Insomnia from stress and racing thoughts: causes and what helps

You go to bed exhausted, but the moment the light goes off your mind replays the day, the conversations and tomorrow’s to-do list. Almost everyone has lain awake from stress at some point, and it usually passes once the pressure eases. But if poor sleep drags on for weeks, it becomes a source of anxiety in its own right: you start to dread the night. Here is why that happens and what you can do, starting tonight.

Insomnia: the causes

Insomnia means trouble falling asleep, waking often during the night or waking too early, and feeling worn out the next day. Most adults need 7-9 hours of sleep, but how you feel during the day matters more than the number. Insomnia that lasts less than three months is called short-term; if it lasts longer, it is long-term, or chronic.

The most common causes are:

• Stress, anxiety and depression.
• Coffee, strong tea, alcohol and smoking.
• Noise, a bedroom that is too hot or too cold, an uncomfortable bed.
• Shift work and jet lag.
• Pain, an overactive thyroid, restless legs syndrome, the menopause.
• Some medicines.

Why stress keeps you awake

Under stress the body switches into a state of readiness: your heart beats faster, your muscles tense and your brain scans for threats. That is useful for survival, not for sleep. At night, with nothing to distract you, thoughts sound louder, and insomnia from racing thoughts often feels like an endless inner conversation.

After a few bad nights a second layer appears: anxiety about sleep itself. “If I don’t sleep, I’ll mess everything up tomorrow.” A thought like that wakes you up as effectively as coffee. Little by little the bed becomes linked with struggle and wakefulness, and the circle closes.

What to do tonight

• Don’t force yourself to sleep. Sleep comes when you stop chasing it. Tell yourself: “It’s fine to just lie here and rest.”
• If sleep won’t come and you start getting frustrated, get up and go to another room. Do something calm in dim light: read a paper book, listen to quiet music. Go back to bed when you feel sleepy.
• Don’t check the clock. Counting the hours left only feeds anxiety. Turn the alarm clock to face the wall.
• Slow your breathing: breathe in for a count of 4 and out for 6. Many people find that a long out-breath helps them step out of anxiety mode.
• If your head is full of tasks, write them on a notepad by the bed. A thought on paper no longer needs holding in your head.

CBT for insomnia: what helps in the long run

For long-term insomnia, the recommended first treatment is cognitive behavioural therapy for insomnia (CBT-I). The American College of Physicians advises this, for example, and the NHS in the UK offers it before sleeping pills. It rests on a few simple principles that work when you stick to them:

• A fixed wake time. Get up at the same time every day, including weekends and after a bad night. This is the main anchor for your body clock.
• Bed is only for sleep. Don’t work, scroll your phone or have difficult conversations in bed. Go to bed when you are actually sleepy, not when it is “time”.
• No daytime naps until your sleep settles, and no lie-ins to catch up.
• Worry time. Set aside 15-20 minutes during the day or early evening: write down everything that is bothering you and, next to each worry, the next small step. If the worry comes back at night, remind yourself: “I’ll think about this tomorrow, at its own time.”
• Limiting time in bed. For a while, the hours you spend in bed are cut back to match how long you actually sleep, so that sleep becomes deeper. This step is best done with a specialist.

In therapy we work with the thoughts that fuel anxiety about sleep and with the body, learning to let tension go. The first weeks can be hard, but consistency is usually what brings results.

A few habits also support sleep:

• Avoid coffee, strong tea and smoking for 6 hours before bed.
• Don’t use alcohol as a sleeping aid: it may help you drop off, but it makes your sleep worse.
• Be active during the day, but not within 4 hours of bedtime.
• Keep the last hour before bed quiet: dim light, no work emails, no news.
• Keep the bedroom dark, quiet and cool.

When to see a doctor

See a doctor if insomnia has lasted for months, changing your habits hasn’t helped, or you are struggling to cope during the day. It is also worth seeing a doctor if your partner notices loud snoring and pauses in your breathing at night, if your legs feel unpleasant in the evening, if pain keeps you awake, or if the insomnia began after a new medicine. These can be signs of sleep apnoea, restless legs syndrome or another condition that needs treating in its own right.

Sleeping pills are rarely prescribed today, and only for a few days or weeks at most, because they can cause dependence and serious side effects. Don’t take them without a prescription, and don’t stop any prescribed medicine on your own.

Insomnia often goes hand in hand with anxiety and depression. If, along with poor sleep, you notice constant worry, tension in your body or a low mood, it is worth talking to a specialist.

If insomnia comes with thoughts of death or of harming yourself, don’t keep them to yourself: tell someone close, write to me or call 911.

Where to start

To see how much anxiety lies behind your poor sleep, you can take the GAD-7 (anxiety) and HAM-A (anxiety in the body) tests on this site. They take a few minutes. The tests don’t give a diagnosis, but they are a good starting point for a conversation. If you would like to work out together what is keeping you awake, book a free 15-minute intro call and we will talk about where to begin. My sessions are held in Armenian or Russian.