Worry, Sleep, and Anxiety: A CBT Game Plan
We are all familiar with the moment we finally get into bed after a long, tiring day, and everything shuts down… Except for our minds. Thoughts about what we haven’t done yet, what we have going on tomorrow, and suddenly, ideas of all of the things that can go wrong. It is very common for sleep and anxiety to feed into each other, so many people notice the relationship there.
CBT (cognitive behavioral therapy) examines the connection between thoughts (“what if I can’t sleep?”), feelings (tension, anxiety), and behaviors (rolling from side to side, checking the time, getting out of bed, scrolling on your phone, etc.). It’s important to know that this isn’t “all in your head.” Anxiety is a whole-body experience in which the nervous system shifts into an alert mode; something the body learns to do, even when there’s no immediate danger and you’re trying to rest. CBT doesn’t assume something is ‘wrong’ with you; it helps you to focus on patterns that keep your anxiety going. If these patterns were learned, most of them can be unlearned!
Learn more about CBT for anxiety →
These changes will be small and realistic. We can’t not worry anymore. Instead, we try to change how we respond to worry, reduce pressure around sleep, and help our bodies regulate and feel safer at night.
The reason worry shows up more at night is because we are not distracted by our daily schedule and the tasks we must complete throughout the day, so our thoughts become louder. Then, the fear of not getting enough sleep creeps in, and we can predict that tomorrow will be ruined, making it harder to fall asleep. This creates a cycle that many people report experiencing: worry -> alertness -> difficulty falling asleep -> more worry. Therefore, breaking any part of this cycle can be helpful and life changing.
CBT provides clients with practical solutions that have been shown to be helpful and effective. Some of these techniques include, for example, recognizing the unhelpful or untrue thoughts we are having as we wind down for the day, such as “tomorrow will be a disaster”, then shifting thoughts to something more true or helpful, like “I don’t need to try to solve tomorrow’s problems tonight”.
See more about unhelpful thinking patterns here →
Another technique that CBT therapy teaches revolves around behavioral changes before sleep, such as having a calming bedtime routine that involves stopping using screens earlier in the evening, stopping attempts to force sleep or repeatedly check the time, and instead calming down, engaging in mindfulness activities or other mind-slowing activities, or, if needed, getting out of bed briefly and returning after regulating. Anxiety is experienced in our minds as much as our bodies, and therefore, CBT also helps clients develop calming skills to lower anxiety, such as breathing techniques and muscle relaxation.
Some people tell themselves that bad nights of sleep mean failure, and the negative emotions of self-criticism and pressure often have a stronger influence than the lack of sleep itself. Therefore, in CBT therapy, your therapist will teach you to try to replace judgment with curiosity and explore together how to improve sleep in the future.
Sleeping with less anxiety is a process, not something we can force or quickly be ‘successful’ at. Small steps learned in CBT therapy can be done with compassion can help our bodies feel calm and safe at night, and sleep will come on its own.
If your anxiety is getting in the way of you getting restful, restorative sleep, East Side CBT can help! Our therapists are skilled at teaching our clients how to set themselves up for sleep success and how to reduce nighttime anxiety using evidence-based strategies that work!