Sleep Deprivation: A Root Cause Of Anxiety Disorders

Sleep and anxiety are closely linked. Sleep deprivation can trigger anxiety and vice versa. When you don't sleep, your body is unable to relieve the stresses of the day, and this can lead to a vicious cycle of sleep deprivation and anxiety. This is known as sleep debt. Sleep debt can cause increased anxiety, even in those who don't usually experience it. It can also lead to unusual physical symptoms, such as tingling in the arms and legs, headaches, and backaches. These symptoms can be extremely stressful and may be misinterpreted as signs of more serious health issues, which can be particularly worrying for those with existing anxiety disorders.

Sleep anxiety: the fear or worry about going to sleep

Sleep anxiety is a feeling of stress or fear about going to sleep. It is a common problem, as anxiety disorders are the most prevalent mental health issue in the US, affecting around 40 million people. Sleep anxiety can be a vicious cycle, as anxiety can cause insomnia, and a lack of sleep can worsen anxiety.

People with sleep anxiety may fear not being able to fall asleep or staying asleep. Some may have a distinct phobia about sleep, called somniphobia, where they think something bad will happen to them while they sleep, or that they need to stay alert and watchful. Sleep anxiety can also be caused by an underlying fear of what might happen the next day, or a general sense of impending doom.

The physical symptoms of sleep anxiety can include nocturnal panic attacks, which only happen at night and wake the person from sleep. Chronically high levels of stress hormones before sleep can make it hard for the body to relax and fall asleep. Sleep anxiety can also affect the rapid eye movement (REM) phase of sleep, which is when people tend to have vivid dreams. Anxiety can turn these dreams into nightmares, which wake the sleeper and reinforce the fear of sleep.

Sleep anxiety can affect adults, teens, and children, and can be a side effect of other sleep disorders, such as Restless Legs Syndrome, or mental health disorders, including depression, bipolar disorder, and substance use disorder.

Treatment

Treatments for sleep anxiety include therapy, better sleep hygiene, and medication. Cognitive Behavioural Therapy for Insomnia (CBT-I) is a common treatment, which teaches patients to break the association between their bed and worry, and to retrain their mind and body to see the bed as a place for sleeping. Relaxation strategies and mindfulness techniques are also used. Medication can be used to treat the anxiety or sleep disorder, but it is important to note that some medications can increase anxiety or make sleep more difficult.

Prevention

Sleep anxiety can be prevented by improving sleep habits, or sleep hygiene. This can include:

• Going to bed and waking up at the same time every day
• Spending time outdoors in natural light
• Regular exercise, but not too close to bedtime
• Keeping naps short and avoiding napping after 3 pm
• Avoiding caffeine, especially if you are prone to panic attacks
• Reviewing medications to check for stimulants
• Avoiding alcohol, large meals, foods that cause heartburn, and too many fluids before bed
• Keeping the bedroom cool, dark, and quiet, without distractions like TV or a computer
• Reading, listening to music, or relaxing with a hot bath or deep breathing before bed

Insomnia: the inability to fall asleep or stay asleep

Insomnia is a common sleep disturbance that can be caused by anxiety. It is characterised by difficulty falling or staying asleep, with symptoms occurring at least three nights a week. This can manifest as tossing and turning for long periods or waking up in the middle of the night with racing thoughts, making it hard to fall back asleep.

The link between insomnia and anxiety operates in a vicious cycle, where insomnia leads to anxiety, and anxiety causes insomnia. This feedback loop can worsen both conditions. Middle-of-the-night wakings are often related to anxiety, and in other cases, anxiety makes it challenging to fall asleep at bedtime.

Managing Anxiety-Related Insomnia

One crucial strategy for managing anxiety-related insomnia is relaxation. Relaxation techniques aim to calm the mind before bed, reducing the likelihood of anxiety and stress interrupting sleep. Relaxation methods include deep breathing exercises, progressive muscle relaxation, meditation, and listening to soft music. Additionally, maintaining a consistent sleep schedule, turning off electronics, and creating a quiet, comfortable environment can improve sleep quality.

If anxiety-related insomnia persists, cognitive behavioural therapy (CBT) is the best evidence-based therapy. CBT helps individuals recognise thoughts that keep them awake and redirect their thinking patterns. This therapy may be combined with anti-anxiety medications or referrals for mental health treatment, especially if underlying conditions like depression are present.

Lifestyle Changes for Better Sleep

Lifestyle modifications can also enhance sleep quality. Proper nutrition, regular exercise, and healthy habits contribute to a good night's rest. It is recommended to avoid caffeine, alcohol, heavy meals, and spicy foods several hours before bedtime. Establishing a relaxing bedtime routine, such as reading or listening to music, can also promote better sleep.

Relaxation techniques: methods such as deep breathing exercises and meditation to induce sleep

Sleep and anxiety are closely intertwined. Sleep problems and mental health disorders like anxiety can feed off each other, creating a never-ending cycle. When you're anxious, you may experience poor sleep and wake up feeling exhausted and cranky. On the other hand, poor sleep can also increase your risk of developing a mental health condition, such as anxiety.

