I've been a fairly decent sleeper most of my life and highly valued sleep, as anyone does, but in particular saw it as a way to help restore/recover/recharge from the daily tolls of my own anxiety. Unfortunately, I had a nocturnal panic attack some six months ago which has changed my relationship to sleep ever since. Now I worry about sleep. Worry about falling asleep, staying asleep. The worry has caused the insomnia, and the insomnia causes increased anxiety. The vicious cycle has caused all sorts of new anxiety symptoms I've never experienced before, like muscle pains and fatigue, chest pains--usually around the left breastbone and rib cage but also a tightening around the middle of my chest which feels like something is sitting on my chest and my lungs feel like they're wheezing. I'll wake up in the morning with an increased heart rate. I'll sometimes wake up in the middle of night with extreme chest pain--as if my heart has been thumping away all night. Sometimes it's not clear if I've fallen asleep. My dreams feel lighter too, deep sleep is gone. When I wake through the night, often 4-5 times, I'll worry if I'll be able to fall back to sleep, and so either don't or if I do it doesn't really feel like I've fallen back to sleep. A bit of parasomnia perhaps where I feel awake even though I'm asleep. Sometimes I'll wake up in the middle of the night with a feeling of deep sickness--as if my body is not getting the rest it needs. Other times I'll feel like there's a rattling inside me, as if I'm to have a spasm but never do. There was also a newfound feeling of deep dread and being on edge--I don't know how to describe it other than that. And all these feelings feed into more anxiety, and I have high health anxiety to begin with, so I get more anxious thoughts that I'm going insane and that all of this is dangerous and I'm somehow killing myself--weakening my heart mostly--from lack of sleep and lack of quality sleep. And of course all of this depresses my mood and with lower energy makes it harder to exercise.
I went to the doctor and there isn't anything wrong with me--vitals are fine. Even saw a cardio, heart is fine. They even said the chronic chest pain meant it wasn't my heart but instead my chest muscles, since it's chronic...
I can't really say if things have changed over the months. It's better than the first week when it happened, when I probably got 3-4 hours of sleep per night. I can likely get 7 or so now, but it usually requires taking a Klonopin/clonopin before bed or in the middle of night if I wake up with an increased pulse and chest pain.
I tried Gabapentin, Remeron, Seroquil, and Trazodone. I tried Ambien. None of them worked. Ambien worked but would give me headaches and muscle pains the next day. I'll likely have to go back on something--I was doing just fine before all this happened and didn't need to be on antidepressants for anxiety. But I've been on plenty of antidepressants before and overtime they stopped working. The only thing that basically works is Klonopin.
I've worked with my therapist and tried doing CBT--paired muscle relaxation, cold wash cloth to the face, working on how I view sleep, de-catastrophizing, etc. Implement good sleep hygiene practices. Working on accepting my worried thoughts as just worry. Working on accepting any anxious feelings and floating through them (Claire Weekes style). And yet, it is still so hard for me to just turn off my brain and go to sleep.
If any of this sounds like you--where you've tried a bunch of different things, both meds or CBT or ACT, etc--did you ever get to a point where your sleep returned to normal? Or you got to a point where it didn't bother you as much anymore? How did you get through it?
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I used to get rapid pulse and chest pains at night. I would wake up several times feeling like my worst nightmare has come true and my child is dead and other bad things have happened. My husband suggested sound at night and I tried an app with sounds. I chose rain which is soothing. When my thoughts raced I say listen to the rain and I relax. Maybe that would help you.
I am trying a white noise machine, and sometimes listen to sleep app sounds/music. Sometimes it helps and other times it makes me more aware of me trying to sleep!
Have you tried NyQuil? I know it's for colds, but that stuff not only knocks me out; it also eases my anxiety. I usually use melatonin because I don't want to abuse the NyQuil, but if melatonin won't be effective for you (especially if anxiety is what's causing it), I would maybe try that. Also, have you considered a therapy animal that can sleep with you? That might ease the anxiety, and if you wake up with anxiety again, the animal might help to calm you down, so that some of the associations of sleep with panic attacks might decrease.
Ha! I did try NyQuil. And also got a prescription for the active ingredient used in a lot of antihistamines, hydroxyzine. I tried melatonin too. My anxiety was way too much for the weaker stuff :). And funny, I had a dog that did sleep with me but the dog kept me up more at night!
I may be in early stages of what you’re describing, but in my case it is basic avoidance of sleep until late at night which is unhealthy for many reasons. I find myself tired in early afternoon almost every day, yet subconsciously keep staying up late every night. My anxiety is not helping and most of the episodes happen at evenings and it takes me a long time to fully calm down and recover, thus I keep staying up. Like you said, the vicious cycle continues. I’m still working on a solution on how to get back to normal sleep schedule, but it hasn’t happened yet. You’re not alone.
It's tough! I'm six months in. It's amazing how one night of bad sleep (for me) can cause such worry and it takes months and months to become desensitized to the worries. One night to mess it all up and months and months to recover. I hope you find something that helps.
Just making sure- doc checked a thyroid level, right?
30 years ago, I was you. I tried everything at the time- I was on flurazepam (similar to a benzo) for a while, Valium for a while, I took Tryptophan, and I practiced precise, obsessive sleep hygiene (link at bottom). I jogged miles and miles to try to tire myself out. I had 2-3 glasses of wine most nights, telling myself I was drinking socially. That was BS. I was self-medicating of course. Prozac (the first SSRI) was in its infancy and no one was prescribing it for anxiety yet. 30 years ago there were fewer sleep aids. For example, Remeron and Ambien have come out since. I don't think melatonin existed yet as a supplement. But my recommendation is for none of these things. I'm going to describe to you the true cure for insomnia (copied, edited and pasted from one of my replies to someone else):
First, cast away any notions you have about sleeplessness. They are all false. Seriously, anything you've read or heard from people about how "not getting enough sleep is harmful", and "lack of sleep can lead to worsening mental health issues", "It raises cortisol levels which can lead to problems" etc etc... it's all complete bunk. I went through 5 years of the most intense insomnia you've ever seen, complete with the symptoms and thoughts that you describe. I never went crazy, It didn't make me deathly ill, and I'm very much alive and well.
