to look for what may go right. Be intentional about noticing what is going well. Look for positive outcomes and possibilities to balance out your fears. It is helpful to do daily gratitude observations. This can be done by journaling your observations, making a list of what you are grateful for today, or doing this as a daily check in with a loved one. A gratitude lens really starts to focus on what is going right, in contrast to the anxiety lens that looks at what may go wrong. With gratitude, the idea is to observe things big and small that you are grateful for. Make a point to look for new things each day.

Sleep Anxiety Tips

Tune in to your body. Don't just listen to your brain!

Do your best to NOT calculate how many hours you slept. I know this is really tempting, but most of us attach a certain meaning to the amount of time we slept the night before.


  • I can be ok if I just sleep 7 hours

  • If I sleep only 5 hours tonight, I am not going to be ok at work tomorrow

  • As long as I sleep 6 hours I will be alright. Otherwise, I am going to feel terrible


Wait and see how the day goes. Focus on your experience of how you feel in the morning versus letting the data tell you how you are going to feel. This is why I sometimes caution people about using sleep trackers (watch, ring, etc.). You may feel great in the morning until you look at your sleep data. If the tracker tells you you scored low or did not sleep efficiently, suddenly you feel bad. More on that in another blog! I also discourage people from talking about sleep too much. Dealing with insomnia is really hard so it is totally understandable that we want to talk about it. However, the conversation tends to focus on how much sleep a person gets. "How did you sleep last night?" is the usual question, not "how are you doing today?". The reality is that you can be alright after a disrupted night of sleep. Insomnia is not pleasant and the day that follows may be more challenging, but you can likely function and get through it.



So, what now?

Struggling with sleep can be a very lonely and isolating experience. It’s hard to be up in the middle of the night when the whole world seems to be sleeping. It’s hard to NOT worry about your sleep. It’s hard to believe you can resume normal life without sleep being such a focus. The good news is that there is support that can help. There is limited awareness of the benefits of sleep therapy. You might seek help from a medical professional rather than a therapist. While it is best practice to rule out physical issues as the root cause, there is an alternative to medication. If you are struggling with your slumber, consider engaging in CBT-I therapy in addition to seeking advice from a doctor. Check out the Society of Behavioral Sleep Medicine directory to find a provider in your area. 

 

 

Anissa Bell, LMFT

Clarity Therapy Associates

Telehealth Throughout California


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