It is 2am and you’re lying awake desperate to sleep but your mind just won’t switch off.. what’s going on? Common signs of hyperarousal in relation to sleep- or rather sleeplessness- are difficulty getting to sleep despite being tired, or waking during the night unable to fall back asleep.
What is hyperarousal?
In short, it is when the arousal system is hyperactive and there is an increased responsiveness to external and internal stimuli (e.g., thoughts and emotions). Hyperarousal can present as physiological and/or psychological symptoms such as increased alertness, anxiety, elevated heart rate and shallow breathing. Hyperarousal or failure to de-arouse is a prominent feature of chronic insomnia. When people with insomnia are in a state of hyperarousal, they often report being “tired but wired”, having difficulty relaxing or switching off which is not conducive for sleep.
The vicious cycle of insomnia
One of the key elements to understanding the relationship between hyperarousal and insomnia is the changes that often occur in sleep-related thoughts and emotional responses that can create distress about sleep. Thoughts such as “I must sleep now or I’ll feel awful tomorrow” or “If I don’t get 8 hours sleep- I’ll get dementia” can make people anxious and worried. These nocturnal thoughts and emotional responses increase the hyperarousal, making people tense and often leading to more wakefulness. The link between thoughts, emotions and increased physical arousal (e.g., increased muscle tension, heart rate and shallow breathing) will often follow unhelpful behaviours such as checking the clock or tossing and turning which then can develop an association between the bed and feeling alert. This can lead to further unhelpful thoughts, and around and around we go in a vicious cycle of insomnia..
The 24 hour cycle of sleep/wake thoughts and behaviours
When discussing hyperarousal and sleep, it is also important to look at the 24 hour cycle and how we think and behave throughout the day. When people are always busy, problem solving, analysing, project managing at work or home and constantly under stress– it is no wonder that it can be hard to fall asleep at night. Or we may be so tired we fall asleep easily- however, when the sleep drive is reduced as the night goes on there is not enough sleep debt to suppress the state of hyperarousal. If people wake during the night, hyperarousal may then catch up and make it hard to return to sleep.
What to do about it?
Reducing hyperarousal is feasible, but it can be challenging to balance responsibilities, daily tasks and taking time after a busy day to rest, decompress and allow the brain to switch off. One of the important things is to develop strategies and tactics that work for you to allow the body and mind to rest. Some people find it helpful to go for a run, practice yoga, mindfulness and relaxation to de-arouse their system. Paying attention to our senses and sensations in our bodies can be a helpful way to pause the overthinking and get a break from a busy mind.
For people with persistent sleep difficulties, Cognitive Behavioural Therapy for insomnia (CBT-I) and Mindfulness-Based Therapy for insomnia can help reduce the effects of hyperarousal, challenge unhelpful sleep thoughts and beliefs, and improve the relationship with sleep. For example, when trying to sleep – holding onto the expectation lightly:
“If I don’t sleep as well tonight, it’s not perfect but I’ll be ok tomorrow”
versus
“If I don’t sleep now, I won’t be able to function tomorrow, and get fired”.
CBT-I is one of the most well studied, effective and safe interventions for any sleep disorder. It is a skills-based approach that is drug-free and involves behavioural and cognitive changes to target the underlying issues contributing to insomnia.
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