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Can antidepressants be prescribed to treat anxiety-related insomnia?

Anxiety disorders can do more than make you miserable while you’re awake. They can also disrupt your sleep. Insomnia, defined as difficulty falling or remaining asleep, can be a symptom of anxiety. An anxiety disorder can cause your brain to stay on high alert, interfering with the chemical processes which encourage restful sleep.

When prescribed, certain antidepressants can help treat anxiety-related insomnia and promote sound slumber. These medications act as a sedative to calm the mind and override racing thoughts that may trigger insomnia. Below are more details about anxiety-related insomnia and the types of antidepressants medical providers may prescribe to treat it.    

What Is Anxiety-Related Insomnia?

Insomnia can cause someone to take hours to fall asleep, wake up frequently during sleep, and feel tired during the day. At the risk of stating the obvious, the medical community characterizes anxiety-related insomnia as sleep problems associated with anxiety, which can lead to feelings of impending doom, worry, and fear. The emotions associated with anxiety disorders make it harder for someone to fall or stay asleep. 

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Neurotransmitters in the brain are responsible for sending signals telling the mind and body when to relax and when to stay alert. Some of the neurotransmitters influencing sleep and awakening include serotonin, cortisol, and adrenaline. An increase in the neurotransmitters responsible for awakening, such as cortisol, can interfere with sleep. Individuals with anxiety disorders usually have higher levels of chemicals that spark alertness. The brain has difficulty calming down, resting, or staying asleep for extended periods. This explains why anxiety-related insomnia develops.

The Anxiety & Depression Association of America (ADAA) reports that 40 million adults have an anxiety disorder. That’s just over 19% of the U.S. adult population. Several physical and environmental factors are thought to increase a person’s risk of developing an anxiety disorder. Those factors include genetics, personality, and traumatic life experiences. While anxiety and anxiety-related insomnia are treatable, not all cases are alike.  

What Are the Different Types of Insomnia?

Insomnia is a condition that can be short-lived or more persistent. Some people may have trouble falling and staying asleep without any coexisting conditions. Others will experience insomnia alongside other medical problems, such as chronic sinus infections. Each type of insomnia is typically defined by its causes and how long it lasts.

Primary Insomnia

Primary insomnia doesn’t coexist with other conditions, such as a generalized anxiety disorder. Someone with primary insomnia does not have another physical or mental issue that could interfere with sleep.

A person with primary insomnia may experience problems with falling asleep or waking up too often during sleep. This type of insomnia might also combine both issues. A person could toss and turn before they drift off, and they could also wake up before a sleep cycle finishes.

A diagnosis of primary insomnia could mean the individual’s environment is not a contributing factor. This means lifestyles, environmental circumstances, and medications are not plausible causes. Primary insomnia can be either acute or chronic.

Secondary Insomnia

Unlike primary cases of insomnia, secondary insomnia occurs alongside another health conditions. The health problem can be physical, such as asthma, or a person could have a mental health issue, such as an anxiety disorder, that triggers their insomnia. Prescription medications and excessive substance use may also contribute to secondary insomnia, which can be short-lived or chronic.

Say a person is taking a course of steroids to treat a deviated septum. Studies show a link between corticosteroid use and insomnia. Other psychiatric effects of steroids include anxiety and mood disorders. Up to 90% of patients who use steroids for longer than 60 days experience undesirable side effects.

Sleep-Onset Insomnia

A person with sleep-onset insomnia has problems falling asleep in the first place. They might toss and turn or lie awake for hours, but they’ll usually stay asleep once they drift off. They also won’t wake up long before the alarm goes off.

While uninterrupted sleep is a positive, someone with sleep-onset insomnia may only get a few hours of sleep instead of a whole night’s worth. They might also frequently get out of bed to pace, watch TV, or read to calm their mind. Anxiety isn’t always the root cause of sleep-onset insomnia, but it can manifest as a symptom.

Sleep-onset insomnia can occur for a couple of weeks or it can be present for months or years. Possible causes of sleep-onset insomnia include consuming high amounts of caffeine, using smartphones before bed, and attempting to sleep in a loud environment.

Sleep-Maintenance Insomnia

This type of insomnia manifests when a person has trouble staying asleep. They might wake up hours before their alarm is set to go off. This doesn’t just happen one night here or there. It occurs consistently enough to lower the individual’s sleep quality. They may wake up tired, feeling as though they didn’t sleep much at all.

Someone with sleep-maintenance insomnia could wake up several times during sleep. They may fall asleep for only a three-hour stretch. Then the individual wakes up for 30 minutes before falling back asleep for another two hours. This pattern repeats throughout the night, making it difficult for the person to feel rested.

Compared to cases of sleep-onset insomnia, sleep-maintenance insomnia stands a higher chance of being primary in nature. Without an underlying cause to address, sleep-maintenance insomnia may be more challenging to treat. Middle-aged adults are at a higher risk of developing sleep-maintenance insomnia, as physical and lifestyle changes can lead to increased stress or disruptions in the brain’s chemical processes.

Paradoxical Insomnia

People who suffer from this form of insomnia believe — erroneously — that they’re getting inadequate sleep. They may have many of the hallmarks of insomnia, such as daytime drowsiness. However, when special studies of sleep are done,, these individuals don’t show any signs of actual sleep disturbances. In other words, they neither wake up frequently nor take hours to fall asleep. Yet they still wake up tired, feeling as though they were asleep for less time than they were. 

