Cara Tucker

If you ask a good sleeper what they do to get to sleep, what do you think they would say? Usually, they say nothing. Yes, you read that right – NOTHING! They don’t use a magical supplement or mystical ritual to send them off to sleep. But how can that be? You’ve trawled the internet and researched all about ways to get to sleep and tried all the relaxation tips, breathing exercises, sleep hygiene measures, weighted blankets, supplements, diet, exercise, and more, and that good night’s sleep still escapes you! In your search for a sleep fix you’ve tried it all, with results that are hit or miss. Sometimes there is a glimmer of hope for a few nights, only for that miracle cure to stop working. Although your sleep problem may have initially been triggered by factors including some of the things you’ve been trying to fix, what’s keeping it going may actually be something else entirely – the pressure to get a good night’s sleep. The struggle to sleep and fear of not getting to sleep has become the problem preventing you from sleeping, referred to as sleep anxiety.

In order to start tackling the problem, we have to take a step back and understand a little bit about how sleep works. Sleep is an automatic process – what this means is that it is not under our conscious control. Sleep is controlled by our circadian rhythm (our internal approximately 24 hour body clock) and homeostatic sleep drive (the body’s urge to sleep that increases the longer you are awake), which can be influenced by our environment and things we do. Good sleepers don’t think about sleep – it just happens. How unfair is that?! But, in focusing so much thought and energy on getting a good night’s sleep, and placing so much importance and pressure on this happening, we put ourselves in a state of anxiety and stress which can trigger a flight or fight response. If we consider this flight or fight response as a survival mechanism to deal with a potential threat, you’re more likely to survive if you are alert and able to respond to the threat. Your brain doesn’t differentiate between this anxiety about sleep or a physical threat to life – they will both trigger the same response – one of high alertness with associated physiological responses of fast heartbeat, rapid shallow breathing, muscle tension and restlessness. So now we’ve got this alerting survival mechanism going, we can see how the worst time to doze off to sleep is when you’re facing a perceived threat. And so, the struggle to sleep puts us in a state that prevents us from sleep. And the longer we experience feeling stressed when we’re in bed, the more likely our brain and body are going to associate the bed with feeling stressed. Sleep anxiety and insomnia can be a vicious cycle – poor sleep makes you anxious, and your anxiety fuels your insomnia.

It’s not only the feelings of anxiety that keep us awake though. In trying to get a good night’s sleep, we start changing our behaviours and routines. We might use caffeine to keep us awake during the day, eat more sugary foods for an energy boost, or take naps and have lie-ins where we can to “catch up” on lost sleep. We might reduce our daytime demands by skipping workouts, avoiding social gatherings, and choosing ready meals. All these behaviours will have a negative effect on our sleep drive and circadian rhythm, as well as our general health and wellbeing.

So what can we do about this? The first line treatment for insomnia as recommended in the NICE guidelines is cognitive behavioural therapy for insomnia (CBT-I), which is a special type of CBT where you learn how to manage your thoughts and behaviours around sleep. It can help you reset your circadian rhythm and sleep-wake cycle, relearn how to sleep better at night, reinforce the connection between being in bed and being asleep, change your perspective on your sleep patterns, manage anxiety and keep it under control, and ensure your environment and sleep habits support good sleep. CBT-I is not a quick-fix and requires you to practice the skills you learn every day. It may be hard to start with and things may feel like they are getting worse before they get better, but CBT-I has been proven to have good effectiveness with lasting results. While there are apps and web-based programmes for doing CBT-I by yourself, the most effective option is still having one-to-one therapy supported by a trained professional. They will be able to personalise the treatment to your specific situation and adapt the treatment if needed.

The struggle to get to sleep can actually make it harder to get to sleep, as it feeds the vicious cycle of anxiety and insomnia. The first line recommended treatment for insomnia is CBT-I which can help kick start your natural ability to sleep and address coexisting anxiety. There are several options for accessing CBT-I including apps, web-based programmes and with a trained professional.