Problems getting to sleep

Fear of going to sleep / Insomnia

Many people with panic disorder can develop a fear about going to sleep.

This can be for various reasons.

They fear sleep because they are frightened they will waken in panic

They fear going to bed because their mind races or feels unreal in the silence of night time when there are no distractions.

If they have experienced panic in bed then bed becomes a trigger.

If they are finding it hard to get to sleep they then feel restless and agitated and more tired on awakening in the morning.

Usually, in the case of people with panic disorder, the overriding concern is that difficulty sleeping will lead to more panic attacks – so this fear has to be worked with first.

Working on the fear of sleep related panic attacks

Work out a PANIC SEQUENCE PROFILE for any previous times you have had a panic attack related to sleeping or waking up.

Observe how your thoughts ABOUT the unpleasant sensations increased the symptoms. Write down all the thoughts and RESTRUCTURE them based on your new understanding.

From this, work out a FLASHCARD.

The key is to CATCH IT – CHALLENGE IT – CHANGE IT – as SOON as the fear arises. The flashcard will help.

If you feel panic – WAIT – don’t jump up out of bed (or jump to conclusions)

REMIND yourself to PRACTICE. Stay with the feelings – let them swirl around and try not to stir them up. Just let them be as they are. Then bring your ‘normalising statements’ to mind – or use your flashcard.

If you need to get up, but do so SLOWLY – this helps remind you that deep down you know it is just fight or flight – so no need to hurry.

Practice MINDFULNESS of your surroundings – the sensations are only a PART of a bigger picture. Listen to sounds. Feel your self in the room. Let go of your stomach. Let your shoulders drop.


It will pass – wait – then wait some more

If you are far on in your exposure practice – try going back to sleep even while the sensations are going on – so what – it’s just adrenaline.

Working on not being able to sleep / Insomnia

What can help with sleep problems?

Firstly identify if there may be another problem which may be causing you to have difficulty sleeping and if there is, is there anything you can do about that problem? If sleeping is the main problem, then the following advice may be helpful.

Develop regular sleep times. Go to bed and get out of bed at about the same time, regardless of how tired you are. Also avoid naps during the day. This allows your body to develop a routine for sleeping.

Develop a good pre-sleep routine – try to use the hour before going to bed to unwind and prepare for sleep.

Reduce or eliminate liquid intake several hours before bedtime. Avoid all caffeine products (such as coke, tea or coffee), heavy foods, cigarettes and alcohol.

Medicines and other drugs – Some drugs can affect sleep because they are stimulants. If you are taking medicine it is worth checking with your pharmacist or doctor.

Use your bed only for sleep (and sex) – Insomnia is often the result of increased anxiety before bedtime and while lying awake in bed. Many who have insomnia use bed for watching TV, talking on the phone, and worrying; and as a result, the bed is associated with anxiety. Watch TV or talk on the phone in another room. If you have friends who call late at night, tell them not to call after a specific hour. Avoid anxiety during the hour before bedtime (for instance, avoid arguments and challenging tasks).

Try not to worry about not getting enough sleep or try desperately to fall asleep – this will only increase your frustration and anxiety. Ironically, a very effective way of increasing sleep is to practice giving up trying to fall asleep. You can say to yourself, “I’ll give up trying to get to sleep and just concentrate on the relaxing feelings in my body”.

Listen to relaxing music or use a relaxation tape which will enhance your restfulness. The body scan exercise in the Mindfulness ebook is a VERY effective way to relax.

If you are lying awake for more that 30 minutes, get up and go into another room. Write down any catastrophic thoughts and restructure them. Typical automatic thoughts are

“I’ll never get to sleep,” “If I don’t get enough sleep I won’t be able to function,” “I need to get to sleep immediately,” and “I’ll get sick from not getting enough sleep.”

The most likely consequence of not getting enough sleep is that you will feel tired and irritable. Although these are uncomfortable inconveniences, they are not catastrophic.

This may seem obvious but – Do not go to bed until you feel sleepy

Don’t stay in bed longer to catch up on lost sleep.

Because your disturbed sleep patterns have taken a long time to learn, it may take you a while to unlearn them. Do not expect immediate results.

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