Wake up with anxiety symptoms

Tips for Coping with Morning Anxiety

Given the stress of living through a pandemic, moderate anxiety is common. Waking up in a panic every morning is more troubling, as it sets in before coping mechanisms can be deployed. Morning anxiety has a biological cause: Cortisol, often called the “stress hormone,” is higher during the first hour after waking for people experiencing stress. Sometimes people feel a measure of control when they worry, so they have trouble stopping the cycle.

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Symptoms of and Myths About Anxiety

Many people conflate stress and anxiety, but they’re different. Webster’s defines anxiety as “being uneasy, apprehensive or worried about what may happen,” whereas stress is “mental or emotional tension or strain characterized by feelings of anxiety, fear, etc.” Stress can also be defined as not having the resources to complete a task, while anxiety is usually tied to a perceived threat, real or imagined. Stress may be alleviated by accomplishing the task, but anxiety sticks around, producing a host of physical and psychological symptoms.

Symptoms of Anxiety

Some of the symptoms commonly associated with anxiety are internally physical in nature, which can range from nausea and headache to rapid heart rate and tight chest. Other symptoms are outwardly physical, such as sweating, shaking or having difficulty breathing. There are also symptoms tied to behavioral or emotional tendencies, such as a sense of panic, difficulty concentrating, restlessness and diminished sex drives. Other potential symptoms are fatigue or problems sleeping.

Common Misconceptions About Anxiety

Unfortunately, there are several myths regarding anxiety and how it’s handled. Some prominent misconceptions include worrying is genetic and incurable, anxiety medication is addictive, using distractions or avoiding stressful situations can help minimize the threat of anxiety, and being around supportive people can cure anxiety.

Prevalence of Anxiety

Anxiety has been on the rise the last few years, as 32% of Americans say they’re more anxious than they were the year before. In 2019, two-thirds of Americans were worried about the safety of themselves and their families as well as their finances. Nearly two-thirds had anxiety about their health, and around half were worried about the effects of politics and had anxiety over various interpersonal relationships.

Ongoing anxiety can cause a variety of physical ailments, such as hypertension (high blood pressure), kidney and heart damage and arrhythmia. It can also exacerbate other conditions, such as depression, irritable bowel syndrome, asthma, heart disease, stroke and chronic pain.

General Anxiety Disorder

While occasional worry is a part of life, frequent excessive anxiety about tasks or situations that most people don’t find threatening could be an indication of generalized anxiety disorder (GAD). Nearly 7 million adult Americans experience GAD annually, per the Anxiety and Depression Association of America. Studies also indicate GAD affects women about twice as often as it affects men. Additionally, people with serious or painful medical conditions or substance misuse problems are more likely to have anxiety disorders.

Everyday Anxiety vs. GAD

An individual experiencing everyday anxiety will spend time worrying about a specific event, assignment, or task. They’ll also have trouble sleeping or concentrating during stressful times, and they’ll experience physical aches and pains from specific situations.

An individual with GAD will experience ongoing general worry about vague, often imagined threats that interfere with daily life. They’ll also experience frequent trouble sleeping or concentrating and experience physical aches and pains for more than six months without a specific cause.

Tips for Reducing Morning Anxiety

If a racing heart or upset stomach greets you first thing in the morning, you can do a few things to help ease your everyday anxiety. For instance, you can engage in exercise, which increases endorphins, improves mental focus, and elevates mood. You can also practice meditation or mindfulness, which can improve ability to calm the mind and stop the cycle of anxious thoughts.

Another tip involves limiting stressors, such as waiting to check news or social media, using an alarm clock instead of a smartphone, or taking the time to self-care. Additionally, you can use tactics designed to exert a sense of control, such as daily planning or writing down and “fact-checking” nagging fears. Finally, resources like meditation apps or podcasts focused on decreasing feelings of isolation can be valuable.

Reaching Out Can Help

If anxiety is impacting your sleep, work, relationships or ability to focus, seek professional help. The National Alliance on Mental Illness connects people with professionals in their area. Call 800-950-NAMI or text “NAMI” to 741741. If anxiety is causing suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Sources

https://www.psychiatry.org/newsroom/apa-public-opinion-poll-annual-meeting-2019

https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad/symptoms

https://adaa.org/sites/default/files/July%2015%20GAD_adaa.pdf

https://adaa.org/understanding-anxiety/myth-conceptions

https://www. frontiersin.org/articles/10.3389/fpsyg.2019.01684/full

https://www.glamour.com/story/if-youre-waking-up-with-anxiety-youre-not-alone

https://www.healthline.com/health/anxiety/effects-on-body#1

https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/exercise-and-stress/art-20044469

https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml

https://www.womenshealth.gov/mental-health/mental-health-conditions/anxiety-disorders

https://www.psychologytoday.com/ca/blog/stroke-awareness/202008/can-i-ease-anxiety-practicing-mindfulness

Causes & Calming Techniques — Talkspace

Waking up anxious in the morning, or waking up at night with anxiety is common for many people. Nearly everyone experiences feelings of anxiety and stress periodically. However, if your anxiety is affecting you daily when you wake up or causing incessant sleeping problems, it might become overwhelming to the point that you can’t perform routine activities like work and interacting with your family.

