Sleep - that singular activity that takes up more than one-third of our time on earth. I will try to spend several blogs on the topic of sleep. As for sleep, we all need it and we often don’t get enough of it. There are many conditions that affect sleep. Sleep can be altered because of anxiety, depression, substance use (such as caffeine or other stimulants) or prescribed medication, or even organic medical conditions. Sleep can also be adversely affected by an identifiable known stressor in one’s life, such as the loss of a loved one or loss of a job.
Patients with anxiety often suffer from sleep problems. “Insomnia” is a phrase we often hear. What is insomnia? Roughly, it is the inability to sleep adequately for an extended period of time when one desires to do so. Insomnia is not in and of itself a psychiatric diagnosis, but often a symptom of one. Let us be more specific, and divide insomnia into three types: early, middle and late. Early insomnia is the most famous. It is when we try to fall asleep, but can’t. This is the famous image of anxious souls tossing and turning in their beds, unable to fall into a slumber. Middle insomnia is characterized by frequent waking during the night. Late insomnia occurs when we consistently wake up earlier then we intend to. For example, we may set our morning alarm clocks for 7:00AM, but awake at 4:00AM instead, unable to complete the remainder of our intended sleep.
Early insomnia is often characterized by anxious or ruminative thought about things that worry us. Specific causes of anxieties often differ from person to person. For some people it’s the taxes, for others it’s a family dispute. For others still, it’s about politics at the water cooler. Whatever the specific cause, anxiety that causes insomnia often has a ruminative quality. Specifically, we find our minds gravitating toward the topic that causes us anxiety. Although it causes us distress, we still find our minds wrapped around the knowing subject, even if we have not resolved anything nor become wiser for it. Although often distressing as a topic, we nevertheless return to the subject in a stereotyped, circular manner.
In middle and late insomnia, we often find ourselves “flooded” with anxious thoughts as soon as we open our eyes. This “flooding” revs up our stress level; our eyes almost become “pried open” with anxiety which is often supplemented with physiologic responses such as increased heart rate and a sense of restlessness.
If you experience either early middle or late insomnia consistently for an extended period of time, and there is no singular, identifiable stressor causing your insomnia, then you might be suffering from an underlying depression or anxiety syndrome. If you feel this might be the case, consult either your primary care doctor or you mental health provider.
Over the next several blogs, we will touch upon ways of treating and thinking about insomnia other then with medications. We will also touch upon how medications can be helpful. Finally, we will look at insomnia as it is connected to lifestyle as a whole.