We all have lots of fears. Fears for our health, family and for some personal safety.
Our news headlines are full of things to be frightened of. Advertisers play on our fears to sell us products to protect us or our family. In this setting, we can perceive that there are threats around every corner. It's not surprising that for some, these fears can interfere with sleep. Being scared or fearful activates our primitive fear response, increasing adrenaline levels and keeping us on high alert. For some it can cause trouble getting to sleep, whereas for others it can result in waking at night or sleep not being restorative.
How does fear cause sleep disturbance?
Anytime we are fearful of things or scared, the natural human response is to activate the fight-and-flight response system. This is called the sympathetic nervous system and increases chemicals such as adrenaline, noradrenaline, dopamine, serotonin and histamine. These are the common neurotransmitters involved in maintaining alertness. So when levels of these neurotransmitters are higher it is much harder to switch off and go to sleep. Some people are still able to get to sleep, but find themselves waking at night and unable to get back to sleep.
When we are scared of something, the brain tries to maintain a degree of awareness or alertness whilst the body maintains muscle tone and energy levels. If we do need to escape quickly from a threat, these changes ensure we have both the muscle strength and energy to do so as well as being alert enough to do detect the threat quickly. These are all things that are not part of normal sleep. Good sleep is usually characterised by unawareness, muscle relaxation and low circulating energy levels.
When the sympathetic nervous system is highly active during sleep, a condition sometimes called hyperarousal, the brain monitors the environment more carefully. This can result in people sensing that sleep is lighter with a greater awareness of things going on around them and they are more easily awoken from sleep. Some people can also experience nightmares and acting out behaviours during sleep (parasomnias) as a consequence of muscles being more active.
This type of hyperarousal does not settle quickly. Even once the source of fear is removed the brain and body can remain in a hyperaroused state over weeks and even months. Commonly in my practice I see people who have begun sleeping poorly in the setting of fear. They've addressed their fears or that set of circumstances have passed, but they're still having ongoing difficulties with sleep and a sense of increased agitation and restlessness.
Fear can also make sleep less refreshing
When people sleep in a hyperaroused state as well as sleep feeling light and readily disturbed it is not as refreshing as it would be otherwise. It seems that the heightened state of activation reduces the brain's ability to clear away waste products accumulated throughout the day, part of the restorative nature of sleep.
There is also interesting research showing that turning off the sympathetic nervous system, particularly during REM sleep, is important for reducing the fear component of our experiences. As such, if people have heightened sympathetic nervous system activity after an exposure to fear it can increase the likelihood of getting ongoing nightmares or other disorders such as post-traumatic stress disorder.
This means it is important to recognise people who have been exposed to a fearful stimulus early and intervene so that they are less likely to develop hyperarousal and post-traumatic stress disorder in the future.
What be done to reduce the impact of fear on sleep?
- Many of our fears are perceived rather than real threats - One of the most important strategies is to recognise our fears for what they are. In modern society we are generally very safe and many of our fears are perceived rather than real threats. It can sometimes be hard to step back from our situation to get this wider perspective but attempting to do so is usually helpful. This is particularly so for our children who often do not have a broader context in which to place their fears and can become overly concerned about things they see on television or in the news which can make threats seem more likely than they are in real life.
- Distraction techniques - If we are awake at night and unable to break the cycle of fear or feeling scared, then using relaxation strategies to distract ourselves from those thoughts can be helpful. Focussing on muscle relaxation or visual imagery can change focus from fearful thoughts to concentrating on muscles or visual images and allow sleep to return. Some audio files with good examples of muscle relaxation of visual imagery exercises are available from the University of Western Sydney and Dartmouth.
- Mindfulness - One of the ways of getting a broader perspective on fear as well as being less focussed on fearful thoughts is mindfulness. The practise of mindfulness is training ourselves in present focussed observation and disconnecting from the judgement and emotion involved in our experiences. This can help us to see fears for what they really are and give insights into whether we should in fact be fearful or whether our fears are not justified or over exaggerated. Mindfulness also has a role in reducing symptoms of disturbed sleep and hyperarousal. Examples of guided mindfulness meditations can be found at A Mindful Way and UCLA's Mindfulness Awareness Research Center.
If you are having trouble with sleep despite the above measures, talk to your health professional about it. They may refer you to a psychologist or a sleep physician if they feel that further investigation or treatment is needed. Some of the treatments health professionals may use are:
- Cognitive behavioural therapy (CBT-I) - I'll often use CBT-I to help with disturbed sleep in the setting of fear. Often, even though sleep problems start in the setting of fear, once the fear has passed, sleep problems continue because of changed thinking and behaviour around sleep. These can be addressed using CBT-I in the same way as this technique is used to treat insomnia.
- Medications - can be used to reduce the sympathetic nervous system response. For example, alpha-blockers or beta-blockers can be effective at reducing nightmares and disturbed sleep that are part of post-traumatic stress disorder.
So, if fear is impacting on your sleep, there are things that you can do and it's also worth talking to your health professional to help get your sleep back on track.
Does fear impact on your sleep? What have you tried to help?