By Carissa Weber, MA, LPC, CSAC
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If you are one of the 284 million people (or 3.8% of the world’s population) that reported being formally diagnosed with generalized anxiety disorder, then insomnia is an all-too familiar side effect. This energy-draining and fear-provoking phenomenon can take down even the most seasoned anxiety fighter (including yours truly). The thing is, how can a basic-human need cause so much anxiety?
In this post, we are going to cover just that: anxiety-induced insomnia. There are many parts to it (types of insomnia, triggers of insomnia, how it impacts your brain, this list could go on forever), and I feel that this is the time in our mental health journey to cover it. Plus, this is a post that I’ve had a lot of people have requested (and is a hot topic in the Anxiety Relief Initiative), and it’s time you got those answers.
First things first, if you haven’t read any of my other posts about anxiety, you should do that before reading this. These posts help you understand how anxiety works in the brain, symptoms, and basic coping skills. Click on them below to find them:
Now, to just do a brief recap, anxiety occurs when your darn amygdala is hyperactive and tells the rest of your brain it needs to be stressed in order to keep you alive, even if the anxiety response isn’t warranted.
What is insomnia?
I’m so happy you asked. I want to start this post off by saying there are many kinds of insomnia. There are many things that trigger insomnia and there are hundreds of treatments for insomnia. This post is only covering anxiety-induced insomnia. That’s it. Otherwise, this post would be a novel.
According to the International Classification of Sleep Disorders (ICSD-3 to keep it brief), insomnia is defined as “persistent difficulty with sleep initiation, duration, consolidation or quality.” I don’t know about you, but that covers a lot of sleep issues. Let’s break it down a bit more.
Different Types of Insomnia
There are a lot of kinds of insomnia, but in the anxiety world, we recognize these:
- Short-term insomnia: This is when you struggle to sleep for a short period of time following a pretty major change in your life. Examples include a change in work, health conditions, a passing of a friend, increased work stress, sick kids, or a relationship change. This short-term insomnia can last for a few weeks, but your normal sleep habits return.
- Chronic insomnia: Now to the scary one we are all familiar with. This is where you struggle to fall and/or stay asleep a minimum of three nights a week for three months (or longer). Mental health (like anxiety), physical health (e.g. – sleep apnea), having a partner in bed with you, poor bedtime habits, medications, and even diet (like that cup of coffee after 2:00) can play a role in chronic-insomnia
Now that we have covered the different types of insomnia, we need to talk about the different classifications of insomnia:
- Sleep onset insomnia: If it takes you longer than 30 minutes to fall asleep after you turn off the lights and try to sleep, you may be struggling with sleep onset insomnia. When we talk about anxiety, sleep onset insomnia has its roots in the prefrontal cortex and the insula taking hints from your body that it is tired, and it is time for sleep. As your body is no longer in motion, your darn amygdala thinks it is time to play! Racing thoughts, regrets from your day, and your hippocampus playing memories from when you embarrassed yourself in high school tend to be the most common things reported with those struggling with anxiety and sleep onset insomnia. It is this action by that darn amygdala that keeps your pineal gland (the part of your brain responsible for sleep), active. It should be noted, sleep onset insomnia is more prevalent in women than in men.
- Sleep Maintenance Insomnia: If you find yourself waking up in the middle of the night and struggling to fall back asleep (like longer than 30 minutes), you could have issues with sleep maintenance insomnia. When we struggle to fall back asleep, it is because that darn amygdala of yours popped up and was awake. I want to note something really quick: people with anxiety are at a higher rate of having vivid nightmares. Why? When you enter the cycle of sleep associated with dreaming, REM sleep, your darn amygdala is still active. It can shift your dreams from being pleasant to being hell.
