science of us

6 Sleep Experts on What to Do When You Worry Yourself Awake

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If you’re a human being who requires sleep, the last year might have thrown a wrench into your snooze time. The more chaotic the political news cycle, the more often I find myself having trouble falling asleep — and sometimes, worrying myself awake in the middle of the night. But even if you’re not a news hound like me, the stress attached to work, school, money, and relationships can be enough to jolt anyone awake.

According to the National Sleep Foundation, this kind of nighttime waking and inability to fall back to sleep, often coupled with fear or worry, is called “maintenance insomnia.”And if you have an underlying anxiety disorder, it can wreak havoc on your sleep cycle on top of those everyday stressors. Lack of sleep or poor-quality sleep then exacerbates anxiety, so it’s a destructive cycle.

Fortunately, we talked to six sleep experts who say it’s possible to stop worrying yourself awake. For me, that probably means turning off the news early and deleting my Twitter app. For you, it could mean 15 minutes of meditation or reading a book until you’re fully tired. Whatever your wind-down looks like, the experts we spoke to emphasized that preparing for rest before you lie down is key.
Remember, sleep is a vital part of your overall health — so if something feels off and you can’t resolve it on your own, talk to your doctor.

“When individuals begin to feel anxious or worried about something during the daytime, they can engage in coping strategies to help distract their attention from these worries, such as calling a friend to talk on phone or turning on their favorite TV show. However, once the distractions of the day are pushed aside, rumination and worries often come to the surface. At night, engaging in some of these coping strategies to distract from the worry may actually cause more difficulty falling asleep because they may be too stimulating. Difficulty falling asleep may unleash its own set of worries and fuel the cycle of anxiety and insomnia.

One of my favorite strategies is setting time aside to worry in the late afternoon or early evening. I sometimes call this a ‘brain dump’ — the goal is to write down any worries or unfinished tasks from the day, as well as creating a plan on steps to take to resolve the worry or stressor. It sounds paradoxical in nature — ‘I want you to sit there and just worry’ — but most people are curious enough to give it a shot. The rationale behind this strategy makes sense to people as well, since we often spend so much of the day running around trying to get our daily tasks done that we have no time set aside to just sit there with our thoughts. It’s no wonder these thoughts creep up at nighttime — it’s quiet, nothing else is distracting us, and it’s one of the only times we are giving our mind a chance to slow down and catch up.”

Michelle Drerup, Psy.D., is the director of behavioral sleep medicine at Cleveland Clinic.

“We actually awaken briefly several times across the night without full awareness, because the brain is always processing information. Stress, worry, and anxiety can make us more susceptible to fully perceive these awakenings — just like we’d be more likely to be aware of increased awakenings if the bedroom was too hot or cold, too noisy, or if we had an ache or pain.

First, stop ‘trying’ to sleep — it invariably results in more frustration and anger, and then you’ve lost the battle. My recommendations would vary greatly depending on what type of worry or anxiety the person has. For example, I always want to know if the anxiety is productive. Is there some plan of action one can think about in the hours before bed that will actually help to reduce the anxiety? If so, work on that and practice the healthiest sleep habits until the period of anxiety has passed. If it’s not productive worry (and is more of the rumination type), again, practicing healthy sleep habits is critical. But I would also recommend reading an actual physical book — something enjoyable. The goal here is to refocus the mind on something else and get it out of the loop of anxiety. The book should be something light that you enjoy, and that has nothing to do with daytime activities (work, school, politics, etc.).

Meditation and other relaxation approaches are also wonderful but only for those who already have a steady meditation practice or who are comfortable with these techniques. Trying to learn meditation in the middle of a stressful period and expecting it to work after only a few nights will likely lead to more frustration, and may turn one off to a very helpful practice that could eventually be helpful at another time.”

Rebecca Q. Scott, Ph.D., is board-certified in sleep disorders medicine by the American Academy of Sleep Medicine. She sees patients in private practice on the Upper West Side of Manhattan and at NYU Langone Comprehensive Epilepsy-Sleep Center.

