Aug 24th, 2021|| Sleep, Anxiety by Dr.Manvir Bhatia & Saunri

Introduction

There is a bidirectional relationship between sleep and anxiety. On one hand, sleep deprivation has been found to cause anxiety disorders, while on the other hand, symptoms of anxiety-related disorders like Generalized anxiety disorder (GAD), Panic disorder, and Post-traumatic stress disorder (PTSD) commonly cause recurring nightmares and insomnia that affect the normal sleep cycle. 

Hence, it has become very difficult to separate what is the cause and what is the effect. Is it stress and anxiety that is making us sleep or less sleep that is making us more anxious?

What is Anxiety?

Anxiety is the human body’s response that warns us of potential danger, hence anxiety on a small scale is helpful for an individual.  However, in anxiety disorders, the individual goes through intense, frequent, and continuous false alarms that may hinder your sleep-wake cycle.

  • About 24% to 36% individuals with insomnia suffer from anxiety disorders.
  • Of the individuals that suffer from PTSD, 68% have difficulty falling asleep.

Relation between Sleep and anxiety

Human sleep consists of two brain states i.e Non-rapid eye movement (NREM) and rapid eye movement (REM) recurring in cycles. These cycles are regulated by acetylcholine, norepinephrine, serotonin and histamine, and GABA neurotransmitters. Dysfunction of these neurotransmitter systems has been implicated in anxiety disorder.

Relation between anxiety and sleep

Anxiety is usually considered one of the symptoms of stress. Stress results in sleep arousal especially through the release of Corticotropin-Releasing Hormone (CRH) and Corticotropins. The CRH system dysregulation in the amygdala of the brain causes fear which is a symptom of anxiety. It also activated the HPA axis and sympathetic nervous system and is seen elevated in insomnia patients.

Treatment for anxiety and sleep

Medication for anxiety disorders usually helps improve sleep, similarly sleep medication has a profound effect on reducing anxiety. Medications for anxiety include antidepressants. Benzodiazepines may be prescribed to reduce feelings of panic. Beta-blockers are used to reduce blood pressure during an episode of anxiety while anticonvulsants are used to relieve the symptoms of anxiety disorders.

Psychotherapy like Cognitive Behavioural Therapy (CBT) is helpful to train individuals in converting the panic-causing thoughts to positive ones. This therapy involves challenging negative thoughts, exposure therapy, and learning relaxation skills. CBT for insomnia (CBT-I) has been seen to help in managing anxiety disorders. Succes of this therapy are usually seen within 12 to 16 weeks.

Some of the tips given by counselors to manage anxiety disorders include:

  • Learning about the disorder and staying away from potential triggers
  • Sticking to the treatment plan and routine of the disorder
  • Reducing caffeine intake
  • Avoiding consumption of alcohol and recreational drugs
  • Exercising 
  • Relaxing and getting better sleep

Hence, sleep and anxiety are very much linked to each other.

Anxiety, Sleep, and COVID-19

During this COVID-19 out-break, negative emotions such as anxiety, depression, and anger in individuals have increased, due to factors such as getting infected with Covid-19, family members getting infected, loss of jobs, staying at home, physical isolation, and craving for human interaction and bonding.

A new term called ‘Coronasomnia’ has been introduced to refer to sleep deprivation during the pandemic. A study published in the Journal of Sleep Research that studied the sleeping habits of people during the pandemic found that those people who had later sleeping schedules or shorter sleep cycles faced insomnia, anxiety, and stress.

Conclusion

Disturbance in sleep is a common symptom of anxiety disorder. It is not only important to identify and treat sleep disorders among patients with anxiety disorder but also among individuals who are not undergoing treatment for anxiety.

To seek help or know more about sleep and anxiety, you can visit the Neurology and Sleep Centre, the 1st sleep centre in the country accredited by the Indian Board of Sleep Medicine at L-23, Hauz Khas Enclave, New Delhi, Delhi-110016 (INDIA)

Or give a call on +91-11-46070321, +91-9643500270

References

  • Staner L. Sleep and anxiety disorders. Dialogues Clin Neurosci. 2003 Sep;5(3):249-58. doi: 10.31887/DCNS.2003.5.3/lstaner. PMID: 22033804; PMCID: PMC3181635.
  • Sher L. COVID-19, anxiety, sleep disturbances and suicide. Sleep Med. 2020 Jun;70:124. doi: 10.1016/j.sleep.2020.04.019. Epub 2020 Apr 25. PMID: 32408252; PMCID: PMC719505
  • Robillard, R., et al. (2020) Profiles of sleep changes during the COVID‐19 pandemic: Demographic, behavioural and psychological factors. Journal of Sleep Research. 

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