Dear Therapist:

I am 43 years old and consider myself a healthy person Baruch HaShem. Recently I began having trouble sleeping. Sometimes falling asleep, but also waking up in middle of the night and not being able to fall back asleep. My doctor said there is nothing wrong with me physically and it is stress related. We have indeed been having some difficulty with our teenage daughter recently. At this point I am winding up tired throughout the day and I stress when it’s time to go to sleep because I worry about getting enough sleep, which makes it harder for me to fall asleep. Forget about once I wake up, then I get so frustrated with the situation that there is no way I’m falling back asleep. So, I’m stuck in a vicious cycle which I am hoping you can give me some suggestions to break out of. What advice can you give me to relax and hopefully get my sleep back on track.
Thanks.

Response:

No one can state unequivocally that your trouble sleeping is stress induced. There can be many reasons for insomnia. However, I imagine that your doctor ruled out common known medical causes, leading to his assumption that stress is the culprit.

Certainly, stress is a common psychological cause of insomnia. Ideally, in order to sleep productively our minds and bodies need to be relaxed. When the mind is stressed, the body typically tenses up; when the body is stressed, the mind responds in kind. This can turn into the vicious cycle to which you referred, wherein emotional stress leads to somatic stress (including muscle clenching, headaches, and other sensations). This somatic stress exacerbates any emotional stress, causing yet further somatic symptoms.

As with any vicious cycle, the approach is to identify its components, then to address one of them—or preferably both. There are many approaches that relate largely to emotional stress, and can help to alleviate feelings of anxiety. These range from meditation to cognitive therapeutic techniques. There are some simple strategies that a therapist who treats anxiety can help you to master in a few sessions.

As discussed, reducing bodily stress can help to reduce emotional stress, thus weakening the vicious cycle. Focusing on the somatic symptoms can seem like a more direct approach. There are a number of methods for reducing stress in the body. Breathing techniques, visualization, and muscle tense-relax methods are a few strategies that can help to relax the body, thus helping the mind to relax as well.

Since psychopharmacology is not my field, I can speak only generally to this. There are medications that can help to reduce both emotional and somatic symptoms of anxiety. Some medications—and ostensibly some “natural” supplements—specifically target somatic stress symptoms. Others are focused on treating feelings of anxiety. Some do both.

Since the mind-body connection is so strong and indistinct, it is likely impossible to completely isolate emotionally-directed treatment from that which is somatically-directed. In all likelihood, they all work on both to one degree or another. Also, remember that working on one will probably decrease symptoms of both.

-Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Woodmere, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 516-218-4200

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