Here, we’ll look at some of the common symptoms of morning and sleep anxiety. We’ll explore some of the causes that can be contributing to you waking up early with a sense of dread about your day. We’ll also offer various calming techniques that you can use, beginning tomorrow morning, to decrease the frequency and intensity of waking up with anxiety every morning.

Why Do I Wake Up With Anxiety?

Waking up with anxiety can put a real strain on your day. Right from the jump, you’re stuck feeling that heavy weight of stress and dread. Some common symptoms of morning anxiety are:

Feeling like your day is doomed right from the beginning
Feeling fatigued, even though you just woke up
Feeling like you just can’t get out of bed
Difficulty focusing and concentrating
Rapid, shallow breathing
Rapid heartbeat
Perspiring

So what causes the morning anxiety?

The natural response

The most common theory about waking up with anxiety has to do with a stress hormone called cortisol. As a defense mechanism designed to protect us, our brain and body will naturally react to stress. Although we no longer face the types of threats our ancestors once did, stress results in our bodies and brains reacting as if we’re under attack.

Thus, when we’re stressed, we release more stress hormones, including adrenaline and cortisol. Adrenaline causes the heart rate to increase, boosts blood pressure, and spikes energy supply. Cortisol is the primary stress hormone in the body. It acts to release more glucose into the blood and enhances the brain’s usage of those sugars to enhance alertness and prepare us to defend ourselves.

Research has shown that cortisol levels already surge in the morning for the first 30 – 45 minutes after waking. This is known as Cortisol Awakening Response (CAR) and may increase morning anxiety.

Stress

The common demands of life, like taking care of your family, accomplishing a huge workload, paying the bills, and preparing for the future, are all stressors. The limbic system of your brain perceives stressors as threats, and that can make you feel anxious from the moment you wake up each morning.

Substance abuse

If you’re using or abusing drugs and/or alcohol, waking up with anxiety can be common. While substance abuse may not have direct links to anxiety, it is known to increase anxiety symptoms.

Relationship struggles

Some studies show that the energy in a relationship may affect how well you sleep at night and how rested and calm you wake up in the morning.

Physical health problems

If you’re dealing with a chronic health condition, it’s natural to be stressed. Anxiety is common for those who have heart disease, diabetes, cancer, asthma, hypertension, and other serious health-related issues. Waking up with anxiety in the middle of the night or in the morning can be common when you have a serious medical condition.

Financial stress

Worrying about money is a normal stress for many adults. Especially if you’re financially insecure, waking up with anxiety about how or when you’ll be able to pay rent, buy groceries, or cover bills is not unreasonable.

Mental health conditions

Like our physical health, mental health conditions can weigh heavily on our psyches. Living with bipolar disorder, depression, or another mental health disorder can result in heightened anxiety at all times of the day, even in the mornings.

“If you find yourself waking up feeling anxious, ask yourself what happened the night before? What were you thinking about before you went to bed? These questions can help you identify the cause of your anxiety.”

Talkspace therapist Bisma Anwar, MA, MSc, LMHC

Fortunately, there are various techniques you can employ, beginning right now, that are known to alleviate morning anxiety symptoms. You can practice these daily upon waking and decrease the frequency and intensity of morning stress.

6 Calming Techniques to Avoid Waking Up with Anxiety

Wondering how to stop waking up with anxiety? You’re not alone. Let’s review some techniques that have been found to help many people wake up more confidently, calm, and energetic, ready to face their day.

Though you might not be able to totally prevent the feeling of anxiety you experience when you first wake up, you can help lessen the symptoms and severity with natural remedies for anxiety. Try using any or all of these methods right away.

“There are many ways to help calm your anxiety. You can do a guided meditation, do yoga or a workout, engage in a deep breathing exercise, have a healthy breakfast, listen to relaxing music, take a walk, or write a journal.”

