Anxiety
Anxiety is fear. Experiencing anxiety in a stressful situation is normal. However, when the anxiety is disproportional to the problem and becomes excessive, it interferes with everyday life.
Anxiety erodes you emotionally and physically. Emotionally, you may feel on-edge, unable to concentrate, moody, irritable, and restless. A sense of impending doom can feel overwhelming. Physically, anxiety can provoke tense muscles, rapid breathing, racing heartbeat, sweating, trembling, and fatigue. You may avoid situations that trigger worry; however, this does not resolve the cause and interrupts academic and social activities. In time, you may become depressed from the state of distress.
Anxiety and sleep problems are bi-directionally connected. Worry makes it harder to fall and stay asleep through the night. Sleep problems, in turn, can worsen anxiety, spurring a negative cycle involving insomnia and anxiety. The bidirectional relationship self-reinforces anxiety and sleep problems. Understanding and addressing the link between anxiety and sleep is fundamental to physical and emotional wellness.
Post-traumatic stress disorder (PTSD) stems from an extreme anxiety response to a life-threatening situation. It manifests as a tendency to avoid places or events that could remind you of the traumatic experience, impairing your life quality and functioning. PTSD can occur in children, adolescents, and adults. Although the disorder is often associated with combat veterans, it is not unique to them. Besides combat exposure, rape, child abuse, traffic accidents, and any event involving a threat to human life may trigger PTSD.
Obsessive-compulsive disorder, or OCD, is manifest by a combination of anxiety-inducing thoughts and behavior. OCD can be time-consuming, create significant distress and take a toll on family, friends, and colleagues. OCD's two main components are ruminative thoughts ("obsessions") and the actions meant to soothe them ("compulsions").
The compulsive, ritualistic behaviors to suppress the stressful thought content (e.g., excessive hand washing) reduce anxiety, but, in time, they are incorporated into the obsessive OCD patterns until they begin inducing stress themselves. This cycle of thoughts and actions exhaust the individual experiencing them, causing them much despair.
What we offer at Sleep and Brain
At Sleep and Brain, we conduct a detailed clinical history and specialized physical examination to evaluate if a sleep disorder is underlying your anxiety. We prudently assess for sleep disorders as exampled below:
Sleep-Disordered Breathing
The repetitive breathing interruptions cause arousals that heighten the sympathetic nervous system (i.e., fight-or-flight system) and dampen the parasympathetic nervous system (i.e., rest and digest system)
Restless Legs Syndrome
Restless, tingly legs with an urgency to move them can masquerade as anxiety. Conversely, sleep deprivation from restless legs can lead to stress.
Periodic Limb Movement Disorder
Your child may unknowingly kick their legs intermittently during sleep. The limb movement can disrupt sleep and cause arousals which heighten anxiety.
Insomnia
Insomnia, defined as difficulty falling asleep, staying asleep, awakening too early, or non-restorative sleep, is linked to anxiety. Anxiety can be both a cause and a result of insomnia.
Nightmares
Pre-sleep rumination may affect rapid eye movement sleep, provoking disturbing dreams and sleep disruptions. Nightmares can create sleep anxiety, reinforcing your sense of dread and fear of going to sleep.
Sleep Deprivation
Sleep deprivation activates areas of the brain associated with emotional processing. The pattern mimics the abnormal neural activity seen in anxiety disorders.
Anxiety is a state of hyperarousal. We may recommend sensitive home sleep testing with peripheral arterial tonometry to quantify your sleep patterns and evaluate sleep-disordered breathing and sympathetic arousal frequency.
Laboratory sleep testing, performed in your home, may be necessary to evaluate additional sleep disorders such as periodic limb movements and sleep-disordered breathing.
We offer sophisticated testing to elucidate areas of brain imbalance. A brain map can pinpoint which brain areas are hyperactive and hypoactive and assess which networks between brain areas are improperly functioning. Together, the data allows us to determine if the brain imbalances support a diagnosis of anxiety versus something else.
Understanding the cause of you or your child's sleep problems is essential to customize a treatment regime for both the sleep disorder and anxiety. Treating sleep problems may improve anxiety because, as mentioned, disordered sleep symptoms can mimic and exaggerate anxiety symptoms. We direct treatment toward the sleep disorder as exampled below:
Removing the tonsils, expanding the palate, and starting CPAP can help anxiety and disordered sleep symptoms.
Iron and dopamine deficiencies can cause RLS and PLMD. We treat RLS with iron supplements, medication, and non-medication therapies.
Identifying and eliminating the cause of awakenings from sleep
Utilizing light therapy to advance or delay your sleep cycle
In addition to treating an underlying sleep disorder, we institute robust sleep hygiene interventions, as partly described below, to make going to bed a pleasant experience and reduce anxiety:
Ensuring your bedroom environment is conducive to sleep
Eliminating sources of sleep interruption like light and noise
Optimizing your diet as food can promote and hinder sleep
Assessing your nighttime habits and rituals
Our scientifically-based cognitive-behavioral therapy for insomnia therapy is a rigorous, 4-week program is vital to treat insomnia and anxiety.
A state of hyperarousal, frequently marked by worry, is a critical factor of insomnia. CBT-I reduces negative thoughts about going to bed, a type of anticipatory anxiety that challenges healthy sleep schedules. Even after falling asleep, you may awaken with anxiety in the middle of the night. CBT-I reorients negative thinking and helps you return to sleep when your mind races with worry. We also utilize relaxation techniques as part of our CBT-I to reduce anxiety and make it easier to fall asleep quickly and peacefully. Guided imagery, deep breathing, and mindfulness meditation are just a few approaches to putting your mind at ease and improving your sleep and anxiety.
Brain TMS has advanced into treating anxiety and multiple disorders associated with anxiety, such as restless leg syndrome, depression, and insomnia. We personalize a TMS protocol based on your unique brain map.
Several medication classes treat anxiety, including anti-anxiety drugs, antidepressants, and beta-blockers. However, these medications mitigate symptoms rather than cure the underlying cause. We judiciously use medications to treat an identified underlying cause.
