Why insomnia provokes performance anxiety that keeps you awake

Anxiety is antithetical to sleep because it entails physiological, cognitive, behavioral and emotional arousal. Unfortunately, anxiety about sleep can be self-perpetuating. When the effort to sleep backfires. we feel even more desperate, resulting in more arousal. It is also common to experience frustration, despair, self-recrimination and feelings of failure, far from the calm comfort we need for sleep.

There’s a paradox we need to satisfy to fall asleep: We achieve the goal by not trying to achieve the goal (paradoxical intention). We need good sleep habits to attract sleep, but from there, it is up to our sleep and not us. We have to let go of striving and monitoring. As the Taoist master Lao Tzu said, “do the work and let it go: for just letting it go is what makes it stay.”

As a sleep psychologist, I teach my patients several methods to quell performance anxiety. Less anxiety does not induce sleepiness, but it does mean we are no longer chasing sleep (away). At a minimum, we suffer less; at best, we sleep better. The methods I suggest here are not a substitute for individualized health care.

Recognize that sleep is a natural process

Consider puppies and babies. They cannot conjure a verbal notion of sleep, let alone try to sleep; sleep naturally overtakes them. We can’t will sleep any more than we can will thirst. Free yourself from responsibility for your sleep. Implement decent sleep habits, but outsource the job of sleep per se to your body.

Use sports psychology

If you were taking your final shot in a free-throw contest with a big cash prize, you’d be better off mindfully engaged in the well-practiced process of setting up and delivering the shot than hung up on the results or stakes. When it comes to sleep, just focus on whatever well-practiced process makes you feel peaceful and unburdened without any goal of sleep. This can also forge helpful associations between the bed and peace.

Let go of tracking your sleep

A sleep diary or a wearable sleep tracker can be informative. But many of my patients track their sleep long term and check their trackers daily, sometimes in the middle of the night. There is even a syndrome called orthosomnia in which people compulsively strive to optimize their sleep per their wearable devices.

I generally advise my patients to let go of long-term monitoring when it has become a source of pressure and striving. For those who have trouble letting go or who make good arguments for continuing, I advise checking their sleep apps just once per week. Many have told me how helpful it has been to take off their monitors altogether.

Borrow from sex therapy

Despite their obvious differences, sexual function and sleep are surprisingly parallel. Both involve natural bodily processes that we misguidedly try to control. The pressure to perform runs high. Try to be a kinder and more merciful partner to yourself. Your love and respect for yourself need not be contingent on how well you sleep.

In addition, as with sex, what we put our minds on matters. Seek out tranquilizing material without a goal of sleep. It’s okay to carry yourself far away with all manner of soothing distractors — such as visualizations or naming the states that begin with A and working your way down the alphabet. If you prefer to be more present with breathing exercises or muscle relaxation or naming things you see, hear and feel, that’s good, too. No need to focus on the future.

Use cognitive strategies

I find it helpful to think of performance anxiety as responsibility (“I need to get to sleep”) meets anticipatory anxiety (“If I don’t, something really bad could happen”). You can address both components by acknowledging that it is not your job to sleep and by de-catastrophizing sleep loss. Reflect on your personal experiences to delineate the worst, best and most likely outcomes of a poor night. It might also help to remind yourself that you are doing something about the problem and that your life is about more than the insomnia.

Consider these issues during the day, and let the analytical mind go at night. Don’t invalidate your all-too-real suffering when you identify cognitive distortions and bring more rational thinking to bear on them.

Try soothing self-talk

Concepts such as de-catastrophizing sleep loss and accepting — rather than fighting — an unpleasant reality can be translated into comforting phrases for nighttime use. Try to adopt a gentle and reassuring tone with phrases such as, “Nothing you need to do,” “You’re safe now,” “Nothing to fight against” and “Just anxiety; it’s okay.”

Explore deeper reasons

Anxiety about sleep and the next day’s functioning can reflect fear of judgment or of disappointing others, feelings of vulnerability, low self-esteem, perfectionism and other issues. Exploring the real problem — for example, insecurity — can help with performance anxiety about sleep.

I like to integrate various approaches to suit the individual, and you may as well. If you are interested in reading about or trying a therapy that integrates acceptance, mindfulness and related concepts in the treatment of the anxiety that attends insomnia, check out acceptance and commitment therapy (ACT) or mindfulness-based therapy for insomnia (MBTI) in addition to standard cognitive-behavioral therapy for insomnia (CBT-I). Don’t hesitate to seek professional help as needed.

Lisa Strauss is a clinical psychologist in private practice in the Boston area. She specializes in sleep disorders.

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