Disorders and their Effects on Insomnia
Anxiety Disorder and the Effects on Sleep
Excessive Worry and Insomnia
When stress takes hold of your life, you may find it hard to shake the resulting anxiety. It may manifest as persistent worry or a tension that won’t leave your muscles. What is generalized anxiety disorder? How does anxiety affect sleep? How might it contribute to insomnia? Learn about the relationship between stress, anxiety, and difficulties sleeping.
What Is Generalized Anxiety Disorder?
No matter your station in life, stress is common. It may lead to worries that won’t go away. If these problems overwhelm your ability to cope, it may be hard to function during the day and impossible to sleep at night. What are the symptoms of generalized anxiety?
Although 18% of people complain of anxiety in a given year, generalized anxiety disorder (GAD) is less common (estimated to occur in 3% of people). It affects twice as many women as compared to men. GAD is defined a chronic, excessive, and pervasive anxiety or worry that lasts for at least 6 months. It is present more days than not. In addition, the anxiety that characterizes the condition affects numerous aspects of life, including work or school as well as other activities. This anxiety is difficult to control. There are often other symptoms associated with GAD, including:
- Restlessness or feeling "on edge"
- Easy fatigue
- Poor concentration
- Muscle tension
- Insomnia or restless sleep
GAD is a chronic condition and it rarely completely remits on its own. It often has a waxing and waning nature, with times that it may be better or worse. It often coexists with depression. GAD has important effects on sleep.
Anxiety and Insomnia
The anxiety that characterizes GAD often interferes with the ability to sleep and leads to insomnia. This is not unexpected. Anxiety might be viewed as an inappropriate escalation of a response called arousal. It is believed that arousal evolved to keep us alert to threats, so that we can respond appropriately and protect ourselves. It is helpful to be nervous when hungry lions are on the prowl. However, when this system inappropriately goes into overdrive, there are negative consequences.
Sleep disturbance is one of the key problems that may develop, impacting 56-75% of people with GAD. Imagine arousal as a bell being rung. It draws your attention, makes you sit up and take note. It also grates on your nerves a little. When the bell keeps ringing through the night, it is hard to sleep. This may result in trouble falling asleep, staying asleep, or sleep that is simply not refreshing. These are collectively called insomnia.
The worries that lead to increased anxiety and tension may come to the forefront when lying down to sleep at night. Once the distractions of the day are pushed away, ruminations about your career, finances, or relationships may come to the surface. Difficulty falling asleep may unleash its own set of worries about the impacts on function the following day. Sleep deprivation may lead to other problems that often characterize GAD, including difficulties with concentration and mood.
When the sleep of people with GAD is studied, there are certain findings that are observed that fit with a diagnosis of insomnia. A formal diagnostic study, called a polysomnogram, will show increased sleep latency (the time it takes to fall asleep) and more wakefulness after sleep onset. The total amount of sleep is reduced. Those with GAD may have early morning awakenings, a symptom that often occurs in depression (which also shows a quicker onset of REM sleep).
The Effects of Obsessive-Compulsive Disorder on Sleep
How might obsessive-compulsive disorder affect sleep? One of the anxiety disorders, obsessive-compulsive disorder may significantly interfere with daily activities. What are the symptoms of the condition? Can obsessive-compulsive disorder also disrupt your ability to sleep at night?
Symptoms of Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) is one of the anxiety disorders that may develop early in life. It may affect children, more often boys who also have a diagnosis of attention deficit hyperactivity disorder (ADHD). It is also diagnosed through adolescence and into early adulthood. Among adults, it affects men and women equally. It occurs in 0.5-1% of people in a given year. OCD is characterized by two features: obsessions and compulsions.
Obsessions are persistent thoughts, images, or impulses that seem intrusive or inappropriate. These ideas are associated with anxiety or distress. One common obsession relates to cleanliness and a belief that objects are contaminated with germs. Some people with OCD may have concern that a task was not completed or done inappropriately. As an example, there may be anxiety about turning off the stove or locking the door, even though these were in fact safely secured. These obsessions are often ignored or suppressed by engaging in some other thought or action, which is called a compulsion.
Compulsions are defined as repetitive and deliberate actions that are done as a response to a specific obsession. By performing these compulsive acts, the obsessive thoughts can be temporarily suppressed. Compulsions are performed in a very predictable and ritualized fashion. Many have compulsions have a superstitious quality. In order to relieve anxiety about a fear of germs, cleaning may occur. To verify that the door is in fact locked, it may be checked three times. Common compulsions include:
- Hand washing
- Repeating words
These compulsions may provide transient relief, but soon the anxiety starts to rise again and the compulsive act must be repeated. When these actions occupy more than 1 hour per day and interfere with the normal routine of life, OCD is diagnosed.
How Does OCD Affect Sleep?
You might conclude that the thoughts and behaviors associated with OCD could become disruptive to sleep. If you fall asleep at night thinking about the things you need to check, you may have resulting insomnia. In fact, checking behaviors may be disruptive if they involve leaving your sleep environment to reassure yourself. Surprisingly, there is little evidence that the condition results in abnormalities that can be identified with a sleep study called a polysomnogram. Some research suggests that there may be less total sleep or more sleep disruption, but this has not been consistently demonstrated. It may not solely be due to the OCD but instead could relate to depression, which often coexists with it.
