Most commonly, having a bad night of sleep (or multiple bad nights in a row) is what triggers anxiety about being able to fall or stay asleep, says neuroscientist Andrew W. Varga, MD, a physician at the Mount Sinai Integrative Sleep Center. “But people can also get sleep anxiety from other things, such as chronic nightmares or hypnagogic hallucinations [aka the usually harmless hallucinations that can happen in the state between wakefulness and sleep],” he says.
“[Sleep anxiety is] like an indoor track at a gym where there are lots of entry points. No matter how you get on, you start running in circles.” —neurologist W. Chris Winter, MD
In any case, once sleep becomes the focus of your anxiety, the extent of both your loss of sleep and the anxiety surrounding it is likely to self-perpetuate, says neurologist W. Chris Winter, MD, sleep advisor for Sleep.com, and author of The Sleep Solution: Why Your Sleep Is Broken and How To Fix It. “It's like an indoor track at a gym where there are lots of entry points,” he says. “No matter how you get on, you start running in circles.”
What to avoid doing if you experience sleep anxiety
Because of all the (well-deserved) hype surrounding getting enough sleep—and the intimidating list of issues that can happen when you don’t—sleep anxiety can lead folks to try anything that might help, including over-the-counter sleep aids like melatonin or an antihistamine like Benadryl, says Dr. Varga. “These won’t do anything for the anxiety, though, and will likely have, at best, a mild effect on sleep initiation and maintenance,” he says. “The same is true for alcohol, which people often try to use for a similar purpose.”
Also common among folks with sleep anxiety is the tendency to start shaking up your sleep schedule or timing—which is not recommended either. “Any behavior that aids with sleep procrastination—like staying up later to do work or watch another episode of a TV show—is not helpful for sleep anxiety, even if it's in the name of using time efficiently,” says Dr. Varga.
On the flip side, getting into bed earlier than usual to try to get some extra sleep can be just as unhelpful, adds Dr. Winter. The more you lie in bed without sleeping, the more the brain becomes conditioned to view the bed as a place where anxiety and insomnia reign, rather than the location of restful sleep. In fact, that’s the same reason why sleep doctors often advise getting out of bed if you wake up in the middle of the night and can’t get back to sleep, rather than tossing and turning endlessly.
How to minimize anxious thoughts at night about falling or staying asleep
Because sleep shouldn’t be an inherently stressful or anxiety-provoking situation, as soon as it becomes one, it’s worth considering where that stress may be originating. To go back to the track metaphor, identify why you started running in the first place. If there’s an outside source you can pinpoint—say, work or relationship stress—you may need to address that root cause before you can quite literally rest easy.
But, as noted above, sleep anxiety can also emerge for no other reason than a night or two of bad sleep and tends to quickly take on a life of its own. At that point, your reason for entering the “track” becomes somewhat irrelevant, says Dr. Winter. From there, it’s more helpful to employ in-the-moment strategies when the anxiety strikes. “That typically starts with reframing time spent in bed awake as the benign act that it is, and not a reason to feel fear or dread,” says Dr. Winter. In a similar vein, the simple reminder that you’re more likely than not to drift off at some point can be helpful, too: “After all, it is biologically impossible not to sleep,” he says.
For persistent sleep anxiety, seeing a sleep specialist for cognitive behavioral therapy (CBT) is likely the way to go, says Dr. Varga. “There’s an important ‘cognitive’ aspect to this that focuses on maladaptive thoughts regarding sleep,” he says. “This can help you recognize what the specific negative thoughts are and whether they’re realistic or exaggerated, and then learn how to avoid those thoughts.” On your own, you can adapt CBT for occasional sleep anxiety by practicing thought-stopping, or a technique where you acknowledge a negative thought as it arises and then actively replace it with a positive one of your own choosing.
It also doesn’t hurt to audit your sleep hygiene and ensure that you’re at least setting yourself up, environmentally, for the best possible sleep (potential anxiety aside). That means limiting your exposure to blue light at night, keeping up a routine for sleep and wake times, and embracing the kinds of bedtime activities known to support relaxation, from calming breathing exercises to sleep-promoting meditation.
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