Med thumb sleep dread collage

 

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Worries appear at all times of the day. They invade is like some sort of parasite, the presence of which is at first unnoticed. Then, we can't ignore them. Bills that need to be paid, conversations that need to be had. They gnaw at at us, distracting us from daily tasks and, often, wrenching us from the arms of sleep. But what if the source of worry is sleep itself? What if the act of sleep is what gives us apprehension?

Depending on who you ask, the condition is known as sleep dread, hypnophobia or sleep preoccupation, and is marked by a debilitating fear of sleep. For one reason or another, sufferers are terrified of the idea of trying to go to bed. And while it’s rarely included in common lists of sleep disorders, it remains a source of great frustration and even bafflement for the thousands who suffer from it.

The condition has been blogged about by doctors and its victims have been profiled by news sites. The phenomenon was even the subject of a series on NPR’s ‘This American Life”. 

Despite this, the causes and treatments of sleep dread remain somewhat under-covered — likely because there are many reasons someone can deveop a fear of sleep. 

What is Sleep Dread? 

Sleep dread is that it’s basically a catchall name for an issue that can stem from a wide variety of issues, ranging from pre-existing sleep disorders to issues with anxiety or depression.

One of the most common causes is likely nightmare disorder, said Michael Perlis, director of the behavioral sleep medicine program at the University of Pennsylvania. Over time, people who suffer from chronic nightmares may actually start to fear what they will experience once they fall asleep.

Over time, people who suffer from chronic nightmares may actually start to fear what they will experience once they fall asleep.

Different sleep disorders can also trigger the phobia. Those with insomnia, for instance, may simply fear going to bed and lying awake; sleepwalkers might be afraid of what they will do after they drift off. Sleep apnea sufferers may even fear for their own safety during sleep.  

Then there are those for whom the anxiety may not be related to a sleep disorder at all. “People who hate work or school will often delay going to bed until really late at night because they’re trying to extend the happy part of their day,” Perlis suggested.

In short, sleep dread may be precipitated by any number of other issues. And this has big implications for how it’s understood and managed.

The Trouble with Treatment

When it comes to the issue of insomnia in particular a pertinent question is whether sleep dread can actually make the problem worse. Many factors may help perpetuate the condition. For instance, people may suffer from a bout of acute, or short-term, insomnia and attempt to compensate for it by adjusting their sleep schedule — say, trying to nap or sleep in when they get the chance, further damaging their ability to sleep normally at night.

If you think of cognition, sleep dread, worry as smoke and you want to get rid of the smoke, you can start fanning away at it -- but it’s not going away.

In these cases, the anxiety that accompanies such long-term insomnia can really be thought of as a symptom of the problem, but not a “primary ingredient,” or perpetuator, said Perlis, whose focus is on behavioral medicine.

“Those things don’t help —  they are like gas to the fire —  but the fire is burning for a different reason,” he said. “If you think of cognition, sleep dread, worry as smoke and you want to get rid of the smoke, you can start fanning away at it -- but it’s not going away. The behaviorist would say, ‘Put out the fire.’”

In other words? Treating the root cause of the anxiety is tantamount to dealing with the fear of sleep, itself. As Perlis pointed out, “If [treatment] serves to improve or normalize sleep, what is left to dread?”

Putting the Dread to Bed

Treatment, in these cases, would vary depending on the root cause of the sleep dread. For instance, insomnia can be treated with medication or various forms of therapy. The same is true for nightmares or sleepwalking. And sleep apnea can be helped via a number of options, the most common of which is a CPAP machine.

However, Perlis noted that other experts may not share his view. Some feel that “cognition is a much more salient and relevant factor” when it comes to problems like insomnia, he said. In fact, a great deal of research has been conducted with the goal of understanding how anxiety, depression or other cognitive processes might affect sleep quality. And certain tools such as the Anxiety and Preoccupation About Sleep Questionnaire, have been developed by psychologists in order to help gauge these effects.

“By addressing this anxious reaction to not sleeping, we can prevent individuals from developing this circular response (can’t sleep, anxious about not sleeping, even less likely to sleep, more anxious about not sleeping, repeat)"

Some experts have suggested that problems like insomnia can develop into a kind of a vicious cycle when coupled with sleep dread, and that treating the fear of sleep can in turn lessen the effects of the original sleep disorder.

“By addressing this anxious reaction to not sleeping, we can prevent individuals from developing this circular response (can’t sleep, anxious about not sleeping, even less likely to sleep, more anxious about not sleeping, repeat) and thus facilitate sleep,” wrote neurologist Christopher Winter in a Huffington Post essay.

Psychologists with this perspective might recommend counseling or various forms of therapy to help manage the fear, itself.

Approaches to battling sleep dread may differ among treatment providers. But on one front, at least, little doubt remains: the phenomenon is real and constitutes a serious, if unusual, problem for those who suffer its effects. With help, the fear will slowly evaporate.