Middle-of-the-Night Anxiety: Experts Explain the Vicious Cycle

It's easy to "catastrophize." Insomnia produces a sense of hopelessness.
When insomnia first surfaces, most people assume their problem is a temporary nuisance. As it continues, many wonder when (or if) they'll ever sleep soundly again.

Short-term vs. chronic insomnia
If pain, illness, or hormonal changes are behind your tossing and turning, chances are you will be able to sleep again once those issues are resolved. But sometimes transient bouts of insomnia become real problems of their own, especially if you've developed anxiety or fear about going to bed and being unable to sleep.

Chronic stress, bad sleep hygiene, or circadian rhythm problems can also trigger insomnia that won't go away easily. In these cases you'll need to make significant changes in your lifestyle and sleep habits—and the longer it goes on, the harder your problem will be to control.

"The biggest health risks for insomniacs, if they're not treated within six months, are mental illness and alcohol abuse," says Ralph Downey III, PhD, director of the Sleep Disorders Center at Loma Linda University in California. "Our rule of thumb here is that when someone comes in with insomnia, we jump on it because we know it will get worse."

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Why you catastrophize at 3 a.m.
Insomnia fuels a cycle of anxiety. Say, for example, you're worried about losing your job. You go to bed, but toss and turn for an hour. At 3 a.m. you wake up, your mind racing with nervous thoughts about work.

Your anxiety quickly spreads to other areas: a nine o'clock doctor's appointment, the pants you forgot at the dry cleaners, and the presentation you're going to blow if you don't get some sleep. Ominous thoughts fill your head: "This is awful.... I can't afford this.... I'm going to be a wreck tomorrow." After a few nights of this repeated inner dialogue, you start dreading any time in bed at all.

"Insomniacs anticipate problems with sleep," says Kenneth Lichstein, PhD, director of the Sleep Research Project in the psychology department at the University of Alabama in Tuscaloosa. "Even before they lie down at night, those worrisome thoughts are already there."

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Lead writer: Gail Belsky
Last Updated: April 27, 2008

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