Talkspace therapist Bisma Anwar, MA, MSc, LMHC

Change your diet

The foods and beverages we choose to consume have an effect on our mood and functioning. Neurotransmitters, hormones, and other biological chemicals are all synthesized in our bodies based on the nutrients (or lack thereof) we get through our diet.

Studies show certain foods are associated with anti-anxiety effects. These include:

Brazil nuts
Eggs
Pumpkin seeds
Chamomile
Yogurt
Turmeric
Dark chocolate
Fatty fish like mackerel and salmon

Consider adding more of these foods in your daily diet to help your mood.

Also, you might want to watch your intake of caffeine and other stimulating substances. If you’re already prone to anxiety, caffeine might exacerbate those symptoms. A glass of warm lemon water or decaf tea with honey in it may not be as exciting as that strong cup of coffee, but it can definitely be more calming.

Meditation & deep breathing (pranayama)

Mindfulness meditation offers many benefits to improve emotional and mental health. You can do it anywhere, without any equipment or memberships. Most communities have group meditation courses and support available. There are several different meditation styles, each having benefits for anxiety. Even just five minutes of meditation or deep breathing daily can have measurable benefits.

Leave the television off & opt for music

Repetitive exposure to negative stories like what we see and hear in the mainstream media these days has been linked to increased anxiety. If you don’t like the silence in the morning, try putting on some calming music to create a more relaxing environment. Remember, “calming” doesn’t have to be the same for everyone. You might prefer classical music, jazz, acoustic…try whatever is soothing to you.

Exercise

There are several various ways that daily exercise helps to alleviate anxiety, including:

Diverting your attention from what’s making you anxious
Activating executive functions in the brain
Decreasing muscle tension
Altering brain chemistry

Regular exercise builds up resources in the body that help increase resilience to erratic emotions. Exercise actually changes your brain chemistry by increasing the availability of neurochemicals that work against anxiety, including gamma-aminobutyric acid (GABA), serotonin, various endocannabinoids, and brain-derived neurotrophic factor (BDNF).

Journaling

Taking a few minutes each morning or at night just before bed to jot down your thoughts can help to calm your mind and focus your thoughts. If you’re journaling in the morning, try tracking your dreams from the night before.

Solidifying your relationship with yourself is an excellent way to decrease anxiety. Doing so can help you stay in touch with your goals and aspirations and spot negative emotions creeping up on you as they occur.

Create a morning routine

Develop a realistic routine for your mornings, and then stick to it. Having a schedule helps you stay focused on your goals and avoid distracting thoughts and actions. It can also let you feel more steady, which can reduce anxious feelings that might stem from a feeling of being out of control. Additionally, knowing you have a routine to wake up to in the morning might help you stop waking up with anxiety in the middle of the night.

Learning How to Manage Anxiety Day-to-Day

If you’re waking up with anxiety every morning, cognitive behavioral therapy (CBT), exposure therapy, and other types of therapy for anxiety and techniques can help. Working with a therapist, you’ll learn new coping skills for how to treat anxiety that can work to decrease your morning stress.

You might also consider taking prescription medication for anxiety like benzodiazepines, anti-anxiety drugs, beta-blockers, or antidepressants, but note that these are often associated with adverse side effects and do little to solve the core problem causing your anxiety. If you and your doctor do decide to try medication for generalized anxiety disorder, it likely will be a short term solution that’s coupled with effective, proactive strategies like those we’ve discussed here today.

Focusing on holistic approaches like mindfulness meditation, taking a relaxing bath, setting and being committed to goals, and showing gratitude are all simple, effective ways to combat waking up with anxiety every morning.

Each of them can help to reduce morning anxiety symptoms so you can have calmer, happier days. If you’re ready to start your journey and take steps to learn how to stop waking up with anxiety, Talkspace can help. Our approach to online therapy makes the process as easy as possible.

See references

Powell D, Schlotz W. Daily Life Stress and the Cortisol Awakening Response: Testing the Anticipation Hypothesis. PLoS One. 2012;7(12):e52067. doi:10.1371/journal.pone.0052067.
Hasler B, Troxel W. Couples’ Nighttime Sleep Efficiency and Concordance: Evidence for Bidirectional Associations With Daytime Relationship Functioning. Psychosom Med. 2010;72(8):794-801. doi:10.1097/psy.0b013e3181ecd08a.
Liu C, Liu Y. Media Exposure and Anxiety during COVID-19: The Mediation Effect of Media Vicarious Traumatization. Int J Environ Res Public Health. 2020;17(13):4720. doi:10.3390/ijerph27134720.
Audiffren M, André N. The exercise–cognition relationship: A virtuous circle. J Sport Health Sci. 2019;8(4):339-347. doi:10.1016/j.jshs.2019.03.001.
Brellenthin A, Crombie K, Hillard C, Koltyn K. Endocannabinoid and Mood Responses to Exercise in Adults with Varying Activity Levels. Medicine & Science in Sports & Exercise. 2017;49(8):1688-1696. doi:10.1249/mss.0000000000001276.

