 Anxiety comes in many forms, from the general worry that comes from everyday life to the intense fear caused by major psychiatric disorders. As debilitating as anxiety can be to our mental and physical health, it’s also corrosive to our quality of sleep—whether you’re a college student pulling an all-nighter or a veteran jolted awake from a nightmare caused by PTSD. This guide covers how anxiety and sleep are interrelated, change with age, and what you can do to improve both. Anxiety and Sleep Nearly 40 million people in the US experience an anxiety disorder in any given year. More than 40 million Americans also suffer from chronic, long-term sleep disorders. Those numbers aren’t a coincidence. Anxiety and sleep are intimately connected: The less sleep you get, the more anxious you feel. The more anxious you feel, the less sleep you get. It’s a cycle many insomnia and anxiety sufferers find hard to break. anxiety and sleep are intimately connected: the less sleep you get, the more anxious you feel. Common anxiety symptoms like restlessness, increased heart rate, rapid breathing, and gastrointestinal (GI) problems make it difficult to fall asleep. Because insomnia and anxiety are so closely linked, one of the first steps in treatment is to determine which is causing the other — that is, which is the primary cause and which is the secondary symptom. “Sometimes, insomnia is secondary,” says psychotherapist Brooke Sprowl, “in that it is caused by another primary disorder such as depression, anxiety, or a medical condition. In this case, usually treating the primary disorder [improves] the insomnia.” Whether insomnia is the primary or secondary cause, natural remedies like magnesium glycinate and melatonin have been shown to help with sleep, says Sprowl. Non-medication treatments like cognitive behavior therapy along with good sleep hygiene are also effective at combating insomnia and anxiety. Health Risks of Insomnia Insomnia affects cognitive functions and cripples school and work performance. According to one study, 70% of college students with lower GPAs also had difficulty falling asleep. Insomnia also slows reaction times, raising the risks of driving a car or operating heavy machinery. Sleep deprivation is also bad for your physical health, increasing your risk for developing high blood pressure and heart disease. And long-term sleep disruptions may even raise the risk of some forms of cancer. Common Sleep Disorders There are many forms of sleep disorder besides insomnia. All interrupt sleep, threaten our health, and increase nervousness and stress. Here are a few common ones: Delayed Sleep Phase SyndromeAnyone who has changed time zones or experienced “jet lag” understands the effects of delayed sleep phase syndrome (DSPS). When your sleep and wake cycles don’t align with the current time zone, you feel groggy when you shouldn’t. While these symptoms are temporary for most, people with DSPS stay out of sync for long stretches of time, negatively affecting their work and activities. Because people with DSPS are forced to conform to the external clock rather than their internal one, they suffer from lack of sleep and increased anxiety. Obstructive Sleep Apnea Obstructive sleep apnea is when a sleeper’s relaxed airways close and obstruct breathing. Interrupted breathing episodes occur numerous times during sleep and are usually accompanied by snoring. Obstructed airways result in lowered oxygen levels and increased carbon dioxide in the blood. Sufferers are often unaware they have the condition. Sleep apnea increases the risk of heart disease, stroke, diabetes, and cancer. Sleep studies are required to diagnose obstructive sleep apnea. Forms of Anxiety How do you know if you have garden-variety nervousness or a more serious anxiety disorder? Usually, the difference is how significantly your anxiety affects your life. For someone at a party who doesn’t know anyone, a certain level of anxiety is normal. However, if their anxiety is interfering with daily activities (e.g. making friends, school work, job performance), They may have a serious anxiety disorder.Whether social nervousness or a serious phobia, every form of anxiety will affect your quality of sleep if it goes on long enough. Below are descriptions of the five major anxiety disorders. If you think you may have one, consult your physician or therapist about diagnosis and treatment.
