Obsessive compulsive disorder - OCD treatment and therapy from NOCD

How do OCD and other mental health conditions impact your sleep?

By Jennifer Dalimonte, LCSW

Jan 09, 20235 minute read

Woman rubbing her temples in fatigue.

Were you one of the kids who hated nap time or begged to have a later bedtime? Are you an adult who now regrets all those missed sleep opportunities? Don’t worry, you’re in good company. By now, we all recognize how instrumental sleep is in our lives. And while we all need sleep, it can be especially elusive for some of us, for various reasons. Let’s explore a few today. 

Mental health and sleep

Were you aware that there is a bidirectional relationship between mental health and sleep patterns? That means that not only can mental health affect one’s sleep, but sleep hygiene can also impact one’s mental health in return. 

You are likely aware of the recommended 8 hours of sleep per night for adults. However, are you aware of all the ways that sleep can impact your body and mind? High-quality sleep can enhance memory, stamina in wakefulness and cognitive functioning, and the opposite is true for poor sleep. Not only can poor sleep create difficulties for the creation and consolidation of memory, but it can also impact overall cognitive functioning. Operating with extreme sleep deficits can be compared to being under the influence of alcohol. 

Those with sleep disorders have higher rates of developing mental health conditions such as anxiety disorders, and vice versa: anxiety disorders predispose people to developing problems with their sleep. Moreover, sleep issues place people at higher risk for suicidal behaviors, even in the absence of a mental health condition. 

With anxiety disorders and other mental health conditions like OCD, people often report having intrusive thoughts throughout the day and night. These thoughts have the ability to interrupt our sleep process or prevent us from feeling safe enough to fall asleep. Sometimes, thoughts and patterns can even create fears about our ability to fall asleep, or things that may happen when we do fall asleep. These thoughts are often so disturbing that we attempt to find certainty about them or resolutions to them, reinforcing the mistaken belief that these thoughts are a threat. Compulsive engagement with thoughts can actually cause intense distress that makes it difficult to rest and enter sleep naturally.

What am I doing wrong?

Unfortunately, many behaviors that can lead to poor sleep are extremely common today. The most tempting can be right at our fingertips, using our cell phones as we head to bed. Alcohol consumption, insufficient physical exercise, daytime naps, caffeine intake, phone or computer usage, and having too much noise or light around one’s bed are all sources of sleep interference, and they can be hard to escape. 

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Additionally, even productive mental actions such as mentally reviewing your day or preparing for upcoming tasks while in bed can lead to our bodies and minds being conditioned to wakefulness when in bed. This is not the message we want to send; instead, we want our bodies to associate being in bed with getting restful sleep.

Why is it such a big deal?

By now it’s probably clear why sleep can be important to overall health, but it’s less commonly known that sleep issues can actually make one less responsive to mental health treatment, making recovery even more difficult. There is good news, however: an evidence-based intervention for sleep known as cognitive behavioral therapy for insomnia (CBT-I) that blends very well with the gold standard treatment for OCD, which is exposure and response prevention (ERP) therapy. This means that sleep issues and OCD can be effectively treated at the same time, disrupting the vicious cycle from both ends. 

Here are a few brief recommendations from CBT-I on the best practices for sleep. CBT-I recommends resisting rumination about one’s ability to fall asleep, and instead using methods similar to response prevention in OCD treatment, addressing these concerns with responses like “maybe I won’t sleep, but I don’t need to think about that now” or “If I don’t sleep, then I guess I’ll feel tired tomorrow.” When we separate from our unwanted thoughts, we stop giving them power over time. 

ERP similarly helps people suffering from OCD or anxiety learn to sit with anxiety and discomfort and see that they don’t need to do any compulsions to rid themselves of perceived danger. It is a false alarm; there is no real danger. You can learn that although it may not be comfortable, you can actually tolerate distress. Eventually, the feelings of anxiety do pass. When you don’t give in and ruminate or complete a compulsion, your brain actually relearns that there was no danger in the first place. But it takes consistent practice; retraining your brain takes time, commitment, and perseverance. 

What can I do now?

Making changes to improve our sleep can be beneficial in many ways. First-line interventions for people to try might involve setting up a healthy sleep hygiene routine to improve one’s ability to fall and stay asleep. Start by setting out a structure for your ideal evening routine, look at times that best fit for winding down, getting into bed and rising in the morning. 

Drastic changes are usually hard to maintain, so consider making small changes each day to move towards your ideal bed/rising times. What can you remove from your evening routines now? Can you get away from your phone and computer for an hour or so before your planned bedtime? What would be a more beneficial use of that time now? Would you like to read a book, take a warm bath, do gentle stretching, or have some tea? Feel free to play around with a few ideas and see what works best for you.

We are here to help!

If you’re struggling with OCD and want to learn more about how to address the bidirectional relationship between sleep and mental health, NOCD can help. Any theme of OCD can interfere with one’s sleep health, so specialty-trained OCD therapists will be able to work with you to design a treatment plan that addresses both sleep issues and other OCD symptoms.

Effective, specialized OCD therapy is here

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At NOCD, our licensed therapists deeply understand OCD and are specialty-trained in treating OCD with ERP. We work side-by-side with the OCD experts and researchers who designed some of the world’s top OCD treatment programs – and that means the best care for our members. You can book a free 15-minute call with our team to get matched with one and get started with OCD treatment.

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