Start looking at it this way:
- Sleep is totally overrated. Believe this and you will be cured.
- Sleeplessness is common, harmless, nothing whatsoever to be concerned about.
- In times of great stress, people go for days without sleeping (ie wartime, catastrophes) and the body is meant to handle that as part of life
- I works in health care and we often go for days without sleeping- on call, back to back shifts, no one shows up so you do a double, etc...
-New moms (and dads!) hardly sleep at all. They are up all night with crying babies, feeding every 2-3 hours, etc
-The human body is AMAZING and when we miss sleep, the body knows how to make up for lost time when we finally do sleep. Just ask any Dr. you know- when they catch those few hours of sleep between being on call for days on end, they sleep HARD.
Yes, anxiety induced insomnia responds beautifully to turning it into a big nothing in your mind. Then you WILL start sleeping better. Lose your fear of sleeplessness, and sleep will come. I remember one night, sitting in the dark, staring out the window at the rain, at the end of my rope, totally despondent, wondering if I should go to the ER (again)- literally rocking back and forth saying, "why can't I sleep, why can't I sleep..." and something started to click in my mind. I decided I didn't care. I decided I would be a raging insomniac my entire life. I decided to go sleepless and totally crazy, which I was convinced would be the outcome. I decided to stop fighting and to start embracing my new sleepless, nocturnal lifestyle. I imagined I was some genius creative type (ha ha- NOT), up all night, frantically working on my literary masterpiece (I started to write back then- fictional things). I utterly gave up the fight. Now this wasn't an overnight thing, but I miraculously started to sleep. I was highly sensitized from so much anxiety at the time (I didn't know that word back then) so it took time. I also needed practice not caring, so it took time. But it was such a relief to stop the fighting. This is how to recover from anxiety itself and so many manifestations of anxiety, not just insomnia. I knew none of this back then- I just knew that all the frantic searching for the magic pill wasn't working at ALL. So I gave up. And started sleeping. And slowly started feeling better in so many other ways.
I did not know all about anxiety that I know now. I was not recovered completely. There were elements of intense, uncomfortable and unnecessary anxiety throughout the years. I didn't understand my mind yet. But I now know the key to anxiety recovery, all of it, is ACCEPTANCE. And turning it into a great, big, nothing. Anxiety is such a paradox.
I rarely have insomnia these days. When I have something bothering me I might have a bout of insomnia, but it's mild and it's a big whatever. I get up and do things. I catch up on stuff. When my daughter has occasional insomnia, we get up together and use that time to do fun things- cook, paint, plan a trip, write cards, etc. I downplay it. I make sure she knows it's a huge "whatever".
Definitely practice sleep hygiene (see link below) but don't expect it to work miracles. It all helps, but "NOTHING" works. That's a GOOD thing. Turning it into a great big nothing actually WORKS. Here's a sleep hygiene link:
I think you're spot on. I'm dealing with the journey to acceptance. The ideal is acceptance and not having to take medication, but I wonder if part of acceptance or getting to acceptance is also being okay with short-term use of medication. Especially if you feel the way I feel, which a lot of people feel! And if you're not at risk of becoming addicted, because believe me, I would love to not take benzos, or don't want to take medication for the rest of my life, because again, I have no interest in taking antidepressants long-term again, then why not try? So I'm talking with my shrink and therapist about my options.
But again, I agree, the real treatment is practicing acceptance. The solution to anything making you anxious is to not fight it. Resistance is what causes the anxiety, because you're anxious about feeling anxious and trying to avoid it (according to the experts...). Then eventually it becomes less of a thing, and eventually no longer makes you anxious. Anxiety-induced insomnia, and honestly any insomnia, is performance anxiety for sleeping (unless you really have a medical issue, my thyroid is fine!). If you remove your heightened sense of importance of sleep and stop caring about it, you remove the performance anxiety, and paradoxically are able to sleep. I'll check out the book rec.
I think the other component of acceptance is self-love and compassion. It's so easy to be distraught, bewildered, to give up when you feel this way. To be jealous of others who don't have anxiety. You lose sense of wanting to help yourself, especially if your mood becomes so depressed or low. And at that state, to pull yourself out of it, seems impossible. But it really requires self-love.
I started doing mindfulness/meditation practices for kindness/self-compassion. And started to realize that when my mind started to worry, and I started to participate in the worry, it wasn't the kind thing for me to do to myself. Like, why am I trying to scare myself again? Why am I entertaining these negative thoughts and feelings? It's hard though, especially when it's your default behavior from years of the same habit and you're sensitized. Why wouldn't you believe all the catastrophe? But reminding myself to be kind in the moment sometimes help check my worry.
Anyway, yours sounds like you finally got to a point where you stopped caring. I wonder if that will happen to me...A gradual desensitization. I'm starting to care less about the insomnia because, to your point, I've had it for six months now and at first thought it was the worst thing in the world, but six months later I haven't dropped dead or gone crazy. I'm sure there are all sorts of ways people finally get to a point of acceptance and acceptance is the only sustainable solution. I still have uncomfortable chest pains but I need to learn to accept those and not care, it's just anxiety, harmless.
I wonder how others got to a point of acceptance too!
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