Our sleep quality is more important than a lot of us give it credit for, and one of the leading factors in poor sleep quality is our worries. The reason I wanted to write this article was that my partner is experiencing another round of sleep difficulties that are linked to worries at work. Thus, I wanted a better understanding, and I thought I’d share what I’d learned with you, my readers, so they could also benefit from that.
The Relationship Between Worry And Sleep Quality
We will all experience worry and anxiety during our lifetimes, because it’s a normal, everyday human emotion and phenomenon (Thielsch et al., 2015). Whether it’s work-related stress, life events, health concerns, or something else that leads to anxiety, it can all affect our sleep.
Thus, it’s very common for people’s worries to make it difficult to fall asleep or to stay asleep. If this is a frequent issue, then this can be a significant sign of generalised anxiety disorder (Fletcher, 2024), also known as GAD.
GAD is based on our worry as a way to problem-solve, in response to a feared stimulus, or as preparation for the worst. The issue is that such worrying is often about unlikely or implausible events (Pillai and Drake, 2015).
Over the decades, many studies have demonstrated the link between our worried minds and our sleep quality. A study by Kelly (2002) found that the more worries we experienced, the bigger the effect on our quality of sleep. Simply put: More worry = Shorter sleep. Interestingly, this was shown to be the case even if people didn’t attribute their sleep issues to worrying.
This is important because that means worrying can affect our sleep quality in very different ways. For some, it might be a lot of overthinking before bed, making it difficult to go to sleep, and potentially waking up throughout the night when the worries pop back into their head. Or it could mean going to sleep and waking up in a state of anxiety.
But it could also be like me. I can fall asleep with no issues; I routinely wake up during the night, but I don’t experience anxiety or any worry-based thoughts, and I can fall asleep again with ease. I do this several times a night, and it seems to coincide with switching to being a mental health therapist, rather than remaining an addiction therapist, where I have the most training.
Therefore, it could be because of my impostor syndrome, which I know I have. And although I am able to separate my work and personal life into two different areas of my life with ease, it seems it may still be affecting my sleep.
Also, according to the metacognitive model of GAD, negative metacognitive beliefs are key in maintaining excessive worrying (Thielsch et al., 2015). This isn’t too dissimilar to mapadated/negative core beliefs in cognitive behavioural therapy (CBT), which can do the same.
Not only can our sleep quality be affected by our worrying, i.e. overthinking (rumination), which is considered to be an indirect route (Kelly, 2002), but there is also the more direct route, whereby subconscious physiological arousal occurs.
A journal article that supports the connection between worry, anxiety, and our sleep quality comes from Pillai and Drake (2015). In their journal article, they argue that research supports that our rumination is a critical factor in our sleep quality, and that this is a key feature of GAD. This is also supported by McGowan, Behar, and Luhmann (2016).
They also argue that the indirect rumination, planning, or struggling to control thoughts route is more significant than the direct subconscious physiological arousal route. This makes sense because pathological worrying is excessive and perceived as uncontrollable (Thielsch et al., 2015).
Furthermore, there’s also the possibility of worry directly triggering hyperarousal, which is the state of elevated mental, emotional, and physical activation that keeps the body’s threat response active when it should be winding down. So the direct and indirect routes work together.
How To Overcome Our Worry And Anxiety Ruining Our Quality Of Sleep
There’s nothing like being told to avoid stressful situations (Fletcher, 2024), which doesn’t even seem possible in the world we live in. There’s only so much we can avoid before avoiding it causes more stress than it avoided. So this kind of advice can be very unhelpful.
But what is useful is what McGowan, Behar, and Luhmann (2016) found in their study. That is, for people for whom worry is a significant factor in their sleep quality, and with GAD in general, it’s important to address and treat that worry. This is also supported by Kelly (2002).
This is important because poor sleep quality can worsen our anxiety, creating a very frustrating negative feedback loop (Fletcher, 2024).
This is corroborated by Thielsch et al. (2015), who conducted a study into the role of metacognitions and found a mutually maintaining relationship between worry and sleep quality. They found that worry leads to poor sleep quality, and poor sleep quality leads to worry.
One way this can manifest is in the form of sleep anxiety, whereby we worry about not getting enough sleep, which is like being kicked when we’re down. Therefore, interventions aimed at breaking this cycle would be useful in both the treatment of insomnia and GAD.
