I’m constantly afraid I won’t be able to sleep. Is it anxiety, OCD, or a sleep disorder?

We’ve all had that dreaded, sleepless night—where sleep is fitful and falls very short of leaving us refreshed. What’s worse, our minds can latch onto these experiences and torment us even more. Whether it’s because of racing thoughts, a feeling of anxiety or panic, or just an inability to get comfortable, we might be running over questions like these:

• “What if I don’t get enough sleep?”
• “What if I don’t sleep and I can’t function in the morning for work?” 
• “What if I don’t sleep and it leads to illness or a health problem?”
• “What if I regularly get poor sleep and this causes Alzheimer’s Disease?” 

While these fears are common for many people, that doesn’t mean they’re not a problem. In fact, they may be a sign of a few different conditions—and there may be something you can do to get better.

What’s causing your fear of not being able to sleep?

When it comes to your fear of not being able to sleep, there are many possible explanations. Of course, there could be an actual sleep disorder going on that affects your sleep and, as a result, leaves you constantly worried that you won’t get enough Zs. Possible issues include:

• Insomnia, a common sleep disorder where you may have trouble falling asleep, staying asleep, or getting good quality sleep.
• Delayed Sleep Phase Disorder, where the onset of sleep is delayed by two hours or more, which in turn causes difficulty in being able to wake up at the desired time.
• Sleep apnea, which happens when your breathing stops and starts while you slumber—a disorder that can be accompanied by frequent wake-ups.
• Sleep anxiety, where you’re riddled with a fear or worry about going to sleep or staying asleep. 
• Some people also have a specific phobia about sleep called somniphobia, where they believe they shouldn’t sleep because something bad will happen. 

These issues often have a medical cause and trying to treat them on your own will be ineffective. While good habits like proper sleep hygiene and regular sleep routines may help with certain sleep disorders, additional medical treatment may be needed, and it’s worth talking to your doctor about.

OCD and sleep fears: When a sleep disorder isn’t to blame

But what if the reason you feel a constant fear that you won’t be able to sleep doesn’t have any physical explanation at all? As it turns out, there’s a possible connection between fears about not sleeping and obsessive-compulsive disorder, or OCD. When OCD is to blame, there comes a point when the fear of not sleeping is actually more problematic than sleeping too little. In that case, the “solution” to your issue isn’t adherence to good sleep hygiene—it’s understanding what’s at the root of your fear in the first place.

Contrary to what you’ve seen depicted in movies and on television, OCD comes in innumerable different forms; it’s not just an obsession with hand-washing or a tidy home. And there are many manifestations of OCD that could be linked to a fear of not getting enough sleep. Here are a few that may be the most helpful to understand:

• Take Health Anxiety OCD, for example, which is characterized by irrational fears around illness and compulsions done to assuage their fears. Someone with Health Anxiety OCD might be worried that not sleeping could lead to an illness. 
• Somatic OCD may also be the culprit behind your fears about getting to sleep. If you find yourself checking how “awake” you feel, fixating on slowing your breathing, monitoring your heart rate or breathing, or worrying about other physical sensations as you head to bed, Somatic OCD may be the cause of your worries.
• Then there’s Perfectionism OCD, an OCD subtype that is characterized by ongoing intrusive thoughts and compulsive behaviors around perfection and making things feel “just right.” A person with Perfectionism OCD may worry that if they don’t get their solid 8 hours, they won’t be able to perform at the top of their game at work or school. Or maybe their bed is not 100% comfortable, so they spend hours trying to get it “just right.”
• With a number of different themes of OCD, obsessive thoughts may be centered on fears of death and dying, far beyond normal concerns. For such people, there may be specific fears present about bad things happening during sleep—such as sleep paralysis.

Signs that your fear of not sleeping could be related OCD

People with OCD who are afraid of not getting enough sleep may engage in compulsive behavior or repetitive actions to alleviate their distress around this fear. Here are some examples of compulsive thoughts or behaviors related to this fear:

• Clock-checking: Looking at the clock repeatedly throughout the night to monitor how long it is taking to fall asleep
• Reassurance thoughts: Repeatedly telling yourself things like, “Doctors can go 48 hours or more without sleep, and they don’t die from lack of sleep”
• Googling: Researching things like how long a person can go without sleep or how to fall asleep quickly
• Self-medicating: Using alcohol, drugs, or sleep aids to induce sleep
• Manipulating sleep times: Going to bed hours early in hopes that you will eventually fall asleep at a “reasonable” time
• Overexercising: Using excessive exercise to “tire yourself out”

While the phrase “You’re so OCD” is tossed around loosely, the truth is that a true OCD diagnosis means it’s likely that your obsessions and compulsions will have a big impact on your life. Repeating compulsions can take up a lot of time, and obsessive thoughts can make it hard to concentrate on other parts of your life and leave you feeling exhausted. You may even feel ashamed of your obsessive thoughts, or worry that they can’t be treated. But rest assured, OCD can absolutely be treated with the right therapy.

How to get help

If your fear of not being able to get enough sleep is connected to an issue unrelated to OCD, then your treatment will be specific to the medical issue you’re dealing with. If it’s anxiety-related, for instance, working with a mental health professional to address the root cause of your anxiety may help you get better shut-eye. Likewise, sleep apnea and other medical disorders that affect sleep will require specific treatment with a doctor and maybe even medication.

If your fears surrounding sleep are connected to OCD (or in some cases, even somniphobia), then a specific type of therapy known as Exposure and Response Prevention therapy (ERP) can help. Finding a therapist with OCD-specific training is crucial, as some clinicians may attempt to treat OCD fears without truly understanding the disorder. The good news is that ERP with a trained therapist has been found to be effective in around two-thirds of patients. 

So how, exactly, does it work? ERP is a type of therapy that encourages you to face your fears and let obsessive thoughts occur without trying to get rid of the fear by engaging in compulsions. You’ll confront the situation that causes anxiety, but you’ll start slow, with a situation you’ll be able to tolerate. For instance, maybe what’s tolerable (although not 100% comfortable for you) is checking the clock just twice during the night instead of every 5 minutes. Once you find that your anxiety does not climb as high from something that you thought would be intolerable, you will then move on to more difficult exercises, gradually developing a tolerance for worries about your sleep and experiencing less anxiety when your thoughts pop up again.

Get help virtually 

ERP done in live, face-to-face teletherapy (like over a video call) is just as effective as traditional in-person ERP therapy. People’s obsessions are often closely related to the environments they find themselves in throughout the day, so the most effective way to expose them to the resulting anxiety is by practicing exposures directly in those environments, rather than finding the closest approximation in a therapist’s office. In other words, your home may be the perfect place to make progress with a qualified therapist. To get matched with a licensed, ERP-trained therapist, I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment with NOCD today.