Before Bed: An Unwanted Date with OCD
Today’s story is written by Joe Antonellis, a student-athlete at Pomona College in California. Joe has the kind of enthusiasm about writing that makes you want to sit down and write too, and brings all this passion to his work writing about mental health and personal journeys.
Alone time is the worst. When you are alone, with nobody else there to pull you back into reality, OCD can kick your brain to the curb and grab control of your mind in an instant. Being alone with your obsessions somehow makes them more real, resistant, and powerful, enabling them to ambush you with ease.
When are these anxiety attacks most likely to occur? Right when your mind is meant to be at its quietest and most tranquil: sleep time. Even if you’re with a partner at this time, you’re forced to avoid interacting with them, as it would be rude to risk waking them up. This makes the time right before bed one of the most frightening times for people with OCD, invoking a deep and interesting relationship between the two very opposite factors.
I remember I would always dread going to sleep when I was suffering with OCD in my younger years. I would avoid bedtime, partaking in various other activities to put off the eventual loneliness of sleeping. I was terrified of being alone with my brain, as I didn’t have the confidence to deal with my OCD on my own when no other activity preoccupied me. Some nights it never struck, and I was able to sleep peacefully, but other nights, obsessions lingered until the I heard the birds singing at dawn. This led to a lack of sleep, of course, resulting in a very unhealthy lifestyle, which contributed negatively to my mental health in addition to my struggles with OCD. It’s not like I was distracting myself with beneficial activities either. Most of the time, the late nights were filled with binge eating, mindless TV shows, and violent video games.
In other cases, my bed would be the getaway place I would try to escape to when an obsession came on. Although torturous at times, it could also serve as a safe haven where I knew none of “my ideas” would come to fruition. It was the perfect excuse when I was younger. Whenever an activity or event came up that I knew would trigger my OCD, I could always say I wanted to take a nap or pretend I was sick to try and get out of it. This was just another defense mechanism to avoid the mental barriers instead of busting through them, and “sleeping,” although difficult due to the imminent loneliness associated with it, allowed an easy escape from my fears. As I said above, OCD is not only a mental condition, but an idea that creates fear in the brain, making those afflicted try to avoid confrontation with it at all costs. Sleep and OCD have a significant duality in the effects of the two on each other, which must be explored further.
The Unwanted Cup of Coffee: An OCD Analogy
Imagine you were forced to drink a full cup of coffee before going to bed every night. You would sit there in bed and stare at the ceiling, with distracting thoughts whirling in your mind for hours. You would never get a good night’s sleep this way, and would never feel rested the next day. Now, I’m sure many of you have experienced this feeling after accidentally having caffeine before bed, or when trying to work or study late into the night– but imagine feeling this way every night. This is what it is like for those suffering with OCD. Research has shown that those with OCD have higher than normal rates of insomnia, and even other sleep issues like delayed sleep phase disorder. These issues are shown to be caused by obsessive thoughts, which keep victims up all night, trapped in their thoughts.
As mentioned before, bedtime is the loneliest part of the day, but also one of the most important times of the day. Sleeping efficiently has many different contributing factors, one of the most important being your “sleep environment.” It takes time every night to get into the ideal sleeping position and get your surroundings all set. This includes factors like outside noise, lighting, bedding, and temperature. If you have OCD, though, one compulsion can disrupt all of this, resetting the sleeping process and delaying your much-needed time in dreamworld. For example, I would often run out of bed to check if the downstairs lights were off, and this alone would set my sleeping process back 20 minutes– assuming I only checked one time. Compulsive behaviors and the obsessive mental processes mentioned above make the ultimate combination standing in the way of a good night’s sleep, but other complexities muddle this process even more.
