The Vicious Cycle of Insomnia and Anxiety

As discussed in previous posts, anxiety is a multi-faceted issue that deeply affects among other aspects of life, insomnia.

According to a dissertation concerning the treatment of insomnia, author Alfonso Marino notes, “Anxiety holds a significant bearing on the onset of insomnia.  Anxiety is usually accompanied by numerous physical and physiological symptoms including autonomic hyperactivity (tachycardia and palpitations, urinary frequency, diarrhea, dry mouth, sweating, flushing, cold hands) back ache, shortness of breath. . .these symptoms may be present through the day and increase just prior to going to bed.  Individuals with chronic insomnia are usually concerned over sleep performance and their ability to function the following day with lack of adequate sleep.”

Anxiety contributes to insomnia in that the disturbing thoughts concerning the inability to fall asleep and maintain sleep become a self-fulfilling prophecy of doom, relived again and again. In the diagnosis of anxiety disorders, one criterion happens to be insomnia.  As Marino writes in his dissertation, “Sleep and vigilance problems are often included in the diagnostic criteria for anxiety disorders.  This is due to the assumption that if anxiety causes sleep disturbances it is also believed that sleep deprivation may produce symptoms which may be considered as anxiety.” In other words, insomnia and anxiety form a vicious cycle in which it’s hard to tell which comes first, which is the chicken and which is the egg.

But before anxiety and before insomnia, we do know that the thoughts are always playing some role. Of course, anxiety is fomented in the thoughts.  We know that we can’t stop or prevent our thoughts, a factor not unrelated to our inability to control precisely when we will fall asleep.  However, the holy fathers have taught us the sweet science of vigilance over our thoughts.  Anxiety-producing thoughts prior to sleep can be cut off or cast aside or replaced by other more healthful and blessed thoughts, according to these ancient fathers.  In a previous post on this subject, I wrote, “Orthodox monasticism likewise emphasizes the importance of spiritual training that takes place outside the explicit contexts of private and corporate prayer. The ascetics repeatedly urge monks and nuns to practice cutting off their will [ekkopē thelēmatos] daily in order to grow in virtue, to become humble, and to acquire compunction.  Merely saying no to inquisitive thoughts about trivial matters cultivates a detachment from insignificant earthly concerns. Although it may not seem like a great accomplishment if a nun wonders what is for dinner, but refrains from asking the cook, over time this practice applied in a variety of situations establishes a proper hierarchy of values in her soul, shifting fundamental beliefs about herself and her world from the ephemeral to the eternal. Another example of patristic advice on planting precepts on virtue along the rolling hills of daily life is the practice of rehearsing in the mind how one would like to act in a troubling situation. For the fathers, this practice is scripturally rooted in psalm 118:60 (LXX): ‘I prepared myself and was not disturbed in keeping thy commandments,’ which they paraphrase as ‘I reviewed in advance how I would handle a chance encounter by considering my resources, and I was not disturbed by tribulations for Christ’s sake.’  According to the ancient ascetics, this previous preparation enabled the three holy youths to enter the Babylonian furnace and hosts of martyrs to face martyrdom without being flustered. By anticipating and considering in advance what may take place, believers in the face of trials can likewise trim down excessive emotional reactions of fear or anger. For example, Saint John Cassian suggests that those who find themselves becoming impatient or angry should practice imagining that they are hindered, wronged or injured, but respond as the saints would—with perfect humility and gentleness of heart.  Saint Nicodemos the Hagiorite likewise recommends that believers prepare themselves before going somewhere or coming into contact with irritating and exasperating people by imagining that others curse them and dishonor them, but that they weather it all with thanksgiving and peace of mind. Saint Theophan the Recluse expands this method to include all the conceivable encounters and imaginable feelings, desires, and reactions that a person might experience. He suggests reflecting on potential attacks at the beginning of the day and mentally planning how to react in a way that is in keeping with the commandments of Christ. This patristic practice also has classical antecedents. In the Christian redaction of Epictetus’s Encheiridion, those who desire to become virtuous are advised to consider in advance the potential difficulties and obstacles that they might come across in any endeavor.”

How can this advice be related to insomnia? To begin with, one can recognize that thoughts like “I’ll never get to sleep,” “I won’t get enough rest,” “Again, the same struggle to sleep,” will come, but one need not focus on them and enlarge them. Anxiety always freeze-frames at the brink of failure, but life continues over brink after brink until we reach our final destination. Furthermore, we can turn our minds in other directions or plan for rest differently. We can recall that “there remains a rest for the people of God” (Hebrews 4:9), that “God gives his beloved sleep” (Psalm 127:2), and with respect to our calamitous thoughts, “Ye shall not fear them: for the Lord your God he shall fight for you” (Deuteronomy 3:22). While I will discuss in more detail spiritual remedies to such anxiety as it relates to insomnia in a future post, it’s important to take note that “stepping outside” of the present anxiety-producing situation or thought provides proper perspective and a curative for despair.  A situation or thought becomes anxiety producing because it falsely tells us that “it” is inevitable and there is nothing to be done but await with dread to go through the ordeal and to suffer the consequences.  This is not true.  I am reminded of the AA slogan, “this too shall pass” that is so often on the lips and in the hearts of those who’ve conquered addiction.  The “it” that produces anxiety is fleeting and will pass if we do not give in to the despair and inevitability it suggests. And that victory begins when we learn what the wise Solomon once taught, “Trust in the Lord with all thine heart; and lean not unto thine own understanding” (Proverbs 3:5).

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