Dear Doctors: I am a shift worker and have developed severe sensitivity to noise at night. My brain constantly scans for noise, and even when there is none, it feels like it’s replaying it. Even in good sleep environments, I’m struggling. I’m very motivated to work on this, and I need guidance.
Dear Reader: The struggle you describe matches the symptoms of sleep anxiety. This is a type of insomnia triggered by fears you will not be able to fall asleep or won’t be able to stay asleep once you do. Sleep anxiety is not a formal diagnosis, but it is a widely recognized pattern. You are not alone in experiencing it. Estimates suggest that up to 35% of people have symptoms of insomnia at some point in their lives. Anxiety is a common trigger.
For many people, sleep anxiety develops gradually. There are many common markers of the condition. You may have anxiety as bedtime approaches. Struggling to fall asleep even when you're very tired is, of course, a common symptom. Sleeping better when you are away from your own home can also happen. The heightened awareness of ambient sounds at bedtime is also common. Sounds from bedside clocks, heating or cooling equipment or the creaks of a house settling can all present challenges. Even the breathing of a bed partner can cause issues. These ambient sounds can lead to racing or repetitive thoughts about sleep. It can also lead to anticipating sounds when none are present, like you described.
Being a shift worker puts you at odds with your body's circadian rhythms. This increases your risk of having sleep problems. The American Academy of Sleep Medicine notes that people who work nontraditional hours are much more likely to have insomnia. This often leads to chronic daytime fatigue. Daytime fatigue, in turn, doesn’t help good sleep. Good sleep is one of the bedrocks of physical and mental health. So your decision to seek help goes beyond just getting a full night of sleep. You are protecting your well-being.
First, see your primary care provider. They will take a medical history. They will discuss possible effects of medications you take. They can also check for physical issues that can interfere with sleep. The next step is to work with a licensed sleep specialist. These therapists usually do a detailed sleep assessment to understand the issues you have. Treatment often includes a structured program of Cognitive Behavioral Therapy for Insomnia, also known as CBT-I. CBT-I is usually done over four to eight sessions. CBT-I involves guided exercises, relaxation techniques and circadian rhythm stabilization. It also involves step-by-step changes to quiet the thoughts and ease the escalations that derail falling asleep. With time and consistent practice, CBT-I can help people fall asleep faster, stay asleep longer and achieve deeper, more restful sleep.
If your own doctor can't offer a referral, there are other resources to check out. The American Academy of Sleep Medicine and the Society of Behavioral Sleep Medicine are good places to start. They have directories of accredited sleep clinics and clinicians you can reach out to.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
