Insomnia has often been related to anxiety and worry at bedtime, but recent research has linked daytime worry and rumination to nighttime insomnia. People often realize that their thinking patterns at night are keeping them awake, but may not consider the impact of worrying that they did earlier in the day to their sleep patterns at night.
Anxious, repetitive thinking takes different forms, and researchers have come to distinguish between worry, which usually involves anxiety about possible negative future events, and rumination, which is repetitive negative thoughts about events in the past or otherwise out of one’s control. These two different types of anxious thinking may actually have different effects on insomnia, so that therapy to improve sleep quality may need to address them in different ways.
Daytime sleep-related impairment may include sleepiness, reduced concentration, irritation or other emotional regulation problems and actually falling asleep at times when alertness is required. Research has shown that worry is more associated with sleep disturbance at night, and rumination is more associated with sleep-related daytime impairment.
This means that people who tend to worry, either during the day or at bedtime, may be more likely to experience “a bad night of sleep” or waking in the middle of the night and being unable to go back to sleep, while those who ruminate might find that their lack of sleep has had a bad effect on their functioning during the day.
These studies suggest that daytime anxiety needs to be taken into account in the management of insomnia, not only anxious thinking that begins around bedtime. Strategies for addressing worry and rumination have been developed to train patients in habits that help with problem-solving and give a regular sense of closure to events.
However, we have also noted the negative effect of getting too preoccupied with quality of sleep such that waking up during the night for a short time is felt to be a failure in the battle against insomnia, and may itself cause worry or rumination. Someone else with the same amount of waking time at night might consider one waking period to be “no big deal” and feel that their functioning is fine. For these situations, and others where the use of technologies and apps may actually create more worry than they solve, we recommend cognitive behavior therapy, which, with the help of a trained therapist, can teach useful techniques and habits to improve sleep quality.
The key is to provide techniques that can be applied to anxiety experienced both during waking and sleeping hours. Both patients and therapists need to take daytime worry and rumination into account when developing treatment plans for insomnia.
Moawad, H. Daytime Negative Thoughts Have an Impact on Sleep. Psychiatric Times; Dec. 15, 2021.