What Is Seasonal Affective Disorder (SAD)? SAD or seasonal affective disorder is a depressive disorder that most often occurs in fall and winter. However, It is not to be confused with the common “winter blues” just described. Symptoms of SAD include fatigue (regardless of the amount of sleep one gets) and weight gain associated with overeating, particularly high-carb treats and sweets. It is associated with higher levels of distress and interference with daily functioning than what most experience in the darker, colder months. According to the American Psychiatric Association, SAD has been linked to a biochemical imbalance in the brain prompted by shorter daylight hours and less sunlight in winter. With seasonal changes, people’s biological clocks or circadian rhythms can fall out of step with their daily schedules. Symptoms of SAD may require the help of a mental health practitioner. Whether SAD or Just Blue, Take Action You (or anyone) can benefit by being proactive and taking steps now to improve your health and wellness so that you’re better prepared to deal effectively with the challenges of fall and winter. Following are tips to give you a better chance of preventing the winter doldrums:
If your depression is severe or if you have suicidal thoughts, please consult a doctor immediately, seek help at the closest emergency room or call the National Suicide Prevention Lifeline – 800-273-TALK (8255). REBECCA MORRA, MA, LPC
 Troubled sleep, insomnia, and oversleeping are classic symptoms of clinical depression. While not all depressed people have sleep disorders, many do. When evaluating patients for depression, doctors typically ask about sleep patterns as part of the diagnosis. Problematically, sleep problems worsen mood and can cause depression themselves, creating a vicious cycle. What is depression? The CDC estimates that just over 7% of Americans have moderate or severe depression. The severity and symptoms of depression vary, but the most common include:
As you can see, sleep problems are core symptoms of depression. Both depression and severe sleep problems are major risk factors for suicide and health problems like heart disease, other mental disorders, and smoking. People with depression have trouble being productive in work or school, which can impact their career and social life. The sleep issues are often one of the reasons depressed people seek out professional help. The symptoms of depression are persistent and pervade all aspects of an individual’s’ life, from work and play to basic needs like eating and sleeping. Within the larger category of depression, there are several different types of depression which come with their own sleep problems:
Anyone can become depressed, but it affects some people more than others, particularly women and adults in middle age. Coincidentally, these two groups are also more likely to have insomnia. The chart below from the CDC reveals the correlation between age and depression as well as the disproportionate prevalence between the genders:  The cyclical relationship between depression and sleep The sleep problems brought on by depression – or the ones that caused it in the first place – make it much more difficult to get better. Sleep deprived people have stronger emotional reactions in general, so it’s tougher to regulate the emotional volatility associated with depression. Abnormal sleep interferes with mood and energy levels during the day, so it’s difficult to stay motivated to engage with others, exercise, and even go to work. To cope, people who are depressed may self-isolate, which can lead to more sleep problems: loneliness itself is associated with fragmented sleep. The cause-and-effect runs both ways. Even if you’re not depressed, lack of sleep increases your chances of depression and other mental illnesses. Depression causes insomnia and hypersomnia. An article in the Journal Sleep reported that children with both insomnia and hypersomnia are more likely to be depressed, to be depressed for longer periods of time, and to experience additional problems such as weight loss. Particularly for young adults, there is a strong correlationbetween insomnia and major depressive disorder. Genes involved in the molecular clock and circadian cycle are known to be involved with bipolar disorder, although nobody exactly knows how. When scientists examine mice with mutations in the so-called CLOCK gene (important in the circadian cycle), they find the mice act like humans with mania. When the mice are given lithium (a treatment for bipolar disorder), their behavior reverts to normal. So it appears that this important part of the sleep control cycle is tied up with mood and mood disorders. Teens who don’t get enough sleep are at a significantly greater risk for depression and suicide. Treatment for depression-related sleep disorders The good news is that treating either depression or related sleep problems tends to improve the symptoms of the other. Getting good sleep is essential for overcoming depression. You may have seen stories of sleep deprivation as the new cure to