Quick overview of the Anxiety Disorders, according to the DSM-IV-TR and their hypothesized link to sleep difficulties

Anxiety disorders (as well as Major Depression) are known as the common colds of mental illness. Anxiety, however, is a normal reaction to a stressor, a performance-motivator and may be a healthy warning sign. A modest amount of anxiety is enormously helpful and adaptive; it motivates you to meet your goals and it propels you out of dangerous situations. However, when taken to its extreme, it can severely interrupt one's daily functioning. The optimal amount of anxiety would look like a bell-curve; too little or too much are harmful.  Here I focus on those with a usually crippling and excessive anxiety. Most of the following disorders are linked to sleep difficulties and come from the DSM-IV:


People with OCD (Obsessive-Compulsive Disorder) quite perturbed by recurrent thoughts and/or irrational behaviors that can be so time consuming that they interfere with daily life, such as work, school or social relationships. Obsessions are "intrusive, inappropriate, recurring and persistent thoughts, impulses, or images that cause marked anxiety or distress." These are much more serious than the usually worries of our everyday lives. The more the person tries to suppress them, the stronger they grow. A common obsession is a fear of germ contamination. Compulsions are the repetitious and often ritualistic behaviors aimed at lowering the discomfort that stem from the obsessions. Repeated, excessive and unnecessary hand-washing would be a common compulsion to those with obsessions about germs. These incessant thoughts and resultant behaviors may dominate every moment of the person's daily life. Imagine trying to sleep, while fearing that bugs, germs, creatures and dust will have their way with you when you fall asleep! If the only way to allay this fear is frequent hand-washing, how much sleep do you think this person will get?

Panic Disorder is diagnosed when attacks become routine, but still difficult to predict. They appear to come out of nowhere. They many occur anywhere at any time, which makes it so crippling.  If a panic attack feels like it's imminent, as it does for many with panic disorder, Lying in bed in itself, expecting an attach may be sufficient in itself to reduce sleep onset and sleep quality.

Phobias are fears marked by significant anxiety in the presence of a given stimulus and should regularly occur during exposure to that stimulus. The phoblic person will attempt to avoid this stimulus at all costs. If the phobia isn't so closely linked to things that can be bothersome in bed, sleep difficulties many not be a likely symptom for this disorder.


PTSD (Post Traumatic Stress Disorder If it were up to me, I'd cut off the 'D,' as this seems like a normal, natural and understandable response to an abnormal situation) occurs after exposure to traumatic events. This person has most likely experienced or witnessed an event that involved actual or threatened death or serious injury, and must have responded with "intense fear, helplessness or horror." This traumatic event is usually re-experienced by the individual in nightmares, flashbacks or physiological stress. The person tends to work hard at suppressing these seemingly unavoidable recurrent experiences. Irritability, difficulty concentrating, hypervigilence, an exaggerated startle response and sleep disturbance are hallmarks of this disorder. How can one sleep soundly when they're continually invaded by past, traumatic and horrific memories, especially in their dreams?!

ASD (Acute Stress Disorder Again, same point) is quite like PTSD but tends to result right after the traumatic event. It may blossom into PTSD. Unlike PTSD, which implies that symptoms last for more than a month, ASD may get resolved quickly. Similarly, sleep is likely to be interrupted after a traumatic event.

GAD (Generalized Anxiety Disorder) affects those who are 'characterologically' anxious; they live with a broad, unspecific sense of dread and pertubation with physiological arousal, in a variety of usually non-threatening, relatively safe situations. Worry and anxiety should be chronic-- presence more days than not. 5% of the general population is estimated to have it, but sadly most don't pursue treatment.  If you're constantly worried about something, is that an ideal mindset for sleep?

Source:

Wedding, Boydm, Niemiec. Movies and Mental Illness 3. 2010 Hogrefe Publishing