Anxiety disorder sufferers tend to have one particular area in which they suffer debilitating and lasting problems: sleeping. It's a natural product of anxiety issues, which raise the body's internal arousal levels (its preparedness to deal with threats through a raised heart rate and increased muscle tension) and therefore make it harder for humans to relax and sleep naturally. Between 24 and 36 percent of all insomniacs suffer from anxiety disorders, according to studies. Anxiety and sleep can also enter into a self-maintaining negative cycle, which I'll talk about in a minute, but for the moment there's a problem that we need to address: how can anxiety sufferers fall asleep in a way that helps their sleep quality rather than prompting escalating panic and self-blaming as insomnia hits once again?
Anxiety disorders, according to the textbook Clinical Sleep Disorders, typically create sleep problems centered around "a sleep-onset or sleep maintenance insomnia, resulting from excessive anxiety or apprehensive expectations about life events." It's a specific problem that affects getting to sleep and then staying asleep in ways that will actually be refreshing.
This means that typical approaches to insomnia, such as avoiding all LED-lit devices an hour before bed because LED light has been shown to affect human levels of the sleep-wakefulness hormone melatonin, are necessary but not sufficient to help anxious people drop off. Aside from conventional techniques for better sleep quality, then, we have to look to science specifically targeted towards anxiety sufferers to improve chances of a good night's rest.
Understand The Sleep-Anxiety Cycle
Anxiety and sleep are not exactly good bedfellows, to make a bad joke. However, being anxious will likely not just cost you one good night's sleep. The tie between them will escalate to produce higher anxiety and worse sleep over time. Dr Robert Rosenberg, a sleep expert, notes in one of his books that studies have shown that sleep deprivation often means that people are more vulnerable to stressors, the things that can set off anxiety: lowered sleep means people react in the same way to minor stressors as they do to major ones. They're also more likely to read faces as hostile rather than friendly, according to a 2015 study. That sets off a spiral of increased stress and anxiety that is then consolidated by worries about insufficient sleep and panic-induced insomnia. Anxious insomniacs are also prone to "catastrophize," believing that their lack of sleep will create deeply problematic consequences and wreak havoc on their lives, which only ramps up their panic further.
The good news is that this can also operate the other way: the Psychiatric Times, in 2012, noted that research shows that successful treatment of insomnia also has a corresponding lowering effect on anxiety disorders.
Be Careful About Using Marijuana
It's a common misconception that marijuana is helpful for sleep disturbance; regular users are likely to say that it helps them fall asleep or chills them out. While that may be true, not all the science seems to back it up. A study from 2016 found that the opposite is actually true. It looked at nearly 100 young people who were frequent, infrequent, or totally abstinent from marijuana, and found that, though light users and non-users showed the same kinds of sleep patterns, those who were heavy marijuana smokers showed more sleep disturbance and a greater degree of insomnia. Twenty percent of the non-users were insomniac, while 39 percent of the heavy users were.
Of course, even if it does help, you may risk withdrawal and more insomnia if you stop, as we see above.
This is still a developing area of research and may be partially explained by the placebo effect, but there are a few studies out there that indicate that aromatherapy, the use of particular smells designed to stimulate specific emotional states, may be useful for increasing sleep quality and quantity. One 2013 study from Evidence-Based Complementary and Alternative Medicine (yes, side-eye that if you like) seemed to find that anxiety was reduced in coronary patients who received aromatherapy in Korean hospitals. But it's also corroborated by other studies; another, which focused on hospice patients, found that both aromatherapy-aided massages and plain ones increased the sleep quality and lowered the anxiety of subjects, though it didn't look at aromatherapy on its own. (It's a good excuse to get a partner to give you a massage before you rest.)
A further study from intensive care units, where sleep is often interrupted and stress levels are high, found that sleep quality was significantly improved by an inhalation of lavender essential oils before bed. If you're not a lavender person, meanwhile, 2010 research from Germany found that two particular compounds from gardenias can be effective as sleep aids because they have an affect on the neurotransmitter GABA, which is highly important for causing sleep. If nothing else, it's cheap, so consider dabbing either fragrance on your pillow before you sleep.
The Anxiety & Depression Association Of America has a particular tip for anxious insomniacs: all clocks need to be removed from the room, particularly those with glowing displays, or at least turned to face the wall. Knowing the time, and therefore how little sleep you may be likely to get before your morning wake-up call, will understandably increase panic, and clock-watching is a natural tic that needs to be suppressed. It's an approach borne out by a 2006 experiment in which anxious people were either given alarm clocks or devices that displayed random numbers every minute; while the two groups took around the same time to fall asleep, the ones subjected to the random numbers felt they'd taken a shorter time and were therefore more inclined to rate their sleep as restful.
Use The SAM App
One particular way in which anxiety before bed can be managed is to attempt to lower anxiety levels overall, through therapeutic intervention, mindfulness meditation, and other mediums. The effects may be good enough to help sleep quality, or if concentrated before bed can lower arousal levels and clear the mind of anxious ruminative thinking. One particularly good tool for this is the free SAM (Self-help for Anxiety Management) App developed by the University of the West Of England.
Like other anxiety apps, it's a step-by-step activity guide to things like meditation and sorting out anxious thinking ruts, but it also provides a lot of information about what anxiety disorders are actually about. Friends with severe anxiety have reported that it's worked wonders for their general anxiety levels and for sleep patterns. To keep its effects maximized, don't use it for an hour before bed to keep free of LED light; look up breathing techniques or a relaxing activity, take the advice, then turn off your phone.