Sleep disturbance in anxiety disorders

Anxiety is often associated with sleep problems. Excessive anxiety and fear not only make it difficult to fall asleep, but also disrupt sleep during the night.

Contents

What is anxiety and anxiety disorders?
What does anxiety look like?
What is the relationship between anxiety and sleep?
How to reduce anxiety and sleep better? nine0010

In turn, sleep deprivation can exacerbate anxiety by triggering a negative cycle involving insomnia and anxiety disorders, whereby understanding and addressing the relationship between anxiety and sleep can be fundamental to physical and emotional well-being.

What is anxiety and anxiety disorders?

Anxiety is a feeling that all people experience from time to time in response to a stressful situation, and this is quite normal. But in anxiety disorders, this distress becomes extreme. Fears are disproportionate to the situation and anxiety begins to interfere with daily life. These sensations become stable and occur on most days for six months or more. nine0003

What does anxiety look like?

The symptoms of an anxiety disorder can affect a person both emotionally and physically. People who suffer from anxiety can become very nervous, and this affects their concentration and mood, which eventually leads to constant irritation, fear, and a sense of danger can sometimes seem overwhelming and uncontrollable. Physical anxiety disorders can cause muscle tension, rapid breathing and heart rate, sweating, trembling, gastrointestinal disturbances, and fatigue. nine0003

What is the relationship between anxiety and sleep?

Severe sleep disturbances, including insomnia, have long been recognized as a common symptom of an anxiety disorder. A person who is worried about something often thinks about his problems in bed, and this anxiety at night can prevent falling asleep. In fact, a state of mental hyperarousal, which is often accompanied by anxiety, has been identified as a major factor in insomnia. People with anxiety disorders are subject to higher sleep reactivity, meaning they are much more likely to have trouble sleeping. Of note, sleep problems have been found in people with various types of anxiety, including generalized anxiety disorder and post-traumatic stress disorder. Several studies over 90% of people with combat-related post-traumatic stress disorder reported symptoms of insomnia. Trouble falling asleep can also complicate the situation, causing anxiety during sleep, increasing a person's feelings of fear and anxiety. These negative thoughts during sleep, a kind of anxious anticipation, can create problems for a healthy sleep routine. Even after falling asleep, a person may wake up in the middle of the night with a feeling of anxiety, and falling asleep again can be quite problematic if the feeling of anxiety returns to him again. nine0003

Ultimately, this can lead to sleep fragmentation, reducing both the quantity and quality of sleep. The link between anxiety disorder and changes in sleep cycles has been identified by the National Center for Biotechnology Information. Research has shown that anxiety and ruminating before bed can affect eye movement REM sleep, including vivid dreams. Anxiety can trigger nightmares and increase the likelihood of sleep disturbances. Nightmares can reinforce negative associations and fear of sleep. At the same time, strong evidence indicates that sleep problems are not just a symptom of anxiety. Studies have shown that people who are prone to anxiety are particularly sensitive to the effects of insufficient sleep, which affects their mood and emotional health. The bidirectional relationship means that anxiety and sleep deprivation can reinforce each other. Anxiety is caused by poor sleep, which increases anxiety, and as a result, sleep problems become global. nine0003

Depression, which is known to negatively affect sleep, can further complicate the situation by creating additional barriers to quality sleep for both those suffering from depression and those with an anxiety disorder. People with obstructive sleep apnea, a sleep disorder that results in repetitive breath holding and interrupted sleep, have been found to have a higher rate of mental health problems, including depression and panic disorder. nine0003

How to reduce anxiety and sleep better?

