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Which Came First, the Anxiety or the Insomnia? Does It Matter?

Struggling to fall asleep, or stay asleep, or sleep long enough, describes insomnia – the most common of all sleep disorders. Anxiety has long been linked to insomnia, though it’s hard to say which came first:

  • Does anxiety lead to insomnia?
  • Does insomnia lead to anxiety?
  • Could it be a little bit of both?

What is comorbidity?

When someone experiences 2 conditions at the same time, these conditions are said to be comorbid to one another. In the case of anxiety and insomnia, they are common comorbidities.

Might this resemble your own bedtime struggle?

When anxiety leads to insomnia

In a recent study, the prevalence of anxiety among nearly 65,000 people with insomnia disorder was quite high, at more than 63 percent. (Note: This study, published in March of 2020, took place before COVID-19 become a global pandemic.)1

The Sleep Foundation notes that “serious sleep disturbances, including insomnia, have long been recognized as a common symptom of anxiety disorders.” People with anxiety tend to ruminate at night, unable to sleep due to “mental hyperarousal.” They’re also more predisposed to sleep problems when facing stress.2

Anxiety disorders that lead to insomnia include:2,3

  • Generalized anxiety disorder (GAD)
  • Obsessive-compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Orthosomnia (anxiety about being unable to sleep)

When insomnia leads to anxiety

The problem of chronic insomnia opens new pathways that lead to anxiety. At least half of all adults experience sleeplessness at some point in their lives.4

A Norwegian study in 2007 showed that people with chronic insomnia faced higher risks for developing anxiety. They studied more than 25,000 adults with insomnia over a decade. The subjects, who reported insomnia at the start of their study, were found to face higher risks for an anxiety disorder during the study’s second phase 10 years later.5

Sleep deprivation — the outcome of chronic insomnia — is the culprit. Sleep deprivation:6

  • Elevates anxiety risk
  • Worsens preexisting anxiety
  • Prevents recovery from anxiety

How to help yourself

If you have chronic insomnia

You may not be diagnosed, but that doesn’t mean you aren’t aware you can’t sleep. Quite the opposite — you’ve likely tried all the tips and tricks, researched solutions online, and shopped for sleep-inducing products. Might you be overlooking anxiety as a potential comorbid companion to your sleeplessness?

Rather than wonder whether your anxiety levels may be contributing to your sleeplessness, why not talk to your doctor to see if there’s more you can do to address them? After all, they’re comorbid conditions.

Even if you don’t have a formal anxiety diagnosis, you may still feel you experience more than what’s considered normal. But who’s to say the anxiety you feel isn’t perfectly normal for what’s happening in your life?  Or, maybe it’s not…

The point is, you don’t have to guess. Just talk to your doctor.

If you’re diagnosed with insomnia and actively treating it, your approach may include strategies for anxiety relief. Cognitive behavior therapy (CBT) and its insomnia-specific version, CBTi, remain the gold standard treatment for chronic insomnia. These include a wide range of relaxation techniques that could help you manage both your insomnia and your anxiety.7

If these don’t work, some medications really can help, so don’t discount these options.4

If you have an anxiety diagnosis

For those with anxiety, CBT or relaxation techniques can bring relief. But what if they don’t? If, for instance, you still deal with racing thoughts at bedtime, a discussion with your doctor is your next step.

Keep this in mind: some anxiety medications can disrupt sleep. The solution may be as simple as changing the dosage of your medication or the time of day you take it.

Whatever you do, don’t make changes without consulting your doctor first; they should listen to your concerns and “tweak” your prescription to better serve your needs. They may change your medication, too, which means you’ll need a new prescription.

A third consideration: COMISA

It’s easy to blame anxiety for sleep problems. However, it’s also common for people to have other kinds of sleep disorders, such as obstructive sleep apnea (OSA), that cause symptoms of insomnia. In this case, it’s called “comorbid insomnia and OSA” (or, “COMISA”).8

Most people don’t consider OSA a separate cause for sleeplessness, but they should. OSA is the second most common sleep disorder after insomnia, and it’s definitely underdiagnosed.9

A simple OSA screening from your doctor can quickly narrow down this possibility. If you’re found at risk for OSA, a sleep study can rule it “in” or “out.”10

If you do have OSA, treating it should lead to relief for your insomnia, as well.11

Which came first, the anxiety or insomnia? Does it matter? Tell us about your experience – it matters.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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