Scared to Sleep

These strategies may help take the dread out of going to sleep.

From the WebMD Archives

Every night, for the last 10 years, Traci Coulter has struggled to sleep. Minutes tick by, then hours. Coulter begins to fret about her to-do list the next day and all her responsibilities as a public relations executive. To make matters worse, she knows a garbage truck is coming by at 3 a.m. and will wake her up - a thought that only makes her more anxious.

“It’s an ongoing cycle of not getting the rest that I need, and it causes such anxiety for me,” says Coulter, 38, who lives in New York City. “I have nights where I sit and stew without any sleep at all.” Some nights, she’s afraid to go to bed.

Going to sleep might seem like a natural act, but for some people, sleep is a source of dread. Becoming anxious about sleep is actually a form of performance anxiety, says Alexander Obolsky, MD, a psychiatrist who specializes in trauma and stress, and assistant professor of clinical psychiatry at Northwestern University Medical School in Chicago.

Some older adults for instance, get worried because the amount of sleep they get diminishes. “They get anxious because they think they’re not sleeping enough,” Obolsky says.

Tossing and Turning

Often, dreading sleep is the result of a sleep disorder. "Sleep dread is extremely common," says Matthew Edlund, MD, director of the Center for Circadian Medicine in Sarasota, Fla., and author of The Power of Rest.

Insomnia, which affects as many as 40% of Americans at one time or another, is the most common cause of this fear. When people don’t get the sleep they need, they become concerned.

But worrying about it only worsens the insomnia, Edlund says. “We’ve turned sleep into a job,” he says. “We think, ‘Oh my gosh, I have to have enough sleep to make everything work.’ They’re worried about sleep, so they can’t sleep.”

Stalked by Chronic Nightmares

Chronic nightmares are another troublesome sleep disorder that can cause fear, says Shelby Harris, PsyD, CBSM, director of the Behavioral Sleep Medicine Program at the Montefiore Medical Center’s Sleep-Wake Disorders Center in New York City. Children are especially vulnerable, but adults - especially those who suffer from post-traumatic stress disorder -- experience nightmares, too.

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Joni Aldrich, 57, of Winston-Salem, N.C., began to dread sleep after she lost her husband to brain cancer four years ago. After he had a seizure, she had to make the difficult decision to suspend treatment, an experience that traumatized her.

Every night, she had nightmares of him begging her to help him, but she couldn’t. She would awaken shaking. Aldrich finally got help from a counselor and began taking an anti-anxiety medication to help her sleep. “I still take the anti-anxiety medication in a very low dose, because I fear the results otherwise,” says Aldrich, CEO of Cancer Lifeline Publications. “Even one of those nightmares wouldn't be worth it. And, I still go to bed later than I should just to make sure that I'm really tired.”

Fears Related to Sleep Apnea

Still others are fretful about sleep because they have health conditions. People who have sleep apnea for example, sometimes fear that they’ll stop breathing in their sleep.

Harris says that fear is rare, but may occur when someone first learns that he or she has sleep apnea and is waiting for a CPAP (continuous positive airway pressure) device to treat the condition.

“Once the apnea is under control, people sleep better knowing they’re not waking up multiple times a night,” Harris says.

So what can you do to eliminate the fear of sleep? Here’s what experts suggest:

Change Your Thinking.

Like many anxieties, dread of sleep is all about perspective. Rather than dwell on the negative effects of sleeplessness, remind yourself that it’s perfectly normal to have occasional bad nights and that occasional nighttime awakenings are to be expected.

If you’re anxious because you’re anticipating a disruption, tell yourself to expect it. “I knew an internist who was on call and couldn’t sleep because he was always expecting a call,” Edlund says. “I told him just to expect calls and not worry about it, and he slept much better after that.”

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Practice Good Sleep Hygiene.

The basics:

  • Go to bed at the same time every night and wake up at the same time every morning.
  • Don’t eat or drink any caffeine in the four to five hours before bed.
  • Resist the urge to nap.
  • Avoid exercise two hours before bed.
  • Keep your bedroom cool and dark.
  • Limit your bedroom activities to sleep and sex.

If you can’t sleep, get up and do something boring. “Keep a boring book on your bed table,” Obolsky says.

Also, create a restful routine. Prime your body for bed by doing the doing the same things every night. A restful routine that involves a warm bath, listening to music, or deep breathing can be especially helpful if you have insomnia, Edlund says.

Consider Getting Medical Help.

If you have a sleep disorder that doesn’t let up, such as insomnia or chronic nightmares, talk to a sleep specialist.

Insomnia can be treated with cognitive behavioral therapy or sleep medications. Chronic nightmares may require imagery rehearsal therapy that involves rewriting and rehearsing a new version of the nightmare during the day. It can also be treated with various prescription medications. You should also talk to your doctor if you think you have sleep apnea or another condition that’s disrupting your sleep.

For Coulter, training for a marathon in 2008 provided a temporary break from the sleeplessness. She also gets some relief by taking a sleep medication, though she says it doesn’t always work. She is now considering seeing a sleep specialist and in the meantime, has started running again. “Running does help,” she says. “I think I shift my anxiety to doing a good run or doing well in a race.”

WebMD Feature Reviewed by Laura J. Martin, MD on November 11, 2010

Sources

SOURCES:

Traci Coulter, public relations executive, New York.

Alexander Obolsky, MD, psychiatrist and assistant professor of clinical psychiatry, Northwestern University Medical School, Chicago.

Matthew Edlund, MD, director of the Center for Circadian Medicine in Sarasota, FL and author of The Power of Rest.

Shelby Harris, PsyD, CBSM, director of the Behavioral Sleep Medicine Program, Montefiore Medical Center’s Sleep-Wake Disorders Center, New York.

Joni Aldrich, CEO, Cancer Lifeline Publications, Winston-Salem, N.C.

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