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  • Mariam Daneshgar

Anxiety & Insomnia: The Two Best Friends

Anxiety and insomnia, each on their own, can create a lot of pain for an individual. But often they occur at the same time and can have a compounded impact on one's life, and on those around them. This blog post will explore how these two conditions are connected and how they affect you, me, and everybody else who might be struggling.

Two girls holding hands
Anxiety & Insomnia: The Two Best Friends

A Very Brief Overview of Each:

Insomnia is a sleep disorder that can cause difficulty with falling asleep or staying asleep throughout the night. It can be chronic or acute (short-term) and can present differently depending on the type. I describe insomnia in more detail HERE. There are several reasons that can cause insomnia, such as medical disorders, mental health conditions, or lifestyle. You can read more about these common causes HERE. As the most common sleep disorder, insomnia can cause significant disruptions to one’s day-to-day life, including their physical and emotional wellbeing.

Anxiety, on the other hand, is an intense feeling of fear and worry and may include uncomfortable and reactive physical symptoms. In the right amount and at the right time, it is very helpful and necessary. However, when anxiety is excessive and out of proportion to the situation or persistent, even in the absence of a trigger, it can become a debilitating disorder. Some of the symptoms may include panic attacks, extreme worry about things going wrong or not happening at all, or even agoraphobia which is an intense fear of public spaces and social interactions. For more information on the difference between Anxiety, Stress, and Worry read my blog HERE.

Both anxiety and insomnia can have severe impacts on one's quality of life; however they can also feed off each other in a vicious cycle where each makes the other worse!

The Relationship Between Anxiety and Insomnia

It is not uncommon for people with anxiety to also suffer from insomnia. In fact, research has shown that around 50-70% of people who struggle with anxiety will also experience problems sleeping. Conversely, 30-50% of people who have trouble sleeping will also experience symptoms of anxiety.

Aside from the co-occurrence of anxiety and insomnia, the relationship between the two is bidirectional; that is, each disorder can either trigger or make the other worse. Those with insomnia are three times as likely to develop an anxiety disorder and individuals with an anxiety disorder are five times as likely to develop insomnia.

How Are They Connected?

The relationship between the two is not fully understood, but there are several theories.

The first is that people with anxiety may experience more racing thoughts and/or worry that those thoughts can carry into the night and make it difficult for them to fall asleep. This ‘mental hyper arousal’ can further keep them from staying asleep throughout the night. Additionally, being in the ‘fight or flight’ state and having an overactive sympathetic nervous system can trigger the stress hormone cortisol, which is meant to keep the person alert and aware. This ‘alert’ system is in direct conflict of the ‘sleep’ system, and for survival purposes (evolutionarily speaking) always overrides the sleep system, preventing the person from falling asleep or sleeping deeply.

On the other hand, those who are struggling with insomnia often worry about nightly sleep and their abilities to carry on the next day and how their fatigue will impact them. Sleep deprivation has also been shown to trigger the regions in the brain that are responsible for emotional processing and regulation, which are the same regions and mechanisms that are sensitive to anxiety. A study at the University of California, Berkeley demonstrated that a night of no sleep resulted in significantly more activity in the emotion-generating regions in the brain that process negative emotions. The lack of sleep also lowered activity in the area of the brain that controls negative emotions, demonstrating a possible neuropathological relationship between the two.

Treatment For Both

Experiencing both anxiety and insomnia can create a vicious cycle that makes symptoms of both conditions worse; leading an anxious person to develop even more problems sleeping and creating a never-ending spiral. However, both conditions are treatable!

One treatment method that works very well with both conditions is Cognitive Behavioural Therapy (CBT). It addresses two very important domains that influence wellbeing: the way we think and how we behave in relation to those thoughts (or events). This type of treatment helps clients work on changing unhelpful ways of thinking and behaviours that are contributing to their insomnia or anxiety. It also places an emphasis on helping individuals learn to be their own therapists, which helps with maintaining the positive outcome for longer.

With many years of evidence-based research backing, CBT has been found to be an effective treatment for both conditions. It has also been further tailored to treat insomnia specifically (Cognitive Behaviour Therapy for Insomnia- CBT-I). CBT-I is a short-term structured process that explores the connection between thoughts, behaviour, and sleep. CBT-I has been shown as the most effective treatment for insomnia with a 70-80% improvement rate (even above medication). Due to this reason, The American College of Physicians recommends CBT-I as the first line of treatment for insomnia. Additionally, CBT can also be integrated with other therapies or combined with medication, if the need is determined.

Impacting You

If you are struggling with anxiety, insomnia, or have both of these disorders simultaneously it can be incredibly challenging. Be kind to yourself and know that you are not alone. If you feel like your symptoms are getting worse and impacting your life in a negative way, there is help available! There are effective treatment options for both conditions, so please do not hesitate to reach out for help.


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