- Early morning awakening insomnia: If you are like me and have grown accustomed to being a “morning person” because “you’re already awake,” there’s a chance you are experiencing early morning awakening insomnia. This type of insomnia has you waking up 15 to 60 minutes prior to your alarm feeling exhausted, but yet like there is no more sleep to be had. More commonly seen in people who have struggled with anxiety for a long period of time (thanks to a constant flow of epinephrine and cortisol), early morning awakening insomnia happens because our body has become used to being on high alert all the time (thanks stupid amygdala!)
- Mixed episode insomnia: I don’t think I need to explain it, but I will anyway. People can have a mix of the previous three insomnias listed. You got that right. As a fellow insomniac, I struggled with all three of them.
Why Does Anxiety Cause Insomnia?
What a great question! When you are already struggling with anxiety symptoms on a regular basis, your darn amygdala is geared to be anxious ALL, THE, TIME. That high alert, on-the-go feeling during the day can easily be channeled into work, family, and other responsibilities, but at night? Ha! Your prefrontal cortex doesn’t have anything to distract your darn amygdala with. Let’s explore the ways you can put your prefrontal cortex back in charge at night.
Coping Skills Alert!
There are many ways to train your brain to prepare for sleep. Remember, these things require daily practice in order for them to work. Your anxiety didn’t develop overnight, neither will healthy brain reweiring.
Create a bedtime routine
Bedtime routines isn’t just for our toddlers. Humans, by nature, are creatures of habit. By creating a routine that:
- supports melatonin production
- predictable in nature
- increases GABA
you are setting yourself up to fall asleep. This routine should be something you can implement most every night, preferably two hours before you try to go to bed to sleep. This routine can consist of any of the following activities:
- Close the window curtains and turn the lights down low. The darkness helps the pineal gland start to produce melatonin.
- Decrease time looking at social media. The blue light used in many personal devices mimic the sun’s rays, tricking your brain into thinking it is daytime.
- Eat a snack that is rich in tryptophan, magnesium, AND melatonin. That’s right, foods rich in these elements can help jumpstart melatonin production. Some of the foods include milk (there is truth to that warm cup of milk), tart cherries, pistachios, and mushrooms (not “magic” mushrooms though).
- Soaking your feet in Epsom salt. A 15-minute soak for your feet can go a long way. Not only will it pull toxins out of your body, but it will start to release the neurotransmitter GABA to calm your body down, relieve muscle tension, and prevent any muscle cramps along the way
- Take up a yoga/meditation practice. It is no secret that both yoga and meditation rely on relaxing our bodies, quieting our minds, and improving oxygenation to help with anxiety symptoms. This helps our body create its own environment to produce melatonin. You can find more on yoga practices here
- Use essential oils. Now before you run away and discredit me, listen. Certain essential oils, like lavender, contain chemicals that relax our parasympathetic nervous system, which is the part of our nervous system that raises our heart rate and respirations. Smelling these 30 minutes before bed stops the production of adrenaline and allows GABA to take over. Other essential oils that relax our parasympathetic nervous system include chamomile, sandalwood, peppermint, cedar, and jasmine. These oils are clinically proven and have the science behind them
- Use melatonin supplements, correctly. Did you know to get the maximum effect from melatonin supplements you should take them two hours before you intend to go to bed? Did you also know you should take a maximum of one milligram to support your own brain’s production of melatonin? Per the researchers at John Hopkins, five milligrams of melatonin are more than enough to help improve your falling asleep time by seven minutes.
Staying asleep all night
One thing I know, is that anxiety makes it a pain to stay asleep. As someone who struggles not just with falling asleep, but with staying asleep, there are things we can do to trigger our pineal gland to give up some of that melatonin when our darn amygdala says that we need to focus (the tigers are going to get us!).
During the day we can wake up at the same time, engage in thirty minutes of activity that raises our heart rate and resist the urge to consume caffeine after 2:00 p.m. (even though our body is screaming for it).
At night, the list is even less tricky:
- Engaging in mindful breathing. It is no secret that the increased oxygen levels decrease our bodies stress responses. When we allow our brain to focus on the counting and physical sensation of breathing, we are distracting our darn amygdala long enough for the pineal gland to trickle melatonin.
