How Can CBT-I Help with the 3am Worry Spiral?
It’s 3 am and you’re awake again. Like clockwork, every night you wake and your mind starts racing. Worry about your health, your children, your finances. Replaying that conversation you had yesterday. Thinking about what you need to do tomorrow at work. You’re exhausted and yet you still can’t get back to sleep and your mind keeps racing. What’s going on? And why is this happening?
Why your mind races at night
There are several factors that can contribute to your mind racing in the middle of the night. Social media will have you believe that it’s all about ‘cortisol spikes,’ but there are many other reasons why someone may be waking at night and having difficulty with returning to sleep.
You’re predisposed to worrying at bedtime or the middle of the night if you’re someone who also worries during the day. For some people, these thoughts only seem to appear at night though (at least in a bothersome way). Sometimes this happens because you’re so busy throughout the day your mind hasn’t had the chance to think about these things. Your to do list, what you need to do at work the next day, a stressful situation you’re going through. So once you get into bed and there are no more distractions from the day, anything that’s bothering you may come to the surface.
There’s also a neurological piece to this. As night falls and our brains get sleepier, it creates a scenario where it’s more challenging to manage worry. We lose some of our ability to regulate our emotions and to redirect our thoughts. So for some people, worries that can come and go during the day become thoughts that spiral, go to worst case scenarios, and just can’t be shut off in the middle of the night. What feels manageable during the day can feel catastrophic at night.
If you’ve been having trouble sleeping for quite some time, your bed may also now serve as a cue for feeling awake and worrying. This is a phenomenon called conditioned arousal. This process makes it so that you can feel super sleepy when you’re not in bed, but once you’re in bed your body can suddenly feel more awake and your mind can feel more alert and anxious. So if you wake up in the middle of the night, you can end up experiencing worry and feeling alert again since you’re in bed, which is now a space that creates distress and wakefulness.
We go through several stages of sleep multiple times over the course of the night. After we cycle through each stage of sleep, we often have a brief waking. For someone with insomnia, this brief waking may turn into a longer one where your brain activates and you begin worrying or thinking about something. This is particularly true if you’re not quite sleepy enough.
So how can CBT-I help with this?
CBT-I can help with the 3am spiral in multiple ways. CBT-I helps to improve sleep systems in your body that create sleepiness and help you fall asleep and stay asleep at night. I like to think of it as creating more of your body’s natural sleep aids for nighttime. Feeling sleepier helps to override some of the brain’s ability to turn on and think at night. So instead of remaining awake thinking, you’re able to get back to sleep.
CBT-I also helps to recondition your bed as just a place for sleep and relaxation. This can take several weeks, but once you’ve done it, means that your bed will be a place that once again elicits sleep and relaxation from your body, rather than alertness and anxiety or worry.
Lastly, CBT-I can give you tools to directly manage your thoughts. Sometimes this may mean you’re directly examining thoughts about your sleep, and if a thought is unhelpful, you may work towards developing a more helpful thought. I also use mindfulness to help get distance from bothersome thoughts. Mindfulness also helps us to view a thought for what it is: a thought.
So if you’re a person who repeatedly wakes in the middle of the night and notices worries that are hard to shut off, CBT-I can really help! You don’t necessarily need that supplement that social media is selling you. CBT-I is called the gold-standard of insomnia treatment for a reason - it generally works better than sleeping pills or other supplements. If you need help with insomnia, reach out today. I have the highest level of training one can have within the field of behavioral sleep medicine, and have treated hundreds of patients experiencing symptoms like yours.
Riemann, D., Spiegelhalder, K., Feige, B., Voderholzer, U., Berger, M., Perlis, M., & Nissen, C. (2010). The hyperarousal model of insomnia: a review of the concept and its evidence. Sleep medicine reviews, 14(1), 19-31.
About Dr. Liz Culnan | Denver, CO
Dr. Liz Culnan is a licensed clinical health psychologist with specialized training in the areas of perinatal/reproductive mental health and behavioral sleep medicine. She is passionate about supporting women through reproductive and life transitions. Learn more here.
Other services offered at Mindful Health Psychology:
Mindful Health Psychology is a practice offering therapy in Denver, CO, and online in 43 states. We specialize in therapy for anxiety, depression,depression and anxiety during pregnancy,postpartum anxiety, postpartum depression, coping with miscarriage and pregnancy loss, PMDD, coping with fertility-related stressors, birth trauma, coping with a chronic medical condition, insomnia, nightmares, circadian rhythm disorders, and hypersomnia disorders.