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The Vicious Cycle of Insomnia and Anxiety

January 27, 2014

As discussed in previous posts, anxiety is a multi-faceted issue that deeply affects among other aspects of life, insomnia.

According to a dissertation concerning the treatment of insomnia, author Alfonso Marino notes, “Anxiety holds a significant bearing on the onset of insomnia.  Anxiety is usually accompanied by numerous physical and physiological symptoms including autonomic hyperactivity (tachycardia and palpitations, urinary frequency, diarrhea, dry mouth, sweating, flushing, cold hands) back ache, shortness of breath. . .these symptoms may be present through the day and increase just prior to going to bed.  Individuals with chronic insomnia are usually concerned over sleep performance and their ability to function the following day with lack of adequate sleep.”

Anxiety contributes to insomnia in that the disturbing thoughts concerning the inability to fall asleep and maintain sleep become a self-fulfilling prophecy of doom, relived again and again. In the diagnosis of anxiety disorders, one criterion happens to be insomnia.  As Marino writes in his dissertation, “Sleep and vigilance problems are often included in the diagnostic criteria for anxiety disorders.  This is due to the assumption that if anxiety causes sleep disturbances it is also believed that sleep deprivation may produce symptoms which may be considered as anxiety.” In other words, insomnia and anxiety form a vicious cycle in which it’s hard to tell which comes first, which is the chicken and which is the egg.

But before anxiety and before insomnia, we do know that the thoughts are always playing some role. Of course, anxiety is fomented in the thoughts.  We know that we can’t stop or prevent our thoughts, a factor not unrelated to our inability to control precisely when we will fall asleep.  However, the holy fathers have taught us the sweet science of vigilance over our thoughts.  Anxiety-producing thoughts prior to sleep can be cut off or cast aside or replaced by other more healthful and blessed thoughts, according to these ancient fathers.  In a previous post on this subject, I wrote, “Orthodox monasticism likewise emphasizes the importance of spiritual training that takes place outside the explicit contexts of private and corporate prayer. The ascetics repeatedly urge monks and nuns to practice cutting off their will [ekkopē thelēmatos] daily in order to grow in virtue, to become humble, and to acquire compunction.  Merely saying no to inquisitive thoughts about trivial matters cultivates a detachment from insignificant earthly concerns. Although it may not seem like a great accomplishment if a nun wonders what is for dinner, but refrains from asking the cook, over time this practice applied in a variety of situations establishes a proper hierarchy of values in her soul, shifting fundamental beliefs about herself and her world from the ephemeral to the eternal. Another example of patristic advice on planting precepts on virtue along the rolling hills of daily life is the practice of rehearsing in the mind how one would like to act in a troubling situation. For the fathers, this practice is scripturally rooted in psalm 118:60 (LXX): ‘I prepared myself and was not disturbed in keeping thy commandments,’ which they paraphrase as ‘I reviewed in advance how I would handle a chance encounter by considering my resources, and I was not disturbed by tribulations for Christ’s sake.’  According to the ancient ascetics, this previous preparation enabled the three holy youths to enter the Babylonian furnace and hosts of martyrs to face martyrdom without being flustered. By anticipating and considering in advance what may take place, believers in the face of trials can likewise trim down excessive emotional reactions of fear or anger. For example, Saint John Cassian suggests that those who find themselves becoming impatient or angry should practice imagining that they are hindered, wronged or injured, but respond as the saints would—with perfect humility and gentleness of heart.  Saint Nicodemos the Hagiorite likewise recommends that believers prepare themselves before going somewhere or coming into contact with irritating and exasperating people by imagining that others curse them and dishonor them, but that they weather it all with thanksgiving and peace of mind. Saint Theophan the Recluse expands this method to include all the conceivable encounters and imaginable feelings, desires, and reactions that a person might experience. He suggests reflecting on potential attacks at the beginning of the day and mentally planning how to react in a way that is in keeping with the commandments of Christ. This patristic practice also has classical antecedents. In the Christian redaction of Epictetus’s Encheiridion, those who desire to become virtuous are advised to consider in advance the potential difficulties and obstacles that they might come across in any endeavor.”