While the consequences of anxiety disorder can be significant, it is one of the most treatable mental health disorders of all. Any person who has persistent and significant sleep disturbance or problems should speak with a physician who can assess the situation and discuss the advantages and disadvantages of potential treatment options in a particular case. nine0003

Cognitive behavioral therapy is one of the most widely used treatments. This is a type of talking therapy that helps refocus negative thinking and helps reduce anxiety. Studies have proven that cognitive behavioral therapy can reduce anxiety even in people who suffer from insomnia. Also, eliminating excessive anxiety can open the way to better sleep, but severe cases of insomnia are not always correctable with cognitive behavioral therapy alone. In such cases, several different types of drugs are used for treatment, including sedatives, antidepressants, and beta-blockers. These medications are meant to relieve symptoms, not treat the underlying anxiety disorder. Through the multifaceted relationship between anxiety and sleep, good rest can help combat feelings of anxiety. Also, developing healthy sleep habits can make sleep more enjoyable and simplify your regular daily routine to improve it. Both sleep and the environment of a person is part of sleep hygiene, and in order to improve it, it is necessary: nine0003

make the bed more comfortable;
eliminate sources of sleep disturbance such as light, noise;
Avoid caffeine and alcohol during the day and evening.

The use of relaxation techniques can also help you find ways to get rid of anxiety and help you fall asleep quickly and peacefully. In addition, relaxation exercises, deep breathing, and meditation can be an integral part of CBT and can break the cycle of worry and rumination. nine0003

Online sources:

https://www.sleepfoundation.org/mental-health/anxiety-and-sleep

https://www.nimh.nih.gov/health/topics/anxiety-disorders/index. shtml

to the list of articlesFind a doctor

Sleep disorders in anxiety and anxiety-depressive disorders | Kovrov G.V., Lebedev M.A., Palatov S.Yu., Merkulova T.B., Posokhov S.I.

In clinical practice, sleep disorders are usually associated with anxiety and depression. Existing studies show a close relationship between sleep disorders and anxiety and depressive disorders [1, 2]. A clear dependence of the severity of the course of both groups of diseases on concomitant sleep disorders was shown [1]. In general somatic practice, the prevalence of insomnia reaches 73% [3], in borderline psychiatry, clinically defined insomnia occurs in 65%, and changes in nocturnal sleep according to polysomnography are noted in 100% of cases [4]. nine0003

Combination of sleep disorders and anxiety disorders

It is known that the relationship between sleep disorders and anxiety disorders is noted, on the one hand, when sleep disorders can provoke the development of anxiety disorders [5], and on the other hand, when the onset of an anxiety disorder precedes the onset of sleep disorders. Complaints about problems associated with sleep are typical for patients with all diseases included in the group of anxiety disorders. In the case of major generalized disorder and post-traumatic stress disorder (PTSD), sleep disturbances are one of the criteria required for a diagnosis. There are objective reasons for the development of sleep disorders within anxiety disorders, namely: anxiety is manifested by increased cortical activation, which entails the difficulty of falling asleep and maintaining sleep. nine0003

In the clinic, anxiety is manifested by anxiety, irritability, motor excitation, decreased concentration of attention, increased fatigue [6].

The most striking manifestation of anxiety disorders is generalized anxiety disorder (GAD), which is diagnosed on the basis of the presence of at least 3 of the following symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbances. The duration of the disease should be at least 6 months, the symptoms should cause psychosomatic discomfort and / or social disadaptation. nine0003

Sleep disorders in this situation are one of the 6 diagnostic criteria for GAD. The main symptom of GAD, excessive, persistent anxiety, is a major predisposing factor in the development of insomnia. Insomnia and GAD are closely related, usually comorbid disorders. The difference between insomnia in anxiety disorder and primary insomnia, not associated with other diseases, is the nature of the experiences in the process of falling asleep. In the case of GAD, the patient is concerned about current problems [7] (work, study, relationships), which hinders the process of falling asleep. In the case of primary insomnia, the anxiety itself is caused by the disease itself. nine0003

A polysomnographic study can reveal changes characteristic of insomnia: increased time to fall asleep, frequent awakenings, reduced sleep efficiency, and a decrease in its total duration.

Another striking example of anxiety disorders is panic disorder, which is manifested by recurrent states of severe anxiety (panic). Attacks are accompanied by phenomena of depersonalization and derealization, as well as severe autonomic disorders. In the behavior of the patient, avoidance of situations in which the attack occurred for the first time is noted. There may be a fear of loneliness, a repetition of the attack. A panic attack occurs spontaneously, outside of formal situations of danger or threat. nine0003

Panic disorder is more common in women and typically begins around the age of 20. A hallmark of panic disorder are spontaneous episodes of panic attacks, characterized by bouts of fear, anxiety, and other autonomic manifestations. About 2/3 of patients with this disorder experience some form of sleep disturbance. Patients complain of difficulty falling asleep, non-restorative sleep, and characteristic nocturnal panic attacks. It should be noted that the presence of certain problems associated with sleep can lead to aggravation of anxiety disorders, including panic disorder. nine0003

A polysomnographic study can detect frequent awakenings, reduced sleep efficiency, and a reduction in its total duration [8]. It is not uncommon to see depression coexisting with anxiety disorders, and it is possible that the presence of other changes in sleep patterns in patients with panic disorder is associated with comorbid depression, and therefore the diagnosis of depression should be excluded in patients with such sleep disorders.

