How to Fall Asleep (with OCD and Anxiety) | Ep. 417

In this episode, Kimberley Quinlan and Sue Chuddy dive into practical strategies for managing OCD and anxiety-related sleep disturbances, offering actionable tools to help you reclaim restful nights.

What You’ll Learn in This Episode

• Why nighttime can amplify OCD symptoms and anxiety.
• The difference between general sleep problems and OCD-driven sleep issues.
• How cognitive behavioral therapy (CBT) and ERP can help you address sleep anxiety.
• The power of radical acceptance in coping with sleeplessness.
• Tips for creating a flexible, non-compulsive bedtime routine.
• How to manage intrusive thoughts and reduce compulsions to achieve better sleep.
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How to Fall Asleep with OCD and Anxiety: Expert Tips from Sue Chuddy

Sleep is essential for our well-being, yet for many people with OCD and anxiety, falling asleep can be an uphill battle. In a recent episode of the Your Anxiety Toolkit Podcast, Kimberley Quinlan sat down with therapist Sue Chuddy to discuss the challenges of sleep disturbances in OCD and anxiety and practical strategies to overcome them. Here’s what they shared.

The Connection Between OCD and Sleep Disturbances

Sue Chuddy highlights a startling statistic: between 40% and 70% of people with OCD experience sleep disturbances. Why? At night, distractions fade, and the quiet creates fertile ground for intrusive thoughts and compulsions.

Common Nighttime OCD Triggers

• Perfectionism: Obsessing over blanket alignment or locked doors.
• Safety fears: Worries about harm, like whether the stove is off.
• Existential concerns: Overanalyzing the purpose of life.
• Relationship OCD: Replaying social or romantic interactions.

Kimberley adds that nighttime can amplify fears related to parenting, religious practices, or even everyday routines, making sleep feel impossible.

Differentiating OCD-Driven Sleep Issues from General Sleep Problems

How can you tell if your sleep challenges are OCD-driven? Sue explains:

• General Sleep Problems: Involve stress or insomnia without obsessions or compulsions. For example, worrying about a work deadline.
• OCD-Driven Sleep Issues: Obsessions (like fear of appliances being left on) paired with compulsions (such as repeatedly checking appliances).

Kimberley describes OCD as creating a loop that keeps the brain stuck, often requiring specific tools to break free.

Addressing Sleep Anxiety: Practical Strategies

Many people with OCD and anxiety fear the consequences of not getting enough sleep, which creates a vicious cycle. Sue and Kimberley shared the following approaches:

Cognitive Behavioral Therapy (CBT) and ERP

• Thought challenging: Identify and question unhelpful thoughts about sleep.
• Exposure and Response Prevention (ERP): Reduce rituals like repeatedly checking the door or swaddling a baby “perfectly.”

Radical Acceptance

Kimberley shares her personal story of learning to accept sleeplessness during early motherhood. “Once I accepted that I’d be tired, coping became easier,” she says.

Scheduling Worry Time

Set aside a specific time earlier in the day to address worries. This reduces the tendency to ruminate when lying in bed.

Medication

Sue mentions that SSRIs can help manage OCD symptoms that disrupt sleep, but this is best discussed with a medical professional.

Creating a Flexible Bedtime Routine

Bedtime rituals can offer comfort, but they can also become compulsive. The key? Flexibility.

• Set a range for bedtime (e.g., between 10:00 and 10:30 p.m.) rather than a strict time.
• Incorporate relaxing activities like gentle stretching, reading, or calming music.
• Avoid rigid rules, like needing to check locks exactly five times.

Using ERP to Address Sleep-Related OCD

ERP is a cornerstone for managing OCD, and Sue provides actionable steps to apply it to sleep challenges:

1. Identify specific compulsions: What rituals are keeping you awake? Checking? Ruminating?
2. Gradually reduce rituals: Focus on response prevention by sitting with discomfort instead of acting on compulsions.
3. Practice managing rumination during the day: Strengthen your ability to handle intrusive thoughts by addressing them earlier.

Kimberley emphasizes that building this skill during daylight hours can make nighttime anxiety feel less overwhelming.

Final Thoughts

Sleep disturbances are a common but manageable challenge for people with OCD and anxiety. By applying CBT, ERP, and acceptance-based strategies, you can work toward more restful nights.

For more resources, visit Sue Chuddy’s website at www.ChuddyCounselingServices.com. Sue also runs free in-person support groups for adults with OCD in San Diego and offers a new sleep-focused group starting in February.

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Transcription: How to Fall Asleep (with OCD and Anxiety)

Kimberley Quinlan: Welcome, everybody! I am so excited for this episode today. We are talking about how to fall asleep with OCD and anxiety. We have the amazing Sue Chuddy here, who is going to share her wisdom. I am so thrilled to have you because this is such an important topic. Thank you for being here, Sue.

Sue Chuddy: I’m so glad to be here. Thank you so much for having me.

Kimberley Quinlan: Sleep is often one of the biggest conversations I have with clients because we need sleep to function well. Sometimes anxiety can prevent us from getting that one thing we need. Sue, can you start by explaining the relationship between OCD and sleep disturbances?

