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May 19, 2023 19 mins

You’re lying there in the dark, trying to fall asleep. Instead, your mind is racing with woulda-coulda-shoulda thoughts you can’t let go of. Anxiety can lead to insomnia, which can trigger even more anxiety. Dr. Saltz tells how to break this vicious and unhealthy cycle.

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Speaker 1 (00:05):
These are challenging times, but you don't have to navigate
them alone. Welcome to how Can I Help? I'm doctor
Gail Saltz. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,

(00:26):
hopefully with understanding, insight and advice. Many people who experience
anxiety during the day notice that it often gets worse
in the evening as they try to go to sleep. Today,
I'm answering a question from a woman who is struggling
with this issue. Having anxious thoughts at night is actually

(00:50):
fairly common. Daily life provides distractions from anxious thoughts. People
busy themselves with all the things things need to be done,
and there are various interactions with other people as a
way of often escaping anxiety. But at night, there's nothing
to distract from the various thoughts and worries that are

(01:14):
swirling around in your head. Another reason anxiety worsens at
night is that the fatigue from the day makes it
more difficult to cope and to be positive about our worries.
The brain just doesn't have the energy needed to put
anxiety into perspective, and this creates the perfect storm for

(01:38):
a flurry of anxious thoughts. And because having anxious thoughts
before bed can make it harder to get a quality
night's sleep, it can make you more tired and less
able to cope with future instances of nighttime anxiety, and
as you can see, it can become a destructive downward spiral.

(02:01):
Anxiety is the anticipation of a future threat. It's different
from fear, which is the emotional response to an imminent threat.
Fear is the response to something known or understood, but
anxiety is about an unknown or something poorly defined, something

(02:25):
that may or may not happen in the future. Fear
and anxiety can both trigger your body's stress response, known
as the fight, flight or freeze response. It is a
physiological reaction to something your body has perceived as a threat,

(02:46):
and in response to this threat, your adrenal glands make
more cortisol, a hormone that then goes on to trigger
the release of blood sugar and fat into your blood.
This gives you a boost of energy, which, if there
were an actual threat going on, would be a good thing.

(03:06):
In other words, if you spotted a bear, you would
hope your adrenal glands would alert you, pump out some cortisol,
and you would now have the blood, sugar and fat
in your system to run far and run fast. These
hormones also increase your heart rate and blood pressure to
help more blood reach your muscles, your heart and other organs,

(03:29):
so you would be ready to fight or run away
from whatever the threat is. In your brain, extra oxygen
will sharpen your senses, increase your alertness, and from an
evolutionary perspective, you can see that the body's stress response
is critical to survival as a species. It's also easy

(03:53):
to see how the hormonal surge of a stress hormone, however,
is not conducive to sleep. The common stressors of our
modern lives, the possibility of failing a test, we're being
laid off from a job might not be life threatening,
but the anxiety they cause still elicits the same type

(04:17):
of stress response. Chronic stress that runs in the background
for long periods of time can be dangerous because the
body doesn't receive a clear signal to turn it off
back to normal functioning. Chronic overexposure distress hormones puts you

(04:38):
at a higher risk for health problems, including cardiovascular disease,
autoimmune disorders, Alzheimer's disease, certain kinds of cancer, depression, and
anxiety disorders overall. But you don't have to have a
clinically diagnosed anxiety disorder to feel the effect of chronic stress,

(05:02):
especially if it's disrupting your sleep. These are hardly ideal
ingredients for a good night's sleep, and there is a
relationship between anxiety and sleep. It is what is called
a bi directional relationship, meaning they feed into and promote

(05:22):
one another. They create a self perpetuating cycle without one
root cause. Anxious thoughts cause or worsen sleep problems, and
lack of sleep exacerbates anxiety. For an anxious mind, the
quiet and stillness of bedtime is the perfect breeding ground

(05:46):
for negative thinking and rumination. Rumination being an obsessive thinking
about an idea, a situation, or a choice, especially when
it's interfering with noise or functioning. So constant repetitive thoughts
about a problem or a future problem can interfere with

