Middle-of-the-Night Anxiety: Experts Explain the Vicious Cycle
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."
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."
[ pagebreak ]Stressing over what will happen if you don't get some sleep feeds right into the loop. Specialists call this catastrophizing.
"Patients adhere to the belief that if they don't sleep, tomorrow will be terrible," says Dr. Downey. "It's very much 'all or none' thinking. It's almost a sense of learned hopelessness."
Anticipating such disaster is called cognitive distortion, because it's so unrealistic. "Occasionally patients come in literally thinking they're going to die," says Michael J. Sateia, MD, professor of psychiatry and chief of sleep medicine at Dartmouth Medical School in Lebanon, N.H. "There is no way you're going to power down and drift off to sleep if that's what's racing through your mind. You might as well put a gun to your head and say, 'Now go to sleep.'"
Anxieties also become more exaggerated during the night for people with sleep problems, says Dr. Sateia. "The relative isolation, quiet, and absence of distractions are probably the big factor here," he adds. "During the day, we can use a variety of strategies to modulate these concerns, including taking direct action to address them. Lying in bed in a dark room, they become overwhelming and inescapable."
Learning to cope with negative thoughts
This is precisely why you shouldn't lie in bed all night waiting to fall asleep, experts agree. It's important to get up and do something else, in another room, until you're truly sleepy, and to keep negative thoughts and worries out of the bedroom.
If your middle-of-the-night anxiety becomes too much to overcome on your own, cognitive-behavioral therapy sessions may help you find strategies to cope.