OCD: A Living Nightmare That Causes Sleep Problems
For many people, sleep can feel like a welcome relief at the end of a long day. Our daily lives can be overwhelming and stressful, and falling into a deep sleep at night is a great way to reset our brains and wake up the next morning recharged, ready to tackle the day ahead.
Unfortunately, this isn’t the case for many people living with OCD. Not only do they need to deal with debilitating symptoms like obsessions and compulsions all day long, but their anxieties and fears can follow them into their sleep as well — causing insomnia and nightmares.
On top of causing nightmares, as we’ll discuss for the rest of this article, it’s important not to forget that OCD is a living nightmare in and of itself. This illness often causes an extreme level of distress, and if left untreated, can wreak havoc on sufferers’ lives.
OCD has two primary symptoms: obsessions and compulsions. Obsessions are intrusive, unwanted thoughts that cause a great deal of fear, dread, and anxiety. These thoughts could be anything from, “Did I turn the stove off?” to “What if I suddenly picked up this knife and stabbed my whole family to death?”. There are no limits to what obsessive thoughts can be about; usually, they revolve around an aspect of life that the person with OCD greatly values.
Compulsions are how the person with OCD reacts to the obsession. Almost everybody gets intrusive, random thoughts from time to time, but only people with OCD react to them with compulsive behavior. Compulsions are any kind of ritualistic or repetitive behavior that is an attempt to try to nullify or “cancel out” the fear or perceived danger of the obsessive thought. Maybe the person checks the stove to make sure it’s off, or puts the knife away to try to push the fear of killing from their mind.
This wouldn’t be such a big deal if the person with OCD could do this kind of anxiety-reducing act one time and move on with their lives. But the problem with OCD is that the person who suffers from it is never convinced that they’re safe. OCD is often referred to as the doubting disease, because people with OCD are unable to tolerate even a small amount of uncertainty or doubt.
This leads to OCD sufferers not only engaging in the compulsive act once, but over and over and over again. Their lives become a waking hell made up of a vicious cycle of obsessions and compulsions. The compulsions are never enough to quell the doubt and anxiety that obsessions bring, so people with OCD live in a perpetual state of fear. On top of that, the need to perform compulsions rob OCD sufferers of hours and hours of precious time that could be used doing other, more productive or enjoyable things.
Now picture that waking nightmare, and imagine it following you into even the deepest corners of your sleeping life as well. Although the exact nature of the relationship between OCD and sleep disorders isn’t yet clear, we do know that many people with OCD suffer from problems falling and staying asleep. Just like their waking lives, their sleep is often anything but peaceful.
OCD is linked to sleep problems from nightmares to insomnia to delayed sleep phase disorder. Recent studies suggest that people with OCD may be up to seven times more likely to be diagnosed with a sleep disorder than people without OCD. Sometimes, people even experience OCD symptoms like obsessions and compulsions while they’re sleeping.
OCD and Nightmares
OCD sufferers often aren’t able to get relief from their symptoms even while they’re asleep. People with OCD have reported that they find themselves living out their obsessional fears and continuing their compulsive behaviors, even in their dreams. It makes sense: if we fall asleep ruminating on our worst obsessions and fears, then it’s not surprising that we’d have nightmares about those same fears, too.
For example, maybe someone with OCD mentally reviews their memories as they’re trying to fall asleep, searching for evidence that they’re not actually a pedophile. They may, then, have a nightmare that they’ve engaged in a pedophilic act without wanting to, or that they’re being persecuted by the law for pedophilia. Or maybe someone falls asleep trying to resist the urge to compulsively check their front door, only to dream about checking their front door over and over again.There aren’t many research studies proving the connection between nightmares and OCD. Some studies have found a significant increase in nightmares for people with OCD, and some have found no link at all. It’s likely that there isn’t a one-size-fits-all answer to this; whether or not you have nightmares might depend on the severity of your OCD as well as any co-occurring disorders you have, like anxiety or depression.
However, the link between OCD and sleep disorders in general is pretty well-established, and the anecdotal experiences of nightmares reported by people with OCD are widespread.
OCD and Insomnia
If you’ve ever experienced even one day with OCD, then it won’t be surprising to you that this disorder can keep people up at night. Research has shown that people with OCD are more likely to experience both insomnia and other sleep disorders like delayed sleep phase disorder and circadian rhythm sleep disorders.
The anxiety that comes along with OCD obsessions is intense. Often, people stay awake late into the night going over and over their obsessions in their minds. Mental review of memories and thoughts can be a compulsive behavior just as much as any physical behaviors. In the dark, quiet hours of the night, there are no external distractions to keep OCD sufferers from circling their obsessive thoughts over, and over, and over again.
