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Too Scared To Sleep

All of us have a number of fears. Fears for our health, family and for some personal safety.
Wireless Function Gold 1 Gang 1 Way Wall Touch Switch Floor LampsOur news headlines are full of things to be frightened of. Advertisers play on our fears to sell us products to guard us or our family. On 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 could cause trouble attending to sleep, whereas for others it can lead to 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 known as the sympathetic nervous system and increases chemicals equivalent to 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 far harder to change off and go to sleep. Some persons are still in a position to get to sleep, but find themselves waking at night and unable to get back to sleep.

When we’re frightened of something, the brain tries to keep up a degree of awareness or alertness whilst the body maintains muscle tone and energy levels. If we do need to flee quickly from a threat, these changes ensure we’ve 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 a part of normal sleep. Good sleep is usually characterised by unawareness, muscle relaxation and low circulating energy levels.

When the sympathetic nervous system is extremely active during sleep, a condition sometimes called hyperarousal, the brain monitors the environment more carefully. This can lead to people sensing that sleep is lighter with a greater awareness of things happening around them and they’re more easily awoken from sleep. Some people also can experience nightmares and acting out behaviours during sleep (parasomnias) as a consequence of muscles being more active.

One of these hyperarousal doesn’t 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’ve 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 way of increased agitation and restlessness.

Fear may make sleep less refreshing
When people sleep in a hyperaroused state in addition to sleep feeling light and readily disturbed it isn’t as refreshing because it could be otherwise. Evidently 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 can also be 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 could possibly increase the likelihood of getting ongoing nightmares or other disorders comparable to post-traumatic stress disorder.

This means it is very important 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 sooner or later.

What be done to reduce the impact of fear on sleep
Many of our fears are perceived rather than real threats – Considered one of an important strategies is to recognise our fears for what they are. In modern society we are generally very safe and a lot of our fears are perceived rather than real threats. It may sometimes be hard to step back from our situation to get this wider perspective but attempting to take action is usually helpful. This is especially so for our children who often should not have a broader context during which to position their fears and might become overly concerned about things they see on television or in the news which can make threats seem more likely than they’re in real life.
Distraction techniques – If we’re awake at night and unable to break the cycle of fear or feeling scared, then using relaxation strategies to distract ourselves from those thoughts may be helpful. Focussing on muscle relaxation or visual imagery can change focus from fearful thoughts to concentrating on muscles or visual images and permit 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 may also help us to see fears for what they really are and provides insights into whether we should actually be fearful or whether our fears should not justified or over exaggerated. Mindfulness also has a job in reducing symptoms of disturbed sleep and hyperarousal. Examples of guided mindfulness meditations could 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 could refer you to a psychologist or a sleep physician in the event that they feel that further investigation or touch switch kit treatment is needed. Some of the treatments health professionals may use are:

Cognitive behavioural therapy (CBT-I) – I will often use CBT-I to help with disturbed sleep in the setting of fear. Often, despite the fact that sleep problems start within the setting of fear, once the fear has passed, sleep problems continue because of changed thinking and behaviour around sleep. These could be addressed using CBT-I in the same way as this system is used to treat insomnia.
Medications – can be used to cut back the sympathetic nervous system response. For instance, alpha-blockers or beta-blockers might be effective at reducing nightmares and disturbed sleep which are part of post-traumatic stress disorder.

So, if fear is impacting on your sleep, there are things that you are able to do and it is also worth talking to your health professional to assist get your sleep back on track.

Does fear impact in your sleep What have you tried to assist
This post originally appeared in a modified form in the online sleep resource, SleepHub. You possibly can follow David Cunnington on Facebook and Twitter.

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