(06:08):
your ability to fall asleep. Sleep latency is the amount
of time it takes you to fall asleep when stress
and anxiety from your daytime follow you into bed. It
will likely take you longer to fall asleep when anxious
thoughts delay the sleep onset. It isn't just about the

(06:31):
minutes or the hours of sleep you're missing. You can
start to feel anxious and frustrated specifically about how long
it is taking you to fall asleep, and that becomes
one more thing that a lot of people ruminate over.
Another problem that's made worse by nighttime anxiety is something

(06:53):
called sleep fragmentation. It is the repetitive, short interruptions of
sleep can make you feel tired the next day. Waking
up in the middle of the night and your mind
immediately going to an anxious thought that you went to
bed with might put you back at square one of

(07:14):
experiencing prolonged sleep latency that further cuts into the amount
of sleep you get. And sleep debt is the running
total of the amount of sleep that you missed as
compared to the sleep that your body needed over a
two week period. When anxiety makes it hard to get

(07:35):
to sleep, your sleep debt will go up. High sleep
debt causes cognitive difficulties and impedes your ability to feel
and function. Your best Over the long term, high sleep
debt or chronic sleep deprivation can increase your risk of
high blood pressure, diabetes, obesity, depression, heart disease, and other

(08:02):
health problems. So getting caught up in the vicious cycle
of anxiety and sleep loss is unfortunately too easy and
can escalate. So with that, right after the break, we'll
get to my listener's question. Welcome back. Let's get to

(08:30):
my listener's question and see how can I help, dear
doctor Saltz. I find that in the hour or so
before bedtime I am more nervous and worried than I
am during the day. I tend to get riled up
and start thinking about potentially bad things happening and what
to do about it. I feel very tense. Then when

(08:55):
I try to go to sleep, it keeps me up.
I'm lying there with spiral concerning thoughts, and I feel
jittery and like I'm just wide awake. Takes me too
long to fall asleep. If I wake up during the night,
the same thing can happen where I am suddenly worrying
about stuff, which makes it hard to get back to sleep.

(09:18):
This is making it increasingly hard to get a good
night's sleep. I would like to find a way to
worry less at night. Can you help. People who have
difficulty with anxiety often find it's worse at night. But
even people who don't experience that much anxiety during the
day can find they have too much anxiety at nighttime.

(09:43):
The day's stresses catch up with them, and they are
more tired and less about to be distracted by something
else taking up their attention. Their minds turned to worry.
As you have noticed, this can interfere with the ability
to rely lax enough to drift off to sleep. You

(10:03):
allude to feeling nervous in your mind, but also in
your body. Indeed, there is a strong relationship between mind
and body, and often by calming your body, you can
also calm your mind. This is why it can be
very helpful to have various techniques aimed specifically at relaxing

(10:27):
your body, which you do an hour before bedtime to
really purposely relax. Examples would be slow paced deep breathing,
progressive muscle relaxation, taking a warm bath, meditation practice. Choose
two that you like and do them in the hour

(10:50):
before bed. Also, about an hour before bed, try writing
down a brief list of worries. As you write them down,
remind yourself these are just the list of worries and
you will attend to what you might want to do
about them tomorrow. By writing them down, you are acknowledging

(11:13):
them and then putting them away for the night. Avoid
screen time in the hour before bed, as it tends
to increase stress and anxiety. Avoid any caffeinated drinks afternoon
of the day, as even by evening they can have

(11:34):
a late effect. Make your sleeping area conducive to sleep,
which means very dark, cool, very quiet, and turn your
clock around so you are not staring at it worrying
about why you have not fallen asleep yet. Lie down, and,

(11:56):
if tense, do some pacede Deep breathing or progressive muscle
relaxation in your bed. If anxiety persists and grows, then
you may wish to have an evaluation by a mental
health professional to see about other treatments for anxiety. But
often employing good sleep hygiene in an hour of targeted

(12:19):
relaxation before bed really does the trick. Good sleep hygiene
habits and a relaxing bedtime routine can help you get
the sleep your body needs. Stress and anxiety from your
day can threaten to keep you up at night, so
it helps to have tools to interrupt your body's stress response.

