​​Is Insomnia Making You Afraid of Going to Sleep?

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Her doctor thinks it might be related to  menopause , but that hasn’t been confirmed. Meditation hasn’t helped, nor have yoga and breathing exercises.
About a third of Americans suffer from at least periodic insomnia, according to the American Academy of Sleep Medicine (AASM). In most cases, the sleep issues resolve on their own. But when insomnia lasts for a month or more, it’s considered a chronic condition that affects about 1 in 10 of us. For Verdery and others who sometimes struggle at night, the stress can create a sleep-disrupting cycle: Lying awake night after night creates anxiety about falling asleep, which exacerbates insomnia.
“This is something I see in almost all my patients with insomnia,” says Joshua Tal, a clinical sleep and health psychologist in New York City. Poor sleep is often a reaction to stress, he explains, and then the problem starts to spiral.
“If you have a couple of bad nights, then the first thing that happens is you start to worry, Will I sleep tonight? But if you’re worrying, then your body is going to keep you awake,” he says. “It’s thinking, Where’s the bear? But the bear is sleep itself. And so it becomes self-perpetuating.”
How age can trigger sleep anxiety
Just the simple fact of aging itself can start the wheels of  anxiety  in motion. “As you get older, you get multiple awakenings throughout the night,” which can lead to the anxiety-insomnia spiral, says Raj Dasgupta, M.D., an AASM fellow and spokesperson.
Age-related reasons for sleep disruptions include menopausal hormone shifts associated with discomfort or restlessness; prostate issues for men that lead to more frequent  trips to the bathroom ; pain from chronic conditions, which can be more common in our later years; and  certain medications  that can cause sleep problems, such as high-blood-pressure meds (including beta-blockers) and antidepressants. Your health provider will also want to rule out apnea , a condition in which breathing stops or is constricted briefly as you sleep.
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Our circadian rhythms also shift as we get older, especially past age 60, when our bodies tend to want to go to bed and wake up earlier; those new bodily rhythms can conflict with our established lifestyles.
Another culprit: caffeine. It can take up to 10 hours to completely clear caffeine from your bloodstream, and half of what you drank in that coffee is often still circulating six hours after consumption,  according to the Cleveland Clinic . And we metabolize food more slowly as we age, says Michael Breus, a sleep specialist and clinical psychologist based in Manhattan Beach, California. To make sure caffeine isn’t affecting your sleep, avoid caffeinated drinks after noon, Breus suggests.
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Many of us turn to a glass of wine or beer in the evening for its sedative effect, but alcohol backfires, too, says Jennifer Mundt, assistant professor of neurology at Northwestern University Feinberg School of Medicine.
“While it may help you feel sleepy at first,” she notes, “it will result in poor-quality, disrupted sleep as the alcohol is metabolized.” According to the Sleep Foundation, two drinks for men or one drink for women can decrease sleep quality by 24 percent.
Breaking the cycle of insomnia
The cornerstone treatment for sleep anxiety is cognitive behavioral therapy for insomnia (CBT-I), which addresses a patient’s habits and thought patterns. With the cognitive part of CBT-I, the therapist — one who specializes in sleep — explores your sleep-related anxieties. When clients tell Tal they’re afraid they’ll never sleep well again, for example, he challenges their assumptions and helps them reframe their fears.
“I ask clients, ‘Is it true that, after a bad night, you won’t sleep well the next night?’” Then he points out what science says: “You’re actually more likely to sleep well the next night. But it’s the anxiety that makes it worse.”
Elaine Harris has experienced this phenomenon. A retired French teacher in Chicago, Harris, 86, struggled with sleep for decades. She would often wake up in the middle of the night and grow increasingly anxious, thinking, How am I going to get through the day on four or five hours of sleep?
Last year, Harris started working with Mundt, who begins by asking her patients to keep a sleep log and to record sleeping times. Over a period of seven or eight months, she talked with Harris about her sleep-related anxieties and stressors, while gradually helping her develop a healthy sleep routine — the behavioral part of the CBT-I program.
It sounds counterintuitive, but sleep therapists often improve your sleep by restricting it. The object is to create so much sleep deprivation that you conk out and sleep through the night without awakening. Once you start sleeping for a solid block of time, say midnight to 6 a.m., the next step is to hit the sack earlier, in 15-minute increments, until you reach a schedule where you are tired enough to fall asleep — and stay asleep — but are not exhausted when you wake up, Breus says. (Forget about  melatonin supplements : They don’t usually help with sleep anxiety, Tal says.)
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