Is Anxiety Keeping You Up at Night? Here's How to Manage Your Worries for a Good Night’s Rest
Last week, I had to delete Twitter from my phone. I couldn’t handle the constant stream of coronavirus-related updates. When I log on to my computer for a few minutes each morning, I’m bombarded with a feed full of tweets about sleepless nights. “I woke up at 3 a.m. and couldn’t get back to sleep” is something I read several times a day, every day.
I haven’t been immune to COVID-19-anxiety-related sleep issues. I’ve been working on ways to shore up my bedtime routine, and talking to experts about how to get through this unprecedented crisis without fully converting into a sleepless zombie. Here’s what they recommend.
First: Understand the problem.
In regular life, nighttime anxiety is normal. Psychologist Dr. Jaime Zuckerman explains: “Worrying often keeps us awake in bed at night. This is because it’s likely the first time we have been still and present all day. Between work, kids, and daily stressors, we are often on automatic pilot throughout our days. It’s not until we lay our head on the pillow that our automatic pilot switches off [and the thoughts] we avoided during the day rush in.” As annoying or stressful as that anxiety may be, explains Dr. Zuckerman, we know how to deal with it because we’ve done it before, and that gives us a sense of personal control. However, pandemic-induced anxiety is different because “it’s constant, with no definite end date,” says Dr. Zuckerman. “And it’s a shared traumatic experience, as it’s everywhere we look rather than just in our own heads.”
It would be great if we could deploy our regular coping mechanisms against this new form of anxiety. But many people can’t, explains Dr. Abhinav Singh, director of the Indiana Sleep Center. “People can’t socialize, see loved ones, go to work, or tap into their favorite avenues of stress-busting.”
Even people who are normally solid sleepers may be suffering from new nighttime anxiety. “Anxiety and sleep have a very close relationship, like a bad marriage. Where you find one, you typically find the other,” explains Dr. Mara Cvejic, a neurologist and the director of sleep medicine at the University of Florida-Jacksonville. She’s been seeing her physician colleagues—people she describes as an “incredibly capable, battle-worn, stalwart group”—struggling to handle their anxiety and sleep well, and isn’t surprised that an uptick in sleeping issues is happening across the board.
But what’s happening in our brains and bodies that’s keeping us from dropping off into sleep—or waking us up in the middle of the night? The short answer: Stress is triggering our bodies to pump out cortisol and adrenaline, two hormones that increase our blood pressure and keep our minds racing, says clinical psychologist Dr. Clinton Moore.
“The reason so many people are experiencing disrupted sleep during this global pandemic is because of the hyperarousal that comes along with anxiety. Your brain is detecting a threat in your environment, so it’s telling your body to stay on high alert, which is not conducive to sleep,” explains clinical psychologist Dr. Megan Johnson. “The anxiety response, commonly referred to as the ‘fight or flight’ response…is incredibly helpful when we are faced with concrete and identifiable threats, such as a mountain lion running toward us on our hikes or an armed robber breaking into our homes,” she says. “But when the threat is something abstract and unseen, that response is less helpful.”
So what are anxiety-affected bad sleepers to do? Learn to override that response.
“Knowing how your physiology plays into [insomnia or sleep issues] and psychologically regaining a sense of acceptance and control over the problem is key,” says Dr. Cvejic. “Physiologically, sleep is a result of your brain, like every other organ in your body, taking time to repair, maintain, and adapt. It’s a very dynamic and important part of our health.”
Next: Understand your options for addressing the problem.
Over and over again, every expert I talked to repeated the same general advice for problem sleepers: Smooth out your sleep hygiene. That means making sure that you’re sleeping in a dark, cool room; staying away from electronics, exercise, and alcohol an hour or two before sleep; and being consistent about your bedtime and wake time, says Laura Mueller, a clinical social worker specializing in insomnia.
But the experts also shared a few tips and tricks to try if your sleep hygiene is good but you’re still having issues drifting off. Here’s what they recommend:
1. Get out of bed.
It sounds counterintuitive, but it’s key to good sleep: “If you’re in bed for more than 20 minutes, get out. It’s really important that you don’t pick up the habit of lying in bed, anxious and overwhelmed. If your mind is racing and you’re anxious, hop out of bed and find something relaxing to do that doesn’t involve electronics, like reading, puzzles, laundry, easy cleaning, gentle/restorative yoga, or journaling,” says Ginger Houghton, LMSW and owner of Bright Spot Counseling. “Also, be aware of physical signs of drowsiness—like dry eyes, feeling cold, or yawning—and head back to bed.”