This is further validated by Narmandakh, Oldehinkel, Masselink, de Jonge, and Roest (2021). Their study discussed the notion of daily unpleasant affect and pleasant affect in regard to sleep quality. If we have a poor night’s sleep, then we’re more likely to experience unpleasant affect, experience worry, and less likely to experience pleasant affect. They also found that our daytime experience with pleasant affect, unpleasant affect, and worry could predict sleep issues the following night.
So in short, instead of allowing the brain to transition naturally into sleep, worry keeps the nervous system on high alert, creating a cycle that disrupts both getting to sleep and staying asleep.
Stimulus control therapy
For some people, they may find that frequent worrying in bed may result in their brain undergoing a classic conditioned response. This is where our brains begin to associate our beds with frustration and hyperarousal rather than rest. Stimulus control can help break that association.
- The 20-minute rule: If we find ourselves awake and worrying for roughly 20 minutes or more, then it’s best to get out of bed. Staying in bed during this state can reinforce the brain’s link between the bed and stress.
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Change the environment: Moving to a quiet, dimly lit room can help avoid this reinforcement while still providing low stimulation to help return to a restful state. It goes without saying that we should avoid screen-related activity while doing this. But things like reading a physical book or listening to soft music until we genuinely feel drowsy is fine. When we do feel drowsy again, then return to bed.
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Reserve the bed for sleep: This is one of the bits of advice that I’ve always hated, because I’ve spent almost my entire adult life in shared accommodation and houses of multiple occupation (HMOs), and thus had no living room. Making my bed my sofa, the place I sleep, and the place I eat. If we’ve got the option, though, avoid using our beds for anything other than sleep and sex.
Worry time
Intrusive thoughts love to find quiet times to flood our minds with thoughts and reminders, and trying to sleep is one of those times because things get quiet and there’s much less to distract us.
One way to overcome this is to have a dedicated worry time, so that we can go through this process at a time that suits us. To do this, all we need to do is schedule a dedicated worry time, which might be daily for 15 minutes or weekly for 30 minutes. Being consistent with this will increase it’s effectivesness.
If a worry pops up while we’re trying to sleep, just remind ourselves: “I have a dedicated time for this (add our scheduled worry time here)”. It can also be useful to note a quick keyword on a notepad by the bed if needed.
Journaling
A strategy I found useful when my brain would bring up all my trauma as I was trying to sleep was to keep a journal by my bed. Before bed, I could write about anything that was on my mind, which allowed me to offload it. If I woke up during the night, I would write down whatever would flood into my mind in those moments of temporary wakefulness. I found it really helped improve my sleep quality.
This also ended up helping me overcome the continued harm my trauma caused me, because it forced me to process it, turning those burning hot traumatic memories into cold memories. It worked like narrative exposure therapy (NET).
Cognitive restructuring and decatastrophising
As mentioned before, sleep quality issues often lead to sleep anxiety, which just sucks. We can experience thoughts like, “If I don’t get eight hours tonight, I won’t be able to function tomorrow”. Although for me, it was four hours, not eight. As long as I got four, I could function, and my psychosis was a lot more manageable. Such thinking before sleep can work as an activator to our body, and thus, further worsen our sleep quality.
If we experience thoughts like this, try reframing to thinking like, “I’ve managed with a poor night’s sleep before. I may feel tired, but I’ll get through the day”, or, “One bad night’s sleep isn’t the end of the world”.
Imagery distraction
It appears we can swap out the unwanted mental chatter by engaging the brain’s visual cortex. We can do this by vividly picturing a detailed, non-emotional scenario or images, such as mentally walking through a familiar park. This takes up our cognitive bandwidth needed for worrying. My inner eye sucks, so I’ve struggled to test this one out.
Problem-solving
When we have worries, it’s one thing to write them down so we can clear our minds to sleep. But all of this is moot if we can’t overcome the cause of our worries.
So whatever route we take to manage our worries so we can get better sleep quality, we all have to make time to figure out the cause of the worry and anxiety. Then we can work on removing that source for longer-term improvements to our sleep quality, and stress and anxiety.
