According to my mother, when I was a baby, I’d cry so hard in my crib that she’d have to take the mattress out and sleep next to me on the floor. Though I don’t wail through the night anymore, I’ve never gotten good at sleeping. In elementary school, I tried to fall asleep with my eyes cracked open—I didn’t want to give up the vigilance of my waking hours. There were years where I couldn’t fall asleep without the television on; it was a way to trick myself out of my fear.
When my mother died in 2018 while I was asleep, I was faced with a new caliber of sleep anxiety. The heart of my fear has included the following what-if questions: What if I never wake up? What if someone I love never wakes up? What if something bad happens to me while I’m sleeping? What if I have a bad dream that I can’t wake up from?
All this is to say: you’re not alone, and your experience doesn’t need to stay hidden in the dark, lonely hours of nighttime. I find any struggle with mental health to be much easier to confront when I let it live in the light. This article will discuss the phenomenon of sleeping anxiety, and anyone can get effective help for it.
What is sleeping anxiety?
People can experience sleeping anxiety for a number of reasons, including the fear of never waking up. If you have sleeping anxiety, you probably find yourself feeling more and more anxious as nighttime approaches. Like most people with anxiety and anxiety-related disorders, you might feel some physical symptoms of that anxiety, too. For example, a racing heart, sweaty palms, nausea, muscle tension, and more—anxiety can affect nearly every part of the body.
It’s likely that your fear of never waking up stems from another mental or physical health condition. Read on for a list of possible conditions that can cause significant anxiety about falling asleep, as well as effective forms of treatment.
Conditions that sleeping anxiety could be a sign of
There are a few conditions that your sleeping anxiety could be emblematic of. First is a phobia known as “somniphobia”, or the fear of sleep. Specific phobias belong to the category of anxiety disorders and are characterized by intense fears related to a specific object, activity, or place. People with phobias are aware that their fear is irrational and extreme, but are unable to change their feelings.
Obsessive-compulsive disorder (OCD)
Next are a few different subtypes, also known as themes, of obsessive-compulsive disorder (OCD). The first theme that might cause sleeping anxiety is existential OCD. Existential OCD, like any theme of the disorder, is characterized by obsessions—intrusive thoughts, images, feelings, sensations, or urges—followed by compulsive behaviors or mental actions done to relieve yourself of the distress caused by those obsessions. People with existential OCD experience obsessive thinking about life, reality, and death. While everyone ponders these philosophical questions from time to time, people with existential OCD find themselves unable to move past their questions and doubts, feeling that they cannot tolerate uncertainty about existence or life. Existential obsessions can sound like:
- What if I’m not really here? What if I’m in a simulation?
- What if I’m already dead, and that means I won’t wake up?
- What if nothing I do matters? How will I know?
- Have I actually been in a dream this entire time?
- What if I can’t stop thinking about what it would feel like to be dead.
The ensuing compulsions done to feel better might look like:
- Constantly researching these topics to try to find answers
- Seeking reassurance from others, such as asking, “Am I real?” or “Do you think there’s a purpose to life?”
- Mentally reviewing the events of your day to make sure they really happened and that you’re real
- Avoiding places or activities that trigger your obsessive thinking, such as sleeping
- Using substances to help you fall asleep despite your fear, or using substances like caffeine to stay awake
The fear of never waking up could also be a sign of health concern OCD. You might find yourself worrying that you have an underlying illness, disease, or irregularity that will cause you to die in your sleep. Obsessions might sound like:
- What if my heartbeat is irregular and a sign of a terminal condition?
- What if my headache is actually a brain tumor or aneurysm, and it kills me overnight?
- What if I came in contact with deadly germs today?
- If my neck is at a bad angle, could I die in my sleep?
- What if I stop breathing in my sleep?
Compulsions done in an attempt to feel safe or at ease might look like:
- Checking your pulse to count your heart rate
- Feeling your scalp to check for a tumor
- Repeatedly washing your hands
- Doing research online about your perceived symptoms
- Praying repeatedly to feel more secure or safe
- Potentially, using substances to help you fall asleep or stay awake
The third theme of OCD that could explain your fear of never waking up is somatic OCD, also known as sensorimotor OCD. Those experiencing somatic OCD are hyperfocused on autonomic bodily functions such as breathing, blinking, swallowing, and one’s heartbeat. Obsessions might sound like:
- Does my breathing sound normal?
- Am I swallowing too much?
- Is my heart rate too high?
- What if I never stop noticing this function?