If you’ve never lived with OCD, imagine the way you felt the night before a stressful event, like a big exam or a public speech you needed to make. You probably lied awake, staring at the ceiling. You may have tossed and turned for hours, imagining every worst-case scenario of how the next day could turn out and making yourself sick. Now imagine feeling this way every single night — this is life with OCD. It’s not hard to imagine why OCD has been linked to sleep disorders so often.
Compulsive behaviors might keep people with OCD from getting restful sleep at night, too. For example, take someone with contamination OCD. Perhaps they decide to wash their hands before they go to bed, just to “make sure” that they’re not bringing any germs to bed with them. But the moment they start washing, they get locked into the OCD cycle of compulsive behavior. No matter how many times they clean their hands, or how much soap they use, their OCD fills them with doubt. Maybe there’s still one germ left. Maybe they didn’t get all of it.
This person may not be able to stop washing their hands, even well after their bedtime. Although they intended to go to sleep at a reasonable hour, their compulsive behavior may keep them up well into the night.
Insomnia in people with OCD has also been linked to depression. OCD has one of the highest co-morbidity rates with depression (that’s just a way of saying that often, people with OCD also suffer from depression). Up to 60 percent of people with OCD experience at least one major depressive episode in their lifetimes. Considering that insomnia is one of the most common symptoms of depression, it naturally follows that people with OCD experience insomnia, too.
OCD Medications and Sleep Problems
Unfortunately, the most common type of medication that’s used to treat OCD — a class of antidepressants called Selective Serotonin Reuptake Inhibitors (or SSRIs) — has been linked in some studies to more intense dreams and nightmares. However, this evidence isn’t conclusive, and most studies show that it’s withdrawal from these medications that are more likely to cause intense dreaming.
You should talk to your doctor to decide whether or not SSRIs are the right treatment choice for you. Keep in mind that around 70 percent of people with OCD experience a significant improvement in their symptoms with SSRIs, and these benefits are also important to consider.
On top of the numerous sleep problems caused by OCD, dreams themselves can become an object of OCD obsessive thinking. To people without OCD, dreams are just dreams; they might find them interesting or even amusing, but they don’t usually think too much about what they dreamt about and what the dreams mean.
For someone with OCD, nothing is safe from the destruction that this disorder brings. For example, let’s imagine someone has a dream that they suddenly went on a killing spree. Of course, this would be a disturbing dream to most of us. Someone without OCD, though, would likely feel appropriately disturbed by the dream but wouldn’t reflect on it for hours, much less days or weeks.
For someone with OCD, this dream may become the perfect fodder for an intense obsession. “What does it mean that I dreamt that I killed people?”, they might wonder. “Could it mean that I secretly want to kill people? Am I turning into a murderer?”The person may start to engage in compulsions to try to nullify the intense feelings of anxiety these thoughts bring. Maybe they start asking their friends repeatedly for reassurance that they’re not becoming a murderer. Maybe they start compulsively avoiding any media with murder in it. Maybe they review their thoughts for hours, checking for any sign of violence.
Of course, just like with any type of OCD, these compulsions may make the anxiety ease for a short period of time, but it’s never enough to make the obsessions go away altogether. OCD cannot tolerate any amount of uncertainty, even a tiny amount. If their friends tell them that it’s almost impossible that someone secretly harbors homicidal tendencies, OCD says, “But what if?”. If they find no sign of violence in their thoughts or memories, OCD, again, whispers, “But what if?”.
Dreams can be especially distressing if someone with OCD dreams about a theme that already causes them a great deal of distress (like someone with homosexual OCD dreaming about being intimate with a member of the same sex, for example). In these scenarios, dreams only make the voice of OCD louder, filling the sufferer with more and more doubt.
Not only does OCD cause sleep problems, but the reverse is also true: sleep problems can make OCD worse. In fact, it’s not just sleep-deprivation that makes a difference; even factors like what time someone goes to sleep can have an impact on OCD symptoms. Studies have shown that the later that someone’s bedtime, even if they were getting 8 hours of sleep, the less control they have over both their obsessive thinking and compulsive behaviors.
Restful sleep allows our bodies and brains to recuperate; when we’re sleep-deprived, we experience signs of impaired cognitive abilities like bad judgment. When we’re not able to think clearly because of a lack of sleep, it’s to be expected that our OCD thoughts will have free reign to consume us.
This means that OCD and sleep disorders can turn into a vicious cycle for some people. The worse your OCD, the less sleep you get every night — but the less sleep you get every night, the worse your OCD gets. That’s why it’s crucial to treat both the sleep disorder as well as the underlying OCD that’s causing it.