Often, a lot of our worries come back to one thing: the unknown. When we’re told our manager wants to have a meeting with us, but we don’t know why, we can fill that void by assuming the worst. A really unhelpful cognitive bias. That can be removed by just asking what the meeting is about, so we don’t fill in that blank ourselves.
It’s the same kind of situation with health anxiety, such as when we’re waiting for a test result to come back. Worrying about it isn’t going to change the outcome, but we often need that unknown aspect to be filled by something. In situations like this, acceptance might be the best path to explore. Accept that there’s nothing that can be done until the results come back. Easier said than done, I know.
By identifying the source, we can hopefully find a way to eliminate it, or at least manage it better so it doesn’t manifest as worries that affect our sleep quality. Sometimes, just reaching out to our social support network can be enough to manage the source of our worries.
Seek support
Never underestimate the benefits of a good social support network. If these people care about us, then we’re not being a burden. A good social support network doesn’t stop at friends and family either; it can include professional help. Reach out to our doctor, a therapist, or both if our sleep quality doesn’t improve.
I’ve undergone several sleep studies and CBT-I, so there’s a lot of support out there. There’s also melatonin, which is a non-addictive sleep aid. Unfortunately, this option doesn’t work for me as it interacts with my beta-blocker for my heart.
Summary
Our sleep quality is important not only to our everyday functioning, but also to our overall health. Annoyingly, knowing that can often lead to poor sleep quality, as it can be a factor in developing sleep anxiety.
But it’s not just worries like this that can affect our sleep quality. Everyday anxiety and work stress can also cause our sleep to suffer. Our brains are problem-solving machines, so if it thinks something is left unresolved, it will remind us using intrusive thoughts. Causing us more problems as a result.
Because of this, we need to find ways to overcome or better contain our worries so it stops affecting our sleep quality. Fortunately, things like journaling, worry time, acceptance, and using our social support network can all help with this. It’s just a matter of finding the right approach that works for us as an individual.
As always, leave your feedback in the comments section below. Also, please share your experiences with sleep quality in the comments section below as well. Don’t forget, if you want to stay up-to-date with my blog, you can sign up for my newsletter below. Alternatively, click the red bell icon in the bottom right corner to get push notifications for new articles.
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References
Fletcher, J. (2024, February 20). What to know about waking up with anxiety. Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/325808.
Kelly, W. E. (2002). Worry and sleep length revisited: Worry, sleep length, and sleep disturbance ascribed to worry. The Journal of Genetic Psychology, 163(3), 296-304. Retrieved from https://www.researchgate.net/profile/William-Kelly-11/publication/11160129_Worry_and_Sleep_Length_Revisited_Worry_Sleep_Length_and_Sleep_Disturbance_Ascribed_to_Worry/links/55f1e1f308aedecb69020c0f/Worry-and-Sleep-Length-Revisited-Worry-Sleep-Length-and-Sleep-Disturbance-Ascribed-to-Worry.pdf.
McGowan, S. K., Behar, E., & Luhmann, M. (2016). Examining the relationship between worry and sleep: A daily process approach. Behavior Therapy, 47(4), 460-473. Retrieved from https://doi.org/10.1016/j.beth.2015.12.003.
Narmandakh, A., Oldehinkel, A. J., Masselink, M., de Jonge, P., & Roest, A. M. (2021). Affect, worry, and sleep: Between-and within-subject associations in a diary study. Journal of Affective Disorders Reports, 4, 100134. Retrieved from https://www.sciencedirect.com/science/article/pii/S2666915321000615.
Pillai, V., & Drake, C. L. (2015). Sleep and repetitive thought: the role of rumination and worry in sleep disturbance. Sleep and Affect, 201-225. Retrieved from https://www.researchgate.net/profile/Christopher-Drake/publication/282595612_Sleep_and_Repetitive_Thought/links/5a5675f9aca272bb6963ee20/Sleep-and-Repetitive-Thought.pdf.
Thielsch, C., Ehring, T., Nestler, S., Wolters, J., Kopei, I., Rist, F., Gerlach, A. L., & Andor, T. (2015). Metacognitions, worry and sleep in everyday life: Studying bidirectional pathways using Ecological Momentary Assessment in GAD patients. Journal of Anxiety Disorders, 33, 53-61. Retrieved from https://doi.org/10.1016/j.janxdis.2015.04.007.