Insomnia and OCD: How are They Related?
Tossing and turning is a hallmark sign of worrying, something those with OCD are all too familiar with. This is so common that mental health conditions are among the oft-named causes of insomnia.
But that doesn’t mean there’s no rest for those affected by the wickedness of obsessive compulsive disorder. There are things suffers can do to assure that a good night’s sleep is part of their regular routine.
And this starts with learning a bit about insomnia.
Insomnia is a sleep disorder where those affected either have trouble falling asleep or staying asleep. They may reposition, unable to rest, or they may fall asleep for a half hour or so and then wake up seemingly ready to start their day.
While insomnia is typically talked about as a chronic disorder, it isn’t always long-lasting. Acute insomnia may occur for a few nights or show up every once in a while. Chronic insomnia, on the other hand, lasts for a minimum of three nights each week and continues on for three months or more. Unsurprisingly, it’s the type of insomnia that is most likely to cause distress, impact health, and increase risks around driving or operating machinery.
The Types of Insomnia
Insomnia is defined by its cause and may be characterized as primary or secondary. In primary insomnia, the sleep issues aren’t linked to any health problems and arise de novo (although they may be linked to external factors). In secondary insomnia, the sleep problems are caused by an underlying condition, either physical or mental.
Secondary insomnia may also arise as the result of substances. For example, someone who drinks coffee right before bed and then fails to fall asleep would fall into the “secondary” category.
Insomnia is quite common, more common than perhaps realized. According to studies, as many as 30% of people suffer from sleeplessness (though some research has found numbers up to 60%). Chronic insomnia isn’t as common as acute and is believed to affect around 10-15% of the population.
It is most prevalent in those of older age, women, people with physical health conditions, and those with mental health conditions. However, it can be seen in anyone, including all ethnicities and nationalities. Though not as common, it can also be found in pets.
Why Insomnia Happens
As discussed above, insomnia may happen for no obvious reason or plenty of obvious ones. Scientifically speaking, it occurs when the body is in a hyperaroused state, primed mentally, physically, or via a combination of both.
The cause of this underlying hyperarousal varies and may include:
- Certain substances that counteract sleep: Chemicals can affect sleep directly or because the body is adjusting to the introduction or withdrawal of that chemical.
- Physical health problems: Any physical health condition that causes pain or discomfort will make sleeping soundly less likely. Arthritis, fibromyalgia, pregnancy, and restless leg syndrome all fit this bill. Kidney, bladder, prostate, or heart conditions that cause frequent urination will disrupt sleep as well. So will sleep apnea or any type of breathing disorder that leaves the sleeper gasping for air.
- Mental health problems: Insomnia is common in those affected by stress, depression, and anxiety. It may also present in people with schizophrenia, bipolar disorder, and OCD (more on that below). Even in the absence of a mental illness, worrying can keep anyone up at night, tossing and turning and fretting and agonizing.
When viewing insomnia by primary versus secondary, the causes are different. For example, the most common primary insomnia causes include:
- Stress or worrying about something imminent
- An unfriendly sleep environment (noisy, bright, or too hot or cold)
- Poor sleep habits
- A change in sleep schedule (including daylight savings or jet lag)
- Shift-work (people whose shifts change consistently, particularly rotating between day and night, are especially prone to insomnia)
The most common secondary insomnia causes include:
- Mental health conditions
- Medications (ADHD medication, illicit drugs, diet pills, blood pressure medication, or cold medication)
- Discomfort, pain, or body aches
- Substance use (including alcohol, nicotine, and coffee)
- Co-occurring sleep disorders (e.g., restless leg syndrome)
- Endocrine problems (for example, an overactive thyroid can make it hard to sleep at night)
The Dangers of Insomnia
A lack of sleep does much more than cause a bad mood; ongoing insomnia can lead to a variety of health ailments and safety concerns. While losing on the snoozing every once in a blue moon isn’t likely to do much, insomnia becomes a health concern when it continues.
In fact, chronic sufferers are at increased risk of:
- Injury: Lack of sleep increases the odds of an automobile accident, a work-related accident, an accident when operating heavy equipment, and accidents through everyday activity (i.e., someone who is sleep-deprived is more likely to fall down the stairs or slip on ice than someone who isn’t).
