Treating Sleep-Related Anxiety with Michael Grandner, PhD

Some primary care physicians might not realize treatment for anxiety-related insomnia should be sleep-focused not anxiety-focused, explained by Michael Grandner, PhD, from the Sleep and Health Research Program at the University of Arizona.¹

Grandner presented on sleep-related anxiety individuals with new onset insomnia at SLEEP 2024, the 38th annual meeting of the Associated Professional Sleep Societies. People who have sleep anxiety may also have a specific phobia about sleep, called somniphobia.² In an interview with HCPLive, he described the difference between sleep-related anxiety with other types of anxiety.¹

“When you have sleep related anxiety, your anxiety is about sleep…your anxiety about sleep becomes the very activation that makes it so you can’t sleep, which then supports the prediction that sleep is going to be a stressful and anxious thing, which means next time you start going to sleep, you’re going to be more stressed and anxious about your sleep because you’re going to predict that you’re not going to be able to sleep,” Grandner said. “So, sleep related anxiety is a little different on its own because it can perpetuate itself by directly making it more difficult to sleep.”

It is common when individuals first experiencing insomnia symptoms go begin feeling “out of control,” as Grandner said.

“That’s really where they start worrying, and they start panicking about not being able to sleep,” Grandner said. “That’s where the cascade really starts.”

Symptoms of sleep-related anxiety include fear around not falling asleep, fear of the consequences of not falling asleep, and fear about not being in control of being able to sleep.

“It’s really about the target of the anxiety, and it just so happens that when that happens, it perpetuates itself by becoming a self-fulfilling prophecy, with that anxiety leading to more wakefulness, leading to more anxiety,” he said.

People with severe sleep-related anxiety may have no problem nodding off on the couch before bedtime, but once they head to their bed and try falling asleep, they wake up not long after.

“[It’s] called a conditioned arousal where the act of trying to fall asleep or being in the bed or being in the bedroom itself creates that cascade of psychophysiological reactions to the environment.”

Sleep-related anxiety in people with new onset insomnia can turn acute insomnia into chronic insomnia since acute insomnia resolves on its own but chronic insomnia can lasts for months, years, and even decades.

“That’s why it’s really important to focus on this issue of sleep related anxiety,” he said. “A lot of people are worried about their sleep, but they don’t realize that the worry itself is what’s creating their problem.”

Treatments for sleep-related anxiety include cognitive therapies like behavioral therapy, acceptance and commitment therapy, and mindfulness techniques.

Tips Grandner has for primary care physicians:

1. Assess for sleep-related anxiety by looking out for symptoms.
2. Tell patients the difference between normal sleep disturbances that won’t dramatically impair functioning and sleep disturbances that will.
3. Advise patients to find alternative ways to channel the anxiety such as doing a distracting activity in the evening like a relaxation exercise.

“It’s important for the people to whom the patients go for help to recognize what it is that they’re seeing,” Grandner said. “Physicians should remember that the behavioral, non-pharmacological approaches to insomnia are recognized as first line therapy and should be integrating some of that in there, especially when you have the sleep related anxiety. [Doctors] often they focus on that anxiety as arousal that they then try to medicate by blunting that arousal, thinking that will solve the problem, but actually it isn’t. It’s more the cognitions-related, and that’s why the behavioral and cognitive therapies work a little better.”

Grandner has no relevant disclosures.

References

1. ^{Grandner, M, Nowakowski, S. Severe Sleep-Related Anxiety in New Onset Insomnia. Session presented at SLEEP 2024. Houston, TX. June 3, 2024.}
2. ^{Sleep Anxiety. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21543-sleep-anxiety. Accessed June 10, 2024.}