If you’re experiencing OCD-related sleep problems, it’s important to treat both the symptoms and the cause. That means that yes, you should practice good sleep hygiene to try to get better sleep at night, but at some point, you’ll also have to address the root of your sleep problems: your OCD.
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Good Sleep Habits for OCD
Although healthy sleep patterns won’t cure your OCD, it’s still important to get restful sleep so that your OCD symptoms don’t get worse. Experts recommend most healthy adults get between 7 or 9 hours of sleep every night. We understand, though, that this can be difficult to achieve when your obsessions or compulsions are keeping you up late into the night.
Whether or not you have OCD, it’s important to get good sleep. Follow these sleep hygiene tips to keep your sleep habits as healthy as possible.
Bed Is for Sleeping
In this day and age, we’re all used to being on our screens almost every waking moment. As tempting as it is to watch TV or scroll through social media while you’re in bed at night, try to avoid this. People who are well-rested spend at least 85% of their time spent in bed actually sleeping. When your head hits the pillow, it’s time for sleep.
Cut Down on Screen Time
This is somewhat related to the previous point. The type of light that’s released from modern screens (like those on our phones or laptops) is strongly associated with insomnia and sleep problems. Power down your screens at least half an hour to an hour before your bedtime, and you’ll likely notice a difference in how long you stay wide awake at night.
Stick to the Schedule
Build good habits around bedtime — partly, that means going to sleep and waking up at around the same time every day. This is especially important for those with OCD, because they often experience a sleep phase disorder. Your body should get into the habit of sticking to a regular sleep schedule instead of going to sleep when you’re simply tired out by compulsions.
An intense amount of anxiety comes along with OCD, which means that if you live with OCD, your body and mind are almost constantly tense and worked up. Obviously, it’s hard to fall asleep easily if you’re intensely anxious all the time. Try practicing mindfulness or relaxation techniques to calm your central nervous system down before going to bed at night. This will help you get into the right headspace for allowing your body (and mind) to rest.
We know: resist compulsions? What could be harder for someone with OCD? But even if you can’t yet resist compulsions during the day, try to at least resist the nighttime ones that interrupt your sleep. For example, if you wake up in the middle of the night and you have the obsession that you left your stove on, resist the temptation to get out of bed and check the stove. This will minimize the amount of sleep time that OCD is taking away from you.
Treatment for OCD
Practicing good sleep hygiene can help you to get better sleep at night, but if your insomnia is due to your OCD, then sooner or later you’ll need to address that root cause of your sleep problems.
Luckily, OCD is a treatable illness, and research has shown that when underlying OCD improves with treatment, sleep problems often improve as well.
The evidence base suggests that the most effective treatment for OCD is a combination of medication and behavioral interventions. The type of medication that’s most often used to treat OCD is a class of antidepressant drugs called SSRIs. Clomipramine (sold under the brand name Anafranil), a tricyclic antidepressant, is also often used to treat OCD. Antidepressant drugs have the additional benefit of targeting the depression that’s often comorbid with OCD. Since many OCD-related sleep disorders have been linked to co-occurring depressive disorders, this is good news if you’re having nightmares.
In terms of therapy and behavioral interventions, the most effective treatment for OCD is a type of Cognitive Behavioral Therapy called Exposure and Response Prevention. Although there are cognitive elements to it, this intervention is very behavioral in nature. The OCD sufferer is asked to engage in exposure activities, in which they intentionally trigger an obsession. Then, they must refrain from responding to the obsession in any compulsive way; they must stay with the feelings of anxiety and not try to nullify it whatsoever.
Eventually, this teaches the brain that the obsession is nothing more than a meaningless, random thought, and that it’s possible to continue on with life without getting trapped in compulsive behaviors — even when these types of scary thoughts pop up.
When these first-line treatments don’t work, transcranial magnetic stimulation (or TMS) may be something to consider trying. TMS therapy uses electromagnetic fields to stimulate certain areas in their brain. There’s some evidence that indicates it could be helpful for OCD, and it’s approved by the Food and Drug Administration for the treatment of depression.
Recovery from OCD Is Possible
OCD is a treatable condition, and you don’t need to live with symptoms like insomnia and nightmares forever. When OCD is properly treated, co-occurring depression usually also gets better. When these symptoms start going away or are better managed, you will naturally be able to sleep better. You’ll also be much less likely to allow compulsions to keep you up at night or to react to nightmares in an obsessive way.
The Impulse Therapy self-guided program uses evidence-based treatments to help you get a handle on your OCD symptoms and start getting closer to a good night’s rest. Learn more about our science-backed program or start your journey today.