Dear Therapist:
I'm really enjoying your column, and I'd love to hear your take on my problem. I am eighteen and I've always suffered from anxiety, and in times of stress also insomnia, but since I graduated from school last year and started working it’s gotten a lot worse. These days, I barely sleep and I am constantly in a state of sleep deprivation and exhaustion. I've tried melatonin, but it doesn't really help much. It basically only makes me drowsy, and if I'm successful in calming myself down enough, then it works, but a few short hours later I'm up again for the rest of the night. I'm not too keen on the idea of sleeping pills because they're addictive. What course of action would you recommend?
Response:
You refer to your issues with anxiety, since you have clearly associated this with your insomnia. Your question, however, is with regard to the insomnia. Despite your recognition that your trouble sleeping is closely linked with your stress levels, your question focuses on how to treat the insomnia. I don’t know whether you’re currently dealing with, or looking to treat, your anxiety. If you are, your insomnia should be included in the treatment of your anxiety. As a symptom of anxiety, trouble sleeping can be improved by reducing the anxiety that lies at the center of this and other symptoms. As an example, symptoms of Generalized Anxiety Disorder can include restlessness, difficulty concentrating, fatigue, irritability, and headaches, among others. Rather than treating each symptom individually, it usually makes sense to treat the source of all the symptoms.
You mentioned that you tried melatonin and are averse to sleeping pills due to their addictive properties. I am not a medical doctor, so I can’t speak to specific pharmacological treatments. There are, however, non-addictive options for the direct treatment of insomnia. In addition, if you’re willing to consider the use of medication for the treatment of the underlying anxiety, there are many non-addictive choices for that as well.
Since you have “always suffered from anxiety,” you likely know that changes and new situations can often trigger a fear response and feelings of stress. The transition from the insulated and often comfortable world of school to the relatively exposed, unfamiliar realm of the workplace can be intimidating and anxiety provoking. You may have had a similar experience upon entering high school after many years of acclimation to elementary and middle school.
There are various psychotherapeutic methods that can help to reduce anxiety, both generally and with regard to specific situations, stressors, and triggers. A competent therapist can help you to identify the method or methods that will best work for you. You can learn to decrease your anxiety, which will help to reduce all of the symptoms associated with it, including your insomnia.
-Yehuda Lieberman, LCSW
psychotherapist in private practice
Brooklyn, NY
author of Self-Esteem: A Primer
www.ylcsw.com / 718-258-5317
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