The sleep paralysis characteristic of narcolepsy can also occur with panic disorder. It is a movement paralysis that occurs during falling asleep or waking up, during which patients experience fear, a feeling of pressure in the chest, and other somatic manifestations of anxiety. This symptom also occurs in patients with post-traumatic stress disorder.

Nighttime panic attacks are a common occurrence in this disease [9]. They are manifested by a sudden awakening and all the symptoms characteristic of panic attacks. Awakening occurs during the phase of non-REM sleep, which most likely excludes their connection with dreams. It was also found that nocturnal attacks are an indicator of a more severe course of the disease. It must be remembered that patients, fearing the recurrence of such episodes, deprive themselves of sleep, which leads to more serious disorders and, in general, reduces the quality of life of these patients.

PTSD is a disease from the group of anxiety disorders, in which sleep disturbances are a diagnostic criterion. Sleep disorders in this disease include 2 main symptoms: nightmares and insomnia. Other phenomena inherent in PTSD and associated with sleep are: somnambulism, sleep-talking, hypnagogic and hypnopompic hallucinations. The changes detected by polysomnography are not specific and in some cases may be absent. Possible changes include: an increase in the representation of the 1st stage of sleep, a decrease in the representation of the 4th stage of sleep. Also, with PTSD, breathing disorders during sleep are often found. nine0003

Agoraphobia can also be a manifestation of anxiety disorders, which is defined as anxiety that occurs in response to situations, the way out of which, according to the patient, is difficult. In the clinical picture, as a rule, there is a persistent fear of the patient to be in a crowded place, public places (shops, open squares and streets, theaters, cinemas, concert halls, workplaces), fear of independent long trips (by various modes of transport). The situational component of the agoraphobia syndrome is expressed in the confinement of phobic experiences to certain situations and in the fear of getting into situations in which, according to patients, a repetition of painful sensations is likely. Often, agoraphobic symptoms cover many fears of various situations, forming panagoraphobia - the fear of leaving the house with the development of deep social maladaptation. There are attempts by the patient to overcome their own experiences, in adverse cases, there is a restriction of social activity. nine0003

Specific phobias are characterized by an association of anxiety with certain situations (air travel, contact with animals, the sight of blood, etc.), also accompanied by an avoidance reaction. Patients are critical of their experiences, however, phobias have a significant impact on various areas of activity of patients. There are the following forms: cardiophobia, cancerophobia, claustrophobia, etc. Sleep disturbances in these patients are non-specific, and from the point of view of the patient, they are a minor manifestation of the disease. nine0003

In general, the most common manifestations of sleep disturbances in anxiety states are presomnic disorders. The initial phase of sleep consists of 2 components: drowsiness, a kind of craving for sleep, and actually falling asleep. Often, patients have no desire to sleep, no desire to sleep, muscle relaxation does not occur, they have to perform various actions aimed at falling asleep. In other cases, there is an inclination to sleep, but its intensity is reduced, drowsiness becomes intermittent, undulating. Drowsiness occurs, the muscles relax, the perception of the environment decreases, the patient takes a comfortable position for falling asleep, and a slight drowsiness appears, but soon it is interrupted, disturbing thoughts and ideas arise in the mind. In the future, the state of wakefulness is again replaced by mild drowsiness and superficial drowsiness. Such changes in states can be repeated several times, leading to emotional discomfort that prevents the onset of sleep. nine0003

In a number of patients, experiences about disturbed sleep can acquire an overvalued hypochondriacal coloration and come to the fore according to the mechanisms of actualization, often there is an obsessive fear of insomnia - agripnophobia. It is usually combined with an anxious and painful expectation of sleep, certain requirements for others and the creation of the above-mentioned special conditions for sleep.

Anxiety depression is characterized by the patient's constant experience of anxiety, a sense of impending danger and insecurity. Anxious experiences change: anxiety about their loved ones, fears about their condition, their actions. The structure of anxious depression, as a rule, includes anxiety, feelings of guilt, motor restlessness, fussiness, fluctuations in affect with worsening in the evening, and somatovegetative symptoms. Anxious and melancholy affects often occur simultaneously, in many cases it is impossible to determine which of them is leading in the patient. Anxiety depression is most often found in people of involutionary age and proceeds according to the type of protracted phases. In addition, it is actually the leading type of neurotic depression [10]. nine0003

The patient exhibits a variety of symptoms of anxiety and depression. Initially, one or more physical symptoms (eg, fatigue, pain, sleep disturbances) may be present. Further questioning allows us to state a depressive mood and/or anxiety.