How can this advice be related to insomnia? To begin with, one can recognize that thoughts like “I’ll never get to sleep,” “I won’t get enough rest,” “Again, the same struggle to sleep,” will come, but one need not focus on them and enlarge them. Anxiety always freeze-frames at the brink of failure, but life continues over brink after brink until we reach our final destination. Furthermore, we can turn our minds in other directions or plan for rest differently. We can recall that “there remains a rest for the people of God” (Hebrews 4:9), that “God gives his beloved sleep” (Psalm 127:2), and with respect to our calamitous thoughts, “Ye shall not fear them: for the Lord your God he shall fight for you” (Deuteronomy 3:22). While I will discuss in more detail spiritual remedies to such anxiety as it relates to insomnia in a future post, it’s important to take note that “stepping outside” of the present anxiety-producing situation or thought provides proper perspective and a curative for despair.  A situation or thought becomes anxiety producing because it falsely tells us that “it” is inevitable and there is nothing to be done but await with dread to go through the ordeal and to suffer the consequences.  This is not true.  I am reminded of the AA slogan, “this too shall pass” that is so often on the lips and in the hearts of those who’ve conquered addiction.  The “it” that produces anxiety is fleeting and will pass if we do not give in to the despair and inevitability it suggests. And that victory begins when we learn what the wise Solomon once taught, “Trust in the Lord with all thine heart; and lean not unto thine own understanding” (Proverbs 3:5).

  1. So excellent and helpful Father. I know that vicious cycle…even the depression/insomnia cycle in which one does NOT know which came first!

    These last few months have led to feelings of despair regarding my situation with insomnia/depression. My doctor keeps trying different medications…but they only assist sometimes. Also, due to the nature of my job ( a few nights on call for the hospital in ultrasound), they have to monitor what I am taking so I am able to perform if I do get called in.

    I do feel like this is *it*…for the rest of my life. I really don’t have those anxious thoughts as much as I used to regarding the lack of sleep…there seems to be a sort of resignation…accepting the fact that I have lost some sleep and will probably feel tired the next day but God will extend the graces needed to fulfill my duties. Sometimes it’s other thoughts…trouble with older children…wondering if I am fulfilling God’s will to the best of my ability…guilt about mistakes made raising my children.

    I especially look forward to your next post…very much. Thank you.

  2. Yes, that is another good observation, Theresa, about the depression/insomnia cycle! And when there is such a cycle, the problem gets spread out and the weight of the problem is lessened, because it’s not just us, but our response to what life brings us. And all of life shares in the suffering and in the desire for healing. There is some healing in these reflections if we think about them deeply.

    I would also say that an acceptance of a condition is a very good starting place for coping with a condition. The realisation that anxious thoughts are not completely true is another step in the right direction. Thank God for every good step we are able to make. And if we misstep, along the way, we ask God’s grace and mercy to provide where we cannot, knowing full well, and rejoicing in the knowledge, that His mercy endures forever.

  3. I enjoy reading your articles, particularly the references to the scientific studies.

    I have started trying to be more positive recently and to be happy with what I have. I am reading a book called “At Day’s Close – A History of Night Time” and it mentions Scotland in the 1780’s where the animals were brought into the sleeping quarters for safety at night. The dung was only cleared out once a year. I am grateful that my bedroom is a lot more comfortable and warm and reading such things help me to realise that I shouldn’t be anxious as I am far luckier than many of those who went before me.

    Historically people also used to use rocks as pillows ( and also tie cow dung to the end of their beds in order to keep gnats away. Now we have feather pillows and aromatherapy which while I do not believe in it, it is far better than cow dung! I have a lot to be grateful for compared to times past and so I should learn to love my bed and not be so anxious about it.

    For me this becomes part of the path to acceptance that I hope will over time reduce my anxiety towards sleep.

  4. Tim Lambert permalink

    Great article!
    I’ve been using the acceptance approach as well and it has greatly (but slowly – ups and downs) helped me come back from this.
    For me I see the root of insomnia being fear/anxiety. All of this being rooted in poorly dealing with stress in my daily life.

    While I pray that I return back to my old self with respects to sleep.
    I am thankful to God for having to go through his ordeal (going on a year now) because it made me realize the errors in my way…. the non-Christian way I was dealing with others as well as myself.

    Fearful thoughts? I accept them.
    Hard time falling asleep? I accept it.
    Hard time staying asleep or falling back to sleep? I accept it.

    I accept them. I think of the words of Thomas Kempis (paraphrased) “Patiently endure what you cannot change in yourself, allow it to be until God ordains otherwise.”

  5. Thank you, Tim, for some great reflections! I especially appreciated those simple questions and simple answers: “Fearful thoughts? I accept them. Hard time falling asleep? I accept it.” And I think simplicity is really important with respect to sleep, just as complexity by its very nature can keep the mind racing here and there.

    • Jan permalink

      Thank you for this. I believe i will be victorious in this ordeal

  6. Karly – No Snore Zone
    Fantastic post! I think the majority of the world’s population has suffered from some form of lack of sleep due to anxiety. I used to worry about all the tasks I needed to do the next day and having to get up so early in the morning. I would then get more anxious as the night went on and I was still awake. It’s can be a vicious cycle and one I sympathise greatly with.

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