What is the relationship between anxiety and sleep deprivation?

From the Guidelines

Anxiety and sleep deprivation are intricately linked, with each exacerbating the other, and the most effective approach to managing this cycle is through a combination of cognitive behavioral therapy for insomnia (CBT-I) and relaxation techniques, as evidenced by the 2021 American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment 1.

Key Components of Therapy

To break the cycle of anxiety and sleep deprivation, several key components of therapy can be employed:

• CBT-I: Combines cognitive therapy strategies with education about sleep regulation, stimulus control instructions, and sleep restriction therapy, often including sleep hygiene education, relaxation training, and other counterarousal methods 1.
• Relaxation Techniques: Such as progressive muscle relaxation, deep breathing exercises, and mindfulness meditation, which can help reduce somatic tension and cognitive arousal that may perpetuate sleep problems 1.
• Stimulus Control: Instructions designed to extinguish the association between the bed/bedroom and wakefulness, and establish a consistent wake-time, including going to bed only when sleepy, getting out of bed when unable to sleep, and using the bed/bedroom for sleep and sex only 1.

Lifestyle Modifications

In addition to therapy, several lifestyle modifications can help manage anxiety and sleep deprivation:

• Establish a consistent sleep schedule by going to bed and waking up at the same times daily, even on weekends.
• Create a relaxing bedtime routine including activities like reading, gentle stretching, or meditation 30-60 minutes before sleep.
• Limit screen time at least one hour before bed as blue light disrupts melatonin production.
• Avoid caffeine after noon, limit alcohol consumption, and exercise regularly but not within 3 hours of bedtime.

Medication Options

If necessary, short-term medication options may include:

• Benzodiazepines like lorazepam (0.5-1mg) for acute anxiety, though these should be used sparingly due to dependency risks.
• Melatonin (1-3mg) 30 minutes before bedtime or prescription options like trazodone (25-100mg) if sleep problems persist. However, it is essential to prioritize non-pharmacological approaches, such as CBT-I and relaxation techniques, due to their effectiveness and lack of side effects, as supported by the 2021 American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment 1.

From the Research

Relationship Between Anxiety and Sleep Deprivation

The relationship between anxiety and sleep deprivation is complex and bidirectional, with anxiety preceding poor sleep and vice versa 2. Key points to consider include:

• Anxiety disorders have a significant impact on sleep, with approximately 50% of individuals with anxiety experiencing sleep disturbances, particularly insomnia 2.
• Sleep deprivation can exacerbate anxiety symptoms, and insufficient sleep can instigate or further exacerbate anxiety 2.
• Non-pharmacological sleep interventions, such as cognitive behavioral therapy for insomnia, can moderately improve anxiety symptoms 3.
• The combined effect size of non-pharmacological sleep interventions on anxiety symptoms is moderate, indicating a reduction in symptoms 3.

Mechanisms Underlying Sleep and Anxiety

Brain mechanisms underlying sleep and anxiety include:

• The adenosinergic receptor system, which plays a role in anxiety, arousal, and sleep 2.
• Brain networks underlying the anxiogenic impact of sleep loss, which can be beneficially affected by sleep 2.
• The role of slow wave sleep as a potential therapeutic target for reducing anxiety 2.

Interventions for Sleep Promotion

Interventions for sleep promotion in individuals with anxiety include:

• Non-pharmacological sleep interventions, such as earplugs, eye masks, and relaxation techniques, which can improve sleep quality and reduce anxiety symptoms 3, 4.
• Cognitive behavioral therapy for insomnia, which can moderately improve anxiety symptoms 3.
• Lifestyle and sleep interventions, such as designated quiet time and environmental modifications, which can support sleep improvement 5.

Effectiveness of Interventions

The effectiveness of interventions for sleep promotion in individuals with anxiety is:

• Moderate for non-pharmacological sleep interventions, with a combined effect size indicating a reduction in anxiety symptoms 3.
• Low to very low for most non-pharmacological interventions, due to clinical heterogeneity and limited quantitative synthesis 4.
• Some evidence suggests that music, relaxation techniques, and sound masking can provide small improvements in subjective measures of sleep quality and quantity, but the quality of the evidence is low 4.