- Serious medical conditions: This covers both physical and mental conditions and may include hypertension, stroke, heart disease, obesity, diabetes, depression, anxiety, and mood disorders. In those who already have medical conditions, insomnia may make them worse.
- Decreased immunity: Sleep allows the immune system to regenerate. Thus, a lack of it compromises the body’s built-in defense mechanisms and makes it harder to fend off viruses, bacteria, toxins, and cancer.
- Irritability, confusion, and frustration
- Grumpiness, which can impact relationships with others (especially a spouse)
- Decreased sex drive
- Impairment of memory, judgment, concentration, and work or school performance
- Daytime sleepiness
- Decreased life expectancy: According to one study, failure to get a full night of rest resulted in a 97% higher risk of premature death. This is due to the increase in health conditions (e.g., hypertension, diabetes, obesity).
Insomnia in OCD
While the link between mental illness and insomnia is well-known, there’s not a lot of research specifically for OCD. What’s more, because OCD is sometimes linked to depression, no one is sure where to direct the bleary side-eye as one may be more culpable in sleeplessness than the other.
Still, it makes sense that OCD sufferers would have a much harder time sleeping than those with quieter minds. Because the disorder is marked by terrifying, egodystonic, and anxiety-provoking thoughts as well as the rituals the sufferer engages in as an attempt to regulate their discomfort, it’s a highly time-consuming condition. OCD sufferers feel so controlled by their thoughts that they affect all parts of life, including rest.
Some research back this, indicating that those with OCD have delayed sleep onset and offset and an increase in delayed sleep phase disorder. According to studies, the more severe the OCD, the more severe the sleep disruption.
The reasons for this might be pretty obvious, especially to anyone with OCD. Sufferers are more likely to spend their night engaging in the following:
Rumination: OCD sufferers may analyze their thoughts, actions, and behaviors that occurred throughout the day and not be able to fall asleep until their analysis feels comprehensive and complete. This quest for certainty, omnipresent in OCD, undoubtedly keeps sufferers from heading off to dreamland.
Rituals: OCD sufferers may refuse to go to bed until their rituals are complete. For instance, someone with Scrupulosity OCD who feels as though they need to pray a certain way may engage in this routine until they feel like their prayers were done correctly. Someone with Contamination OCD may stay up late cleaning the kitchen until they feel like there is no risk of germs or toxins. Someone with Checking OCD may spend hours making sure all the doors are locked, the windows are closed, and the electronics, coffee pots, and ovens are shut off.
Somniphobia: A portion of people who suffer from OCD suffer from Somniphobia (fear of going to sleep). This isn’t seen in all flavors of OCD and some sufferers may look forward to bed, reasoning that sleep is the only time they can turn their brain off. But those with Health Anxiety OCD, which involves irrational fears around one’s wellness, may be afraid of dying in their sleep, resulting in a fear of falling asleep. In these cases, their insomnia may be intentional as they go to great measures to plan sleep around their compulsions. For instance, a woman with Health Anxiety OCD may refuse to go to bed until her husband comes home from work, believing that his presence next to her will make her less likely to die.
Does Bedtime Affect OCD?
For anyone with OCD who views themselves as a night owl, it might be time to hang up the feathers. According to recent research conducted at Binghamton University in New York, going to bed later causes less perceived control over obsessive thoughts.
During this study, the researchers monitored a group of participants diagnosed with OCD as well as those who, though undiagnosed, showed signs and symptoms. The participants were instructed to keep a sleep diary that tracked the control they felt over their intrusive thoughts and compulsions.
The diaries showed a dramatic difference in those who went to bed late, leaving the researchers to link a late bedtime with less perceived control and worsening OCD.
Interestingly, 40% of the people in the study showed signs of delayed sleep phase disorder and didn’t get to sleep until approximately 3:00 AM. Even if they still got adequate sleep (i.e., they went to bed at 3:00 AM and got up at 11:00 AM), their perceived control was still compromised. In other words, getting enough sleep isn’t enough: Going to bed at a prudent hour matters too.
