Ever dreamed that you were late for a big exam? Or that you could not find your classroom on the first day of school?

Stress Degrades Sleep

Many people experience restless sleep in the face of stress, and many scientific studies confirm this. In one such test, subjects were told that they would have to give a speech the next morning, which caused the subjects to take longer to fall asleep (called sleep onset latency). Similarly, another study involved showing male test subjects a stressful video about Australian aborigine penile subincision before sleep, and results showed the subjects had increased sleep latency, number of awakenings, and anxious dreams. Another study looked at the sleep of medical students before their board exams and found less slow wave sleep and more awakenings than average.

Anxiety and Sleep Problems Correlated

As the above studies show, sleep and anxiety are closely related. Poor sleep can induce anxiety and anxiety can produce poor sleep. This complex interaction between sleep and anxiety is not yet completely understood by scientists and doctors. What they do know is that roughly half of patients diagnosed with insomnia also have a psychological disorder. Furthermore, one of the characteristics looked for when diagnosing general anxiety disorder (GAD) is insomnia.

Prevalence

With one and three Americans complaining of insomnia and over one quarter of Americans exhibiting symptoms of anxiety disorders at some point in their lives, it is important for our society to be aware of the connection between sleep disorders and anxiety disorders. If we are aware of the effects anxiety has on our sleep, we can take measures to prevent sleep problems in stressful times in their lives.

Anxiety Disorders

The term anxiety disorder encompasses a variety of subcategories. The main anxiety disorders that have been addressed in sleep-anxiety disorder studies include GAD, panic disorder, post-traumatic stress disorder (PTSD), and obsessive compulsive disorder (OCD).

General Anxiety Disorder (GAD)

Patients with GAD exhibit all kinds of insomnia. Studies have shown that on average, GAD patients have longer sleep onset latency, have a harder time staying asleep (middle insomnia), and have less deep sleep (Stage 3 and 4 non-REM sleep). These patients also complain about excessive sleepiness during the day.

Panic Disorder

Panic disorder patients are mainly disturbed by nocturnal panic attacks. These nighttime panic attacks cause confusion and sleep disruption in roughly 70% of patients with panic disorder.

Post-Traumatic Stress Disorder (PTSD)

In contrast, PTSD patients experience sleep disruption through nightmares and night terrors. Studies have also found that PTSD patients do not accurately assess the quality of their sleep. They think they took longer to fall asleep and woke up more in the night than they actually did.

Obsessive Compulsive Disorder (OCD)

Unlike the other anxiety disorder patients, OCD patients did not exhibit any common sleep disruptions as a group. Individuals may have insomnia due to their bedtime rituals, like obsessively checking if the bedroom door is locked, but OCD does not appear to have direct connections with sleep problems.

Perception of Sleep

One study revealed that a big difference between subjects with anxiety disorders and controls is how they perceived their sleep. The anxiety disorder subjects accurately assessed their time to fall asleep and the number of times that they awoke in the night, whereas the controls underestimated these values, leading the controls to think they got more sleep than they actually did. This would indicate that anxiety disorder patients may be plagued more by noticing imperfections in their sleep than actually having disturbances in their sleep.

Prevention



Even if you do not have an anxiety order, there are several steps you can take to prevent unpleasant sleep in the face of stress.

1) Turn off the TV and computer before bed. Doctors suggest turning off all of electronics within an hour before bed, because the flickering screen can stimulate the brain.

2) Have a bedtime routine. Do you like to drink herbal tea before bed? Or do you read a short story before turning off the light? Perhaps you like to get ready for sleep by mediating for five minutes. If you have a routine for the bedtime period, the routine acts as a reminder to your brain that it is time to get sleepy and ready for bed.

3) If you cannot sleep, get up! If after 15 minutes in bed you are still wide awake, get up and read or do something relaxing. When you are ready, get back and try sleeping again.

4) Prioritize sleep. If you know you have a stressful week ahead of you, make sure you include sufficient time to sleep in your schedule. Not sleeping will just make a stressful situation worse. Bad sleep can cause anxiety and anxiety can cause further bad sleep, leading you into a spiral of anxiety, stress, and sleep deprivation.

References:

Catherine Bourdet and Françoise Goldenberg, “Insomnia in anxiety: Sleep EEG changes”, Journal of Psychosomatic Research, Volume 38, Supplement 1, 1994, Pages 93-104.

Chris Idzikowski, “Insomnia and depression—Sleep EEG changes”, Journal of Psychosomatic Research, Volume 38, Supplement 1, 1994, Pages 27-40.

Colleen Carney, Insomnia and Anxiety, Springer, New York, 2010.

Constance Guille, Bernadette M. Cortese, and Thomas W. Uhde, “Chapter 55 – Sleep in Anxiety Disorders”, Therapy in Sleep Medicine, W.B. Saunders, Philadelphia, 2012, Pages 682-694.

Frederick Bkeland, David Koulack, and Richard Lasky, “EFFECTS OF A STRESSFUL PRESLEEP EXPERIENCE ON ELECTROENCEPHALOGRAPHRECORDED SLEEP,” Psychophysiology, Volume 4, Issue 4, 2007, Pages 436-443.

Holly J. Ramsawh, et al., “Relationship of anxiety disorders, sleep quality, and functional impairment in a community sample,” Journal of psychiatric research, Volume 43, Issue 10, 2009, Pages 926-933.

Jaime M. Monti and Daniel Monti, “Sleep disturbance in generalized anxiety disorder and its treatment”, Sleep Medicine Reviews, Volume 4, Issue 3, June 2000, Pages 263-276.

Victor I. Spoormaker and Jan van den Bout, “Depression and anxiety; relations with sleep disturbances,” European psychiatry, Volume 20, 2005, Pages 243-245.