It is very common that as stress and anxiety build in someone’s life, they have trouble sleeping. Often, stress can create thoughts, worries and problem solving to the point where the mind will not shut off. Just as often, stress appears as negative emotions or tension in the body. The net result is typically problems falling asleep or waking up in the middle of the night unable to fall back to sleep.

Chain reaction

The problems can also go the other way: poor sleep increases negative emotions during the next day, as well as sensitivity to negative experiences in our lives while decreasing positive emotions and reactions to positive experiences. Indeed, poor sleep — especially insomnia — has been shown to increase the risk of developing a variety of anxiety disorders. This is, in part, because poor sleep negatively impacts the fear system in our brain.

Similarly, insomnia is a common symptom of depression. Even more so than with anxiety, though, the connection goes the other way. Having insomnia increases the risk of later experiencing depression, and insomnia has also been shown to be related to suicidal thoughts and behaviors. The insomnia-depression connection has been shown in teens, adults and the elderly.

“Treating anxiety or depression may help sleep some, but nowhere near as much as focusing directly on treating the insomnia.”

Treating the cause

If anxiety and depression increase the risk of sleeping difficulties, and insomnia increases the risk of anxiety and depression, it follows that many people experience both insomnia and one of these mental health challenges. So, if you have both, which do you treat? Well, treating anxiety or depression may help sleep some, but nowhere near as much as focusing directly on treating the insomnia. This makes sense in the cases where insomnia came first. Even when insomnia comes second, it is not merely a symptom of anxiety and depression. Rather, it takes on a life of its own and becomes a separate problem. So, insomnia needs to be specifically treated.

Fortunately, Cognitive Behavioral Therapy for Insomnia (CBT-I), the gold standard treatment for insomnia, is extremely effective. About 75% of the people who are treated by a knowledgeable sleep expert with CBT-I show clinically meaningful improvements. CBT-I is suggested as the first-line treatment in most of the major treatment guidelines, including those recently published by American College of Physicians.

This is because of how well CBT-I works and because CBT-I has a better risk-benefit ratio than medications. Treating insomnia can also have positive benefits for anxiety and depression (although it will not eliminate severe anxiety or depression). You might want to consider treating both, but if you want your sleep problems improved, you will most likely need to treat them directly.