Sleep through anxiety disorders or anxiety through sleep disorders?

31. October 2022

A quarter of all adults in Germany suffer from a mental illness. More than half of them even suffer from two. Mental suffering is often complex and disorders are not always clearly separable, but rather mutually dependent. About half of all sufferers of sleep disorders also suffer from an anxiety disorder and vice versa. But what came first? Finding out is of great importance, especially with regard to treatment.

Sleep as a basis for health

Good sleep is essential for both physical and mental health. It goes without saying that you can’t always sleep well. Everyone suffers from sleep problems from time to time, especially in stressful phases with a lot of worries. It only becomes really problematic when you sleep less, worse and more irregularly over a longer period of time and your mental well-being and performance are significantly impaired. Then one speaks officially of a sleep disturbance. This not only has a high comorbidity with many mental illnesses, such as anxiety disorder, but is often accompanied by other risk factors:

  • Impairment of learning and memory processes
  • Emotional imbalance
  • Low physical performance
  • Diseases such as high blood pressure, metabolic disorders or diabetes
  • Increased appetite and overweight
  • Weak immune system and infectious diseases

Lack of sleep makes you anxious

The importance of sleep is also made clear by the current studies on sleep disorders and the associated higher anxiety reactions. Using the method of functional magnetic resonance imaging (fMRI) it could be shown that after a sleepless night the medial prefrontal cortex, which has a central function in fear control, is inactive and fear reactions on the next day are up to three times stronger than usual. In contrast, emotional areas in the brain become overly active due to insufficient sleep and consequently can be poorly inhibited by the lack of fear control. Furthermore, the studies showed that deep sleep in particular, so-called non-REM sleep, significantly counteracts anxiety and is also beneficial for emotion regulation.

Quick help for better sleep

Promoting sleep, and deep sleep in particular, is therefore essential for reducing anxiety. But what helps with sleep disorders? First, there are some tips that can be tried independently at home:

Regular bedtimes
Sleep rituals
Physical activity during the day
Relaxation method
Coffee only in the morning
Abstaining from alcohol and sleeping pills
Light meals in the evening
Record stressful thoughts in writing

If all these measures do not help, it is advisable to seek professional support in the form of psychotherapy. A trained therapist can help to identify the deeper reasons for the sleep disorder and create the framework for a joint reappraisal.

When anxiety robs you of sleep

Now let’s look at the opposite case: Sleep disorders are also often part of the clinical picture in anxiety disorders. And here, too, there is a conclusive explanation: the stress hormone cortisol. In any anxiety disorder, the affected persons are permanently in a fight-flight mechanism, which signals to the body that there is danger and that it must be efficient. This results in a high release of cortisol as well as adrenaline and noradrenaline. The heartbeat also increases, blood pressure rises and digestion slows down. These mechanisms are basically vital, but in the case of an anxiety disorder they also occur in objectively non-threatening situations and thus excessively. Due to the constant alertness, those affected develop sleep problems and the body can no longer regenerate, which in turn leads to a slower reduction of cortisol. A vicious circle.

What treatment options are available for anxiety disorders?

In order to be able to regenerate sufficiently again and improve sleep, it is important to actively work on the anxiety disorder. The following steps can help:1. psychotherapyIt is often difficult to take the first step and open up to accept professional help. However, in many cases, one can no longer get out of the anxiety-devil circle on one’s own. The therapy method of choice is usually behavioral therapy, which helps the patient to understand his underlying thought processes and to correct avoidant behaviors.2. relaxation methodsIf you want to try it on your own or do more in parallel to psychotherapy, various relaxation methods such as meditation, yoga or progressive muscle relaxation can be effective. In addition to mental relaxation, the focus is on physical recovery, which can also have a very beneficial effect on sleep.3. Healthy Diet & Exercise Exercisepromotes the release of the happiness hormones serotonin and endorphin and thus promotes the reduction of the stress hormone cortisol. Just as eating healthy fats (e.g., nuts, olives, flaxseeds), high-quality proteins (e.g., yogurt, lentils, salmon) and carbohydrates (e.g., whole grains, legumes, potatoes) relieve stress. Simple carbohydrates and sugar in excess cause blood sugar levels to fluctuate greatly, thus leading to stress and should be avoided. The same applies to caffeine and alcohol in larger quantities, as these substances can also trigger tension and restlessness.4. Changing perceptionFinally, there is a tip for acute anxiety situations, such as a panic attack. Here, the attention is consciously directed away from the negative anxiety thoughts with the 5-4-3-2-1 exercise:Name – aloud or in your thoughts – five things that you are currently seeing Name – aloudor in your thoughts – five things that you are currently hearingName –aloud or in your thoughts – five things that you are currently feelingRepeat the three steps again with four, three, two and one things.Conclusion: The reciprocal relationship between a disturbed circadian rhythm and anxiety disorders should now have become clear. It is very important to understand both factors in a disorder and to be clear about what is the hen and what is the egg so that targeted treatment can be given. Of course, the aids that can be implemented at home alone and often start with the relaxation of those affected can be used in parallel to ensure a rapid improvement in both clinical pictures. It is always important to keep in mind that there is a way out of the vicious circle between sleep problems and anxiety and only the right starting point must be found.

References
  • Dilling, Horst et al: ICD-10: International Classification of Mental Disorders. G├Âttingen, 2015.
  • Kulzer, Bernhard; Hermanns, Norbert: Depression, anxiety and sleep disorders – important comorbidities of neuropathy. Diabetologist (2009), vol. 5.
  • Starostzik, Christine: Consequences of permanent stress: depression, anxiety, sleep disorders. CME (2021), Vol. 18, Helft 31.
Verena Klein
Author Verena Klein
"LIMES Schlosskliniken specializes in the treatment of mental and psychosomatic illnesses. With the help of the blog, we as a clinic group would like to examine the various mental illnesses in more detail and present different therapies as well as current topics."

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