2. Hack your body’s temperature.
No special equipment required. “Heating up the body and then cooling it down during the day or right before sleep can trigger the body’s parasympathetic response (the ‘rest and digest’ nervous system) and promote calm,” explains Dr. Amy Serin, neuropsychologist and founder of the Serin Center. “If you exercise and sweat during the day, you’ll be more likely to sleep at night and stay asleep. Can’t exercise during the lockdown? Hack your system by taking a hot shower and then use cool water before you get out. The rise and fall of your body temperature can help stimulate melatonin release and set the stage for a better night’s sleep.”
3. Create a sleep routine you enjoy.
Doing the same relaxing routine each night can help your brain wind down and prime your body for good sleep, explains health psychologist Dr. Aurelie Lucette. “It could look like taking a shower and brushing your teeth, reading for 20 minutes, getting in bed and turning off the light, and doing a five-minute deep breathing exercise.
“The routine should be consistent. When you wake up at night, engaging in a shorter version of the bedtime routine (getting up to read for a little bit, getting back into bed, doing a breathing exercise) can help with falling back asleep more easily.”
4. Schedule worry time.
This might seem like the opposite of what you want to do before bed, but experts swear by it. Dr. Moore explains, “A common cause of sleep difficulties is being unable to let go of worries. This can put you into a cycle of rumination, which can keep you awake for hours.”
For scheduled worry times, keep a pen and paper next to your bed, and when you start to notice yourself worrying, write everything down. “You don’t even need to turn the light on. Just scrawl them on the paper. This means that you can tell your mind ‘It’s written down now, you can stop reminding me about this threat,” says Dr. Moore. “To make the strategy stick, you need to commit to making time the next day to review these worries and problem-solve whatever you can.”
5. Utilize the box breathing technique.
“When you’re in a state of hyperarousal, your breathing is rapid and shallow, which means less oxygen is reaching the brain, as oxygen is instead being used by your muscles to presumably run from the threat,” says Dr. Johnson. “If you’re able to calm your breath, other parts of your body and brain will also follow suit and return to a state of calm.”
Dr. Johnson’s box breathing instructions go like this: Breath in deeply through your nose for four counts. Hold the in-breath for four counts. Exhale slowly through your mouth for four counts. Hold the out-breath for four counts. While you’re doing this, visualize a box in your mind, tracing one side of the square for each four-second interval. Repeat several times.
6. Try yoga for sleep.
Yoga teacher Sonya Matejko recommends that those with trouble sleeping try Yoga Nidra or Yogic Sleep. “This form of yoga is…a conscious relaxation practice [that] can help reduce stress and bring the body closer toward sleep. I personally use this practice on the days when my brain is moving a million miles a minute and I feel like I can’t shut off,” she says. “I usually put on a 20-30 minute Yoga Nidra meditation on Insight Timer and rarely have I ever not fallen asleep before the track ends.”
She also recommends specific poses to relax your body before sleep, all of which can be done from the comfort of bed: legs up the wall, supine twists, restorative bridge pose, reclining bound angle pose, happy baby, child’s pose, and savasana.
7. Reach out for help.
If you try these tips, but they don’t work, don’t despair and do call in reinforcements. “If sleep issues persist and interfere with functioning during the day, or if they seem to impact your mood significantly, I recommend reaching out to your primary care physician or a psychologist,” says Dr. Lucette. “Treatments are available to help with sleep issues, including medications and behavioral treatments. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a safe and effective treatment for insomnia that is offered by some licensed psychologists, with good results.”
8. Good luck and sweet dreams—but not-so-sweet ones are okay, too.
The most important thing to remember as you try to manage your sleep during a period of elevated anxiety is that your body knows what it needs and will find a way to sleep eventually. Certified clinical sleep health educator and founder of Insomnia Coach Martin Reed reminds us that we’ll get through this. “Accept that sleep disruption at the current time is completely normal. Right now, we might not be getting as much sleep as we want to get. We might be waking more often and spending more time awake during the night,” he says. “Our sleep might not be feeling as restorative as we want it to feel. However, we will always get enough sleep to keep us going.”