Sue Chuddy: Absolutely. Depending on the source, somewhere between 40% and 70% of people with OCD experience some kind of sleep disturbance. That’s huge. OCD can be particularly active when people are trying to go to sleep because there are fewer distractions. During the day, we might be at work, with family, or doing social activities that occupy our minds. But at night, those distractions fade, allowing intrusive thoughts and compulsive behaviors to surface more prominently.

Kimberley Quinlan: Yes, it’s like OCD says, “Now is the perfect time to process everything.” For many people, nighttime becomes a hotbed for rumination and rituals.

Sue Chuddy: Exactly. People might start to reflect on their day, analyze social interactions, or mentally review situations. For some, this quiet time feels like the only chance to solve life’s problems, but it’s actually fueling their OCD.

Kimberley Quinlan: I’ve had clients who are terrified of losing control when falling asleep. The vulnerability of sleep itself becomes a trigger for their anxiety. Have you noticed any specific types of intrusive thoughts that make OCD-related insomnia worse?

Sue Chuddy: Definitely. Perfectionism is a big one—thoughts like, “Is my blanket perfectly aligned?” or “Did I lock the door?” There are also fears of harm and safety-related intrusions, existential worries, and even relationship OCD thoughts about social or romantic interactions. Nighttime amplifies all of these uncertainties.

Kimberley Quinlan: Yes, OCD has a way of attacking any area. Intrusive thoughts about religious practices, parenting, or safety often rear their heads at night. Postpartum OCD, for example, can involve looping fears about whether a baby is swaddled correctly or whether they might roll over in their sleep.

Differentiating OCD-Driven Sleep Issues from General Sleep Problems

Kimberley Quinlan: How can someone listening today differentiate between general sleep problems and OCD-driven sleep disturbances?

Sue Chuddy: Great question. General sleep disturbances, like insomnia or stress-induced wakefulness, don’t usually involve obsessions or compulsions. Someone with general sleep problems might be unable to sleep because they’re stressed about work, but they’re not obsessing over it. OCD-driven sleep issues involve specific fears or compulsions that keep the person stuck in a loop.

Kimberley Quinlan: That makes sense. For example, with general anxiety, someone might wake up at 3 a.m. because of high cortisol levels, whereas someone with OCD might wake up to check if an appliance is unplugged.

Addressing Sleep Anxiety

Kimberley Quinlan: Let’s talk about how listeners with OCD or anxiety can address sleep anxiety, particularly when they fear they won’t get enough rest.

Sue Chuddy: That’s such a common fear. I recommend starting with CBT techniques, like thought challenging and exposure and response prevention (ERP), particularly for bedtime rituals. Scheduling worry time earlier in the day can also help.

Kimberley Quinlan: For me, radical acceptance was key. When I had my first child, I was more afraid of not getting sleep than I was of the actual challenges of parenting. I had to accept that I would be tired, and once I practiced that acceptance, it became easier to cope.

Sue Chuddy: That’s a powerful shift—accepting imperfection and letting go of the need to control sleep. Medications like SSRIs can also help manage OCD symptoms that interfere with sleep.

Balancing Comfort and Flexibility

Kimberley Quinlan: Bedtime rituals can be comforting but also compulsive. How can someone strike a balance between healthy routines and avoiding compulsive behaviors?

Sue Chuddy: The key is flexibility. Routines are helpful, but they shouldn’t be rigid. For example, aim to go to bed between 10 and 10:30 p.m. rather than at an exact time. Keep the routine simple and avoid adding too many rules or rituals.

Kimberley Quinlan: That’s great advice. A flexible wind-down routine, like 20 minutes of gentle stretching, reading non-triggering material, or listening to calming music, can help set the stage for sleep without becoming compulsive.

Using ERP to Address Sleep-Related OCD

Kimberley Quinlan: How can we use exposure and response prevention (ERP) to address sleep-related OCD issues?

Sue Chuddy: Start by assessing the specific compulsions. Focus on response prevention first. Gradually reduce rituals and teach skills to manage rumination. Practicing attention control during the day can strengthen the ability to manage intrusive thoughts at night.

Kimberley Quinlan: Yes, building that muscle during the day helps at night. I’ve had clients practice managing rumination during the day, and it significantly improves their ability to handle nighttime anxiety.

Sue Chuddy: Absolutely. Exposure might involve intentionally not checking or challenging perfectionistic thoughts. The goal is to learn to sit with the discomfort rather than trying to eliminate it.

Final Thoughts and Resources

Kimberley Quinlan: Sue, thank you so much for sharing your expertise. Tell us where people can learn more about you and your work.

Sue Chuddy: Thank you, Kimberley. People can visit my website at www.ChuddyCounselingServices.com or email me at suechuddylcsw@gmail.com. I’m offering a new sleep group starting in February, and I also run free in-person support groups for adults with OCD in San Diego, as well as a free consultation group for clinicians.

Kimberley Quinlan: That’s amazing. Thank you for all the incredible work you do. And thank you, listeners, for joining us. I hope this episode on how to fall asleep with OCD was helpful. If you need additional resources, reach out to Sue—she’s a powerhouse in this area. Thanks again, Sue.

Sue Chuddy: Thank you so much for having me.