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Tossing and Turning: OCD and Sleep

There are strategies to help you get as much rest as possible.

Source: Andrea Piacquadio/pexels
Source: Andrea Piacquadio/pexels

Each of us, at some point, has spent a restless night tossing and turning in bed, kept awake by worry. But Obsessive-Compulsive Disorder can turn a sleepless night from an ordinary disruption into sheer misery. If you already spend your daylight hours managing your OCD, fighting off circular thoughts, and resisting compulsive rituals, that inner struggle can easily extend long into the night. Hours spent alone in a dark, silent room, with nothing to engage or distract you, are an opportunity for OCD to run wild.

It's important to consult with your therapist or psychiatrist about your personal sleep issues—but here are a few simple measures you can try to implement.

Good Sleep Hygiene and Headspace for Sleep

The first step to reclaiming your nights from OCD is to practice good sleep hygiene. Going to bed and waking up at regular hours is important—setting an alarm is an obvious measure, but a daylight lamp with a timer can help your brain recognize it’s time to start the day. Try to avoid midday naps as well.

Establishing a headspace for sleep is just as important as keeping regular hours. Your bed should be a place for sleeping—and only for sleeping. Using your phone or computer in bed at night can have disastrous effects. When you use a piece of technology that your brain associates with high-effort activities like information-seeking, languaging, and socializing, you’re sending your brain mixed signals about how alert it needs to be.

Try to identify other environmental factors that interfere with your sleep and implement corrective measures. If light creeps in through the cracks in the windows or doors, consider light-blocking curtains. If background noise keeps you awake, try a sound machine or a fan. If you struggle with headaches or congestion, invest in an elevated headrest or humidifier. Trying to sleep in a disruptive environment is like trying to run a marathon with untied shoelaces—it’s an unnecessary handicap when you really need every variable working in your favor.

Effects of Medication

Likewise, it may be helpful to pay close attention and take some notes on how your medication influences your state of alertness through the day. It’s not just about sleeping meds—if your daily medication makes you groggy first thing in the morning, or if you experience a “crash” in the early afternoon, that can have knock-on effects that disrupt your ability to sleep through the night. If you think your medication may be causing problems, try keeping a notebook for a week or two to record how your meds affect your alertness throughout the hours of the day—this information may help your psychiatrist determine the cause of the problem and prescribe a better solution.

Unfortunately, these are all preventative measures, and they won’t do much good when you’re already up at night tossing and turning. But as I’m sure you’re aware, trying to force yourself to surrender to sleep is a frustrating and likely fruitless endeavor. Paradoxically, whenever you tell yourself “I need to stop worrying” or “I need to relax,” you’re engaging the same linguistic and problem-solving systems that are already causing you to worry. Such thoughts can quickly spiral into “obsessing about obsessing”—when the OCD symptoms themselves become a trigger for anxieties about your mental health and wellbeing.

Tolerating the Uncertainty

The best advice I can give you, in these circumstances, is to apply the same skills you’ve learned to fight all forms of OCD—tolerance of discomfort and acceptance of uncertainty. Acknowledge that your mind is currently generating disruptive words and images, that this process is automatic and beyond your control, and then—as best you can—direct whatever thoughts you can actually control to focus on peace and quiet. Most of all, try not to catastrophize. Lying awake in bed isn’t much fun, but it’s not the end of the world, and it’s not necessarily a permanent thing. All this means is you’re going to be a little bit off tomorrow morning, and then once you get through the day, you’ll have another chance to sleep tomorrow night.

Obsessive thoughts that keep you awake at night can be some of the most challenging to manage—particularly because the circumstances make it harder than usual to disrupt or ignore them. The most effective approaches are preventative—controlling your behaviors and environment throughout the day and evening to maximize your chances at a good night‘s sleep. But even when you’re staring at the clock at 3:00 AM, there are still strategies to employ to make sure you get as much rest as possible.

Copyright, Fletcher Wortmann, 2020

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