Perfectionism and Sleep Anxiety |

Generally speaking, people suffering from anxiety problems are challenged by what they cannot control and by situations that require a tolerance for uncertainty. Fear of not being able to fall or stay asleep, of vomiting, of what others think of them, of experiencing intense anxiety, and the like are common because, when you really think about it, there is very little in life we can directly control or even know with certainty. The more we try to prevent dreaded outcomes or know the unknowable, the more stuck our brains become, and the more anxiety we experience.

At the root of anxiety specifically about sleep is the fear that a lack of sufficient sleep will lead to negative, unwanted consequences. My patients report excessive concerns about making mistakes, not meeting personal or parental standards, or not being socially adept.

Moreover, nighttime marks the end to our structured activities. So, if you have an anxious mind, it’s open season for worrying.

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The Impact of Poor Sleep

We all know how restorative sleep is. Even little kids know this. How often does your partner or parent ask how well you slept last night? The message is clear: Sleep is vitally important for a good next day. Those who don’t suffer from perfectionism and sleep anxiety learn that they can pull an all-nighter and ace a test or presentation or hold an important meeting, without a full night’s sleep. They also know better than to make a habit of that.

Children and adults alike who suffer from sleep anxiety almost always worry about the potential negative impact the lack of sleep will have on their performance the next day:

“If I don’t sleep tonight, I won’t do well on my math test.”

“If I can’t sleep, I’ll be in a bad mood and won’t be as nice to others.”

“If I don’t sleep, I’ll get scared and be the only one awake in my house.”

“If I don’t sleep well tonight, it will happen again tomorrow night and the night after that, and I won’t be able to function.”

“If I don’t get a good night’s sleep, I will blow the big presentation.”

“If I don’t sleep enough, I won’t be able to think on my feet and wow my audience.”

How do you think holding these types of thoughts at bedtime affects an individual? It activates them, which makes sleep less likely to come. In other words, it creates a vicious cycle. Once this cycle starts, over time, our brains start to associate our beds and bedtime with anxiety rather than rest and relaxation, which compounds the problem.

The Sleep Anxiety and Perfectionism Connection

I know this sounds extreme, but I have found that all my patients with sleep anxiety also suffer from perfectionism. I have never encountered the problem of sleep anxiety without coexisting perfectionism. A wide body of research backs up my observations. Perfectionism relates to fears of making mistakes and of not meeting self-imposed, unrealistically high standards. Certainly, people can suffer from sleep problems for other reasons, but anxiety about it positively correlates with perfectionism.

When I suspect perfectionism—based on the various problems for which a patient seeks my help—I ask them if they hold themselves to high standards. They invariably say I’m mistaken. In fact, they say they don’t do much well, they make mistakes and procrastinate excessively, and they are lazy failures. Usually, this is in direct contrast with the person’s actual achievements and potential.

If one holds oneself to unrealistically high standards, one will not meet those standards. The problem is that the person doesn’t see it this way. They believe their unrealistic standards keep them in line—in control—and that if they adjusted their standards to more reasonable levels, they would fail in life. There are kid and adult versions of this, but both operate under the same basic principle. Untreated perfectionism exacts heavy costs on individuals and families and is associated with decreased productivity, poor self-esteem, depression, impaired health, troubled interpersonal relationships, and an overall reduced quality of life.

Making the Problem Worse

Adults, children, and parents resort to all kinds of behaviors they believe will make sleep more likely and will prevent the feared negative effects of poor sleep. These behaviors—which we refer to as safety behaviors, because you do them thinking they will keep you safe from anxiety—include clock watching, calculating the number of hours of sleep you believe you need to perform well the following day, performing elaborate wind-down practices, playing calming sounds, and using special bedding. People may also adhere to a rigid schedule to make sleep more likely or take sleep medications, both prescribed and over the counter.

Parents may develop elaborate bedtime rituals with their children to stave off sleep anxiety. They make special accommodations for their child, such as installing special lighting or providing a special mattress. They may allow their child to sleep in the parents’ bed, promise to check in on the child, or administer melatonin or even antihistamines to foster sleep. Parents who change their child’s normal routines and habits in such a manner essentially engage the child in the kinds of safety behaviors adults with anxiety resort to.

A vicious cycle develops when adults develop safety behaviors and parents make accommodations for their child’s sleep anxiety. The very behaviors adopted to help a person sleep feed and maintain that person’s anxiety about sleep.

Treating Sleep Anxiety

To effectively treat a person of any age who suffers from anxiety about sleep, a clinician must address their perfectionism, reduce and eliminate their use of safety behaviors, and employ an evidence-based protocol of cognitive behavioral therapy (CBT) for insomnia.

If your problem is severe, therapy may be your starting point. However, many people are able to use CBT tools and strategies on their own to help them overcome their sleep anxiety. The following are simple but powerful practices I recommend:

1. Take the pressure off the desired end result (i.e., falling asleep) by banning the “S” word. For example, you might say, “My job is to lie and rest.”
2. Lean into your fear of getting insufficient sleep. For example, tell yourself, “If it happens, I’ll deal with it” or “I may lie awake all night.”
3. Establish good sleep hygiene. Follow consistent bedtimes and wake-up times. Stop the use of electronic screens an hour before bedtime and limit caffeine intake late in the day.
4. Limit what you do in your bed. Beds are for sleep (and, if you’re an adult, for sex); beds are not for eating, watching movies or TV, scrolling on a phone, texting, etc.
5. If you start tossing and turning and fretting about not sleeping, get out of bed. Settle in a comfy chair and read, journal, or meditate until you feel drowsy again. Then get back in bed. Repeat as necessary.