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Generalized Anxiety Disorder and the Effects on Sleep

Excessive Worry May Lead to Insomnia

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Updated August 30, 2012

When stress takes hold of your life, you may find it hard to shake the resulting anxiety. It may manifest as persistent worry or a tension that won’t leave your muscles. What is generalized anxiety disorder? How does anxiety affect sleep? How might it contribute to insomnia? Learn about the relationship between stress, anxiety, and difficulties sleeping.

What Is Generalized Anxiety Disorder?

No matter your station in life, stress is common. It may lead to worries that won’t go away. If these problems overwhelm your ability to cope, it may be hard to function during the day and impossible to sleep at night. What are the symptoms of generalized anxiety?

Although 18% of people complain of anxiety in a given year, generalized anxiety disorder (GAD) is less common (estimated to occur in 3% of people). It affects twice as many women as compared to men. GAD is defined a chronic, excessive, and pervasive anxiety or worry that lasts for at least 6 months. It is present more days than not. In addition, the anxiety that characterizes the condition affects numerous aspects of life, including work or school as well as other activities. This anxiety is difficult to control. There are often other symptoms associated with GAD, including:

  • Restlessness or feeling "on edge"
  • Easy fatigue
  • Poor concentration
  • Irritability
  • Muscle tension
  • Insomnia or restless sleep

GAD is a chronic condition and it rarely completely remits on its own. It often has a waxing and waning nature, with times that it may be better or worse. It often coexists with depression. GAD has important effects on sleep.

Anxiety and Insomnia

The anxiety that characterizes GAD often interferes with the ability to sleep and leads to insomnia. This is not unexpected. Anxiety might be viewed as an inappropriate escalation of a response called arousal. It is believed that arousal evolved to keep us alert to threats, so that we can respond appropriately and protect ourselves. It is helpful to be nervous when hungry lions are on the prowl. However, when this system inappropriately goes into overdrive, there are negative consequences.

Sleep disturbance is one of the key problems that may develop, impacting 56-75% of people with GAD. Imagine arousal as a bell being rung. It draws your attention, makes you sit up and take note. It also grates on your nerves a little. When the bell keeps ringing through the night, it is hard to sleep. This may result in trouble falling asleep, staying asleep, or sleep that is simply not refreshing. These are collectively called insomnia.

The worries that lead to increased anxiety and tension may come to the forefront when lying down to sleep at night. Once the distractions of the day are pushed away, ruminations about your career, finances, or relationships may come to the surface. Difficulty falling asleep may unleash its own set of worries about the impacts on function the following day. Sleep deprivation may lead to other problems that often characterize GAD, including difficulties with concentration and mood.

When the sleep of people with GAD is studied, there are certain findings that are observed that fit with a diagnosis of insomnia. A formal diagnostic study, called a polysomnogram, will show increased sleep latency (the time it takes to fall asleep) and more wakefulness after sleep onset. The total amount of sleep is reduced. Those with GAD may have early morning awakenings, a symptom that often occurs in depression (which also shows a quicker onset of REM sleep).

Treatment of Generalized Anxiety Disorder

The treatment options for generalized anxiety disorder are similar to those used in other anxiety disorders. The approach typically combines the use of medications, cognitive behavioral therapy, and relaxation techniques. As GAD is often a chronic condition, it may involve a prolonged treatment over many years.

Benzodiazepines are the most commonly used medications to relieve anxiety. In particular, alprazolam and clonazepam are often prescribed. Though these medications are not recommended for the long-term treatment of insomnia, they can be helpful chronically to relieve anxiety. In addition, selective serotonin reuptake inhibitors (SSRIs) like venlafaxine are used.

Cognitive behavioral therapy is highly effective to manage GAD. This therapy is often administered by specially trained psychologists or psychiatrists. It is a preferred treatment in the elderly who may suffer from adverse side effects from benzodiazepine medications, including the risk of harmful falls.

For those who suffer from uncontrolled anxiety and worry, especially if this results in insomnia, start by speaking with your primary care physician who may recommend a referral to a psychiatrist.

Sources:

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), American Psychiatric Press, 4th edition, 1994.

Kryger, MH et al. "Principles and Practice of Sleep Medicine." ExpertConsult, 5th edition, 2011, pp. 1477-1478.

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