The reason likely has to do with the power of time as it can alter the circadian rhythm. If the body’s internal clock is out of whack, then the mind’s perception of control, impulse, and the ability to ward off compulsions may be too.
OCD sufferers as well as members of the general population can take certain steps to avoid insomnia or prevent an acute episode from turning chronic.
Some of the tips most recommended include:
- Engaging in mindfulness, breathing exercises, meditation, and other relaxation techniques (these may be especially helpful right before bed)
- Exercising regularly (exercise should be performed at least three hours before bedtime to avoid sleep interference)
- Going to bed at the same time each night
- Refraining from using smartphones, computers, televisions, or eBooks right before bed
- Avoiding nicotine, alcohol, or caffeine in the evenings
- Avoiding heavy meals right before bed
- Eating a light snack before bed
- Implementing a calming bedtime ritual (such as a warm bath, lightning incense, or stretching)
- Making the bedroom as conducive as possible (eliminating noise, light, and other distractions)
- Setting the thermostat to a comfortable temperature
- Using the bed for sleep and sex only and not using it to watch TV or work
- Getting up the same time each morning (including weekends) so there’s no disruption in the sleep routine
- Relying on old wives’ tales (there’s no scientific evidence that a glass of warm milk makes someone sleepy, but it might offer a psychosomatic benefit)
Additionally, anyone who finds that they’re having a hard time falling asleep is advised to get up and do something (something boring like reading the manual to the vacuum cleaner). They should then go back to bed only when they start to feel drowsy.
Treatment for Insomnia
It’s not always possible to head insomnia off at the pass and sometimes professional help is needed. Anyone whose insomnia is ongoing, affecting their health, causing excessive daytime sleepiness, disrupting nighttime breathing patterns, or worsening OCD or other mental conditions should see a doctor.
Some of the most common insomnia treatments include:
Acupuncture: This traditional Chinese medicine involves inserting thin needles into specific points of the body, ultimately influencing how the body functions. It’s often used for insomnia and may be used for OCD. While research is ongoing, anecdotal reports speak to its effectiveness.
Prescription Medications: There are a variety of medications that may be used to help with shuteye. These include sedatives, orexin receptor antagonists, and antihistamines.
Anyone prescribed medication must be forthcoming about the meds they’re already taking as many of these drugs interact with each other. Taking them together can depress the central nervous system and cause respiratory distress (which can lead to coma and death in the most serious instances). Drugs.com allows consumers to search their medications for contraindications.
Herbal Supplements: Herbal supplements can also interact with prescription medication (as well as other herbs), which means they shouldn’t be taken without talking to a doctor. When they are consumed, some of the most common ones for insomnia include melatonin, valerian root, chamomile, passionflower, hops, and lemon balm.
Treatment for the Underlying Health Condition: Secondary insomnia must be treated by getting to the cause. This means that the health condition helping the insomnia take root has to be addressed. For example, if chronic pain is the cause of insomnia, getting on a pain management plan may be part of treatment. If obesity is causing sleeplessness, then a weight loss plan might be involved. If asthma is the cause of tossing and turning, then working with a respiratory therapist or getting a new inhaler may help. If the insomnia is the result of depression or anxiety, then antidepressants may be prescribed.
Psychotherapy: Psychotherapy is almost always used when insomnia is the result of a mental health condition (such as OCD). The psychotherapy will address the underlying issue; as the issue gets better, the insomnia will go away.
Nonetheless, a pre-diagnosis is not required when using psychotherapy for insomnia. Therapists can also help individuals practice good sleep hygiene, engage in mindfulness, or eliminate insomnia-causing stressors from their everyday routine.
Treatment for OCD
If the insomnia is fallout from OCD, then Cognitive Behavioral Therapy with Exposure Response Prevention therapy is necessary. This can help OCD sufferers dismiss their intrusive thoughts and invalidate their OCD by ignoring the compulsions it demands they complete. Often, medication is used supplementally as well as Acceptance and Commitment Therapy.
To find a clinician qualified to treat OCD, look for OCD-specific training. This is highly important because of the epidemic tendencies of clinicians to treat OCD without proper understanding. The International OCD Foundation offers a search function by location and zip code.