Anxiety and Insomnia
Anxiety
Anxiety is an emotion that all humans experience. Anxiety is the clinical term for the cluster of physical sensations associated with fear. Fear is a normal response to danger that is essential for survival in all animals. However, too little or too much fear can have long-lasting negative consequences.
The purest and simplest expression of fear is the startle response which can be seen in infants. The startle response and the body's reaction to fear are perfectly normal and don't need to be learned. Through learning, the feeling of fear becomes associated with experiences. In this way anxiety comes to affect feelings, thoughts and behaviors.
The physical sensations of anxiety originate in the central nervous system. These sensations are all the result of the body automatically readying itself for fight or flight (escape): muscles contract; breathing becomes shallow; and senses become more acute. Most people aren't aware of the muscle tension, shallow breathing and hyper-vigilance that is part of our animal nature.
Complaints about anxiety symptoms usually identify secondary symptoms: muscle tension can lead to trembling, shaking, and overall fatigue; shallow breathing can lead to feeling a choking or smothering sensation; lack of oxygen to the brain can result in feeling dizzy, faint, lightheaded; and hyper-vigilance can cause insomnia or disrupted sleep. Physical symptoms of nausea and chills or hot flashes can also be the secondary result of the body reacting to anxiety.
Just as there are predictable or normal sensations associated with anxiety, there are predictable or typical irrational beliefs about the symptoms. These irrational beliefs include: "I am going to lose control"; "I am going to have a heart attack"; "I am going to go crazy"; and "I am going to die". Thinking logically and rationally is one step to managing anxiety. Knowing that the physical sensations and the extreme thoughts are normal can help with recovery from anxiety.
The skills for coping with anxiety are numerous, but must be personalized based on each person's symptoms. Behavioral therapy is focused on attempts to counter the physical symptoms that are common when anxious: practicing: relaxation and deep breathing and aerobic exercise or yoga; are ways to help the body return to a non-anxious state. Cognitive therapy is focused on attempts to change the thoughts that are common when anxious: questioning and challenging automatic thoughts and visualization or self-hypnosis are techniques to help the mind return to a non-anxious state. Many people find talking to a friend or writing in a journal helps them think more clearly and/or get their mind off their anxiety.
Facing fears and learning to tolerate anxiety is no easy task, and as a result many people avoid anxiety provoking situations. Others may use drugs or alcohol as a way of self medicating. These coping skills may bring short-term relief but no long-term solution and only reinforce the anxiety and the belief that these behaviors are necessary. This is a self-fulfilling prophecy. Likewise, giving in to the idea "I am going crazy" or "I can't control my breathing" will only sustain or worsen one's anxiety.
There is help available when anxiety becomes troubling. An evaluation by a trained professional will assess your experience of anxiety and plan the optimal treatment approach for you. A combination of cognitive and behavioral therapies will probably be recommended. Your treatment might also include therapy that involves talking about your past as it relates to your anxiety and addressing any health conditions or personal circumstances that may be impacting your symptoms. Discussion will likely also address diet, exercise and sleep.
Insomnia
Most adults need 7-8 hours of sleep per night. Fewer than 1% of people have a genetic mutation that enables them to be fully rested with 20-25% less sleep. Yet more than one third of all Americans have insomnia which prevents them from getting the sleep they need and 15% of adults suffer from chronic insomnia.
Anxiety can cause or worsen insomnia. Most adults have had some trouble sleeping because they felt worried or nervous. For those with anxiety, the quiet and inactivity of night often brings on stressful thoughts or even fears that can keep a person awake. When this happens for many nights an individual may start to associate feeling anxious with bedtime. In this way, even mild anxiety can lead to chronic insomnia.
Chronic insomnia can also be the result of factors such as: medical conditions (diabetes, neurological disorders); substance use (caffeine, alcohol, prescription medications or tobacco); stress; aging; poor sleep habits; or other mental health issues.
Treatments for insomnia can include behavioral therapy or medications. Medications work faster than behavioral interventions, but they do have side effects. Also, though they may increase sleep time, the drugs used to counteract insomnia usually have a negative impact on the quality of the sleep. Finally, sleep medications can lose effectiveness over time and can be addictive.
The Cognitive Behavioral Therapy (CBT) for insomnia usually takes five to ten weeks. CBT focuses on the behaviors and beliefs that are interfering with sleep. A study by Dr. Ryan Wetzler at Sleep Medicine Specialists in Kentucky found that two to ten sessions of CBT resulted in remission of insomnia in 50-66% of patients. Among those who were using sleep medications three or more days a week, 78% slept better and discontinued using the drugs after just four sessions of CBT.
The Cognitive component of CBT for insomnia involves identifying, challenging and replacing beliefs that create anxiety and beliefs that only perpetuate insomnia. Some unhealthy beliefs about sleep include, “I’m never going to get to sleep” or “I’m going to feel awful tomorrow.”
The Behavioral component of CBT for insomnia is referred to as “sleep hygiene” and is focused on education about optimal sleep conditions and encouraging those struggling with insomnia to incorporate those behaviors into their own sleep regimen. This may involve changing long established patterns – not an easy task.
The sleep hygiene psycho-education about ideal sleep practices includes teaching people to wind-down and practice the same bedtime rituals as a way to signal their body that they are expecting to sleep. It also involves stressing the importance of a regular sleep and wakefulness schedule, and reserving time spent in bed to sleep rather than eating, watching television, worrying or even reading. Sleep hygiene also includes optimizing the bedroom setting by making sure that it is dark, cool and quiet and that the clock is out of view.
Success with a course of CBT for insomnia requires both motivation and commitment. There is “homework” that usually includes keeping a sleep log and expectations about practicing the CBT techniques daily, but the benefits are long-lasting.
For more information, visit the National Sleep Foundation web-site.