Compulsions might look like:
- Conducting excessive research online to determine the “normal” way for these autonomic functions to happen
- Reassuring yourself or seeking reassurance from others that your functioning “normally”
- Avoiding sleep because you feel like you have to pay attention to your functions in order for them to happen “correctly”
- Using substances to help you get to sleep
Note that anxiety and OCD are separate conditions, with distinct categories in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Both are marked by excessive worry, but OCD consists of intrusive thoughts and compulsions, whereas anxiety does not.
Picture it like this: anxiety is being worried that the sky is going to fall, and OCD is being worried that the sky is going to fall and then doing everything you can to be certain that it won’t. With OCD, you might be inundated with thoughts like, What if I want the sky to fall? What if I’m responsible for holding up the sky? My worries must be a sign that the sky is going to fall; If the sky falls, it’ll be my fault, or it may involve distressing images of the sky falling and crushing your whole family, which you then interpret as you wanting your family to be crushed. You would then do excessive research about the likelihood of the sky falling, repeatedly reassuring yourself that you don’t want your family to be crushed, and you might even avoid going outside at all. Dr. Patrick McGrath, Chief Clinical Officer at NOCD, says that “OCD can involve anxiety, but it can also involve guilt, shame, and other emotions.”
The next category of conditions that could be the root of your sleeping anxiety is sleep disorders; namely, sleep paralysis, sleep apnea, and nightmare disorder.
Sleep paralysis is a terrifying experience where one’s mind wakes up, but their bodies don’t. In other words, they feel awake, but they can’t move their body. Those experiencing sleep paralysis worry that they’ll never be able to wake up. If you experience this regularly, you might want to avoid sleeping altogether out of fear that one of these times you really won’t wake up.
With sleep apnea, one’s breathing repeatedly stops and starts. If you wake up gasping or have been told that you stop breathing while asleep, you may develop the fear of never waking up one morning.
People with nightmare disorder, experience meaning repeated, frequent, and vivid nightmares. Some often worry that they’ll get “stuck” in the nightmare and never wake up, feeling highly anxious nearly every time they lay down for their nightly rest.
People who are afraid of never waking up could also be experiencing post-traumatic stress disorder (PTSD). PTSD occurs when one has experienced or witnessed an extreme, terrifying event. If you’ve witnessed someone die in their sleep, for example, and that began your fear of the same, it’s possible you’re experiencing PTSD.
Other symptoms include: having flashbacks of the traumatic event, emotional or physical responses to something that reminds you of the event, a particularly negative worldview, feeling detached from loved ones, activities that used to interest you, and your life in general, feeling numb, and having difficulty feeling positive emotions.
Treatment for sleeping anxiety
Treatment will depend, of course, on which of the above conditions is the root of your sleeping anxiety. If you’re not sure which, if any, of the above apply to you, a mental health professional can help you reach a diagnosis before deciding on a course of treatment.
If you’re experiencing somniphobia or any theme of OCD, the evidence-based, gold-standard treatment is the same: exposure and response prevention therapy (ERP). While you may have heard this modality referred to simply as exposure therapy, both the exposure and response prevention components are crucial.
First, you and your therapist will work together to create a hierarchy of your triggers. This means that you’ll start small and work your way up to the things that trigger you the most. Some exposures will happen in the therapy session—reading a distressing news article, for example—and some will happen outside of therapy as “homework” between sessions. Alongside conducting exposures, your therapist will teach you strategies for resisting compulsions. Dr. McGrath says he would begin treatment of the fear of never waking up by focusing on what someone does in preparation for bedtime. For example, he says, if someone tries to stay awake by setting multiple alarms, drinking caffeine, or using other substances, he and the client would begin by cutting those things out one by one. You would then work your way up to having a full night’s sleep without preventing sleep, inducing it in unsafe ways, repeatedly “checking” for bodily sensations, or information-seeking behaviors.
If you think your fear of never waking up might stem from PTSD, evidence-based treatments include prolonged exposure (PE) therapy. In PE—which, at its core, is somewhat similar to ERP as another exposure-based therapeutic intervention—consists of client and therapist working together to approach the feelings and memories related to their trauma. In doing so in a careful and structured manner, the highly sensitive “alarm bells” of post-traumatic stress can be reduced, and previously triggering situations like sleep can be approached with newfound confidence and a sense of greater safety.
If you think you might be experiencing a sleep disorder, meet with a sleep specialist. They’ll help diagnose and treat whatever you’re experiencing. Click here for a directory of sleep specialists, searchable by state.
This information might be overwhelming. Recognizing that you have a problem and that it’s time to ask for help can sound like a big, daunting step, but think about the life that’s waiting on the other side. You deserve to have deep, rejuvenating sleep without haunting fear and debilitating compulsions hovering over you.