Helping Anxious Clients Sleep

Our anxious clients have difficulty getting good sleep, and their lack of sleep increases their anxiety. In the stress-filled days during this pandemic, anxiety is becoming more of a problem and sleep is elusive. How can we help clients get out of this exhausting cycle? 

Promoting sleep hygiene

Of course, we need to start by making sure aspects of their daily life are not interfering with sleep. We check on caffeine intake, alcohol use, and encourage exercise (but not in the evening before bed). We discourage napping during the day and ask them to establish consistent sleep and wake times, if possible.

We also promote good sleep hygiene, encouraging them to refrain from anything but sleep or sex in their beds; to have a sleeping environment that is quiet, dark, and cool, with a comfortable bed; and to avoid sleeping with children or pets. A regular nightly ritual is encouraged to promote the onset of sleep, and light exposure (including screen time) in the hour before bed, and while in bed, should be discouraged. We encourage muscle relaxation, deep breathing, or yoga to promote relaxation in the body.

Introducing the role of the amygdala

But we also need to explain the role of the amygdala in maintaining wakefulness. I like to explain to my clients that the amygdala’s job is to protect us from danger, and if it detects a threat of any kind, the amygdala is likely to promote arousal that interferes with falling asleep. If you have spent the hours before bed trying to balance your bank account or watching the news, you have likely exposed yourself to distressing thoughts or images. The amygdala will react to these thoughts and images, producing arousal in the body and alertness in the brain that prevents sleep. 

I explain that the amygdala monitors what is happening in the cortex, like a child watching television, and that we can’t expect the amygdala to let its guard down if the cortex is on the Worry Channel. If we get the cortex on a different channel, one that is not distressing or threatening, the amygdala will stop activating arousal in the body.

Developing a bedtime ‘listening strategy’

I let my clients in on an important secret. The brain may be able to do thousands of different operations at once, but it can only focus our attention on one thing at a time. Focusing your attention on something neutral and nonthreatening will help a great deal in making sure the amygdala has no reason to keep you aroused and alert. We need to choose carefully, because some things that seem neutral don’t work very well. For example, music is often not helpful because we can worry right along with the music. We need something that blocks or replaces the amygdala-activating thoughts and images, especially as you are lying in bed.

Listening to a podcast or an audiobook is often an effective solution. We all know how hard it is to focus on something when someone is talking to you, so we use this to our advantage. When clients focus their attention on listening to talk about a neutral topic, they find that they can fall asleep more easily. 

Combine this listening strategy with muscle relaxation and deep breathing, known to reduce amygdala activation, and you can make sleep much more likely. We calm the amygdala by getting the cortex off the Worry Channel and on a more neutral channel. The challenge is sometimes helping clients keep their focus on whatever is being read or discussed, but they typically can do so with some practice, especially with some training in mindfulness.

Calming the Anxious Brain: Using neuroscience to end anxiety, panic and worry, a two-part live video webcast training with Catherine Pittman, will be live streamed on 1-2 October 2020. Click here to book your place.