When worries stop sleep and then you worry about not sleeping ABC Health & Wellbeing

By Cathy Johnson, 13 October 2016

Being awake at an ungodly hour, your mind a tangle of anxious thoughts, is a wretched experience.

Whether you’re thinking about work or family worries, the events of the day, or tasks you face tomorrow, it tends to kill off the chance of sleep.

It’s a common problem, with “thoughts” second only to “needing to go to the toilet” in the list of sleep disrupters identified by the 20,018 people who completed the ABC’s Sleep Snapshot survey a few weeks ago.

And when asked to describe in their own words what sabotaged their sleep, the words “work”, “anxiety,” “stress” and “worry” were frequently used.

All too often, there’s a snowball effect with the initial worries compounded by concern about the impact the poor sleep will have on productivity the next day.

Three-quarters of our snapshot respondents said they worried about sleep at least some of the time and 23 per cent of people often did.

Edie Eicas, a 66-year-old poet, artist and editor from Adelaide, often wakes in the middle of the night and finds intrusive thoughts stop her going back to sleep, sometimes for periods up to several hours.

She’s experienced this for around 20 years. Sometimes it’s nearby traffic noise that wakes her up.

She believes a traumatic marital separation may have been the initial trigger for her sleep issues.

“If my mind’s going a mile a minute, I try and distract myself by listening to podcasts … Sometimes they work, but sometimes I stay awake because they’re interesting,” she said.

“When sleep’s really bad, I do worry because I recognise that I’m not up to speed [the next day]. I hate not being productive to the level I expect of myself.”

Ms Eicas was one of the many people who got in touch when we asked you to share your sleep stories as part of Reboot Your Life this month.

We asked sleep physician Professor David Hillman from the Sleep Health Foundation for some tips to help Ms Eicas get better rest.

Sleep tips for Edie

  • Try something other than listening to podcasts to help get back to sleep: The fact podcasts sometimes stimulate suggests they are not the ideal activity. She needs to try something more relaxing. Perhaps books or audio books that are not too arousing in their story lines could be worth a try.
  • Don’t stay in bed to do activities to help get back to sleep: If Edie can’t readily drop off to sleep again within say 20 minutes, she should get up out of bed to do a relaxing activity, keeping the lights low, and return to bed only when she starts to feel sleepy again. The brain needs to learn to associate being in bed with being asleep. Lying in bed awake and frustrated, or doing a stimulating activity, gives your brain mixed messages that can weaken its ‘drive’ to send you to sleep.
  • Accept that sleep isn’t perfect for everyone, but especially if you’re over 65: Edie needs to understand that waking in the night is a normal part of sleep sometimes. If you’re over 65, this may be especially so because the sleep cycle is a bit less robust in older people (thought to be linked to weaker rises in the sleep hormone melatonin in the brain, compared to younger people.) Believing night waking is a sign of failure or a disastrous problem will only make you more anxious and so make it less likely you’ll return to sleep rapidly.
  • Don’t spend too long in bed, hoping to get sleep: When sleep is fragmented, it’s tempting to go to bed earlier, and stay in bed later the next day to try to ‘catch up’. In fact, this can weaken the drive to sleep. Edie should try limiting her total time in bed to the hours of sleep she actually needs. So she should avoid staying in bed 9.5 or 10 hours when she only needs 7.5-8 hours (older people have slightly reduced sleep needs, but this does vary from person to person). It might be tough going for a few nights, but done regularly, restricting sleep helps to consolidate it, so awakenings are shorter.
  • Try to reduce noise in the sleep environment: Earplugs are cheap and there are online stores that have a large variety of styles and sizes to try for a comfortable fit. Other options include double glazing on windows, or moving to another room in the house, further away from the street, to sleep.
  • Consider seeing a counsellor about unresolved psychological issues: Primary insomnia that has no other obvious cause can often be traced back to some traumatic event where sleep first became dislodged. Long after the issue was settled, the problem may persist. Occasionally, the event has been resolved at only a superficial level and there are still some gnawing deep-seated issues. If Edie thinks this might be the case, it could be worth trying some psychological therapy to try to resolve things.

Set aside worry time

If the busy mind scenario sounds familiar, Professor Hillman suggests setting aside some deliberate “worry time” earlier in the evening to reflect on the day’s activities and how you’re going to deal with them.

“You can use a pencil and paper if you want to be formal about it,” he said.

“A lot of people only think about things when they’ve got to bed. That’s the wrong time. The advice is to get some of the processing done in advance of going to sleep. Don’t leave thoughts in suspense to be worked on overnight.”

He also suggests a good ‘wind down routine’.

“It can be as formal or as informal as you like, right through to meditation and muscle relaxation exercises. Some of these techniques are really just more elaborate forms of the ancient counting sheep ploy,” he said.

“They distract your mind a little bit and put it into a relaxed mode. You can’t invent a one-size-fits-all solution.

“I mean whale music would just drive me bananas but some people find it quite useful.”

Changing sleep thoughts

But solving a sleep worry problem often depends on more than changing behaviours, said sleep psychologist Professor Dorothy Bruck of the Sleep Health Foundation. Often it involves changing the way you think about sleep too, to be less perfectionistic about your sleep goals.

“Some people have a few problems sleeping and then they start to dread going to bed every night because they see themselves as failing in terms of getting the perfect night’s sleep. And then [they’re] almost ‘over catastrophising’ about the consequences of that the next day,” she said.

Professor Hillman agrees.

“People tend to underestimate how much sleep they’re getting and overestimate its catastrophic impacts. This fear of not coping actually has a destructive effect on attempts to sleep,” he said.

It can be helpful to reframe your anxious thoughts to something like “I might be a bit tired tomorrow, but I’ll cope”, he said.

Changing these thinking patterns can be tricky if they’ve existed a long time, he concedes. There are some excellent self-help books and online resources that can help. (The Sleep Health Foundation lists some low-cost online sleep improvement programs you can try.)

Such online tools can be helpful if you live in a rural or remote location or have a busy schedule that makes appointments with a health professional difficult.

“These online tools have been studied and compared to cognitive behavioural therapy face-to-face with a clinical psychologist. While there are advantages to face to face contact, these things stand up pretty well alongside that,” Professor Hillman said.

The sedative trap

While it might be tempting to try sleeping medications, Professor Hillman is adamant non-drug measures are the best way to go.

“Sedatives have a very very small part to play [in solving sleep problems],” he said.

“They’re for bereavements and temporary upsets, not for long term. You start taking them and you get hooked on them psychologically and physically and when you try to withdraw from them, the sleep gets temporarily more disrupted.”

This can make it difficult to stop taking them.

If you still have issues after trying self-help, your GP can refer you to a clinical psychologist. Sometimes just a few sessions can make a big difference.

“If you own efforts to improve your sleep are not enough, don’t just accept the problem, consider getting a bit of extra help,” Professor Hillman said.

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