How to Defeat Anxiety and Get a Good Night's Sleep

This week I did an AMA on Lifehacker where I ran into some of the same questions I saw in my practice daily. People all over the country are caught in the stress - restless sleep - stress cycle.


Here are some common questions and tips on letting go of anxious thoughts so you can finally get good sleep and wake up refreshed.

Question: I always seem to be sleepy on the couch after work. Then when I go to bed, I can’t fall asleep! My mind is racing and it seems like all the small problems of the day loom large. I go over the day and my mind seems to race and I can’t fall asleep. Why is that?

Answer: This is a really common problem! The fact that you are sleepy on the couch means there is some kind of sleep deprivation. This means that the drive to sleep is increased. So when things quiet down, sleepiness finds you. After all, while watching tv on the couch, are you worried about trying to fall asleep? Are you reliving your day, or simply watching Seinfeld reruns?

But once you go to bed, now the mind is less distracted, and the mind will find things to worry about. Racing thoughts is a form of arousal, or anxiety.

Anxiety isn’t just something for people with anxiety disorders. We all feel it from time to time. So how do we manage anxiety? It isn’t easy. You just can’t think “anxiety go away” because usually that’d just make it worse. Often the best thing is to give it an outlet. One effective measure is setting sleep reminders and keep a worry journal. Many of our users on PeerWell use it, here is a summary:

Health Hack #1: Make Sleep Reminders
  • Set 1 alarm for when you should be in bed ready to sleep. Account for at least 7.5 hours of sleep. By this time, electronics should be off, lights should be off, and you should be in bed.
  • Set a 2nd alarm for 30 mins earlier than #1. This is the signal to start shutting things down. Finish emails, social media, TV shows, etc.
Health Hack #2: Keep a Worry Notebook
  • Use a dedicated notebook to express your thoughts for 5 minutes daily. Do not lift pen from paper, and write continuously, simply reflecting what comes to your mind. Set a timer and stop at 5 minutes, even if mid sentence. Once you are finished, close the notebook. Start a new section each day to compartmentalize that day's worries.

Question: I have no problem falling asleep, but I wake up in the middle of the night, and I can’t fall back asleep. I try to do all the right things in the middle of the night, but it takes me 40-50 minutes to fall back asleep. Sometimes, I seem to get sleepy just before my alarm is set to go off.


Answer: This is really common too, and there is a reason why some people get sleepy just before their alarm (to their great frustration).

But first, let’s talk about some science behind sleep. Think of days you’ve been highly stressed. Usually you don’t sleep that well that night. It’s because that stress is still affecting you in the middle of the night. There are parts of your brain that don’t sleep. It’s the part of your brain that’s listening for burglars breaking glass, or smoke alarms signaling smoke.

If that part of the brain is still carrying the day’s stress, the arousal threshold changes. This means that little things you’d normally sleep through are now enough to wake you up.

Do you know we can wake up many times at night and not remember it? I’ve had patients wake up hundreds of times at night and not realize it.

The trouble is that if you wake up and fall back asleep quickly, you won’t remember it the next day. When you’re extra stressed, your new arousal threshold allows more things to wake you up. So the way of fixing the problem is to manage your arousal threshold.

This is a good time to mention that alcohol is not nearly as good at promoting sleep as many think. It changes the arousal threshold (in a bad way) in the second half of the night. Don’t do it!

The solution? Rather than do things in the middle of the night to relax you, manage your arousal threshold in the beginning of the night. This effect lasts hours and saves you the trouble of waking in the middle of the night. I’m going to list a few things you can do, but it’s important to know how fast these things work. It can take several days or even a week to see an effect. So if you want to do an experiment, do it for at least a week to see how much it helps.

Health Hack #3: Power Down to Fall Asleep Faster

Sleeping an extra hour is connected with a 16% increase of pay due to improved productivity and job promotions. Most people think sleep hygiene helps people fall asleep faster. But that's only half of the benefit. It also helps people sleep deeper in the middle of the night, making you more rested the next day. But remember, these tips will not improve sleep on the first day, but build over 1-2 weeks.

  • Set a timer before bedtime - Set an alarm 45 minutes before bedtime to remind you to start your bedtime routine.
  • Manage light - Tablet, phone, or tv illuminates with bright blue light, which can cause shallow and fitful sleep. That light confuses the part of the brain affecting circadian rhythm.
  • Avoid alcohol after dinner - Alcohol contributes to shallower sleep in the 2nd half of the night. Use your bed for sleep / sex only - Working in bed or watching tv trains your brain to delay sleep onset. It can cause insomnia.
  • Avoid strenuous exercise before bedtime - While exercising during the day has many positive effects on sleep, exercising within an hour or two before sleep can make it hard to wind down when you want to.
  • Limit liquids - Cutting down on fluid intake after dinner will lead to less trips to the bathroom during the night. Definitely cut any drinks that contain caffeine!

TL;DR

The key to getting a good night's rest is managing what happens before you get into bed.

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Nitun is a sleep medicine physician. He's built clinics to help people understand their sleep so they can be more alert and effective. He connects the best of tech with the best of medicine.

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