depression, but be wary of these. Researchers have indeed found that a night of sleep deprivation reduces symptoms of depression the following day. However, they can experience a rebound effect (known as “residual insomnia”) the following day. Moreover, sleep deprivation on a long-term basis is simply impractical – and also dangerous, given the serious side effects for your mental, physical, and emotional health. Rather, the recommended treatment for depression typically combines psychotherapy and/or pharmacology. Psychotherapy One popular form of psychotherapy is cognitive-behavioral therapy (CBT). CBT focuses on helping the individual recognize the negative or destructive thoughts (the cognitive aspect) that make them feel depressed, and the behaviors they’ve become accustomed to responding with. Once they learn to recognize these thoughts and behaviors, they develop new ways of thinking or responding. A sub-type of CBT is CBT-I, which applies the same techniques to curing insomnia. Pharmacology Although both depression and insomnia can be treated without drugs, there are pharmacological interventions for both, and not coincidentally, both can be addressed with antidepressants. The most common antidepressant medications today are selective serotonin reuptake inhibitors (SSRIs). Those with insomnia who start taking one of those drugs often find relief for their sleeping problems. The pharmacological treatment for idiopathic hypersomnia is usually a stimulant – something that works opposite of sleeping pills. That’s why it is important for doctors to evaluate whether long-sleeping patients might have depression and be a better candidate for anti-depressant medication. Tips for getting better sleep with depression In addition to the therapies suggested above, the following advice can help you get better sleep while you’re getting treated for depression and related sleep problems. 1. Keep a sleep diary. If you believe you are suffering from depression and/or a comorbid sleep disorder, keep a sleep/mood diary for 2 weeks to share with your doctor. Note when you go to bed, how long it takes you to fall asleep, when you wake up, and how much time you spent asleep. Also note your level of fatigue or energy throughout the day, as well as any changes in mood, diet, libido, or thought patterns. 2. Turn your bedroom into a sleep haven. Use your bedroom exclusively for sleep and sex. Everything else, from watching television to working to socializing, should take place elsewhere. You want your mind to see your bedroom as a place of rest, not of worry, stress, or social activity. Keep your bedroom as cool and as dark as possible by removing electronics and using blackout curtains if necessary. Invest in a comfortable, supportive mattress that makes sleep come easier. 3. Stick to a regular sleep schedule. Go to bed and wake up at the same time every day, even weekends. Ensure you leave enough room for you to conceivably get at least 7 hours of sleep, but don’t worry about whether you spend all of that time asleep. Your only goal is to stick to the schedule; eventually your brain will catch up and train itself to sleep and wake at those times more naturally. Avoid napping if you can. If you’re absolutely exhausted, limit them to short power naps of 30 minutes or less. 4. Create a calming bedtime routine.Depression and anxiety-producing thoughts are a recipe for insomnia. Help ease your mind of worries with a calming bedtime routine. Try relaxation techniques, deep breathing exercises, or meditation. Take a warm bath or light some candles. If your mind continues to race at night, take time to write your thoughts down in a worry journal – getting them out of your head and onto the page will diminish their power. Relieve anxieties by listing out any remaining to-do items you can take care of tomorrow. 5. Get plenty of sunshine. Natural sunlight facilitates a healthy sleep-wake cycle. Aim to get plenty of sunshine, ideally by exercising outdoors in the morning or early part of the day. This will give you an energy boost that makes it easier to feel better and less fatigued during the day time. Then, as it gets dark, your brain will recognize it’s time to wind down and fall asleep. While you’re at work or school, sit by the windows to increase your amount of sunlight. 6. Eat well and avoid stimulating substances. Foods that are high in sugar or fats mess with your sleep, your health, and your mood. Instead, fill your diet with foods that promote healthy energy levels and sleep. Also take care to avoid any stimulating substances in the afternoon or evening that interfere with sleep, such as caffeine, alcohol, or nicotine. 7. Stay calm when you wake up. Unfortunately, retraining your body to sleep well is not an overnight process. Expect – and accept – that you’ll continue having disturbed sleep during this process. When you do wake up, practice your deep breathing or progressive muscle relaxation exercises. Meditate or visualize something that makes you feel happy or calm. Turn on a soft lamp and read a book. Stay calm and sleep will come.