- Use the skills of wise mind. Wise mind is a great distress tolerance skill for when our darn amygdala is running amuck. It allows you to validate what your darn amygdala is saying, while allowing the prefrontal cortex to assist in problem solving so that you can fall back asleep.
- Use progressive muscle relaxation. This is a great mindfulness skill that brings your brains attention to your body. This particular skill prepares your brain to release GABA to calm your body, endorphins to decrease any physical and or any emotional pain and shut down adrenaline receptors that your darn amygdala has activated. Practice this skill with some help.
- Whatever you do, do not look at your phone!!!!!!! As discussed earlier, the blue light that is emitted from our devices mimics daylight which shuts down melatonin production. if you need something to do, activity wise, have a book nearby, a word search puzzle at the ready, or even your favorite crotchet raring to go (my go-to for keeping my hands busy). These activities can help your prefrontal cortex and insula process the information without shutting down your pineal gland. Using dim lights, such as a table side light, will be fine. Just stay away from your phone!
- Do not sit up typing blog posts right before bed. (Oops I just called myself out) maybe right before bed is not the time to engage in highly stimulating research and writing. The blue light from the computer screen is just as damaging to restful sleep as our phones. If you must write, try to use good old-fashioned paper.
- Have a roll in the hay. No really, sex is a great way to release endorphins and the feel-good neurotransmitters of oxytocin and dopamine. Couple that with the quick (but not too quick) burst of physical exertion and you have a recipe for almost coma-like sleep.
Talk about a lot of valuable information about anxiety and sleep! Hopefully knowing what is happening inside your brain that is causing your sleep issues and a few easy skills to shut up your darn amygdala, will help to put your worries to bed.
implement the coping skill into your life. This week’s handouts (that’s right, handouts!) go over foods that promote melatonin release, helpful hints for falling asleep, and stay asleep. Enjoy!
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- American Academy of Sleep Medicine (2014). International classification of Sleep Disorders; insomnia. Retrieved from American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers (aasm.org)
- Bolge, S. C., Joish, V. N., Balkrishnan, R., Kannan, H., & Drake, C. L. (2010). Burden of chronic sleep maintenance insomnia characterized by nighttime awakenings among anxiety and depression sufferers: results of a national survey. Primary care companion to the Journal of clinical psychiatry, 12(2), PCC.09m00824. https://doi.org/10.4088/PCC.09m00824gry
- Bjorøy, I., Jørgensen, V. A., Pallesen, S., & Bjorvatn, B. (2020). The Prevalence of Insomnia Subtypes in Relation to Demographic Characteristics, Anxiety, Depression, Alcohol Consumption and Use of Hypnotics. Frontiers in psychology, 11, 527.https://doi.org/10.3389/fpsyg.2020.00527
- Breus, Michael (2021). Eat These 10 Foods High in Melatonin for Better Sleep. Retrieved from Eat These 10 Foods High in Melatonin for Better Sleep – The Sleep Doctor
- Dartmouth College (date unknown). Progressive Muscle Relaxation. Retrieved from Progressive Muscle Relaxation | Student Wellness Center (dartmouth.edu)
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- Kalmbach DA, Anderson JR, Drake CL. The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders. J Sleep Res. 2018 Dec;27(6):e12710. doi: 10.1111/jsr.12710. Epub 2018 May 24. PMID: 29797753; PMCID: PMC7045300. Retrieved from The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders – PubMed (nih.gov)
- Suni, Eric (2021). What Are the Different Types of Insomnia? Retrieved from What Are the Different Types of Insomnia? – Sleep Foundation
- Zhang, B., & Wing, Y. K. (2006). Sex differences in insomnia: a meta-analysis. Sleep, 29(1), 85–93. https://doi.org/10.1093/sleep/29.1.85