How might obsessive-compulsive disorder affect sleep? One of the anxiety disorders, obsessive-compulsive disorder may significantly interfere with daily activities. What are the symptoms of the condition? Can obsessive-compulsive disorder also disrupt your ability to sleep at night?
Symptoms of Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) is one of the anxiety disorders that may develop early in life. It may affect children, more often boys who also have a diagnosis of attention deficit hyperactivity disorder (ADHD). It is also diagnosed through adolescence and into early adulthood. Among adults, it affects men and women equally. It occurs in 0.5-1% of people in a given year. OCD is characterized by two features: obsessions and compulsions.
Obsessions are persistent thoughts, images, or impulses that seem intrusive or inappropriate. These ideas are associated with anxiety or distress. One common obsession relates to cleanliness and a belief that objects are contaminated with germs. Some people with OCD may have concern that a task was not completed or done inappropriately. As an example, there may be anxiety about turning off the stove or locking the door, even though these were in fact safely secured. These obsessions are often ignored or suppressed by engaging in some other thought or action, which is called a compulsion.
Compulsions are defined as repetitive and deliberate actions that are done as a response to a specific obsession. By performing these compulsive acts, the obsessive thoughts can be temporarily suppressed. Compulsions are performed in a very predictable and ritualized fashion. Many have compulsions have a superstitious quality. In order to relieve anxiety about a fear of germs, cleaning may occur. To verify that the door is in fact locked, it may be checked three times. Common compulsions include:
- Hand washing
- Repeating words
These compulsions may provide transient relief, but soon the anxiety starts to rise again and the compulsive act must be repeated. When these actions occupy more than 1 hour per day and interfere with the normal routine of life, OCD is diagnosed.
How Does OCD Affect Sleep?
You might conclude that the thoughts and behaviors associated with OCD could become disruptive to sleep. If you fall asleep at night thinking about the things you need to check, you may have resulting insomnia. In fact, checking behaviors may be disruptive if they involve leaving your sleep environment to reassure yourself. Surprisingly, there is little evidence that the condition results in abnormalities that can be identified with a sleep study called a polysomnogram. Some research suggests that there may be less total sleep or more sleep disruption, but this has not been consistently demonstrated. It may not solely be due to the OCD but instead could relate to depression, which often coexists with it.
Treatment of OCD
For those people who suffer from OCD, there are a variety of treatment options. Medications such as tricyclic antidepressants (including clomipramine) and selective serotonin receptor inhibitors (SSRIs) are often used. Some of the more commonly used SSRIs are: fluoxetine, fluvoxamine, paroxetine, and sertraline. In addition, working with a psychologist who is trained in desensitization and cognitive behavioral therapy can be helpful. In very rare cases, surgery may be used to alleviate the symptoms.
If you believe that you may be suffering from OCD, you can start by speaking with your primary care physician who may suggest a referral to a psychiatrist to help you feel better.
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." Elsevier, 5th edition, pp. 1480-1481.