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Sleep Disorders Insomnia

A Hard Day's Night: Coping with Sleep and Anxiety

Medical Reviewer:

Vikram Tarugu, MD

Medically Reviewed On: November 05, 2013

Does it ever happen that people fear sleep?
People can become afraid of going to sleep for a variety of reasons. There are times when people develop a concern that their bedroom is no longer a good place to sleep. So they begin to associate the room with not being able to fall asleep, and then they become fearful of trying to go to sleep in that room because they know they can't. So a vicious cycle begins to develop.

People with post-traumatic stress disorder, who have been traumatized psychologically by some terrible event, can be very hypervigilant, very aware of the environment, and therefore actually uncomfortable about going to sleep in the nighttime.

How are anxiety disorders treated?
The treatment of anxiety disorders typically is either pharmacological or psychotherapeutic. In terms of the psychotherapy, there are many very effective treatments. There's a lot of evidence that what is termed cognitive behavioral therapy can be very useful. “By cognitive behavioral, I mean gently challenging the ideas that a person has about sleep and their sleep disturbance,” says Ross.

For example, a person might have the idea that death could occur when sleeping. A person might have read that heart attacks occur at a certain time during the night and might actually be afraid to go to sleep. A cognitive behavioral therapist could challenge that idea and educate the person.

There are many pharmacological treatments for the anxiety disorders. Currently, psychiatrists are likely to use drugs that were originally introduced as antidepressant drugs, but have since been appreciated for their anti-anxiety effects.

Interestingly, though, sometimes the antidepressants can interfere with sleep as a side effect. Oftentimes a psychiatrist will recommend taking an antidepressant drug early in the day to avoid this. And there are anti-anxiety medications such as clonazepam and alprazolam.

What are some strategies to help people sleep?
In general, it's very important to avoid stimulating behaviors before bedtime and to emphasize good sleep hygiene. These behaviors are going to vary from person to person but in general it means avoiding caffeine after 5 p.m., and not just coffee but also tea and caffeinated soda. It means not smoking shortly before bedtime because nicotine is a stimulant. It means not going to bed and lying awake for a long time. Instead, it's better to get up after a short while, go to a different part of the house, do something relaxing and then try to go back to sleep.

You may find it very relaxing to have a phone conversation with a particular person before going to bed. That person might be able to provide some reassurance and help the sleeper feel calmer. On the other hand, it wouldn't be a good idea to have a phone conversation with someone with whom you're having a disagreement.

What medications can help with sleep problems associated with anxiety?
There are several medications for insomnia. In the past, psychiatrists typically used drugs of the benzodiazepine class, such as Valium and Librium, to help people with sleep. There's agreement among psychiatrists that in the short term that a benzodiazepine is useful. However, there isn't yet a consensus that long-term treatment with benzodiazepines is helpful.

There are newer medications that act a little bit differently from the old-time benzodiazepines, and seem to have a shorter duration of action. So you can get help with sleep, but then not feel very tired, hung over or drugged the next day.

Why do worries often surface at night?
“The question of why worries often surface at night is an interesting one, and I have to say at the outset that I don't have the answer to that,” says Ross. “In this modern day, when we're all trying to do so many things and balance so many activities in our lives, I think there's a tendency to use the bedroom as a place to accomplish things other than sleep.”

Historically, Freud and other psychoanalytic thinkers thought that there was something about dreaming that enabled a person to work out certain internal conflicts. So it's probably worth saying that it may be that conflicts are worked out at night in our sleep.

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