“One of the things I recommend for people who worry a lot when they get into bed or during nighttime awakenings is to set aside ‘worry time’ during the day. So if someone is spending an hour every night laying awake in bed worrying about relationship problems, work problems, financial problems, or anything else, I ask them to carve out a time during the day when they can sit in a quiet place and dedicate an hour to worrying. This helps them put the worrying into the daytime, where it belongs. The person has more awareness during the daytime, and is able to think more critically and logically about what’s bothering them. At night, the person may be more vulnerable, and may have fewer resources to really deal with whatever problem is bugging them. So, we take the daytime activity of worrying out of the nighttime, and we put it back where it belongs. Some people will come back to me and say that the problems they have don’t seem worthy of worrying about during the day. That can be an eye-opener. If the problem isn’t worth attending to during the day, why bother worrying about it at night?

In addition to this technique, cognitive behavior therapy (CBT) can be very helpful in dealing with worry, anxiety, and associated sleep difficulties. Some people may really benefit from medication.”

Gary Zammit, Ph.D., is a board-certified sleep specialist and a fellow of the American Academy of Sleep Medicine. He is the founder and director of the Sleep Disorders Institute in New York City.

“I recommend strategies to manage anxiety better during the day and at bedtime. Exercise and meditation are very helpful in managing anxiety during the day and early evening. It’s also important to create a separation between day and night by turning off phones, tablets, and computers in the evening so the mind has a chance to slow down before bed. I recommend reading fiction at bedtime because it occupies the mind away from anxious thoughts and allows the body’s fatigue to take over. Sleep hygiene is especially important when stress is disrupting sleep. It’s tempting to sleep late or go to bed early to make up for lost sleep, but altering the sleep schedule makes it harder to rebound from a bad night. Sticking to a consistent wake-up time will help the person to fall asleep more easily the next night and get back on track.

Sleep aids, like Ambien or Lunesta, can be helpful for short-term sleep disturbances, but it’s easy to start relying on them too much — and they can actually increase anxiety and undermine a person’s confidence in her ability to fall asleep naturally. Most sleep disturbances resolve on their own when the stress or trigger passes. However, if a person is struggling with sleep or regularly taking sleep aids for more than a couple of weeks, it’s a good idea to see a psychologist who specializes in CBT-I, [a specific type of CBT for insomnia]. And if anxiety is persistent and disruptive, psychotherapy and/or medication can help.”

Janet Kennedy, Ph.D., is a clinical psychologist and founder of NYC Sleep Doctor.

“I find many people with this issue have dual concerns — they worry about a problem, then they worry that they’ll forget the problem if they fall asleep, so they stay awake all night repeating and refining the problem. So on a practical level, I recommend that people with these kind of sleep and anxiety issues keep a notepad next to their bed and empty all their worries onto it before they go to sleep. Write down everything you’re worried about, tell yourself you’ll reread the list and resume worry in the morning, and then take the night off, knowing all of your worries are safe and sound. It seems absurd, but for many people it’s just the kind of mind game they need to clock out and get some sleep.

Longer-term talk therapy can help people to not only manage symptoms, but to understand and treat the underlying cause of their anxiety and sleep problems. For example, many people with trauma or abuse in their past, or who experienced a great deal of pressure to be perfect or always succeed, or those who have difficulties with grief and loss, can find it difficult to sleep because their mind is trying to resolve or avoid the questions and emotions associated with it. Therapies that go beyond symptom management help people work through these issues and come to a place of acceptance that allows them to relax and sleep easy. “

Ryan Howes, Ph.D., is a clinical psychologist in Pasadena, C.A.

“The brain is always actively processing activities of the day and scanning the memory networks by running ‘virus checks’ on the integrity of this information. As the brain is programmed to scan for threats for optimal survival, particularly during REM sleep, it’s biased toward information that might be viewed with suspicion. If the emotional load is too weighted, these worries might awaken the sleeper both in the form of bad dreams as well as insomnia.

In order to maintain restful sleep, it’s helpful to go to bed in a deactivated state. Breathing, guided imagery, mental and physical relaxation techniques, and mindful meditation are some of the many tools one can employ. But the key to stilling the night mind is by tending to the mind when awake. Take regular breaks, [deeply] breathe often, exercise, eat well, avoid excessive caffeine and alcohol, and try to avoid excessive stimulation in the evening, especially the use of electronics. Sufficient wind-down time prior to sleep is often critical here. And never go to bed unless you’re sleepy, not just tired. The stronger the sleep drive, the more restful the sleep.”

Ross Levin, Ph.D., is a clinical psychologist and behavioral sleep specialist in New York City. His practice is devoted to treating sleep disorders, especially insomnia. 

Interviews have been edited for length and clarity. 

What to Do When You Worry Yourself Awake