The Vicious Cycle: OCD and Reduced Sleep
Let’s assume that your OCD is taking away an hour’s worth of sleep from your night, at minimum. Whether it’s a constant stream of obsessive thoughts or compulsions, you never get to bed by the time you wanted to. This lack of sleep is not only affecting the sharpness of your brain and the fatigue of your body the next day, though. It’s probably increasing the severity of your OCD as well. Studies have shown that a lack of sleep can cause an increase in the commonality and duration of obsessions the next day. Thus, the relationship between sleep and OCD is not only causal, but by nature circular. First, OCD causes you to lose sleep, then this lack of sleep causes your OCD symptoms to arise more frequently. If you suffer with this OCD-related insomnia, this seemingly exponential relationship can seem very daunting and undefeatable, much like a runaway train, impossible to stop. The first issue is viewing the problem as the entire thousand-ton train. You must stop the train one gear at a time, picking off one little piece any chance you get, in order to stop it. The cycle can be stopped, and the first real step is to truly believe in your mind that it can be, recognizing that it will not be easy but can be done.
Combating the Sleep-Stealing Obsessions and Compulsions
When it comes to OCD and sleep, it is best to start off by gaining a few small victories. First, I would like to address the in-bed compulsions that could cause you to wreck your sleeping environment and set back your sleep cycle. Let’s say you feel a strong urge to check something in your house. Getting up and checking it is self-defeating, so the main goal is to not perform the compulsion. If you have strategies that work during the daytime (like counting backwards from 200 by multiples of seven, or observing 10 things in your immediate environment) then you can try those at night too.
If you don’t have any strategies yet, or they’re not working, distraction is your next best bet. Try something that won’t keep you awake, like journaling, reading, or listening to quiet music. As long as it won’t ultimately be harmful to your health, anything you can come up with will be better than giving in to your compulsions. Try new things, especially if they’re things you’re actually interested in. And don’t be discouraged if things don’t work out too well at first: the goal is improvement, not perfection.
Although reassurance-seeking is not an ideal strategy, and can be another compulsion in itself, in extreme cases the need for sleep might outweigh your OCD treatment goals in the immediate short term. Let’s say you have a final exam tomorrow, and you just can’t get yourself to sleep. Maybe, for one night only, it might make sense to put yourself at ease. For example, if you always have to double-check that the lights are off in the house, a strategy to allow yourself to relax could be taking a picture of the dark room, to reassure yourself on your own without any outside help. Again, reassurance is not a great strategy because it tends to strengthen the obsessive-compulsive circles in the long run. It always feels good to get reassurance in the immediate, but for your long-term recovery it’s important to work on strategies to for diffusion or distraction, not reassurance. But we won’t pretend like there are never nights when it’s better to sacrifice this treatment objective and get some sleep.
Although these are steps to help you prevent compulsive behaviors, it is harder to deal with the obsessive thoughts that plague your brain for hours when you’re alone in bed. Meditation practice often helps me in these situations, combined with a form of self-questioning. If you ever find yourself obsessing all night, it is best to start taking deep, slow breaths, trying to focus all your attention on the rising and falling of your chest. This will allow for at least an attempt to clear your mind of the obsession for a moment. Next, after calming down your stream of thought, try to question the validity of the obsession. Why am I thinking this? Why is this important? Do I have to think this? Note that if one of your compulsions is to try to figure out the answer to these questions, this particular strategy probably won’t help you. Otherwise, these questions might help put your obsession in perspective, and perhaps this combination will help you drift off to sleep faster than you previously would have.
Sleep is the quiet force that allows us to keep living. All humans need it, but much like everything else in the world, everyone’s ability to attain it varies. I would like to conclude with Walt Whitman’s famous poem In Midnight’s Sleep, a recount of the horrors he saw in the Civil War, and how they constantly reappeared in his dreams and disrupted him in the middle of the night. I want you all to visualize OCD as a war going on in the mind. Just like in the poem below, there is hope of ending the war, but this hope is not there without the existence of hard-fought battles. This hope is not there without the recognition of beauty in the struggle. And finally, this hope is not there without dreams. I encourage you to keep fighting these battles everyday, no matter how small. Be resilient in your efforts, and be strong, because no matter what you think, it is inside each and every one of you.
If you need treatment for OCD, ERP is the most effective form, especially when the therapist conducting the treatment has experience with OCD and training in ERP. At NOCD, all therapists specialize in OCD and receive ERP-specific training. If you are ready to seek treatment, you can schedule a free call with the NOCD clinical team to learn more about how a licensed therapist can help you.
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If you or someone you know is struggling with OCD, you can schedule a free call today with the NOCD clinical team to learn more about how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.