Anxiety is an emotion that all humans experience. Anxiety is the clinical term for the cluster of physical sensations associated with fear. Fear is a normal response to danger that is essential for survival in all animals. However, too little or too much fear can have long-lasting negative consequences.
The purest and simplest expression of fear is the startle response which can be seen in infants. The startle response and the body's reaction to fear are perfectly normal and don't need to be learned. Through learning, the feeling of fear becomes associated with experiences. In this way anxiety comes to affect feelings, thoughts and behaviors.
The physical sensations of anxiety originate in the central nervous system. These sensations are all the result of the body automatically readying itself for fight or flight (escape): muscles contract; breathing becomes shallow; and senses become more acute. Most people aren't aware of the muscle tension, shallow breathing and hyper-vigilance that is part of our animal nature.
Complaints about anxiety symptoms usually identify secondary symptoms: muscle tension can lead to trembling, shaking, and overall fatigue; shallow breathing can lead to feeling a choking or smothering sensation; lack of oxygen to the brain can result in feeling dizzy, faint, lightheaded; and hyper-vigilance can cause insomnia or disrupted sleep. Physical symptoms of nausea and chills or hot flashes can also be the secondary result of the body reacting to anxiety.
Just as there are predictable or normal sensations associated with anxiety, there are predictable or typical irrational beliefs about the symptoms. These irrational beliefs include: "I am going to lose control"; "I am going to have a heart attack"; "I am going to go crazy"; and "I am going to die". Thinking logically and rationally is one step to managing anxiety. Knowing that the physical sensations and the extreme thoughts are normal can help with recovery from anxiety.
The skills for coping with anxiety are numerous, but must be personalized based on each person's symptoms. Behavioral therapy is focused on attempts to counter the physical symptoms that are common when anxious: practicing: relaxation and deep breathing and aerobic exercise or yoga; are ways to help the body return to a non-anxious state. Cognitive therapy is focused on attempts to change the thoughts that are common when anxious: questioning and challenging automatic thoughts and visualization or self-hypnosis are techniques to help the mind return to a non-anxious state. Many people find talking to a friend or writing in a journal helps them think more clearly and/or get their mind off their anxiety.
Facing fears and learning to tolerate anxiety is no easy task, and as a result many people avoid anxiety provoking situations. Others may use drugs or alcohol as a way of self medicating. These coping skills may bring short-term relief but no long-term solution and only reinforce the anxiety and the belief that these behaviors are necessary. This is a self-fulfilling prophecy. Likewise, giving in to the idea "I am going crazy" or "I can't control my breathing" will only sustain or worsen one's anxiety.
There is help available when anxiety becomes troubling. An evaluation by a trained professional will assess your experience of anxiety and plan the optimal treatment approach for you. A combination of cognitive and behavioral therapies will probably be recommended. Your treatment might also include therapy that involves talking about your past as it relates to your anxiety and addressing any health conditions or personal circumstances that may be impacting your symptoms. Discussion will likely also address diet, exercise and sleep.
Insomnia
Most adults need 7-8 hours of sleep per night. Fewer than 1% of people have a genetic mutation that enables them to be fully rested with 20-25% less sleep. Yet more than one third of all Americans have insomnia which prevents them from getting the sleep they need and 15% of adults suffer from chronic insomnia.
Anxiety can cause or worsen insomnia. Most adults have had some trouble sleeping because they felt worried or nervous. For those with anxiety, the quiet and inactivity of night often brings on stressful thoughts or even fears that can keep a person awake. When this happens for many nights an individual may start to associate feeling anxious with bedtime. In this way, even mild anxiety can lead to chronic insomnia.
Chronic insomnia can also be the result of factors such as: medical conditions (diabetes, neurological disorders); substance use (caffeine, alcohol, prescription medications or tobacco); stress; aging; poor sleep habits; or other mental health issues.
Treatments for insomnia can include behavioral therapy or medications. Medications work faster than behavioral interventions, but they do have side effects. Also, though they may increase sleep time, the drugs used to counteract insomnia usually have a negative impact on the quality of the sleep. Finally, sleep medications can lose effectiveness over time and can be addictive.
The Cognitive Behavioral Therapy (CBT) for insomnia usually takes five to ten weeks. CBT focuses on the behaviors and beliefs that are interfering with sleep. A study by Dr. Ryan Wetzler at Sleep Medicine Specialists in Kentucky found that two to ten sessions of CBT resulted in remission of insomnia in 50-66% of patients. Among those who were using sleep medications three or more days a week, 78% slept better and discontinued using the drugs after just four sessions of CBT.
The Cognitive component of CBT for insomnia involves identifying, challenging and replacing beliefs that create anxiety and beliefs that only perpetuate insomnia. Some unhealthy beliefs about sleep include, “I’m never going to get to sleep” or “I’m going to feel awful tomorrow.”
The Behavioral component of CBT for insomnia is referred to as “sleep hygiene” and is focused on education about optimal sleep conditions and encouraging those struggling with insomnia to incorporate those behaviors into their own sleep regimen. This may involve changing long established patterns – not an easy task.
The sleep hygiene psycho-education about ideal sleep practices includes teaching people to wind-down and practice the same bedtime rituals as a way to signal their body that they are expecting to sleep. It also involves stressing the importance of a regular sleep and wakefulness schedule, and reserving time spent in bed to sleep rather than eating, watching television, worrying or even reading. Sleep hygiene also includes optimizing the bedroom setting by making sure that it is dark, cool and quiet and that the clock is out of view.
Success with a course of CBT for insomnia requires both motivation and commitment. There is “homework” that usually includes keeping a sleep log and expectations about practicing the CBT techniques daily, but the benefits are long-lasting.
For more information, visit the National Sleep Foundation web-site.