The Effects of Panic Disorder and Panic Attacks on Sleep
Anxiety is a common complaint that can affect your ability to function during the day. When the anxiety is associated with panic attacks, the consequences can be significant, especially when these attacks interrupt your sleep. What are the symptoms of panic attacks? What are the effects of panic disorder and panic attacks on sleep? How should panic attacks be treated? Consider the answers that may help put your worries to rest and allow you to get the sleep that you need.
The Symptoms of Panic Attacks
Anxiety is a common complaint that affects 18% of people in a given year. Insomnia, the most common sleep disorder, may occur in 1 out of 3 people. These two conditions often occur together and a panic disorder with frequent panic attacks may be disruptive to sleep.
Panic disorder typically develops in early adulthood, most often in the late teens or early twenties. It is more apt to afflict women. Approximately 2-3% of people are diagnosed with panic disorder, which is used to describe someone who has recurrent unexpected panic attacks lasting 1 month or longer. There may be anxiety about the potential for future attacks, avoidance of triggers (especially places or situations), and worry about underlying medical disorders. But what are the characteristic symptoms of panic attacks?
Panic attacks consist of a sudden episode of severe anxiety, fear, or discomfort with associated physical symptoms, including:
- Chest pain
- Fast heart rate or palpitations
- Sweating, hot flashes, or chills
- Shortness of breath or choking
- Lightheadedness or dizziness
- Nausea or upset stomach
- Numbness or tingling
- Fear of dying, losing control, or going crazy
- Trembling or shaking
- Feelings of unreality or being detached from oneself (depersonalization)
The symptoms start abruptly, last only seconds to minutes, and typically reach a peak within 10 minutes. Panic attacks may occur during sleep and may be associated with nightmares.
Panic Attacks and the Effects on Sleep
Approximately two-thirds of people with panic disorder will have moderate to severe difficulties sleeping, most often complaining of insomnia. Insomnia is difficult falling asleep, staying asleep, or sleep that is not refreshing. Panic attacks that occur out of sleep can be an important contributor to this insomnia.
Nighttime panic attacks consist of an abrupt awakening from sleep, often associated with shortness of breath. This occurs out of deep slow-wave sleep (NREM sleep) and these panic attacks are not typically associated with dreams. Though it only occurs in half of people with panic disorder, it can be recurrent.
Unfortunately, panic attacks that disrupt sleep may lead to sleep deprivation and worsen anxiety and further panic attacks. When sleep is studied in people with panic disorder, the polysomnogram may show decreased sleep efficiency and less total sleep time.
People with panic attacks are often more likely to experience isolated sleep paralysis which may consist of an inability to move, anxiety, chest pressure, and hallucinations. It is described as "isolated" because if sleep paralysis occurs with other symptoms, it can lead to the diagnosis of narcolepsy.
Anxiety and depression often walk hand in hand. Therefore, it is important to recognize and treat any overlapping depression as this can also disrupt sleep.
Social Phobia and Sleep Effects
Whenever you have a big presentation at work you find yourself approaching the situation with utter dread. Standing in front of your colleagues has been consistently embarrassing. Your knees knock, your palms sweat, and you can’t stop shaking. Anxiety may come on in specific situations like this, especially when faced with the blinding light of scrutiny amongst your peers. This may result in negative feelings and physical symptoms. Can this social phobia also lead to effects on your sleep?
What is Social Phobia?
Also known as social anxiety disorder, social phobia is characterized as excessive fear of being judged negatively, embarrassed, or humiliated by a social situation or performance. This fear often manifests when exposed to unfamiliar people or to scrutiny by others. The textbook example is a fear of public speaking. It may also be present when interacting with authority figures or peers.
This fear may lead to anxiety and even panic attacks. There can also be recognizable physical symptoms, such as:
- Racing heart
- Shaking or tremor
- Uncontrolled movements (tics)
Even though these symptoms may not be noticed by another person, their presence can be extremely distressing to the person with social phobia who experiences them. Even though the fear is acknowledged as being excessive or even unreasonable, the negative experiences may lead to avoidance of the provoking situations.
Many people with social phobia report that they have "always been shy". Approximately half of people begin to have symptoms suggestive of the condition in childhood while the other half develops them as a teen. It occurs slightly more often in women. It may coexist with depression or substance abuse, especially alcoholism.
Social Phobia and Sleep
In general, social phobia does not profoundly affect sleep. There may be some acute insomnia, especially just before a feared event, but this is not persistent. Often it may be harder to fall asleep as part of this. Nevertheless, 60% of people with social anxiety describe themselves as poor sleepers and 18% will be diagnosed with moderate to severe insomnia. As might be expected among people with insomnia, sleep studies (called polysomnograms) of those with social phobia are normal.
Many people with social phobia use alcohol to relieve their anxiety and this may lead to alcohol abuse or dependence. Alcohol is disruptive to sleep and you should disclose your degree of use with your doctor. Depression may also impact sleep and this should be discussed as well to understand what role it may play.
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Dr. Edward Giaquinto, Ph.D. - A licensed, clinical psychologist who has been assisting people in improving their life by increasing their emotional and mental health.