What Is Somniphobia? What to Do If You Have Sleep Anxiety
Somniphobia, or sleep anxiety, is when extreme worry and fear about sleep keeps you up at night. Learn how to recognize it and find treatment.
Imagine dreading going to sleep every night and thinking of your bed not as a place for relaxation and comfort, but as a source of fear.
That is what happens if you have sleep dread, also known as sleep anxiety, somniphobia, hypnophobia, or clinophobia.
Considering sleep is vital for brain health, weight loss, and a strong heart, actively avoiding going to bed can have serious ramifications for your well-being. Here’s what experts say is behind somniphobia and how you can ease this extreme anxiety.
(Related: How to Know If Your Anxiety Is “Normal”)
Causes of sleep anxiety
Sleep dread may not be an official term, but you can think of it as an offspring of insomnia, says Virginia Runko, PhD, a behavioural sleep medicine specialist and psychologist in Washington, D.C.
“People who have problems falling asleep see how that affects them during the day, and so there’s this anxiety around how the night will go. Sleepless nights are a terrible experience, and no one wants to go through that,” she says.
However, it’s important to note that because sleep anxiety is a phobia, or an irrational fear, this usually causes disruption in day-to-day activities and can have a serious toll on mental health.
(Related: What Your Sleep Problems May Be Telling You)
Is it anxiety, insomnia, a phobia, or something else?
Knowing the proper way to treat your somniphobia depends on the root issue at play, says Martin Seif, PhD, a clinical psychologist specializing in anxiety in Greenwich, Connecticut. Here are a few possibilities:
Anxiety or generalized anxiety disorder: Your mind spirals into worry when you’re alone. Or, you have worries that are out of proportion to reality such as fear of a home invasion when you live in a safe community or a fear of dying in your sleep when you are a healthy person.
Anticipatory anxiety: You dread going to bed because you think about everything you need to do at work the next day, explains Seif.
Relationship issues: You don’t want to go to bed because you don’t want to have sex with your partner.
Insomnia: You’re preoccupied with the amount of sleep you’re getting because you feel as if you have to sleep to perform well the next day. Sleep is an ironic process, says Seif. Focusing on falling asleep makes it harder to sleep.
A phobia: Research shows that somniphobia can stem from recurrent sleep paralysis, a condition where you are awake but temporarily cannot move. You may also have hallucinations at the same time, which can be extremely disturbing, according to a 2016 study in Current Sleep Medicine Reports. (One 2019 case report in the Brazilian journal, Revista Paulista de Pediatria, recounted that these sleep paralysis episodes were so frightening that it impacted the patient’s sleep and school performance.) Severe nightmares may also be behind somniphobia.
(Related: How to Find the Best Sleep Aid for You)
Signs and symptoms of sleep anxiety
Sleep problems and anxiety tend to go hand in hand. Someone with anxiety tends to have difficulty sleeping; having problems sleeping can lead to anxiety. According to the Anxiety and Depression Association of America, sleep problems tend to be common in most psychiatric disorders.
Symptoms of sleep anxiety can manifest themselves both mentally and physically. If your fear of sleep is due to a phobia (rather than, say an anticipatory anxiety or insomnia-related), you may experience the following as it relates to approaching sleep, says the Anxiety and Depression Association of America: a feeling of imminent danger or doom, heart palpitations, sweating, trembling, a fear of dying, feeling faint or light-headed, chest pains, or a fear of losing control.
Risk factors for sleep anxiety
Experiencing post-traumatic stress disorder (PTSD) and having nightmares also may make you more vulnerable to somniphobia. Some estimates say that up to 96 percent of people with PTSD have nightmares and they may happen several times per week, according to the U.S. Department of Veterans Affairs. It’s not hard to imagine that people may experience sleep dread due to fear of having nightmares. (Related: Magic Mushrooms for PTSD—Here’s Why Psychedelics May Help Heal Trauma)
Other reasons for an uptick in nightmares right now: Covid-19, the upcoming election, and the social justice movement. “Many people are having triggering and very negative dreams,” says Runko. If that’s you, talking to a therapist can provide the support you need to process your thoughts, experience, and fears.
Treatment for sleep anxiety
Now that you’ve identified the reason why you may be experiencing anxiety around sleep, you can focus your efforts there. For instance, if you have anxiety about going to bed in an effort to avoid sex with your partner, relationship therapy (together or alone) may be in order.
Insomnia can benefit from strategies like sleep hygiene or psychoeducation about sleep, says Seif. (“People can perform very well on less sleep than they think,” he says, which can help you put the night in perspective.) If it’s anxiety or a phobia, then cognitive behavioural therapy (CBT) or exposure therapy is often recommended. Here’s what you need to know about each treatment option.
Therapy vs. medication
The first line of treatment for somniphobia caused by insomnia is cognitive behavioural therapy for insomnia, or CBT-I, says Runko. You might first be asked to set up a specific sleep schedule. You’ll also be given tools that help you feel more confident going to bed, including relaxation exercises or reframing negative thoughts surrounding bedtime.
Sleep dread is often magnified by spiraling thoughts, like “I’ll never be able to sleep and then I won’t be able to function, and I’ll lose my job…”
“Reining those thoughts in and addressing those directly can be helpful,” says Runko. A therapist can help you develop these skills.
The American College of Physicians recommends using CBT-I as the initial treatment for the sleep disorder before prescribing medication. If CBT-I isn’t enough, doctors are then advised to consider adding a short-term course of medication (around four to five weeks) that treats insomnia, which may include benzodiazepines, nonbenzodiazepines (commonly known as “Z” drugs), or certain antidepressants.
Some people have also found melatonin helpful in treating sleep anxiety.
(Related: Can You Use Melatonin for Anxiety?)
Plan a transition period between awake time and going to bed. “Your brain needs to slow down to shift gears, and too many people try to be super productive to the last minute,” says Alex Dimitriu, MD, a dual-board certified doctor in psychiatry and sleep medicine in Menlo Park, California.
If worries tend to spiral before bed, Dr. Dimitriu recommends journalling. “It’s common to be flooded with thoughts at bedtime, but if you sit and work through them [rather than avoiding them by filling the space with scrolling on your phone], these thoughts tend to get better in 20 or 30 minutes,” he says.
The trick with journaling, though, is that you have to write in an honest, real, and vulnerable way. Get deep: Write down your fears and detail the dark stuff hijacking your brain.
When to see a professional
A professional can help you focus your sleep efforts in a way that helps, not hinders, your sleep. Runko suggests searching to see if you can find a nearby provider who is board-certified in behavioural sleep medicine, which is designated as CBSM or DBSM.
Runko also recommends the self-help book: Quiet Your Mind and Get to Sleep.