Signs of anxiety depression:

depressed mood;
loss of interest;
severe anxiety.

The following symptoms are also often seen: nine0003

sleep disorders;
physical weakness and loss of energy;
fatigue or reduced activity;
difficulty concentrating, fidgeting;
impaired concentration;
excitation or retardation of movements or speech;
appetite disorders;
dry mouth;
tension and anxiety;
irritability;
tremor;
heartbeat;
dizziness;
suicidal thoughts.

Often with anxiety depression, variants of presomnic disorders are observed, in which the desire to sleep is pronounced, drowsiness increases rapidly, and the patient falls asleep relatively easily, but wakes up suddenly after 5-10 minutes, drowsiness completely disappears, and then within 1-2 hours he does not can fall asleep. This period without sleep is characterized by unpleasant ideas, thoughts, fears, reflecting to a greater or lesser extent the experienced conflict situation and the reaction to the inability to sleep. There is also hyperesthesia to sensory stimuli. Those suffering from this form of sleep disorder react extremely painfully to the slightest sensory stimuli, up to flashes of affect. nine0003

For disturbed falling asleep, lengthening of the drowsy period is characteristic. This drowsy state is often accompanied by motor, sensory and visceral automatisms, sharp shudders, vivid perceptions of sounds and visual images, palpitations, sensations of muscle spasms. Often these phenomena, awakening the patient, cause various painful ideas and fears, sometimes acquiring an obsessive character.

Sleep disorders and their polysomnographic manifestations among mental illnesses are the most studied for depressive disorder. Among the sleep disorders in depressive disorder, insomnia is the most common. The severity and duration of insomnia are manifestations of a more severe depressive disorder, and the appearance of insomnia during remission indicates the imminent occurrence of a recurrent depressive episode [1]. In addition, sleep disorders in this disease are the most persistent symptom. The close relationship of this disorder with sleep disorders is explained by the biochemical processes characteristic of depression. In particular, in depressive disorder, there is a decrease in the level of serotonin, which plays a role in the initiation of REM sleep and the organization of delta sleep [11]. Depressive disorder is characterized by the following manifestations of sleep disturbances: difficulty falling asleep [10], non-restorative sleep, as a rule, reduced total sleep time. The most specific symptoms for depression are frequent nocturnal awakenings and early terminal awakenings. Complaints about difficulty falling asleep are more often observed in young patients, and frequent awakenings are more characteristic of the elderly [12]. nine0003

With masked depression, complaints of sleep disturbances may be the only manifestation of the disease. In depression, in contrast to primary insomnia, there are complaints of sleep disturbances typical of this disease: frequent awakenings, early morning awakening, etc. [12].

In polysomnographic study, the following changes are observed: an increase in the time to fall asleep, a decrease in sleep efficiency. The most common and depressive disorder-specific symptoms are shortened REM sleep latency and reduced delta sleep. It has been found that patients with a higher proportion of delta sleep stay in remission longer than those with a decrease in the proportion of delta sleep [13]. nine0003

Attempts have been made to explore the possibility of using depression-specific sleep disturbances as markers of depressive disorder. Due to the heterogeneity of the manifestations of sleep disorders, this issue remains not fully resolved.

The features of sleep disorders in various types of depression were also highlighted. For patients with a predominance of the anxious component, difficulty falling asleep and early awakenings are more characteristic. With this type of depression, dream plots are associated with persecution, threats, etc. In addition, in these patients, in general, there was a high level of wakefulness before falling asleep. For depressions with the leading affect of melancholy, early morning awakenings and dreams of static types of gloomy content are most characteristic. Depression with the affect of apathy is characterized by early awakenings and rare, unsaturated dreams. Also typical of depression with apathetic affect is the loss of a sense of boundaries between sleep and wakefulness. Patients with bipolar disorder have a similar polysomnographic pattern [14]. nine0003

Features of sleep disturbance in bipolar disorder are a significant decrease in the duration of sleep during a manic episode and a greater tendency of patients to hypersomnia during depressive episodes compared with the unipolar course of the disorder. Complaints of sleep disturbances during manic episodes are usually absent.