Deep breathing exercises and meditation are effective relaxation techniques that can help you sleep better. Here are some methods you can try:

Deep Breathing Exercises:

• 4-7-8 Breathing Technique: This technique involves exhaling completely with a breathy "whoosh" sound, inhaling silently through the nose for a count of 4 seconds, holding your breath for 7 seconds, and then exhaling again for 8 seconds with a whooshing sound. Repeat this cycle 4 times initially and gradually work your way up to 8 repetitions.
• Bhramari Pranayama Breathing Exercise: Close your eyes and breathe deeply. Cover your ears with your hands, placing your index fingers above your eyebrows and the rest of your fingers over your eyes. Gently press on the sides of your nose and focus on your brow area. Keep your mouth closed and exhale slowly through your nose, making a humming "Om" sound. Repeat this process 5 times.
• Three-Part Breathing Exercise: This technique involves taking a long, deep inhale, exhaling fully while focusing on your body, and then slowing down your exhale so that it's twice as long as your inhale.
• Diaphragmatic Breathing Exercise: Lie on your back with bent knees and a pillow under your head, or sit in a chair. Place one hand on your chest and the other on your stomach. Breathe slowly through your nose, keeping the hand on your chest still while the hand on your stomach moves with your breaths. Eventually, aim for chest-still breaths.
• Alternate Nostril Breathing Exercise: Sit comfortably with crossed legs. Use your right thumb to close your right nostril and inhale slowly through your left nostril. Close your left nostril and exhale through the right. Continue alternating for 5 minutes, ending with an exhale through the left nostril.
• Buteyko Breathing: Sit in bed with your mouth gently closed and breathe naturally through your nose for about 30 seconds. Then, breathe intentionally in and out through your nose once. Pinch your nose closed until you need to breathe again. Take a deep breath in and out through your nose, keeping your mouth closed.
• The Papworth Method: Sit up straight or lie down, and take deep breaths in and out through your nose or mouth, counting to 4 with each inhale and exhale. Focus on your abdomen's movement and the sound of your breath.
• Box Breathing: Sit up straight, inhale slowly through your nose while counting to 4, hold your breath for a count of 4, and then exhale slowly through your mouth. Focus on pushing all the air out of your lungs.

Meditation Techniques:

• Mindfulness Meditation: Focus on the present moment without judgment. Increase your awareness of your consciousness, breathing, and body. If a thought arises, observe it without attachment and gently return your attention to your breath.
• Guided Meditation: Listen to a recording that guides you through each step of meditation, instructing you on breathing, relaxing your body, and visualizing images or sounds.
• Body Scan Meditation: Focus your attention on each part of your body, from your face to your feet, noticing any physical sensations, tension, or pain. If your mind wanders, gently bring your attention back to your body.

Cognitive behavioural therapy (CBT): a common treatment for anxiety disorders

Sleep anxiety is a common problem, and it often goes hand-in-hand with mental health disorders like anxiety. If you have an anxiety disorder, you may find it difficult to fall asleep or stay asleep. This can lead to a cycle of insomnia, stress, and worry, with one condition exacerbating the other.

Cognitive Behavioral Therapy for Insomnia (CBT-I) is a common treatment for insomnia and anxiety disorders. It is a form of talk therapy that works to reorient negative thinking and has been successful in decreasing anxiety. CBT-I teaches patients how to break the association between their bed and worry and distress, and to retrain their body and mind to see the bed as a place for sleeping. This is done by focusing on limiting total time in bed, getting out of bed when awake, and keeping regular sleep and wake times.

CBT-I may also include relaxation strategies and mindfulness techniques. It involves examining thoughts and feelings about sleep to determine if they are accurate and if behaviours promote or disrupt sleep. A CBT-I provider will then reframe misconceptions and challenges in a way that is more conducive to restful sleep. Treatment is brief and usually lasts around four to eight sessions, although this can differ depending on the patient's needs.

During CBT-I, patients may learn to:

• Avoid behaviours or environmental factors that trigger anxiety or make sleeping difficult.
• Understand how sleep and anxiety affect the brain and the rest of the body.
• Change negative or inaccurate thinking about bedtime or sleep.

CBT-I is considered a first-line treatment for insomnia and has proven effective for many types of insomnia. It is also useful for those at high risk of experiencing insomnia, such as pregnant people, people with post-traumatic stress disorder (PTSD), and people experiencing insomnia after cancer treatment.

Lifestyle changes: habits such as avoiding caffeine and alcohol, and improving sleep hygiene, can help reduce anxiety

Sleep and anxiety are closely intertwined. One can often make the other worse, so it can feel like a never-ending cycle. However, there are some lifestyle changes you can make to help reduce anxiety and improve your sleep.

Avoid caffeine

Caffeine can worsen anxiety symptoms and disrupt your sleep. It is a stimulant that works on the central nervous system (the brain and spinal cord), blocking the chemical adenosine that causes alertness. The side effects of caffeine, such as nervousness and restlessness, are similar to anxiety symptoms. These side effects can kick in as soon as 45 to 60 minutes after consumption and can last up to 5 hours. It is recommended to avoid caffeine in the late afternoon or evening.

Avoid alcohol

Excessive drinking can cause anxiety in the short and long term. While alcohol may temporarily reduce worries and lower stress levels, the next day you may experience 'hangxiety', a phenomenon where a hangover results in feelings of anxiety and panic. Alcohol abuse can also worsen existing anxiety disorders in the long term and lead to other mental and physical health problems.

Improve sleep hygiene

Sleep habits, or sleep hygiene, are your routines around bedtime that can affect your sleep. Some ways to improve your sleep hygiene include:

• Avoid drinking lots of fluids before bed, especially alcohol.
• Do relaxing activities before bed, such as meditation or listening to soft, peaceful music.
• Don't consume caffeine in the late afternoon or evening.
• Go to bed and wake up at the same time every day.
• If you don't fall asleep within 20 minutes, get out of bed.
• Make sure your bedroom is comfortable, quiet, and softly lit.
• Only use your bed for sleep and sex. Avoid watching television or working in bed.
• Aim for at least seven hours of sleep every night.
• Stop using electronic devices at least 30 minutes before bedtime.
• Avoid eating right before bedtime; if you're hungry, opt for a light snack instead of a big meal.

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