 According to Anxiety and Depression Association of America (ADAA), anxiety is a reaction to stress. Its keymarkers are feelings of tension, worried thoughts, and physical changes such as elevated blood pressure. Just like physical pain, in and of itself anxiety is not a bad thing: it signals that something is wrong. Temporary anxiety is normal and can count as healthy, because it draws our attention to causes of stress that might need correcting. But anxiety disorders–the excessive and chronic reactions to stress–are mental illnesses. Anxiety disorders are, in other words, worry that sticks way past its usefulness to us; it does not go away and often gets worse with time. According to National Institute of Mental Health, anxiety disorders–from post-traumatic stress disorder, through obsessive compulsive disorder, to a variety of phobias–are the most common mental disorders experienced by Americans. They affect 40 million adults over 18 in the United States, or 18 percent of the population. Many anxiety disorders negatively affect sleep–and vice versa. Doctors call them comorbid: they go hand-in-hand. In other words, anxiety and sleep are connected via a self-reinforcing feedback loop. Feeling rested has been proved to combat anxiety and feeling less anxious leads to sounder sleep. The converse is also true: insomnia feeds anxiety and anxiety keeps us up at night. According to The Cleveland Clinic, two-thirdsof patients referred to sleep disorders centers have a psychiatric disorder. “Anxiety is an emotion that actually wakes us up,” Dr. Steve Orma, author of Stop Worrying and Go to Sleep: How to Put Insomnia to Bed for Good,told The Huffington Post. “There are all kinds of physical changes happening that ramp you up, which is the exact opposite state of what you need to be in when you’re trying to fall asleep.”  This guide gets at the link between anxiety and sleep and covers several anxiety disorders that interfere with sleep and which can be alleviated with sleep: generalized anxiety disorder (GAD); social anxiety; obsessive-compulsive disorder (OCD); phobias; post-traumatic stress disorder (PTSD); and panic disorder. It offers solutions to the sleep deprived anxiety sufferers, from treatment options, through online forums, tips regarding healthy sleep hygiene and banishing anxious thoughts, to medical associations that can help. Anyone who lost a night to insomnia on account of troubling thoughts has been where many chronic anxiety sufferers find themselves all too frequently. According to UC Berkeley researchers, lack of sleep plays a role in ramping up brain regions that trigger excessive worry. Additionally, those who tend to worry too much are more vulnerable to sleep disorders. “These findings help us realize that those people who are anxious by nature are the same people who will suffer the greatest harm from sleep deprivation,” said Matthew Walker, a professor of psychology and neuroscience at UC Berkeley and senior author of the study. Worry about lack of sleep becomes a self-fulfilling prophecy at times. Anxiety causes sleep loss, which in turn can provoke further anxiety in sufferers. The mechanism behind this phenomenon has to do with what researchers call anticipatory anxiety. People prone to sleep deprivation worry that they might not be able to sleep, perhaps based on past experience. That worry fires up the brain’s amygdala and insular cortex, mimicking the neural activity seen in anxiety disorders. And now, indeed, because of the anticipatory anxiety, sleep becomes elusive. Researchers at University of California Berkeley’s Sleep and Neuroimaging Laboratoryfound that when deprived of sleep, the brain reverts back to more primitive patterns of activity. What this means is that subjects kept awake were less likely to put emotionally-charged information in context. The good news is found in the reverse. Doing the opposite–finding ways to get better sleep–presents us with a tried-and-true solution to alleviate anxiety. “By restoring good quality sleep in people suffering from anxiety, we may be able to help ameliorate their excessive worry and disabling fearful expectations,” says Dr. Allison Harvey, one of the authors of the study published in the Journal of Neuroscience. This article on the correlation between sleep and anxiety was shared with us from Tuck.
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