Treatment

For the treatment of anxiety and depressive disorders, drugs of various pharmacological groups are used: tranquilizers (mainly long-acting or short-acting benzodiazepine drugs), selective serotonin reuptake inhibitors, selective serotonin reuptake stimulants, tricyclic antidepressants. All these drugs, to one degree or another, affect a person’s sleep, making it easier to fall asleep, reducing the number and duration of nocturnal awakenings, thereby affecting the recovery processes that occur during a night’s sleep. When constructing tactics for the treatment of sleep disorders associated with anxiety and depressive manifestations, it is important to remember that insomnia itself can increase anxiety, worsen well-being, mood, as a rule, in the morning hours after poor sleep [15]. In this regard, the use of hypnotics in the treatment may be promising in the presence of a predominance of insomnia symptoms in the clinical picture in order to prevent exacerbation of anxiety and depressive disorders. In this regard, the most effective helpers can be sleeping pills that affect the GABAergic (GABA - γ-aminobutyric acid) system - histamine receptor blockers (Valocordin®-Doxylamine) and melatonin preparation. The most convenient to use in the treatment of insomnia is Valocordin®-Doxylamine, which is available in drops, which allows you to select an individual dose of the drug. nine0003

Valocordin®-Doxylamine is a unique drug used as a hypnotic. Most known hypnotic drugs (benzodiazepines, cyclopyrrolones, imidazopyridines, etc.) act on the GABAergic complex, activating the activity of somnogenic systems, while histamine receptor blockers act on wakefulness systems, not sleep ones, reducing their activation. A fundamentally different mechanism of hypnotic action makes it possible to use Valocordin®-Doxylamine more widely: when changing one drug to another, reducing the dosages of "habitual hypnotics", and also, if necessary, canceling hypnotics. nine0003

A drug study conducted on healthy subjects showed that doxylamine succinate leads to a decrease in the duration of nocturnal awakenings and stage 1 sleep and an increase in stage 2 without a significant effect on the duration of stages 3 and 4 sleep and REM sleep. There was no significant subjective effect on the reports of healthy volunteers, however, compared with placebo, doxylamine increased the depth of sleep and improved its quality [16].

In Russia, one of the first studies was carried out under the supervision of A.M. Wayne [17]. It has been shown that under the influence of doxylamine such subjective characteristics of sleep as the duration of falling asleep, the duration and quality of sleep, the number of night awakenings and the quality of morning awakenings improve. An analysis of the objective characteristics of sleep showed that while taking doxylamine, there was a reduction in the time of wakefulness during sleep, a decrease in the duration of falling asleep, an increase in the duration of sleep, the time of the REM sleep phase, and the sleep quality index. It was also shown that doxylamine did not reduce the effectiveness of other drugs in patients, such as antihypertensive, vasoactive, etc. The results of a study of the effect of doxylamine on patients with insomnia indicate the effectiveness of this drug in these patients. Subjective feelings of a positive effect are confirmed by objective studies of the structure of sleep, which undergoes positive shifts, which affect such indicators as sleep duration, falling asleep duration, REM sleep phase. Of great importance is also the absence of any changes in the results of personal data regarding drowsiness and sleep apnea syndrome, which indicates the absence of an aftereffect of the drug in relation to the worsening of the course of obstructive sleep apnea syndrome. However, if obstructive sleep apnea is suspected, doxylamine should be used with caution. nine0003

Modern clinical studies do not reveal serious side effects in the treatment of therapeutic doses of the drug, but it is always necessary to remember the possible appearance of symptoms that arise due to the individual characteristics of the body, and contraindications (glaucoma; difficulty urinating due to benign prostatic hyperplasia; age up to 15 years; increased drug sensitivity).

Simultaneous administration of the drug Valocordin®-Doxylamine and sedative drugs that affect the central nervous system (CNS): neuroleptics, tranquilizers, antidepressants, hypnotics, analgesics, anesthetics, antiepileptic drugs, may enhance their effect. Procarbazines and antihistamines should be combined with caution to minimize CNS depression and potential drug potentiation. During treatment with Valocordin®-Doxylamine, alcohol should be avoided as it may unpredictably affect the effects of doxylamine succinate. nine0003

During the use of this drug, it is recommended to exclude driving a car and working with mechanisms, as well as other activities accompanied by an increased risk, at least at the first stage of treatment. The attending physician is advised to evaluate the individual reaction rate when choosing a dose. It is important to consider these features of the effect of the drug in the treatment of patients with insomnia in order to increase the effectiveness of Valocordin®-Doxylamine and exclude possible undesirable effects. nine0003

Conclusion

When diagnosing a disease, it is important to remember that, as a rule, problems falling asleep indicate the presence of severe anxiety, early awakenings are a manifestation of depression.

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