(12:43):
By adding relaxation techniques to your evening wind down, you
can train your mind to release anxious thoughts and get
into a relaxation mode. First is something called autogenic training.
It's actually take nique that uses verbal commands to encourage
your body to deeply relax by mentally visualizing it. The

(13:10):
goal is to make your mind and body respond to
what you're telling it, so for example, saying things to
yourself like my arms are becoming warm and heavy. Another
technique is progressive muscle relaxation, which helps prepare your body
for sleep one area at a time, So starting from

(13:33):
your feet toes and moving up the body, you will
focus on tensing and then relaxing each muscle group before
moving on to the next muscle group. Tensing to account
of five and then relaxing. Relaxing your tongue and jaw
can actually be especially calming for nighttime. The goal is

(13:55):
actually to bring the parasympathetic nervous system back online, which
tells the body to rest the opposite of the sympathetic
nervous system, which is saying fight and flight. Another technique
is relaxing sounds from a white noise machine. So examples

(14:16):
would be using something like gently rolling ocean waves or
a quiet mountain breeze that's rustling the leaves. Finding one
that puts you at ease and can help you, through sound,
create a feeling of calm and serenity. Breathing techniques are
very helpful in promoting relaxation, especially at night, because they

(14:40):
draw your focus away from thoughts and onto your breath.
So diaphragmatic breathing or belly breathing is deep breathing designed
to engage the diaphragm, which lowers the heart rate and
stabilizes your blood pressure. A particular breathing technique that is

(15:02):
basically the four seven eight breathing is when you elongate
the exhalation of your breath, which sends the signal to
your brain that it's safe and not in danger, which
helps again to move to the parasympathetic nervous system. Longer
exhalation than inhalation slows your heart rate, you emptier lungs

(15:26):
of all the air. Then you inhale through your nose
to account of four, then hold your breath in for
account of seven and exhale slowly and evenly through your
mouth to account of eight. Repeating this four or five
times can help you, especially if used in bed to

(15:50):
fall asleep. Some people find yoga and the breathing and
movement associated with it to calm them down at the
end of the day. Yoga movement has been shown to
increase levels of gabba or gamma amino bututeric acid and
neurotransmitter that slows activity in the nervous system, which calms

(16:13):
stress and helps to decrease negative feelings. Using good sleep
hygiene and relaxation may help you decrease your anxious thoughts
enough to drift off to sleep, and that, unfortunately, can
be especially frustrating when you wake up a few hours
later and again have difficulty getting back to sleep. But

(16:35):
what you need to do is avoid getting caught up
and replaying those anxious thoughts. So start again with your
deep breathing, the four seven eight method or progressive muscle
relaxation if that works better for you. Using guided imagery
in other words, visualizing something serene and pleasurable. A beautiful

(16:58):
spot added to this can help relax you. But I
do want to say that if you can't fall asleep
after a reasonable amount of time, don't stay in bed
for too long. Instead, it's better to do what's called
a sleep reset. Basically, this helps prevent your brain from

(17:21):
forming or strengthening an association between your bed and being
too wakeful. So to reset, get out of your bed
and do something relaxing, yes, even if it's the middle
of the night. Read a boring book, listen to soft music,

(17:42):
but be sitting up and then when you start to
feel sleepy, return to your bed. It's also important to
keep in mind to avoid artificial light. You can do
this by using screens that have blue light blockers or
by using blue light blocking glasses. It's relatively easy to

(18:05):
find either of these things, but basically, starting in the evening,
you really want to avoid artificial light exposure. Eliminating anxiety
and excessive mental stimulation in general are the key to
getting better sleep. It's important to do what you can

(18:26):
to escape the vicious cycle of sleep loss and anxiety
before it builds. Diagnosing crippling anxiety and anxiety disorders should
actually be handled by a mental health professional. So if
that is what's going on and it's really interfering with
your day, then you should get an evaluation and likely treatment.

(18:47):
But anyone who is experiencing more of just the evening
anxiety can take steps on their own to improve their
sleep hygiene and adopt relaxation techniques that make it easy
to calm their mind and fall asleep. Do you have
a problem I can help with? If so, email me

(19:09):
at how Can I Help? At senecawomen dot com. All
centers remain anonymous and listen every Friday to how can
I help with Me? Doctor Gale's Salts
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