Like other forms of insomnia, paradoxical insomnia can be acute or chronic. And given its quixotic nature, it can be more difficult to identify the cause(s) of the condition. It’s moderately good news, then, that clinical studies have found less than 5% of insomniacs have paradoxical insomnia. Younger and middle-aged adults tend to make up most of this population.

How Is Anxiety-Related Insomnia Diagnosed?  

Currently, there are no medical tests for diagnosing insomnia per se. Healthcare providers will usually try to identify anxiety-related insomnia through a combination of activities. They’ll look at medical histories and medications and ask about a patient’s symptoms. Physical exams can also play a role in the diagnosis.

For starters, a healthcare provider will want to rule out various potential causes of a patient’s symptoms. They may begin with a physical and blood test to eliminate underlying conditions, such as hypothyroidism. Medical studies have shown some correlation between thyroid conditions and insomnia. Too little or too much thyroid hormone may interfere with sleep and heighten anxiety.

Doctors may also ask patients to document their sleep patterns and symptoms. In some cases, patients will undergo a sleep study. The objective is to see whether the person has other disorders, such as sleep apnea. A diagnosis of anxiety-related insomnia can result when medical professionals have eliminated other potential sources of a patient’s sleep problems.

How Is Anxiety-Related Insomnia Treated? 

For patients with anxiety-related insomnia, treatment usually involves therapy and medication. Cognitive behavioral therapy is the most commonly studied option and has shown to be very effective. Medications may include those which specifically induce sleep, tricyclic antidepressants, or selective serotonin reuptake inhibitors (SSRIs) which are another commonly prescribed form of antidepressant.

Depressants like benzodiazepines are commonly prescribed as a short term solution. When anxiety keeps a person awake because their thoughts are racing, these act as a calming agent. They work by slowing down the messages from the brain to the body.

When finding a long term solution, doctors usually start patients with lower doses of tricyclic antidepressants, such as amitriptyline, to see how they respond. This medication works by balancing certain chemicals in the brain, like serotonin. This option may help improve mood, relieve anxiety, and increase your energy level. However, they can have more serious side effects, such as excessive drowsiness. 

Medications affect each person differently. Some individuals with anxiety-related insomnia may receive prescriptions for selective serotonin reuptake inhibitors. SSRIs block the brain’s reabsorption of serotonin, so there is more available to transmit messages within the brain. But they can also induce sleep as part of their effect and this effect can be exploited to help treat insomnia.

Many medications can be an effective treatment for anxiety and anxiety-related insomnia. However, everyone’s brain is wired differently and will require individualized treatment. It may take some trial and error to find the right prescription and dose, but the good news is that there are options.

Lifestyle Changes That Can Help Manage Anxiety-Related Insomnia

Medication can help manage anxiety-related insomnia, but treatment that also involves therapy and lifestyle changes is usually more successful. Anxiety may cause someone to use coping mechanisms that create poor sleeping habits. For example, you might leave the TV on in your bedroom to help you fall asleep. But the noise and light from the television interfere with healthy sleep cycles.

A doctor may recommend specific lifestyle changes as part of a treatment plan. These may include following a regular sleep schedule. With a set schedule, you’ll go to bed at the same time each evening. You’ll also attempt to get out of bed at a designated time every morning.

Other common lifestyle changes include eliminating distractions from the bedroom, such as light and noise. Your doctor may ask you to stop consuming caffeine and alcohol for a certain number of hours before going to sleep. Getting routine exercise can also be a helpful lifestyle change, although you may need to do so well before you wind down for the night. Exercise increases the production of adrenaline, which can prevent you from falling asleep.

Practicing meditation, listening to relaxing music, and doing breathing exercises are additional techniques for reducing anxiety. Engaging in these activities consistently could be part of your overall treatment. 

Questions to Ask Your Doctor If You Think You Might Have Anxiety-Related Insomnia   

Making an appointment with your medical provider to discuss your sleep-related symptoms is wise. Not getting treatment for anxiety-related insomnia can exacerbate its troublesome impacts, including poor work performance. Even though anxiety disorders are treatable, according to ADAA statistics, only about 37% of those with them undergo treatment.

While talking about potential solutions with a doctor is the right thing to do, it can be overwhelming. It’s easy to overlook some of your concerns when you’re in the moment. Preparing a set of questions beforehand can steer the discussion toward what you need to know about your treatment plan. Here is a list of questions to ask during your appointment – you may add to this list according to your needs:

  • What type of anxiety is causing my insomnia?
  • What form(s) of anxiety-related insomnia do I have?
  • Will cognitive behavioral therapy relieve my symptoms? 
  • Can other forms of therapy help with sleep?
  • How many times per week (or month) should I attend therapy sessions?
  • How long will my treatment program last?
  • When should I expect to see improvement in my symptoms?
  • Should I change my sleep environment by putting up blackout curtains or removing all electronics?
  • Do you recommend medication? How long will I need to take it?
  • What are the side effects of the prescription?
  • How will antidepressants interact with other medications and supplements I’m taking?

Is It Time to Seek Treatment?

If you suspect you have anxiety-related insomnia, it’s important to schedule a consultation with a medical professional. They can confirm your diagnosis and recommend the proper course of treatment. Whether your plan consists of antidepressants, therapy, or lifestyle adjustments, a professional will address your concerns before you begin. Once you start, you’ll be that much closer to getting a good night’s sleep.      

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