The loop
A hard week at work, a sick parent, money worries. You lie down and your mind starts listing everything. You fall asleep late, wake at 4 a.m., and the next day you are foggy, short-tempered and more worried than before. That night you go to bed already dreading another bad night.
Both directions are well documented. The National Heart, Lung, and Blood Institute (NHLBI) says stress or worry about work, relationships, money or a death raises the risk of insomnia, and that worrying about whether you will get enough sleep can make it harder to sleep. NHLBI also notes that insomnia itself can make you feel anxious, depressed or easily annoyed.
Sleep changes are also part of the conditions themselves. NIMH lists difficulty sleeping, waking too early in the morning, or oversleeping among the symptoms of depression.
Short-term trouble or insomnia?
Almost everyone has nights of poor sleep. NHLBI separates two patterns:
- Short-term insomnia, often triggered by stress or a change in schedule or surroundings, lasting days or weeks
- Chronic insomnia, which occurs three or more nights a week, lasts more than three months, and is not fully explained by another health problem
Chronic insomnia is worth taking seriously. NHLBI notes that it can affect memory and concentration and raises the risk of high blood pressure, heart disease and diabetes.
Habits that keep the loop going
Many of the things people do to cope with a bad night make the next one harder. NHLBI lists these lifestyle risks:
- Changing your routine often, including going to bed and waking at different times
- Long naps during the day
- Too little physical activity
- Caffeine, nicotine, alcohol or recreational drugs
- TV or devices close to bedtime
Alcohol deserves a closer look because so many people use it to wind down. NHLBI explains that while alcohol can make it easier to fall asleep, it makes sleep lighter and more likely to break during the night. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) adds that even moderate amounts can change the structure of sleep, and that in people who drink heavily, sleep can take a month or more without alcohol to recover. Alcohol, Cannabis and Mood: What to Know in Michigan goes further into that.
What to try tonight
These come from NHLBI's guidance on healthy sleep habits. None of them is a quick fix, but together they give your body a steady signal.
- Get up at the same time every day, including weekends, even after a poor night.
- Skip afternoon naps, so you are tired enough at bedtime.
- Move during the day, finishing exercise at least five to six hours before bed.
- Keep caffeine, nicotine and alcohol away from the hours before bed.
- Build a wind-down routine: dim lights, a book, music or a warm bath.
- Go to bed only when sleepy, and if you cannot sleep, get up and do something quiet until you are.
- Use the bed only for sleep and sex, not for work, scrolling or worrying.
For racing thoughts, some people find it helps to write tomorrow's list or the worry itself on paper an hour before bed, then close the notebook. The point is to give the worry a time and place that is not your pillow. Managing Constant Worry: What Can Help has more on that.
What a sleep diary shows
NHLBI recommends keeping a sleep diary and sharing it with your provider. For one to two weeks, note:
- When you went to bed, about when you fell asleep, and when you got up
- How many times you woke and for how long
- Caffeine, alcohol, naps and exercise
- Your mood and worry level that day, from 1 to 10
Patterns often show up quickly: the drink that seems to help but leads to 3 a.m. waking, or the anxious days that follow short nights.
When poor sleep points to something more
Sometimes the sleep problem is the first visible sign of something else. NIMH lists both insomnia and oversleeping among the symptoms of depression, so sleeping ten hours and still waking exhausted can matter as much as lying awake. NIAAA advises clinicians to ask about drinking when patients report insomnia, early morning waking or fatigue, because heavy alcohol use is a common hidden cause. If your sleep has changed along with your mood, appetite or interest in things, mention all of it together to your doctor rather than asking only for something to help you sleep.
Treatment for insomnia
NHLBI describes cognitive behavioral therapy for insomnia (CBT-I) as a structured six- to eight-week program that is usually recommended as the first treatment for long-term insomnia. NHLBI says it can be delivered by a doctor, nurse or therapist, in person, by phone or online, and combines several parts: cognitive therapy to ease worry about not sleeping, relaxation training, sleep education, stimulus control, and sleep restriction, which sets a fixed window of time in bed and widens it as sleep improves. It is a specialized approach, so if you want it, ask a clinician directly whether they are trained in CBT-I.
Prescription and over-the-counter sleep medicines are another route, and decisions about them belong with your doctor. NHLBI notes that research has not shown melatonin to be an effective treatment for insomnia, and that its side effects can include worsening depression. Tell your provider about any sleep aids or supplements you use, and talk with your prescriber before starting or stopping anything.
When sleep problems are tangled up with worry or low mood, it often helps to treat those too. Therapy can address what keeps your mind busy at night, such as unresolved conflict, grief or a constant sense of threat. Dr. Lehmann, a licensed clinical psychologist in Franklin, offers anxiety therapy and depression therapy for adults, in person or by telehealth for clients located in Michigan.